In August, the respected and influential British Medical Journal (BMJ) published a series of articles investigating the Covid-19 response in Canada. Contrary to the impression of many Canadians that Canada handled the Covid pandemic well, especially as compared to the United States and the UK, the BMJ had a long list of skathing criticisms, and stated in several places that a national enquiry is needed to make sure that important lessons are learned for the future.
“The picture that emerges is an ill prepared country with outdated data systems, poor coordination and cohesion and blindness about its citizens’ diverse needs. What saved Canada was a largely willing and conforming populace that withstood stringent public health measures and achieved among the world’s highest levels of vaccination coverage. In other words, Canadians delivered on the pandemic response while its governments faltered.” … The Guardian
“The willingness of Canadians to comply with vaccination requirements and harsh public health restrictions did more to bring Covid-19 under control than the fragmented, deficient and unsavvy response of governments … Canada leads wealthy nations for Covid related fatalities in care homes, despite more than 100 reports and inquiries over 50 years that foreshadowed a nursing home crisis … More long-term care home outbreaks occurred in 2022 than 2020 and 2021 combined.” … National Post
During the pandemic, many articles in this blog were pretty critical of the decisions and actions taken, and the actions not taken, from public health officials to politicians. The vaccine rollout was particularly chaotic. People scrambled to find out where they could get a vaccination and in the beginning a lot depended on word of mouth. It took Ontario three months to provide a vaccine reservation system, but for weeks it was overloaded and crashed, making it difficult for people to book a shot. In the meantime Doug Ford blamed Justin Trudeau for not delivering enough vaccines. The botched vaccine rollout was a classic case of a series of bad management decisions. The effect was that vaccine distribution was inequitable for many and stressful for everybody.
Bad Management 1. No planning for a vaccine rollout
By May 2020 it was clear that the results of the phase 3 clinical trials for the Moderna and Pfizer vaccines would be submitted to the FDA by December 2020 and that with fast track approval, vaccines would be ready to ship in January 2021.
Neither the federal nor provincial governments began any serious planning until vaccine deliveries were confirmed in December.
Here is a revealing interview that makes this clear. One week before the first batch of vaccines were due to be delivered, the CEO of UHN, which was the first vaccine distribution center for Toronto, had only a few vague answers but no answers for a lot of key questions that should have been planned many months before. “How will we make this logistically work?” “Healthcare workers have been really busy, do we have the right people?” “We have not been told anything about the next batches of vaccines.”
Bad Management 2. Poor selection of leaders
The Trump administration appointed F. Perna, a four-star general and a logistics expert, as the chief operating officer of “Operation Warp Speed”. The thinking was that the major challenge of the vaccine rollout was the logistics to move vaccines from suppliers to vaccine centers and that military people had the experience with these kinds of logistics. Canada followed suit as did Ontario.
At the end of November, about one week before vaccines were due to arrive in Canada, Trudeau appointed Major-General Dany Fortin, a former NATO commander in Iraq, to head up the Federal vaccinations task force. A short time later, Doug Ford appointed former head of the Canadian Armed Forces, General Rick Hillier, to lead a new task force to oversee the rollout of the Covid-19 vaccines in Ontario.
What shallow thinking. Using large military aircraft to move military equipment and thousands of troops across the globe is a logistics problem that is quite different from shipping boxes of vaccines from a handful of suppliers to a few vaccination centers across the country. The “logistics” of shipping vaccines from suppliers to vaccination centers is the easiest part of the overall vaccination distribution. The challenging part is how to get the vaccines from vaccination centers into the arms of millions of people. Who was going to administer the shots? Nurses were overloaded with Covid cases in the hospitals. Would additional people be recruited? Who would train them? How would people get their vaccinations? Would they line up for hours in ad hoc locations such as community centers or would modern technology be used so that people could reserve in advance at a time and location of their choosing? What about the many people who couldn’t use the Internet? Would there be enough phone lines and people to answer the phones to provide information and help people book a reservation?
The high rank military generals had many years of experience in the military but no significant experience working in civilian life. The values and orientations of the military focussing on preparing for battle or securing defensive positions is quite different. This was clearly born out when General Hillier suspended the vaccination program in Ontario in December 2020 so that people could enjoy their holiday season. He clearly did not understand the urgency that civilians wanted to proceed with vaccinations as quickly as possible. A pause in vaccinations was as absurd as firefighters leaving a five alarm blaze for a lunch break. The public outroar was furious and Hillier had to walk it back quickly, issuing an apology and promising not to take off any more days in the vaccine rollout. Hillier resigned three months later. He was replaced by someone with a medical background, Homer Chin-nan Tien, the president of the air ambulance service Ornge.
In spite of the grandiose statements about the expertise of the Canadian military, there seems to be only one case of military planes being used, to deliver 5 freezers for Canada’s North.
On the other hand there were many interviews and photo ops with the Minister of Procurement Anita Anand on the tarmac meeting large cargo planes arriving with vaccines. They were always FedEx planes.
Lessons Learned?
“Lessons from the outbreak of SARS-CoV-1 in 2003 which impacted Canada more than any other country outside of Asia went unheeded and left the country’s governments and health authorities ill prepared for Covid-19. An independent, national inquiry is needed to review Canada’s Covid-19 response, draw lessons, and ensure accountability for the past and future pandemic preparedness.” … British Medical Journal
There is no commitment or announcement from the Canadian government to undertake such an inquiry.
Is Canada going to learn from the lessons of history, or is Canada doomed to repeat history, again?
The Internet was made “safe” for E-commerce back in 1995 when Netscape developed encryption for web traffic. However many people did not trust providing their credit card information for Internet purchases. But when the Covid-19 pandemic and lockdowns began in 2020, many more people started to make purchases over the Internet for such basic things as grocery delivery and take out food. Using credit card information on the Internet is fairly safe but there are a number of risks.
Almost all websites use a secure (encrypted) connection, denoted by https instead of http in the address line of a browser, often shown with a lock icon
This means that all the information being sent to the website is encrypted, including your credit card information.
