Speeding up vaccination could avert `plane crash'
Ontario's lagging COVID-19 vaccine rollout will cost the lives of hundreds of long-term care residents, two leading Ontario doctors warned during testimony before the province's long-term care commission this week.
Drs. Nathan Stall, a geriatrician at Toronto's Mount Sinai Hospital, and Alison McGeer, a clinical scientist at Mount Sinai, urged the province to reduce further deaths by working day and night to finish vaccinating long-term care residents. They recommended the province suspend other vaccinations, including second doses to hospital workers, until those are complete.
“We should be vaccinating 24/7, because when you see the deaths, you see the cases, you know it is averting a plane crash if we get this done,” Stall said. “The urgency cannot be (overstated).”
More than a month after the first vaccines arrived in Ontario, residents of about half of the long-term care homes in the province have received a first dose of COVID -19 vaccine.
Stall and McGeer presented modelling showing that vaccinating all long-term care residents with a first dose by Jan. 21 — which was achieved in a handful of high-priority regions — would have saved the lives of 370 longterm care residents compared to the current plan to complete first doses across the province by Feb. 15.
Stall and McGeer said the province could have vaccinated all 70,000 long-term care residents by then, or even weeks earlier, if not for a “lack of urgency” and a series of missteps that cost time and directed limited vaccine supplies to those at lower risk of severe outcomes.
Among key missteps, they pointed to Ontario's failure to negotiate with Pfizer to move the vaccine doses received in December outside hospitals, as other provinces and countries did. That delayed vaccination of long-term care residents by weeks and meant many doses of the vaccines, now in short supply, went to people at lower risk of death from COVID-19.
Given the current caseload among long-term care residents and a death rate around 20 per cent, the delays mean more cases and more deaths, they said.
“Each day, literally, when we have the amount of long-term care residents dying in our province, does mean lives,” Stall said.
More than 3,200 Ontario longterm care residents have died of COVID-19 since the pandemic began, representing about twothirds of all deaths. The long-term care death toll during the ongoing second wave is forecast to be higher than that of the first wave.
The province now says all Ontario long-term care residents will get their first doses of vaccine by Feb. 15. Those in Ottawa and parts of the GTA have already received one dose. All long-term care residents in Toronto, Peel, York and Windsor-Essex, which are considered high-priority regions, were to have been given one dose by Jan. 21.
That leaves substantial regions of the province that are incomplete, creating stark regional disparities, Stall said.
The worst ongoing outbreak in the province — at Roberta Place long-term care home in Barrie — is in a region that had its supply of Moderna vaccine diverted to the GTA to meet the Jan. 21 vaccination deadline there. Nineteen residents of the home have died and 100 have been infected, some with the new, more contagious variant. On Thursday, the region's associate medical officer of health said he believed the outbreak would have been less severe if the region had those Moderna vaccines or had been able to move Pfizer vaccines out of the hospital sooner.
Stall and McGeer are urging the province to “substantially accelerate” its plan and to finish first-dose long-term care vaccinations by the end of January, a target they say is both achievable and necessary. Based on their modelling, 220 lives could be saved if all residents receive their first dose of vaccine by Jan. 31 rather than Feb. 15.
Stall and McGeer testified before the commission on Jan. 19. Transcripts were released late Wednesday.
They testified that the province's approach to vaccinating vulnerable long-term care and retirement-home residents had been politicized, lacked transparency and showed a lack of urgency and a sidelining of public health.
In addition, Ontario has lagged behind other provinces. Alberta has vaccinated all long-term care residents and both Quebec and British Columbia are on course to finish all long-term care residents this month.
On Thursday, Dr. Merrilee Fullerton, minister of long-term care, said she believes Ontario began vaccinating at “lightning speed” once it overcame the obstacle of being able to move the Pfizer vaccine outside of hospitals. Ottawa became the first jurisdiction to move the vaccine in the province earlier this month.
Stall and McGeer say Ontario's inability to negotiate with Pfizer to take the vaccines directly into long-term care homes earlier is one reason the province is lagging in vaccinating the vulnerable longterm care population.
“One of the things that really bothered Dr. McGeer and I was the initial resistance to work with the manufacturer to modify their very stringent requirements for transport, storage and distribution. There were fears that not complying exactly with what the manufacturer had laid out in the product monograph with respect to the cold chain storage and the
handling could jeopardize the supply chain,” Stall said. “But I have a hard time believing that, knowing that many other jurisdictions were able to do this. This was done elsewhere and it was done elsewhere in December.”
McGeer said the politicization of the vaccination process, combined with a “lack of trust between our current government and many local public health units,” had contributed to a lack of urgency and lack of clarity around the vaccination process.
“We chose to create a separate system in which other people are vaccinating residents of long-term care instead of using the system we already had, which works beautifully,” she said.
Fullerton, taking questions after a news conference Thursday, said the province was on track to complete first vaccinations of long-term care residents by Feb. 15 or sooner. She said the province could vaccinate more people more quickly if it had the supply.
Pfizer is temporarily cutting doses delivered to Canada while it retools its European production facility, which has angered Premier Doug Ford.
Each day, literally, when we have the amount of longterm care residents dying in our province, does mean lives.