Covid 19 Vaccine update.Dec2020

      We have been fielding a lot of inquiries about covid vaccine and vaccination.  Concepts surrounding it are often misunderstood and misrepresented.  The Pfizzer product selected in Canada is a new technology which has been rushed to market for numerous reasons.  This will be our first experience with this technology.  It essentially takes a small particle of messenger RNA which codes for the Coronavirus spike protein, and presents it to our cells,  which in turn  trigger a lasting immune response to be produced.  It is extremely fragile, and gets destroyed easily, so researchers put it into a fatty nano bubble to allow entry into our cells.  This is also why it has to stay frozen at -70C until ready to use. The minute it comes out of the freezer, assuming anyone has one these very expensive things, and gets fluid added for injection, it starts to fall apart and becomes denatured and non effective within 6 hours.  Doctors offices and even our health departments dont have these special freezers.   A second injection is also needed 3-4 weeks later to boost any response.  The rush to market did not include children so that data is absent.  There is no advantage or role for costly testing  before any injections. It just adds to our financial disaster.  Previous infection does not seem to matter either.  Other  vaccines with different ways of approaching the problem are about to emerg as well.  

   One worrisome concept is that politicians, some doctors and most news media mistake the concept of efficay with effectiveness.  They are far from being the same.  There is no basis in the claim that it is 97 % effective.  You need to understand some of the science behind it.  In developing a covid vaccine, any given company will run a  "clinical trial".  The details of the Pfizzer trial are not released until an application for liscencing occurrs.  That process involves a group of scientists looking at and tearing the data apart.  So how does testing occurr?  You basically find one or more groups of people around the globe, choose 30,000 candidates and give half your test vaccine and placebo to the rest. In an ideal situation, you would expose everyone to covid, but that is unethical.  Instead, you then wait and test for natural  infection to occurr.  In the Pfizzer trial, less than 1% of volunteers eventually tested positive.  So these 200 people become your study group. Immense work for small numbers.  It turns out both vaccine and placebo groups developed covid infections, but much less so in the vaccinated group.  You then apply statistical magic and come up with an "efficacy" value, which reflects the results in that group.  How similar are your vaccine and placebo groups is always a burning question.  This is vastly simplified and things are much different in the real world.   Based on these findings, it was determined that there is benefit to the 1st generation of liscened vaccine.  It is a bit of a stretch to claim it will fully protect anyone or cure the pandemic.  The notion of issuing cards to vaccinated people and somehow implying that they are free of any worry, is rather misguided in my view.    Longer term side effects will emerge and require evalution.  Because vaccine manufacturers take large financial risks and hope to attain enormous financial gains. there are other pressures at stake.  Pfizzer and others started large scale production before final studies were completed, so that they could have the millions of doses available for sale upon successful liscencing.  Its a business strategy.  Countries which first approve use, get to buy it sooner and receive delivery.  As with other vaccines, refinements will be made and newer vaccines will probably emerg.  There is a great deal of speculation of how to get this product successfully into arms of masses.  I too await a practical solution.  So stay tuned as the first sleeve roll up begin somewhere. It will take over a year or more to determine if this strategy was highly effective or marginally so. Historicly, mankind seems predisposed to often claim credit for mother natures work.  If it is like the influenza data, it will be a maze of numbers with inferences and exceptions.  Lets try to stay positive!  

Dec 2020 Lockdown. 

    It looks like the star of this years FLU SEASON   goes to coronavirus.   For the last 25 years, this is the time of year that our local hospitals would call a "code gridlock".  All beds would be occupied and hallways jammed with make shift stretchers to accomodate the annual influx of sick souls.  According to last weeks update there were about 19 influenza cases of various types spotted across the nation with about 8000 patients tested.  That compares to thousands of cases this time last year.   FLU SEASON refers to a constellation of respiratory illness with similar symptoms,  and predominately viruses  on which antibiotics don't make a difference.  Most of our influenza viruses traditionally originate in the Asian sub continent and China.   Probably because most of the planets human population is concentrated there, and statistically more mutations can occurr in larger populations.  Predictions about Australia being the source have not materialized. Regular flushots are still available.  