Breaking encryption is well beyond the capability of any hacker who is intent on stealing your credit card information as it travels over the Internet. However, the NSA (U.S. National Security Agency) is able to break encryption. But this is only after years of spending more than a billion dollars developing widespread network surveillance, large data bases, specialized supercomputers and collaboration with large American technology companies to siphon off Internet traffic (as revealed in documents released by Edward Snowden). How US and UK spy agencies defeat internet security
A bigger risk is if you happen to have malware on your computer that monitors everything you type. This type of malware, called “spyware”, will record credit card information and send it back to a hacker’s computer. The protection for this is to make sure that you have antivirus software running on your computer that includes anti-spyware. If your antivirus does not include anti-spyware, you can add a separate anti-spyware package.
Another risk is your credit card information being stolen from the website long after you have made a purchase. Most websites store your credit card information. This makes it more convenient for you if you order from them again. But there have been many security breaches in which hackers have broken into the servers of some very large companies and stolen millions of credit cards. Biggest credit card data breaches
This risk is something that you may be able to minimize. In Europe privacy laws make it illegal for websites to store credit card information without your express consent. But in North America, privacy laws are way behind and there is no such protection. Websites should really ask you if you want to save your information, but most of them do not. And they don’t provide an option for you to remove your credit card information from their servers.
However, if you use PayPal instead of a credit card, you have more control over websites retaining your payment information. You can go into your PayPal account and look at all the websites that have “Automatic Payment” turned on and turn them off. In general you want to do that for all websites except those in which you have set up a monthly regular payment, such as Netflix which is a monthly subscription service, or services you use regularly such as Uber. When I went through my PayPal account, I found three Automatic Payments to TicketKing going back several years.
PayPal also provides more security for your payment credentials. When you use PayPal to make a purchase on a website, you are directed to PayPal to log into your account. The webserver does not see your password and so it cannot save it. If a hacker breaks into a webserver and steals PayPal account information, it cannot be used to make purchases or access your PayPal account. However there is one caveat here, which is that a hacker may try to break into your PayPal account by guessing your password. As long as you guard your PayPal login information carefully you will be pretty safe.
Not many PayPal data breaches have been reported compared to credit card breaches but one was reported in 2022. Only personal information was stolen and there was no indication of any financial losses. PayPal breach
In summary, what can you do to minimize your Internet payment information being compromised?
1. Make sure you have anti-spyware software protecting your computer (it may be part of your antivirus software).
2. Use PayPal whenever possible for online payments instead of credit cards. After completing the transaction, go into your PayPal account and turn off Automatic Payment for that website, unless it is a bona fide subscription service.
There have been scattered reports about increasing Covid cases. As explained in the previous blog article, case counts are unreliable now so hospital admissions are the best statistic to watch. This statistic shows a 15% uptick in August 2023 in Canada and a 24% increase in the U.S.
A rapidly rising Omicron subvariant EG.5 (“Eris”) which is circulating in many countries was designated as a “variant of interest” by the World Health Organization (WHO) on August 9, 2023. It is now becoming the dominant variant in the U.S.
EG.5 is a variant in the XBB branch of Covid mutations which have been the main variants in circulation in Canada and the U.S. since they started to spread rapidly in January 2023. XBB is a mutation of the Omicron variant. The original Omicron variant is no longer in circulation.
However, Pfizer and Moderna are developing new vaccines that target these Covid subvariants.
It’s generally recommended that you don’t get a Covid booster until 6 months after your last booster or Covid infection, whichever is later. If you are due for a booster, it is probably better to wait for the new Covid vaccines which promise to be more effective against the current variants that are circulating. While Pfizer and Moderna expect to have their new vaccines ready by September, with the typical delays in getting approvals they likely will not be available until October.
On the vaccine front, more exciting news than the improved Covid vaccines is the new vaccine for RSV.
RSV is Respiratory Syncytial Virus, a common respiratory virus that causes cold-like symptoms. It is seasonal lung infection, a common childhood illness that can also affect adults. Most cases are mild and last only 3 to 7 days but a severe infection can lead to pneumonia.
RSV is highly contagious. After an infected person sneezes or coughs, you can get the airborne virus through your eyes, nose or mouth. RSV can survive on hard surfaces so if you touch something like a counter or a toy that has the virus on it and then touch your face or mouth, you can get infected.
Severe RSV can be unpredictable and is the leading cause of hospitalization in infants. Adults 65 and over and adults with chronic conditions or weakened immune systems are at high risk for developing severe RSV.
Autumn 2022 saw a surge in RSV cases in children and adults. It was a “tripledemic” year of RSV, Covid and influenza. This pattern is expected to repeat in Fall of 2023.
But …
A new vaccine for RSV has just been approved! (FDA May 2023, Health Canada August 2023)
The clinical trial results for the RSV vaccine Arexvy were pretty impressive: 82% efficacy in preventing lower respiratory tract disease caused by RSV and efficacy of 94% in older adults with one or more underlying medical condition. Health Canada approves RSV vaccine
This is the first vaccine for RSV after decades of research. Scientists started working on a vaccine soon after RSV was discovered in 1956, but some disastrous clinical trials in the 1960s that led to the deaths of several children and more failed attempts later stymied progress for years. RSV vaccines are finally here
With the onset of winter 2024, we could be heading into another tripledemic year of seasonal respiratory illness, but you can counter that with triple vaccinations – flu, Covid and RSV. To get an RSV vaccination, contact your doctor.
News about Covid and the pandemic have been out of the headlines for months. The last post on this blog was August 2022. There are still plenty of people getting sick with Covid and dying but cases have generally been declining. It has become more difficult to get statistics. A lot of organizations and websites that used to update information daily stopped carrying Covid news. Case counts became unreliable in 2022 since many people were not being tested and public health does not have a record of those who test at home with a rapid test kit. The most effective way to gauge the spread of Covid is through hospital admissions and death counts, statistics that are backed by records and are fairly reliable.
In the US, the New York Times still maintains a fairly comprehensive Covid page with national graphs and statistics and breakdowns by state. Their summary page shows the strong downward trend in daily Covid hospital admissions after a bit of a winter peak in January 2023. Note that the breakdown by ages shows that the rate for people 70+ is four times the daily average for All ages.
In Canada I’ve relied on Public Health Ontario for hospital admissions and death counts (other provinces may maintain similar statistics). The weekly hospital admissions in Ontario for the last year shows a strong downward trend.
