Throughout the pandemic, I’ve been tracking COVID-19 cases among healthcare professionals and other healthcare workers (HCW) in the B.C. healthcare system. This is information that requires a specific request to the BC Centre for Disease Control.

The data usually takes at least a week or two to obtain. Soon after I receive it, the BCCDC posts it on its website, presumably to show transparency for all. Few other journalists have taken an interest in the information, for whatever reasons.

Each time I have reported the figures, I’ve been shocked at the increases. But latest data (up to Feb. 19) shows that while nearly 6,000 healthcare workers have been infected by COVID-19 since the pandemic began a year ago, the cases are starting to recede a little. Healthcare workers now represent 7.9% of all cases in B.C. up to Feb. 19 when there were a total of 75,546 cases. That compares to 8.1% when I last reported this just over a month ago.

With about 80,000 lab-confirmed, cumulative cases of COVID in B.C., one can project that as of March 1, more than 6,300 healthcare workers will have been infected if the proportion is the same, at about 8% of all cases.

Still, the latest figures represent what can be viewed as an improving situation, likely attributable to vaccinations in HCW that began at the end of 2020. Indeed, as I write this, hospital-based and community physicians and other frontline healthcare workers are finally being immunized with first or second shots. Hallelujah to that!

The latest figures show that care aides, who most often work in long-term care, have been most affected – 1,402 of them have been infected – accounting for 23.6% of cases among HCW. There are about 30,000 care aides working in B.C. which means about 5% have been infected.

It should be pointed out that not all HCW are infected on the job; they could have been infected anywhere in their communities.

Those who work in the nursing category – registered nurses, licensed practical nurses, nursing practitioners, and nursing assistants – are virtually even with care aides; about 1,400 working in nursing have been infected. There are about 53,000 nurses in B.C.

Here’s the list of all categories below. You will see at the bottom two large figures for categories called “other” and “unknown.” The “other” category represents HCW whose roles were identified by four or fewer COVID cases. The unknown category, which accounts for 11.1% of all cases, are cases of HCW who would not disclose or specify their roles when they got tested.

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The post HEALTHCARE WORKERS INFECTED BY COVID-19: latest data appeared first on Medicine Matters.

BY PAMELA FAYERMAN

Blood samples from residents and staff of long term care (LTC) facilities will provide precious clues into how the immune system reacts to both COVID-19 infections and vaccinations.

Vancouver researchers at Providence Health Care, Simon Fraser University, UBC and the BC Centre for Excellence in HIV/AIDS have been granted over $1 million from the federal government to conduct and analyze blood draws from residents and staff of LTC facilities before and after vaccinations. That will allow experts to learn how to understand more about immunity so they can learn how to protect individuals who live and work in the facilities from future outbreaks. Healthcare workers in acute care facilities will also be included in the blood analysis research.

No one knows for sure yet how long immunity to COVID-19 will endure after vaccinations and/or infections. Will we require shots on an annual basis as is the case for protection from influenza? Perhaps, especially the elderly with less robust immune systems.

Principal investigator Dr. Marc Romney said in an interview that hundreds of blood samples have already been collected – including from individuals who died at Holy Family Hospital during an outbreak last year. Their blood has been banked as will all other samples drawn from study participants who will be asked for at least four specimens over a one-year period, including before vaccination, a month after and then again after their second vaccine doses. (Blood samples from deceased individuals will obviously not be useful for post-vaccination research).

The durability of the immune system response will be evidenced by various components including antibodies, T-cells, B-cells and cytokines.

Dr. Romney, the clinical associate professor at UBC and medical leader for medical microbiology and virology at St. Paul’s Hospital, said the hypothesis is that immunosenescence is a defining factor in immune durability. Immunosenescence is the gradual deterioration of immune systems as individuals age which affects the capacity to respond to infections and to maintain long-term immune memory acquired by infection or vaccination.

“The elderly have fragile white blood cells. They’re relatively immune compromised so it’s important to know how durable their vaccine protection is for them,” he said.

