Vaccines and pregnancy

 An unplanned Facebook post about Pregnancy, Breastfeeding and COVID-19 vaccinations

I am not sure this will end up being proven by statistics but I think there is a pregnancy boom out there. Two or three new pregnant patients a week is unheard of in my practise even if compared to my baby delivering days. Many of these newly pregnant women delayed getting pregnant until they had two COVID-19 vaccines and although I understand their line of thinking, I am glad they received their vaccines in the late spring and summer. The delta variant is nasty and it preys on folks who are immunocompromised. Many people may not be aware that pregnancy induces an immunocompromised state. The body's immune responses are damped down during pregnancy and for good reason. The fetus has it's own unique make up and, more specifically, it's own unique proteins. If the pregnant mother continued with a non-pregnant immune response during pregnancy, her immune system would attack the fetus's proteins putting the life of the fetus at risk. COVID thrives in this state of damped down immune responses. Pregnant women who become infected with COVID-19 have a much greater chance of developing serious illness, becoming hospitalized, being admitted to the ICU and dying of the virus. What comes to mind is the very recent story of a Saskatchewan man whose pregnant wife contracted COVID-19 and was just transferred to an ICU hundreds of miles from home in oder to be place on ECMO which stands for extracorporeal membrane oxygenation. An ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. It's a bypass machine. If a person with COVID needs their blood to be oxygenated by a machine outside of her body, that means that her lungs are so damaged that not even a ventilator can help. This husband and father knew what his wife and unborn baby's chances of survival were. He spoke about the fact that he could not be at her bedside If she died and that her death would mean the death of their child. He knew that her chances of dying were almost 40 percent and that if she survived, the likelihood of long term chronic lung issues and long haul symptoms were also high. In pregnancy, the risk of hospitalization after COVID-19 infection is 10 times greater than in the non-pregnant person. https://www.cbc.ca/news/health/covid-pregnancy-risk-icu-hospitalization-1.6176742 To put it in other terms, you are 15 % more likely to develop serious illness requiring hospitalization if you are pregnant and infected with COVID-19. COVID-19 vaccination is strongly recommended during pregnancy (regardless of trimester), breastfeeding or trying to conceive. Both the Pfizer and Moderna vaccines have been proven to be safe in pregnant and breastfeeding mothers. In a study of over 35,000 pregnant women who received an mRNA COVID-19 vaccine, no serious adverse reactions occurred. An Ontario study showed similar findings. https://www.bornontario.ca/en/whats-happening/resources/Documents/BORN-COVID-19-Vaccination-During-Pregnancy-in-Ontario-Report-2---FINAL.pdf. New evidence shows that mRNA vaccines do not transfer into breast milk. But, COVID-19 antibodies produced as a result of being vaccinated can transfer through breast milk potentially providing protection to the breastfed infant against COVID-19 infection. https://jamanetwork.com/journals/jama/fullarticle/2778766 And, just to reiterate what I have stated in several posts, Public Health Ontario reports that there is no evidence of an association between COVID-19 vaccination and female or male fertility. https://www.publichealthontario.ca/-/media/documents/ncov/vaccines/2021/09/covid-19-vaccines-fertility.pdf?sc_lang=en. As Ontario re-opens, as we head into the winter months and being to gather more indoors and with the upcoming Christmas season ( two month away folks), individuals who have not been fully vaccinated against COVID-19 are at much greater risk of infection and once infected, unvaccinated people have a seven-fold higher risk of symptomatic COVID-19 disease, a 25-fold higher risk of being in the hospital and a 60-fold higher risk of being in the ICU compared to the fully vaccinated. Pregnancy increases the risk even further. Please, if you are pregnant or breastfeeding and not yet vaccinated, get vaccinated. Your life and the life of your babe may depend on it. Serious stuff.....but backed up by good science and research. Get fully vaccinated. Anne-Marie Please share widely!!

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NO FUEL FOR COVID-19

 

And here we are......

