COVID-19 update, Nov 21,2022

Many (if not most or even all) regions of Canada are facing significant pressures on the health care system due to increases in respiratory virus infections:

  • COVID-19 continues to circulate at fairly high levels throughout the country. While there has not been a corresponding increase in hospitalizations or deaths (likely as a result of high levels of population immunity associated with vaccination and/or recent infection), emerging new strains (such as BQ.1 and BQ.1.1) could change this, as they are associated with even higher levels of transmissibility and immune escape compared to the currently predominant strain (BA.5).
  • Influenza has reached epidemic levels earlier in the season than usual and case counts are quite high (in Canada, influenza is characterized as an epidemic when test positivity rates exceed 5%. This generally occurs every fall, but has not over the past two years presumably as a result of COVID-19 mitigations that were in place). As has always been the case with influenza, there is a higher risk of severe clinical outcomes (severe symptoms, hospitalization, death) associated with factors such as age, comorbidities, immunosuppression, and certain social/economic factors.
  • RSV (Respiratory Syncytial Virus) infections have reached much higher levels than what has been the historical norm. RSV can infect people of all ages, and infection rates typically peak in the autumn. In most adults and older children, RSV infection results in cold/cough type symptoms. However, in younger children, more severe symptoms can arise such as croup/wheezing, which may lead to ER visits or hospitalization. Adults can transmit RSV to children, so this virus is a concern for the entire community. One theory for the significant increase in cases compared to the average is that for the last 2 fall seasons, there has been very little circulating RSV (again likely related to COVID-19 restrictions and mitigations in place), so several years’ worth of young children are being exposed to RSV all at the same time instead of having the same number of cases spread over several years).

The upswing in respiratory virus infections is also occurring in the context of other concerns that we have noted previously, including:

  • Changes in public health guidance: As you know, Ontario (and other jurisdictions) have altered isolation requirements, raising concerns that individuals with infections are less likely to remain at home when sick and may be more likely to be present in the workplace or other public spaces (thereby increasing community infection transmission). 
  • Suboptimal vaccine uptake: The proportion of Canadians who have remained up to date with their COVID vaccinations has declined over time. This is a particular concern in light of the next point.
  • Decreasing effectiveness of the immune response over time on a population level (as time since last vaccination and/or infection increases, the protection afforded against infection declines (however, the protection against severe outcomes decreases more slowly)).

Key Actions you can take:

  1. Stay up to date with your COVID-19 vaccinations. Generally (for most working age individuals), this means getting a booster if it has been more than 6 months since your last vaccine dose or infection. Attached is a flow chart that takes people through the decision making regarding timing of the booster.
  2. Get a flu shot. You can have the flu shot at the same time as your COVID booster.
  3. Stay home if you are ill, and consult employee health regarding when you can return to work. Continue to wear a well-fitted mask when you are inside around other people until at least 10 days have elapsed since the onset of your symptoms.
  4. Wearing a mask when in indoor public spaces (including the workplace) is strongly recommended to help protect you against infection with COVID, influenza, and other respiratory viruses. Wearing a mask will enhance your protection even if nobody else around you is wearing a mask.
  5. Wash or sanitize your hands before touching areas of your face and before eating. Hand hygiene can significantly reduce the risk of becoming infected with common respiratory and gastrointestinal viruses.
  6. If you are immunocompromised, have underlying health conditions, or are olderconsult your health practitioner about whether available preventive medications(e.g., Evusheld) and treatments (e.g., Paxlovid, Tamiflu) are appropriate for you. 

Update on November 16, 2022

Masks are strongly recommended for travelling or close contact indoors

Canada is currently experiencing an early surge of Respiratory Syncytial Virus (RSV), which has created record levels of pediatric hospitalizations for the virus. This influx coincides with the beginning of flu season and an increase in COVID-19 transmission creating a triple threat for our healthcare system. While it is a distracting conversation, particularly as we head towards winter and the holiday season:


Canada’s Chief Public Health Officer Theresa Tam shared that cases of RSV and influenza have now risen above seasonal levels. Federal data shows there are nearly 300 COVID-19 deaths per week, and more than 6,000 hospital beds are occupied by COVID-19 patients across Canada.

Please remember the incubation period for COVID-19 is typically much longer than RSV or influenza. Symptoms generally appear within three to seven days after exposure, but it may take as long as 14 days.

  1. Stay up to date with your COVID-19 vaccinations: Generally (for most working age individuals), this means getting a booster if it has been more than six months since your last vaccine dose or infection.
  2. Get a flu shot: You can have the flu shot at the same time as your COVID-19 booster.
  3. Stay home if you are ill: Consult Employee Health regarding when you can return to work. Once you return, continue to wear a well-fitted mask when you are inside and around other people for at least 10 days after the onset of your symptoms.
  4. Wear a mask: Wearing a mask is strongly recommended when indoors to help protect you against infection with COVID-19, influenza, and other respiratory viruses. Wearing a mask will enhance your protection even if nobody else around you is wearing a mask.
  5. Wash your hands: Washing or sanitizing your hands before touching your face and before eating is an effective precaution to limit the spread of viruses.
  6. If you are immunocompromised, have underlying health conditions, or are older, consult your health practitioner about whether available preventive medications and treatments are appropriate for you.

The attached infographic assists in determining when to get a COVID-19 Booster Shot.

For any questions, please contact Anthony, Dan or Trish.

Update on September 8, 2022

Although COVID infection levels declined in most regions in August 2022, COVID-19 continues to circulate in our communities at relatively high levels. Increases in COVID infections are anticipated over the fall and winter, as students return to school, and as more activities take place in indoor settings, and this is likely to be compounded by seasonal increases in infections with other respiratory viruses (e.g., influenza, RSV) over the same time frame.

The good news is that because of high levels of immunity in the population (related to vaccination and prior infections), and because the currently circulating strains of COVID are associated with less severe illness, the risk of a severe outcome with COVID-19 infection (e.g., severe illness, hospitalization, or death) is much lower than at earlier points in the pandemic.

The less good news is that even mild COVID infections are associated with a higher long-term risk of multiple significant health problems including heart attacks, blood clots, and stroke. Also, each COVID-19 infection carries a risk of developing chronic symptoms (commonly called long COVID). Symptoms can vary between individuals, with commonly reported symptoms being fatigue, sleep disturbances, “brain fog,” cough, chest pain, and headaches, and the symptoms can be associated with activity limitations. The risk of long COVID appears to be somewhat lower with currently circulating Omicron strains, and with vaccination, but the most recent data suggests that at least ~5–10% of individuals who are infected will experience some degree of chronic symptoms lasting 12 weeks or more.

  • Vaccines: Ensure you are up to date with your COVID-19 vaccinations, and have received all vaccine doses that are available to you in the context of your age and any comorbidities. Get the seasonal influenza vaccine (which will be available in the coming weeks).
  • Masks: As public health requirements have been eased in most jurisdictions, you may not know if people around you have COVID-19. Consider wearing a well-fitted high-quality mask when in indoor public spaces, which will reduce your risk of infection with COVID and other respiratory viruses—even when others around you are not masked.
  • COVID-19 treatments: Individuals who have a higher risk of more severe COVID-19 (e.g., people of advanced age, or who are immunocompromised) should consult their health care provider about whether therapeutic agents (such as Paxlovid or monoclonal antibodies) would be recommended to reduce the risk of severe illness and make a plan to access the treatment in the event of infection.
  • Manage your health: Your overall health status can impact your risk of becoming infected or developing severe illness. Pay attention to nutrition, exercise, sleep and stress. Try to maintain a healthy body weight and ensure that any chronic health conditions are optimally managed.

Ontario recently announced changes to its public health guidance for COVID. The key recommendation is that we stay home when sick. Here’s a summary of the updated guidance for infections, which applies to people with COVID or any other respiratory infection (e.g., colds, influenza):

  • Individuals who have symptoms of ANY respiratory illness (not just COVID) should stay home until symptoms have been improving for at least 24 hours (48 hours in the event of nausea, vomiting or diarrhea).
  • If they have a fever, they should stay home until the fever is completely gone.
  • Avoid non-essential visits to vulnerable people for a full 10 days starting the day after symptoms appear.
  • Individuals who are symptomatic and/or those who test positive for COVID-19 should wear a mask when in public spaces for 10 days from the start of symptoms/positive test result.
  • For those who are hospitalized, immunocompromised or reside in a high-risk setting (i.e., acute care, long-term care and retirement homes, group homes, shelters, etc.), the 10-day isolation remains and symptoms must be improving as noted above.

These changes are similar to recommendations in many other provinces (e.g., Manitoba, Alberta, New Brunswick, Nova Scotia) and other countries (e.g., UK, Norway, Denmark, Iceland).

Health Canada recently approved a bivalent vaccine from Moderna for people 18 years of age and older, and approval for a similar vaccine from Pfizer-BioNTech is anticipated to occur very soon. These vaccines target both the original COVID-19 strain as well as the BA.1 strain, and are anticipated to result in higher levels of immunity and protection from severe infection outcomes in the context of currently circulating strains of the Omicron variant. The new vaccine should be available very soon for individuals at highest risk, with more supply rolling out for other adults over the coming weeks.

Booster doses are important to maintain optimal protection from severe illness for all adults, and the bivalent vaccines are expected to provide higher levels of protection compared to the original vaccines. Certain considerations may make a booster dose even more important, such as:

  • Age: Age is an important predictor of the risk of severe COVID. Individuals 60 years of age and over are at the highest risk for severe COVID-related illness and death.
  • Immunocompromised: People with compromised immune systems (e.g., from a medical condition or certain medications) are at increased risk for severe outcomes with COVID-19 infection.
  • Medical conditions: People with certain medical conditions (e.g., obesity, diabetes, lung disease, cardiovascular disease) are at higher risk of severe outcomes and hospitalization from COVID-19.
  • Most recent infection or vaccination: The level of immunity and protection against severe illness decreases ~6 months after the most recent vaccination or ~3 months after the most recent COVID infection.
  • Personal factors: These can include living with someone who is at higher risk, living in a congregate setting, or being from a racialized/marginalized population.

Consider consulting with your health care provider to determine the best timing of a booster dose in the context of your own health.

Update on January 19, 2022

Under the current guidance, if not working in a highest risk setting, the employee can end isolation after 5 days if symptoms are improved for at least 24 hours (48 hours for any gastrointestinal symptoms). Noting that ~30% of cases will remain infectious at day 6, we had previously discussed adding a requirement for 1-2 negative RAT prior to RTW as an added risk reduction measure, but this is not required by the provincial guidance. If RAT is to be done, it would be optimal (supplies permitting) if 2 tests could be done 24 hours apart prior to RTW.

As for the employee’s spouse, the current guidance requires them to isolate for the same time frame as the case (the employee). However, if they develop symptoms (or have a positive RAT/PCR), the spouse would need to begin a new isolation period in accordance with their vaccination status and the other factors noted in the table I attached to the prior email. The employee (the original case) would not normally need to re-isolate, but this would be dependent on when the spouse’s case occurs. E.g. if the onset of the spouse’s symptoms occurs during the original isolation period, it is likely that the source of the spouse’s case was the original case (employee), so no new isolation would be required. But if the onset of the spouse’s symptoms is several weeks later, this would suggest a new source of the infection, and a new self isolation period would be required (as a household contact of a case).

Omicron Variant Q&A – January 10, 2022

  • Omicron has outcompeted all other SARS-CoV-2 variants, and is now the predominant strainin Ontario and most other jurisdictions.
  • The increased transmissibility of Omicronmay be related to several factors, including the variant’s ability to rapidly multiply within human nasal cells, the high rate of asymptomatic infections (which can still transmit the virus to others), the shortened incubation period (with the time between exposure and onset of symptoms frequently as little as 1-2 days), and potentially greater risk for airborne spread.
  • Recent data has shown that Omicron is causing less severe infections on average, compared to Delta, with hospitalization rates ~50%of what was being observed with Delta, and ICU admission rates in Ontario being ~25% of the rate with Delta.
  • The reduction in severity appears to be related to both intrinsic properties of the Omicron variant (which appears to be less effective at infection human lungs), and the high levels of vaccination in the population.
  • With regard to vaccination, data has suggested that two doses of the vaccine offer limited protection against infection, but continue to provide reasonably high levels of protection from severe illness, hospitalization, or death. Administration of a third (booster) dose significantly increases the vaccine effectiveness against infection.
  • The duration of the effect from the booster dose is not currently known, and some jurisdictions have begun administering 4thdoses to selected populations who may be at elevated risk from COVID-19.

Omicron typically results in a somewhat different set of symptoms when compared to earlier variants. Because of this, Ontario has revised its symptom checklist:

  • Fever and/or chills; OR
  • Cough; OR
  • Shortness of breath; OR
  • Decrease or loss of taste or smell; OR
  • Two or more of:
    • runny nose/nasal congestion
    • headache
    • extreme fatigue
    • sore throat
    • muscle aches/joint pain
    • gastrointestinal symptoms (i.e. vomiting or diarrhea)
  • Due to constraints in the availability of PCR tests, Ontario and many other jurisdictions have changed public health guidance regarding eligibility for these tests.  PCR testing is now restrictedto groups at increased risk of severe outcomes and those living and working in settings conferring significantly increased risk. Most healthy workers in non-health care settings will now be unable to get testing unless they fall into one of the high risk groups. Further information is available here.
  • Rapid antigen tests (RATs) have reduced sensitivity (the ability of the test to pick up the presence of infection) for detection of Omicron, both when compared to PCR tests, and compared to the sensitivity for detection of Delta.
  • RAT may still be usefulin some settings:
    • Screen testing of asymptomatic people 
      • Screen testing is frequent, systematic testing of people who are asymptomatic and without known exposure to a COVID-19 case with the goal of identifying cases that are pre-symptomatic or asymptomatic.
      • Screen testing with RATs involves routine testing one or more times per week. Individuals in non-highest risk settings participating in routine asymptomatic RAT testing who have a positive result do not require a PCR/rapid molecular confirmatory test and need to isolate in accordance with public health guidance
    • For people with symptoms 
      • If a RAT is available to the person with  symptoms, a  positive RAT is highly indicative that the individual has COVID-19, and the individual is required to self-isolate as per the guidance outlined below.
      • In the community non-high risk setting,  positive RATs do NOT need to be confirmed by PCR/rapid molecular test.
      • Positive RAT tests do NOT need to be reported to the public health unit.
    • For return to work following infection (to reduce the likelihood that a person remains infectious following their isolation period)
    • For test-to-work purposes in high risk settings(e.g. hospitals and health care facilities and congregate living settings)
    • For episodic testing of asymptomatic individuals(e.g. prior to a social event or gathering)
      • RATs have low sensitivity for COVID-19 in people who are asymptomatic and without a known exposure to a confirmed case of COVID-19.
      • People infected with COVID-19 may test negative for several days before testing positive on RAT. Therefore, a negative test may represent a false negative and the infection status of the individual may change within hours of taking the test.
      • Those with a negative one-off RAT should still follow existing public health measures including masking and limiting contacts.
  • Vaccines, and especially booster doses of vaccines: While vaccination will not provide complete protection against Omicron, it is anticipated that vaccination will continue to reduce the risk of severe outcomes like hospitalization and death. Data has suggested that two doses of the vaccine offer limited protection against infection, but continue to provide reasonably high levels of protection from severe illness, hospitalization, or death. Administration of a third (booster) dose significantly increases the vaccine effectiveness against infection.  ***Get vaccinated and get your booster shot as soon as you can***.
  • Masks and eye protection: Use well-fitted medical grade masks at all timeswhen in indoor settings, and in more populated outdoor settings. If using a medical grade mask, consider double masking (using a cloth mask over the medical mask) and/or knotting the earloops to improve the fit of the mask, which will enhance the effectiveness of the mask. Consider use of masks which may offer enhanced filtration, such as a KN95, KF94, or N95 masks (note that to offer maximum protection, these masks require formal fit testing). Use eye protection (face shield or goggles) if physical distancing cannot be consistently assured.
  • Hand hygiene: Wash or sanitize your hands before and after touching around your face.
  • Physical distancing: Because COVID-19 can be transmitted by airborne particles, the virus can be spread over distances longer than 6 feet (especially in indoor settings). However, studies have confirmed that physical distancing can help to reduce the risk of spread.
  • Avoid/minimize time spent in shared indoor spaces, especially if not wearing a mask (e.g. lunchroom, restaurants, bars).
  • Stay home if symptomatic, even with mild symptoms
  • Air circulation/filtration: Wherever possible, try to maximize ventilation and filtration of circulated air in indoor spaces. Consider using portable HEPA filtration units.

COVID-19 FAQs as of December 17, 2021

There are two main elements that went into this change:

  1. In the context of the Delta variant, there was already evidence that immunity and vaccine effectiveness against infection was decreasing slowly after the initial 2 doses, so that by 6 months out, there was a meaningful impact on community infection rates. There is ample evidence that booster doses restore very high levels of immunity and vaccine effectiveness.
  2. With Omicron, the early data is demonstrating that 2 doses of mRNA or AstraZeneca vaccine are likely to offer very little protection against infection except in the first few months after immunization (when antibody levels are very high), but that high levels of protection are restored by administering a booster dose. Now that Omicron has emerged and is spreading rapidly, there is a pressing need to get boosters into as many arms as possible, as quickly as possible, to try to dampen the spread of Omicron. Waiting 6 months for a booster is no longer a viable option, because we need a higher wall to outpace the spread of Omicron, and in the latter part of the 6 months, people will have suboptimal protection.

Omicron Variant of Concern – December 9, 2021

  • It appears that Omicron spreads more rapidly (is more transmissible than) the Delta variant (which is currently the predominant circulating strain in Canada and the US)
  • It is not yet known whether the increase in contagiousness is a consequence of the changes in the Omicron variant itself, or whether it might be related to reduction in the effectiveness of the immune response induced by vaccination or prior infection
  • While Omicron has been overtaking Delta as the predominant circulating strain in South Africa, it is not yet known whether the same pattern will be observed in Canada and the USA, due to differences in population demographics, vaccination rate, public health measures, etc.
  • Early reports from South Africa have suggested that Omicron infections may be associated with less severe illness than Delta infection.
  • However, there is not yet sufficient data to know whether this pattern will be the same in other jurisdictions, which may have different demographics
  • Research from South Africa has suggested that Omicron is approximately twice as likely to cause reinfection in individuals with a prior history of COVID-19 infection compared to other variants
  • Lab studies to date have indicated that the ability of antibodies induced by two doses of mRNA vaccines to neutralize Omicron is significantly reduced, but that a third (booster) dose may restore the level of protection back to the level that two vaccine doses have offered against earlier strains.
  • Real world data regarding vaccine effectiveness is not yet available, but is anticipated to be reported over the coming weeks to months.
  • Companies have already announced that they will be developing Omicron-specific booster vaccines. However, it is not yet known whether these will be required, as it is possible that the immune response induced by the currently available vaccine may prove to be sufficient to maintain overall vaccine effectiveness.
  • Information to date indicates that the tests for COVID-19 that we currently use (both PCR and rapid antigen tests) will be able to detect the Omicron varian
  • Get vaccinated, and if you are eligible, get a booster. Eligibility for booster vaccines may be expanded in the coming weeks, and booster shots have been shown to restore very high levels of immunity (which may have slowly waned over the months since the first two vaccine doses).
  • Continue to follow public health recommendations, including wearing a mask, washing your hands, limiting your exposure to others indoors, and maximizing ventilation.
  • Follow the news from evidence-based authorities such as the Public Health Agency of Canada (PHAC), the Centers for Disease Control (CDC), and the World Health Organization (WHO).

COVID-19 FAQs as of November 1, 2021

Here is the latest information about COVID-19 and B&M activities and responses in the format of Frequently Asked Questions (FAQs). New questions and answers have been added below. You will also find some updated answers to previously submitted questions, shown in italics, in the Past FAQs section.

“Information on this page does not constitute medical advice or treatment recommendations. Please contact your health care provider if you have any concerns”.

Why You Should Vaccinate Your Kids Against COVID-19 – November 1, 2021

Booster vaccines for COVID-19 – November 1, 2021

Booster doses of the COVID-19 are being considered or offered in many jurisdictions. Booster doses are distinct from the “third doses” that have been available for several months for immunocompromised persons, who would have a suboptimal response to their initial vaccine series of two doses. Booster doses are intended to address the slow decrease in immunity that occurs over a period of months following vaccination.

Based on evidence to date, booster doses are safe and well tolerated. There is clear evidence that administration of a booster dose results in marked reductions in the risk of infection and severe illness, over and above the risk reduction resulting from the first two doses of the vaccine.

On 29 Oct. 2021, the National Advisory Committee on Immunization (NACI) updated their recommendations for booster doses as follows:

  • Populations at highest risk of waning protection following their primary series and at highest risk of severe COVID-19 illness should be offered a booster dose of an mRNA COVID-19 vaccine at least 6 months after completing their primary series. These populations include:
    • Adults living in long-term care or other congregate settings that provide care for seniors (as recommended by NACI on September 28, 2021)
    • Adults 80 years of age and older
  • Other key populations who may be at increased risk of lower protection over time since vaccination, increased risk of severe illness, or who are essential for maintaining health system capacity, may be offered a booster dose of an mRNA COVID-19 vaccine at least 6 months after completing their primary series. These populations include:
    • Adults 70 to 79 years of age;
    • People who received two doses of the AstraZeneca Vaxzevria/COVISHIELD vaccine or one dose of the Janssen vaccine;
    • Adults in or from First Nations, Inuit and Métis communities; and
    • Adults who are frontline healthcare workers who have direct in-person contact with patients and who were vaccinated with a very short interval.

The application of this guidance may differ between provinces. For example, on 26Oct2021, British Columbia announced availability of booster shots beginning on 1Nov2021 for seniors 70+ and Indigenous people 12+, residents in independent living facilities, home care recipients, health care workers who received their first two doses on a shortened schedule (less than 42 days between dose 1 and dose 2), and people who live in rural and remote Indigenous communities. Beginning in Jan 2022, everyone else in BC will be able to receive a booster dose 6-8 months after their second dose.

In the US, booster shots are available for:

  • Individuals who received the Pfizer-BioNTech vaccine or Moderna vaccine, at least 6 months after the second dose:
  • Individuals 18 years and older who received the Johnson & Johnson vaccine, at least 2 months after the second dose.

As more data is accumulated regarding the effectiveness of the vaccines over time at preventing infections and severe complications such as hospitalization or death, recommendations regarding booster doses may change to reflect the best available evidence. Stay tuned for more information!

COVID-19 vaccination for children – what we know so far – November 1, 2021

Vaccines for COVID-19 have already been approved for adolescents aged 12 and up, and Health Canada and the FDA are currently reviewing data from trials of the vaccine in children aged 5-11 years. Approval of the COVID-19 vaccines for children in this younger age group is anticipated to occur in both countries within the coming days to weeks.

Published data with regard to the Pfizer-BioNTech vaccine, which was studied in more than 1500 children 5-11 years of age. The vaccine dose used was 10 micrograms, which is one third of the dose used for adults. The data shows that the vaccine was well tolerated and produced an immune response and side effects comparable to those seen in a study of people ages 16 to 25. The most common reactions included fatigue, headache, muscle pain, and chills. No cases of myocarditis/pericarditis were observed during the vaccination period through approximately 3 months of follow-up. Vaccine effectiveness against laboratory-confirmed symptomatic COVID-19 occurring at least 7 days after Dose 2 was approximately 91%.

Why should children receive the COVID-19 vaccine?

Until recently, the COVID-19 infection rate in children has been relatively low, and most infected children experience no symptoms or mild symptoms. However, some children do develop severe disease and might require hospitalization. In Canada, cumulative data to October 1, 2021 indicated that children aged 0 to 19 years old accounted for 20% of cases but much lower proportions of hospitalizations (2.0%), intensive care unit (ICU) admissions (1.2%), and deaths (0.1%%). Unfortunately, in recent months, the proportion of children experiencing COVID-19 infection has increased. In addition to acute COVID-19, children may develop a rare post-SARS CoV-2 complication known as multisystem inflammatory syndrome in children (MIS-C).

Children with certain underlying chronic medical conditions are at increased risk for severe COVID-19. It is reported that 39% of children admitted to hospital because of COVID-19 had at least one underlying comorbidity, most commonly chronic encephalopathy, obesity, asthma, chronic lung disease other than asthma, epilepsy, and neurodevelopmental disorders. Obesity, chronic neurological conditions, and chronic lung diseases other than asthma have been associated with greater COVID-19 severity. Other Canadian surveillance data indicate that the proportion of COVID-19 cases being hospitalized or admitted to an ICU is 4 to 5 times higher for individuals 12 years of age and older with immunodeficiency, than for the general population.