Since everyone will want the results “yesterday,” Romney said researchers will release interim results in stages to help with vaccination planning in 2022 and beyond. Romney has also been active in the development of pre-flight rapid testing protocols at the Vancouver International Airport.

The study will utilize state of the art technology that helps analyze vaccine-induced immunity.  The research is part of the federal government’s COVID-19 Immunity Task Force (CITF). Scientists across Canada have been asked to conduct research that helps answer what proportion of the general population has antibodies to COVID-19; how long immunity lasts after infections; what antibody tests are the best; and how long individuals are protected against COVID after being vaccinated.

In Alberta, teams will look at vaccine-induced immunity as well as whether sewage wastewater can be used as an early warning system to detect outbreaks in LTC facilities. Wastewater samples from selected LTC facilities in Edmonton will be analyzed to determine whether the virus is circulating even before residents and staff develop symptoms. If levels of COVID biomarkers are detected, then it would trigger rapid testing to identify those who are infected to help prevent the spread of the disease.

EMAIL: [email protected]

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COVID-19 vaccinations are expected to resume again in the next few weeks after a lull due to vaccine scarcity from suppliers. Selfie photos posted on social media of individuals getting vaccinated can trigger negative emotions on the part of those waiting for vaccinations. A commentary on this is by Ben Huang, an emergency medicine resident at the University of B.C. who is also a Global Journalism Fellow at the Dalla Lana School of Public Health at the University of Toronto.

BY BEN HUANG

As doctors across Canada receive COVID-19 vaccines, many are sharing photographs on social media to inspire hope and to encourage others to get vaccinated too.

This has sparked controversy around “vaccine selfies,” as other doctors say the pictures provoke anxiety, anger and envy.

The debate among doctors over how to use social media is merely the tip of the iceberg, with inequalities in Canada’s slow and irregular vaccine rollout at the root of the frustrations.

Studies over the past decade have demonstrated links between browsing social media and depressive symptoms, especially when online content triggers envy. And during the COVID-19 pandemic, vaccine envy is inevitable, with vaccines being limited and the pandemic continuing to rapidly grow.

By all means celebrate, but celebrate privately….We get it—we’re happy for you. Just don’t rub salt in our wounds.

Social media triggers
For some health-care workers, social media selfies are an unwelcome trigger.

“Social media is complicated,” says Dr. Amelia Yip, a cardiologist in Waterloo, Ont., who recently received her first dose vaccine. “Even within the healthcare profession, there are people who should be getting it before others. But the way it’s being rolled out doesn’t always work that way.”

“The way the distribution is happening, it feels like there isn’t a coordinated effort. It feels under-appreciative for healthcare workers, or even those at risk, not just doctors,” says Dr. Yip.

Canada’s vaccine rollout has been highly variable between provinces. In Ontario, for example, almost 19% of vaccinated people have completed both doses, compared to only 1.5% in British Columbia.

And in Québec, where second doses are being postponed significantly until mid-March, no one has yet received two doses.

Dr. Yip says there are pockets of people who have been missed in her local rollout, and that at her hospital, cardiologists had to remind authorities that they, too, are involved in critical care.

Meanwhile, says Dr. Yip, it’s been doubly frustrating to see vaccine selfies posted by people who don’t work on the frontlines.

“Yesterday, a completely non-medical person who’s an accountant and happens to work at a Toronto hospital got it. When you see someone not even working [with COVID-19 patients] getting it, it feels like the person is jumping the queue.”

Anger and resignation
The vaccine rollout in B.C. has featured similar criticisms and controversies around queue-jumping by doctors and administrators.

Dr. Alan Drummond, an emergency physician in Perth, Ont., where frontline workers are still waiting for word of vaccines, says: “You have to take the broader context to understand where some of the disappointment and anger is coming from. For at least 10 months, ER physicians and nurses were dealing with a novel virus that has the potential to be quite deadly. I don’t know anybody in my sphere who shied away from the responsibilities of looking after patients—nobody.”

