Centers for Disease Control and Prevention (CDC) recommended that any individuals who develop myocarditis/pericarditis after a dose of an mRNA COVID-19 vaccine should defer receiving a subsequent dose until additional safety data are available.
On 9th November, 2021, the CDC allows mix and match of booster shots in USA.
National Advisory Committee on Immunization (NACI) recommended boosters for other high-risk groups, including people 70 years of age and older and front-line health care workers who had a short period of time between their first two shots.
NACI also recommended boosters for people who received two doses of the Astra Zeneca vaccine, as the mRNA vaccines appear to offer better protection.
On 4th November, 2021, the United Kingdom became the first country to approve Pfizer’s competitorOK competitor Merck's COVID-19 pill, which is already under review at the Food and Drug Administration (FDA) after showing strong initial results. Other antivirals are under consideration including an agent from Pfizer (Paxlovid). While promising, caution should be taken with interpreting data from oral antivirals as currently, no published data exist and much conclusions are drawn off grey literature .
India’s Covaxin covid 19 vaccine by Bharat Biotech reported a vaccine effectiveness of 77.8% from a clinical trial. , 2021, a CDC reported vaccine efficacy of 90.9% with primary data from one phase II/III clinical trial in preventing symptomatic, laboratory-confirmed COVID-19 in children aged 5–11 years with or without evidence of previous SARS-CoV-2 infection.
November 2, 2021
October 21st, 2021 Pfizer Inc. and BioNTech announced results from a Phase 3 randomized, controlled trial evaluating the efficacy and safety of a 30-µg booster dose of the Pfizer-BioNTech COVID-19 with a relative vaccine efficacy of 95.6%.
On 21st October, 2021, the advisory panel for the Centers for Disease Control and Prevention (CDC) said people who received Moderna and Johnson & Johnson (J&J) COVID-19 vaccines should receive a booster dose, and should continue with the original vaccine they recieved.
NACI’s latest guidelines suggest provinces should offer boosters to Canadians who received two doses of the Oxford-AstraZeneca vaccine or one dose of the Johnson & Johnson vaccine.
The US Food and Drug Administration (FDA) vaccine advisory group on 26th October 2021 approved the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 at a reduced dosage from the stanard dosing available for those over 12.
Therapeutic Goods Administration (Australia) has provisionally approved a third dose of the Pfizer (Comirnaty) vaccine for individuals 18 years or older. Pfizer (Comirnaty) is recommended as a single booster dose, irrespective of the primary COVID-19 vaccine used.
On 29th October, 2021, NACI issued new guidance "strongly" recommending booster shots for seniors 80 and older.
A survey at University of Oxford, UK, found that social media played a part in children aged 9 to 18 being more undecided than their older counterparts.
A report by the CDC found that the effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization was 93% during the period of B.1.617.2 (Delta) variant dominance among children and adolescents aged 12–18 years.
November 23, 2021
- Delta dominance - Delta continues to account for most of variants sequenced from surveillance data from Public Health Ontario, Public Health England and ECDC.
- The Delta sub-lineage AY.4.2 (Delta plus) accounts for a slowly increasing proportion of Delta cases in the UK. However, evidence is still emerging on its effect on vaccine efficacy and disease severity.
- Increased disease severity (hospitalization) has been observed in adults 18 to 49 years during Delta variant dominance and has been attributed to the low vaccination rates among this age group.
- Epidemiological models predict a new wave of infection if measures such as NPIs are relaxed due to changes in immune escape capability and transmissibility of variants.
- While of moderate certainty, evidence exists to suggest the Delta variant is associated with a higher secondary attack rate, especially among unvaccinated populations.
November 12, 2021
- Emerging data suggest the Delta variant can initiate fast-rising outbreaks in populations with immune responses to prior variants, resulting in reinfections and vaccination breakthroughs. However, we have low certainty of evidence at this point. - A quarter of Delta-associated outbreaks in Ontario were reported in elementary school settings for the week of September 12 to September 18, 2021.
- Full vaccination against COVID-19 has been reported to be more effective in protecting against Delta infection and severe illness (hospitalization and ICU admissions) than partial vaccination.
- Effective protection for essential workers and prompt surveillance of occupational health in the workplace are needed due to disproportionate Delta variant infection among workers such as cleaners.
