COVID-19

Third doses are now available in Ontario for those whose last dose was at least 3 months (84 days) ago, and who are older than 18.

Fourth doses are available for those over age 60 or who are immunocompromised.  The National Advisory Committee on Immunization recommends all people 80 and over to get the fourth dose.

Everyone in Ontario aged 5 and over can (and should) now receive the vaccine.

While there is no longer a provincial mask mandate in Ontario for all situations, it does remain in effect for health care facilities, and for certain people.  Just because there is no mandate, it still remains a smart idea to wear a mask when in close proximity to others, particularly indoors.

Dr.May getting the Pfizer vaccine!

COVID-19 is a respiratory infection that is transmitted in droplets that we spread when we breath or cough.  Omicron is spreading so fast there is now a concern that significant spread may be occurring via airborne route.

VACCINE INFORMATION:

Several vaccines have been demonstrated to be effective and safe of which six are so far approved in Canada, the Pfizer Comirnaty and the Moderna Spikevax vaccines are mRNA vaccines.  The Johnson & Johnson and AstraZeneca vaccines are DNA vaccines in a safe viral vector.  AstraZeneca and Johnson & Johnson are still excellent vaccines, but are mostly unavailable now.  Novavax' Nuvaxovid (ages 18 up) is a recombinant protein vaccine.  Medicago's Covifenz (ages 18-64) is Canada's own vaccine made from plant based protein.  

Religious concerns: Please note that if you are Catholic, your church approves the use of any COVID-19 vaccine, though I think they prefer the Moderna and Pfizer vaccines.  You can link to the usccb.org website and search up COVID-19 vaccine.

Some treatments that have some benefit:

1) Paxlovid - available for people at risk of serious outcomes - must be started within 5 days of symptom onset.

2) There is some evidence that Remdesivir can reduce duration of illness in those severely infected, but does not improve survivability.  Remdesivir is an injected medication and is not available in pharmacies, and certainly not over the internet.  Our  local hospital will start to carry remdesivir despite its dubious benefit - but access will be very limited.

3) Dexamethasone looks like it can improve outcomes for those with moderate disease or worse - that means in hospital and on oxygen.  More of an effect is seen if used in somebody in ICU on a ventilator.  It appears to worsen mortality in those who are not in this situation.  Dexamethasone works by suppressing the immune system and therefore carries increased risk of invasive fungal infections.

4) Tocilizumab looks beneficial, but it is only available to those with severe COVID illness in the ICU and is given by injection.  It is not clear if it helps reduce mortality, but it does reduce ventilator usage. 

5) The monoclonal antibiodies that were effective before, are no longer effective as of the Omicron BA2 variety. 

6) The antidepressant Fluvoxamine shows some evidence of benefit - and is not very expensive.  I am terribly worried however, as I have patients who need this old antidepressant for their severe depression, and since it is old, there is not a ton of supply, and if suddenly people are taking this for COVID, the supply will be rapidly gone, and typically it takes a manufacturer months to prepare new batches - supply is planned a long time in advance.  Unfortunately we have seen this happen even with Ivermectin and Hydroxychloroquine where people with very limited knowledge had decided that they were useful in treating COVID, and even before we had the numbers we are seeing with Omicron now - these drugs which are very important for people with conditions that can actually be treated by them, suddenly were unavailable.

7) Pulmicort (the asthma medication) has been found to be useful in certain circumstances.  It is now on backorder and unavailable (see point 6).

Omicron, unlike prior strains is a very different virus.  While up until now we have seen droplet spread mostly, we may now be dealing with airborne spread, which is exceptionally difficult to prevent.  Droplet spread is still likely a major contributor, so we need to maintain all the measures as berore:  keep 2 metres or 6 feet from each other as droplets do not spread beyond that distance.  This is actually quite a far distance.  As this might not always be possible (passing someone in an aisle at the grocery store, for instance), we recommend that everybody wear a mask when going out.  This mask is more to prevent you from transmitting virus to others, but if everyone is wearing a mask then transmission is reduced - and this has indeed been observed in careful case-control studies where masks have reduced spread by around 50%.   Many people ask for medical exemptions.  Only very unusually could a medical exemption be justified - principally in those with severe intellectual delay who do not have the ability to self-regulate, or comprehend, and for those who would be unable to communicate distress (such as infants).  Even once you are vaccinated - continue to take precautions like mask wearing and distancing as we need to prevent new variants developing for which the vaccine might not offer as good protection (as now, where even 3 doses of vaccine are giving 70-75% protection from symptomatic disease), and because we know that we can continue to spread the disease even if we don't fall sick ourselves.  

Treatment is really only supportive care - for example Tylenol for fever.  Most cases are mild and should be taken care of by staying at home (in fact you must self-isolate at home if you have symptoms of a cold - only leave to go to emergency).  You should seek medical help if you develop shortness of breath as breathing is important to life.  If you are having pressure in your chest that gets worse when you do effort - you should go to the emergency room.  Just because there is COVID-19 does not mean that people cannot get heart attacks!  If you are an essential worker or you live in a retirement home or long term care residence you must get tested promptly if you have any symptoms of a cold, if you are at risk of progressing to serious illness (see the public health website for your area to see if you should get tested), you should also get tested, otherwise we are not testing.  If you are uncertain if you have symptoms of COVID-19 - please go to the self assessment tool found on the covid-19.ontario.ca website. 

To get tested - call the following numbers for an appointment depending on where you live:

For trustworthy information on COVID-19, please go to the sites below: