World AIDS Day- the 40th Anniversary

 World AIDS Day- 40th Anniversary.

In 2023, AIDS claimed 630,000 lives worldwide and 1.3 million people were newly infected. Almost half of these new infections were among young women and girls. Globally, there are 39 million people living with HIV.

When I started treating HIV in 1990, all of my patients died within a few years with the exception of a few. There were no treatments. The HIV treating physicians in the province of Ontario at the time became experts in the palliative care management of the patient dying of AIDS. I loved them all. My heart aches to this day when I think of each one of them. I was in my 20s and so were they. Today, they might be grandparents or happy retirees still living with their partners and loving their friends and families.

In 2006, that all changed with the advent of new life-saving treatments which involved a handful of pills taken three times a day. The treatment was toxic and caused so many side effects but people lived. Fast forward 19 years later and my patients are now treated with either one pill once a day or injections given every two months with few side effects. We are growing old together and I love them all. They have careers and partners and families and lives. It has been an honour treating this disease for 35 years, watching how the world responded and how my patients lived on as a result. We are so close to a cure; to the end of AIDS.

Today, 9 million people in resource poor countries do not have access to this life-saving treatment. Every week, 4,000 adolescent girls and young women are newly infected with HIV.

But there is so much hope. The Joint United Nations Programme on HIV/AIDS ( UNAIDS) set the 95-95-95 declaration that called on all member states to ensure that 95% of people living with HIV know their HIV status, 95% of people who know their status are receiving HIV treatment, and 95% of people on treatment are virally suppressed - the goal of treatment. People who are virally suppressed cannot transmit and can live normal, healthy lives.

Today, Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe have reached these targets. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

This is the path that will end AIDS. This path will also help prepare for and tackle future pandemics and advance progress towards achieving all of the Sustainable Development Goals.

If you are not aware of these goals, check them out: https://sdgs.un.org/goals

I love these goals. They are the reason I am on a political path. We can achieve them all if leaders lead and we all take action.

For those I loved who passed away and to those I love who have a future, I mark with respect and humility, this 40th World AIDS Day.

Dr. Anne-Marie Zajdlik
MD CCFP O. Ont. MSM
Founder of ARCH Clinic Guelph and Waterloo
( now called HIVe Clinic)
Founder of Bracelet of Hope

Donate at https://www.braceletofhope.ca/ways-to-give/ as we strive to end AIDS and reach these goals in Lesotho, Africa.

Politics and Public Health

 

This is very strange for me. I am writing a post that is both for public health and for politics which I believe need to be combined in order to strive to make communities across the country, healthier. It's time for more MDs to become MPs.

First off, public health:

1/ There are 25 cases of measles in New Brunswick. Last year, two children died of measles in Ontario. This is a very infectious disease that spreads with ease among children who have not been vaccinated. Please consider vaccinating your child. There are two vaccines: the first is given at age one and the second at age four.

2/ Last night, two of my colleagues saw 47 people at our on call clinic. That is an overwhelming number. By far most of these folks were suffering from respiratory viruses. One respiratory virus is the respiratory syncytial virus (RSV). This too can be deadly. It causes mild to moderate cold symptoms in most people but in children under two and in adults over 65, the illness can cause severe symptoms that can lead to hospitalization. There is an RSV vaccine for kids born in 2024 and children under two who are at risk. There is also and adult vaccine for people over 65. The adult vaccine is not covered by OHIP or public health.

And now, to politics. I am the candidate for the Federal Green Party of Canada in the Guelph riding. I have chosen this path in order to focus on three things:

1/ To improve the quality of our healthcare system with a focus on primary care. Primary care is the care that is provided by your nurse practitioner or your family doctor. There will be 56,000 people in Guelph and area who will not have access to a primary care clinician in the next 18 months. Elect me as your Member of Parliament and I will work to build a clinic that cares for these patients while working on much needed primary care reform.