- While the certainty is low, evidence exists to suggest that a lower gross domestic product (GDP) per capita, higher diabetes prevalence, higher cardiovascular disease rate, and lower percentage of fully vaccinated people have been reported as predictors of higher Delta variant Case Fatality Rate (CFR)
Asamoah, G; Badea, A; Lee, S; Shumilak, G; Reeder, B; Groot, G; Muhajarine, N; Hernandez-Ronquillo L; Miller, L; Howell-Spooner, B. What is the epidemiology of variants and what are the implications for healthcare? 2021 Nov 23. Document no.: EOC031801v017 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 48 p. (CEST rapid review report).
Miller, L. Howell-Spooner, B. What is the epidemiology of variants and what are the implications for healthcare? 2021 Nov 05, Document no.: EOC031801v017 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 23 p. (CEST evidence search report).
In October, WHO released a consensus definition of post COVID-19 condition that includes 12 domains. This development should lead to better standardization of reporting and contribute to more precise prevalence estimates and better understanding of associated risk factors.
The effects of Variants of Concern (VoC) and COVID vaccination on progression of Long COVID symptoms remains unclear.
Risk factors for developing Long COVID symptoms were similar but limited evidence suggests that pre-pandemic psychological distress and poor general health were associated with developing persistent symptoms. Evidence is too limited to determine whether vaccination reduces the risk of developing Long COVID among persons with breakthrough infections.
Given the protean manifestations of Long COVID symptoms, the underlying causes are likely multifactorial; however, strong evidence to substantiate the theories of causation remains limited.
Research related to longer-term consequences of SARS CoV-2 infections in pediatric populations is growing but remains limited.
March 15, 2021
There is a lack of consensus around the clinical definition of Long COVID which in turn causes challenges with understanding the incidence and prevalence as well as the potential impact for the health care system
Information about the natural history of Long COVID is incomplete but limited evidence suggests that the immune response trajectories differ for those with few or no symptoms compared to those with severe disease. Individuals with severe disease are more likely to exhibit immunological marker abnormalities but anyone can experience functional limitations.
The mechanisms underlying the development of persistent symptoms in Long COVID remain an enigma. Despite multiple theories, there is little empirical evidence for specific immunological and or biochemical abnormalities in samples of individuals with symptoms consistent with Long COVID.
Risk factors for Long COVID include female gender, older age, higher body mass index, pre-existing asthma and the number of symptoms.
Few studies explored the short-term impact of Long COVID on health care utilization patterns and found a higher impact for those with severe disease compared with mild disease.
Williams-Roberts, H; Groot, G; Mueller, M; Dalidowicz, M. Long COVID: What does it mean for the healthcare system and programs? 2021 Oct 29. Document no.: EOC021901v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Mueller, M; Dalidowicz, M. Long COVID: What does it mean for the healthcare system and programs to? 2021 Oct 21, Document no.: EOC021901v2 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 70 p. (CEST rapid review report).
Consequences of delayed surgeries have potential patient-level and system-level consequences
Modelling indicates that even complete resumption of services requires additional resources to clear the backlogs caused by service disruptions
Retrospective data analysis indicates that minor delays for most cancer surgeries does not negatively impact patients, however the length of time to safely delay is largely dependent on condition and urgency
Badea, A; Groot, G; Young, C; Mueller, M. What have been the consequences of delayed surgeries due to the COVID-19 pandemic? 2021 Oct 18. Document no.: EOC210903 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Emerging evidence suggesting waning levels of immune markers with time, particularly against more virulent variants. How this will correlate to functional immunity is yet to be documented.
Immunocompromised populations with lower levels of responses to standard 2-dose regimens may benefit from a 3rd dose of mRNA vaccine as a part of the primary series, though their response may still be lower than what is expected in the general population
Current recommendation for populations to receive a 3rd dose include adults over a certain age (depending on jurisdiction), those living in long-term care settings, frontline health and social workers and/or people working in high risk settings, those with immune compromising conditions leading to increased risk of severe disease/poor outcomes if infected
Safety trials have indicated that side effects to 3rd/booster doses are similar to those following the 2nd dose in initial vaccination series
Badea, A; Groot, G; Muhajarine, N; Lee, S; Shumilak, G; Hernandez-Ronquillo, L; Tian, K. What is the current evidence and recommendations regarding COVID-19 vaccine booster shots (exceeding 2 doses) for the general population? 2021 Oct 07, Document no.: EOC210902 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).