Dr. Drummond says the initial arrival of vaccines in Canada was met with hope and enthusiasm, and that it was “entirely appropriate” that doctors celebrated on social media as a sign of the beginning of change.

But as selfies continue to get posted online, Dr. Drummond says he and his colleagues are beginning to feel resigned and angry.

“The inequities are starting to show…. We need an appropriate queue—we certainly aren’t in it. And [the selfies are] the icing on the cake.”

Impacts of stress
Stress due to providing care to coronavirus patients has significant consequences. Frontline doctors, nurses and therapists are burned out. Tragically, 35-year-old Dr. Karine Dion recently died by suicide. Emergency and intensive care doctors have also reported feeling overwhelmed.

Dr. Sarah Giles, a rural family and emergency doctor in Kenora, Ont., says her community will not be receiving vaccines until April.

“When we look at inequalities, we know that there is a lifespan discrepancy between living in northwest Ontario and in southern Ontario. As my friend said, we’re at the end of the supply for fruits and vegetables and you can tell: We’re at the end for vaccines as well.”

And especially in rural communities, says Dr. Giles, every healthcare worker is paramount.

“We have human resources issues. If we lose a couple of doctors or nurses, it’s going to be a big problem.”

For Dr. Giles, who lives alone, vaccine selfies have been personally anxiety-provoking; she says when she gets vaccinated, she will not post a selfie.

As for Dr. Drummond, he has this message for doctors: “By all means celebrate, but celebrate privately. Just don’t do it so publicly when a lot of your colleagues who are dealing with their own anxieties and fears. We get it—we’re happy for you. Just don’t rub salt in our wounds.”

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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COVID-19 infections continue to rise amongst B.C. healthcare workers as data just released shows the cumulative number of infections rose 34% in the past month, to 4,850.

The count provided by the B.C. Centre for Disease Control only goes up to January 15 when there were a total of about 60,000 COVID cases in the province. As of today, there are over 68,000 cases so it is likely there have now been somewhere around 5,400 infections among healthcare workers since the pandemic began. In mid-December, there were 3,624 cumulative cases among healthcare workers.

The good news, if you can call it that, is that COVID-19 infections among healthcare workers continue to account for just over eight percent of all cases in B.C. That proportion has not risen for a few months. As well, first vaccinations have been completed among all staff and residents of long-term care facilities so infections in LTC sector staff should start to fall.

Care aides who most commonly work in LTC facilities and nurses in various categories  – RN, nurse practitioner and licensed practical – continue to head the list. As you will see from the table below, care aides account for about 25% of all infections in the healthcare sector while nurses are a close second, accounting for another 24%.

Cases among dental professionals (156) slightly outnumber those in physicians (151). The only professionals who’ve been vaccinated so far in B.C. are those who work in intensive care units, emergency departments and COVID units. That means healthcare workers like nurses, dentists and physicians not providing direct care to COVID-19 patients have not yet been inoculated.

The government and Dr. Bonnie Henry continually emphasize that not all COVID infections are contracted on the job. But it is clear that wherever healthcare workers acquire COVID-19, they are vulnerable and carry a heavy burden when it comes to the virus. A category called unknown/unspecified has 577 cases. That means individuals answered yes when they were asked during testing if they worked in healthcare but they declined to provide more information about their occupation.

In an ideal world, every healthcare worker would be getting vaccinated now. But the supply for most of February has dried up because of modifications to vaccine production facilities in Belgium.

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The post COVID-19 cases rise 34% among B.C. healthcare workers in past month alone appeared first on Medicine Matters.

Vancouver Coastal Health is investigating reports of physicians who got their second COVID-19 vaccine doses before they were permitted to do so. Such physicians may be disciplined, according to an internal memo.

Health Minister Adrian Dix said today it’s disappointing to hear about these cases but he emphasized that they were picked up because of a provincial database that tracks every dose.