2/ To address housing, food and economic insecurity. In other words, affordability. This is a major concern for the Green Party of Canada. I witness the effects of the affordability crisis in my medical practise every day. I have been treating my patients for 34 years. I have never seen anything like the suffering many are experiencing now.

3/ To address the effects of climate change. We can lead our young people away from despair and into a bright future by highlighting what is already being done in our community and by fighting for what needs to be done by all levels of government.

I need your support. Please consider signing up to help with my political campaign. Man, I never thought I would write those words. Of all the things I have done in my career, this is by far the most terrifying. More than anything else, I need your encouragement. That's what kept me going as I posted during the pandemic. You inspired me.

If you would like to volunteer, click on this link:

https://www.greenparty.ca/en/volunteer?riding=2013-35032...

If you are able to donate, click on this link and read carefully about the significant tax rebates that you receive depending on the amount you donate:

https://www.greenparty.ca/en/civicrm/contribute/transact...

And finally, if you would like to order a lawn sign for the 2025 election, click here:

https://www.greenparty.ca/en/get-a-sign

Here's to a hopeful and healthier future.

Anne-Marie

Please share.

P.S. A modest woman raised by a good Italian mother, the thought of lawn signs with my name on them doesn't sit well. I will need your encouragement to keep up the fight once these signs sprout up around town.

Yep,
It's a COVID update.

Heading back to school, cooler temperatures today reminiscent of the fall, canning everything in my garden....it is time. We are heading indoors folks and here is what you need to know.

Most of us are no longer wearing masks. My staff took their masks off a couple of months ago and we have enjoyed that freedom. I will advise them to put the masks back on next week. We need to be prepared for an influx of upper respiratory infections caused by the flu, RSV and COVID-19. It's tough to distinguish between these three. They can all present with the same symptoms. Because we see so many of these patients in the fall and winter and in expectation of a huge surge in mild to moderately ill children and adults, the masks will go back on. I will also strongly recommend that all of my staff get vaccinated. Because I am the oldest and I am not 60 yet, we are holding out for the new Moderna vaccine which will be omicron XBB variant specific. It's been about 8 months since our last vaccine.

So, what the heck is XBB and what about this new and very different variant? XBB.1.5, XBB.1.16 and XBB.2.3 are all COVID 19 viruses that are members of the Omicron sub-variant family. XBB has been the most common COVID-19 virus circulating in the last year globally taking over the BA-4 and BA-5 Omicron sub-variants and causing most COVID-19 infections world-wide. Thankfully, the infections caused by XBB have been mostly mild to moderate upper respiratory tract infections with serious illnesses occurring mainly in the elderly, the immunocompromised and those with chronic health issues. COVID-19 still causes 40 deaths a week in Canada.

Most low risk people had their last vaccine last fall and early winter and most of us received the Pfizer bivalent vaccine which protected against BA-4 and BA- 5 viruses. Over the course of the spring, the number new cases of infection dropped steadily and dramatically and then settled into a low level of infection throughout the summer. But then XBB slowly became the main circulating virus and cases are now increasing as we head into the fall.

What does that mean for people who are considering their next vaccine? Both Moderna and now Pfizer, have created a new vaccine that is XBB specific and very effective at reducing the risk of serious illness and reducing the spread of the virus. The XBB specific Moderna vaccine should be available in Ontario by mid-October just around the same time that flu shots will become available.

The good news is that the XBB specific vaccines are also proving, in pre-clinical data, to have some efficacy against the new variant of concern that is now circulating, EG.5.1 or Eris. (Please stop reading and have a cup of tea or your favourite summer beverage on your porch if this is triggering any traumatic memories. That's where I am headed after this).

What EG.5.1 does remains to be seen. Of interest, the original COVID viruses, Delta, Beta, Alpha are now extinct. That's what mutated and more transmissible variants do. They wipe out all pre-existing viruses as they become the dominant circulating strain. Yeah, I am still a geek when it comes to this stuff.