Mueller, M; Young, C. What have been the consequences of delayed surgeries due to the COVID-19 pandemic? 2021 Oct 04. Document no.: EOC210903 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 64 p. (CEST rapid review report).
Miller, L., Howell-Spooner, B. What is the current evidence and recommendations regarding COVID-19 vaccine booster shots (exceeding 2 doses) for the general population? 2021 Sep 29, Document no.: EOC210902 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
August 18, 2021
- Proof of vaccine “freebies” to customers are slowing
- Many vaccine “lotteries” have now ended with prizes being given out, retrospective analysis of vaccine numbers and assumptions regarding causality will likely follow in the near future
- More state-sponsored incentives such as partnerships with ride-share companies, childcare centers, etc.
- Post-secondary institutions offering incentives mostly in the form of raffles with grand prizes of cash/scholarships for staff/students with proof of vaccination
- ESN evidence synthesis found 8 systematic reviews providing some evidence of positive impact of financial incentives with or without other interventions for non-COVID-19 vaccines, 3 reviews found no effect
- Several European countries (Greece, France, Italy) mandating vaccination for healthcare workers with refusers facing sanctions/fines/suspensions/job loss
- Ontario requiring hospitals, licensed care homes and other high-risk settings such as post-secondary institutions, women’s shelters, youth care facilities, etc. to establish vaccination policies – while vaccination will not likely be mandatory, those who are not vaccinated will be subject to frequent antigen testing.
- In Pakistan, the government will be blocking the SIM cards of vaccine refusers, and allowing business to resume in areas with a vaccination rate of greater than 20%
- In Indonesia, vaccine refusers will have any social aid suspended and face fines
- In the Philippines, the President is threatening to find ways to legalize arresting and forcing vaccination for refusers
- A retrospective analysis of vaccination data in Israel found a peak of 2nd dose vaccinations correlating with the exemption of quarantine for vaccinated individuals beginning January 17th, and high rates continued following the day with the highest new daily cases as well as the day of highest fatality rates
- Israeli survey of 500 individuals found that 21% of respondents were not intending to vaccinate. The implementation of the ‘Green Pass’ would possibly or definitely convince 31% of respondents, but 46% of respondents indicated that it would not.
May 27, 2021
Vaccine incentives are beginning to emerge in North America in various forms due to a lagging vaccine uptake combined with the threat of SARS-CoV-2 variants
Vaccine incentives range from free items and discounts offered by businesses to customers to financial incentives offered by companies to employees such as paid time off or cash bonuses
Some states/provinces have developed vaccine incentive programs offering large lotteries with cash prizes or scholarship awards, cash incentives or offers for free/discounted entertainment options
Some incentives are specifically geared to high priority populations, for example offering gift cards to anyone within a certain age demographic that receives a vaccine at certain sites, or offering the single-dose Johnson & Johnson vaccine at walk-up vaccination sites in subway stations with the addition of free transit passes
Badea, A; Reeder, B; Groot, G; Ellsworth, C. What are other jurisdictions offering for incentive-based COVID-19? 2021 Aug 24, Document no.: EOC210501v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 10 p. (CEST rapid review report).
Ellsworth, C. What are other jurisdictions offering for incentive-based COVID-19 vaccine campaigns? 2021 Aug 17, Document no.: EOC210501v2 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).
Miller, L, Howell-Spooner, B. What is known about safety/efficacy of global vaccines not approved in Canada? What are the impacts on international travel and vaccination policies? 2021 Jul 16, Document no.: INF210701 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 24 p. (CEST evidence search report).
Long COVID-19 is likely to increase healthcare demands across the health system, including emergency departments, hospital admissions, primary care visits, specialists appointments, and home care and rehabilitation services.
The clinical care burden of long COVID-19 is the greatest in the first 3 months after testing and is likely to place the greatest demand on primary care services.
Patients with severe COVID-19 illness are more likely to place longer-term demands (4-6 months) on specialist care due to respiratory, circulatory, endocrine, metabolic, psychiatric and unspecified conditions.
McLean, M; Williams-Roberts, H; Reeder, B; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2021 Jul 12, Document no.: EPM210602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 23 p. (CEST rapid review report).