The internal memo stated:

“Through this system, it has come to our attention that there haven been instances in which physicians have attended our clinics and received their second dose of vaccine before they were invited or permitted to do so. These instances will be investigated and may result in disciplinary action.”

The government’s approach is to provide second doses of both the Pfizer and Moderna vaccines about 35 days after the first dose. B.C. decided to delay the second dose to 35 days, rather than the manufacturers’ recommendation of 21 to 28 days. By the end of March, B.C. expects that just over 240,000 people will have received two doses.

Dix said the government won’t comment further on physicians who skirted rules because “these are human resource issues and we won’t be commenting on them publicly.” He said while there have been media reports about  “a few” individuals who’ve “gotten out of line”  for immunizations, such cases shouldn’t detract from the success of the “work to date that overall has been excellent.”

Doctors of B.C., the group representing 14,000 physicians across the province, did not have a comment on the matter. Sharon Shore, a spokeswoman, said: “Given that we just found out about this situation a little while ago, we cannot comment without knowing more about what happened.” (The internal memo was obtained by MedicineMatters.ca yesterday).

About 63,000 doses have been delivered to high priority individuals like front line healthcare workers and residents of long term care thus far. The number of vaccinations has steadily declined in the past week because of shrinking supplies but the province is expecting more deliveries today and throughout the rest of the week.

Dr. Penny Ballem, chair of the VCH board, said she takes the matter involving the physicians who got earlier vaccinations seriously and “we hope it won’t be something we see a recurrence of.”

Vancouver Coastal Health was asked for comments yesterday, after I obtained the internal memo. The response sent today says:

“Vancouver Coastal Health (VCH) is committed to the roll-out of the COVID-19 immunization program in line with guidelines set out by the Ministry and the National Advisory Committee on Immunizations.

Administering the first doses of vaccine to as many vulnerable and high-risk people as possible in these early weeks will have the greatest impact on reducing severe illness, hospitalizations and death.

The overwhelming majority of healthcare professionals are following public health direction, and we are following-up on any individuals who have received a second dose of vaccine before they were invited to do so.

VCH is currently investigating and appropriate action will be taken to address any breaches of public health direction regarding vaccine administration.”

Meanwhile, at a teleconference press briefing, Dix announced that Ballem will be taking on an additional role as the provincial immunization leader for the “largest vaccination program in history.”

Dr. Ross Brown, who has been heading the pandemic response program since November, will continue to work on the vaccination program, under Ballem’s direction.

“I feel very happy and honoured to have this opportunity,” Ballem said. “It’s a mammoth task, but it can be done.”

Ballem, a former hematologist whose high-powered career has included jobs including deputy minister of health and Vancouver city manager, will lead the coordination efforts across the province. Provincial health officer Dr. Bonnie Henry said Ballem will direct the massive effort  “whether it’s business or government or municipalities to help support us being able to equitably and rapidly provide this protection to as many of our community members as possible.”

The goal is to achieve herd immunity to COVID-19 by September.

While about 25,000 B.C. residents have been vaccinated weekly in the past month, Dix said the numbers should almost triple by next month when nearly 70,000 doses a week are delivered.

The B.C. vaccine plan is here.

[email protected]

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A Fraser Health physician leader, Dr. Dayan Muthayan, circulated an internal memo to doctors and other healthcare professionals recently, asking for their help as COVID-19 immunizers. The plea, right around New Year’s, produced instant results, a good thing since no other health region in B.C. has been as hard hit by COVID-19 as Fraser Health.

The region accounts for two-thirds of all the COVID-19 cases in B.C. since the pandemic began. Of late, the test positivity rate has been hovering around 10%.

Many hundreds of doctors, nurses, and pharmacists answered the call by Muthayan, the executive medical director of Fraser Health. But after only three days and 1,200 vaccinations, the clinic at Royal Columbian Hospital where the Pfizer-BioNTech vaccine was being distributed to frontline health care workers was shut down. One of the doctors – Dr. Kathleen Ross, the former president of Doctors of B.C. – vented her frustrations on Twitter:

I asked Ross the next day for more information and she said she was “politely asked not to engage (with) the media.” Another way to say muzzled.