    Please observe common sense rules of hygiene.  We have been in this for almost a year, and the term pandemic will soon have to undergo refinement.  It is safe to estimate that the number of Canadians that have had a successfull encounter with this virus numbers in the millions, similar to what  a bad flu season has done numerous times in the past.  There is no good means to identify this group, so the default is that we assume almost everyone is susceptible.  Ideally, the symbiotic relationship between humans and respiratory viruses  leaves a great deal to yet be learned.  Most encounters are mild, and the viruses technically don't invade the body, but travel down the airways to the lung surfaces. There is exchange of genetic material which is intriguing.  Most symptoms that we feel are the result of our own immune system responding.  We can spend  an entire year discussing the minute and rare exceptions and have been doing just that, and have changed our lives permanently along the way.   We will not eradicate this.  It will most likely subside in the same manner that all respiratory viruses have in the past.  

    Our anxiety, depression and ongoing health conditions have taken a beating during this time.  Please respect the lockdown.  Our directives mandate that we provide urgent care using virtual and electronic means, and in person as a last resort.  Living outside the lockdown areas does not make one immune to the directives.   Last week in Peel alone,  five large Shoppers Drug Marts  were identified as hot spots of spread.    The color coded scheme is confusing to everyone including us.  It seems like every household has at least one essential worker, a situation that requires common sense to address.  The lockdown efforts are simply aimed to try and not cause a grid lock in hospitals, and protect the frail elderly.    If you are worried about getting infection, avoid places with sick people.   The good solid data is difficult to find.  But it seems that children and young people are much less affected and serious infections are rare.  Influenza exerts a greater toll in this group. 

   During this time, try to enjoy the spirit of the season.   We know that excercise is crucial to help our systems cope with illness, even a brisk walk helps.  A healthy diet, avoiding sugar containing foods,  Vitamin  C and Vitamin D  supplements in recommended doses are helpful.   Finally, if you go for a test and the result is positive, don't panic.  Leave us a message and we will get through it together.  There exists a great deal of grief and suffering in our world that we now sadly ignore if we can't link it to the latest virus.  Ensure you have a Merry Christmas!

2020 Flushots. Recalls & Covid Update. Nov 18,2020.  Seasonal flushot vaccine still available during special clinic. High Dose are depleted and province is not purchasing any more.  However, most people do fine with the regular shot, since it contains one extra strain.

THE CURRENT RECALL of FLULAVAL tetra Lot #KX9F7, and Lot#J442P does NOT involve ANYONE WHO RECEIVED VACCINE IN OUR CLINIC. Rest assurred.

Please call the office and book yourself and your immediate social bubble (up to 5 people) at one time.  Family members will be eligible to also recieve a shot, but need to produce a valid ontario health card.   Vaccine is fully funded by the province.   You will need to arrive at the building at least  5 min before your time.  If you come early, please wait in your car.   If you come late,  DO NOT come into the office with other social bubbles. call and get a new time.

Please wear a mask,  follow the directional arrows in the clinic and return to your vehicle afterwards.  We recommend you wait in your car 10-20 minutes to ensure no allergic reactions emerg. 

 We will have 2 different types available. Several different manufacturers are involved in the product and produce similar but slightly different products.   The strains contained in the vaccine  are A(H1N1)  and A(H3N2)  along with 2 B strains.   Influenza A produces more serious disease.  As always, it is largely a guess with a dash of hopefull science thrown in that predict which strains are manufactured, so that how effective  this years shot will be remains to be seen.  We recommend that if you are over 65, or are afflicted with numerous medicals conditions,  smoke or have lung problems, then please get a free shot.  There is no charge.   Those over 65 will recieve high dose flushots. 

IF YOU RECIEVED A FLUSHOT IN OUR CLINIC BETWEEN OCT 9-31, 2020.

THIS IS WHICH PRODUCT WAS PROVIDED FOR YOU:

FluLaval TETRA 2020-2021 (GSK) lot 20620214069576  exp 2021 Jun,  3YP93 ,   0.5 ml was injected intramuscularly

 for those whose are elderly and with immunocompromised systems received.

FLUZONE -HIGH DOSE trivalent split virion.  (Sanofi-Pasteur) 2020-2021  lot UJ449AB  exp 28 Mar 2021.

 As many know I have a Ph.D. in medical science and come from a research background. I have been following the progress of the virus closely. I am partly ashamed of how it has been handled in the scientific community and media.  Censorship, sensationalization, overt threats make for very poor science. I believe as a medical community, I hold a responsibility to put things in context in relationship to your entire health, future and other factors, whether economic or impacting the entire world.  One of the most balanced and refreshing sources, that I have been referring to can now be found on youtube.  It is long, but can be watched in sections.  Please consider watching as it may shed some sensible light on the state of the world as a whole.    LINK:      

https://youtu.be/T_COvdCujaA

1.  We may have to live with C19 for months or years.  Let's not deny it or panic.  Let's not make our lives useless.  Let's learn to live with this fact. 

