Thread by @jeffgilchrist

COVID-19: Impact of being unvaccinated with limited public health measures

This is a long thread which is aimed at providing facts and not focus on blame of individuals so please read all the way until the end to get the full details. 🧵1/

If a person has not received a COVID-19 vaccine for whatever reason (not eligible, barrier to access, personal choice, medical exemption) there are very real impacts to the community that can now easily be seen when few or no public health measures are in place. 2/

To save space I will refer to that person as unvaccinated, even though they may have been vaccinated for other viruses. 3/

1. Increased transmission

The Delta variant is very transmissible and infects people who are unvaccinated at a rate 7 times higher than those who are fully vaccinated for ages 18-59 and 15.8 times higher for children 12-17 ( gilchrist.ca/jeff/COVID-19/… ). 4/

The unvaccinated are also infected 14.5 times higher for adults 60-79, and 29.2 times higher for adults 80+ ( gilchrist.ca/jeff/COVID-19/… ). The vast majority of infections are currently being driven by the unvaccinated ( theatlantic.com/ideas/archive/… ). 5/

2. Increased chances for new variants

With increased infections there are more chances for the virus to mutate and create potentially even more transmissible and deadly variants of the virus (

https://twitter.com/tryangregory/status/1438540148296331265?s=21

). 6/

The unvaccinated make up the majority of people who are now infected and viral loads stay higher for longer periods of time leading to additional chances for mutation every time the virus replicates ( medrxiv.org/content/10.110… ). 7/

3. Infecting others who are at higher risk for complications

You can't transmit the virus to someone else if you are not infected. Fully vaccinated people are 85% less likely to become infected than someone who is unvaccinated for ages 18-59. 8/

Fully vaccinated are 93.7% less likely for children 12-17, 93.1% less likely for adults 60-79, and 96.6% less likely for adults 80+ ( gilchrist.ca/jeff/COVID-19/… ). 9/

Even someone who may be at lower risk for complications themselves if they get infected could infect others who are at higher risk and those people are now ending up in the hospital, ICU, and some are dying. 10/

4. Health care system collapse

Unfortunately we have real world examples in Canada of what happens when our elected leaders make bad policy choices which lead us into this disaster. Look no further than Alberta and Saskatchewan whose health care systems are collapsing. 11/

ICUs have become full and hospitals are overflowing with COVID-19 patients, most of whom are unvaccinated. 12/

Although it is still possible to become infected at a much lower rate, the fully vaccinated are 90% less likely to be hospitalized and 97% less likely to be admitted to the ICU if they do become infected ( gilchrist.ca/jeff/COVID-19/… ). 13/

With hospitals full and health care workers overwhelmed there have been mass cancellation of surgeries including urgent, children's cancers, and transplants so now others will continue to suffer and possibly die due to the overflow of unvaccinated patients now hospitalized. 14/

While Alberta's triage protocol has not been fully implemented yet, doctors are already rationing care ( cbc.ca/news/canada/ed… ). 15/

Major components of triage have already begun in the province including critically ill COVID-19 patients who should be on ventilators not getting them. 16/

Patients are being kept on main wards rather than in ICUs because they don't have the resources, and are not brought to the ICU until they absolutely deteriorate to the point of crashing. 17/

"People will suffer and will die by this." Sadly, one of the reasons why the ICUs have not been completely overwhelmed already is due to the number of patients dying in the ICU and freeing up space for new patients. 18/

In Alberta, an additional 195 ICU spaces have been created to accommodate the influx of COVID-19 patients by taking over operating rooms (one reason for mass surgery cancellations) and reassigning staff (another reason). 19/

The problem is that nurses and other specialists aren't interchangeable and ICU staff have very specialized training that takes time to learn (

https://twitter.com/matthewjdouma/status/1442224242209157120

). They may have the same core knowledge but a different area of expertise. 20/

It takes 4.2 ICU nurses to keep an ICU bed open so if the military sends 8 ICU nurses to help full-time they will not be able to keep 2 full ICU beds open consistently. 21/