Throughout the pandemic, doctors have taken to Twitter to share their knowledge, opinions and frustrations. And all too often they’ve been silenced. Some hospital staff like emergency room physicians have been threatened with firing if they speak out.

So it was good to get 15 minutes on the phone with Dr. Victoria Lee, CEO of Fraser Health today. She said she was happy to see how many hundreds of physicians and other health care professionals offered to do inoculations. “The response was tremendous. Everyone is stepping up and leaning in.”

She said that while healthcare staff in emergency departments, COVID-19 wards, and intensive care units at four hospitals – Abbotsford, Surrey, Burnaby and Royal Columbian – were the focus of vaccinations from the middle of December through the first week of New Year’s, the priority now is residents and staff in long term care and assisted living residences, especially because there isn’t an abundant supply of the vaccine.

Lee’s Twitter posts are decidedly more positive in tone than those from frustrated frontline health care workers:

A sizeable chunk of healthcare professionals have gotten COVID-19, especially care aides in long-term care facilities who’ve unwittingly transmitted infections to residents, resulting in outbreaks. Yesterday, the B.C. government finally offered more information on those outbreaks in care facilities, unveiling a new system to improve transparency. Two-thirds of the 988 deaths caused by COVID have been among elders in long term care.

Lee said like jurisdictions around the world, B.C. is at a “dire stage and whether we have vaccine or not, we need to maintain our vigilance.”

Dr. Bonnie Henry, the provincial health officer, revealed the priority groups for each stage of vaccinations, including 30,000 health-care workers by the end of February, providing vaccine supplies are constantly refreshed.

“We are constrained by logistics and also by how many vaccines we are receiving, but we’re optimistic, and we are focused intensely on making sure we protect people in long-term care and assisted living as quickly as we possibly can – and of course, protecting those most at risk in our communities,” she said.

B.C. had administered 46,259 COVID-vaccines to date, 65% of the 71,200 doses received so far.

Every province is struggling with vaccine supplies. In Ottawa today, Public Services and Procurement Minister Anita Anand said she’s been pressing vaccine manufacturers to expedite supplies and deliveries.

“I have spoken with the CEOs of both [vaccine] companies this week already, and I will continue to engage with them, as will my department, to move up doses from Q3 to Q2, from Q2 to Q1,”  said, referring to the quarters of the calendar year.

Maj.-Gen. Dany Fortin, the military commander leading vaccine logistics for the Public Health Agency of Canada, said Canada is expected to receive four million doses of the Pfizer-BioNTech product and two million Moderna shots by the end of March — enough to vaccinate just three million people.

Here’s a detailed memo sent by the Fraser Health communications department, regarding that health region’s plans:

“We are currently in the first stage of the vaccine rollout across Fraser Health, with work well underway to vaccinate staff, medical staff, residents, and essential visitors in long term care and assisted living facilities, people awaiting long term care placement in acute and community settings, and priority acute care staff, medical staff and paramedics. We expect all eligible long term care and assisted living staff, medical staff and residents in the region to receive their first COVID-19 vaccination by mid-January.

Priority acute care health care workers include staff, medical staff and dedicated support services in emergency departments, critical care units, and COVID-19 units. We expect to immunize more than 6,000 of these priority staff and medical staff at acute care sites by January 23.

Dedicated immunization clinics in acute care began with our three regional COVID-19 hospitals – Surrey Memorial, Abbotsford Regional and Royal Columbian Hospitals. Burnaby Hospital also began immunization clinics this week, given the ongoing and significant outbreaks at that site. Remote First Nations communities will begin receiving vaccinations on January 13.

Over the next few weeks, we expect to immunize 12,000 to 15,000 individuals per week, and by February, we expect to be able to immunize up to 30,000 individuals per week.