Covid was back in the headline news recently. On May 4, 2023 the World Health Organization WHO declared that:
Covid-19 is over as a global health emergency. Even though worldwide, someone dies of Covid every three minutes, the downward trend of the pandemic with population immunity increasing from vaccination and infection, mortality decreasing and the pressure on health systems easing has allowed most countries to return to life as we knew it before Covid-19. This means that it is time for countries to transition from emergency mode to managing Covid-19 alongside other infectious diseases. WHO declares end to Covid global health emergency
Although the WHO declaration just confirmed what many countries had been doing in reducing various health and financial supports for the pandemic, the timing of this announcement proved to be very ironic for us. About a week later, after having stayed healthy throughout the whole pandemic, we succumbed to a Covid home invasion.
Covid Case 1
On the evening of Mother’s Day May 14, my wife N said she had a bit of a sore throat. The next day it was more persistent, but without additional symptoms it did not warrant doing a Covid test. However, the following day she woke up with a really congested sinus, a headache and she was very tired. A rapid test revealed that she was positive for Covid. N was up to date on her Covid vaccinations but “breakthrough” cases of the Omicron variant that infected vaccinated people had become common and was a big part of the reason that there was a large Omicron wave in the winter of 2022.
The incubation period for Omicron is 2.5 – 4.6 days. Counting backwards this number of days from Sunday night, the most likely event that would have exposed N to Covid in that period was the day that she had returned to an in person class. With the decreasing Covid cases we felt that it was safe enough to attend more in person events after three long years of zooming. COVID-19 Omicron Variant of Concern and Communicability
It was still very early in the Covid infection cycle. Because of her age N would qualify for an antiviral, which must be given within 5 days of the first symptoms to be effective. She called up our local pharmacy and after a short screening questionnaire with the pharmacist, she was approved for Paxlovid. It was ready for pick up in an hour.
Paxlovid was developed by Pfizer in record time based on some earlier work they had done on SARS (severe acute respiratory syndrome), the 2003 outbreak that was caused by a new coronavirus. They were convinced that a protease inhibitor would prevent a coronavirus from replicating. They synthesize hundreds of unique chemical compounds and then tested them against the Covid virus in the lab. How Pfizer developed a COVID pill in record time
The clinical trial that supported the FDA approval for Paxlovid in Dec 2021 had an 89% reduction in the risk of hospitalization and death in unvaccinated people. A later real-world study showed that people who received Paxlovid had a 51% lower hospitalization rate. Paxlovid Associated with Decreased Hospitalization Rate Among Adults with COVID-19
N got a package of Paxlovid, 3 pills taken twice a day for 5 days. In a few days she began to feel better and the Covid symptoms were less severe, but there were side effects from the Paxlovid. She found it hard on the stomach and had some back muscle pain.
Covid Case 2
N had started to self isolate. She confined herself to the bedroom and her office and used other rooms, like the kitchen, wearing a mask and only when no one else was there. We also opened windows in most of the rooms for improved ventilation. I moved out of the bedroom into the spare room but it was all too little too late. Omicron is incredibly contagious and two days after N had tested positive I woke up with a headache and a real cold. As expected, I tested positive for Covid.
I am immunocompromised and so at high risk. My immune system is compromised and not as effective in detecting and attacking disease as in a person who has a well functioning immune system.
There are many different reasons that someone may become immunocompromised. In my case it’s because I have multiple myeloma, a blood cancer. Although it has been well controlled with different medications over the years, the cancer as well as the treatments suppress my blood counts and my immune system. Most of my levels in a complete blood count (CBC) are below normal, from red blood cells to white blood cells, as are all of the important components of the immune system, from B cells to T cells. Although blood cancer patients are severely immunocompromised, the people who are most severely immunocompromised are transplant patients who have to take immunosuppressant drugs to prevent their immune system from attacking the foreign transplanted tissue.
Immunocompromised people are more susceptible to all kinds of infections. People with blood cancer do not die from the cancer itself. Generally they die from an infection that overwhelms their immune system. Even pneumonia which a normal person can recover from, perhaps with the help of an antibiotic, is the cause of death for many people with blood cancer.
In addition, people who are immunocompromised do not mount a very strong immune response to the Covid vaccine. A vaccination is not an injection of antibodies that will then protect you from disease or infection. Rather, a vaccination is designed to stimulate your immune system to produce antibodies which are created by white blood cells and then circulate in your blood to attack a specific virus. With a weak immune system you don’t generate very many antibodies. After my fourth Covid vaccination I got a blood test to measure my level of Covid antibodies and it was lower than most people had after only their first vaccination. So for all intents and purposes I had been negotiating the coronavirus pandemic as an unvaccinated person.
I checked in with my hematologist at Princess Margaret Cancer Center and she directed me to the hospital Covid Clinic. A telephone screening with a nurse practitioner recommended remdesivir, the second of the two Covid antivirals available in Ontario, because the blood thinner that I take for atrial fibrillation (afib) was a contraindication for Paxlovid. Remdesivir also had impressive clinical results, reducing the risk of hospitalization by 87%. It has fewer side effects than Paxlovid, but it can only be given as an intravenous (IV) infusion over 3 days.
Remdesivir was originally developed to treat hepatitis C and was subsequently investigated for Ebola virus disease. It wasn’t very effective for either of them.
In 2007 Dr. Mark Denison discovered that coronaviruses have a “proofreading” system. He and some other experts thought it might be possible to trick a virus with a drug that dodged the proofreading system and blocked the virus’s growing RNA chain, making it terminate prematurely. Denison learned that Gilead Sciences had dozens of drugs that might do this. In a series of lab tests, most worked to shut down coronaviruses. One of the best was remdesivir. “I like to call it the Terminator,” Denison said. How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected
With the COVID-19 outbreak spreading rapidly and a lack of alternative therapeutics, the first clinical trials using remdesivir were begun in China in February 2020. As Covid-19 began to grow into a pandemic, many scientists realized that remdesivir might be the best solution at hand. It had already undergone animal testing and safety testing in humans. So doctors began giving it to patients in studies without controls and even outside of studies altogether. Anecdotes fueled demand. Gilead sponsored some of these studies and gave the drug to doctors who treated hundreds of patients under compassionate use, a legal exemption permitting use of an unapproved drug to treat patients. In May 2020 the FDA issued Emergency Use Authorization (EUA) for remdesivir.