On the other side of the fourth wave. For now. Well done Ontario! Only 373 new cases in the province today and our seven day rolling average just dropped below 400 to 389. It was 441 a week ago. Check out my favourite graph: https://covid-19canada.com/graphs#ON Scroll down to New Cases Analysis by Date and look at that 7-day rolling average curve. Despite schools re-opening to in-class learning and despite a major holiday and long weekend, that curve is coming down. Meanwhile, the main reason behind our success is obvious; 87 % of Ontarions have received at least one dose of vaccine and 83 % are fully vaccinated. The frail and elderly in longterm care homes and congregate settings along with the immunocompromised have received a third dose. Next week, we expect to hear about the next step in the province's plan to offer a third dose to people over the age of 70 and it is anticipated that Health Canada will approve the Pfizer vaccine for use in children under 12 in the coming weeks. The federal government has already purchased almost 3 million doses of this vaccine which is the same as the adult vaccine except that it is a third of the dose. The US drug regulating authority, the Food and Drug Administration (FDA) are reviewing the data on kids vaccines and they appear to be highly effective at preventing symptomatic infections in kids under 12. They FDA is expected to make their decision concerning the use of the Pfizer vaccine in kids next week. The scientists presently reviewing the data concluded that the vaccine's benefit for preventing hospitalizations and death from COVID-19 far outweigh any serious potential side effects. As with adults, the kids vaccine is 91 % effective at preventing symptomatic infections. There were no severe illnesses reported among any of the children in the study, but the vaccinated ones had much milder symptoms than their unvaccinated counterparts. The FDA review found no new or unexpected side effects, which mostly consisted of sore arms, fever and achiness. It should be noted that the study of the Pfizer vaccine in children under 12 was not large enough to detect extremely rare side effects, including myocarditis. Rare side effects are discovered after millions of people have been vaccinated. It is likely that the 28 million children under 12 in the USA will begin receiving the Pfizer vaccine as early as the end of November. The COVID-19 situation in the USA remains very different than the situation in Canada. Nearly 6.2 million children in the USA have been infected with COVID-19, 1.1 million in the last six weeks and more than 680 people under the age of 18 have died from COVID-19 infection in the USA. There is a sense of urgency to vaccinate children in the states because the virus remains out of control in many states. Here is what I predict. Given that: 1/ We have such good control of the virus at present in most provinces. 2/ Our vaccination rates are so high with some communities like Guelph now reaching over 90 % fully vaccinated. 3/ We seem to be conquering the fourth wave as a result of mass vaccinations. 4/ Children under 12 who are at less risk of developing serious COVID-19 infections and at extremely rare risk of dying of COVID-19. The urgency around vaccinating children under 12 is not as acute in Canada. They need to be vaccinated, there is no doubt of that. But Health Canada will do their due diligence before approving this vaccine. They will not rush. Our children will likely begin being vaccinated in the new year at which time, millions of American children will have been vaccinated. We will be able to see if there are rare risks associated with the Pfizer vaccine in children under 12. Our willingness to be vaccinated along with our ability to adhere to public health guidelines that include limited gathering indoors and wearing masks in public have left us in excellent shape. We will continue to protect our children under 12 as a result of these efforts until we know and understand the safety of these vaccines in this age group. I am concerned about opening up to soon. I agree with the present provincial plan to start lessening limit restrictions in public places next week. I have huge confidence in our Chief Medical Office of Health, Dr. Kieran Moore. He seems to have a strong and steady hand that will not likely be moved by politics. If we are not ready to fully open by March, we will not fully open in March regardless of any political agenda or a looming provincial election in June. We may need to keep masks on until the summer and indoor gatherings may need to stay under 25 well into next summer. We have the strength and resilience to do this. We must do this if it is proven to be the correct thing to do as we move through the winter months. Do not be anxious to take those masks off. We'll get there. NO FUEL FOR COVID-19. Let this bugger burn out. Starve it of any human hosts. That's the plan and we are doing it. Anne-Marie Please share We are assisting in the roll out of the J and J vaccine in Lesotho. If you would like to be apart of this vitally important work towards making sure that vaccines are distributed in resource poor countries like Lesotho, you can donate here: https://www.braceletofhope.ca/ways-to-give/ For non-Facebook users, you can find this post here: https://braceletofhope.blogspot.com/

A hodgepodge of things.

