Isaac Bogoch Profile picture
Infectious Diseases physician and scientist, with thoughts on Infectious Diseases, Tropical Medicine, HIV Prevention, Public Health, and Global Health issues
papillon4444, rabble-rousing crone ๐Ÿ‡จ๐Ÿ‡ฆ ๐ŸŒˆ ๐ŸŽ๐Ÿ˜ทโ˜ฎ๏ธ Profile picture We're all in this together (separately) #staysafe Profile picture 3 added to My Authors
12 May
1/ A few #COVID19 vaccine updates for Ontario:

The province will receive 250K doses of AstraZeneca this month, likely reserved for 2nd doses.

Also, it is likely that those who received 1st dose of AZ *may* get a 2nd dose of an mRNA vaccine.

(Photography: Jay Kerr @bombippy)
2/ The push for vaccine equity by pouring vaccines into 114 heavily impacted postal codes was largely successful (to date), with a higher proportion of people receiving a 1st dose in those areas compared to other neighborhoods.

Good news, but the job isn't done.
3/ Pharmacies will massively expand their administration of mRNA vaccines (Pfizer/Moderna) with an aim to have ~2500 online (in all regions) vaccinating by the end of the month.

This will significantly push our vaccination rates higher & help with the rollout.
Read 6 tweets
11 May
Ontario is pausing 1st doses of AstraZenca vaccine today as per Dr. David Williams, the Chief Medical Officer of Health,

He cites:
1. Risk of thrombosis
2. Greater supply of mRNA vaccines

Those with 1st dose of AZ will either get a 2nd dose of AZ or perhaps an mRNA vaccine.
They cite the risk of blood clots (aka VITT*) as ~1:60000, based on Ontario data.

*vaccine-induced immune thrombotic thrombocytopenia
The time frame for VITT (blood clots) to develop is between 4-28 days following AstraZeneca.

More on VITT from the Ontario Science Table ๐Ÿ‘‡

bit.ly/3tDuee5
Read 5 tweets
6 May
1/ Ontario #COVID19 vaccine update (Take 2 - after twitter hack/drama):

Ontario has vaccinated >130000 people per day May 4, 5 & on track for this today too.

Over 40% of adults in the province have received at least 1 dose.

Some details on past few days & next few weeks ๐Ÿ‘‡
2/ We doled out a ton of AstraZeneca when eligibility dropped from 55 to 40 yrs, but then โฌ‡๏ธ supply led to โฌ‡๏ธ pace of AZ vaccination.

Currently there is very little AZ administered this week following recent public discourse.

I am happy for those who received this vaccine.
3/ Equity of vaccine administration was an issue earlier in April. There is ongoing prioritization of supply to heavily impacted neighbourhoods & it's working.

This graph was when 25% of vax supply went to hot spots.

Now hot spots get 50% of supply for the next 2 weeks.
Read 11 tweets
6 May
1/ A few #COVID19 vaccine updates for Ontario:

The pace of vaccination is picking up again.

>130000 vaccines were administered May 4, and >133000 today so far.

>40% of adults in ON have received a 1st dose.

Some thoughts about the past & future weeks๐Ÿ‘‡ Image
2/ People came out in droves for AstraZeneca when the age limit dropped to 40. We had a lot of AZ in the freezer at that time & now there is not much left.

(Much has been said about AZ since then. I am happy for people who received it)
3/ AstraZeneca administered via ~1400 pharmacies & primary care (family doctors & nurse practitioners) pushed our daily vaccine rate to over 130K/day. The pace slowly dropped as supply diminished.

AZ use significantly dropped yesterday & today, likely driven by public discourse.
Read 15 tweets
1 May
1. "Health Minister Patty Hajdu says her government embraces the concept of 'vaccine passports' & will come up with a form of certification to allow vaccinated Canadians to travel internationally."

Smart move & good to be proactive.

bit.ly/3eNTusr by @peterzimonjic
2/ There are a growing number of countries requiring proof of #COVID19 vaccination for travel...18 are currently listed here.

Also the EU just announced they would be open to vaccinated travellers from the USA this summer.

bit.ly/336woIo
3/ #COVID19 vaccine certification for travel will likely be a global norm:

Read 6 tweets
28 Apr
1/ A few points to clarify a few points...

These vaccines are really really good, but not perfect.

One dose of a vaccine provides excellent protection against #COVID19 infection, but of course 2 doses provide more protection.
2/ NACI outlines protection after 1 dose of a vaccine in their recent document:

"Most importantly, these studies show one dose of the Pfizer-BioNTech & AstraZeneca vaccines are
approximately 80% effective against hospitalization..."

Details: tinyurl.com/saby9kma
3/ Here is some of the data backing up NACI's statement above, but from a clinical trial.

This graph below is with Pfizer...look at how people start to gain protection ~12-14 days after their 1st dose (red line).

Pretty impressive.