Gilead had flown their entire stock of remdesivir left over from Ebola research to its filling plant in California in February. They began working on restarting remdesivir production in their manufacturing plant in Edmonton and finished the first new batch of remdesivir in April 2020. Gilead Drug Remdesivir: Rare Example of Foresight in the Pandemic
Full FDA approval for remdesivir was given in Oct 2020, the first drug approved for Covid. However clinical trial results were not that strong and some trials did not show any real benefit. The approval of remdesivir was very controversial. The bad look of remdesivir, the first FDA-approved COVID-19 drug
In January 2022 the FDA expanded the indication for remdesivir to include its use in non-hospitalized adults. Used much earlier in the Covid infection cycle instead of only with patients sick in hospital, remdesivir had impressive clinical trial results comparable to Paxlovid, reducing the risk of hospitalization by 87%. FDA Takes Actions to Expand Use of Treatment for Outpatients with Mild-to-Moderate COVID-19
To get started on my remdesivir infusion, the nurse said she would get someone to call me to make arrangements. I received a call back a short time later from an administrator who said there were two hospitals in Toronto where I could go. The closest one had time slots for the following morning. I was a bit flabbergasted; in a large city the size of Toronto that has about 30 hospitals, were there only two that were able to deliver a simple intravenous infusion?
I was anxious to get started as soon as possible so I told the administrator that the second hospital was not that much further and I would prefer to go there if I could get started that day. She called back a little while later and said that this second hospital did not have any openings until the following day but she had found out that the first hospital would be able to take me if I could get there in an hour. I replied that it would be no problem. I had just finished my lunch and so I headed out.
I drove down to Women’s College Hospital in downtown Toronto in good time. The hospital had had a major reconstruction a few years earlier and it looked like a gleaming new, modern facility. It had the best parking of any hospitals I’ve ever been to; right in the building with a short elevator ride up to the main lobby. I went to the Ambulatory Care Clinic. It was very quiet. I didn’t have to wait too long to be shown into a treatment room. On my way down the hall I saw only one other patient and otherwise not a soul. This was really kind of unexpected. The Canadian news had been full of reports about the shortcomings of healthcare budgets and services for many months. Yet here was this practically brand new hospital that seemed kind of empty. Were people having trouble finding this hospital? It was around a quiet corner on a small back street but it wasn’t that hard to find.
A nurse came in dressed in full PPE (Personal Protective Equipment) with gown, mask, visor and gloves. She gave me an information sheet on remdesivir and explained the procedure. It was going to be a 1 hour infusion followed by a 30 minute flush and observation for side effects. She proceeded to set up the IV, a small plastic tube, a catheter, that is inserted into the vein with a sharp needle. Then the needle is removed with a quick spring release, leaving the catheter inside the vein. After flushing the line with saline solution to make sure that fluid will flow through the line into the vein, she connected the valve at the end of the catheter to the tubing that was connected to the bag of fluid containing the medication on an IV stand.
Meanwhile a young doctor came in to see if I had further questions. I asked if they had been administering remdesivir to many patients. She said that they were not very busy and in fact many of their Covid activities were being curtailed or shut down as budgets for Covid were expiring and were not being renewed.
I lay back on the bed waiting for the nurse to come back and start the infusion. When she returned she apologized for the delay and said that their pharmacy no longer prepared this drug so she had to mix it herself and it took some time for it to dissolve properly. After checking my vital signs – temperature, blood pressure, oxygen – she started the infusion.
During this time I received a call from Home Care to arrange the next two infusions as they would not be done in the hospital. I had initially been told that because of budget cuts Home Care would not actually come to your home if you are ambulatory and instead you would have to go to a public health care clinic. However, when I spoke to them to confirm a time, they informed me that in fact for this treatment they would send out a nurse to my home. We arranged a time for the following afternoon.
When the infusion and flush were completed, the nurse removed the tubing but left the IV line in my arm and wrapped it carefully in gauze so that it could be used again on subsequent days without having to do another needle insertion. Even though I had basically been lying in a bed for a couple hours and actually dozed off a few times, I was pretty tired. I was lucky to just miss the peak of rush hour on my drive back home. When I walked in the door it was almost 5 hours since I had left for the 90 minute treatment.
After a real nap, when I got up there was a message on my phone. It was from some pharmaceutical company who said that they would be delivering medical supplies that evening up until 11:30 p.m. At 10:00 p.m. I was pretty tired and ready for my night time sleep. I turned on the outside light and asked N to wait up and answer the door for the medical delivery.
The next morning when I woke up I was feeling about the same. I wasn’t really expecting to see a big improvement after just one treatment but at least I wasn’t feeling worse. I hoped that was an indication that the Covid infection was not advancing. I did have a little more chest congestion but I think it was an overnight accumulation. I took some Robitussin Cough Control which was quite effective in loosening some of the mucus and phlegm buildup in my chest and later in the morning I started to feel a bit better.
Downstairs I found that three packages had arrived. One box had the medicine, one box contained all kinds of hospital equipment: syringes, various types of intravenous lines, alcohol cleaning pads, packages of sterile gauze and various other items. Wrapped up in a long package was what I guessed was the IV stand, a pole to hold the IV bag.
In the afternoon the nurses arrived in full PPE dress. It was actually two nurses because one was in training. They came into my office room and checked all the medical supplies that had arrived. Everything seemed to be in order.
I asked the nurse if she had administered remdesivir before. She said no but the instructions were pretty straightforward. She took the bottle of remdesivir and extracted it into a large syringe and verified the volume. Then she added another liquid into the syringe and finally injected the contents of the syringe into an IV bag that was prefilled with saline solution. Unlike what I understood had been done in the hospital, this drug was mixed from liquid not from a powder and so there was no waiting time for it to dissolve.
Meanwhile the nurse trainee had set up the IV pole. It was a simple pole that was made from cardboard, the kind you find on the inside of a roll of paper towel or toilet paper, but somewhat heavier. It was designed to be disposable so that after being used in an environment where there was an infectious disease such as Covid, it could be easily and safely discarded.
After setting up the tubing and connecting it to the IV line in my arm, the nurse simply adjusted the valve for the right drip amount. Unlike an IV in the hospital, this IV had no pump and it was going to work strictly by gravity feed. That’s the reason that I think that the IV pole was so high.
Here’s a picture of my private hospital with my two nurses in attendance.
On Sunday I woke up with a lot of chest congestion. After using the Robitussin again and coughing up a fair bit of phlegm I felt that most of my symptoms had distinctly improved. For the first time since testing positive I was feeling better. However my breathing was somewhat labored, like a mild wheezing without any sound. And I had shortness of breath after walking up the stairs.