Along with the risks to physical health posed by COVID infection, the COVID-19 pandemic and the public health response to it have had significant indirect effects on children’s health. Disruptions in family routines, school and other educational activities, play, and sports, as well as separation from friends, grandparents, and other close family members, are affecting the mental health of children and adolescents in Canada, as manifested by eating disorders, anxiety, depression and problematic substance use.

Children can also transmit SARS-CoV-2 infection to others, which may pose a risk to adults in their family and community, especially if the adults themselves have underlying health conditions or are elderly.

Vaccination of children against COVID-19 will reduce the risk of infection and complications related to infection in children, and will reduce the risk that a child will transmit infection to adults around them. It is a vital step in helping children and their families “return to normal”, and will help to make our communities safer for everyone. Evidence to date shows that the COVID vaccine is safe and effective in children, and is associated with mild and relatively minor side effects.

Booster Vaccines – October 7, 2021

Third doses of the COVID-19 vaccine are being administered to different subgroups of people in many countries around the world. The evidence to date supports that third doses of the mRNA vaccines are safe and effective at increasing antibody levels, at least over the short term. To date, additional doses given have used existing vaccines rather than reformulated vaccines (there are several reformulated vaccines currently under study, in an effort to improve the immune response to emerging SARS-CoV-2 variants).

The decision to provide booster doses has been based on the observation that over time there has been a gradual decrease in protection against symptomatic infection afforded by the COVID-19 vaccine. This has been correlated with a gradual increase in infection rates among individuals who are fully vaccinated. This effect has been more pronounced in certain groups, including those who are older in age and those who are immunocompromised.

It is important to note that protection against severe COVID-19—including severe symptoms, hospitalization and death—from the two dose mRNA vaccines or one dose in the case of the Johnson & Johnson vaccine has not significantly decreased over time, and remains very high for the mRNA vaccines.

In Canada, the National Advisory Committee on Immunizations (NACI), an independent group of experts that advises Health Canada, has recently recommended that booster doses of an mRNA vaccine be offered to all long-term care residents and seniors living in other congregate settings, at an interval of at least six months after the primary series has been completed. Additionally, several provinces have begun administering booster doses to higher risk groups, with variation between provinces. For example, in Ontario, booster doses are offered at least two months after the primary series to:

  • Transplant recipients, including solid organ transplant and hematopoietic stem cell transplants
  • Those undergoing active treatment for solid tumors
  • Individuals receiving therapy with an anti-CD20 agent commonly used for conditions such as multiple sclerosis, rheumatoid arthritis, leukemias/lymphoma, etc.
  • Those undergoing active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids, alkylating agents, antimetabolites, or Tumor-Necrosis Factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive
  • Individuals receiving active treatment for malignant hematologic disorders, including chemotherapy, targeted therapies, immunotherapy for AML, CML, ALL, CLL, etc.
  • Those in receipt of Chimeric Antigen Receptor (CAR)-T-cell
  • Those with moderate or severe primary immunodeficiency, such as DiGeorge syndrome and Wiskott-Aldrich syndrome
  • Stage 3 or advanced untreated HIV infection and those with AIDS

In the USA, the Food and Drug Administration (FDA) recently authorized booster doses for the Pfizer-BioNTech vaccine for:

  • Individuals 65 years of age and older
  • Individuals 18-64 years of age at high risk of severe COVID-19
  • Individuals 18-64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19, including severe COVID-19

As new research emerges regarding the effectiveness of the COVID-19 vaccines over time and impact of booster doses, it is anticipated that the recommendations regarding receiving extra vaccine doses will change to reflect the growing scientific understanding.

Vaccine names

Coinciding with the granting of full authorization by the US Food and Drug Administration (FDA) and by Health Canada, the vaccine manufacturers are now legally allowed to market the vaccines using brand names. It is important to note that there has been no change in the vaccines themselves, and that the only change is to the label, which now incorporates a brand name in addition to the generic name.

The vaccine brand names are as follows:

  • Pfizer-BioNTech vaccine: Comirnaty
  • Moderna vaccine: Spikevax
  • AstraZeneca vaccine: Vaxzevria, Covishield
  • Johnson & Johnson vaccine: no brand name to date
Vaccine passports

Over the past several months, every Canadian province has announced plans to implement proof of vaccination programs, otherwise known as “vaccine passports”. This program has already come into effect across much of the country. While there are some differences in the precise implementation between provinces, it is generally the case that all individuals 12 years and older will be required to provide proof of vaccination to access non-essential settings (e.g., restaurants, clubs, sports venues, movies, gyms), but such proof would not be required for access to essential services (e.g., grocery stores, religious settings, personal service facilities). Proof of vaccination may be an electronic credential or a paper copy of a vaccination receipt (depending on the province and the stage of implementation). The programs generally provide an exemption for individuals who are medically unable to receive the COVID-19 vaccine. Since unvaccinated individuals are responsible for a disproportionate amount of the spread of COVID-19 at this time, implementation of these programs will help to reduce the risk of transmission in settings where proof of vaccination is required.

Mu variant

The Mu variant is a strain of SARS-CoV-2 that was first identified in Colombia in early 2021. Since then it has spread to many countries around the globe. The Mu variant has been classified as a “variant of interest” by the World Health Organization, because it has mutations that are associated with the potential for reduced vaccine effectiveness—there has been evidence that antibodies formed against other SARS-CoV-2 strains may be less able to neutralize the Mu variant. Despite the concern about this variant, it is important to note that apart from Colombia and Ecuador, the prevalence of the Mu variant remains very low (i.e., less than 0.5 per cent of cases in Canada). The Delta variant remains the predominant strain across both Canada and the U.S. at this time.

CDC (US) Information for Booster Shots – Sept. 28, 2021

Additional populations may be recommended to receive a booster shot as more data become available. The COVID-19 vaccines approved and authorized in the United States continue to be effective at reducing risk of severe disease, hospitalization, and death. Experts are looking at all available data to understand how well the vaccines are working for different populations. This includes looking at how new variants, like Delta, affect vaccine effectiveness.

The Advisory Committee on Immunization Practices (ACIP) and CDC’s recommendations are bound by what the U.S. Food and Drug Administration’s (FDA) authorization allows. At this time, the Pfizer-BioNTech booster authorization only applies to people whose primary series was Pfizer-BioNTech vaccine. People in the recommended groups who got the Moderna or J&J/Janssen vaccine will likely need a booster shot. More data on the effectiveness and safety of Moderna and J&J/Janssen booster shots are expected soon. With those data in hand, CDC will keep the public informed with a timely plan for Moderna and J&J/Janssen booster shots.

No. COVID-19 vaccines are working well to prevent severe illness, hospitalization, and death, even against the widely circulating Delta variant. However, public health experts are starting to see reduced protection, especially among certain populations, against mild and moderate disease.

So far, reactions reported [4.7 MB, 88 pages] after getting the Pfizer-BioNTech booster shot were similar to that of the 2-shot primary series. Fatigue and pain at the injection site were the most commonly reported side effects, and overall, most side effects were mild to moderate. However, as with the 2-shot primary series, serious side effects are rare, but may occur.

Yes. Everyone is still considered fully vaccinated two weeks after their second dose in a 2-shot series, such as the Pfizer-BioNTech or Moderna vaccines, or two weeks after a single-dose vaccine, such as the J&J/Janssen vaccine.

Dr. Levine Q&A – Sept. 9, 2021

No, there is no evidence for this. The mRNA contained in the vaccine is rapidly broken down within the cells of the human body, and is only present for a short period of time in the cell (hours to days at the most), resulting in human cells producing copies of the spike protein (the target for the human immune response) for only a short length of time. Moreover, the mRNA in the vaccine cannot physically enter the nucleus of the cell, where DNA (in the form of chromosomes) is located – therefore, the mRNA in the vaccines cannot affect human DNA. Because of this, there would not be a concern that the vaccine could result in development of early dementia. It is worth noting, however, that COVID-19 infection itself has been associated with a risk persistent cognitive dysfunction in some individuals, so while this risk is not known to be associated with the vaccine, it can be associated with the disease the vaccine helps to prevent.

Yes, vaccinated individuals are capable of shedding virus and causing infection in other people. However, the risk of this occurring is much lower for vaccinated people than for unvaccinated people. This is because vaccinated people have a lower risk of becoming infected in the first place (you can’t spread the virus if you don’t have it), and because vaccinated people tend to shed the virus from their airways for a much shorter period of time than unvaccinated people (so there is a shorter “window” of time where a vaccinated person is infectious to others, compared to unvaccinated people).

CBO – COVID-19 e-Q&A with Dr. Levine
Master Question Bank (July 27, 2021)

In Canada, mixing vaccines, or using one vaccine for the first dose and a different vaccine for the second dose, has been referred to in two different contexts:

  1. AstraZeneca vaccine for the first dose followed by an mRNA (Moderna or Pfizer‑BioNTech) vaccine for the second dose: Recent studies in Europe (Germany, Spain and the UK) have demonstrated the safety and immune responses produced using mixed COVID-19 vaccine schedules. Evidence to date shows that this approach offers improved levels of immunity to COVID-19 compared with two doses of the AstraZeneca vaccine. Because of the (very low) risk of blood clots associated with the AstraZeneca vaccine (not observed with the mRNA vaccines) and the evidence of improved effectiveness (especially for the predominant variants of concern), the National Advisory Committee on Immunization (NACI)—an independent panel of vaccine experts that advises Health Canada regarding immunizations—has recommended the use of an mRNA vaccine for the second dose as an alternative to using the AstraZeneca vaccine for both doses. You can read more about NACI’s recommendations and rationale here.
  2. Interchanging brands of mRNA vaccines for the first and second doses: For individuals who received an mRNA (Pfizer or Moderna) vaccine for their first dose, NACI and the Ontario government now recommend that if supply of the first‑dose vaccine is limited, the alternative mRNA vaccine can be used for the second dose. While the two vaccines are not identical, they are highly similar and produce comparable levels of protection against COVID-19 in clinical trials. It is worth noting that this approach is used with other vaccines, such as the vaccines for hepatitis B and influenza.

Studies regarding the blood clots associated with the use of the AstraZeneca and Johnson & Johnson vaccines are ongoing. To date, estimates of the incidence of the blood clots, also known as Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT), range from 1 case per 26,000 to 1 case per 127,000 doses of AstraZeneca administered, and approximately 1 case per 500,000 for the Johnson & Johnson vaccine. When recognized early, treatment can be effective, but there is still an estimated fatality rate of 25–40%. It should be noted that COVID‑19 itself carries a much higher risk of blood clots than the risk associated with vaccination. Several studies have suggested that 30–70% of people who are admitted into intensive care units with COVID‑19 will develop blood clots in the deep veins of their legs or in the lungs, while approximately 25% will develop a blockage in one of the arteries supplying blood to the lungs.

While the Johnson & Johnson vaccine has been approved for use in Canada, Health Canada has not, to date, authorized the release of any supply for use, reportedly due to quality control concerns related to the manufacturing of the vaccine. Given the higher vaccine effectiveness of mRNA vaccines, the risk of blood clots (VITT) associated with the Johnson & Johnson vaccine and the concerns regarding manufacturing quality control, it does not appear that there are plans in the near term to begin using the Johnson & Johnson vaccine in Canada. It should be noted that even in the US, use of the Johnson & Johnson vaccine has been relatively low compared with use of the Moderna and Pfizer‑BioNTech vaccines, with 13.23 million doses of the Johnson & Johnson vaccine administered as of July 25, 2021, compared with 137.83 million and 190.47 million for Moderna and Pfizer‑BioNTech respectively.

Both myocarditis and pericarditis involve inflammation of the heart in response to an infection (including COVID-19, but also many other pathogens), exposure to a toxic substance or radiation, or other health events. Prior to COVID-19, myocarditis and pericarditis were found to occur at a rate of 10–20 cases per 100,000 people per year, and were most commonly seen in younger, healthy people. Beginning in early 2021, there have been a small number of reported cases of myocarditis and/or pericarditis following vaccination with the mRNA (Moderna and Pfizer‑BioNTech) vaccines, which appears to exceed the expected background rate for these conditions. Post-vaccination myocarditis and pericarditis have been reported more frequently in people 30 years of age and younger, in males compared to females, and after the second dose compared to the first dose. The majority of cases are mild, with a fairly quick recovery and no long‑term complications. Currently, we do not know why there is a higher incidence of myocarditis and pericarditis following the second dose, but it might have something to do with a stronger immune response being provoked.

