#COVID-19: Comparing provinces with other countries 20 January Update, including vaccinations

The latest charts, compiled 20 January.

Vaccinations: Canada appears to be in the middle of the pack compared to G7 countries save for the UK and USA. Vaccination rates in the Canadian North are relatively high. The change in the Pfizer delivery schedule will be felt in the coming weeks, likely affecting our relative ranking.

Trendline charts:

Infections per million: Alberta no longer appears to be overtaking Quebec but Ontario appears to be approaching Prairie rates.

Deaths per million: Prairies continue to be slightly higher than Ontario with Alberta slightly behind Ontario.

Minor week to week changes:

Infections per million: UK ahead of Sweden

Deaths per million: No change

Impact of Covid-19 on Immigration to Canada – Working Deck – Full November 2020 data

Shout out to IRCC for releasing all the November data to allow for this comprehensive November portrait.

Highlights:

  • Overall, numbers of permanent residents, temporary residents and students remained flat compared to October;
  • Permanent resident admissions three times more than temporary residents and twice more than students April to November 2020/19;
  • Applications for permanent residency and study permits declined by over 60 percent April to November 2020/19;
  • Permanent Residents: A large proportion of admissions are from previous temporary residents, particularly those in the Post-graduate work program;
  • Temporary Residents IMP mainly Canadian interests, mainly the post-graduate work program;
  • Temporary Residents TFWP, small increase driven by agriculture works;
  • Citizenship decline of over 70 percent April to November 2020/19;
  • Visitor visa virtual shutdown, 96 percent decline April to November 2020/19

This data, and the ongoing nature of COVID waves, travel restrictions and expect vaccination roll-out make the government’s planned immigration levels of 401,000 in 2021 and possibly 411,000 in 2022 increasingly unlikely.

Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

The province that has the highest infection and death rates, comparable to some of the worst hit G7 countries, is taking this risky approach. This will generate some good comparative data regarding following the Pharma companies advice and not doing so. But as someone who follows the instructions on my meds, question the wisdom: 

Quebec will wait up to 90 days before giving a COVID-19 vaccine booster to people who have received a first shot, Health Minister Christian Dube said Thursday.

That delay goes far beyond the recommendations of vaccine manufacturers Pfizer and Moderna, which propose intervals of 21 and 28 days respectively, and is more than double the 42-day maximum proposed by Canada’s national vaccine advisory committee.

Dube told a news conference that the decision was made in order to vaccinate as many vulnerable people as possible and to reduce the pressure on the health system.

“In our context, this is the best strategy, because we have to contend with (having) very few vaccines, and we’re in a race against the clock,” Dube said at a news conference.

Dube said the province had discussed the decision with both vaccine manufacturers and federal public health officials. He said the latter acknowledged that the 42-day recommended maximum can be extended depending on the disease’s progression in a particular province.

He said the high rate of community transmission, hospitalizations and deaths in Quebec justified the change.

“In Quebec we don’t have the same situation as in New Brunswick or British Columbia,” he said.

Richard Masse, a senior public health adviser, said the change would allow up to 500,000 seniors who are most at risk of complications — including those in private residences and those aged 80 and up — to receive their vaccine several weeks earlier than originally thought.

He said the justification to extend the interval was based on the “experience of working with many vaccines through time,” which shows that vaccine immunity does not suddenly drop off within a month or two.

However, he said the province was carefully monitoring the efficacy of the shot and would immediately give second doses if it saw evidence of decreased immunity in certain groups, such as the elderly.

Both Masse and Dube said the province would work to shorten the interval between first and second doses once the province begins to receive larger quantities of vaccine.

Meanwhile, the province was reporting some regions of the province have few or no doses of COVID-19 vaccine remaining as the vaccination effort outpaces the speed of delivery.

Quebec says as of Thursday morning, the Gaspe region, Iles-de-la-Madeleine, Nord-du-Quebec and the James Bay Cree Nation territories are out or almost out of vaccine; the province expects new deliveries Friday or Saturday.

Four other regions had almost used up all their doses but received new supplies Tuesday.

The province reported 2,132 new cases of COVID-19 Thursday and 64 more deaths attributed to the novel coronavirus, including 15 that occurred in the previous 24 hours.

One death previously attributed to COVID-19 was removed from the total after it was determined to be unrelated. Quebec has reported a total of 236,827 infections and 8,878 deaths linked to the virus.

Jean Morin, a spokesman for the Gaspe region’s health authority, said the vaccination campaign was going “exceedingly well” despite the fact nearly all the doses have been used.

Morin said there are logistical challenges to vaccinating people in the vast and thinly populated region, including having to transport people to clinics to receive their shots.

He says he expects the highest-priority groups in the region will be vaccinated by the end of January.

Source: Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

As Canadians we’re proud of diversity, so why is multicultural media being left in the dark about COVID-19

While I agree that more can and should be done, one of my observations from tracking ethnic media coverage of the 2019 election campaign was that much of their coverage reflected articles in the mainstream media, and those who relied on ethnic media would be reasonable informed on the electoral platforms and choices.

It may be more a matter of resources than anything else but would be nice to know what governments are doing to publicize COVID health related information on ethnic media:

After writing my last op-ed on the underutilization of multicultural media to disseminate clear COVID-19 information, I’ve received an overwhelming response.

Some messages were from physicians and public health officials interested in utilizing these platforms to inform communities on how to stay safe. Others were a nod of acknowledgment from the Canadian public who finally felt seen and heard. And a lot of them were questions regarding why such important platforms remained underutilized when they could have been important tools to disseminate critical life saving information.