We are grateful for the tremendous response from our staff and medical staff, as well as community physicians, local pharmacists, and other community partners who have stepped up to help administer the COVID-19 vaccine in our region. To date, nearly 550 medical staff, more than 75 pharmacists and 200 peer immunizers have expressed interest in administering the COVID-19 vaccine. In addition, Fraser Health has hired 60 dedicated immunizers and has redeployed additional staff to support our efforts.

Thanks to the efforts of our vaccine coordination centre and all those who have come forward to support immunizations, we have rapidly expanded our daily capacity from a few hundred to over 2,800 immunized per day as of yesterday. 

Due to the numerous complexities of the vaccine rollout, our vaccine coordination centre teams are working around the clock to rapidly adjust and augment our schedules and strategies. We ask for the patience of those in our priority groups who are awaiting their vaccine as we endeavour to deliver an effective and efficient COVID-19 vaccine program.

Our vaccine coordinating and local Royal Columbian Hospital teams have done an incredible job with onsite vaccine clinics. As they had substantially completed their efforts to vaccinate priority acute care staff, medical staff and dedicated support services staff, a previously scheduled vaccine clinic at Royal Columbian Hospital was redirected to support our efforts to prioritize vaccination of our long term care and assisted living staff, medical staff and essential visitors.

Stage two of the vaccine rollout will begin before the end of January and will include broader groups of staff and medical staff who work in the health system.”

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BY PAMELA FAYERMAN

In the last post by pharmaceutical expert Lu-Ann Murdoch, she reviewed proper inoculation techniques for deltoid injections. Since COVID-19 vaccinations are going into deltoid muscles, those doing the shots – and individuals getting them – should know exactly how it should be done, especially to avoid or minimize subsequent shoulder pain.

In the article below, Murdoch discusses the confusing matter of allergic reactions to the Pfizer-BioNTech vaccine and whether individuals who’ve had anaphylactic reactions to anything in the past should avoid that vaccine altogether.

In Britain, authorities have updated their instructions because of some reports of anaphylaxis after the Pfizer-BioNTech vaccine. Canada has made the matter more ambiguous for individuals, advising them to talk to their doctors first if they have a history of serious allergic reactions to anything or allergies to any of the ingredients in the vaccines. First, many individuals don’t have regular family doctors and second, most people would have no way of interpreting the medicinal or non-medicinal ingredients.

In the U.S., the CDC now recommends that anyone with a history of immediate allergic reaction of any severity to a previous dose of, or any component of, an mRNA COVID-19 vaccine, or to polysorbate, should not be vaccinated with either of the mRNA vaccines. That means that anyone who has developed a severe allergic reaction after a first dose of mRNA COVID-19 vaccine should not receive a second dose. Polysorbate is not an ingredient in the vaccine, but people who are allergic to it may potentially react to polyethylene glycol in the vaccine since it is closely related. The CDC vaccine fact sheets and many other online sources provide lists of ingredients for each vaccine.

The CDC defined an immediate allergic reaction as: hives, swelling away from the site of the injection, respiratory distress such as wheezing or shortness of breath, or passing out within four hours after the injection. Most allergic reactions occur within 15 to 30 minutes. Non-allergic side effects can include fever, chills or fatigue, usually one to three days after vaccination.

Canada should follow the lead of the U.K. and the U.S. to give clear advice. The federal government has posted some data about adverse events related to the vaccinations up to Jan. 8 when there were 24 reported, 10 of them considered serious. The serious reactions represent 0.003% of all doses delivered to individuals across Canada to that date – about 340,000.

The article below is republished with permission from The Medical Post.

BY LU-ANN MURDOCH

As immunization begins with the Pfizer-BioNTech COVID-19 vaccine for high-priority patients across Canada, some individuals may be hesitant to receive the vaccine due to media reports of two cases of anaphylaxis following use of the vaccine in Britain.

