Oh Canada! – let us not follow you.

Written By: - Date published: 3:19 pm, April 17th, 2021 - 23 comments
Categories: covid-19, health, uncategorized - Tags: , ,

The vaccination program in NZ is due to escalate when it goes into phase 3 – probably in May. The recently released projections on the Covid-19 dashboard (hat-tip: BusinessDesk “How we will get to full vaccination“) show a breakdown of expected vaccination rates by DHB, week and other factors.

It is pretty ambitious logistical operation to vaccinate a whole population with the resources in-country within a few months. There are a lot of potential gotchas. As a comment on the BusinessDesk article comments – it’d be nice to know how many vaccine doses were planned to be in country and when. But there are also issues finding mass vaccination sites. Notifying people in various phases that they should come and get a first jab. Notifying people to get second jabs at an appropriate time.

Just getting enough trained staff or training staff to do the jabs and handle any complications within the period of a few months is going to be a pain. After nearly 45 years, I remember being trained as a army medic on how to administer injections on each other. Such was the trauma, that the memory is still vivid. At least as an 18 year old medic, we didn’t have the thin skins of the elderly to deal with.

But this all has to happen in the midst of a worldwide epidemic. So while this process is going on, the last thing we need is an outbreak. Harder now that we’re opening up to Australia because that will significantly raise the risk level in NZ as it bypasses the quarantine facilities.

To refresh people memories on exactly how fast an outbreak can take hold, just look at the current wave going on in Ontario and in particular Toronto – while the vaccination program is actively running. Less than a month ago there were around 1000 new cases of covid-19 in Ontario. Now their daily rates are well above 4000 in a full-blown outbreak. BBC World reports in “Covid: Canada sounds the alarm as cases overtake US“

The rate of coronavirus infections in Canada’s biggest province has reached an all-time high as hospitals warn they are close to being overwhelmed.

A panel of experts say infections in Ontario could increase by 600% by June if public health measures are weak and vaccination rates do not pick up.

Last week, for the first time since the pandemic began, Canada registered more cases per million than the US.

About 22% of Canadians have now received a first vaccine dose.

That compares to 37% in the US.

Ontario is now introducing strict new public measures, including:

  • a six-week stay-at-home order
  • restrictions on non-essential travel, including checkpoints at the borders with the neighbouring provinces of Quebec and Manitoba
  • new powers for police to stop and question people who leave home
  • a halt to non-essential construction

Canadian Prime Minister Justin Trudeau said the federal government would help Toronto, the largest city in the country, which has been hard-hit by the latest surge.

“We’re going to do whatever it takes to help. Discussions are ongoing about extra healthcare providers, and we are ready to step up,” he said on Friday.

Basically the new UK variant B1.1.7 with it faster infection rate managed to cause and exponential growth.

On Friday, Ontario reported 4,812 new cases, its third straight day of setting new records since the pandemic began.

Hospital admissions and the number of patients in intensive care also set records for Ontario: 1,955 and 701, respectively.

The expert panel said the best-case scenario would bring new cases down to about 5,000 a day, but only with considerably more stringent public health measures than the ones now in place.

It would also require a vaccination rate of 300,000 a day – three times the current pace.

Last week the College of Physicians and Surgeons of Ontario warned doctors that they might have to start making decisions about who to admit to intensive care, because units were stretched almost to capacity

I am sure that we will have the usual dimwits (curtain call for Mike Hosking) and even irresponsible National MPs and other carping critics calling for fast opening of borders and faster vaccination regimes. However in the history of pandemics and epidemics, we are getting into the most dangerous stage after the initial spread.

This is when populations get complacent. In history it is when the first wave or two of a pandemic flood through and there is a hiatus of few new cases. Then a variant with a better infection system comes through and demonstrates the number of people still in the population without immunity or with limited immunity to the new variant.

In this case, people get their first shot or even their second, feel that the worst is over, and lower their precautions against spread and infection. But it is likely that people who are vaccinated may still be able to carry and transmit the infection to others – we won’t know that for certain for each vaccine for months or years. Raised levels of infection in the population also increase the probability of even the vaccinated getting infected with a more virulent variant.

Vaccines aren’t silver bullets that guard any particular individual – even if they are vaccinated. They reduce probabilities of infection. What guards the individual in a population is that an infection is capable of gaining a significiant foothold in the population to the point it can produce new variants and an exponential spread.

Basically vaccination is a communal response rather than an individual one. We need to concentrate on how to get that right now in the preliminary phases before we start the phase 3 and 4 process of vaccinating the whole population. That last thing we want is an outbreak happening in the middle of the main vaccination programs. That will screw up are complex logistics if a mass vaccination program.

Normal life should resume inside NZ and Australia about the time that we have about an 70-80% double vaccination rate. The earliest that is likely to happen in around the end of this year, and possibly longer in Australia.

