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/

My own Lisa LaFlamme story.

It would appear to be the appropriate time to tell my story, or at least one of them related to the inappropriate dismissal of much needed leaders. I am throwing my hat into the ring, so to speak, in support of Lisa and anyone else whose professions and reputations have been damaged by boards of directors who lack good governance or who make reckless decisions in order to gain power, hold onto power or take secret pleasure in wiping out a person with power, especially if she is female. Make no mistake, it is not just men who populate these boards. Women do too and in my experience, they can do just as much if not more damage with intent and purposeful planning, to other women. My heart goes out to you Lisa. In a much more minor way, I have suffered as a result of terrible board decisions as well.

In 2005, I founded the province's 14th HIV clinic with the support of the AIDS Bureau and a large group of individuals who possessed a passion to help people living with HIV and dying of AIDS. I don't feel comfortable telling people that I founded an HIV clinic. It smacks of a lack of humility. Perhaps I was wrong. Perhaps if I had made it known at regular intervals who I was, the mess that has ensued over the last 4 years would not have happened.

The clinic served Guelph and Wellington County, Grey-Bruce, Dufferin and Kitchener Waterloo. A satellite clinic in Waterloo was created 5 years later by Dr. Chris Steingart and Michelle Steingart. Look up their names to find out where their path eventually took them. These are magnificent human beings. The two clinics have served thousands of HIV positive patients and their families saving hundreds of lives and preventing the transmission of HIV to their partners and many newborns.

In 2018, something felt off. As medical director of the clinic, it was my responsibility to oversea clinic services while the executive director managed the AIDS Service Organization and reported to the board of directors. The board had the responsibility of overseeing the whole ship and managing the hundreds of thousands of dollars in provincial government funding that flowed through the AIDS Bureau.

I asked to meet with the president of the board to discuss my concerns. All of the people involved in this story no longer work with the organization. You won't find their names if you look them up and I won't share their names as a matter of principle. The vice president of the board was present at the meeting. I was not aware that this person would be there. Within minutes, I realized that my concerns were not on the agenda. I was dismissed without cause. Lisa used the word 'blindsided'. I use the phrase, 'sucker punched'. Fifteen years of work wiped out by one board decision based on rumours of my character and behaviour or so I learned years later. There was no evidence of bad behaviour or poor character but who needs evidence when a malevolent force has already captured the boards attention and spent years building a pretty believable case against the founder.

In a recent article written by the Toronto Star, the author talks about what a short-sighted and disastrous decision it was for the powers that be at CTV to dismiss Lisa without cause and to do it so disrespectfully. Words like devastating, disastrous and destructive have been written repeatedly. The outcome might be a sinking CTV ship. What the author of this article suggests is that boards can be so dysfunctional and distanced from the organization they work for and so interested in their own ambitions that they forget the value of their product which in this case was Lisa and her incredible talent.

https://www.thestar.com/opinion/star-columnists/2022/08/20/no-way-for-bell-media-and-ctv-news-to-walk-back-this-disaster.html?fbclid=IwAR2w3KreA1SbF-95HeWLR486cAP-Z4DYa-cpy1jR_RCvB3eYMmHHgM1BdB4

What the mis-informed board of the organization I founded did not understand was that my patients had the right to follow me out of the clinic. And, they did. About 95% of them. I have been caring for many of these folks for over 3 decades. Why would they stay in a clinic that just ousted their physician without cause? Unfortunately, the government funding for these patients has stayed at the clinic. I continue to try to manage these sometimes very complex patients without the support of a team and without funding. The sad part is that I can name three patients who have died because of the lack of team support.

A leader leads. I will continue to care for these patients and Lisa will find a brilliant path forward too.