Link: bit.ly/3aO00OR
Read 8 tweets
23 Apr
1. Ontario administered >125000 vaccines today.
2. Todays ~125K is not the final count, there are still a couple of hours left.

Yesterday ON vaccinated ~134K (that's 0.91% of ON population in a day).

By comparison, yesterday the USA vaccinated ~3.1 million (0.94% of USA population in a day).

We are catching up.
3. The provinces are all pretty comparable in administering vaccines delivered to them, with a range between 71% to 86% in arms.

Ontario has administered 81% of vaccines delivered to the province. Very much aligned with the others.

Source: bit.ly/3sJCuZA
Read 5 tweets
23 Apr
1. Ontario has prioritized pregnant individuals for #COVID19 vaccination (see below).

Really glad to see this happen - it's the right move.

(Expecting to hear further sign-up details from other Public Health Units shortly)

@TaliBogler *I think they mean "highest risk" below.
Read 6 tweets
15 Apr
A few points to clarify vaccine distribution in Ontario.

1. We get ~400K doses of Pfizer weekly. It shows up like clockwork. It gets distributed throughout the province in ~1-2 days & there is very little at the end of the week. This is administered at mass vaccine clinics.
2. We get several hundred thousand doses of Moderna every 2 weeks. Also rapidly shipped to locations in the province. For various reasons, Moderna shipments are occasionally delayed. There is very little Moderna in freezers at the end of the 2 weeks.
3. We have infrequent large boluses of AstraZeneca. This is administered by primary care in 6 Public Health Units, and by ~1400 pharmacies throughout the province.

It is available to anyone 55 years of age and older.
Read 17 tweets
11 Apr
1/ Eventually we will see a decoupling of new #COVID19 cases from hospitalizations as population-level immunity grows (through vaccination & recovery from natural infection), especially among those at greatest risk for more severe infections.
2/ But with variants of concern driving more explosive outbreaks, causing more significant symptoms & impacting younger people, this decoupling of new cases from hospitalization will require more widespread population-level immunity.
3/ No fear mongering or 'sky-is-falling' rhetoric here, but a 4th wave is certainly possible if we rapidly & prematurely re-open as we exit wave 3, especially if we don't have a significant degree of population-level immunity at that time.
Read 7 tweets
7 Apr
ANYBODY in Ontario who lives in a high burden neighbourhood who is 18 years and older will be eligible for #COVID19 vaccination.

This will help essential workers, families, communities, etc.

A very smart move.
Mobile teams to help bring the vaccine to the people. This will happen in workplaces, congregate settings, dense urban areas, etc.

1. More access to vaccine.
2. Lower barriers to vaccination.
This is the part of the Phase 2 Vaccine roll out that prioritizes communities at greater risk.

Link: bit.ly/2R5Ffaj
Read 7 tweets
6 Apr
1/ Ontario's Phase 2 #COVID19 vaccine rollout prioritizes:

1. Those at risk of having a severe outcome from infection (e.g. age, medical comorbidity).

2. Those at risk of getting infected (e.g. essential workers, shelters).

3. Communities disproportionately impacted.
2/ That is a lot of people in Phase 2. While vaccines are pouring into the country & the province, it is still not enough to flip a switch and prioritize everyone at once in this Phase.

Still, it has started and will gear up substantially given the recent large shipment.
3/ I am hesitant to put in the slide with the tentative dates of each part of Phase 2, as there is an important caveat at the bottom that often gets missed:

"All timelines subject to supply availability"

We now have more availability so this will be moving faster.
Read 8 tweets
24 Feb
Some highlights of Ontario's #COVID19 rollout:

1. Centralized online and telephone booking to start in mid-March.

2. Mass vaccine clinics & community centers will be a major focus for vaccinations.

3. Pharmacies will administer 10-20% of vaccines, and scale up further.
4. Each Public Health Unit expected to vaccinate a minimum of 10K people per day.

5. Larger Public Health Units will vaccinate significantly more. E.g. Toronto expected to vaccinate 400K per week when things get rolling, through 9 mass vaccine sites.
6. Details of the prioritization within Phase 2 (e.g. underlying medical conditions, etc) will come out shortly.

The task force has submitted their recommendations to Cabinet. This will be publicly released asap when approved.
Read 7 tweets
17 Feb
1/ @nature asked over 100 scientists if they felt that #COVID19 was going to become endemic & circulate on earth for years to come. ~90% felt this was a likely or very likely scenario.

Link: go.nature.com/3aquiaw
2/ Why will #COVID19 be around for a while? A few reasons....

*It is very contagious
*Mild-to-no symptoms in many (harder to identify cases)
*Significant pre-symptomatic transmission
*Non-animal reservoirs of the virus
*People can get re-infected

...more below...
3/ cont....

*Vaccines reduce the risk of infection but do not prevent infection all the time

*Vaccines may reduce risk of transmission but likely not all the time

*Slow/inequitable global vaccine rollout

*I'm sure there are many other reasons...