If you experience any of the following symptoms following vaccination, you should seek medical attention: chest pain, shortness of breath, or a feeling of having a rapid or abnormal heart rhythm.

The concept of herd immunity refers to when a large part of the population of an area is immune to a specific disease, so there is nowhere for the virus to spread. While not every single individual may be immune, the group as a whole has protection. Herd immunity protects at‑risk populations, who may not be able to be vaccinated for medical reasons or whose bodies cannot mount an effective immune response on their own. When herd immunity occurs, the basic reproduction number (R0) falls below 1, meaning that the average person who gets infected transmits disease to less than one person. Several factors affect the proportion of the population that needs to be vaccinated in order to achieve herd immunity, including the transmissibility of circulating viral strains, vaccine effectiveness following immunization, duration of vaccine effectiveness over time, the effect of removing non‑pharmacologic interventions (e.g. masking, physical distancing, occupancy restrictions) and individual factors (e.g. personal level of susceptibility to infection). With the significantly increased level of transmissibility associated with the Delta VOC (the predominant circulating strain at this time), it is thought that the proportion of the population needing to be vaccinated to achieve herd immunity may be 85–90% or even higher.

Research regarding emerging variants of SARS‑CoV‑2 is being conducted on an ongoing basis, and as time goes on, we will undoubtedly continue to discover new mutations, new strains of the virus and new insights into how variants affect humans. While disease and pandemic modelling is complicated (you can read more about it here and here), research to date has demonstrated that the Delta VOC (the predominant circulating strain at this time) is 5–8 times more transmissible than the original circulating strain of SARS‑CoV‑2 and is associated with higher viral loads and viral shedding in infected individuals. For the vaccines in use in Canada, effectiveness against the Delta strain appears to be slightly reduced, but the vaccines still provide a high degree of efficacy as long as you receive your second dose; vaccine effectiveness against the Delta VOC after only a single vaccine dose is significantly lower. While no one can predict the future with certainty, in regions where the Delta variant has resulted in significant upsurges in cases (e.g. in Israel, parts of the US and several countries in Europe), public health measures have been reintroduced to try to arrest the spread of the variant. These have included mask mandates, occupancy limits and physical distancing requirements. However, given the potential for significant economic disruption associated with stay‑at‑home orders, and noting the high levels of vaccine effectiveness observed to date, one hopes that a complete shutdown of society will not be in the cards.

Booster doses for COVID-19 might be required for a couple of different reasons:

  • Firstly, the immune response induced by vaccination can wane, or slowly decrease, over time. To date, the group of individuals who were vaccinated the earliest (in late 2020) are still exhibiting high levels of immunity, and low levels of infection are occurring in this group, although recent data from Israel has shown a potential drop-off in protection 6+ months after vaccination. As researchers continue to monitor the levels of immunity and infection, we may find that, over time, the protection from the vaccine will start to diminish, which will tell us if and when booster shots might be required for all of us.
  • Secondly, because of the mutation of the virus, it is possible that a new strain might emerge that is resistant to the immune response generated by the vaccines we currently have, and might require a booster shot with a reformulated vaccine to ensure adequate immunity. To date, the vaccines that we have appear to result in good immunity to the variants of concern that are circulating. Researchers continue to monitor this, and the vaccine manufacturers are already studying reformulated vaccines that aim to provide improved immunity for VOCs.

Some countries (Israel, UK) have begun to administer booster shots to targeted populations. To date, these have been older people and immunocompromised individuals, both of which might not develop a strong immune response with vaccination. Stay tuned over the coming weeks to months as more information emerges.

Clinical trials of both the Moderna and Pfizer‑BioNTech vaccines in children under 12 have been under way since spring 2021. Pfizer has indicated that they anticipate submitting the necessary documentation to obtain FDA authorization for use in children under 12 by September or October of this year. A recent report suggested that the FDA might approve use of the Pfizer‑BioNTech vaccine in children under 12 by early to mid-winter. There has been no specific indication regarding when Health Canada might approve the vaccines for children under 12 in Canada. It is likely that vaccine use in both countries will initially be authorized for children 6–11 years of age, with authorization for use in children under 6 coming later.

There does not appear to be evidence to date that the COVID‑19 vaccines currently in use are associated with harm to either pregnant women or their unborn children. Studies are being conducted on an ongoing basis. The Society of Obstetricians and Gynaecologists of Canada (SOGC) has issued a statement outlining that the evidence supports that the benefits of COVID‑19 vaccination outweigh the risks of vaccination (and of COVID-19 infection itself) at any time during pregnancy or breastfeeding. With regard to vaccination for women planning pregnancy, the SOGC has indicated that the COVID-19 vaccination series should ideally be completed “ahead of pregnancy to benefit from maximal vaccine efficacy . . . . It is not known whether an individual should delay pregnancy following receipt of the vaccine, and a risk-benefit discussion for those planning pregnancy should occur similar to the discussion for vaccination of pregnant and breastfeeding individuals.” The Ontario Ministry of Health, based on its review of the evidence, has also supported vaccination during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) has issued a similar statement, as has the US Centers for Disease Control and Prevention (CDC).

Over the past several months, mask mandates have been discontinued in many jurisdictions, including several Canadian provinces. However, with rising case counts correlated with plateaus in vaccine uptake and the emergence of the Delta VOC, many jurisdictions have reinstituted mandatory mask use, including Israel and several US jurisdictions (Los Angeles County, St. Louis, Las Vegas and Chicago). At present, Ontario continues to require mask use in indoor public settings with some exceptions. The point at which mask use and other non‑pharmacological interventions such as physical distancing can be discontinued in Ontario will be dependent on the vaccination levels that can be achieved and the level of spread in our communities over time. Even if the province does stop requiring mask use indoors, it is possible that if infection levels begin to increase again, mask use and other measures might be reinstituted in the future to try to slow the spread of infection.

Several combined vaccines for COVID-19 and influenza are under development (see examples here and here), but the timeline for authorization for use in Canada is not presently known. In the near term, separate vaccinations for COVID-19 and influenza will likely continue to be the norm, as influenza vaccines are required annually and, at this time, the frequency that might be required for potential COVID-19 vaccine booster doses is not yet known. There are currently no data on the simultaneous administration of COVID-19 vaccines with other vaccines, although a number of studies are ongoing. Current recommendations from NACI are that COVID-19 vaccine doses not be administered within 14 days after other vaccines or 28 days prior to other vaccines, but this recommendation appears to be based on an abundance of caution rather than any specific evidence to date.

Several combined vaccines for COVID-19 and influenza are under development (see examples here and here), but the timeline for authorization for use in Canada is not presently known. In the near term, separate vaccinations for COVID-19 and influenza will likely continue to be the norm, as influenza vaccines are required annually and, at this time, the frequency that might be required for potential COVID-19 vaccine booster doses is not yet known. There are currently no data on the simultaneous administration of COVID-19 vaccines with other vaccines, although a number of studies are ongoing. Current recommendations from NACI are that COVID-19 vaccine doses not be administered within 14 days after other vaccines or 28 days prior to other vaccines, but this recommendation appears to be based on an abundance of caution rather than any specific evidence to date.

Summary of estimated vaccine efficacy (June 21, 2021)

A recent update from the Ontario Ministry of Health provided the following summary of estimated vaccine efficacy for the COVID-19 vaccines currently authorized for use in Canada, based on published evidence to date.

With regard to whether the effectiveness changes if one receives a different vaccine for the second dose, we are still awaiting evidence regarding the effect of mixed vaccination regimens on both immune response and risk of infection from an ongoing trial currently being conducted in the UK. This data is anticipated to be released by the end of June 2021. There is data available from smaller studies in Spain and Germany that suggests that mixing different vaccines might produce an improved immune response.

On June 17, 2021, NACI (the National Advisory Committee on Immunizations, an independent group of experts which advises Health Canada) released new guidance which included the following statement: “An mRNA vaccine is now preferred as the second dose for individuals who received a first dose of the AstraZeneca/COVISHIELD vaccine, based on emerging evidence of a potentially better immune response from this mixed vaccine schedule and to mitigate the potential risk of VITT associated with viral vector vaccines. People who received two doses of AstraZeneca/COVISHIELD vaccine can rest assured that the vaccine provides good protection against infection and very good protection against severe disease and hospitalization.”

Stay tuned for more information on this important topic as more evidence emerges!

Viruses, Variants, and Vaccines (June 9, 2021)

  • Wear a mask. Surgical masks are preferred. If cloth masks are used, they should be constructed of 2 layers of tightly woven with 1 layer of non-woven filtering material in between (refer to guidelines from Health Canada). It is important that the mask fit snugly around your mouth and nose. Consider measures to improve fit, such as double masking (wearing a cloth mask over a surgical mask).
  • Maintain physical distancing of 6 feet / 2 metres – this helps to reduce the risk of transmission of COVID-19 through large respiratory droplets.
  • Use eye protection (face shield or goggles) if physical distancing cannot be consistently assured.
  • Practice hand hygiene (wash or sanitize your hands) before and after touching your face or your mask.
  • Stay home when you have any symptoms.
  • Avoid the “3 C’s” – closed spaces, crowded places, and close contact settings. These settings may increase the risk of airborne transmission of COVID-19 over distances greater than 6 feet / 2 metres.
  • Get vaccinated when you are eligible, and make sure you get your second dose when scheduled in order to obtain maximal, long-lasting protection from COVID-19.

For individuals who have received the AstraZeneca vaccine for their first dose, there might be an option of receiving either the Pfizer-BioNTech vaccine or Moderna vaccine for the second dose. This option is being considered for several reasons:

  • Canada has experienced challenges procuring a steady supply of the AstraZeneca vaccine
  • Evidence has emerged regarding a rare but serious risk associated with the AstraZeneca vaccine, vaccine-induced thrombotic thrombocytopenia (VITT). Current estimated risk of this complication is approximately 1 in 60,000 for first doses, and approximately 1 in 500,000 for second doses.

On June 1, 2021, NACI (National Advisory Committee on Immunization, an independent body of experts which advises Health Canada) recommended that individuals who received a dose of the AstraZeneca vaccine for their first dose could be offered either the AstraZeneca vaccine or a mRNA vaccine (Pfizer-BioNTech or Moderna) for their second dose. They also recommended that if your first dose was an mRNA vaccine, you can receive the other mRNA vaccine for your second dose if the first vaccine is not readily available.

NACI is awaiting data regarding a mixed vaccination regimen from a study currently being conducted in the United Kingdom. This trial is examining the impact of receiving doses of two different vaccines (AstraZeneca and Pfizer-BioNTech vaccines), versus receiving two doses of the same vaccine. Initial data from this trial did not demonstrate any safety concerns, but there was an increase in mild to moderate side effects in the groups who received two different vaccines for the first and second doses. The trial is expected to release additional data in June 2021, which will provide evidence regarding the immune response generated by a mixed schedule versus the standard vaccine schedule.

A smaller study from Spain demonstrated that for people whose first dose was the AstraZeneca vaccine, the level of neutralizing antibodies approximately doubled if their second dose was also AstraZeneca, but increased by approximately 7 times if the second dose was the Pfizer-BioNTech vaccine. While this data is promising, the data from the larger UK trial will provide more evidence that will help inform decision making in the coming weeks.

Stay tuned for more information!

  • In general, vaccine effectiveness is about 60-80% for preventing COVID-19 infection 3-4 weeks after receiving a single dose of Pfizer, Moderna or AstraZeneca vaccine, although this varies by population (i.e. general population, older adults, long-term care residents and health care workers).
  • Vaccine effectiveness increases to greater than 85% after a second dose.
  • Vaccine effectiveness for preventing severe disease and COVID-19-related hospitalization ranges from 70 to 90% for the Pfizer, Moderna and AstraZeneca vaccines.
  • Vaccine effectiveness for preventing death from COVID-19 is up to 96%.
  • Vaccine effectiveness against COVID-19 variants of concern (VOC) is being studied. Data to date shows the following:
    • For the UK (B.1.1.7) VOC, vaccine effectiveness is estimated to be 85-90% for the Pfizer-BioNTech vaccine and 70-75% for the AstraZeneca vaccine.
    • For the South African (B.1.351) VOC, vaccine effectiveness is estimated to be somewhat lower, at 75% for the Pfizer-BioNTech vaccine and 10-15% for the AstraZeneca vaccine. It is important to note that this VOC is not circulating at high levels in Canada at this time.
    • The vaccines appear to be effective against the Brazil (P.1) VOC, but there has been limited data to date.
    • For the Indian (B.1.617) VOC, vaccine effectiveness is estimated to be approximately 88% for the Pfizer-BioNTech vaccine (data is not available yet for the AstraZeneca vaccine).