In my story, rumours were racing. Information trickles out when no cause is given and everyone is asking for a just cause. I was accused of being a racist. I have created an organization called Bracelet of Hope which serves the people of Lesotho, Africa. The citizens of that country are black. I was accused of being a physician who was not transgender friendly. The transgender patients in my practise might disagree with that. I was accused of stealing thousands of dollars from the coffers of the organization which of course, makes no sense. A well governed board doesn't believe a rumour of such gigantic proportion without setting out to investigate and retrieve the thousands I was said to have taken. The members of the poorly functioning board that started this mess have all departed. Many of the staff of the organization have moved on too.

Last month, according to a reputable source, the newest board imploded. They all resigned. At one point, no one was leading this organization; no board, no executive director, no clinic coordinator and no medical director. That's a pretty risky place for a government funded organization to be. It is our tax dollars that are no longer being supervised or, and this is my opinion, used for the purposes for which they were designed. Services are not being delivered to the patients who need them and that is not only tragic but dangerous. .

Just like the people of Canada lost a trustworthy and well-loved news anchor, the HIV positive population in this large region of Ontario have been separated from much needed care, all because of the disastrous decision of a board of directors.

I continue to attempt to communicate with the AIDS Bureau. That's the branch of the Ministry of Health that oversees all of the HIV clinics and AIDS Service Organizations in the province. They are now involved with the process of salvaging this organization. I have offered to separate myself from my patients and allow another HIV treating physician to reconcile them with the HIV clinic. That's how desperately I want these folks to receive team care. More will die without it. No takers so far.

It is my hope that the AIDS Bureau will do the right thing and at least give the founding physicians of the two HIV clinics in our region a chance to re-introduce themselves and their patients to government funded care. My fear is that the disrespectful dismissal of a vital member of a team can soil the reputation of that person making it easy for some folks to believe the rumours they have heard.

I will continue to reach out, ever hopeful for some kind of justice to take place that improves the care of the patients I serve.

Always a take home message: The time and place for malfunctioning boards needs to end. There are governance rules and stop gap measures that can protect organizations like CTV and the one I founded from short-sited, powerful players with questionable motivations. This needs advocacy.

Anne-Marie

Please share widely. Our stories need to be told.

And to continue providing primary 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/

Third dose, booster dose, fourth dose, fall dose......I am confused. Are you?

OK. Let me try to unpack this a bit. Sometimes it is a good idea to remember where you have been in order to know to where you are going. It might be time for a COVID-19 variant and vaccine history lesson.

March 2020- COVID-19 is declared a pandemic

Alpha- The first variant of concern (VOC) - December 2020. It was 20 % more transmissible than the original COVID-19 virus. It increased the number requiring hospitalized by 52 % and increased the number of mortalities by 57 %. Remember the dark days of the fall and winter of 2020 when we all spent Christmas alone or in our very tiny bubbles?

Beta- The second VOC- Jan 2021. Beta was 25 % more transmissible than Alpha but did not cause an increase in hospitalizations or deaths.

Gamma- declared a VOC in Jan of 2021 but it remained mostly localized to Brazil and South America.

Delta- The fourth major VOC- May 2021, caused a major surge in global cases. It was 97 % more transmissible than the alpha variant. Hospitalizations increased by 85 % above the alpha variant and deaths increased by 137 % above the alpha variant. This variant tortured India.

Omicron- declared a major VOC in November of 2021. This guy is interesting ( no gender reference intended). Although more transmissible than the delta variant, it caused less serious illness with a hospitalization rate that decreased by 57 % relative to the Delta variant and a decrease in mortality of 63 % relative to delta.

None of the other VOC's are circulating now. Omicron has taken over world-wide. In some ways that is good news. The new VOC's seem to be more transmissible but much less deadly. The newest offshoots of Omicron are BA-4 and BA-5. They are fuelling a global surge in cases with a 30 % increase in cases worldwide over the last week! BA-5 is the most transmissible Omicron variant so far. But, early data from South Africa has not shown a sharp rise in deaths from this sub-variant.

BA-4 and BA-5 have up to 50 more mutations ( changes on the surface of the virus) than previous variants. Twenty-six of these mutations are unique to this variant and more than 30 on the spike protein. This allows the variant to get past some of the anti-bodies we produce after vaccination or natural infection; the reason I had COVID twice in May.