Both patients had a history of severe allergic reactions and carried epinephrine autoinjectors, and both received prompt treatment and fully recovered.(1,2)

U.K. guidance

On Dec. 9, 2020, Dr. June Raine, chief executive of the Medicines and Healthcare Products Regulatory Agency (MHRA) in the U.K. noted the agency has issued updated guidance to COVID-19 vaccination centres, subsequent to the two reports of anaphylaxis and one report of a possible allergic reaction following immunization with the Pfizer-BioNTech COVID-19 vaccine.(2)

The new U.K. guidance specifies that “Any person with a history of immediate-onset anaphylaxis to a vaccine, medicine or food should not receive the Pfizer/BioNTech vaccine. A second dose should not be given to anyone who has experienced anaphylaxis following administration of the first dose of this vaccine.”(2)

Dr. Raine confirmed that, “Anaphylaxis is a known, although very rare, side effect with any vaccine. Most people will not get anaphylaxis and the benefits in protecting people against COVID-19 outweigh the risks. Anyone due to receive the vaccine should continue with their appointment and discuss any questions or medical history of serious allergies with the healthcare professional prior to getting the jab.”(2)

The U.K. MHRA stresses that vaccine recipients should be monitored for 15 minutes after vaccination, with a longer observation period when clinically indicated. In addition, a protocol for the management of anaphylaxis and an anaphylaxis kit must always be available whenever the Pfizer/BioNTech vaccine is given.(2)

Health Canada’s stance

In a Dec. 12, 2020 public advisory, Health Canada recommends patients with allergies to any of the ingredients in the Pfizer-BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine) should not receive it. The full list of ingredients can be found in the vaccine’s Canadian product monograph.(1, 3)

Health Canada also advises patients to speak with their healthcare professional about any serious allergies or other health conditions before receiving the vaccine.(1) The agency points out that all vaccines in Canada carry a warning about the risk of serious allergic reactions, including anaphylaxis, and immunization clinics must be equipped to manage these rare events.(1)

Information in the product monograph

Health Canada concludes the current product monograph for the Pfizer-BioNTech COVID-19 vaccine contains appropriate guidance about the rare risk of anaphylaxis; therefore, no changes are currently being recommended to the product’s use. This means Health Canada is not specifically advising patients with a previous anaphylactic reaction to avoid the vaccine; rather, patients should notify their healthcare provider of any history of anaphylaxis and discuss the situation with their healthcare provider before receiving the Pfizer-BioNTech COVID-19 vaccine.(1)

Health Canada will continue to monitor for any adverse events of the Pfizer-BioNTech COVID-19 vaccine and will take action if any new safety issues are identified.(2, 4) The manufacturer (Pfizer Canada ULC and BioNTech Manufacturing GmbH) is legally required to submit reports of vaccine adverse events to Health Canada.(4)

Vaccine injury support program announced

In related news, on December 10, 2020, Canada’s federal government announced that the Public Health Agency of Canada will be implementing a pan-Canadian no-fault vaccine injury support program for all Health Canada-approved vaccines, in collaboration with the provinces and territories. The program will ensure that Canadians have access to support in the rare event they experience a serious adverse reaction to a vaccine.(5)

Initial vaccine supplies 

Health Canada has also announced that the Pfizer/BioNTech vaccine will initially be supplied with English-only labels on the cartons and vials in order to expedite the global distribution of the vaccine. The vial and/or carton labels include the statements “For use under Emergency Use Authorization,” which is U.S.-specific information that should be disregarded as it does not apply to Canada.(6) As Canadian-specific information is missing from the vial and carton labels, it’s important for healthcare providers to consult the Canadian product monograph for the vaccine to obtain complete product information.(3) Vaccine supplies with Canadian-specific labelling in French and English will be available as soon as feasible.(6)

