Invermere & District Hospital Chief talks about COVID-19 variants and addresses community questions
Submitted by Dr. Gareth Mannheimer
Chief of Staff for the Invermere & District Hospital
Dr. Gareth Mannheimer, Chief of Staff for the Invermere & District Hospital, and a family physician, provides an update on new cases in the Columbia Valley, the spread of COVID-19 variants and answers questions on vaccination.
Hello everyone, it’s been a while since my last update. I know many of us are finding it harder to deal with the fear of contracting this virus, the impacts of social distancing and isolation and constantly changing health orders. It’s a kind of malaise that comes with wondering if it’s been worth the sacrifice, while wishing we were back enjoying normal activities.
Vaccination rollout has been slow. We have suffered numerous challenges ranging from unreliable supply chains, clunky booking systems and message inconsistency around some of the vaccines. There are teams of people working very hard to overcome these obstacles. New COVID-19 variants are currently outpacing vaccination rates as the third wave shows no signs of slowing down. Over the past few weeks, this has unfortunately and noticeably impacted our community.
Thinking back to over a year ago, we had a lot to feel proud about. We did a great job of following health guidelines, putting others ahead of ourselves and keeping this little piece of heaven we call home – safe. But, I suppose i nescapably, this has changed and not for the better. The recent classification of the Columbia Valley by the Centers for Disease Control and Prevention (CDC) to a red zone speaks to many of us loosening up our guard on prevention guidelines. This is an important concept because our infection numbers are not a consequence of any one particular outbreak. COVID-19 is being spread through the region from multiple sources – and, some of these are local. Currently, there are 46 active cases in our region and climbing. Our local and regional facilities are strained. Access to higher levels of care is logistically difficult. This puts us in a precarious position. Vaccinations are starting to pick up as supply becomes available and reliable, and booking systems are improving with the new online portal www.getvaccinated.gov.bc.ca. But, we are nowhere near where we need to be to combat the possible impacts of COVID-19 and its variants.
What do we need to do to address COVID-19 variants to stay safe?
Right now, there are three COVID-19 variants of concern in Canada. The first variant of B.1.1.7 was identified in the United Kingdom. The second variant of the B.1.351 strain was detected in South Africa and the third P.1 variant is from Brazil. For context, as of April 8, 2021, there were more than 15,000 confirmed cases of variants in Canada, up from 9,000 on March 30. About three weeks ago, cases of the P.1 variant in Canada were far outnumbered by the 14,790 cases of the B.1.1.7 variant first identified in the U.K. But now, the P.1 variant is charging ahead quickly, particularly in B.C.
The reason I’m concerned about these variants is because they tend to be far more easily transmissible during the same time when many people are softening their prevention techniques. There is little doubt this is why our numbers have climbed fast over the past few weeks. These variants also appear to impact younger, healthier people including children, more than the original COVID-19 virus did. Again, there is no question, this is what we are seeing locally. While we don’t know which variant is currently in the Valley, I can confirm we know there is a variant here and we are testing to determine which one.
What we do know is to keep safe and minimize our chance of contracting the virus, we should continue to follow all provincial orders, restrictions, health guidelines and use all the layers of protection we have been using over the last year- without exception. This means social distancing, wearing a mask, washing our hands and making the right choices to heed this advice and do our part to keep each other safe as a collective. If you aren’t feeling well, please don’t go to work or school until you have been tested. Isolate until those results are available. This takes 1-2 days. I do worry about our physical and mental health and I recognize our need to support and nurture one another which includes visiting with our closer community. This is still encouraged, but it must happen safely. Please follow the provincial guidelines recommending this happen outdoors, with limited numbers (which includes the children), standing apart and using the recommended layers of protection.
If you feel you are experiencing anxiety, depression or other mental health challenges, please reach out to us. There are great resources for virtual mental health support during COVID-19 on the gov.bc.ca website. We also have numerous resources for the youth and young adults in our community. These services are available through our community clinics and our teams are keen and willing to share them.
I encourage you to get vaccinated. Vaccination has tragically become an emotionally and politically charged issue, rather than a medical one and conversations about it tend to be confrontational, rather than engaging and collegial. I enjoy the opportunity to share information and ideas, but when these start from a position of pre-determined concrete falsehoods, there tend to be lots of talking, some hearing and no listening. The Canadian data we are seeing shows good protection against severe disease, hospitalization and mortality in the vaccinated groups, including for some of the new variants. There are three steps to getting vaccinated. Register when it’s your turn. Book an appointment. Get the vaccine. With the recent outbreaks, we are actively engaged in advocacy with the B.C. provincial government to accelerate vaccination, given our climb in new cases. We want to be able to offer anyone over the age of 18 the opportunity to access the vaccine if they would like it. This is a complex process and I hope we will be successful in our discussions.