I knew that people with Covid could have a sudden drop of oxygen which was a sign that you might need to go into the hospital for medical assistance such as oxygen. I got out my pulse oximeter and clamped it on my finger. It quickly climbed up to 95% oxygen. No worries there.
Then I got concerned that the Covid virus may have now reached deeper into my lungs and that it was affecting my breathing. I was really in a classic race condition. This chart shows the race between the Virus and the Antivirus. In this model the Antivirus is the combination of Covid antibodies (which are very low in my case) and the antiviral drug remdesivir given on Days 3, 4 and 5. The Virus was replicating and the Antivirus was attacking it and reducing its ability to grow. This was my last day of remdesivir. Would the drug continue to work after today? If not, the Virus could win the race. This picture did not look promising.
(The numbers on the left axis are not real world measurements of Virus or Antivirus levels, they are abstract numbers used in the spreadsheet to show this chart.)
On the other hand, vaccinated people with healthy immune systems might do just fine in this scenario. Their immune systems responded to vaccinations and prior Covid infections and generated a higher level of Covid antibodies that circulates in their blood when Covid is first contracted. The combination of higher Covid antibodies with the antiviral drug on Days 3, 4 and 5 is enough to kill off the virus.
So a critical question was “How long would remdesivir remain in my body and continue to have antiviral benefits?”
I did some Google searches and could not find a clear answer to this. However there were some articles that said the half-life of remdesivir was about an hour. That was worrisome; it didn’t seem like that would be long enough to win the race against the virus.
To get a better answer I did what I have been doing for the last few months when I did not get a good answer from Google search for more complicated questions. I posed the questions to ChatGPT. It gave a very good explanation and reassured me that remdesivir would probably work long enough for me to recover. ____________________________________________
Question: How long is remdesivir active in combating Covid after infusion?
Answer: Remdesivir undergoes a process called intracellular metabolism, where it is converted into its active form which works by inhibiting the replication of certain viruses, including the SARS-CoV-2 virus responsible for COVID-19. It is incorporated into the viral RNA chain during replication, leading to premature termination of viral RNA synthesis.
The half-life of remdesivir is relatively short, averaging around one hour in plasma. However, the drug’s effect on combating COVID-19 extends beyond its half-life. Remdesivir’s antiviral activity is primarily driven by its active metabolite, which has a longer half-life and remains in the body for a more extended period.
The exact duration of remdesivir’s activity in combating COVID-19 after infusion is not precisely defined. However, clinical studies have shown that the drug’s beneficial effects can persist beyond the treatment period. It is believed that the active metabolite continues to exert its antiviral effects on viral replication even after the infusion is completed. ____________________________________________
In the afternoon my nurses arrived for the final infusion. They were now experts at it. In no time the head nurse had mixed the remdesivir and set it up on my IV pole. It was again scheduled for a 1 hour drip. The nurse said they had quite a number of calls that day, about 19, and she wondered if I would be able to remove the IV line by myself at the end. I had done this in the past so I said OK so that they didn’t have to wait around for an hour. I bid them goodbye as they went off on their next mission to provide home service for people in need. I thanked them profusely and told them what a great service it was.
When the drip stopped I took the bag and tubing off the IV stand and brought it over to the sink in the bathroom. I got N to press a piece of gauze over the insertion point while I removed the holding tape and pulled out the line. There was a big squirt of blood into the sink. I got a large fresh piece of gauze and put it in a better location, applying enough pressure to stop the bleeding. My arm was pretty bruised around the vein after having been in place for three days and used for three infusions. But that was a pretty minor inconvenience, all things considered.
Later on I gathered together all the leftover medical supplies that had been delivered. Even after allowing for spares for each item, there was a huge amount of extra, most of which hadn’t even been needed. This all had to be thrown into the garbage. Even though most were in protective sterile packaging, a clinic or the pharmaceutical company wouldn’t take it back, especially since they had been in a house infected with Covid. The pharmacy had an exact order of what I needed for two infusions. Why they packed so much extra into the box is beyond me. This was just another example of terrible waste in our medical system. Here’s a picture of all the extra medical equipment that had to be dumped into the garbage.
The following day I had a follow-up phone meeting with the nurse practitioner at the Covid Clinic. I reported that most of my original symptoms had improved and she seemed to think that I was doing pretty well. I told her my concern about the new difficulty breathing. She said that it was likely due to the inflammation that had been caused by Covid infection in the lungs. I asked if ibuprofen, which I’ve always found to be the best medicine to combat inflammation, would help but she said she didn’t think so and that I would just recover with time. Overall she did not seem to be too worried about my case and just scheduled another follow-up call for the end of the week.
As the week progressed, I seemed to be getting better each day. I still had some chest congestion accumulation overnight but it usually cleared without resorting to Robitussin. My breathing wasn’t fully back to normal but I knew from a past bout of pneumonia that lung infections are a slow recovery process that can take a month or two.
However I didn’t know if I was out of the woods. Many people who had Covid have reported “Long Covid”, symptoms that persist for three months and more.
Statistics Canada reported that nearly 15% of people who contracted Covid after Dec 2021 experienced lingering symptoms such as fatigue, shortness of breath or brain fog three months or more after their initial infection. This was a marked improvement from earlier in the pandemic when 25% of people who had Covid reported symptoms three months after their infection. It seems that the likelihood of Long Covid increases with the severity of the initial infection. Only 6% of those who rated their initial case as mild came down with Long Covid. What studies reveal about long COVID
Not a lot is known about what causes Long Covid or how to treat it. Research is being done but there do not seem to be very many conclusive results that lead to reliable treatment as of yet.
On my phone call at the end of the week with the nurse in the Covid Clinic, I asked about my risk for Long Covid. She said that I didn’t fit the profile. I was showing distinct improvement while people with Long Covid don’t get better at all. I was still concerned about relapse since my Covid antibodies are so low. She said I wouldn’t likely get reinfected by the same Covid virus that was still circulating in our house as we were recovering. There was a risk of reinfection from a different Covid variant but that would have to come from the outside.