And here we go with recommendations:

1/Most healthy people under the age of 65 whose last COVID vaccine was more than 6 months ago should wait for the XBB specific Moderna vaccine. We can wait because the majority of the population in Canada has already developed longer lasting protection against serious illness after multiple rounds of vaccine, illness or both. There will be lots of the old Pfizer bivalent vaccine in freezers out there so make sure you ask for the Moderna XBB vaccine. The recommendations will be that this low risk group consider getting a COVID vaccine annually from this point on.

2/ Anyone at higher risk of serious illness including adults older than 65, pregnant people, people who are immunocompromised or with serious underlying acute or chronic illnesses should be vaccinated every 6 months. Because we are so close to having the Moderna XBB variant specific vaccine in Canada, I am telling my patients who belong to this group to stay safe, wear a mask and avoid indoor gatherings until they receive this vaccine.

3/ It is considered safe to get your flu shot and COVID vaccine at the same time.

4/ Health Canada is actively reviewing submissions for updated vaccines for children six months of age and up. No recommendations for this group presently exist.

This post is getting a bit long but I do want to add some important information about the Rapid Antigen Test ( RAT). The RAT test was designed to detect the original COVID viruses. Some studies suggest that the RAT test is only about 20 % effective at detecting the newer variants of COVID-19 including XBB. It is important to be able to test for COVID -19 for so many reasons but especially in at-risk groups who are eligible for the anti-viral, Paxlovid. Paxlovid reduces the length and severity of COVID infection but a person needs a positive test to receive this medication from their primary prescriber or their pharmacist. The medication is taken twice daily for five days and needs to be started within 5 days of the start of symptoms in order to be effective.

So how do we test? You are not going to like this. We still use the RAT but we test at five sites for 5 seconds at each site: inside the lower gum line on both sides, the back of the throat and deep into each nostril. Yep. Hold and twist the swab for 5 seconds at each site. I don't think I can hold a swab at the back of my throat for five seconds without gagging and possibly vomiting so lets hope a new RAT is available soon.

More updates to follow and please leave your questions in the comments section. That will help me as I generate new posts.

Anne-Marie

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To continue providing primary care, COVID testing and HIV care to the beautiful people of Lesotho, you can click to donate here:
https://www.braceletofhope.ca/ways-to-give/
For non-Facebook users, you can find this post here:
https://braceletofhope.blogspot.com/

New info about COVID -19 infection and it's complications

Deaths due to heart problems have surged world-wide since the start of the pandemic.

A study done in the UK involving 53,000 participants was published in the British Medical Journal and points to a link between COVID-19 infection and heart disease and stroke.

Serious Illness caused by COVID-19 infection can lead to long term heart damage, death from cardiovascular disease and heart failure. People admitted to hospital with COVID -19 were 17.5 times more likely to suffer a stroke, 10 times more likely to suffer a heart attack and 21 times more likely to develop heart failure than people who avoided hospitalization with COVID-19. These rates were highest in the first 30 days after infection but remained elevated for up to 1 year after infection.

Less severe COVID-19 infections did not lead to this jump in risk of heart disease, stroke or heart failure in this study I reviewed tonight.

Here is the link to the study done in the UK and printed in the British Medical Journal - a very reputable scientific journal:

https://heart.bmj.com/content/heartjnl/early/2022/09/21/heartjnl-2022-321492.full.pdf

COVID is not over yet and it is likely here to stay. Protecting yourself with public health measures when appropriate and vaccinations remains a top priority. We can live with COVID. We do not need to die from COVID or develop serious, life-threatening illnesses as a result of COVID-19.

Vaccines dramatically reduce the risk of serious illness, hospitalization and death. I am running my first bivalent COVID vaccine clinic tomorrow. I am about 15th in line.

Please play it safe and consider getting the next vaccine booster required in your booster series.