References

1. Government of Canada. Pfizer-BioNTech COVID-19 vaccine: Health Canada recommendations for people with serious allergies. December 12, 2020. https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/74543a-eng.php (accessed December 14, 2020).
2. Medicines and Healthcare products Regulatory Agency. Confirmation of guidance to vaccination centres on managing allergic reactions following COVID-19 vaccination with the Pfizer/BioNTech vaccine [press release]. December 9, 2020. https://www.gov.uk/government/news/confirmation-of-guidance-to-vaccination-centres-on-managing-allergic-reactions-following-covid-19-vaccination-with-the-pfizer-biontech-vaccine (accessed December 14, 2020).
3. Pfizer Canada. Pfizer-BioNTech COVID-19 Vaccine (COVID-19 mRNA vaccine, suspension for intramuscular injection) product monograph. Kirkland, QC; December 9, 2020. https://pdf.hres.ca/dpd_pm/00059112.PDF (accessed December 14, 2020).
4. Government of Canada. Pfizer-BioNTech COVID-19 vaccine: what you should know. https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/pfizer-biontech.html#a4 (accessed December 14, 2020).
5. Government of Canada. Government of Canada announces pan-Canadian Vaccine Injury Support Program. December 10, 2020. https://www.canada.ca/en/public-health/news/2020/12/government-of-canada-announces-pan-canadian-vaccine-injury-support-program.html (accessed December 14, 2020).
6. Government of Canada. Authorization of Pfizer-BioNTech COVID-19 vaccine with English-only carton and vial labels. December 12, 2020. https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/74541a-eng.php (accessed December 14, 2020).

The post UK and USA issue firm advice about anaphylaxis after COVID-19 vaccinations appeared first on Medicine Matters.

As of today, healthcare workers and residents in long term care will be the priority for COVID-19 immunizations – a most precious resource due to limited supply and great demand.

There have been reports of brazen queue-jumping all around the world.

In British Columbia, there are about 70,000 residents and staff of long-term care and assisted living facilities in B.C. and as of this week, they are the focus of immunizations with the Moderna vaccine. An internal memo to Vancouver Coastal Health, obtained by MedicineMatters.ca, attempts to quiet the criticisms by some who believe there have been stumbles at the start of the vaccination campaign.

As I reported in my last article, frontline healthcare workers who’ve accounted for a 151% increase in COVID-19 infections in just the last six weeks, were lining up for hours on their days off at a “pop up” clinic near Vancouver Hospital last week. As well, BC Nursing Union president Christine Sorensen told CBC that administrators have jumped the queue even though they don’t provide direct patient care.

But as I reported here, administrators who work in health care have been hard hit by COVID too, accounting for 204 cases as of Dec. 17. That’s six percent of all B.C. cases among those who work in health care. They didn’t necessarily get infected at their workplaces and the same can be said for all care aides and nurses who together account for the most cases among healthcare workers.

The controversies could die down a bit over the next few weeks as the aforementioned memo from pandemic planning leaders Dr. Ross Brown and Dr. Chad Kim Sing (below) makes it clear that long term care (LTC) staff and residents are now the priority since the vast majority of deaths have occurred in seniors residential care.  The referenced meeting called for Jan. 20, 2021, could have some fireworks. Here’s the internal memo to VCH staff:

Just over 8,000 vaccinations have been completed in B.C. before Christmas and the goal is to complete 400,000 by March, 2021.

These are B.C.’s plans for vaccinations, based on recommendations from the National Advisory Committee on Immunization:

First priority groups

• Long-term care and assisted living facility residents and staff
• Health care facility staff for COVID-19 patients in settings like Intensive Care Units, COVID-19 wards and emergency departments
• Indigenous people living in rural or remote communities
• High-risk people living in group settings like shelters
• People over 80 years old

Second priority groups

In spring 2021, as more vaccine becomes available, the second phase of vaccination will begin for:

• Older people under age 80 in descending five-year-age groups, with a focus on the oldest people first
• Key frontline workers including:
  • All other healthcare workers
  • Police
  • Fire and first responders
  • People working in grocery stores
  • People working in K to 12 education settings and child care providers
  • People working in transportation
  • People working in manufacturing and production facilities

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