Category Archives: COVID-19

COVID-19 | Omicron | Winter of Our Discontent

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Amidst rising COVID-19 cases — mostly the less virulent, but 3 to 5 times more transmissible Omicron variant — with reimposed restrictions by public health authorities, more stringent mask mandates, a speeded up mRNA booster programme (at least in some Canadian jurisdictions, if not in British Columbia), more testing, renewed travel advisories, the closure of bars and gyms, and the likely prospect of increased infections and restrictions in the days to come and over the next couple of weeks, Christmas 2021 is quite not what most people had hoped it might be.

A couple of weeks back, on the day federal Finance Minister Chrystia Freeland presented her budget update, Politico Canada’s Nick Taylor-Vaisey reported that while interviewing senior government officials in lock up, the Deputy Ministers of Health and Finance, as well as representatives from the Prime Minister’s office, told the gathered journalists that the federal government doesn’t foresee Canada “getting a handle on” COVID-19 until the summer of 2023, at the earliest.

Although the likelihood is great that late spring and early summer 2022 will see a reduction in the number of COVID-19 infections — as was the case in the summers of 2020 and 2021 — next autumn and winter, including the holiday season in 2022, will in all likelihood mirror what we’ve all experienced over the course of the past almost 22 months. Sad and disappointing news, but our new collective reality.

British Columbia’s Public Health Officer, Dr. Bonnie Henry, told British Columbians last Tuesday that all British Columbians will likely become infected with the Omicron variant, clarifying her statement this past Friday, saying that, “All British Columbians will come into contact with Omicron in January.”

Jens von Bergmann, data scientist with British Columbia’s COVID-19 Modelling Group

For the moment, Dr. Henry is choosing to ignore the advice of the B.C. COVID-19 Modelling Group. In an article published in the Vancouver Sun last week, the member scientists in the modelling group told reporter Lisa Cordasco that …

“An Omicron tidal wave is coming, hospitals will be overwhelmed — although 20 to 40 per cent fewer people will end up in hospital, as Omicron cases skyrocket our health care system will be challenged,” said Jens von Bergmann, a data scientist and a member of the modelling group, who went on to say that “although most people who are vaccinated will suffer only mild symptoms from the Omicron variant, the sheer number of people becoming infected across British Columbia will mean that many of our fellow citizens will suffer severe illness and death.”

“It is not clear to me that we have done enough and I think there is a very good chance that it is not (enough),” said von Bergmann. “If we have large indoor gatherings, these are opportunities for super spreader events. That certainly includes large sporting events like Canucks games, or going to restaurants to dine.”

The member scientists in British Columbia’s COVID-19 modelling group said they believe the only way to prevent super spreader events is, at a minimum, by shutting down all restaurants and indoor public events for three weeks.

On Tuesday December 21st, Dr. Henry ordered all bars, nightclubs, gyms, fitness centres, yoga and dance studios to close, and limited sports venues to 50% capacity until Tuesday, January 18th.

The members of B.C.’s COVID-19 modelling group have stated emphatically that the actions of British Columbia’s Public Health Office, and B.C.’s Ministry of Health taken to date are far from adequate to meet the challenge of the fast spreading Omicron variant. This past Friday, Health Minister Adrian Dix told reporters at the hastily-called 10 a.m. press conference that this coming Wednesday, December 29th, he and Dr. Henry will hold another press conference that could very well include more restrictions.

As is the case with many people, VanRamblings has chosen to stay close to home for the next month, going out only to shop for groceries, when we wear our Health Canada-recommended three-layer mask with a polypropylene melt blown 5 layer pm2.5 Activated Carbon filter, placing a new filter in the mask each week.

Where we’d planned to spend much of the holiday season sequestered in one darkenend cinema or another, due to the spread of the Omicron variant, we have opted for safety over indulgence, and instead have chosen to spend our evenings in front of the luxurious 4K screen in our home theatre system, taking in all of the soon-to-be Oscar nominated films available on streaming platforms such as Netflix, Amazon Prime of Apple TV, or setting about to watch Oscar nominatable films available On Demand through our service provider.

Safe, rather than sorry.

The salutary aspects of the Omicron variant: it burns bright, but just as is the case with a shooting star, it begins to burn itself out — in the case of Omicron, within a month, and six weeks in settles down, with case counts plummeting.

Far fewer of those who contract the Omicron variant will be hospitalized, or die. If one is wise and does not place themselves in harm’s way by going out to restaurants, or attending large sporting or other events inside, the prospects are good that you’ll survive Omicron, and go on to thrive, and live another day.

This afternoon, after 3pm, when the province releases its 3-day totals for Friday to Saturday, Saturday to Sunday and Sunday to Monday, if the three-day infection total tops 10,000 — in spite of the fact testing capacity is topped out, and all those who’ve contracted the Omicron variant can’t possibly be reflected in the COVID-19 infection numbers that will be released this afternoon, as a variant on what Dr.  Henry told British Columbians last week, “We’ll be in a whole new ballgame.”

If infections rates are indeed climbing, come Wednesday British Columbians can reasonably expect to find a new and varied set of restrictions imposed, up to and including, in the worst case scenario, a circuit-breaker lockdown.