Who uses that word anymore? It's a good word though. It's like alphabet soup; a bit of everything all mixed up and a little confusing. That sums things up pretty well. Notice, that we may still be confused about issues related to COVID-19 but there is no question as to where we are. We are heading to a time when COVID will no longer be the first word on our tongues in every single conversation. Man, I am really looking forward to that. I look forward to the main topic of conversation amongst Canadians going back to benign things like the weather. Up first, third doses: Canada's National Advisory Committee on Immunization (NACI) has so far only recommended third doses for people living in long-term care and people who have one of a handful of specific conditions that makes them moderately to severely immunocompromised. Click on this link to review the list of people who are eligible for a third dose: https://wdgpublichealth.ca/your-health/covid-19-information-public/covid-19-vaccine-information/third-dose-eligibility-and-how Why not ramp up third doses for the general public? To put it simply, it's not time yet but that time is coming. Most experts agree that we will need a third dose and subsequent booster doses down the road but at the moment, the signals that would prompt the widespread recommendation for boosters are not there yet. We are are living with the 'Canadian advantage' and that's a really good thing. The powers that be made a couple of risky decisions early on that have really paid off. Last March, NACI recommended lengthening the time between the first and second dose to a maximum of 16 weeks instead of three weeks for Pfizer and four weeks for Moderna. This decision proved to be very beneficial. The longer interval led to a stronger and possibly longer antibody response and increased level of vaccine protection. Researchers, immunologists, infectious disease specialists, public health units and all levels of government are constantly looking for "signals" that would suggest immunity is waning in certain parts of the population. They are watching "daily and obsessively". They are watching for an increase in the number of breakthrough infections and serious illness among fully vaccinated people. They are also monitoring the antibody levels of people enrolled in research trials who have been double vaccinated. Antibody levels in the elderly and in people who are immunocompromised decline more quickly but for healthy individuals, antibody levels appear to be staying high more than six months after the second dose. Another Canadian advantage, and specifically in provinces whose % vaccinated has exceeded 80 %, is that the high rate of vaccination is protecting people with lower antibody levels just by virtue of the fact that the amount of circulating virus is so low. Healthcare workers who received their vaccines more than 10 months ago will likely be next on the list for the third shot followed by the the elderly living independently using the same age-related criteria that was used for the first two vaccines, working from the oldest to the youngest keeping in mind that the vaccination of the under 12 population is just around the corner. Third doses will have to be carefully timed around this age group and their need for vaccines. Second up: Pfizer presented their study results in children under 12 to Health Canada today. We may be only weeks away from the approval of this vaccine in this age group. The spike in cases after the start of school and the possible rapid spread of COVID among school-aged children did not materialize and that is good news. We are still waiting to see if the 'Thanksgiving' effect shows up this week. Third point: Misinformation about vaccines is still out there and many people remain vaccine hesitant. This paragraph is for them. The mRNA in the vaccine does not enter breastmilk. These vaccines do not contain live virus. The mRNA vaccines do not cause transmission of virus or any virus particle to enter breast milk. All known vaccines are safe in breast feeding women, the COVID-19 vaccines are safe as well. There is now a vast amount of research that has proven these vaccines to be safe in pregnancy. The risk of myocarditis after vaccination is highest in men under the age of 39. The risk using Ontario data is 37.4/million doses of vaccine. This condition is more common after the second dose and usually occurs within several days after vaccination. By far the majority of patients who develop this condition respond well to medication and rest, are better within a week and return to normal activities with ease. The risk of myocarditis with COVID infection is 450/million cases but the condition is much more serious when caused by COVID-19. The first vaccine research trials started 20 months ago. One of my vaccine hesitant patients said he believed these vaccines had only undergone three months of research. Not true. Almost 7 billion doses of vaccine have been administered worldwide. 250 million people ( likely a vast under estimate) have been infected with COVID-19 and almost 5 million have died. It's and extremely dangerous virus. Get the vaccine. The vaccines do not cause infertility and biological are not capable of causing infertility. Longterm complications from these vaccines are also highly unlikely and biologically implausible. This point is shocking: up to 35 % of COVID-19 patients develop long-haul symptoms. That's a third of COVID survivors. And their symptoms? Fatigue Shortness of breath or difficulty breathing Cough Joint pain Chest pain Memory, concentration or sleep problems Muscle pain or headache Fast or pounding heartbeat Loss of smell or taste Depression or anxiety Fever Memory loss, brain fog, cognitive decline Worsened symptoms after physical or mental activities So, to be blunt, 'can it' with the concerns over the possible longterm effects of vaccination. It's the longterm effects of COVID that you should really be worried about. Yeah, I am really frustrated with this particular piece of unfounded mis-information. We are doing GREAT Ontario. Widespread vaccinations have made our communities so much safer. We are not there yet. Keep wearing masks. Be careful with indoor gatherings now that we are entering our colder months. If someone in your crowd is not vaccinated, wear a mask and stay six feet apart. Keep the size of your indoor gatherings small, much less than 25 if possible. Protect the frail and elderly whose antibody response to these vaccines is far less robust. Keep them safe and when in doubt, wear a mask. It is also time for flushots. Most pharmacies and many doctors offices now have them. Reducing the risk of the flu will keep our hospitals open and ready to receive patients with other serious illnesses. You can get the flushot and a COVID vaccine on the same day. No need for any delay. That's it for the hodgepodge. Have a good night. Anne-Marie Please share.