To staff those extra 195 ICU spaces the province needs around 800 additional fully trained ICU nurses. If a nurse gets deployed from another department they may only be 30-60% effective depending on training and in addition an ICU nurse will need to supervise and train them. 22/

Redeployed nurses aren't the solution that is needed, better public health measures are. Even though Alberta has now re-introduced a set of new public health measures and a vaccine passport, deaths from COVID-19 continue to grow. 23/

Alberta deaths are running at 3.4 times higher than the Canadian average while Saskatchewan is close by at 3.3 times higher ( cbc.ca/news/canada/ed… ). 24/

Alberta continues to lead the country in active cases accounting for almost 50% of active cases in the entire country despite only having around a tenth of the population. 25/

It is unfair to shift all of the blame on individuals who are unvaccinated and away from our elected leaders who made these bad policy choices to remove/reduce public health restrictions even with many experts warning them this would happen (

https://twitter.com/awong37/status/1442508959001182209?s=21

). 26/

Good policy can help reduce death and lower suffering. Despite calls for a hard lockdown in Alberta to help reduce numbers more quickly and get things back under control, the premier rejected the idea so bad policy continues. 27/

In Ontario, the vast majority of those infected, hospitalized, and admitted to the ICU are also unvaccinated and they are adding an increasing burden to our health care system as well ( gilchrist.ca/jeff/COVID-19/… ). 28/

Since many public health measures including universal masking indoors remain in place and vaccine passports have been implemented, the amount of transmission has so far remained much lower than Alberta and Saskatchewan. 29/

Last week the Ontario Human Rights Commission released a policy statement on COVID-19 vaccine mandates and proof of vaccination certificates ( ohrc.on.ca/en/news_centre… ). 30/

It states that some people are not able to receive the vaccine for medical or disability-related reasons and under the Code and organizations have a duty to accommodate them, unless it would significantly interfere with people's health and safety. 31/

COVID testing as an alternative is an acceptable accommodation for this group. 32/

Importantly the OHRC points out that while receiving a COVID-19 vaccine is voluntary, "a person who chooses not to be vaccinated based on personal preference does not have the right to accommodation under the Code." 33/

"The OHRC is not aware of any tribunal or court decision that found a singular belief against vaccinations or masks amounted to a creed within the meaning of the Code." 34/

OHRC states while the COVID-19 vaccine is readily available in Ontario, there are still barriers that exist which need to be addressed including:
- Older people or people living with disabilities may have difficulty booking or going to their vaccine or testing appointment
35/

- Low-wage workers with multiple jobs and caregiving responsibilities may lack the time or resources to prioritize visiting a vaccination site or taking a COVID test
36/

- Individuals and groups who have faced discrimination or traumatic experiences while receiving health-care services may not trust vaccines or testing
37/

Sabina Vohra-Miller (

https://twitter.com/SabiVM/status/1442523820900880393

) and colleagues created this infographic to help people navigate the sea of information out there for what are valid reasons for a medical exemption ( uwaterloo.ca/pharmacy/sites… ). Most people can safely get a COVID-19 vaccine. 38/

It also helps explain situations that are *not* reasons for exemption from getting the vaccine such as being pregnant, fertility, breastfeeding, allergies to other vaccines, other anaphylactic allergies, serious health conditions, and medications that affect the immune system.39/

If you are eligible to be vaccinated and do not have one of the few valid reasons for a medical exemption, please realize that the impact of your personal choice is not just limited to you but potentially many others in your community as well. 40/

Consider getting vaccinated to not only help protect yourself from serious illness and potentially taking up a bed in the hospital or ICU, but also help others around you by reducing the chance of becoming infected in the first place, ... 41/

... reducing the chance of creating a more dangerous variant, reducing the chance of infecting others, and helping to prevent hospitals from becoming overwhelmed so that others can get the non-COVID related surgeries and urgent care that they need. 42/