Anne-Marie

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To continue providing primary/COVID care and HIV care to the beautiful people of Lesotho, you can click to donate here:
https://www.braceletofhope.ca/ways-to-give/
For non-Facebook users, you can find this post here:
https://braceletofhope.blogspot.com/

Bivalent vaccines and new variants of concern

 It might be time for a COVID-19 update:

Here are the main new variants of concern and what to expect:

BQ.1.1- 4 % of new cases in Canada

BA.2.75.2- 3% of new cases in Canada

XBB- < 1% of new cases in Canada

There are more than 300 Omicron sub-variants being tracked worldwide but these three are receiving the most attention and XBB seems to be the main variant to watch with the greatest number of immune escaping mutations. The world is watching as Singapore struggles with an XBB driven wave that is driving hospitalizations up despite a high vaccination rate in that country. 79 % of Singapore's population has received a booster dose which means three of the original COVID vaccines. The number of new cases there since September 20th has more than doubled from 16,000 a week to more than 40,000 between October 4th to 10th. The number of new hospitalizations have tripled there since the beginning of October, mostly driven by XBB.

Singapore has a high vaccination rate, but not with the new bivalent vaccines.

I am not happy about reading these tables and seeing phrases like '7 day rolling average' and 'number of ICU admissions'. It's triggering a bit of panic. Although we have made tremendous strides in our battle against COVID-19, we have all been traumatized in various ways by so many forces in this new world stained by COVID-19. What I need to remember is that we have the tools to keep COVID at bay but we need to remember how to use them.

BQ.1.1 and XBB may cause waves of infection but there are two main ways we could prevent them from causing a huge increase is serious illness and death: Bivalent vaccines specific to Omicron and antivirals like Paxlovid.

Here are some sobering numbers.

62.5 % of Canadians have had COVID-19. 19.6 million Canadians were infected between December 15, 2021 and August 15, 2022. I was one of them....twice.

That's 80,000 new infections a day!

Check out this link: https://www.covid19immunitytaskforce.ca/

That was the effect of the incredibly infectious Omicron variant. There will be a thread in the comments of this post suggesting that vaccines must not work if so many Canadians were infected with COVID-19. The vast majority of these Canadians had mild illness with only a small percentage requiring hospitalization. Now, in this phase of the COVID pandemic, it is not about infections, it is about the rate of serious illness and death and the ability of vaccines to reduce this rate.

Just over 50 % of Canadians have more than the original series of two COVID vaccines. Bivalent vaccines are here with Pfizer's BA 4-5 bivalent vaccine available now to everyone over 18. Will this vaccine provide protection against an Omicron wave of BQ.1.1 and XBB variants? That is under intense study. We do know that these vaccines provide better protection than the original COVID vaccine which means that for folks with only the original COVID series or boosters with the original COVID vaccine, you are less protected than if you line up for a boost of the bivalent vaccine.

For healthcare workers barely managing at this moment, our greatest fear is an early flu season, which is already here, and a wave of one of these new Omicron variants smashing together with disastrous consequences.

Please consider four things that will protect you, your family, the elderly and frail and your precious healthcare system:

1/ Get a bivalent booster. I am option for Pfizer's BA 4-5 vaccine this week. It is recommended that you wait 3 - 6 months from your last vaccine or COVID infection before receiving this booster.

2/ Get a flu shot. In this province alone, you will decrease the number of hospitalizations caused by the flu by 2,400. Keep 2,400 children and frail adults from getting seriously from the flu.

3/ Remember paxlovid. It is an antiviral used within 5 days of the onset of COVID infection that dramatically reduces the risk of serious illness and death from COVID-19. Click here to review your or your family member's eligibility for paxlovid:

https://www.ontariohealth.ca/sites/ontariohealth/files/2022-04/Guidance%20for%20health%20care%20providers%20-%20Access%20to%20Paxlovid%20-%20EN.pdf

4/ Wear a mask in public.

Until we see where things go this fall and whether or not one of these new strains create a massive new wave with a new variant of concern that could escape immune protection, I am wearing a mask in public. I am looking at my masks again making sure that they are new, unsoiled, well fitting N95's.