We are assisting in the roll out of the J and J vaccine in Lesotho. If you would like to be apart of this vitally important work towards making sure that vaccines are distributed in resource poor countries like Lesotho, you can donate here:

https://www.braceletofhope.ca/ways-to-give/

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You are MARVELLOUS!

That's a phrase we used so many times in medical school, thirty-three years ago. I look back on this and realize how much the world has changed. I am not sure if medical school is as 'vicious' now as it was then. I went to McMaster Medical School in Hamilton. It was known for it's new way of thinking and learning and it's open mindedness with respect to treating the entire patient from a holistic and compassionate point of view.

Working at the bottom of the medical school totem pole was humbling to say the least. Some senior residents and specialists set great examples of professional behaviour, others, not so much. I did the obstetrics part of my residency at St. Joseph's Hospital. It was and still is a very busy place. I remember one infamous obstetrician-gynecologist in particular. He was widely feared. On one particularly busy night, several of the residents and interns were called in to watch him deliver a breech baby. Babies in breech position are now delivered by C-section unless that option is not available but back then, women were given a shot at a very risky vaginal delivery. So many things could go wrong and on this particular night, many things did. We asked the labour and delivery nurses what to expect when we entered the delivery room. In other words, how do we manage this feared MD. Their answer? "DUCK".

Sure enough, once every part of that newborn was delivered except the head which then got stuck and the dangling newborn body started to turn blue, the stress and anger in that room were palpable. All of a sudden, this guy decides to throw one of the forceps he failed to use effectively, in our direction. We did what we were told. We ducked. A scalpel blade came next. We ducked again. Four of us, standing like frozen soldiers in a dutiful row, all ducked at the same time. That, in large part, was how we were treated by many angry folks who had not learned how to handle an intensely stressful situation without becoming abusive or did not care about managing an intensely stressful situation in a professional and respectful way. Times have changed and thankfully, this type of behaviour still exists but is no longer seen as acceptable.

On the opposite end of the professionalism spectrum, I remember assisting an obstetrician-gynecologist while she was removing a uterus. I can't remember what went wrong but the patient's pelvis quickly filled with blood and her vital signs become very unstable. We all watched the surgeon. She could have screamed and yelled profanities, maybe even thrown a scalpel blade or two.... we waited. She worked swiftly to control the bleeding but she also understood that we were looking to her for leadership and control. So, she started singing. It was the late 80's and Bobby McFerrin's hit, 'Don't worry, Be Happy' was at the top of the charts. That is what she sang. I learned more about staying calm and professional in that moment than I think any other. The entire operating room relaxed and every order she gave after singing that song was responded to with precision and expertise. We all work better together as a team when we are being led well with calmness, professionalism, dignity and level-headedness.