The frequency of Long COVID symptoms varies widely across studies based on populations studied, duration of follow up and methods of assessment of symptoms.
It is estimated that 1 in 50 persons experience Long COVID symptoms after 12 weeks; however, higher estimates up to 80% have been reported in studies with a greater proportion of persons who were previously hospitalized. A recent study of a mixed cohort of 96 persons found that only 22.9% had no symptoms at 12 months post diagnosis.
A wide range of symptoms affecting multiple organ systems has been reported. For many persons symptoms improve over time while others experience persistent and/or new symptoms. Among studies with the longest duration of follow up, the most frequently reported symptoms included fatigue (up to 65%), dyspnea (up to 50%), headache (up to 45%), anosmia/ageusia (up to 25%), cognitive memory/concentration (up to 39.6%) and sleep disorders (up to 26%).
Few studies estimated the duration of symptoms with estimates ranging from 2.2% for 6 months and 27% for 7-9 months.
The mechanism(s) leading to Long COVID remain unclear but those experiencing post acute sequelae tend to be older, have a greater number of symptoms during the acute phase of illness or manifest specific symptoms and live with multiple comorbid conditions such as obesity.
The lack of consensus on a definition of Long COVID contributes to marked variations in robust prevalence estimates.
Williams-Roberts, H; Groot, G; Reeder, B; Howell-Spooner, B; Ellsworth, C. What is the incidence and duration of Long COVID cases? 2021 Jul 09, Document no.: EPM210601 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 19 p. (CEST rapid review report).
Howell-Spooner, B; Ellsworth, E. What is the incidence and duration of long COVID cases? 2021 Jun 25, Document no.: EPM210601 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 62 p. (CEST rapid review report).
Howell-Spooner, B; Ellsworth, E. What are long COVID's demands on the healthcare system, and it? 2021 Jun 25, Document no.: EPM210602 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 64 p. (CEST rapid review report).
Requiring proof of vaccination for entry into another country is not a new idea. There are regulations that need to be followed to set up a “vaccine passport” in relation to international travel (International Health Regulations (IHR) (2005))
At present the World Health Organization does not recommend vaccine passports for international travel, but they are working on a standard Smart Vaccination Certificate technical specification and standards to allow for harmonised processes to include COVID-19 vaccines into an updated version of the IHR (2005)
Countries around the world are beginning to put vaccine passports into place for international travel, as well as in some countries within country travel and access to services or businesses including Israel, France, Italy, Denmark, and the EU
The Canadian Federal government is supportive of a vaccine passport for international travel but recognize the issuing of vaccine passports will need to be province led
As of May 13, 2021, the province of Quebec has begun issuing a downloadable QR code that individual can keep on their smart phone.
As of June 9, 2021, the Federal government of Canada discussed easing restrictions for fully vaccinated Canadian citizens returning to the country
Ethical considerations in the use of vaccine passports include equitable access to vaccination (domestically and internationally), access to technology (eg. Smartphone passports), marginalization, or stigmatization especially among historically racialized groups, and socially isolated populations
Legal considerations include
o Clarifying who has the legal authority to require proof of vaccination,
o Ensuring that if new legislation is created and implemented it is in line with all pre-existing legislation (Charter of Rights and Freedoms, Human Rights Codes, privacy legislation, employment legislation),
o Ensuring that, if created by the government, there is coordination of the Provincial and Federal governments for international travel with respect to jurisdictional overlap, security of information, fraud
Health care facilities should be able to legally enact vaccination policies for patient-facing employees so long as they allow for exemptions due to medical inability or bona fide religious, or conscientious beliefs
Six in ten Canadians (61%) expect vaccine passports to be widely used in Canada by the end of 2021, the same proportion (61%) of Canadians also agreed that only vaccinated people should be allowed to engage in events involving larger crowds such as public transit, air travel, or attending cultural and sports events
Lashta E, von Tigerstrom B, Reeder B, Groot G; Miller, L; Mueller, M. What are the ethical/legal aspects of vaccine requirements? 2021 Jun 21, Document no.: EOC210503 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 25 p. (CEST rapid review report).
Badea, A; Groot, G; Reeder, B; Young, C; Ellsworth, C. What are legitimate exemptions/contraindications for COVID-19 vaccines from a medical point of view? 2021 Jun 10, Document no.: EOC210502 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).