The guidelines for self isolation for immunocompromised people were to stay at home for 10 days and until your symptoms were improving for at least 24 hours. I now met these conditions. It was the weekend and finally some nice, sunny weather after a rather long winter and dreary spring. Open Doors Toronto was on and we went out to see a few buildings of interest: the Ismaili Center which is adjacent to the Aga Khan Museum and the Canadian Film Institute which is the old estate of E. P. Taylor. It was nice to get out like a normal person.
News of the pandemic and Covid-19 cases have dropped off the front pages and largely out of the news for most of the last several months. You would think that the pandemic has passed and that not very many people are getting sick or dying.
However, if you look at the daily death rate from Covid in August, you’ll see that Covid deaths greatly outnumber deaths from automobile accidents and guns.
You can quickly see the Covid case counts in your area by clicking on the Layers icon in Google maps and selecting “Covid-19 Info”. Here’s the map for the New York City and New Jersey area, showing several counties in red that have high case counts (this feature is not available for Canada).
However, case counts are no longer a very reliable statistic for understanding the exposure risk in your area because Covid testing is not as widespread as it was in the beginning of the pandemic. One of the best indicators to see the extent of Covid is the number of hospitalizations.
So you still need to be careful about getting infected with Covid, especially if you are elderly or have any health issues. The best protection is still from a Covid-19 vaccine. But vaccines generally wain after 5 months, so if you are approaching that time since your last vaccination or booster, you should be considering getting another shot.
Quebec announced that it will be providing 5th doses of Covid vaccines in August.
However all existing Covid vaccines were developed to combat the original virus. That virus has not been in circulation for a long time. Currently almost all cases in Canada and the US are Omicron variants. Pfizer and Moderna have developed a new vaccine that specifically targets the Omicron variant. This vaccine will be a lot more effective than the current vaccines. https://globalnews.ca/news/8959603/moderna-seeks-approval-canada-bivalent-boosterd-booster/
However it is not clear when this vaccine will actually be available. So should you proceed with a 4th or 5th dose of the current vaccine or wait for the new one?
The following article suggests that you should get a 4th or 5th shot if you have not received a vaccine or recovered from a Covid infection in the past six months, because your immunity has probably waned.
However, if you have received a booster shot in the past and are under 50 without any underlying health conditions or have recovered from a Covid infection you can wait for the Omicron-specific booster.
The Omicron BA.2 variant is steadily increasing as a proportion of all cases and is dominant in some regions of Canada. This has started a sixth wave in Quebec and Ontario. The rest of Canada will follow soon. The same signs are not as strong in the U.S. right now but will likely follow this same pattern that started in Europe In January.
Here is a frank report by Colin Furness who doesn’t dance around to avoid criticizing government policy but tells it like it is.
“There’s no doubt a sixth wave of Covid-19 is sweeping across Ontario being driven by the highly transmissible BA.2 subvariant. At the same time restrictions have been lifted. We’ve opened the doors to a new variant, then eliminated all of our defenses.” Sixth wave in Ontario driven by lifting restrictions
Like most of the other pandemic waves Doug Ford ignored the recommendations of doctors and his own Science Table and implemented controls too little and/or too late or controsl that didn’t make sense (such as closing playgrounds!) because of his own political reasons, ignoring the principles of public health safety.
As any dummy with two eyes or even one eye can see, even though the number of hospitalizations in Ontario have come down a lot from the peak on Jan 23, the current number of people in hospital is still quite high and has started to go back up.
Removing the vaccine mandate was not actually a bad decision. The Omicron variant can inhabit the nasal passages of people who have been vaccinated. They might not get very sick with Covid or even know that they are infected but they can still pass on the virus to others. The rationale for a vaccine mandate was to provide safe spaces for people who were vaccinated where they could congregate with a low risk of being exposed to the virus. Since people can now catch the virus from other vaccinated people, a vaccine mandate no longer offers the same protection.
However, ending the mask mandate was really a bad decision. There is not a single doctor who agrees with this Ford government policy. .Masks are your last line of defense as summarized in this diagram from an earlier blog.
Everyone who cares about their health should be using a K/N95 mask for maximum 83% protection as summarized by the results in this recent study.
I have pointed out the shortcomings of public health and government policies on many occasions. Many doctors have also been critical of the poor decisions that have been made and recommended actions based on medicine and science. That is what one would expect. However, it seems that under the Ford government, political pressure has been used to “shut up” doctors who are too critical. When people hear about this type of suppression in China and Russia, they are incensed. So how can it happen here?
This is another dimension of how badly Ford and his government have handled the pandemic. At 8:17 in this video the doctor reveals that Doug Ford called the CEO of his hospital to complain about the medical facts that the doctor was saying to warn people. The doctor was soon fired from his role as Director of Critical Care at his hospital. How politics muzzled a doctor.
This was unbelievable. Canadian truckers received accolades around the world from Fox News, right wing U.S. senators and Trump himself to demonstrators in Paris and other cities. But amongst serious people in the world, Canada was a laughing stock. There is not a single country in the world that would have put up with a siege of their capital city and a blockade of its seat of government for this long a time.
How in the world did this all happen?
Fundamentally it was a Perfect Storm of Stupid decisions that just kept compoinding the issue into something that kept getting bigger than it ever should have.
Stupid #1
The Trudeau government brought in a vaccine mandate for truckers crossing the border into Canada on January 15. Was there any science behind this decision? I never saw any numbers.
In mid January there were more than 32,000 cases of Covid being reported per day in Canada (and probably many more since many people have not been able to get tested). About 90% of Canadian truckers were already vaccinated. Were the number of additional Covid cases that would be caused by an unvaccinated truck driver crossing the border make a significant difference? Not likely. Most epidemiologists didn’t think so either. https://www.cbc.ca/news/canada/truck-driver-vaccine-mandate-canada-1.6315936
The Trudeau government should have done this analysis and seen that that it didn’t make a lot of sense. As an incentive to get more truckers to get vaccinated, it would not have made much difference either. Most of the 10% of truckers who aren’t vaccinated had made up their minds by now.
The government also should have had some ears on the ground and realized that the strong willed truckers would react negatively to the mandate. Truckers had been given special consideration as critical workers throughout the pandemic and were exempt from vaccination requirements. This was not the time to change that status for so little gain.
In fact the whole Canadian mandate was a moot point. The US had instituted a vaccine mandate for truckers crossing into the US. It went into effect a week after the Canadian mandate but the net effect was that unvaccinated Canadian truckers could not cross the border into the U.S. So the net effect of Trudeau’s mandate was to prevent a few unvaccinated American truckers from crossing into Canada.