The first COVID vaccines in Canada were administered in December 2020. Remember that miracle of speed and scale in vaccine production and administration? By June of 2021, half the population had received one dose. Another miracle. By July of 2021, more than half the population had received two doses and by the end of 2021 almost 80 % were fully vaccinated. Thank you for that. That national effort allowed us to cope well with both the delta wave and the first Omicron wave.

But, here we are in July of 2022 and more than half the vaccinated population have only had two doses.

https://health-infobase.canada.ca/covid-19/vaccination-coverage/

Third doses became available in December of 2021. We know that 2 doses of vaccine provides almost no protection against the new Omicron sub-variants ( BA-4 and BA-5).

My recommendations:

1/ The first and most important recommendation is that everyone who has had only two doses, get a third. That third dose of vaccine dramatically boosts your immunity and keeps you away from serious illness.

2/ If you have had three doses but your last dose was over 6 months ago and you are over 50 or have major chronic illnesses get a fourth dose this summer. Your immunity is waning and that 4th dose will boost your immunity to BA-4 and BA-5 just as we start climbing the seventh wave.

4th doses will be available to adults 18 and older in the next week or so in Ontario. Again, younger adults could hold off until the fall.

3/ If you have had three doses of vaccine and a case of COVID in the last three months, still consider that fourth dose. The early recommendations suggest waiting 3 months from your positive test. Natural infection does not protect as well as vaccination and the amount of protection provided by natural infection is not predictable.

4/ If your third dose of vaccine was less than 4 months ago and you are under 50 and healthy, you could hold off making a decision about a 4th dose until the fall when there may be an Omicron specific vaccine which is now under development.

Take home message, COVID is not gone. This 7th wave has the ability to cause serious illness and death in those at risk and to knock the last breath out of our healthcare system. Even mild to moderate illness will interrupt your life in many ways. See my last post for personal details on that!

Vaccines are still your best protection and I am wearing a mask at Tims, at the grocery store and at indoor gatherings.

I reserve the right to modify these recommendations as new information arises. Remember, science is not the truth; science discovers the truth. No nasty comments when advice changes. Go with the flow.

Most importantly, be optimistic and don't read too much or watch too many news programs. The press may make things seem worse than the are. Re-read the paragraph where I mention the miracles of science and medicine. We are learning to live well with COVID-19. We just need to be smart about it.

Anne-Marie

Please share.

As we continue to work to help vaccinate the beautiful people of Lesotho, consider donating on behalf of your mom. 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/

Post COVID-19 infection.....TIMES TWO

 

I woke up this morning and felt like myself for the first time in 2 and a half years. I realized that moments of feeling contented, grateful and hopeful have become rare. I felt one of those moments last night. It's not even a moment really, more like a brief ray of passing light. It's funny, these brief moments. They remind me of how I used to be and how I used to feel most of the time and they come during the most mundane activities: brushing my teeth, cutting a tomato, making my morning coffee. And this one most frequently brings me that fleeting of joy; pulling out a fresh pair of pyjamas.

Yeah sure, let's talk about pyjamas in a facebook post. That should stir things up. I keep my PJ's in two neat stacks. One stack of bottoms and one stack of tops. My closets and drawers are in a state of mayhem but not the shelf my PJ's are on. When I see that shelf, that sense of peace washes over me ever so briefly as I pull from both piles. It is so bizarre. I have thought about this a lot because, frankly, I'd like this feeling to be present more often, as it used to be. It's the end of the day. I have PJ's to get into. I have a nice comfortable bed in a comfortable home in a safe place. The day's stress is over and now I can allow my burned out brain and body to rest.

Yes. PJ's and all the evening trappings.... gifts that many people in the world do not have.

I am grateful.