Our medical school class was very close. We had each other's backs. It was a well loved, now retired oncologist who started this comforting, encouraging phrase which was used to shore up an abused classmate. I don't remember who she helped first but it must have been some collapsing medical student who had just had a scalpel and a profanity hurled at them. She took them aside and whispered, " You are Marvellous". It caught on very quickly and soon became standard operating procedure. Right in front of the most abusive specialist, any nearby classmates would chant those words. It bewildered and confused the abusers. It also silenced them.

I am not sure why I am telling you this story except to make sure you know how marvellous you are, what a marvellous job we have done as a province and how close we are to making COVID-19 a manageable illness. I am also very concerned about leaders in general. The big political leaders that hold positions like premiers, presidents and prime ministers. Not all of them but too many do not live up to what we need and expect in terms of professionalism, decency, respect and kindness. But you had had some great leaders in this province and nationally. Quiet, unsung, medical leaders and professionals who have given their all in the last 19 months.

I'd like to say 'thank you' to them. They have steered us to a place where hospitalizations have remained low and steady, where 87 % of vaccine eligible Ontarions have received one dose of vaccine and 82 % have received two and where our 7 day rolling average is down to 537 not 8,000 which is what the worst case scenario modelling predicted.

Well done. YOU ARE MARVELLOUS!

Kids vaccines are next. Both the Pfizer and Moderna vaccine trials in kids have shown exceptional results with just a third of the adult dose. Kids in these trials have experienced fewer short term, minor side effects. The American Food and Drug Administration is expected to approve the use of these vaccines in children under 12 in the next couple of weeks. Health Canada will likely follow shortly thereafter. Because we are naturally very protective of our children, these studies will be reviewed with great care. I will start informing you of these studies as soon as they are available for general review. In the meantime, as we head indoors, get vaccinated. Keep your families and your communities safe. Keep our new daily cases low. Keep our hospitals open for business. Give our hospitals time to recuperate from the many, many far reaching effects of this pandemic. We are not in good shape as a medical community. Holding the fractured and broken health care system on our shoulders is a daunting and exhausting task. Be patient. Be kind. Tell someone you know in the medical field that THEY are marvellous too.

Yeah.....that's a big Thanksgiving carrot. You guys have bestowed me with great 'carrot' luck.

Be well and safe out there.

Anne-Marie

Please share.

We are assisting in the roll out of the J and J vaccine in Lesotho. If you would like to be apart of this vitally important work towards making sure that vaccines are distributed in resource poor countries like Lesotho, you can donate here:

https://www.braceletofhope.ca/ways-to-give/

For non-Facebook users, you can find this post here:

https://braceletofhope.blogspot.com/

No Doom and Gloom, just hope!

 Despite all the doom and gloom predicted for this fall with spikes after Thanksgiving and the Christmas season, I see things a little differently. I think there is hope by the bucketload on the horizon. Grab onto it as our energy wane and our mood heads for a dip with the shortening of daylight. Look to the hope.

