Inside: It’s going to be an ‘ugly’ January, Canada.
Unless you’ve fallen victim to one of humanity’s most self-destructive disinformation campaigns, a vaccine is a wonderful idea. Vaccines aren’t on-off switches: They don’t rain from the sky. But since COVID-19 arrived, we’ve waited for them because nothing else really works.
“Vaccines are coming,” said Prime Minister Justin Trudeau at a hastily called press conference Monday morning. “The great news is that this is a beginning.”
Assuming it is approved by Health Canada in the next week or so, the first doses of Pfizer could be out before Christmas: 249,000 of the two-dose vaccine across Canada, which would immunize 124,500 Canadians, assuming nothing spoils. Pfizer needs to be kept at -70 degrees, so best to hedge on the exact amount.
It’s hope, or the start of it. Assuming Health Canada approval, there are 2.4-million Pfizer and Moderna doses expected in the first quarter of 2021 in Ontario, covering 1.2million people.
The Moderna vaccine doesn’t need to be refrigerated at supercold temperatures.
And again, if deemed approved and safe — and safety cannot be compromised, no matter how much anybody yells at Health Canada — Johnson & Johnson’s vaccine only requires simple refrigeration, and the company has colossal production abilities. It is the third of the seven vaccines Canada invested in relatively early.
Safe vaccines are scientific miracles. They conjure up images of life as it was, in the old world: crowded restaurants, lively bars, families together, children at play. It’s a path forward to what we had. Imagine.
But this is only a start, and we can’t get to the next world without marching through this one first.
“Yes, vaccines are on the way, and yes, vaccines will help,” says Dr. Isaac Bogoch, an infectious diseases specialist at the University of Toronto who is on Ontario’s vaccine task force. “But it’s going to be ugly in January.”
The first Pfizer delivery will vaccinate approximately 48,000 Ontarians, depending on how the per-capita calculations are done. They will go to vulnerable populations first, as they should: long-term-care residents, staff, essential caregivers and other employees of congregate living homes. Though Pfizer comes in batches of 975 and are not supposed to be transported once opened, so there are significant logistical challenges there.
Then health-care workers, adults in Indigenous communities — though because of its logistical challenges, Pfizer will not be used in remote communities like the north — and adults in chronic home care. We need to take care of the most vulnerable first.
Look, we are counting on foreign companies to manufacture vaccines in foreign countries before we can get them. We still haven’t even seen enough data to know if vaccines stop transmission, or just symptoms. This is just the first step toward hope.
But a vaccine is not time travel, and it’s not a get-out-of-jail-free card. We’re still in the thick of this, and the premiers who have been bellowing loudest for vaccine information from the federal government while letting the pandemic spread are like people who set fire to their own house, and then complain the fire department is taking too long to arrive.
Which is why Ontario — along with Alberta, Manitoba, Saskatchewan, Quebec and British Columbia — can still get smarter, and try to protect more people, using the tools we have right now.
Ontario case counts are still cresting since the second wave started in late August. Hospitalizations keep rising: There were 213 in intensive care units Monday, 121 of whom were on ventilators, and that is the result of cases from 10 days to two weeks ago. Four-hundred ICU patients is said to be the number at which the entire hospital system is severely impacted, beyond just cancelling surgeries.
And Peel and Toronto lockdowns have only slowed transmission rates, not flattened curves, while regions like York, Hamilton, Windsor-Essex, Durham, Eastern Ontario, MiddlesexLondon are all rising, some sharply. When York asked not to be locked down it relied on social-media data that showed mobility hasn’t been reduced nearly as much as in first-wave lockdowns; a Toronto Public Health poll conducted between Oct. 20-30 showed in Toronto, 48 per cent of people were still going to offices at least occasionally, 39 per cent were socializing indoors with four-to-six people, 45 per cent were going to malls.
The best argument for closing small non-dining businesses was to reduce contact rates; that likely isn’t helping now. The lockdowns are incomplete in both the bigger geographical and specific population contexts.
“The harder work needs to be done, so that’s not necessarily locking down, it’s significant restrictions while allowing some economic viability for places that aren’t contributing to the pandemic in a negative manner,” says Bogoch.
“But the flip side is the heavy lifting has to get done, right? (Transmission is) happening in probably private gatherings — OK, that’s communication and community engagement — and factories and essential workplaces where people are going back to their families. So paid sick leave, rapid testing on site, rapid communication and support so they don’t infect their family members (with isolation facilities). There’s nothing new. There’s no original thought on this.
“We’re not reinventing the wheel. You just need to know the fundamental principles of public health, and see it through several lenses, including an equity lens. People say what do you do, and the answer is, what you should have been doing all along. It’s fundamental epidemic response principles.”
As a province, Ontario has spent most of the eight months misplacing its epidemiologists, and getting lucky. An extended school break could slow any school transmission, and protect against Christmas get-togethers, after we saw spikes that seemed to follow Mother’s Day, Thanksgiving, and perhaps Diwali. But when asked about public health recommendations for Christmas, Premier Doug Ford mostly gave a long answer on what cottage owners should do because he’s been hearing lots of questions about that.
It’s all there: Provincial paid sick leave, better business supports, isolation facilities, eviction bans, rapid tests used smartly: We should try to give so much more to save what we can, and who we can, before the next world slowly arrives.
Vaccines are what we will get. Public health and epidemiology, right now, are what we have.