23 comments on “Oh Canada! – let us not follow you. ”

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  1. Reality 1
    17 April 2021 at 5:12 pm

    Hosking and his ilk seem to have gone a bit quiet about opening the borders as they have surely seen the further outbreaks in Europe and now Canada. But I well remember them and dear Judith last year demanding the borders be opened. Thank goodness Jacinda was cautious and did not give way to their noise.

  2. Treetop 2
    17 April 2021 at 5:40 pm

    The trans – Tasman bubble has not yet opened and already I am anticipating community spread in NZ which will require a level 3 or 4 lockdown. The best chance for NZ would have been vaccinating as many people in NZ as could be vaccinated with two doses of the Pfizer vaccine and then opening the trans – Tasman bubble. I estimated about October after the flu season.

    The P.1 B.1.167 strain with its double mutation in India is not under control. As bad as it is, how effective the vaccines are and how long they give protection for is still unknown?

    Any freedom gained living in a Covid world is dependent on vaccination, an effective treatment and a health system which can deliver health care.

    • Treetop 2.1
      17 April 2021 at 5:57 pm

      Could you remove P.1 as an error start of second paragraph.

    • In Vino 2.2
      17 April 2021 at 6:00 pm

      I fear we are overrating the effectiveness of vaccination. It seems that our Pfizer jab is now not very effective against the new variants – more infectious, and therefore more likely to be the one that breaks into our country via the bubble.

      In the famous words of George Dubya, we may have misunderestimated this tricky virus. (Tricky in the dictionary sense of 'difficult to solve.')

      Those who look forward to 'business as usual' Utopia need to be told that they are dreaming.

      I think Covid is going to keep us closed down for several years yet.

      • Rosemary McDonald 2.2.1
        18 April 2021 at 1:38 pm

        I fear we are overrating the effectiveness of vaccination.

        Me too. I also fear we have erred in placing all our hopes for 'normal' on the vaccines.

        Survivors will look back and wonder why it was that just about all options other than a Vaccine have been effectively dismissed , and any discussion of treatments or immune supportive programmes have been deemed "misinformation". "disinformation" and proponents labelled "anti-vaxxers" ….whether they are actually are or not.

        • Drowsy M. Kram 2.2.1.1
          18 April 2021 at 2:46 pm

          I also consider that any hope of returning to 'normal' is unrealistic, but an on-going global vaccination programme, similar to that used to reduce influenza-related symptoms and deaths, is already decreasing the number of excess COVID-19 deaths in some countries.

          According to the large study by Piroth et al. (second link below), COVID-19 is nearly three times more lethal than influenza, and some ‘long-COVID’ symptoms are nasty.

          Medical treatments for COVID-19 infections will improve (who knows, maybe vitamin D supplements, ivermectin and whatever pops up next are ‘te answer‘), and it's possible that at some time in the future COVID-19 in all its mutated forms will be no more lethal than influenza. Regardless, COVID-19 vaccination programmes to train human immune systems will be crucial to controlling this pandemic sooner rather than later.

          COVID-19 is not influenza
          A surprising finding of the study by Piroth and colleagues was that, among patients younger than 18 years, the rates of ICU admission were significantly higher for COVID-19 than influenza. The need for intensive care was highest in patients with COVID-19 who were younger than 5 years (14 [2·3%] of 613 for COVID-19 vs 65 [0·9%] of 6973 for influenza), but mortality in the COVID-19 group was not higher than for influenza. Mortality was ten-times higher in children aged 11–17 years with COVID-19 than in patients in the same age group with influenza (5 [1·1%] of 458 vs 1 [0·1%] of 804). These findings are supported by a study of 4784 children and adolescents with COVID-19 from Brazil and a study of children and adolescents from Spain. Clearly, COVID-19 is not an innocent infection in children and adolescents.

          Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study
          The presentation of patients with COVID-19 and seasonal influenza requiring hospitalisation differs considerably. Severe acute respiratory syndrome coronavirus 2 is likely to have a higher potential for respiratory pathogenicity, leading to more respiratory complications and to higher mortality. In children, although the rate of hospitalisation for COVID-19 appears to be lower than for influenza, in-hospital mortality is higher; however, low patient numbers limit this finding. These findings highlight the importance of appropriate preventive measures for COVID-19, as well as the need for a specific vaccine and treatment.

        • Andre 2.2.1.2
          18 April 2021 at 3:31 pm

          There's been no shortage of people trialling other treatments for covid. The common pattern is a blaze of media publicity stoked by those that want to believe they have "the answer", applying motivated reasoning to over-hype weak results from poorly designed and conducted studies. Then more careful studies are conducted, and no benefits are found.

          Think hydroxychloroquine, ivermectin, vitamin D, remdesivir – the list is long. Here's a piece that looks in more detail at the case of ivermectin:

          https://sciencebasedmedicine.org/ivermectin-is-the-new-hydroxychloroquine/

          There have been a few successes in repurposing older cheap medicines to help covid patients. Dexamethasone is the standout, but there are others. Here's a summary of where things stand with some of the treatments (hardly a comprehensive list):

          https://www.medpagetoday.com/special-reports/exclusives/91680

          Bottom line is, there's been plenty of effort go into trying to find treatments, but there's not much publicity about those efforts, because by and large they don't fkn work. Dexamethasone excepted, but that's more about treating the immune system's over-reaction to the infection rather than treating the actual viral infection.