2.  You can't destroy C19 viruses that have  penetrated cell walls, by drinking gallons of hot water -  you'll just go to the bathroom more often. 

3.  Washing hands and maintaining a two-metre physical distance is the best method for your protection.  

4.  If you dont have a C19 patient at home, there's no need to disinfect the surfaces at your home.  

5.  Packaged cargo, gas pumps, shopping carts and ATMs do not cause infection.  If you wash your hands, live your life as usual.

6.  C19 is not a food infection.  It is associated with drops of infection like the flu.  There is no demonstrated risk that C19 is transmitted by food.  

7.  You can lose your sense of smell with a lot of allergies and viral infections.  This is only a non-specific symptom of C19.

8.  Once at home, you don't need to change your clothes urgently and go shower!  Purity is a virtue, Paranoia is not!

9.  The C19 virus doesn't hang in the air for long.  This is a respiratory droplet infection that requires close contact.

10. The air is clean, you can walk through the gardens and through parks (just keeping your physical protection distance).

11.  It is sufficient to use normal soap against C19, not antibacterial soap.  This is a virus, not a bacteria.

12.  You don't have to worry about your food orders.  But you can heat it all up in the microwave, if you wish.  

13.  The chances of bringing C19 home with your shoes is like being struck by lightning twice in a day.  I've been working against viruses for 20 years, drop infections don't                 spread like that!

14.  You can't be protected from the virus by taking vinegar, sugarcane juice and ginger!  These are for immunity, not a cure!

15.  Wearing a mask for long periods can interfere with breathing and oxygen levels in some people.  Wear it only in crowds. 

16.  Wearing gloves continuously is also a bad idea; the virus can accumulate into the glove and be easily transmitted if you touch your face.

17.  Better just to wash your hands regularly.  Immunity is greatly weakened by always staying in a sterile environment.  

18.  Even if you eat immune boosting foods, please go out of your house regularly to any park/beach.  

19.  Immunity is increased by EXPOSURE TO PATHOGENS, not by sitting at home and consuming fried/spicy/sugary food and aerated drinks.

Be smart and stay informed!

Live life sensibly and to the fullest.

Be Kind Be Calm and Be Safe

Dr. Bonnie Henry

An Important Update    Sept 21, 2020

The COVID-19 situation is evolving. We are situated next to one of the Provinces largest COVID testing sites with long wait times, and little monitoring  which have had an impact on our operations (washrooms) .  Unfortunately, some individuals awaiting testing have been wandering through the medical building for various reasons.

Today we were notified that a staff member who works in the building has been confirmed with having the COVID-19 virus. This employee last worked on 15^th September 2020.

Please continue to follow covid-19 precautions and observe our evolving directives of how to best handle patient care.

Our medical center is still inundated on a daily basis with dozens of cars full of potential covid patients awaiting testing, which can take hours.  Our local hospital continues to operate their drive thru testing center out their back door, which happens to be our front door.  If you happen to find yourself waiting in this line, please do not park and roam the property or enter the building for whatever reason.  It is making stage 3 difficult to manage for the dozens of practitioners in our building.  We continue to use virtual and remote resources to help manage your health, but at times it is necessary to do in person examinations or procedures that cannot be deferred indefinitely.

Numbers broadcast with regards to covid can cause some concern, because they are often reported without context.  A happy child with sniffles seems to make National News with the same enthusiasm as does an elderly patient suffering dementia, diabetes  who test positive for Covid.  Severity or outcome dont seem to matter to news outlets.  Our ICU occupancy rate in the province remains little different than other years and has the built in buffer room to accomodate a lot more if needed at this time.   It would be so nice to know how many patients in a daily report are actually hospitalized or intubated, which would lend much ability for various agencies to plan instead of panic.  As long as I have been in practice, we have always taught residents, that the third week of september seems to produce a deluge of pediatric infections for numerous reasons.  

Here is some perspective. 

In 2016  the World Health Organization has statistics on 56.9 million people who died. 

The top cause of death for 15 million people was stroke and heart disease.

The top infectious cause of death on our planet is TUBERCULOSIS, followed by other infectious lung diseases, totalling about 3.5 million

Coronavirus has allegedly claimed just over 920K, but there has been confusion in classification and reporting. 

Influenza claims between 250-500k lives on an annual basis, despite everything we do.

Road injuries claim about 1.4 million people annually.

Chronic lung disease mostly with smoking, claims about 3.7 million people

You may be surprised to find that diarrheal illness claims 2.4 million people yearly.