What about COVID-19 vaccines? Are they safe and effective?
So, let’s address the science. The COVID-19 vaccine is an important and effective step in combating the pandemic to keep us safe personally and collectively. The COVID-19 vaccines approved in Canada, requiring one or two doses provide excellent protection against the COVID-19 virus, preventing up to 95 per cent of infections and serious illness. Every vaccine approved in Canada has undergone rigorous and extensive testing. Contrary to expectations, science has accomplished the unthinkable and has delivered several vaccines. This is also due to rapid advances in research and vaccine development. No steps have been skipped, particularly in the clinical trial stages. Massive funding, worldwide collaboration of scientists, advances in technology with a responsive industry has enabled vaccines to be developed more quickly. But, maximizing the benefit from vaccination requires numbers in order to be effective in preventing disease in a population. This means the more people who are vaccinated, the harder it is for the disease to spread. Some approved vaccines have two doses. If you receive a two-dose vaccine, make sure you follow up with the second dose, so it’s effective for the long term. I recognize there is conflict here around dosing schedules. We expect booster doses will be made available to improve outcomes and vaccine effectiveness over the longer term. Please get vaccinated!
Why should you get a vaccine? How does this protect me?
Ultimately, it’s a personal choice. I got mine. At its core, the reason for you to get a vaccine is simple. Vaccines help our bodies to develop immunity to the virus without us having to suffer the illness. This allows us to protect ourselves, our families and, if enough people get it, potentially entire communities. Different vaccines work in different ways to offer this protection, but with all types of vaccines, the body is left with a supply of “memory” T-lymphocytes as well B-lymphocytes, which are special cells that will remember how to fight the virus in the future.
Every adult over the age of 18 should get a vaccine. The vaccines approved so far in Canada have not been tested on children, although clinical trials are underway for those under 18. Once we understand the scientific evidence for populations under 18, the recommendations for vaccination will likely change.
It is recommended the following people consult their doctor to discuss risks and benefits of vaccination. Do not hesitate to reach out to us for questions if you fall into this category: Have a weakened immune system due to medical treatment or disease; Have an autoimmune condition or disease; Are pregnant or planning to become pregnant; Are breastfeeding; Have had a severe allergic reaction to the first dose of the vaccine or any of the ingredients in any of the approved vaccines.
When will I get a vaccine? Why is it taking so long?
I know everyone is trying to being patient. It’s frustrating to know a vaccine is out there for you, but it’s not accessible right now, particularly because of our recent infection rates. Currently in Canada, we don’t have pharmaceutical production capable and sophisticated enough to produce our own vaccine. So, we are buying it. This puts us in a queue with other countries eager to get their vaccine. And so, there are bumps in the road. Vaccine delivery is a complex undertaking. Limited supplies, vaccine storage requirements at sub-zero temperatures and two dose regimens place a massive amount of complexity into the supply chain and the delivery system. We also have to find appropriate staff to administer the vaccines in facilities that do not put anyone who may have an asymptomatic infection at risk.
The priority system chosen by our public health experts in B.C. is to protect the most vulnerable first. In the Columbia Valley, we have vaccinated approximately 1,600 people so far. The rationale is the older a person is, the greater the risk for severe illness, hospitalization or death. Older people also have more chronic health conditions, which increases their risk further. This is why B.C. has implemented a phased approach.
We are in Phase 3. The schedule is as follows and will change depending on vaccine availability and supply. Many more details are available on the BCCDC website at: http://covid-19.bccdc.ca/. I encourage you to keep watching to know when it’s your turn. Information will be widely shared and updated, so it is timely when it comes for the public to register for vaccines.
Phase 2: February – April: Priority populations not vaccinated in Phase 1; Community based seniors 80 years old; Indigenous seniors at least 65 years old; People 69-16 who are considered clinically extremely vulnerable.
Phase 3: April – May: April 14 – 1971 or earlier; April 16 – 1976 or earlier; April 19 – 1981 or earlier; Front-line priority workers.
Phase 4: May – June: Remaining age groups 18 and over in five year increments.