Without using these tools, we are " Sleep walking on a tightrope". Dr David Naylor, Co-Chair Canada's COVID-19 immunity Task Force.

I am so sorry about this folks. This is bloody exhausting. I am exhausted, your are exhausted and the world will never be the same but we are a resilient lot. We have the ability to keep on going, keep being grateful, keep finding joy and keep building a future. Be smart and.....I haven't said this in a long while, we've got this.

Anne-Marie

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Hate will not be tolerated in the comments section of this post. Extreme hate or threats will be reported. If you do not agree with vaccines, move on.

To continue providing primary/COVID care and HIV care to the beautiful people of Lesotho, you can click to donate here:
https://www.braceletofhope.ca/ways-to-give/
For non-Facebook users, you can find this post here:
https://braceletofhope.blogspot.com/

New Vaccines

https://www.facebook.com/watch/?v=549268289332187

 This video is old and it tells us how fearful a time we have come through and how much progress we have made with respect to COVID-19. Get your 4th dose if you have not yet it. The 4th dose or second booster is the original COVID-19 vaccine. Once you have had your 4th dose or second booster, consider getting a 5th dose. You can receive one of the new bivalent vaccines as you 5th dose: Moderna's bivalent which has protection against the original omicron virus and the BA-2 Omicron variant and the soon to be available Pfizer's bivalent vaccine which contains the original COVID vaccine and the BA-4-5 omicron specific vaccine. We should hear about the availability of this vaccine in the next week or so.

This vaccine is showing improved protection above the original COVID vaccine with superior protection against the present dominant circulating strains. Wait three to six months from your last vaccine to your next and three to six months from a COVID infection and your next vaccine.

Find more information about these vaccines, how to book and which one is available to you or your children on the Guelph Wellington Dufferin website.

https://wdgpublichealth.ca/

I continue to recommend these vaccines to all eligible age groups. They protect against serious illness and death and they also can prevent transmission of infection reducing a person's risk for medium and long COVID. The fatigue and decreased exercise tolerance and cough can last for months.

Anne-Marie

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And to continue providing primary/COVID care and HIV care to the beautiful people of Lesotho, you can click to donate here:
https://www.braceletofhope.ca/ways-to-give/
For non-Facebook users, you can find this post here:
https://braceletofhope.blogspot.com/

For mental health support here:
https://familyserviceguelph.on.ca/
For local assistance with anxiety and depression:
www.here4help.ca
CMHA WW Website: www.cmhaww.ca
Here 24/7 at 1-844-HERE-247 or www.here247.ca.
And for post-secondary students, Good2Talk
https://good2talk.ca/

A COVID Update: Should we get a booster this fall?

 

First off, there is no dispute concerning the fact that we should be vaccinated against COVID-19. If you have not started your vaccination series, please consider doing so especially if you are in a high risk group. At present, the vaccines that are available are active against the initial COVID-19 virus and all it's variants with less effectiveness against preventing infection with the present Omicron BA-4 and 5 which are the variants that are widely circulating at this time. The COVID-19 vaccine series ( 2 doses and 2 boosters for eligible groups) DOES reduce the risk of serious illness, hospitalization and death.

Should your children aged 5- 11 receive a booster dose?

As of August 2022, the rate of hospitalizations due to serious illness from COVID-19 in children ages 5-11 was 0.2/100,000. The rate of hospitalizations in people over 80 was 22.6/100,000. Therefore, Omicron BA-4 and 5 cause mild illness in kids for the most part. Those at greatest risk are people over 80 years of age.

See table four on this Public Health Ontario document:

https://www.publichealthontario.ca/-/media/Documents/nCoV/epi/covid-19-weekly-epi-summary-report.pdf?sc_lang=en

It is interesting to note that wave 7, caused by Omicron BA- 4 and BA-5 had a much reduced case fatality rate ( the number of people who die from an illness ) of 2.2% compared to all of the other waves. This is likely the result of widespread vaccination and the fact that these variants are less deadly.

