Have you heard the good news? We are doing something right! The lockdowns, the masking, the distancing and maybe even worldwide attention to these is making a difference. We have reduced COVID cases in Canada.

In COVID testing, the positivity rate (the percentage of all coronavirus tests performed that are actually positive) is now 10% (anything above 3% is considered high) but down from 16.4% in the second week of January 2021. The number of COVID deaths are decreasing also. Hallelujah! We are winning against the second wave! Time to loosen controls- right?

To assess the effect of government decisions on COVID spread, let’s look at 2 European countries-Portugal and Denmark, that have preceded Canada with similar COVID infection patterns.

Portugal is just starting to get control over one of the worst waves seen in the world. They loosened controls after the second wave. This wave (third wave) has been predominantly the nasty S:N501 South African variant (I will speak about this later).

Denmark on the other hand, with relatively little vaccine available, and relying on all the basic precautions we speak about, is mandating a lockdown until the end of February, and is avoiding increasing viral growth. In fact, it is on its way to ZERO cases!

Why do I bring this up?  Because Alberta, Ontario, and Quebec, are talking about loosening restrictions despite all the scientific evidence to the contrary. With modeling suggesting that by March, B117 (the more transmissible British COVID-19 variant) will be the dominant viral strain, I think you know where am going with this…

Remember when you were a kid playing with blocks (LEGO was the best), and you piled the pieces higher and higher, building a wall around your fort/castle protecting it from all sorts of fantastical invaders (or your siblings)?

Piling up your protections against the COVID virus protects you, and lowers your risk of COVID infection. It’s not time to drop your guard - not yet. Stay home if you can, wear a mask, stay distant, avoid crowded places, clean hands and touchable surfaces frequently and open windows.  Finally - get outside and get some sun! (even if it is hard to find).

VACCINE UPDATE: Pressure on governments by Family Medicine are yielding results.  There is now discussion on how to roll out vaccines for Family Medicine practices. Our fridges and vaccine protocols have been inspected by Public Health and we have been approved to receive vaccines, as soon as they are available. I will keep you posted on further progress.

Stay safe and stay well.  Download the COVID app.

V

New COVID variants are emerging daily. For now, the 2 variants creating the most chatter, are the B117 (British) and S:N501 the (South African) variants. Both the B117 and South African S:N501 variants contain spike protein mutations.

Both these variants appear to spread more quickly in the community than wild COVID. The exact mechanism by which transmissibility occurs is not yet known. Increased transmissibility means that in an unprotected exposure (in for example a health worker) the risk of becoming infected with COVID has been 10%. With the new variants this has increased to 15%. This is called “the attack rate”, (this is the 50% increase in transmissibility quoted in the press). At the individual level this may not seem that significant, but multiply this in a population with more exposures, more virus, and increasing duration of viral presence and the numbers are concerning. We still do not know how people are getting infected, for example, does the virus “stick” to host cells better?  Is the infection exposure time shortened, or do these viruses aerosolize better (more able to be carried in the air)?

As of Feb 12 2021, B117 prevalence (the percentage of a population that is affected with a particular disease at a given time) is about 10% of the COVID positive cases tested. In 6-8 weeks, it is projected to make up > 50% of the COVID cases. Assuredly, here will be a surge in COVID cases mid-March. “The third wave?”

S:N501 (South African variant) variant is the most concerning. It contains 2 more mutations E484K and K417N making it even more transmissible. There is one case confirmed in Brampton in a non-travelling individual.

In laboratory testing S:N501 triggers less of an antibody production (antibody is our body’s first line of defense against an invader) than wild COVID-19. This variant can, and does, cause COVID reinfection in a previously COVID affected individual.  This is called immune evasion. Since a  travel history is often the way we find out about a new variant this means that there are more cases of this S:N501 Virus in the  population that we are not aware of.

Unlike B117 (British), variant S:N501 (South African) cannot be picked up by regular PCR testing (polymerase chain reaction- this test detects the presence of virus or viral fragments in an infected person) and can only be picked up by genetic sequencing.

Early testing (small numbers) with Pfizer and Moderna vaccines have suggested reduced protection against this South African variant.