While COVID-19 infections are generally less severe in children, it is possible for children to get COVID-19, become sick, and spread it to others. Vaccinating children will help to protect them as well as the people around them. This might be even more important when in person education starts again.

Also, approximately 15% of Canada’s population is under the age of 18. In order to reach sufficiently high levels of vaccination in our communities, we will have to include children in our vaccination program.

In Canada, the Pfizer-BioNTech vaccine is currently approved for use in children 12 years of age and older.

In clinical studies, the Pfizer-BioNTech vaccine was found to be 100% effective at preventing cases of COVID-19 among children aged 12 to 15. These studies did not identify any safety issues with use of the vaccine in children. Like adults who receive the vaccine, many children experience minor side effects which typically last a short period of time, such as arm pain, fatigue, headaches, chills, muscle pain, fever, and joint pain. Some of the side effects (headaches, fever/chills) were more frequent in children when compared to adults, which might be related to children having a more powerful immune response to the vaccine.

The vaccines currently in use can cause side effects in many people who are vaccinated. These side effects are related to the activation of the immune response by the vaccine, which is the goal of vaccination. Side effects can be felt in the arm receiving the vaccination (such as pain, redness, swelling) or more generally (such as fatigue, headache, muscle pains, fever, chills, nausea). These side effects are typically mild to moderate in intensity, and generally last from one to several days in most people. Use of hot compresses/heating pads may help symptoms in the arm which received the injection. If you do not have any medical reasons to avoid them, over the counter medications such as acetaminophen or ibuprofen can be taken to relieve fever, chills, or muscle aches, but it is recommended that these medications not be taken prior to the vaccination occurring. If redness or pain continues to worsen after 24 hours, you should seek medical attention.

Rarely, more severe side effects, such as allergic reactions, can occur in some people who receive the vaccines. Allergic reactions will most commonly occur within a few minutes of receiving the vaccine, and because of this, you will be asked to remain at the vaccination site for 15 minutes or more, so that any reactions that occur can be immediately addressed. In the very rare case where you experience symptoms which might be related to an allergic response after leaving the vaccination clinic, you should seek immediate medical attention by calling 911.

Booster vaccinations (beyond the two initial doses of the vaccine) may be required to address waning levels of immunity, or to increase the immune response to emerging strains of COVID-19 (variants of concerns). It is anticipated that a third dose will likely be recommended, but the timing needed for this dose is not yet known. To date, the immune response to COVID-19 provoked by vaccination has remained strong even when measured 6 months after vaccination. As researchers continue to monitor the immune response in the earliest group of people who received the vaccine, it will allow health authorities to make informed recommendations regarding when a booster shot might be required. It is also not yet known whether subsequent booster vaccinations (e.g. annually, or every 5-10 years) might eventually be required to improve immunity to new strains of COVID-19. Stay tuned!

Airborne transmission of COVID-19 refers to spread of the virus by smaller respiratory droplets that can remain aloft in the air for longer periods of time, and travel over distances further than the 6 feet which is recommended for physical distancing. Airborne spread is a concern when we are indoors (when outdoors, the ventilation and sunlight help to reduce the risk). There are many factors which can impact the risk for airborne transmission of COVID-19, including:

  • Size/volume of the room: A bigger room, with a larger volume of air, helps to dilute respiratory droplets and reduce the total exposure to them.
  • Number of people in the room: As more people are in a space, there is a higher amount of respiratory droplets expelled into the air.
  • Activities being performed: More respiratory droplets are released by activities such as yelling, singing, and exercise, as compared to quiet breathing.
  • Masks: Wearing masks helps to reduce the amount of respiratory droplets expelled into the air.
  • Ventilation: Circulation of the air in the room helps to reduce the concentration of airborne respiratory droplets.
  • Fresh air: Addition of fresh air into a room helps to reduce the concentration of airborne respiratory droplets.
  • Filtration: Increased levels of filtration in the HVAC system, and use of appropriately sized portable HEPA filtration systems, help to reduce the concentration of airborne respiratory droplets.

Current public health guidance throughout Canada requires that masks be worn when indoors, even after full vaccination. It is anticipated that many provincial public health authorities might revise their guidance for mask use in the coming months, as more evidence accumulates regarding vaccine effectiveness, as case counts continue to decrease, and as community vaccination rates increase. Black & McDonald continually reviews its policies regarding COVID-19 to ensure compliance with all applicable public health guidance and evidence-supported practices.

  • The minimum interval between first and second doses is 21 days (for the Pfizer-BioNTech vaccine) or 28 days (for the Moderna or AstraZeneca vaccines).
  • NACI (National Advisory Committee on Immunization, an independent body of experts which advises Health Canada) has recommended that the second dose of these vaccines can be administered up to 16 weeks after the first dose.
  • There is evidence that delaying the second dose of the AstraZeneca vaccine to 12 weeks produces a more powerful immune response as compared to when the two doses are administered 4 weeks apart.
  • Depending on the province in which you are located, and on other factors such as the presence of underlying medical conditions or belonging to certain high risk groups), you may be able to receive your second dose as soon as 28 days after your first dose.
  • The purpose of the COVID-19 vaccines is to cause your body’s immune system to react to a part of the virus, and then remember that response, so that if your body ever encounters the actual virus, your immune system can recognize the COVID-19 virus and stop or curtail the infection.
  • mRNA is a type of genetic instruction that our own cells use to tell our cell machinery how to make proteins
  • The COVID-19 mRNA vaccines contain fragments of mRNA that are a recipe for our cells to make the spike protein found on the outside of the COVID-19 virus. When these snippets of mRNA enter our cells, our cell machinery begins to make this spike protein. Then, our immune system is exposed to this spike protein, and builds antibodies and immune cells to react to it. If in the future, you are infected with COVID-19, your immune system will already recognize the spike protein that covers each virus, and can fight off the infection.
  • The spike protein is only a component of the COVID-19 virus, and it cannot cause infection on its own.
  • Your body quickly destroys the mRNA in the vaccine after making spike proteins. It does not stay in your body for long and does not make any long-term changes, other than helping you build your antibodies and white blood cells.
  • Human beings do not have the ability to convert the mRNA found in the vaccines into DNA (which is format of our body’s genetic code). So there is not a way for the mRNA in the vaccine to affect the DNA in our cells/chromosomes. The mRNA vaccines cannot affect your genes or your DNA.
  • There have been reports that a very small number of teenagers and young adults have been found to have mild heart inflammation (called myocarditis) after receiving an mRNA vaccine in the U.S., France, and Israel. The reports to date indicate that cases of myocarditis after vaccinations are more common in males than females, generally occur after the second dose of the vaccine, and typically happen within four days after vaccination.
  • It is not unusual for viruses to cause myocarditis. Myocarditis can also be seen as a result of the body’s immune response to infection.
  • The research to date show that myocarditis following vaccination is rare, and often causes no symptoms. The condition generally resolves on its own.
  • Based on what we know at this time, the benefits of vaccination in protecting teenagers and young adults from COVID-19 outweigh the very small risk of myocarditis.
  • Seek medical attention for any teenager/young adult who experiences the following symptoms after receiving an mRNA vaccine: chest pain, shortness of breath, rapid or irregular heartbeat or palpitations.

FAQ regarding Ontario pausing the use of the AstraZeneca vaccine (May 12, 2021)

On May 10, 2021, Ontario announced that it would be suspending the use of the AstraZeneca vaccine.

Provincial medical experts have been monitoring the emerging research regarding the risk of a very rare but severe complication associated with the AstraZeneca vaccine, called VIIT (vaccineinduced thrombotic thrombocytopenia). VIIT involves the development of blood clots in unusual locations in the body, associated with low platelet counts in the blood (platelets are blood cells that are involved in the body’s normal clotting response to help stop bleeding). VIIT can occur within 4-28 days of vaccination, and may cause symptoms like headache, blurred vision, shortness of breath, abdominal pain, or significant changes in a limb (e.g. swelling, redness or a cold feeling). VITT is treatable when diagnosed, but can be fatal in some cases. To date, there have been 17 cases of VITT linked to more that 2,300,000 doses of AstraZeneca vaccine administered in Canada to date.

The initial data regarding VIIT indicated that this complication from vaccination occurred at a rate between 1 in 1,000,000 and 1 in 100,000 vaccinations. However, data that has emerged more recently suggests that the risk may be closer to 1 in 60,000, which is still extremely small. At the same time, because rates of COVID-19 have begun to decline, the risk of COVID-19-related severe illness, hospitalization, or death is decreasing. Because of the change in apparent balance of risk, out of an abundance of caution, provincial medical experts have recommended that use of the AstraZeneca vaccine be suspended while further investigation into this risk is carried out.

As noted in the previous response, even with the more recent research, it remains the case that the risk of VIIT following vaccination with the AstraZeneca vaccine is extremely low at 1 in 60,000 (for reference, the estimated chance of being struck by lightning over the course of your lifetime is 1 in 15,000). While your chance of developing VIIT is extremely small, you should seek immediate medical attention if within the first 4-28 days following vaccination, you develop symptoms like headache, blurred vision, shortness of breath, abdominal pain, or significant changes in a limb (e.g. swelling, redness or a cold feeling).

No. By getting your first dose as soon as you could, you helped prevent the spread of COVID-19 in Ontario and you contributed to the decrease in COVID-19 cases and hospitalization rates now being seen in the province. Getting a dose of the vaccine helps to protect yourself, your family, your friends, your colleagues, and your community. Because of your vaccination, you will have a significantly lower risk of developing severe illness, of being hospitalized, or of dying from COVID-19.

Provincial public health officials have not yet announced guidance regarding second doses. Very soon, we are expecting to receive early data from a study in the UK which examined the level of protection offered by vaccination with one vaccine for the first dose, and a different vaccine for the second dose (the study used the AstraZeneca vaccine and Pfizer-BioNTech vaccine). If this study shows that mixing vaccines does not reduce the level of protection offered, it is possible that Ontario may recommend that people who have received one dose of the AstraZeneca vaccine should receive either the Pfizer-BioNTech or Moderna vaccine for their second dose. Ontario public health officials have indicated that the province still plans for people to receive their second dose 12-16 weeks after receiving their first dose, which means that the first people to receive the AstraZeneca vaccine are scheduled to receive their second dose by July – so there should be an announcement from the province about plans for the second dose soon.

COVID-19 Vaccine FAQs (May 5, 2021)

It is important to understand that the clinical trials for the development of the Pfizer-BioNTech and Moderna vaccines (the first two vaccines released) ended in the fall of 2020, and the vaccines have only been in widespread use in the general population since December 2020. Because of this, while research to date has demonstrated that vaccination results in a robust immune response which remains evident through at least 6 months, the evidence for vaccine effectiveness over longer time frames is not yet available. Clinical studies will continue, so over time, we will be able to form a more precise estimate of how long immunity will last post-vaccination.

Currently, we don’t know precisely how long vaccine-induced immunity will last following the initial vaccination, or whether booster doses will be required, and if so, at what interval. Recent evidence has indicated that the vaccine-induced immune response remains high at 6 months after vaccination for the Pfizer and Moderna vaccines, and it is anticipated that other vaccines will demonstrate similar sustained levels of effectiveness.

While it appears that the vaccines currently available generate effective immune responses for some of the variants of concern (VOCs) currently circulating (e.g. B117 [UK variant], and B1351 [South African variant]), the vaccine-induced immune response may be less effective for other VOCs (e.g. P1 [Brazil variant]). Therefore, vaccine producers are currently studying whether the addition of a booster vaccination using a reformulated vaccine would provide an improved response for VOCs—if the studies bear this out, a booster dose may become the norm over the coming months.

The recommendation by the National Advisory Committee on Immunization (NACI), which is an independent body of vaccine experts that provides advice to Health Canada, to extend the interval between doses of the Pfizer-BioNTech, Moderna, and AstraZeneca vaccines, was based on several factors:

  • Evidence shows high levels of vaccine effectiveness after a single dose. Pfizer and Moderna showed up to 92% efficacy after dose 1 in clinical trials, and 60–80% effectiveness after dose 1 in the real world in Canada, Israel, the UK and the US.
  • AstraZeneca clinical trials showed betterefficacy when delaying the second dose to ≥ 12 weeks, compared with shorter intervals.
  • Canada has experienced challenges with procuring vaccine supply over the past several months (although recently, this situation has improved). As vaccine supply improves, it appears likely that the interval between doses might be shortened.