Note Belgian virologist, Dr. Guido Vanham (right) and his son, Peter

Today, we’ll leave you with a hopeful note, a letter sent by Dr. Guido Vanham, a Belgian virologist, to his family on how best to protect themselves — and by extension, us — from the Omicron variant. You may read the entire letter by clicking on the link available at the top of this paragraph.

In part, here’s how the letter reads …

Dear grandchildren,

Your mom and I are so very much looking forward to celebrating the holidays with you — and especially with the newest member of our family! We’re so glad you’re all safe and that Valeria had a good pregnancy and got herself protected by taking a vaccine (and soon a booster) early.

Sadly, the Omicron “variant” of the COVID-19 virus is spreading all over the world now. And I know that you’re wondering: What should we expect? Is this going to be the first wave all over again or will we be better off?

My assessment is: This may be the most contagious variant yet, with a possible tsunami of infections and sadly little effect of the vaccines on that front. We therefore are better safe than sorry and should do everything we can to protect ourselves and those around us.

Here’s what I think you should know:

First, this Omicron “variant” is a new form of the COVID-19 virus, which causes a new wave of infections because it’s somehow more potent than the previous variant. Omicron is both more contagious than previous variants (Alpha, Beta, Gamma, Delta) and also escapes from the “immunity” the antibodies induced from the previous variants.

Omicron remains sensitive to the vaccine, but less than Delta. That’s why you need a third dose of the vaccine to help protect you from serious illness and hospitalization.

Unfortunately, even three doses don’t protect against the infection itself. If you’ve been vaccinated three times and still become infected, you’ll often hardly notice it: You may have a “common cold,” a sore throat, and sometimes a fever. So I know you’re all lining up for your boosters and you’re doing the right thing.

This pandemic will pass, just like the Spanish Flu a hundred years ago, but no one can predict when. I hope with all of you that this is our last COVID-19 winter, but I’m only a doctor and a scientist — and a father and grandfather — not a prophet …

Take care, and let’s hope we can still get together for the holidays, albeit extremely carefully,

Dad

You may click here to read Dr. Vanham’s letter to his son in its entirety.

COVID-19 | British Columbia Has Entered the Endemic Phase

BC Politics, COVID-19, Food & Health, Vancouver, , , , ,

Over the past weekend, VanRamblings had the opportunity to speak with a senior member of British Columbia’s public health pandemic response team, and the information with which we were provided was hopeful for B.C.’s near term future.

“British Columbia has entered the endemic phase of what we’ve all come to know as the pandemic this past 19 months, in fact, some while ago,” our unnamed source, unauthorized to speak on behalf of the office of British Columbia’s Public Health Office, told VanRamblings. “We’re not far off from removing mask mandates in those areas of the province where the full vaccination rate exceeds 90%, as is the case in Vancouver city proper, where the rate of fully vaccinated persons is currently 95% plus. Other regions of the province — Fraser Valley East, the Interior and Northern Health — have a ways to go before mask mandates, and other restrictions are removed by British Columbia’s public health office.”

VanRamblings asked the individual with whom we spoke about the current high COVID-19 infection rates we’re experiencing in British Columbia — most recently, the 3rd highest in Canada — and how this phenomenon might be accounted for …

“In British Columbia, we’re experiencing a series of super spreader events brought on by the unvaccinated members of regional communities, mostly situated in the three regions of the province where vaccination rates are low. Fully 98% of all COVID-19 hospitalizations and admissions to hospital ICU’s has occurred either within the unvaccinated community, or resultant from vulnerable vaccinated persons coming into contact with unvaccinated persons,” avers our public health source.

VanRamblings was told that in all likelihood British Columbians will be out of the worst of COVID-19 — even given the current and deadly virulence of the Delta variant — by early spring 2022, when life will return to some sense of “normal”, as we’ve all been observing now with capacity restrictions being lifted at Vancouver Canucks home games, within movie theatre complexes, and even at concerts.

When we asked our source about the 327 doctors, nurses and other health care professionals in British Columbia who have yet to get their first mRNA vaccine dose, our source simply rolled their eyes, muttering …

“As a health care professional, you are a scientist. Why you wouldn’t acknowledge the science on vaccines is beyond me? To say the least, that unfortunate development is disappointing, for those of us in the profession, and for all British Columbians.”

Or, as British Columbia Public Health Officer Dr. Bonnie Henry stated on Monday …

On balance, it is probable that the comfort level for most of us in the general public will not be alleviated until infection, hospitalization and ICU rates are observed as being significantly reduced, with COVID-19 death rates all but eliminated on most reporting days, and the rate of death from COVID-19 in B.C. minimal at worst.

COVID-19 | The Path | Outbreak, Epidemic, Pandemic, and Endemic

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Not all infectious disease terms are created equal, though often they’re mistakenly used interchangeably.

The distinction between the words “pandemic,” “epidemic,” and “endemic” is often blurred, even by doctors. This is because the definition of each term is fluid and changes as diseases become more or less prevalent over time.

The word “endemic” is regularly mentioned, especially among public health leaders and experts as they discuss potential future scenarios. So, it’s important to define exactly what it would mean for COVID to be endemic.