The success of the Public Health response to these variants depends on the success of public acceptance of general measures, case and contact tracing, rapid identification with testing, and increased capacity for genomic testing (still limited). Challenges exist in all of these.

If public measures are STILL the first line of defense against these more transmissible variants, what are the new recommendations from Canada Public Health to the public?

There are none.

The suggested guidelines for exposure set early in the epidemic has been 6 feet and 15 minutes of exposure.  It’s a guideline, not a hard and fast rule. “There is no magic number when it comes to distance or duration!” says Emily Gurley, an epidemiologist and contact-tracing expert at the Johns Hopkins Bloomberg School of Public Health.

In the absence of a centralized direction from Public Health Agency of Canada, local public health units are making their own recommendations. Public Health Ontario has recently told regional units in the province of Ontario to reduce the threshold for classifying exposure to COVID due to the presence of new variants. Duration of exposure in York Region has the interaction duration at 10 minutes not 15 minutes. Alberta is now quarantining contacts of the new variants for 24 days (up from 14 days). Dr. Fauci has asked Americans to up their mask game.

Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton and an associate professor at McMaster University, states we “would like some centralization based on the science and we're hearing different things across the country in terms of quarantine and what an exposure risk is. Are people going to really adhere when again the rules keep changing left and right?"

In 2007 Justice A. Campbell headed the SARS commission. He stated was that when there is scientific uncertainty, to err on the side of caution and protect health care workers and protect Canadians”. He based his recommendations on the Precautionary principle. The basic tenet of that principle is to always take the safest approach in an outbreak and not wait for all of the scientific evidence before acting.

 Where are the precautionary principle recommendations now?

Early in  the pandemic,  in Help me Rhonda,  I wrote about masks. Public Health (and many of us - oh yes, me too)- said mask use was questionable. Yikes! Were we ever wrong! Masks DO protect the wearer. The more protection (layers) the mask has the better it is at protecting. Medical masks are specially designed to protect the wearer more effectively for close contact work.  In the community, mask types have varied in protection, appearance, fit, how they are worn, etc…

A single-layer mask isn't really effective in blocking aerosols, and even homemade two- and three-ply fabric masks are only partially protective -- somewhere in the 50% to 60% range of effectiveness. Surgical masks are about 50% effective at protecting the wearer from other people's aerosols and between 60% and 70% effective at protecting others.

At the USA Presidential Inauguration, many including President Biden wore double masks. It makes more sense that double layers will be more protective against COVID. With more mutant variants appearing, maybe we should…. However, wearing 2 masks is more uncomfortable, the 2 layers masks can slip on each other, it may be more difficult to breathe with them on, and there is increased chance of perspiration. Any one of these difficulties increases the chance of hands to the face- an absolute ”no no”.

Double masking is not being officially recommended yet, nor pooh-poohed. Given the new variant transmissibility, DO wear masks outside especially where physical distancing is not being maintained. Oh, by the way-viral particles travel further in cold air.

MASK DO’S

1. Masks are NOT a fashion statement.

“I only wear a silk masks” said a voice behind me at the crosswalk. I had to look…. There it was, a lovely silk sheet matching her outfit, draping gently across her face, falling off her nose, constantly being readjusted. That is not a mask!

2. Wear a tightly fitting mask.

3. masks should go over the bridge of the nose, under the chin line and be flush on the face, resting along the skin.

4. Wash cloth masks daily.

5. Store cloth masks in a sealed plastic bag if you do not wash them immediately. Detergent is the main ingredient in washing. Wash them in hot water and detergent (preferably in the washing machine). Air dry or machine dry.

6. Dispose of disposable mask in the garbage, preferably with a lid closure, folded inside out, preferably in a bag.

7. Wash hands before and after using the mask.

8. Handle the mask by the ear slings only.

MASK DON’Ts

1. DO NOT Wear any damp mask (paper or cloth). Damp masks allow bacteria to grow.

2. DO NOT touch the mask, or your face, once the mask is on.

Read more about masks here.

A tiny backtrack… a mask can be a fashion statement… youth poet laureate Amanda Gorman showed that. So did Dr. Jill Biden. But, they double masked also.

If you have any questions please call our office and speak with any member of our medical staff.