One of the main advantages of the Johnson & Johnson vaccine being a single-dose medicine is that it removes the issue of waiting for a second dose, simplifies the vaccine rollout and may contribute to freeing up supplies of the other vaccines—making them available for second doses for more individuals sooner.

Currently, the public health guidance in Canada and Ontario has not changed based on individuals being vaccinated. There is no indication as to when Canada or Ontario might alter this guidance, but multiple factors could be behind this stance:

  • Increasing community prevalence of infection, with active infection levels in Ontario and Canada continuing to rise at this time
  • Increasing predominance of new variants of concern, which have higher levels of transmissibility between people, and which are also associated with higher mortality levels
  • Overall level of vaccination in Canada being nowhere close to the level required to drive down infection rates or provide herd immunity
  • Concern that vaccinated individuals might still be able to transmit COVID-19 to others without experiencing any symptoms themselves (some evidence has emerged recently suggesting that the Pfizer-BioNTech vaccine prevents asymptomatic infection and spread, but the evidence is not yet definitive)

Until the public health guidance in your region is changed, we still recommend you do the following in the workplace:

  • Use a mask at all times when at work in any shared spaces, unless you are alone in a room with the door closed.
  • Maintain physical distancing of 2 metres (6 feet) from other people.
  • Use eye protection when consistent 2-metre (6-foot) distancing cannot be assured.
  • Avoid direct physical contact.
  • Pay attention to hand hygiene.
  • Pay attention to the risk associated with enclosed shared indoor spaces, which is dependent on the size of the space, the number of people in the space, the level of ventilation, the air filtration, the time spent in the space and other factors. Rooms where people are not masked (e.g. lunchrooms) are of particular concern.
  • Stay home from work and consult with your supervisor / Health and Safety representative if you have any symptoms that might be consistent with COVID-19, or if a member of your household has any symptoms.

It is likely that as higher levels of vaccination are achieved in our communities and workplaces, the need for these risk mitigation measures will be lessened, and they may no longer be necessary at all one day. This is one of the many reasons to get vaccinated as soon as it is available to you: the sooner we all have our shots, the sooner we can remove the practices necessitated by the pandemic!

COVID-19 Variants of Concern: FAQs (April 19, 2021)

There are currently no differences to quarantine requirements for fully vaccinated individuals who are household contacts of a confirmed case of COVID-19.

They will still have to quarantine for 14 days following their last contact with the case while the case was infectious ((in some cases, this may be a total quarantine period of 24 days or longer, if they remain in contact with the case throughout the ten day period during which the case is infectious and/or if others in the household become cases during this time (this will actually reset the clock)).

Note: In the USA, under some circumstances, fully vaccinated individuals may not be required to quarantine as a result of household contact.

Household contacts of symptomatic individuals who have not yet been tested (and are therefore not confirmed cases), are recommended to remain at home pending the results of the COVID-19 test for the person(s) with symptoms (regardless of the vaccination status).

  • If the COVID-19 test is negative, the household can likely return to work with careful self-monitoring for symptoms (cease work if ANY symptoms develop).
  • If the COVID-19 test is positive, the household contact must quarantine.

The genetic material of the virus constantly changes (or mutates), and this frequently results in the emergence of novel strains of viruses. The strains of COVID-19 that have emerged over the past several months in the UK, South Africa, and Brazil are not the first new strains of COVID-19 that have been found during the pandemic. However, these novel strains have been the subject of intense interest as they appear to be more transmissible between humans and might also result in higher mortality rates related to COVID-19. There is also a concern that vaccines may be somewhat less effective against these variants.

The South African variant, the UK variant, the Eeek mutation, the Brazil variant, the Denmark variant and the original variant.

  • This form was found in South Africa in early October and announced in December.
  • It appears to affect younger people and contributed to the spread of the illness across the country.
  • This mutation has been identified in more than two dozen countries, including Canada, Australia and Israel, however it does not seem to be more deadly than the original disease.
  • Moderna has said its vaccine protects against the variant first identified in South Africa. However, the vaccine-elicited antibodies were also less effective at neutralizing this mutation in a laboratory dish.
  • Pfizer and BioNTech released their own study, not yet peer-reviewed, that suggests their vaccine results in antibodies that effectively neutralize this variant, though was slightly less effective.
  • On Jan. 29, Johnson & Johnson said its single-shot vaccine was robustly effective in a massive global trial, but that its protection against symptomatic COVID-19 was weaker in South Africa than in other regions.
  • In South Africa, the distribution of the Oxford-AstraZeneca vaccine has been halted. The vaccine did not provide sufficient protection against mild and moderate cases caused by the new variant.
  • This variant, also known as the Kent variant, has been spreading rapidly in Britain, Denmark and Ireland since December. Dozens of countries have seen infections from this variant of the virus.
  • The Centers for Disease Control and Prevention released a model forecast in early January that indicated the variant could become the dominant strain in the United States by some point in March. A recent study showed this variant was spreading rapidly in the United States by early February. There is also evidence of community spread in many regions in Canada. It appears more transmissible than the more common strain.
  • The scientific consensus is that the vaccines will remain effective against this mutation because those inoculations provoke an array of neutralizing antibodies and other immune-system responses that are not all affected by the mutations in this strain.
  • Biotechnology companies Pfizer and Moderna have said their vaccines appear to work against this variant.
  • A study of older adults showed that the immune response triggered by the Pfizer vaccine was modestly less effective against the variant first identified in the UK.
  • The Eek mutation has appeared many times since the start of the pandemic, but experts have been concerned about it. This mutation gained mainstream attention when it started to coincide with other variants that are more contagious.
  • Eeek has been seen in the variants first discovered in the UK, South Africa and Brazil.
  • The Eeek mutation changes the virus’s spike protein, which is what vaccines target.
  • By itself, the mutation does not change the virus significantly. The concern with this mutation is when it’s paired with the other variants, which could help the virus evade detection and make neutralization by the human immune system less efficient.

Clinical trial data indicate that vaccines are less effective in preventing infections with variants in South Africa featuring the mutation. But the vaccines still dramatically lowered the chance of severe illness or death.

  • Sequencing studies found the variant in Brazil, mainly in Rio de Janeiro, as early as July.
  • Researchers in Japan discovered it in travelers from Brazil in January.

It has been confirmed in Brazil, Peru, Germany, South Korea, the US and Japan, among other places.

  • There’s no strong evidence right now suggesting that vaccines won’t work against the variant first identified in Brazil. However, scientists have raised the possibility that this variant can evade antibodies, which might impact the current vaccines’ effectiveness.
  • Moderna announced that it would develop a new vaccine tailored to a similar variant in case an updated shot becomes necessary.

This variant was detected in Denmark in March.

The mutation has been spreading in Northern California and has been linked to outbreaks at nursing homes, jails and a hospital in the San Jose, US, area. It has also been confirmed in Southern California and more than a dozen US states.

It’s not yet clear whether this coronavirus strain is any more transmissible or lethal than the dominant mutation.

Some scientists think this variant might be more resistant to vaccines because the mutation is in the spike protein, which enables the virus to attach to cells. However, they also say that more study is needed before they can draw conclusions.

Q&A with Dr. Levine (January 26, 2021)

  • There are effectively no more zones as the province is in full lockdown.
  • There may be coloured zones after the lockdown depending on outbreak numbers. Some places will have to remain in lockdown longer than others.
  • Do your best to comply and minimize the spread.
  • Stay at home to minimize your contact to your household only.
  • Use electronic means when socializing with friends and family outside of your household.
  • If you have to go out or see to any elders within your family make sure to follow the protocols to keep yourself and others safe. Use masks, 2 m (6 ft) distancing and continuous washing of hands.
  • If you are less than 2 m (6 ft) away then face shield and goggles should be worn to prevent any droplet contamination.
  • Spoggles are acceptable as long as they are tightly fitted around the face.
  • When in an indoor space, if anyone is in the room with you then masks should be worn at all times. No exceptions.
  • If you have a closed office with a door you can leave your mask off if you are alone and the door is fully shut, but it is recommended to wear a mask at all times while out in shared spaces.
  • RNA changes in the virus are natural and we will be hearing a lot more about new strains as time goes on. The spike protein on the UK variant is more sticky then the original COVID virus and now is 50% more transmittable.
  • The UK variant is not more deadly than the original virus.
  • Studies have proven that the vaccines are effective on this variant also.
  • Steps that can be taken to mitigate the spread of COVID-19 is more fresh air. Open windows, regularly change air filters on exchanges. Portable hepa filters appropriate for the room size are ways of getting more clean air. A more expensive solution is UV lights for air exchange systems but this is not a simple solution.
  • Yes, temperature checks should be done to screen for possible cases.
  • Medical masks should be worn specially for essential workers. They have three layers and are disposable. Cleanliness with cloth masks can be an issue if someone is reusing them without the proper steps of sanitizing and cleaning them.
  • Once essential workers are vaccinated the medicines should be available to others by late summer.
  • We will see a significant ramp up in supplies available in March/April.

COVID-19 Vaccine FAQs

  • COVID-19 vaccines produced by Pfizer-BioNTech and Moderna are the first vaccines approved for use. Both vaccines have been tested in large clinical trials to ensure they meet safety standards, and both have been licensed and approved.
  • More information on vaccine production status can be found at the links below for the applicable country.
  • At first, there will be a limited supply of the vaccines as the global demand far outweighs the supply.
  • Because vaccination falls under provincial and state jurisdiction, the exact sequence and timing for different individuals receiving the vaccines will be different in each province or state.
  • In most jurisdictions the initial rollout will target health care workers in hospitals and long-term care homes. The priority is protecting people who are vulnerable to severe illness and death from COVID-19, and reducing the spread to high-risk populations.
  • As more vaccines are deployed throughout Canada and the U.S., the vaccination program will be expanded to other health care workers, older adults and other targeted groups.
  • In many jurisdictions, vaccination of the general adult population is anticipated to begin in the spring of 2021, depending on vaccine supply and other considerations.
  • While vaccination is not mandatory, everyone is strongly encouraged by all public health authorities to get vaccinated. In Canada, the vaccine will be available free-of-charge through provincial vaccination programs.
  • The Pfizer-BioNTech and Moderna vaccines contain instructions to tell our cells to make a protein that is found specifically on the outer part of the coronavirus (which is the virus that causes the COVID-19 illness). These “spike proteins,” although harmless to us, will trigger our body to start making antibodies. These new antibodies will help to protect us from illness if we are exposed to the coronavirus.
  • The vaccines do not contain the virus and so they cannot give us COVID-19.
  • Even after vaccination, it is important to continue to practice public health measures to prevent the spread of COVID-19.
  • Vaccines will help protect us against COVID-19. Like any medicine, some people may experience side effects from the vaccines. Common side effects such as a sore arm, muscle aches or a mild fever may occur, typically lasting only a few days. You may be requested to remain at your health care provider’s office or the clinic where you received the vaccine for 15 minutes after the vaccine is given. Your health care provider or the clinic is prepared to treat any reactions, if they happen.
  • Report to your health care provider if you have any unusual symptoms after receiving the vaccine.
    Symptoms may include:

    • A high fever (greater than 40C/104F)
    • An allergic reaction (rash, hives, itching, throat swelling, difficulty swallowing/breathing)
    • Severe vomiting, diarrhea and/or headache
    • Reactions that are severe or that do not go away, requiring a visit to a doctor or hospitalization
  • mRNA vaccines (of which the Pfizer-BioNTech and Moderna COVID-19 vaccines are examples) have been used for a while in animal models for influenza, Zika, Rabies, CMV and cancer treatment. Because the mRNA vaccine platform can be quickly adapted to include instructions for an antibody target for a new virus such as COVID-19, the vaccines could be developed much more quickly than in the past.
  • No steps were skipped in the process of developing, testing, approving and producing the vaccine. Independent scientists have thoroughly reviewed all the data before approving the vaccines as safe and effective.
  • The vaccines were produced more quickly than before, not because of skipped steps, but because of never-before-seen levels of collaboration and funding around the world invested in this effort. Unlike with previous vaccines that go one step at a time and then plan the next step, for the COVID-19 vaccines governments invested in having companies plan all the steps at the beginning and build up their manufacturing capacity right away.
  • Normally, vaccine clinical trials need 6,000-8,000 people for the approval process. The Pfizer-BioNTech trial had more than 40,000 people and the Moderna trial more than 30,000. Even with these larger-than-typical clinical trials, there were no serious safety concerns.
  • The Pfizer-BioNTech vaccine is licensed for use in people 16 years of age and older, including seniors. The Moderna vaccine is licensed for use in people 18 years of age and older.
  • Consult with your health care provider if you:
    • Are younger than 18 years of age
    • Are pregnant, want to become pregnant soon after vaccination, or breastfeeding
    • Have an autoimmune disorder or weakened immune system (immunosuppression) due to illness or treatment
    • Have a bleeding problem or bruise easily
    • Have potential allergic reactions (anaphylactic)
  • Vaccination is not currently recommended for:
    • Individuals with a history of anaphylaxis after previous administration of the vaccine
    • Persons with proven immediate or anaphylactic hypersensitivity to any component of the vaccine or its container, including polyethylene glycol
    • Vaccination should be deferred in symptomatic individuals with confirmed or suspected SARS-CoV-2 infection, or those with symptoms of COVID-19
    • Acutely ill individuals
    • Individuals who have received another vaccine (not a COVID-19 vaccine) in the past 14 days
  • Some people may have had COVID-19 and recovered. It is still recommended that they get vaccinated. Current evidence suggests that reinfection with the virus that causes COVID-19 is uncommon in the 90 days after the initial infection. However, although experts do not know for sure how long this protection (immunity) lasts, the risk of severe illness or death from COVID-19 far outweighs any benefits of natural immunity. The COVID-19 vaccination will help protect you by creating an antibody (immune system) response without having to experience the sickness.
  • Individuals with current COVID-19 infection or other active infection should wait until the infection is cleared and their healthcare professional has advised that they can proceed with vaccination.
  • There is limited information relating to the use of COVID-19 vaccines in pregnant women. If you are pregnant, breastfeeding or planning to have a baby, it is important to discuss COVID-19 with your health care provider to review the potential benefits and risks.
  • As a precaution, avoid trying to get pregnant for one to two months after finishing the two-dose vaccine.
  • People with stable health conditions such as diabetes, high blood pressure and HIV may receive COVID-19 vaccines as long they are not on medications that weaken the immune system. This also includes people with stable hepatitis B or C.
  • It is recommended that you speak with your health care provider in advance to ensure that your health conditions will not be impacted by the vaccine.
  • Even after vaccination, it is still important for everyone to continue with public health measures, such as wearing a mask, physical distancing and washing hands often, until vaccines are more widely available and we can be sure that they prevent the spread of most COVID-19 infections. These measures, combined with a healthy and active lifestyle, provide the best protection against COVID-19 and other viruses.
  • All COVID-19 vaccines currently approved for use have been shown to be highly effective at preventing COVID-19.
  • The remaining vaccines in development are being evaluated carefully in clinical trials and will be authorized and approved only if they make it substantially less likely that you will contract COVID-19.
  • Based on what is known about vaccines for other diseases and early data from clinical trials for COVID-19 vaccine, experts believe that getting vaccinated may keep you from getting seriously ill if you do contract COVID-19.

COVID Crisis Management with Dr. Levine (November 3, 2020)

The data shows that initially in the last two months younger people were affected disproportionately. That doesn’t appear to be the case anymore. There are more cases in the 40-60 age group right now.

At the moment supply of the vaccine may seem to be constrained, but it will ramp up quickly. We do not usually have a huge supply at this point in the year anyway. The demand is going to be higher this year, but the government has ordered many more vaccination kits than is typically the case. It will just take time for the shots to get to every pharmacy, medical office, etc.

I would strongly encourage you to follow the indoor gathering limits of ten, taking into account the type of space in which the meetings are held. A group of ten individuals meeting in a huge gym is very different from the same number of people congregating in a small meeting room. I would encourage you to eliminate in person meetings or at least minimize the number of people meeting to reduce the risk as much as possible.

This is an evolving area of knowledge. A number of people in various countries have gotten the virus a second time. It’s not common – these are pretty isolated incidences – but clearly not every infection confers long lasting immunity. It is something that is worth keeping an eye on. How repeat infections apply to a future vaccine is also an open question.

While it is possible to contract the infection through surface contact it doesn’t seem to be an especially important form of spread. Droplet spread and airborne transmission are more prevalent and risky. That’s not to say you should stop cleaning surfaces, but it doesn’t need to be the main focus. Masking and distancing are more effective in preventing the spread of the virus than avoiding potentially contaminated surfaces.

We are still not completely sure about the role airborne transmission plays with this virus. It’s clear that relatively large droplets emitted by breathing, speaking and sneezing are the main way this virus is transmitted, and these droplets travel over limited distances. How important small droplets are for transmission via air currents is unclear, but they do not appear to be unimportant. However, we do think that small droplets are not as infectious as large droplets.

In practical terms the more time you spend in an enclosed space, for example in an office, the more the risk increases of contracting COVID-19 by airborne spread. As we begin working more inside during the winter months, the issue of indoor airborne spread will likely increase in importance.

Yes, I recommend that they remain off work and get a test. You cannot assume that people who are sick have just come down with a “regular” cold. There is no way to distinguish a cold from COVID-19 symptoms without a test. Sick people showing symptoms have to remain off work and possibly get another test after that period as well.

More FAQs

There are plenty of fun alternatives to trick-or-treating! Consider encouraging kids to dress up and participate in virtual activities and parties. You may want to organize a candy hunt with people living in your household. Or you may want to have a scary Halloween night and watch movies and trade frightening stories. There is no reason why Halloween cannot be enjoyable.

Even if your kids can go out, trick-or-treating this year will be tricky. Ensure that your kids go out with members of their household and remain within their neighbourhood; that they maintain physical distancing of at least two metres (six feet); and that they wear a face mask designed to prevent the spread of the virus. Also, ensure that they avoid high-touch surfaces and objects, such as door bells and handrails, and that they wash hands thoroughly or use hand sanitizer.

The standard would be that both conditions are met: either a negative test plus 48 hours of being symptom free, or an asymptomatic individual with a negative test and the 48 hours met while waiting for the test results.

Anything that can be done to lessen the chance of contracting seasonal flu is a good thing for everyone, not just the elderly or those with underlying health issues. Everyone should get vaccinated.

If people with predisposed conditions get COVID-19 they are more likely to have increased severity of symptoms but they are not more likely to contract the disease. Those with compromised immune systems may have an increased chance of contracting the disease.

Although there is still much to learn about the virus, it increasingly appears that not only does COVID-19 affect the upper respiratory system and lungs but may also possibly affect blood vessels and other organs in the body.

It depends on which classes and which schools. There is a very wide spectrum of resources in terms of particular school boards, particular schools, the demographic within a certain community and the constraints that they each face.

Parents and teachers need to make wearing masks something that is fun for kids; it needs to be something that is part of their personality. Whatever methods that teachers and resource staff can use to create a positive culture around mask wearing is important.

It comes down to what’s the given environment. Schools that are more likely to have difficulties with ventilation that is outdated or have fewer resources in general to do distance learning may represent a higher risk situation.

This is another logistical challenge that is going to require attention. School buses are not designed to allow distancing within them, but this might be accomplished by keeping seats empty.

Masks are critical. A school bus represents an indoor environment that is not well ventilated, and for some kids rides can be upwards of 45 minutes or longer. Additionally it’s important to make sure that hands are washed before getting on the bus and that hand sanitizer is provided on the bus at entry.

Actually, the answer is somewhat complicated. It depends on an assessment of the probability that the negative test is a “true negative” rather than a “false negative”. This assessment would be informed by a variety of factors, including:

  • The nature and severity of the person’s symptoms and the timeline of those symptoms.
  • Any epidemiological link between the person and a known case or cluster/outbreak of cases, including an analysis of the nature/duration of any contact.
  • Local prevalence of COVID-19.
  • Risky behaviour (lack of diligence in wearing PPE and practicing hand/face hygiene, lack of diligence in avoiding contact with known cases, history of attendance in higher risk environments, etc.).

Each situation needs to be assessed on its own merits. In some cases, an employee could return to work immediately after a negative test is received. This could include situations where the symptoms are determined to be unlikely to be COVID-19 related from a clinical perspective, and where the symptoms are resolved or significantly improved, and where there is not a known connection to a positive case. Other situations may require a full 10-14 days off of work, even with a negative test and with resolution of symptoms, depending on the specifics of the situation. Unfortunately, this means that a one-size-fits-all approach is probably not possible or advisable.

There are no definite plans to change the recommendations for physical distancing in Canada at this time. A recent review of this issue in the Lancet found that transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m, and that protection was increased as distance was lengthened, with the review finding a reduction of risk by approximately 50 per cent with each additional metre of distance (this should be viewed as being very approximate given the limitations of the research to date). It is clear that the further people remain apart, the lower the risk will be for direct droplet-borne spread, which accounts for the bulk of spread of COVID-19. Policy recommendations from authorities in this regard would seem to be more about how much risk reduction they want to achieve using physical distancing, balanced against competing imperatives (e.g., available space, population density) and this may vary somewhat according to the particular context of the authority making the recommendation (e.g., rates of mask use, testing positivity rate, success in contact tracing). What is appropriate in one jurisdiction might not be appropriate in another. As with everything else to do with COVID-19, the answer is complicated.

The CDC continues to recommend a 14 day quarantine following close contact with a known case of COVID-19 (see

This is in line with Canadian requirements, and with most other global jurisdictions. The recommendation for being off work for ten days is for “cases” (i.e. ten days after onset of symptoms, or after a positive test), not for “contacts of cases”. The rationale is that following contact with a known case of COVID-19, it can take up to 14 days for an individual to manifest symptoms, so the full 14 day period must be waited out to determine whether the contact leads to a new case (if the contact remains asymptomatic for the full 14 days, they would be released from quarantine). However, once a person develops symptoms and becomes a case (generally on the basis of a positive test), we know that the period where they are most contagious to others is 48-72 hours prior to symptom development until ten days after the onset of symptoms. So this leads to a difference in recommendations for quarantine/isolation between contacts of cases and cases themselves. Paradoxically, it can lead to asymptomatic contacts of known cases being off work for longer periods than the cases themselves! (Updated 2021 – The CDC continues to recommend a full 14 day quarantine, but also allows for cessation of quarantine after seven days with a negative test, or 10 days without a test, while recognizing that earlier termination of quarantine does carry some risk of missing a developing case of COVID-19 during the days following the end of quarantine)

For COVID-19, a “close contact” is anyone who was within 2 m (6 ft) of an infected person for at least 15 minutes cumulatively over a 24 hour period. According to the CDS, an infected person can spread COVID-19 starting 48 hours before the person has any symptoms or tests positive for COVID-19.

Yes, according to the CDC you are considered a “close contact” even if you are wearing a mask while you were around someone with COVID-19. Masks are meant to protect other people from the wearer, not to protect you from becoming infected.

Duration of the COVID-19 virus in the body is more complicated than what you might expect, as is everything else related to it. There appears to be significant variability between individuals in terms of duration of symptoms and in terms of duration of viral shedding – these two parameters do not always correspond. In the case of asymptomatic individuals (i.e. discovered to have a positive test), viral shedding can persist for quite a few weeks in some cases, but the period of infectivity is thought to be mostly limited to the first ten days of illness. Since we cannot determine the start date of the illness, we recommend starting the ten day count from the date on which they were tested (not the date on which the positive result was obtained, which would generally be 1-2 days later).

Answer provided by Dr. Noah Levine

Testing positive twice is most likely indicative of an infected individual who, despite having recovered symptomatically, continues to shed virus RNA, which is what the COVID-19 PCR test detects. The current evidence is that this asymptomatic shedding of virus RNA following recovery from symptomatic infection can persist for many weeks, but is most likely not a significant source of viral spread. There are many theories about why this might be the case. It is also conceivable that following recovery from symptomatic infection the individual became re-infected (most likely with a different strain), resulting in a second course of illness. Without knowing more about the specific clinical details of the case in question it is difficult to be more precise in my response.

Answer provided by Dr. Noah Levine

This scenario is not at all surprising for a few reasons. First of all, the test itself has a false negative rate of up to 30 per cent, meaning that the first test for this individual had up to a 30 per cent chance of being reported as negative even if the virus was actually present. Secondly, it can take several days for sufficient virus to be excreted in the upper respiratory tract to register a positive test, so if a person is tested very early after contact with an infected individual, the test can be negative even while an infection is “brewing”. Thirdly, it is also possible that the person was actually not infected at the time of the first test and then became infected during the five day interval between the tests (e.g., when out grocery shopping or from some other contact or mode of transmission). So there are many reasons why one might observe the phenomenon of a negative test followed by a positive test. For this reason, we caution employers not to place too much stock on a negative test when making return to work decisions.