Scientists predict COVID will become endemic over time but there will still be sporadic outbreaks where it gets out of control. The transition from pandemic to endemic will play out differently in different locations around the world.

While conversational use of these words might not require precise definitions, knowing the difference is important to help all of us better understand public health news and appropriate public health responses.

First let’s recap the public health terms Canadians have been increasingly using in conversation over the last 19 months. These words cover the lifecycle of disease and include “outbreak”, “epidemic”, “pandemic” and “endemic”.

An outbreak is a rise in disease cases over what is normally expected in a small and specific location generally over a short period of time, as occurred in Wuhan, China in late 2019 and early 2020. Food borne diseases caused by Salmonella contamination provides another example of the outbreak phenomena.

Epidemics are outbreaks without tight geographical restrictions. The Ebola virus that spread in 3 West African countries from 2014–2016 was an epidemic.

A pandemic is an epidemic that spreads across many countries & continents around the world, as has been the case with COVID-19 over the course of the past 19 months. Past pandemic examples include those caused by influenza A(H1N1) or the “Spanish Flu” in 1918, HIV/AIDS, SARS-CoV-1 and the Zika virus.

What’s the usual path from pandemic to endemic?

A simple way to understand the difference between an epidemic and a pandemic is to remember the “P” in pandemic, which means a pandemic has a passport. A pandemic is an epidemic that travels.

But what’s the difference between epidemic and endemic?

An epidemic is actively spreading; new cases of the disease far exceed what is expected. More broadly, it’s used to describe any problem that’s out of control, such as “the opioid epidemic.”

An epidemic is localized to a region, but the number of those infected is significantly higher than normal. For example, when COVID-19 was limited to Wuhan, China, it was an epidemic. The geographical spread turned it into a pandemic.

Endemics, on the other hand, are a constant presence in a specific location. Malaria is endemic to parts of Africa. Ice is endemic to Antarctica.

Over time and arising from public health orders from mask wearing to vaccination, the pandemic could disappear like small pox and polio did — or it might gradually become endemic. The latter, most scientists agree, is the more likely scenario. Host, environment and virus factors combine to explain why some viruses are endemic while others are epidemic.

When we look at the SARS-CoV-2 virus that causes COVID, we see it is infecting human hosts with no prior immunity.

In terms of environment, the virus transmits better in cold, dry, crowded, close-contact, confined settings with poor ventilation. Each virus has its own characteristics, from speed of virus replication to drug resistance. The new COVID strains are transmitted faster and cause different symptoms.

Viruses are more likely to become endemic if they become adapted to a local environment and/or have a continuous supply of susceptible hosts. For COVID these would be hosts with low or zero immunity.

How long will it take for COVID-19 to become an endemic?

Most public health officials currently agree COVID is here to stay rather than likely to disappear like small pox. Scientific mathematical modelling provides some idea of likely COVID epidemic outcomes.

Globally, the road from pandemic to endemic will be a rocky one.

https://twitter.com/EDenhoff/status/1448531678561931269?s=20

In Canada, the federal government and provincial Premiers some time ago announced plans to re-open businesses, and soon that will be the case with borders, as well. The process of having done this has worked out better in some provinces than others. In the prairie provinces of Alberta and Saskatchewan, the fourth wave of COVID has taken a particularly strong foothold — resulting in a virulent and devastating epidemic renewal of COVID.

People are dying, and our health care system has been challenged.

Vaccination rates will protect many — as will the vaccine passports that have been issued in all provinces across the country — but there are still those who won’t get vaccinated, which puts all of us at much greater risk.

With time, though, scientists predict COVID will become more like the common cold coronaviruses. Despite periodic spikes in caseloads each season or immediately after relaxation of economic, social, and travel restrictions, COVID will eventually become more manageable, and by next spring we could very well be out of the worst of COVID-19, and the worst impacts of the Delta variant.

Countries will not enter an endemic phase at the same time because of variable host, environmental, virus factors including vaccination rates. Because of Canada’s high vaccination rate, our country is much more likely to proceed to the endemic stage than our neighbours to the south.

The availability and roll-out of booster vaccine shots each year or season will also shape the path towards the transition to an endemic. Poor vaccine coverage could allow the virus to continue at an epidemic level for longer — as would appear to be the case in the northern health, Fraser Valley East and Interior / Okanagan and Kootenay regions of our province.

Once we see a stable level of SARS-CoV-2 transmission indicating a new “baseline” of COVID, we will know the pandemic has ended and the virus is endemic. This will include seasonal trends as we see now with flu, and next autumn a dual flu and COVID shot, currently being developed by Pfizer and NovaVax.

The most important thing all of us can do to help reach a safe level of endemic COVID is to ensure that our families and each of us gets vaccinated and that we continue to adhere to COVID-safe practices, like social distancing, mask wearing and staying home when we’re not feeling well.

By doing so we protect ourselves, our families, all those around us, as together we move collectively towards an endemic phase of the COVID-19 virus that has had us in its grip since March 2020.

If we fail to work together in common cause, things could turn for the worse very quickly and prolong the end of the pandemic — which none of us want.