So, where did COVID- 19 go and where are all the updates? It would seem that it is not politically correct to update you about this pandemic anymore. It also seems politically incorrect to make efforts to restore your health care system and support your healthcare staff; thus the burn out. Google seventh wave of COVID and you won't find much. But here it is. We are at the start of a seventh wave driven by two Omicron variants: BA-4 and BA- 5. In the middle of June BA-5, the variant that is causing the most concern of the two, made up 14.8 % of all cases in Ontario with a weekly growth rate of 3.1 %. It now makes up 70 % of new cases in Ontario.

https://www.publichealthontario.ca/-/media/Documents/nCoV/voc/2022/06/evidence-brief-ba4-ba5-risk-assessment-jul-8.pdf?sc_lang=en

It is more transmissible than the original Omicron variant but it seems to cause the same amount of morbidity and mortality with most people suffering mild to moderate illness and a small percentage requiring hospital admissions.

Test positivity is up to over 13 % and waste water signals are climbing. There are about 1100 new cases/day and the number of people requiring hospitalization due to COVID is up to 741 with a weekly increase of about 136.

https://covid19-sciencetable.ca/ontario-dashboard/

The number of people in the ICU is also increasing. Welcome to the 7th wave. So, what are we doing about this? Pretty much nothing as far as I can see. What should we do about this? Update your vaccines and wear a mask in indoor crowded settings. That includes stores, restaurants ( before you are seated) churches and indoor recreational events and gatherings. You don't have to wear a mask if you are not inclined but let me tell you my own story. The first week of May my husband brought Omicron home from his hockey team's change room. He passed it on to me. I still love him. At that point in time, we were likely infected with the original Omicron variant. He was quite unwell. I missed a day of work, suffered through a four day weekend with very mild symptoms and was fully recovered. Then, I went to San Francisco to visit my son and his partner. This was the last week of May. I took off my mask to eat and drink on the plane home and that was a mistake. BA-5 is most likely what hit me and it hit me hard and fast. I was out of commission for 5 days, away from work for 10 and to this day, I have not fully recovered. I feel 10 years older. My energy wanes by mid-day. My brain is not functioning as it used to with new cognitive limits I have never known before. Two weeks ago my office was under-staffed due to illness. I saw 110 patients in four days and it set me back by at least a couple of weeks. If I push too hard, mild symptoms come back. I am only now starting to read again. My garden is not bringing me as much joy and it is a chore to finish 25 km on my bike.

Does it sound like I am complaining? I am not, actually. I am giving a factual account of the hazards of COVID-19 in healthy people over 40. You can definitely get it twice. You can definitely become more ill than you remember ever being before and fatigue, cognitive and mood issues 1 month later happen and they are no joke. I have not posted since mother's day. That's a consequence of COVID.-19 My office is so far behind. Pre-booked appointments are months away. That's a consequence of COVID-19. The emergency rooms and hospitals are filled beyond any reasonable capacity. That's an extremely dangerous consequence of COVID-19. Every aspect of your health care system is struggling. That is decreasing your access to care. That is causing timely treatment to be way beyond any developed country's standard of care. I believe that the average life expectancy will decline as a result And further disintegration in health care is inevitable.

Politically incorrect to update you about COVID? It would seem so. Politically incorrect to put a plan in place to address the annihilation of your health care system? It appears that way to me. Strong words? Maybe. Watch the mass exodus of family and emergency room physicians in the next year and you will think my words were not strong enough.

Here is the name of a new campaign that I hope you will hear more about. " Imagine a world without family physicians (primary care) ". I have worked in countries with no primary care. We should be marching in the streets. Everyone should be protesting in every way possible. We are not because we are totally exhausted.

I am putting myself back in the saddle but it is taking a huge effort to hoist myself up. I will post again. For now, please get a booster dose of a vaccine if you have not yet had one, if only to protect you and your family form having to exist without an intact healthcare system.