In the meantime various people in the trucking industry were organizing a convoy to protest the vaccine mandate. But the effect of their protest to get the Canadian government to remove its mandate was essentially just going to be for the benefit of unvaccinated American truckers coming into Canada. I wonder how many Canadian truckers who were driving across Canada to protest in Ottawa and other border crossings understood this?
It became the “Freedom Convoy”. But not a single trucker has had his freedoms revoked and been forced to get vaccinated. If a trucker felt he was being coerced into getting vaccinated because he wanted to do business across the border it was in order to comply with the U.S. mandate. Demonstrating in Canada to get the Canadian vaccine mandate for truckers removed would not change that.
At this point the Trudeau government should have seen how futile the Canadian vaccine mandate for truckers was going to be and just withdrawn it. But Trudeau had no vision or understanding of the dynamics.
In fact a retraction may not have dampened the truck convoy movement because the original protest had morphed into a general protest against intrusions into rights and freedoms. This was now a movement which was attracting all kinds of other activists like anti-vaxxers and white supremacists and it was getting millions of dollars in funding, much of it from the U.S.
As the truckers arrived and camped on Wellington Street in front of the Parliament buildings, their horns at full blast, Sloly was interviewed on CBC national news. He said that he thought this could not be handled by the police and would have to be dealt with by other means.
More and more trucks arrived and camped out on the streets creating a disturbance and a public nuisance that intimidated the residents who lived in that part of Ottawa. There was no attempt by Ottawa police to clear vehicles that had been illegally parked for days at a time.
Stupid #4
In the meantime, other trucker protests were tying up border crossings across the country, most significantly at the Ambassador Bridge between Windsor and Detroit. Day after day the NDP opposition in the Ontario legislature was asking questions about what the government was going to do about these blockades. Doug Ford was not even in the house. Nobody knew where he was and there were no statements coming from him.
A few days later some plants in Detroit which depended on shipments of auto parts from suppliers in Windsor were starting to shut down. Joe Biden called Trudeau on it, the governor of Michigan made statements that Canada needed to solve this problem quickly and some Michigan State legislators started to say that the U.S. auto industry should be using American sources for all its parts since Canada was unreliable.
Suddenly Ford appeared and announced that truckers who were obstructing traffic in Windsor would face fines up to $100,000 and jail time. It still took several days for the police to clear the bridge so that critical commercial traffic could flow again.
Ford also said that the truckers were staging an illegal siege of Ottawa and they shuld go home. But no real action followed. While Ottawa may be the capital of Canada, the federal government has no jurisdiction over the city. Ottawa is a city in Ontario and it is the province of Ontario along with the municipality of Ottawa that has jurisdiction over roads and highways in Ottawa, not the federal government.
Why did Ford do so little? He once again demonstrated, as he has so many times throughout this pandemic when he ignored recommendations of his own Science Table, that he is a petty little politician who does not act for the benefit of most of the people in Ontario.
The Result
In the face of this complete gridlock and no prospect of any movement, Trudeau invoked the Emergency Measures Act. The OPP finally sent in reinforcements to Ottawa along with police from Quebec and even some western provinces in order to end the blockade.
PSS (Perfect Storm of Stupidity) = Trudeau x Truckers x Sloly x Ford
The head of the Ottawa police chief has already rolled as did the chair of the Ottawa Police Service Board who hired him. Let’s see if any more heads roll as people come to see how badly this situation has been handled from start to finish. Two of the biggest heads however will continue to bobble and will not roll until the next elections roll around.
“Has Omicron peaked?” seems to be the number one news item.
If you look at overall case counts, it looks like the UK has peaked and is declining, following the pattern seen earlier in South Africa. In Canada and the U.S. people are hoping that the same pattern will follow, and soon.
Because of the shortage of Covid tests, many people who get Omicron do not get tested and so the number of reported cases is much lower than the true number of people with Covid. Here is the forecast for Canada that takes the unreported cases into account.
The January 4 blog predicted that Omicron would peak towards the end of January at about 125,000 cases and return to pre-Omicron levels at the end of February. The Canada forecast here is similar but with a sharper and more rapid peak and decline by the end of January.
If this forecast holds true, it does not mean the crisis will be over by the end of January. Hospitalizations and deaths lag the case counts by a few weeks. There has just been a sharp increase in ICU cases and deaths.
There was another informative email from Dr. Andrew Morris this week. If you haven’t read it, here are some of the key points.
– in previous waves we have seen “false peaks” where it looked like a peak was achieved, when really it was a temporary decline that preceded another increase in cases.
-people in Canada will unnecessarily suffer more from Covid because of a shortage of therapeutic agents (medicines that have been approved for treating people who are sick with Covid). We suffer from insufficient production, insufficient procurement, poor coordination, delayed approvals and mismanagement by some provincial officials.
– one reason Ontario hospitals are struggling is because it has very few hospital beds per capita.
Masks
Because Omicron is so much more transmissible than previous variants, it is highly recommended that people use an N95 or KN95 mask. These masks are almost twice as effective as the more widely used surgical masks or cloth masks.
However, a lot of K/N95 masks that are being sold, even from reputable sources, do not meet the standard of filtering 95% of particles. The following report shows the test results of many masks being sold.
The K/N95 masks generally make it harder to breathe and may be uncomfortable if you need to wear it for a long period of time. I initially used a N95 mask that had two ties that go over the head. I found this very awkward because it was difficult to undo enough of the mask to take a drink of water or wipe your nose. I switched to a KN95 mask that has ear loops which I found to be more flexible and also more comfortable.
More and more people are talking about herd immunity or the pandemic becoming endemic after the Omicron wave. This is all conjecture. I haven’t seen any science. Here is a way to estimate this.
1. Using the basic epidemiological model with an estimate of R0 = 10.0 for Omicron, herd immunity is reached when immunity of the population is at least 90%.
2. Canada’s vaccination rate is currently 78% of the whole population. Not many of the remaining unvaccinated people are likely to get vaccinated. After numerous campaigns, vaccine mandates and various other incentives, most of the unvaccinated are pretty firm in their position. Tracking the spread of the coronavirus in Canada
3. The number of people who have been infected with Covid and received natural immunity is currently about 3 million. Adding in an estimate for the uncounted cases during the Omicron wave will increase this to about 5 million, or 13% of Canada’s population.
