10 covid questions that may be keeping you up at night

i am optimistic that while we may experience more cases that may result in resumption of some targeted restrictions, we hopefully can contain them as bumps in the road.

when will canada likely have an effective vaccine?

as expected, china has prevented canada from using the jointly developed can-sino vaccine for political reasons. we are now scrambling to procure a vaccine from groups with phase 3 trials. our government is not being open about where we stand in line given the pre-production purchase of most early product by the country developing the vaccine and operation warp speed , a u.s. plan to produce and deliver 300 million doses of safe and effective vaccines by january 2021. made in canada vaccines are also not pre-purchased. while the u.s. is highly likely to have a relatively safe vaccine available by the end of the year, my guess is that canada will lag in availability until at least the summer of 2021. in my view, it is an example of lack of judgement at best, and incompetence at worst.

the cdc and health canada will review the phase 3 test data for candidate vaccines and determine if a safety standard has been met. initial vaccination will likely be for healthcare and essential workers, and then the most vulnerable. there will be time to review the risks and the early results in these populations to hopefully bring comfort to most people about safety.

while limited vaccination may start before the u.s. election in november, it is doubtful that very large numbers will be vaccinated in the u.s. before the end of the year. this time frame is remarkably fast given the conventional time it takes to get a vaccine to market — which is usually many years. china and russia have started vaccinations prior to completion of phase 3 trials, which are usually assessed for safety in about 30,000 people. they will likely hide some bad outcomes, but we will probably know if there are major problems since the truth will eventually come out. the oxford vaccine was halted after a trial participant developed neurological symptoms consistent with transverse myelitis, a rare but serious spinal inflammatory disorder. trials have since resumed.

the moderna vaccine has enrolled about 25,000 people in the phase 3 trial with about 10,000 already receiving a second dose. hopefully, this means trial results can be analyzed by early november and if positive, vaccine rollout can start by the end of the year.

remdesivir, an anti-viral drug, was shown to reduce hospitalization and its supply bought up and hoarded by the u.s. it’s likely not the most effective drug anyway, which means less worry about availability. the good news is that the steroidal anti-inflammatory drug dexamethasone was shown in the british trial to reduce mortality. this result then led to the premature termination of other steroid trials before they could each show similar benefit. however, by pooling data from the other halted steroid trials, the benefits of dexamethasone to suppress the overactive immune response was confirmed. in addition, other steroids are also likely effective so there is also less worry about running out of dexamethasone.

other treatment possibilities include colchicine , an anti-inflammatory drug used to treat gout, also showed a risk reduction, but its place in when to treat is not yet clear. statins, which work by reducing inflammation in heart arteries, also showed a positive benefit; however, more study is needed to know if more people not already on them should take them. vitamin d may also be beneficial and is readily available and easy to take. outcomes in covid-19 infection were worse in people with low natural levels.

thomas smith in elemental reported on a study by dr. daniel jacobson published in elife that used a supercomputer to crunch data from a large genetic database, coming up with a new explanation for why the disease can be so severe in some people. rather than just being due to a cytokine storm — an immune over-reaction — they hypothesized based on the genetic information that elevated bradykinin, a chemical we produce to regulate blood pressure, could explain the myriad of lung and other organ damage that can occur with covid-19. an excess of bradykinin due to overproduction and reduced breakdown, can cause leaky vessels as well as gelatinous material in the lungs, thus restricting oxygenation. the researchers propose a number of possible readily available steroidal drugs such as danazol and stanozolol that may reduce bradykinin levels and possibly disease severity. this is an interesting hypothesis, but not one that has a treatment strategy yet.

there is a great deal of anxiety among parents and teachers as children go back to school. fortunately, children are at low risk of bad outcomes, yet there is still some risk. we also have to consider the possible spread to more vulnerable teachers, parents and grandparents. any child with fever or a cold will likely require exclusionary covid testing to return to school. reduced class sizes, distancing and bubbles will help reduce disease, more so than in countries who didn’t take such precautions. at-risk older relatives may choose to distance again until it is clear that school openings have been achieved at low risk. so far, a small number of school-related infections have occurred, but it requires close follow-up.

the conventional thinking is that about 60 per cent of people need to be infected with covid-19 to have herd immunity — that is, a low rate of secondary infection. sweden likely has had a 15 to 20 per cent country wide rate of infection as they were less restrictive than most countries. they now have a low burden of disease and few deaths, despite fewer restrictions on gatherings and masks. this has led some to speculate that 20 per cent may be the right number for herd immunity. while this would be good, it is not confirmed to be the case. we can thus overcome the worst of this pandemic, even if not everyone agrees to be vaccinated if we come close to herd immunity.

a recent study showed that the use of convalescent serum, that is, blood from people already infected who have antibodies, was useful in the treatment of critically ill people with covid-19. the results may have been overstated. such serum is in short supply and the hope is that manufactured antibodies that are similar to the body’s own immune response will be an important treatment. too early to tell, but hopeful.

social media is full of misinformation and the tv media often can’t refrain from their political bias. robert redfield, the head of the center for disease control (cdc) has the courage to tell the truth. his message? a vaccine won’t be approved in the u.s. until shown to be relatively safe, and if you don’t form antibodies after receiving it, you need to continue to distance and wear a mask. anthony fauci continues to speak the truth wherever he can, unafraid of the criticism with advice supported by rigorous science.

we have a challenging and frustrating winter ahead of us, but we have to hang in there, be hopeful and believe that the spring will bring the promise of a better year. as albert einstein said “learn from yesterday, live for today and hope for tomorrow.” this too shall pass.

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10 covid questions that may be keeping you up at night

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