          Vaccines are getting the publicity now, because they actually do work. Astonishingly effectively, and astonishingly cheaply and astonishingly safely. Even at the extraordinarily high price of USD 20ish per dose for the Pfizer, that’s still a tiny fraction of the cost incurred by one covid infection.

    • Incognito 2.3
      17 April 2021 at 6:05 pm

      Incorrect. The P1 strain is the so-called Brazilian variant and is not the double mutant, which is B.1.167.

  3. RedBaronCV 3
    17 April 2021 at 6:34 pm

    Yeah for the sake of a few tourist operators and an industry that doesn't really add anything to GDP we are going to risk a decent out break. I'd be happy to pen the tourist's and the operators up in a few areas only

    • Graeme 3.1
      17 April 2021 at 8:41 pm

      The TT bubble isn't going to do very much for tourism, people don't want to travel unless it's for a real reason, like visiting family. Accomodation bookings into Queenstown haven't shown any increase due to the bubble, and airfares next week are the same as mid August. Aussies don't want to travel.

      The big winner out of the bubble is MIQ. Their workload has halved so they can deal with what's coming from outside the Australia / New Zealand bubble. Reality is that there is just as much chance of an outbreak originating in New Zealand as Australia.

  4. DukeEll 4
    18 April 2021 at 8:39 am

    Plenty of countries are managing to vaccinate their people rapidly and effectively.

    israel and Great Britain are two examples.

    Or is this article pre apologising for the failure of the ministry of health by laying out some convenient excuses?

    • lprent 4.1
      18 April 2021 at 10:39 am

      Or is this article pre apologising for the failure of the ministry of health by laying out some convenient excuses?

      Are you an illiterate who can't read news? Or just a simpleton who writes whatever pops from your primary thinking organ? Or just stupid (I suspect the last based o n your attempted rewrite of the facts)

      Israel and the UK had a completely different imperative to NZ. Both had widespread outbreaks when they started their vaccination campaigns. The entire point about my post was that the worst time to run a vaccination campaign when there were high numbers of new cases.

      The Israelis started their vaccination campaign at the end of December. At the same time a outbreak was going exponential, mostly within their ultra orthodox community who seemed to have the perfect transmission vectors. The number of new cases peaked on Jan 17, and they didn’t quell the outbreak until March

      The UK started their vaccination campaign on December 8th. With the recognition of the emergence of the B1.1.7 variant in late November, they realised that they were already in the midst of an very serious outbreak. That outbreak peaked in January 10.

      In Jan, Oh UK! or Oh Israel! would have been appropriate.

      The point about my post was that doing a vaccination campaign during an outbreak was the worst time to do it, it disrupts planning to do good coverage and requires desperation measures to do it. In all probability there will be downstream consequences to doing it in a desperate fashion. I’d prefer that to not happen here.

      Perhaps you could read what I write and think about it before responding rather than inventing stupid false stories. You sound pretty damn desperate yourself.

  5. Andre 5
    18 April 2021 at 3:09 pm

    So far in the US, the vaccines used appear to have an astonishingly high efficacy out in the field. By the numbers, over 75 million people have been fully vaccinated. Of those, there have been 5800 reported infections, ie instances where the vaccine was not fully effective in preventing illness. That's 0.007% of those that have been vaccinated have become ill in the weeks or months that have passed since getting their vaccine.

    By comparison, the daily new infection rate in the US is around 72,000 new cases per day (down from a peak of 251,000 per day in late January). That works out to 0.02% of the population getting infected every day.

    https://arstechnica.com/science/2021/04/99-992-of-fully-vaccinated-people-have-dodged-covid-cdc-data-shows/

    Note that most vaccinations in the US are either the Pfizer or Moderna mRNA vaccines, like we're getting here in NZ. Just a smallish proportion in the US have received the J&J/Janssen modified adenovirus vaccine.

    • lprent 5.1
      18 April 2021 at 9:55 pm

      What I'd going to be interesting is to see the efficacy of vaccines against new variants, and eventually at diminishing the creation of new variants due to infected populations diminishing the frequency of recombination.

  6. Bryan 6
    18 April 2021 at 5:38 pm

    The lurking potential catastrophe with COVID, as we see vividly in Canada is the swamping of the capacity of healthcare to cope with both COVID and the all of the other healthcare events. Elimination has given us a real opportunity to vaccinate and hugely decrease potential transmission and severe illness without having to manage ongoing and potentially exponential viral spread.

    I was thrilled to get my first dose of vaccine 11 days ago as our DHB vaccinates staff. With reportedly 90% of border staff moving through the course of vaccination and then the systematic and progressive rollout with group 4 due to get vaccinated from July we remain in a uniquely favourable position despite a diverse coterie of doom and gloom merchants..