4. The total immunity in Canada after the Omicron wave will be 78% + 13% = 91%. This is on the border for herd immunity.
However, because of increasing breakthrough infections in people who have been vaccinated, the effective level of immunity will be less than 91%.
It remains to be seen if Omicron is the last wave, but even if it is, many people will continue to get sick and die from Covid. This is an endemic state, similar to influenza. In 2018-2019, before the coronavirus pandemic, there were 10,000 cases of flu per week in Canada during the winter peak.
Since the major mode of transmission of the coronavirus is between people who are in proximity to each other, it seems intuitive that in societies where there are more crowded living conditions there would be more spread of Covid-19. Since the first days of the pandemic, people have suggested that the virus was spreading more rapidly in areas and countries that were more densely populated.
However this article, in a widely read usually responsible newspaper, argues that the relationship between population density and the spread of Covid-19 is a “myth” and has been “debunked”. Stop Blaming COVID-19 Deaths On Population Density
While there are quite a number of good arguments here, this is a classic case of someone forming his own conjecture without reading the science. I don’t think the reporter who wrote this article reviewed any of the many scientific studies that examined this question. This is a really good example of people who “do my own research” instead of studying the actual science. This lazy approach has been a big reason there has been so much misinformation circulated about the pandemic. It’s not easy to read some of the science. Published papers are long and dense with a lot of detail and you need to have some understanding of statistics to understand the research and the results. Read this for example. Temperature and population density influence SARS-CoV-2 transmission
The Huffpost reporter argues quite well that there are many reasons to explain the spread of Covid, such as – public health policy – residential overcrowding (which is not the same as population density) – work environments which increase the frequency of face-to-face interactions
But this does not mean that population density is not an important factor. There are many factors that affect the spread of a respiratory illness.
It does seem true that there does not seem to be a connection between Covid and population density at the country level. If Covid increased with population density, the data points on this chart. would form a line rising from left to right.
But when you look at a more granular level, at smaller regions within a country, there does seem to be a very strong relationship. There have been a number of statistical studies to try and analyze this more completely. One of the better papers concludes that
Population density and temperature are drivers of R0 at state level in the United States (p<0.001), but the effect of lockdown is greater.
The additional conclusion about temperature is that as temperature increases Covid cases decrease. This has been widely noted by epidemiologists who have pointed out that in winter, people congregate indoors more than in summer and this is an important factor that gives rise to the spread of all respiratory illnesses such as seasonal flu.
It’s pretty easy to see that population density drives Covid cases yourself. Charts on the next few pages show it for the U.S. and Europe. If you look at the Covid hot spots on the first map, it is usually an area of high population density on the second map.
People reporting on TV, from politicians to public health scientists, seemed to be alarmed and a bit surprised. They shouldn’t be. Shortly after South Africa reported the new variant Omicron at the end of November, they provided statistics that showed that the number of cases was doubling every 2-3 days. This is really simple math. You don’t need a sophisticated epidemiological model, you don’t even need a calculator to see the impact of this over a few weeks. If 4 people with Omicron arrived in Canada from South Africa before the variant was identified, those 4 cases could have spread to 32,000 people by January 1, 2022, which is roughly what the latest case count is for Canada.
There were early reports from South Africa that Omicron is less severe than Delta. But the population profile in South Africa is a lot younger than the UK, Canada and the U.S. It was not so clear that this pattern of milder infections would be true for older people who have been a lot more vulnerable to the previous strains of the coronavirus.
On Dec 22, a careful study was published by Neil Ferguson and his team at the Imperial College London. He is one of the pre-eminent epidemiologists in the world. The analysis controlled for many variables such as age and sex and concluded that the reduction in the risk of hospitalisation for Omicron relative to Delta was 40-45%. This now seems to be an accepted characteristic of Omicron. https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-50-severity-omicron/
But even if the probability of hospitalization is lower, when there are so many more cases than Delta, there may be an overall increase in hospitalizations. In fact, patient admissions to hospitals have now started to increase sharply.
This is what is alarming many public health officials. This trend could overrun the health care system. So, many regions are re-introducing social controls. While most governments are insisting that “lockdowns” are a thing of the past, in fact what we are seeing now is “creeping lockdowns”.
One thing that does not seem to be reported very clearly is how long this wave will last. In South Africa it seems that it peaked quite quickly and is coming down (see first graph) but that does not mean it will happen here.
To try and answer this question, I updated my coronavirus model for the Omicron variant with the following assumptions: 1. By January 9, Omicron will account for 90% of the coronavirus cases in Canada. 2. Omicron is 4 times as transmissible as Delta.
Based on this, it does look like the Omicron wave will peak more quickly and decline more quickly than the earlier waves. The peak is towards the end of January with cases returning to pre-Omicron levels at the end of February. What determines when the decline begins is when the total immunity based on both vaccinations and natural immunity from people who have had Covid reaches a critical threshold. This model is very sensitive to the assumptions, so the peak cases may be more or less than 100,000 depending on how effective the various new restrictions are in reducing social interactions and transmission of the virus.
One thing that some epidemiologists are saying is that almost everyone will get Omicron, even vaccinated people. I don’t see anything like this. The total number of people in Canada who had Covid-19 at the end of the Omicron wave in the model, both symptomatic and asymptomatic, is about 8 million people out of a total population of 37 million. So about 30 million people will not get Covid because they are being protected by the vaccine, in spite of many breakthrough cases. So it does not make sense from a health perspective to surrender, throw caution to the wind and not worry about getting infected because “everyone will get it anyway”. It’s hard to predict if you will have a mild case or not. In addition, very little is known at this point what the effect of Omicron is on “long covid”. With earlier variants, 5% of people who were infected have lingering symptoms for many months and in some cases much longer. What is my risk of getting Long Covid
The other thing some epidemiologists are saying is that this may be the last wave of the pandemic after which Covid will become endemic. It won’t disappear and will continue to infect people, but not at an epidemic rate, and will become more like a seasonal flu. However Dr. Fauci commented that most pandemics in the past have subsided after two waves, but Covid-19 has been unprecedented and has now proceeded to a fourth wave. So the most experienced experts in the field are really not able to predict what will happen. And the threat of another variant after Omicron is of course still possible.