๐Ÿ‘‡
Read 8 tweets
11 Feb
1/ Tocilizumab appears to reduce the risk of death in those hospitalized with severe #COVID19 infection, with results from the RECOVERY trial available today.

This is an anti-inflammatory/immunosuppressive medication, used in rheumatic diseases.

๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡

bit.ly/3p7725v
2/

2022 patients were randomized to receive tocilizumab; 2094 to receive standard care. 80% of the participants were using dexamethasone.

596 (29%) in the tocilizumab group died within 28 days VS 694 (33%) in the usual care group.
3/

"Tocilizumab also increased the probability of discharge alive within 28 days from 47% to 54% (rate ratio 1.23, [95% CI 1.12 to 1.34], p<0.0001)."

"This means that for every 25 patients treated with tocilizumab, one additional life would be saved."
Read 6 tweets
31 Jan
1/ Many are talking about gradually lifting public health measures as #COVID19 cases are dropping in Canadian settings.

What is needed to avoid undoing our collective efforts & sacrifices as we reopen? And how do we account for more transmissible variants (eg B.1.1.7)? ๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡
2/ We often hear people say that because of the more transmissible variants we need to "double down" on control efforts & vaccinate.

What exactly does doubling down mean?

It most likely means keeping R at (or preferably below) 0.8 to account for greater transmissibility.
3/
Maintaining R at/below 0.8 would likely allow for a continued decline in cases as we see more B.1.1.7 circulate.

So what questions do we need to address to gradually & safely reopen in the context of community #COVID19 transmission & growing burden of B.1.1.7?

A few Q's๐Ÿ‘‡
Read 11 tweets
30 Jan
1/ What is the #COVID19 situation like in Canada now?

Cases are down & the situation is improving in much of the country, but we still have a long way to go.

A few additional thoughts below...
2/ Most of the country has recovered from peaks in December or from a post-Christmas peak.

A few examples below Nationally & in AB, ON, QC.

Despite outbreaks in Eastern Provinces, cases still remain low there.

From: bit.ly/2Yul9qY
3/ Long Term Care - a significant black eye for Canada, is also improving. We failed to protect our most vulnerable (twice!), but cases are rapidly declining, perhaps mirroring reduced community transmission, widespread vaccination, or both.

Read 13 tweets
29 Jan
1/ Johnson & Johnson #COVID19 vaccine results are out.

As per press release, preventing both moderate & severe illness 28 days after vaccination:

-66% Overall
-72% USA
-66% Latin America
-57% in South Africa

bit.ly/3pwTWiW
2/ Important point:

"85% effective overall in preventing severe disease & demonstrated complete protection against #COVID19 related hospitalization and death as of Day 28"

If this can keep people from getting very sick/prevent hospitalization/death then this is an obvious win.
3/ This is a single dose vaccine, requires conventional refrigeration for storage & would be much easier to administer to populations.

Canada has access to this vaccine.
Read 4 tweets
29 Jan
The Novavax vaccine has excellent efficacy (~90%) against symptomatic #COVID19, where ~50% of cases were from the variant discovered in the UK (B117).

But it only had ~60% efficacy in the variant discovered in South Africa (B1351). bit.ly/3puHOiH

A good explanation๐Ÿ‘‡
60% efficacy against B1351 is decent, but not amazing.
Important to point out that the numbers are still very small in this trial & this could change with more data. Also if the vaccine prevents severe #COVID19 disease (which it likely does), it would still be extremely helpful.
Just to clarify, in the South Africa study, efficacy is ~60% in those who were HIV negative, ~50% in entire trial including HIV+ individuals.

Still, no severe disease seen in #COVID19 cases confirmed to have B1351 (variant discovered from South Africa) in those vaccinated.
Read 4 tweets
25 Jan
"Vaccination with the Moderna #COVID19 Vaccine produced neutralizing titers against all key emerging variants tested, including B.1.1.7 and B.1.351, first identified in the UK and Republic of South Africa, respectively."

**Translation: This is really good news.**
(Also, yes this is science by press release, but see how they included valuable information/data here?)
There may still is an attenuated response to the variant discovered in South Africa, but it appears the vaccine will still provide some protection - and there is a lot more to an immune response than these antibodies.
Read 6 tweets
23 Jan
1/ Colchicine may be an effective treatment for #COVID19.

In a well designed trial (prospective, randomized, >4000 people) colchicine "resulted in a 25% decrease in hospitalizations, a 50% decrease in the use of ventilation & a decrease in deaths by 44%.โ€œ bit.ly/39Vwpls
2/ This was in non-hospitalized patients with confirmed infection.

Standard caveats: Press release, no preprint data, etc.

Colchicine is a cheap, widely available pill.

If this pans out it will be very helpful - works via anti-inflammatory (& immunomodulatory?) mechanism.
Also, I'm still baffled that a pre-print (with actual data/analyses) could not be made available at the time of press release. That should be standard.
Read 6 tweets