I trust that most of you had a quiet, safe and somewhat ‘less stressful’ holiday season. For me, I discovered that my first ‘quiet’ Christmas was unexpectedly pleasant. There was no rush to get groceries, cook, clean, set up, entertain and clean again. I really relaxed and got recharged.
With some free time, I had a chance to reflect on 2020 and prepare for 2021.
In retrospect, I realized I experienced some PTSD in the early months of this pandemic. I recalled my fears of dying during SARS and it’s impact on our family as both Mom and Dad were working inside SARS hospitals. Robert, my son, was around 5 years old at the time. We decided to pull him out of kindergarten for fear he would get sick from us and then infect other kids.
Our pathway to immunity against COVID-19 will only be successful with widespread vaccination to a point where this virus cannot infect so many people and cause disruption to our businesses, our health and our lives. This is in fact the definition of herd or population immunity.
To achieve ‘herd immunity’ with COVID-19 will require at least an 80% vaccination rate. Given the acceleration of this pandemic, I’ve heard Dr. Fauci say 90% is what’s needed if the pandemic worsens.
An Advancing Pandemic
I waited two weeks before writing this blog, hoping that the numbers would be going down as the ‘bump’ from the holidays resolved. With the arrival of the vaccines, I was cautiously optimistic that 2021 would be a better year. That optimism is now tempered with some new concerns.
I fear the pandemic will get worse in 2021. I wish it was otherwise. The more contagious strain appears to be taking hold.
The models that public health departments are sharing are all about rising case counts which begins to accelerate in March. And if you want to read more, check out my trusted friend Ivan Semeniuk’s Globe and Mail detailed article: COVID-19 Variants threaten to push Ontario past perilous turning point.
A CBC news story summarizes the modelling work done by Dr. Troy Day, a member of the Ontario Modelling Consensus Table and a mathematical biologist at Queen’s University in Kingston.
He states: “The threat posed by the more contagious variant partly lies in the time it takes for the number of COVID-19 cases to double, between 10 and 15 days, far fewer than the estimated 40 days of the current coronavirus strain.”
This modelling caused me to realize that we must do more now, especially as a community of leaders.
New Coronavirus Strains
As case counts rise despite Emergency Stay at Home orders in place, I’m afraid it may get worse before it gets better. The labs are lagging in decoding to screen for the new coronavirus strains. We already know there are 23 cases of the UK Strain (17 in Ontario) and 2 cases of the Brazil Strain in Canada as of Wednesday morning. It appears a Barrie nursing home has been infected with a new variant strain – type to be confirmed in the coming days.
At least four new variants of the coronavirus are keeping public health officials awake at night.
Globally, the UK strain known as B.1.1.7, has now shown up in more than 50 countries. Though this strain is no more deadly than the present dominant strain, a more contagious strain could be worse because it makes people sicker and causes so many more people to become infected, resulting in a higher death toll.
After about a month, a 50% more deadly strain would cause 1.5 times the number of deaths compared to baseline. But a 50% more contagious strain could cause over 11 times the number of deaths over the same time period. That’s if you assume an average of five days from the time someone gets infected, and the time they infect someone else.
More Contagious = More Cases = More Hospitalizations = More Deaths
Other variants, identified in South Africa (B.1.351) and Brazil (P.1 and P.2), haven’t traveled as far and wide, but show a different range of mutations.
B.1.351 has a different pattern of mutations that causes more physical alterations in the structure of the spike protein than B.1.1.7 does. One important mutation, called E484K, appears to affect the receptor binding domain, the part of the spike protein most important for attaching to cells. It could help the virus partly escape the effects of vaccines.
So far, none of the newer strains have mutated to the point that it causes more severe disease, or evades the protection provided by vaccination. While some of the new variants appear to have changes that look like they could affect immune response, it’s only by a matter of degree.
With widespread vaccination not anticipated until the Spring/Summer, these viral strains could spread like wildfire across North America. And with so many hosts to infect and replicate, the virus will freely continue to mutate. As the virus strains spread, I pray it will not mutate to a point that they become resistant to the vaccine we are now distributing.
We need to urgently get the world vaccinated to slow down the infection rate and the opportunity the virus has to continually mutate with new hosts. It will take at least 3 months of production time to modify the mRNA vaccines to cope with new DNA mutations if that is required. And yes, that would mean another round of vaccinations around the world.
About the Vaccines
Q: When will I get access to the vaccines?
A: Ontario has started to roll out its three-phased vaccine distribution implementation plan. Phase 3 which will see the wider rollout of the vaccine to the general population is not anticipated until August 2021.
But physicians have not been given little additional information other than what has so far been made available to the media. It’s clear to me that the supply chain and access to vaccines will continue to be an issue until Spring (April 2021). Rest assured you’ll be notified by me as soon as I know more specifics.
Q: Which vaccine should I get?
A: Simple answer – get whatever you can get. Likely none of us will have a choice.
And my only word of caution, I’m not keen on mix and match and waiting beyond the recommendations of when to get a second dose.
Q: Is it safe?
While many have called this vaccine, a miracle, I would reposition it as a trifecta of decades of breakthrough scientific research, tons of money and luck that the virus DNA is relatively ‘stable’.
It was the biggest science and business bets of the century:
- Baseline research around mRNA for cancer immunotherapy, had already been done before the pandemic. They were already working on influenza vaccines.
- Once the COVID-19 vaccines were developed by the drug companies, they started manufacturing before clinical trials without proof they would be safe and effective.
- Normally, phased trials run sequentially. Phase 1 to be followed by Phase 2 and finally Phase 3. To speed up the process, the FDA allowed these trials to run their phases simultaneously.
- We were ‘lucky’ that the virus mutated slowly (unlike the influenza and Ebola viruses).
- And the vaccines so far have proven to not only be safe, but amazingly effective (above 90%).
Until we get access to vaccines, support my communications campaign to encourage your family, friends and colleagues to get the vaccine by sharing this blog.
ELAINE CHIN, M.D., M.B.A. FOUNDER, CHIEF MEDICAL OFFICER North American trailblazer in Precision Medicine. Founder of Executive Health Centre, a Medical Wellness and Anti-Aging Clinic. Medical expert on CitylineTV and in Good Housekeeping Magazine’s GH Institute.