Coronavirus and its other respiratory cousins are definitely a problem. No one is claiming that it can be erradicated.  The current strains, like dozens before them, will be incorporated into the fabric of human existence on our planet. The main reason for changing our entire way of life, is a fear that the slow creep can turn into a deluge, but it seems that in Canada,  we have been able to step up and control at every juncture.  Current models suggest that each infected person can infect one to two others during the course of their 3-14 day illness.  There is no scientific basis to assume that a supposedly invisible asymptomatic pupil will take down an entire classroom or school.  I urge everyone to demand better, more contextual reporting.  Covid or other virus, the one thing we know for sure is that every year, our hospitals get overwhelmed with respiratory illness around Christmas with patients taking up space everywhere.  I think a lot more people may finally notice this in the coming months.

Finally, flushots.  Health department is not accepting orders for a few weeks, and then we tend to be the last to get them so we hope by end of october to start vaccinating. Please remember, they do not provide any protection against covid.   Blood antibody testing is being made available to a small group of high risk patients.  It is of value only in severe clinical situations.  Private testing runs about $300 and is supposedly available.

We have uploaded a comparison tool for you to use under the latest editorial section.

In a hope to add some balance and comparison of viewpoints.  I have added an article by a canadian physician with 50 years experience.  His views on the current situation and how it evolved to this fear, mass bankrupcy and escalation of mental health problems is interesting. It can be found under ARTICLES on our website.  It originally appeared in the Medical Post on Sept 4, 2020.

Covid 19 Update

  It seems that new stages of reopening are emerging every day. We have no idea how many there will be in total. There are numerous requirements which must be met in order to provide personal care. For the time being and into the future, until full opening is achieved,  most urgent problems will be dealt with virtually and in person as a last resort. At this time we still do not have enough personal protective  equipment to allow full reopening.  Our waiting room is closed.  Under current guidelines  we would have to work anywhere from 12 to 18 hour days in order to meet the same level of service as was in place prior to Covid lockdown. We are attempting to provide urgent care in a minimal contact fashion. This may involve  attending in person to have specific testing along with a follow-up virtual visit. Our virtual counselling services are currently taxed to the limit and extensive wait times can be encountered. Different clinics and specialists are also handling things differently due to the confusion. We will all have to be patient and attempt to adapt.

Please do not call and ask for a referral that is non-urgent. There is no advantage to be placed on a waiting list since they do not exist. Each request is  handled on a case-by-case  basis with urgent  request taking precedent.  If you are looking for results from another physician or clinic, then it is best to call the practitioner who ordered the results or is monitoring that aspect of your care.  We will contact you  for any abnormalities ordered through our clinic.

It is mandatory to wear a mask in all public areas of our medical building.  This also includes inside of clinics. We asked that you do not  come to the medical centre without  a confirmed appointment. There are times specifically set aside  to follow-up  those that have  recovered from Covid and we would appreciate  that this be accomplished in isolation with minimal exposure to other patients.

We highly encourage you to keep track of things like blood pressure, weight, blood sugar  etc. at home and  either email or call in results to us if you have any concerns.

We  will continue to attempt to keep immunization and prenatal appointments on schedule.

It is important that you show up at the time given to you. Maintaining social distancing depends on this.  If you are late, please call ahead  so that we can rebook you into a better more appropriate  appointment time.

Some patients are panicking  with paperwork that  demands medical deadlines.. These cannot be met or accomplished during a coronavirus lockdown. We suggest you contact the  institution or company which issued the paperwork or demand.  Accommodations are being made in most cases.

it is our hope that by early fall we may be in a position to tackle the large volume of  normal and preventative testing that has accumulated. We encourage everyone to follow the current provincial guidelines.

To:  The Right Honourable Justin Trudeau, P.C., M.P., Prime Minister of Canada

Date: July 6, 2020

RE: Dealing with COVID-19: A Balanced Response

The undersigned represent current and past leaders in public health, health care systems and academia.  We are writing to you to with our thoughts regarding a balanced approach to dealing with COVID-19  We strongly believe that population health and equity are important considerations that must be applied to future decisions regarding pandemic management. 

The current approach to dealing with COVID-19 carries significant risks to overall population health and threatens to increase inequities across the country.  Aiming to prevent or contain every case of COVID-19 is simply no longer sustainable at this stage in the pandemic.  We need to accept that COVID-19 will be with us for some time and to find ways to deal with it.  

The current and proposed measures for reopening will continue to disproportionately impact lower income groups, Black and other racialized groups, recent immigrants to Canada, Indigenous peoples and other populations.  And it risks significantly harming our children, particularly the very young, by affecting their development, with life-long consequences in terms of education, skills development, income and overall health. 