Answer provided by Dr. Noah Levine

All B&M employees who work in health care settings are required to continually abide by the hospital’s or client’s standards. At this time, the CDC and OSHA have recommended using a combination of standard precautions, contact precautions, airborne precautions and personal protective equipment (gowns, gloves, N95 masks, and eye protection) to protect healthcare workers with exposure to the virus.

Engineering controls such as physical barriers, airborne infection isolation rooms will likely be set up in health care settings. Ensure that you understand the layout and ask questions if you’re unsure.

If ever in doubt, contact your direct supervisor or your Regional HSE for guidance.

All B&M employees who work in airport settings are required to continually abide by the airport’s or client’s standards.

Alert your health care provider immediately if you think you have been infected with COVID-19, including exposure to someone with the virus and have signs/symptoms of infection.

If you believe you have been exposed on the job, alert your direct supervisor and Regional HSE.

Your healthcare provider can determine if your signs and symptoms are explained by other causes, or if there is reason to suspect you may have COVID-19. If laboratory testing is appropriate, your healthcare provider will work with health officials in your province/state to collect any clinical specimens for diagnosis.

There is no current vaccine or specific treatment available. Hospitals can provide supportive care for infected people. (Update 2021 – vaccines are now available, and are being administered to high priority groups currently, with vaccination of the wider population to follow.)

It is not yet known whether the weather and temperature will impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during the cold winter months, but that does not mean it is impossible to become sick with these viruses during other months. At this time, it is not known whether the spread of COVID-19 will decrease when weather becomes warmer.

Absolutely not. No one race or ethnicity is more or less susceptible to COVID-19 than another.

Early information, out of China, where COVID-19 first started, shows that some people are at higher risk of getting sick. These include:

  • Older adults
  • People with serious chronic medical conditions such as:
    • Heart disease
    • Diabetes
    • Lung disease

If you are within these higher risk groups, the following are some precautions suggested by the CDC:

  • Contact your health care provider to ask about obtaining extra necessary medications to have on hand in case you need to stay home for a prolonged period of time. If you cannot get extra medications, consider mail-order medications.
  • Have enough household items and groceries so that you will be prepared to stay at home for a period of time.

It can take two to 14 days for a person to develop symptoms after initial exposure to the virus. The average is about five days.

The WHO reports that 80 per cent of patients have a mild to moderate disease from infection. The milder cases are because the body’s immune response is able to contain the virus in the upper respiratory tract. These are typically healthy people with no pre-existing conditions.

In 13.8 per cent of severe cases, and 6.1 per cent of critical cases, the virus made its way to the lower respiratory tract through the windpipe. As the virus moves towards the lungs, it will continue to replicate and can cause problems such as bronchitis and pneumonia.

When pneumonia occurs, a thin layer of alveolar cells is damaged by the virus. The body then reacts by sending immune cells to the lung to fight it off. This results in the linings becoming thicker than normal. As they thicken more and more, they choke off alveoli (air pockets), which is what you need to get oxygen to your blood.

While there is no concrete answer, it is anticipated that a vaccine will take approximately 12-18 months to be created. (Update 2021 – several vaccines are now approved for use)

Vaccines are given to people who are healthy as a preventative measure. Preventative vaccines don’t treat or cure sickness, but rather they gear up your immune system to fight the potential disease.

The purpose of the vaccines would be to help your immune system by recognizing the difference between your healthy cells and the harmful cells.

Flattening the curve refers to using protective practices to slow the rate of COVID-19 infection so that hospitals have room, supplies and doctors for all the patients who need care.

Do not travel by air anywhere and seriously reconsider car travel outside of your home region for any reason.

Stopping the transmission of COVID-19 means we all must adopt extreme measures to limit our social interaction with others both at work, in public and at home.  This is what social distancing is.

If we only practice it at work and not home, we are seriously undermining our collective efforts to slow the spread of the virus.

Please follow these social distancing recommendations for work and home:

  1. Keep your distance. Stay 6 ft apart from others whenever possible.
  2. Avoid all physical contact, even when greeting, No handshakes, hugs, kisses, knuckle bumps or high fives.
  3. Take care of your family but limit socializing with anyone outside the home or office. No lunches, parties, playdates, sleepovers or visiting friends.
  4. Reduce the frequency of going out in public, even to stores and restaurants.
  5. Limit interactions with older people. This includes parents and relatives, as they are the most vulnerable.
  6. Stay home if you are sick. Isolate from everyone, including family, whenever possible. Seek medical attention.

These changes to your daily lives and preferred routines represent burdensome and annoying sacrifices, but recent experiences of countries worldwide have demonstrated that taking these actions early can have a dramatic impact on the magnitude of the outbreak.

We are encouraging everyone to be vigilant about monitoring their health for symptoms of COVID-19 and also identifying and reporting sources of potential exposure to the virus (contact with people who are infected, recent international travel, etc.).

In the vernacular of public health, isolation and quarantine mean different but related practices. With respect to a health emergency such as COVID-19, isolation is simply the practice of keeping ill people separate from those who are well while quarantine is the practice of restricting the movement of people who were exposed to a contagious disease to see if they become sick.

At Black & McDonald we are using the term isolate to describe our internal and personal efforts to keep ill people away from those who are well.

Isolate basically means you stay at home if you have COVID-19. Isolation is required for those who have been confirmed to have COVID-19. Isolation is a health care term that means keeping people who are infected with a contagious illness away from those who are not infected. Isolation can take place at home or at a health care facility.

Self-isolation (or self-quarantining) means that you stay at home because you suspect you may be ill because you have COVID-like symptoms and/or you suspect you came in contact with a person who has a suspected or confirmed case at home, in public or while travelling.

If you are ill with COVID-19 symptoms, contact your supervisor or HSE rep, and stay at home. Isolate yourself from family and others to the best of your ability. Follow the instructions of your local/regional health unit regarding next steps. Seek medical attention if your condition worsens, particularly as it relates to breathing difficulties.

This means you have been explicitly instructed to separate yourself from others, with the purpose of preventing the spread of the virus, including those within your home. If you are ill, you should be separated from others in your household to the greatest extent possible.

Until cleared by your health care professional, self-isolation means:

  • Do not use public transportation, including taxis or ride share programs (like Uber).
  • Do not go to work, school or other public areas.
  • Limit the number of visitors in your home.
  • Stay in a separate room away from other people in your home as much as possible. Use a separate bathroom, if possible.
  • Make sure that any shared rooms have good air flow.
  • Cover your coughs and your sneezes; wash your hands after.
  • Wash your hands after emptying waste baskets.
  • Use soap and water to wash your hands.
  • Dry your hands with a paper towel, or towel that no one else uses.
  • Use alcohol based hand sanitizer.
  • Wear a mask if you are within two metres of people, or need to leave your house to see your health care provider.
  • Clean all high-touch/high-traffic areas such as counters, toilets, sink tap handles, tabletops, doorknobs, TV remotes, phones and bedside tables daily with regular household cleaners.
  • Wear disposable gloves when cleaning surfaces.
  • Do not return to work, school or public activity until you have been cleared by your health care practitioner.

We greatly appreciate people’s concerns about this issue and rest assured we are responding with sensible and fair solutions that align with our company values. Unfortunately, there is not an easy answer to this question because the answer is different according to what you do, where you do it and where you live.

Black & McDonald must work in concert and be compliant with local government labour regulations and collective agreements so our internal rules governing leave compensation will vary according to geography and relevant collective agreements. As of March 16, we are providing corporately-developed pay and leave guidelines to all Black & McDonald regions, specific to the COVID-19 pandemic, so that all offices can quickly set and implement local policy.

Governments are also actively deploying strategies to provide greater access to pandemic financial relief for employers and employees to incent responsible self-isolation practices and to extend support to ill citizens.

Those who are infected with COVID-19 may have little to no symptoms. You may not know you have symptoms of COVID-19 because they are similar to a cold or flu. Symptoms may take up to 14 days to appear after exposure to COVID-19. This is the longest known infectious period for this disease.

Symptoms of COVID-19 can vary from person to person. They may also vary in different age groups.

Some of the more commonly reported symptoms include:

  • New or worsening cough
  • Shortness of breath or difficulty breathing
  • Temperature equal to or over 38C
  • Feeling feverish
  • Chills
  • Fatigue or weakness
  • Muscle or body aches
  • New loss of smell or taste
  • Headache
  • Gastrointestinal symptoms (abdominal pain, diarrhea, vomiting)
  • Feeling very unwell

Children tend to have abdominal symptoms and skin changes or rashes.

Some patients have reported gastrointestinal symptoms such as nausea and diarrhea, however it’s relatively uncommon.

Symptoms become more severe once the infection has made its way to the lower respiratory tract.

COVID-19 is thought to spread mainly from person-to-person between two people who are in close contact with each other, through respiratory droplets produced when an infected person coughs.

People are thought to be most contagious when they are the most symptomatic. However, spread can occur for 48 hours before people show symptoms.

COVID-19 can also be spread by touching a surface or object that has the virus on it, and then touching their own mouth, nose or possibly their eyes. This is not thought to be the main way that the virus spreads.

We recommend that the best everyday ways to protect yourself and others from the spread of germs are to:

  1. Wash your hands regularly and thoroughly with soap and water or alcohol-based hand sanitizer. The World Health Organization (WHO) provides an excellent tutorial on the most effective hand washing technique:
  2. Stop touching your eyes, nose and mouth with unwashed hands.
  3. Keep your germs to yourself by sneezing and coughing into your sleeve or a disposal tissue. Stay at home if you are sick.
  4. Maintain a safe distance from sick people of at least 3 ft whenever possible.
  5. Monitor your health for the signs and symptoms of the COVID-19 virus particularly fever, the onset of a dry cough or difficulty breathing.

Beyond staying abreast of B&M updates, we encourage you to continue to stay informed by visiting the World Health Organization (WHO), PHAC and CDC websites:


Municipal health authorities are also an excellent source of general COVID-19 information, local updates, and specific instructions to citizens. For example, Toronto Public Health or City of Kansas City.

Like the flu, coronaviruses are spread principally through direct contact. Although less likely, they can be spread indirectly when respiratory droplets from an infected person contaminate nearby surfaces and objects. To proceed with caution we recommend good workplace hygiene by regularly disinfecting shared facilities such as washrooms and kitchens, work surfaces ,including door handles, coffee pots, and appliances, and phones, keyboards and laptops with anti-bacterial wipes or disinfectants, particularly in high traffic areas or when workstations are shared by multiple people.

There is no known risk of COVID-19 entering Canada or the US on parcels or packages coming from affected regions. Currently there is no evidence to support the transmission of COVID-19 associated with imported goods.

If you become sick when you are travelling or after you return, avoid contact with others, inform your supervisor and a member of HSE, and in most provinces and states contact your local public health unit to advise of your symptoms, where you have been travelling and if you’ve made contact with a sick person. If feeling ill during a flight home or upon arrival, inform the flight attendant or a Border Security Officer.

Wearing a mask can help prevent the spread of the infection to others. Certain work environments within Black & McDonald may also require the use of a mask, typically defined by hazard assessment. Wearing a mask when you are not ill and are not at high risk for developing symptoms may give a false sense of security. Masks can easily become contaminated and need to be changed frequently and fitted properly for them to provide adequate protection.

Masks should be worn whenever you are indoors while outside your household, and any time you are around other people who are not part of your household (even if outside).

Patients with confirmed or possible COVID-19 should wear a facemask when being evaluated medically.. The CDC recommend following everyday preventative actions such as hand-washing, covering your cough and staying at home when you are sick.

While a recent study suggests that the virus that causes COVID-19 may have the potential to infect some types of animals, similar to what is known for SARS-CoV, there is currently no evidence that pets or other domestic animals have a significant risk of becoming infected with COVID-19 virus or can be a source of infection to people. This, however, is still under investigation as there are many unknowns to COVID-19.

The Black & McDonald COVID-19 Crisis Management Committee along with regional resources will continue to review and assess the overall risk levels to our employees, customers, clients and subcontractors.

If you have any questions or require support, please reach out to your Health & Safety Representative or Corporate HSE.