Hope is arriving in three packages: 1/ The peak worse case scenario modelling for the province of Ontario predicted by our brilliant scientist and epidemiologists did not materialize. We did not reach 4,000 cases a day once schools were in session. We have consistently stayed below 1,000 cases/day and for the last 7 days, we have been below 800 cases per day. Take a look at my favourite graph: https://covid-19canada.com/graphs#ON Scroll down to 'New cases analysis by date'. Wave one peak, 560 cases/day. Wave 2 peak, 3700 cases/day. Wave 3 peak, 4300 cases/day and look at wave four: looks like a levelling off at under 800 cases/day and while there may be an increase in cases as we move indoors, this declining 7 day average is WHAT WE ARE CAPABLE OF through vaccinations, distancing and mask wearing. Wave 1- COVID in the dark spring of 2020 with widespread lockdowns, nothing but grocery stores, pharmacy, hospitals and doctors offices open. Remember how bleak it was? Wave 2- the dark winter of 2021 driven by indoor gatherings as we struggled to have some sort of Christmas and New Year's celebrations many of us locked in and reaching out to loved ones on Christmas morning via phone and zoom and text. Wave 3- the monstrous wave caused by the Beta variant; More transmissible, more infections, more virulent. It pummelled the UK. That was April of 2021. Our daily case rate soared to over 4,000 with our hospitals and ICU's reaching maximum capacity. Wave 4- driven by the exceptionally infections Delta variant that raced through India and the US in the spring and summer of 2021. In Ontario, cases have stayed below 800. Today's 7 day rolling average was coming in at under 600. In the spring of 2021, vaccines became widely available in Canada. Ontario stepped up and is now 80 % fully vaccinated and as a result, the virus is running out of it's source of fuel; that's us, it's human host. 2/ Vaccine effectiveness is exceeding our expectations with a very low risk of serious side effects and no deaths when given following the appropriate medical procedures. In Guelph, for example, 92.4% have received one dose and 88.4 % are full vaccinated. Over a two day span last weekend, there were only 6 new cases. 3/ Hospitalizations, ICU admissions and deaths have remained incredibly low, day after day with virtually no significant increase in weeks. I will say that again; hospitalizations, ICU admissions and deaths have remained incredibly low, day after day with virtually no significant increase in weeks. This is what counts. This is where the vaccines are most effective and this is why it is very, very unlikely that we will face lockdowns this winter. The capacity of our healthcare system will not be overwhelmed as the number of vaccinated increase. https://covid-19.ontario.ca/data/hospitalizations COVID-19 will become endemic. Endemic is when a disease becomes manageable. An endemic disease does not cause and undue burden on hospitals or other healthcare resources. An endemic disease causes serious illness in very very few and at the present time, the vast majority who are becoming seriously ill and hospitalized are unvaccinated. Very few infectious diseases that have caused pandemics become fully eradicated. The properties of the virus that causes COVID-19 ( SARS-coV-2) make it unlikely to be completely eradicated but vaccines, and drugs not yet approved for use, will prevent it from remaining the serious, deadly, widespread infection it presently is. We are closer to this new state of reality than you think; months not years. Vaccine will serve as the conduit to for controlling COVID-19. We will continue experience mild cases of COVID-19 with minor, manageable symptoms but the days of this pandemic in this country, are numbered. And what a magnificent feat we have accomplished so far. It is not time to rest. We are not safe yet. Please get vaccinated and get our provincial vaccination rate above 90% or, even better, 95%. Do not gather with groups of people who are not vaccinated this weekend. Keep the number of people in your indoor gatherings as low as possible and definitely under 25. Keep the windows open if you can. Remain outside as much as possible and put masks on when you are not eating. I know, we don't have to wear masks inside if we are in a setting where everyone is vaccinated but the children are not yet vaccinated. COVID-19 can spread at your Thanksgiving event and the folks at your event will get sick if they are exposed. Most will not become seriously ill or require hospitalization but there is no absolute guarantee of this. Play it safe but enjoy.....because, this year, you can. Some added information: Booster shots are only available to a select few. You can find that list on your public health website. https://wdgpublichealth.ca/your-health/covid-19-information-public/covid-19-vaccine-information/third-dose-eligibility-and-how People with who had mixed vaccines are not yet on the list for a third dose but I would like to activate for that and I will in an upcoming post that may contain a petition. Don't you just love petitions? Let's not forget resource poor countries. COVID-19 will not become endemic in all countries until resource poor countries have the same access to these vaccines. Anne-Marie We are assisting in the roll out of the J and J vaccine in Lesotho. If you would like to be apart of this vitally important work towards making sure that vaccines are distributed in resource poor countries like Lesotho, you can donate here: https://www.braceletofhope.ca/ways-to-give/ For non-Facebook users, you can find this post here: https://braceletofhope.blogspot.com/