Ask the Pharmacist – COVID updates

Q) Every day I am bombarded by updates regarding the pandemic and efforts to mitigate its effects. It’s hard to keep track of it all. What were some of the stories that caught your attention?

A) It really is difficult to keep track of the ever changing news regarding this epidemic. The past week or so has brought a real “mixed-bag” of updates with some being of a very encouraging nature and other headlines leaving one to shake their head in frustration.

One of the more positive developments has been the rapid decrease in case numbers in Ontario. If you can recall, it was just a little more than two weeks ago that the new modelling for Ontario predicted that daily case numbers would average 6,000 by the end of January and that our intensive care units would be overwhelmed by early February. Instead, almost undoubtedly due to the lockdown, we have gone from 3,840 cases back on January the 4th to 1,958 on the 25th and 1,670 on the 27th. Clearly, the lockdown, as distasteful as it can be and as damaging as it has been for many of our local businesses, is at least achieving its intended goal.

This is all the more remarkable due to the fact that the far more contagious variant known as B117 (formerly known as the UK variant) is clearly here in Ontario and is expected to be the dominant version in our province by the end of March. As of January 31st, there were already more than 50 plus confirmed cases in Ontario and quite possibly hundreds more will be detected once the DNA sequencing is completed.

The emergence of this more infectious version (it is estimated that it is at least 56% more transmissible) has caused experts to, once again, reconsider their mask recommendations. These changes in guidelines are frustrating but they reflect the fact that viruses change as they evolve not unlike any other living organism.

Canada currently recommends the use of three-layer non-medical masks (two layers of the mask should be made up of a tightly woven fabric such as cotton/ linen with a middle layer made up of a filter-type fabric) but has not updated its recommendations since last November, before there was any hint of these new variants. These cotton type masks filter out approximately 50% of the particles we breathe in but some epidemiologists believe we are at the stage now where we need to up our mask game. As such, they are recommending surgical masks like the ones used at dental clinics (or of course an N95 type mask if you can procure one) which filter out more particles and provide, even more importantly, a better fit.

How do you know when you have a good fit? Well, the mask should expand and contract as you breathe so that air is going through the mask rather than out the sides. One way to help ensure a better fit is to wear a second mask at the same time. This recommendation is not so much about filtering out even more particles but rather to make the mask that is closest to your skin fit more snugly. If you’re wearing a well-fitted mask, this suggestion provides no extra benefit, but there are many masks seen around town that do not exactly grip the face.

The recommendations are also changing as to where you should wear a mask. While outdoor transmission is still less likely than in confined spaces, areas such as San Francisco and New Brunswick have now mandated outdoor mask use. There have been a number of documented cases of outdoor transmission in Canada with the original version of the virus and while the risk is still low, some experts are suggesting wearing at least the more comfortable cloth masks when walking outside in more crowded areas like downtown streets or popular hiking trails. None of this is fun, but the end is in sight, although not as close as it appeared to be a few weeks ago.

Of course, this is in reference to the sudden, uncertain supply of COVID vaccines that Canada and many other countries are facing. With having vaccinated only 2% of our population, we have a long way to go in order to achieve herd immunity and put a more permanent stop to these interminable restrictions.

Most of us by now have heard about the Pfizer vaccine delays (they have cutback deliveries by about 67% since mid-January and is shipping roughly 80% fewer shots over the next 4 weeks than originally promised) as they retool their Belgium facility but, this week, brought news that the only other approved vaccine in Canada at the moment, by Moderna, is also having “issues”. They will only ship about 3/4 of the expected supply to Canada for the month of February.

The Canadian government still insists they will meet their target of vaccinating 6 million people by the end of March, but the task to make this happen looks daunting to say the least. As for vaccinating all of Canada (at least those of us who are willing and able) by the end of September as was the original plan? Well, we will have to ramp up our administration schedule from the one million doses a month we are currently doing to roughly one million a week which seems rather unlikely.

Is the government to blame for this? Hard to say but, right now, we rank 21st in the world and are behind countries like Portugal, Lithuania and Poland who have no internal vaccine production either and lack the formidable resources that Canada has been blessed with. Tough questions will need to be asked down the road.

Overall how has Canada’s response been? Well, a non-partisan Australian think tank ranked Canada 61st out of 90 countries with New Zealand being the best and Brazil finishing last. Countries were ranked on testing, infection rates and mortality rates among other parameters. Once again, this does not seem like a great score given the many advantages this country has. There have been so many other points of discussion over the last week that it’s hard to know when to stop.

Other newsworthy items that bear mentioning are the new travel rules soon to be put in effect to reduce the variant from taking hold. As well, Pfizer’s attempts to reclassify their vaccine vials as containing six doses rather than the five that they originally labeled them as (apparently one can get 6 doses out of a vial if a specialized syringe known as a low dead space syringe is used, but these, like the vaccines themselves, are in short supply). In this way, Pfizer could receive all of its expected revenue while delivering 1/6th fewer vials.

It’s nice to see that in this world of turmoil some things don’t change. Greed is apparently alive and well in the pharmaceutical industry. For more information about this or any other health related questions, contact your pharmacist.