See Table six of this document:

https://www.publichealthontario.ca/-/media/Documents/nCoV/epi/covid-19-weekly-epi-summary-report.pdf?sc_lang=en

At present, a child who has received two doses of vaccine has a 36.8 % reduced risk of becoming infected with COVID-19 and a 82.7% reduced risk against hospitalization.

https://www.nejm.org/doi/full/10.1056/NEJMoa2203209

NACI ( the National Advisory Committee on Immunization) has now recommended a booster dose for children aged 5- 11. The intent of the booster dose is to restore protection from the two dose series. The protection provided by two doses in this age group has likely decreased over time to a level that is no longer deemed sufficient to reduce the risk of infection or hospitalization. NACI also recommends that the booster dose be given at least 6 months since the completion of the 2 dose series.

Only 42 % of children in this age group have received 2 doses of vaccine. For your child to receive the best vaccine protection this fall, start the vaccination series as soon as you can. Pfizer is used in this age group.

https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-first-booster-dose-pfizer-biontech-comirnaty-covid-19-vaccine-children-5-11-years.pdf

Please note, that manufactures are working on new COVID-19 vaccines including 'multivalent' vaccines. Multivalent vaccines target the original COVID-19 virus and it's variants. These multivalent vaccines will not likely be available to adults until late fall or the new year. Please consider getting a second booster dose of vaccine if you are over 18. That second booster will be all that is available to protect you from what will likely be an 8th wave or a surge of the 7th wave this fall.

To summarize:

1/Omicron BA-4 and BA-5 are the dominant COVID-19 viruses that are presently circulating. The mRNA vaccines ( moderna and pfizer) are not effective at preventing illness from these variants. They do reduce the risk of serious illness and hospitalization.

2/ Omicron BA-4 and BA-5 pose the greatest risk in the over 80 age group with a very low risk of serious illness and hospitalization in children aged 5- 11 and in all younger age groups. Vaccines have reduced this risk. Natural immunity acquired from infection has reduced this risk and the fact that these variants are less deadly has also reduced this risk.

3/ We are now in a long and encouraging stretch during which no new variant of concern has threatened to take over Omicron BA-4 and 5. This is great news. The longer this variant circulates the more immunity we build and the longer we have to create very effective multivalent vaccines. If we coast through the fall with no new variants we could be at the point in this pandemic when annual vaccines are all that is required. Amen to that!

Would I give my child aged 5-11 a booster dose? Yes, I think I would. The risk of serious concerns from vaccines in this age group are extremely low ( see the above link the the New England Journal of Medicine article for review of these risks.) The risk of my healthy children developing serious illness or requiring hospitalization from COVID infection is also extremely low. Vaccinating these kids reduces the risk of spreading infection to those at much higher risk ( 80 years of age and above, the immunocompromised, those with chronic illnesses). It will also reduce the amount of circulating virus in the community. The more virus that circulates, the greater the risk of new variants of concern evolving. Widespread vaccination gets us closer to this virus becoming an illness that requires an annual vaccine to control.

As we move indoors, I am going to put my mask back on in public spaces. I never really took it off but in the last month or so, I have been running into this shop or that store for a quick purchase without a mask on. I have had four doses of vaccine and two cases of COVID in May/June. By the end of September, my immunity will be down again. Wear a mask until the multivalent vaccines are available. And, stay home if you have COVID, for at least 5 days or more if your symptoms are persisting. The government gives us guidance which follows the science but is also assessed through a political and economic lens. If you are able, follow the science as much as possible.

Anne-Marie

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And to continue providing primary/COVID care and HIV care to the beautiful people of Lesotho, you can click to donate here:
https://www.braceletofhope.ca/ways-to-give/
For non-Facebook users, you can find this post here:
https://braceletofhope.blogspot.com/