Ask the Pharmacist

Q) I heard on the news that Theresa Tam has announced that Canada is now officially in the 4th wave of the pandemic. How is this possible given all the vaccinated people we have?

A) Yes, Dr. Tam, Canada’s chief public health officer, announced last Thursday what many of us who had been tracking case numbers already feared; Canada is now in the midst of yet another wave in this pandemic which officially makes it our fourth.

Canada’s 7 day average for new daily cases was 1,984 as of August 16th, which compares unfavourably with the 1,300 daily average back on the 11th of August which in itself was 60% higher than the previous week. The trend is unmistakeable. All of the “waves” have differed somewhat from each other and the fourth promises to be the most unique one yet for a number of reasons.

First and foremost is the variant of this virus that is driving this rise. Though it is still technically being caused by COVID-19, the new version that is better known as the Delta variant is the most troublesome one we have come across so far. This will likely be a trend with other new variants that arise in the future (yikes!). Much like all living things, the virus will continue to adapt to their surroundings in order to survive. Adapting, when it comes to viruses, is just another term for becoming more contagious.

The Delta variant was first detected in India just last December and as of July 11th was responsible for 78% of all cases in Canada. In the US, the number is pegged at 93% of all new cases. Comparing this to the week of May 9th when it accounted for only 8% gives you a fairly clear indication of just how dominant this strain has become relative to the three versions that came before it. In the words of one virologist, all variants have a super power that makes them more dangerous than their originator.

Delta’s superpower is transmissibility. Chinese researchers have found that people infected with this variant carry 1,260 times more virus in their nares (the medical term for nostrils) than the original version of the disease. In real terms, this helps make the Delta variant about 50-60 percent more contagious than the Alpha variant (the one first discovered in the UK) which itself was 50 percent more contagious than the original virus. The Delta virus also has a much quicker onset of action. Delta can cause symptoms two to three days faster than its predecessors which means that our immune systems have even less time to mount a defence. The nature of these symptoms initially tends to be different as well.

Whereas the onset of the original was similar to the flu, those infected with the Delta variant at first feel more like they are suffering from a summer cold. The majority of these new cases start out with the sniffles and a sore throat. Eventually most of the significant symptoms are very similar (shortness of breath, extreme fatigue…) but those with the Delta seem to be less likely to lose their sense of taste or smell or suffer from a cough.

As for the severity of the Delta variant, a study published June 14th in the prestigious medical journal, The Lancet, found that the risk of hospitalization from this variant based on data from Scotland was roughly doubled when compared with people infected with the Alpha variant. Recall that the Alpha variant was more virulent than the original version. Are you sensing a pattern here???

England’s data is even worse indicating a 2.61 times greater chance of forcing you to be hospitalized if infected with it. Now, in the interest of fairness, researchers will only go so far as to say it is “likely” more severe than other versions since some of these increased numbers of hospitalizations can be attributed to its increased contagiousness.

Regardless, Delta is not a joke and needs to be taken seriously as we have indicated over several previous columns. If this isn’t bad enough, there are now reports emerging from some scientists of a Delta Plus variant which has an additional mutation that apparently has been shown to evade immune protection from either vaccines or a previous COVID infection.

On the positive side, there is some good news as well. Our vaccines do offer strong protection against Delta. They are particularly strong at preventing severe illness or death from this variant. In the case of the Pfizer vaccines, two doses were about 80% effective against preventing infection, 88% effective at preventing symptomatic disease and 96% effective against hospitalization with the Delta variant. As well, the hospitalized patients seemed to be milder cases on the whole.

Public Health England has stated that AstraZeneca’s two dose regimen is 92% effective at preventing hospitalization. As for Moderna’s vaccine, a lab study has released the surprising revelation that this vaccine is capable of producing even greater antibody responses to Delta than it did against the Beta variant. This seems to be supported by real-world data since a study carried out by New York researchers suggested the vaccine was 94 to 95 percent effective in preventing COVID-19 with the Delta variant.

Note that none of these numbers are 100%.

That means that you may still become infected with COVID despite being fully vaccinated. In the unlikely event that a fully vaccinated person does become infected with the Delta variant, the CDC has warned that those persons may be as contagious as the unvaccinated to those around him/ her due to Delta’s ability to at least partially avoid antibodies produced by a vaccine or previous infection. These vaccines and the dominance of the Delta variant are the main reason our 4th wave is likely to look so dramatically different than the previous waves.

As you have undoubtedly heard by now, this 4th wave is going to be a wave reserved almost exclusively for the partially (i.e. one dose only of vaccine which may be only 35% effective) or the unvaccinated people among us. Concrete proof of this point can be found in the latest federal public health data which indicates that roughly 90% of all COVID-19 cases reported in Canada since the start of our national vaccine program back in December have been among unvaccinated individuals. Just 0.5% of cases have been in fully vaccinated people and the breakdown for hospitalizations and deaths are remarkably similar.

Data like this makes one wonder how one can argue against the effectiveness of these vaccines. With roughly 60% of Canadians being fully vaccinated, there is hope that this wave will not overwhelm our health care system nor wipe out scores of seniors in our long-term care homes. Our case numbers could eventually be at an all-time Canadian high given how infectious this virus is, while still limiting (but certainly not eliminating) the numbers we see requiring hospitalization or worse.

The fact that 40% of Canadians (including all children under the age of 12) is still unvaccinated, there is still plenty of potential for our hospital capacity to be stretched very thin indeed. This is especially so because many public health restrictions are at risk of being removed as provincial governments grapple with the political costs (take Mr. Kenney of Alberta as an example!) of continuing such proven effective measures as indoor mask wearing in light of the fact that a number of their core supporters are adamantly opposed to any restrictions on their “rights”.

And with schools set to re-open in September, there is the potential for a catastrophe. Dr. Isaac Bogoch, an infectious disease physician and a member of Ontario’s COVID-19 task force, believes that if Ontario were to drop all such measures, we could have 20,000 ICU admissions within 6 to 8 weeks. Hopefully, Doug Ford will continue his recent trend of acting like a real leader and make the tough decisions that politicians should have to make.

We, as citizens and as frustrated as we may be by the unvaccinated among us that continue to perpetuate this pandemic, must not lose our sense of humanity for those that fall sick. Remember that there are lots of us who cannot be vaccinated or did try the one dose and had a significant enough of an adverse reaction that they have been told not receive their second dose. But, even for those who are unvaccinated by choice, no one deserves to get sick. This does not make them “bad” people. There are likely people in your life that are friends, family, co-workers etc., whom you may like and respect a great deal despite the fact that their vaccine beliefs could not be any further apart than your own.

Hopefully, we will not allow these singular points of difference in opinions impede our ability to care for each other as members of a community. This isn’t too dissimilar when we learn of a smoker who gets lung cancer; we continue to show compassion and empathy for them as nobody ever deserves to get sick. This holds true for those people that are unvaccinated if they are unfortunate enough to get seriously ill with COVID. Let’s be proud to live in Canada and hope that as citizens of this country we will always be “all in this, together”. For more information about this or any other health related questions, contact your pharmacist.