Canada must work to minimize the impact of COVID-19 by using measures that are practical, effective and compatible with our values and sense of social justice.  We need to focus on preventing deaths and serious illness by protecting the vulnerable while enabling society to function and thrive.

Elimination of COVID-19 is not a practical objective for Canada until we have a vaccine. While there is hope for a vaccine to be developed soon, we must be realistic about the time it will actually take to develop and evaluate it and then deliver an immunization campaign covering the entire population.  We cannot sustain universal control measures indefinitely. 

We need to accept that there will be cases and outbreaks of COVID-19.  We need localized control measures that are risk-based.  We should consistently reassess quarantine and isolation periods, recommendations for physical distancing and non-medical masks, and travel restrictions based on current best evidence and levels of risk.

At the same time we must improve infection prevention and control in long-term care and congregate living settings.  We should provide support for people living in the community who need to or choose to isolate when the disease is active, as well as those who have been adversely affected by COVID-19, or the consequences of the public health measures. 

Canadians have developed a fear of COVID-19.  Going forward, they have to be supported in understanding their true level of risk, and learning how to deal with this disease, while getting on with their lives – back to work, back to school, and back to healthy lives and vibrant, active communities across this country.

We acknowledge the heroic work that has been done in recent months by many across all levels of government and the public and private sector, and the sacrifices that Canadians have made to get to this stage.  As we look forward, Canada must balance its response to COVID-19.  

Sincerely yours,

Robert Bell, MDCM, MSc, FRCSC, FACS, Former Deputy Minister of Health, Province of Ontario
David Butler-Jones, MD, MHSc LLD(hc), DSc(hc), FRCPC, FACPM, FCFP, CCFP
Canada’s first Chief Public Health Officer and former Deputy Minister for the Public Health Agency of Canada
Jean Clinton, BMus, MD, FRCPC Former President and CEO, University Health Network, Toronto
Janet Davidson, OC, BScN, MHSA, LLD(Hon)Former Deputy Minister, Alberta Health,Former CEO, Trillium Health
Martha Fulford, MA, MD, FRCPC,Infectious Diseases Specialist, McMaster University
Brian Postl, MD, FRCPC,Dean, Rady Faculty of Health Sciences  Univ of Manitoba
Neil Rau, MD, FCPC,Infectious Disease Specialist
Richard Reznick, MD, FRCSC, )Dean Emeritus, Faculty of Health Sciences, Queen’s Univ
Susan Richardson, MDCM, FCRPC,Professor Emerita,  Toronto
Richard Schabas, MD, MHSC, FRCPC,Former Chief Medical Officer of Health,  Ontario
Gregory Taylor, MD, FRCPC, Former Chief Public Health Officer of Canada
David Walker, MD, FRCPC,Former Dean of Health Sciences, Queens Univ Expert Panel on SARS, 2003
Catharine Whiteside, CM, MD, PhD, FRCPS(C), FCAHS,  Former Dean of Medicine, Univ of Tor
Trevor Young, MD, PhD, FRCPC, FCAHS,Dean, Faculty of Medicine  Univ of Tor.  and others.

YOU TEST POSITIVE - Public Health will contact all positive cases

-Self isolate at home for 14 days from the onset of your symptoms

-You can come out of isolation 14 days after your symptoms began, if you're feeling better, and don't have a fever (your temperature remains lower than 37.8 degrees Celsius) and can return to work but must maintain physical distancing.  

-Clearance swabs are not required for individuals to return to work.  

YOU TESTED NEGATIVE

-If you tested negative for Covid-19 you will still need to stay in self-isolation for a period of time, as you could still be at risk of developing Covid-19 based on your exposure or you may have another illness.

If no known exposures to a Covid -19 case:

-You should remain in self-isolation for 24 hours after your symptoms resolve

If you recently travelled outside of Canada or have been in close contact (eg. in the household or workplace) with a case of Covid -19, you need to:

-Remain in self-isolation for 14 days after your last exposure.

Though you tested negative, if you develop new or worsening symptoms, you may need to get re-tested.

YOU ARE AWAITING RESULTS

-Self-isolate at home until your results are received.

-Members of your household should self-isolate with you until your results are received.

HOW CAN I OBTAIN MY TEST RESULTS

 -Follow guidance provided by the clinician who test you.

-Check the online portal

-Refer to the website of the institution where you were tested:

  Trillium Health Partner

  William Osler Health System

  Headwaters Health Care Centre