If you are over 60 you are eligible for a fourth dose. That list needs to be expanded. I am waiting to see what the fall brings in terms of 4th doses and boosters but no word yet. Here is a link that comprehensively covers third and fourth dose eligibility.

https://covid-19.ontario.ca/getting-covid-19-vaccine

COVID-19 may not be increasing your risk of dying if you are young and healthy but, the extra strain on our beloved health care system is definitely increasing all-cause mortality rates for all of us. Masks back on. Boosters in!

Anne-Marie

Please share.

PS. I am doing just fine. Better everyday.

As we continue to work to help vaccinate the beautiful people of Lesotho, consider donating on behalf of your mom. 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/

Man, I feel better already

 Man, I feel better already,

I opened the door this morning and saw a bunny perched on my patio. Earlier, while I was making my coffee, a chipmunk was sitting on his haunches on my deck. Don't mention these critters to my husband. The magnolia tree is in full bloom and every tree is ready to burst. The birds have suddenly descended. I didn't even mind their chatter at 5:30 am. Spring has been a long time coming this year. It's been tough for those of us who are eager to get into our gardens or on our bikes. Today may be the day I pull that bike out of it's dark corner in the barn. I am not watching the news, at least not for a bit but I did read one of Ryan Imgrund's tweets and it too made me smile. Whether masks were removed too early or not, and they were in my opinion, the Reproductive Values for the Omicron variant are under 1.0 in every province and territory. Seventy-five percent of Canadians have had COVID-19 in the last 6 weeks since mask mandates were lifted and now 90 % of Canadians either have immunity from vaccines or natural infection. Ninety percent is huge and that immunity is what is driving down the ability for the virus to spread from person to person. https://www.imgrund.ca/canada-rt The Omicron wave has officially plateaued but it's curve has flattened not receded. On average, there are 1500 people in hospital with COVID-19 ( 1800 yesterday) , 200 plus in the ICU ( 204 on the 6th and that number is climbing) and 20 new deaths from COVID-19 a day. That number is also climbing. So, we reached a high level of immunity but we did that at great and needless cost. Our healthcare system in Ontario is in ruins. Strong words, right? Those of us in the system have just soldiered on with packed emergency rooms and hospital beds occupied by elderly folks who linger there for weeks waiting for a longterm care spot. These spots are almost non-existent. I have a patient who broke her hip 8 weeks ago. She is still in a hospital bed at our local hospital. Her suffering, being trapped in an acute care hospital is one thing. I can't even imagine. But she represents as system that is absolutely jammed. Patients who should be in longterm care hold acute care beds leaving other patients with acute problems in hallways, again. The emergency rooms are clogged with, often times, a line of paramedics standing by their patients brought into the ER by ambulance....in hallways. No beds in ER for these patients. Operating rooms that were starting to address the hundreds of thousands of delayed surgeries in the province or now empty because a well functioning OR needs pre-op beds, post- op beds, ICU beds and if these beds are occupied by patients who can't be moved to where they should be because everything is so bloody bottle-necked......And who is addressing this crisis? Of course, the frontline workers and administrative staff who have been pushed so far in the last two years that everyone who has not left the system is struggling with burn out. This is the state of your health care system which prides itself on services that are free and universally available to everyone. We took off masks too early and yes, our R values across the country look fabulous. But the multi-layered, complex and disastrous consequences will continue for months if not years to come and the struggling system will be ignored by governments and not even known to you until you need the system and end up in one of those gurneys in the hallway with a broken hip or a fever or heart failure. The politicalization of the pandemic makes me rage as a healthcare worker. The wonton neglect of this precious healthcare resource for political purposes was egregious before the pandemic. Now it is criminal. Please make sure you carefully review the platforms of all the political parties before June's provincial election. If there is no plan to address the pervasive problems in healthcare and education and, for God's sake, no platform to address climate change, move on. The greatest risk to our health and education is an uninhabitable planet. If governments refuse to address that, push them aside. We have the power to do that. Back to the good news. It is safer now than any other time in this pandemic to be out and about. You need three doses of vaccine if you are eligible, four doses for those over 60 and those at risk. Wear a mask in public spaces like grocery stores and large public events at least until the Omicron wave recedes. If the folks in your workplace are not wearing masks, you can wear one if you want that added protection. By far most Omicron infections are 'mild' but it is now everywhere with so many families home ill sometimes for weeks. I am going to try to avoid a two week illness and the risk of serious acute COVID and long COVID. That mask is still my friend. An Omicron-focused booster will likely be available to you in the fall but make sure you are up to date on your boosters now. This is a good document that reviews the recommended COVID-19 vaccine schedule for all age groups. It is a great review. Focus on page 4.