For anyone in previous phases that opted not to get the vaccine, but has changed their minds, they still have the option at any time.
Why are vaccines prioritized for some and not for others? Is the system fair?
People aged 16-74 who are clinically extremely vulnerable will receive a patient invitation letter to be vaccinated. Expert physicians and providers in cancer care, kidney diseases and other immunocompromised conditions have been working with public health and international COVID-19 data to define this list. The work included clinically relevant research by pediatricians for youth aged 16 to 19 and was supported by an ethics expert to ensure the list was fair and equitable.
Please review this list and determine if you are eligible for an earlier vaccine: Solid organ transplant recipients; People with specific cancers including of the blood or bone marrow such as leukemia, lymphoma, myeloma who are at any stage of treatment; People with cancer undergoing chemotherapy; People with lung cancer who are undergoing radical radiotherapy; People having immunotherapy or other continuing antibody treatments for cancer; People having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors; People who have had bone marrow or stem-cell transplants in the last six months or who are taking immunosuppression drugs; People with severe respiratory conditions, including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease; People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency, homozygous sickle cell disease); People on immunosuppression therapies sufficient to significantly increase risk of infection (biologic modifiers, high-dose steroids, AZT, cyclophosphamide); People who had a splenectomy (spleen removed); Adults with very significant development disabilities that increase risk (details to come from the health ministry); Adults on dialysis or with chronic kidney disease (Stage 5); Women who are pregnant with significant heart disease, congenital or acquired; Significant neuromuscular conditions requiring respiratory support.
If you feel you have a condition not on this list that warrants access to an earlier vaccine, please contact your physician or one of our clinics to review this with your clinician. We have the knowledge and insight to motivate you for vaccination. We want to help you.
Over the past year, I have received a considerable amount of correspondence from the community at large. I apologize for not being able to address these individually, but to be honest, I have simply not had the time nor capacity. Having read and considered each one, please know I have contemplated every word. Here are a few common recurring questions and quick answers to them.
Q: Are our local cases because of an influx of out of community travellers including out of province and international visitors?
A: This is hard to answer. We are doing a good job of contact tracing. Certainly, while some cases do originate from out of town, it’s hard to know if those are from out of towners travelling here or us travelling out of town and bringing it back. As with everything in life, both scenarios are probably true. Certainly, the community spread that we are seeing can only come about as a consequence of relaxing our prevention vigilance.
Q: I heard the COVID-19 vaccine causes more deaths than the COVID-19 virus and is this true?
A: No, it doesn’t, that is ridiculous.
Q: I have heard or read the vaccine causes a COVID-19 infection?
A: No, it doesn’t. It typically takes a few weeks after vaccination for the body to produce immunity. Therefore, it’s possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and then get sick because the vaccine did not have enough time to produce protection. Sometimes, after vaccination, the process of building immunity can cause symptoms such as fever, pain or fatigue. These are normal symptoms and a sign the body is building immunity, not that it’s being infected.
Q: Why would you get the vaccine if it doesn’t protect you or others from contracting the virus?
A: There is robust data to support the argument the current vaccines protect those getting vaccinated and those around them. I think this question keeps coming up because there is still a small possibility of spreading the virus if you are vaccinated, but it’s considerably less than if you were not vaccinated.
Q: If I had the virus why do I need a vaccine?
A: There are many cases of people who have contracted the virus more than once. We don’t know how long the innate immunity from contracting the virus offers. Also, getting vaccinated not only protects you, but also those around you, so it’s more widely beneficial. The data we have on the vaccinated population is very encouraging. While it may not seem palatable to many, it’s the best option available to help us protect our vulnerable neighbours and to ensure our healthcare system functions for those that need it for other reasons.
Q: All this masking isn’t making a difference and why should I wear one?
A: Negative. Categorically untrue. There is no doubt that face masks when used appropriately combined with other preventative measures slow the spread of the virus.
In conclusion, I know you are weary of making sacrifices, enduring restrictions and waiting your turn for a vaccine. The recent community surge of infections has added fear and anxiety to our already blistered psyche. We continue to work hard to understand new developments, protect and treat our community and motivate many to expand our vaccination program. Access to reliable numbers is harder than it sounds, and while I know we could do better, we do try to provide transparency about new cases and risks.
Essentially though, the ultimate burden of preventing the spread of this infection around our community still lies with each and every member within it. The infections may possibly come from far and wide, but they are still spread among us because of us.
