PERSPECTIVES

Drs. Chagla and Bhandari discussed the recent trends in the COVID-19 pandemic, updates for vaccines and the potential for societal reopening after mass immunity strategy. Our discussion uncovered 3 core themes. These themes and their supporting insights are highlighted below.

1. Second Wave of COVID-19 Infections in Canada

As of November 23, the coronavirus cases in Canada have been over 310,000 (Coronavirus Cases). For about a week, there have been above 1,400 daily new cases of COVID-19 in the two most hit provinces, Ontario and Quebec. There has also been a significant rise in infection rates in provinces that were not hit hard in the first wave, including Manitoba, Saskatchewan, Alberta, and some regions in British Columbia, within a short period of time.

During summer, several factors protected people from respiratory viruses including less congregation, being outdoors more and being more dispersed than in winter. Unfortunately, winter is when respiratory viruses come back because these conditions are not easily met. There are balanced priorities including reopening schools and most businesses, and for the healthcare system, resuming surgeries and providing routine care as appropriately as possible. The Canadian society is responding to the pandemic with measures such as wearing masks, social distancing and getting tested for COVID-19 infections.

The mortality rate of COVID-19 has gone down between the first wave and the second wave but the exact reasons for this are still unclear. Dr. Chagla shared a few theories that may explain the reduction in mortality rates. First, currently with an improved treatment strategy of early, non-invasive ventilation and high-flow oxygen, many of the hospitalized patients can get through the disease. Second, the RECOVERY trial conducted in the United Kingdom has shown a significant benefit of giving dexamethasone to those who are hospitalized and on oxygen, and even more of a benefit for those who need mechanical ventilation. The practice of giving dexamethasone based on the finding of this study has changed the initial high mortality. Third, with evidence-based guidelines and a streamlined pathway of appropriate drugs now becoming available, compared to giving random therapies to patients without knowing their efficacies in the first wave, a reduction in mortality has been observed.

2. Study Results of Vaccine Efficacy

Pfizer and Moderna announced about 95% efficacy rate of their vaccines in the real world clinical trials via press release. Some of these studies involved elderly participants. In Dr. Chagla’s opinion, the results indicated significant effects of what a vaccine can achieve, and was much more than what the government's expectations were for a vaccine at 50% efficacy.

3. When Will the Vaccine Be Accessible

Dr. Chagla believed that it was a prospective sign for the COVID-19 vaccine to become available as the Pfizer studies reached a 162-patient threshold (announcement released on November 18) and started applying to the Food and Drug Administration (FDA) for emergency use authorization. Another vaccine based on the adenovirus vector model and developed by Oxford University and AstraZeneca will be also released on November 23 (News).

Dr. Chagla shared that from sources including the Canadian government and the Ontario government, vaccines will be showing up in Canada as early as January 2021.

Dr. Chagla explained that with the vaccination strategy moving forward, as well as after people from vulnerable sectors and healthcare workers all receive the vaccine hopefully by the end or mid 2021, we will start to see the calm of COVID-19 becoming a manageable disease, where the hospitalization rate will be low, and the death rate will be even lower.

SENSE-MAKING

Dr. Chagla shared the potential reasons for the second wave of COVID-19, theories that possibly explained a lower mortality rate compared to the first wave, prospect of COVID-19 vaccines and estimated “back-to-normal” time after mass vaccination next year in 2021.