https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/COVID_19_vaccine_up_to_date.pdf And may I just say, on this beautiful Mother's Day, that despite the poor politics of late, we have done a marvellous job as a province and a country. Here we are, through our efforts, heading into a summer that will be more like a pre-2020 summer. That will be grand. Happy Mother's Day. Anne-Marie Please share. As we continue to work to help vaccinate the beautiful people of Lesotho, consider donating on behalf of your mom. 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/

Projections:

This is an interesting graph. It looks at where hospitalizations may go in the next 6 weeks . The grey line shows us where we have been with respect to COVID- 19 hospitalizations with a peak in mid-January and a decline until mid-March. March 10th is when the Omicron BA.2 variant started it's rise. Mask mandates were lifted on March 21st in the province of Ontario and the graph shows the increase in hospitalizations, as predicted, two weeks later.

New modelling, as set out by Ontario's Science Advisory Table, paints a more alarming picture than the numbers released by the table last month. They estimated that there would be 800 COVID patients in hospital by May and 300 in the ICU. But then the BA.2 Omicron sub-variant became the dominant strain in the province and mask mandates were lifted.

Today, there are 1392 people in hospital with COVID-19 up 23 % week over week and the highest it's been since mid-February. Most likely case scenario is that we surpass 3,000 hospitalizations in May with 500 in the ICU. The worse case-scenario shows us reaching more than 4,000 hospitalizations with 600 in the ICU.

There is good news. Waste-water signals indicate that the sixth wave has peaked. This weekend may change that if folks gather without taking great care.

While presenting these numbers, the science table made it clear that masking in indoor areas “will substantially reduce the risk of getting and spreading COVID-19” and noted that the “community benefits from masking are most pronounced when adopted widely in public spaces, schools and workplaces.”

Hmmmmm. Looks like masks might be a good idea. They may just keep us moving past the peak of the sixth wave without becoming ill.

More good news and this is what we need to focus on for the future of this pandemic. This is why we should be cautiously optimistic about seeing the backside of this pandemic:

1/ It is likely that between 4.5 and six million Ontarians have contracted COVID-19 since Dec. 1, accounting for at least one-third of the province’s population.

2/ More than 7 million have received three doses and many of them will not contract COVID-19 even if exposed, most will avoid serious illness and hospitalization if they do contract COVID-19.

Epidemiologist can only take a stab at figuring out how many of us now have immunity but it could well be over 75% of the population. Are we building a strong wall of immunity against COVID-19 in the province? I hope so. Will this protect us from future waves? Possibly. Will this bring about herd immunity? Wouldn't that be grand but it is more likely that we will be able to push COVID-19 from a pandemic state to an endemic state which would allow us to move on with our lives with no restrictions; government or self-imposed.

Self-imposed mask mandates, crowd size limitations and social distancing is all we are left with right now but I think we should be continuing with restrictions, especially masking, so that we can minimize the number of hospitalizations and ICU admissions that will happen in the coming weeks, reduce serious illness and death and take the strain off an overburdened healthcare system.

It is up to us this weekend.

And another gentle reminder; get vaccinated with three doses. Up to 10 % of unvaccinated people who contract the virus end up with long haul COVID the most common symptom of which is extreme fatigue.

Anne-Marie

Please share and have a Blessed and safe Easter, Passover celebration or Ramadan.

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/