One of the things we are most proud of as Canadians is multiculturalism, yet, there’s a divide: a lack of ethnic and linguistic diversity on mainstream media. This is why multicultural and ethnic media is a much needed voice for minority communities across Canada. Along with providing language and culturally sensitive critical health information and public communication, these mediums foster a sense of culture, and community for the minority and immigrant Canadians.

While these media outlets can be very important for people with no knowledge of English or French, these platforms do more than address language barriers. For many Canadians, it’s a platform to help stay connected to one’s culture and heritage and is a heavily relied upon source of information.

The problem? These platforms can play a substantial role in sharing life-saving critical health information, and have proven to do so with information around cancer pre-pandemic. So why aren’t they getting the clear COVID-19 precaution information now?

Firstly, there is a lack of awareness. What emerged from my discussions with many physician colleagues is that many were unaware these channels existed. At the medical school education level, there needs to be better knowledge dissemination about the importance of these community platforms and how multicultural media can be leveraged to provide health related information to the public.

Secondly, there isn’t a clear bridge between mainstream and multicultural media. Mainstream media needs to do a better job at supporting and amplifying the voices of multicultural media platforms. This could be done by hosting multicultural media representatives on mainstream shows and vice versa. Moreover, government and public health bodies need to develop two-way streets with multicultural media outlets and have an ongoing regular communication with these media representatives.

Thirdly, after speaking to various multicultural media spokespersons, I learned that there is a lack of funding and financial support, particularly for the radio show channels. Their hands are tied and they have to heavily rely on advertisements to cover their expenses and are unable to afford the latest technology or means to be on par with popular mainstream outlets. Their sole profit sometimes is from advertisements; some of these advertisements can be alternative care providers or various sources in radio, TV, and print media. As part of the advertisement package, it’s hard for media channels to control knowledge dissemination. This as one can imagine then can be a source of misinformation on top of an already existing information vacuum due to underutilization of the media platforms which is exponentially dangerous.

We as Canadians are proud of our multiculturalism and public health care system and therefore it is heartbreaking to hear that multicultural media struggles to thrive. It’s an important vehicle to deliver health related and public communication to all Canadians. It is critical for us to engage multicultural and ethnic media to ensure pandemic messaging reaches to everyone nationally.

As we combat the second wave, develop an inclusive vaccination strategy, and disseminate vaccine and COVID-19 related information, it’s still not too late to incorporate linguistic and culturally sensitive print, radio and TV media outlets in our armamentarium to deliver critical health related information.

Source: As Canadians we’re proud of diversity, so why is multicultural media being left in the dark about COVID-19

#COVID-19: Comparing provinces with other countries 13 January Update, including vaccinations

As vaccination data is becoming available, I have started to compile this data (number of vaccinations administered) by province and my standard list of countries. Some countries have yet to publish vaccination data. While Canada is far behind the UK and USA, it is ahead of China and France:

The standard charts can be found below.

Minor week to week changes:

Infections per million: California ahead of USA, Ontario ahead of Canada less Quebec, Japan ahead of Pakistan, Atlantic Canada ahead of Australia 

Deaths per million: Alberta moved ahead of Canada less Quebec

Military medical intelligence warnings gathered dust as public health struggled to define COVID-19

Sigh… Yet another oversight. So PHAC relied exclusively on the WHO which appears to have relied exclusively on the Chinese government, and did not explore other data sources:

Public health officials failed to cite early warnings about the threat of COVID-19 gathered through classified military intelligence as the pandemic crisis emerged a year ago, CBC News has learned — an oversight described as a strategic failure by intelligence and public health experts.

For over seven decades, Canada and some of its closest allies have operated a largely secret formal exchange of military medical intelligence. That relationship regularly produces troves of highly detailed data on emerging health threats.

The small, specialized unit within the Canadian military’s intelligence branch began producing warnings about COVID-19 in early January of last year — assessments based largely on classified allied intelligence. Those warnings generally were three weeks ahead of other open sources, say defence insiders.

But documents show the Public Health Agency of Canada’s (PHAC) COVID-19 rapid risk assessments — which politicians and public servants used to guide their choices in early days of the pandemic — contained no input from the military’s warnings, which remain classified.

Three of the five PHAC risk assessments — obtained under access to information law by one of the country’s leading intelligence experts and CBC News — show federal health officials relying almost exclusively on assessments from the World Health Organization.

Even those writing the risk assessment reports acknowledged the dearth of intelligence.

Confidence level ‘low’

“Due to the limited epidemiologic data from China, and limited virologic information available for the etiologic agent, the confidence level for this assessment is considered as ‘low’ and the algorithm outputs remain uncertain at this time,” said the Feb. 2, 2020 PHAC risk assessment report.

The analysts at PHAC were uncertain because — as the world learned later — China was stonewalling the WHO about the extent of the Wuhan outbreak and assuring international health experts that everything was under control.

Meanwhile, in the military medical community, alarm bells were ringing. In the U.S., the National Center for Medical Intelligence (NCMI), located in Fort Detrick, Maryland, was not only gathering raw intelligence through various classified means — it was producing comprehensive assessments of the trajectory of the virus as of last February.

“This coronavirus pandemic is right in their wheelhouse, which is part of their core mission — to be on the lookout for any early indications of infectious disease,” said Dr. Jonathan Clemente, a physician practicing in Charlotte, North Carolina who has researched and written extensively about the history of medical intelligence.

‘Strategic surprise’

The original purpose of military medical intelligence among the allies was to assess sanitary and health conditions in the places around the globe where their troops were deployed.

But over the years, Clemente said, the mandate evolved to include “preventing strategic surprise” — such as pandemics and deliberate biological attacks.

“So there’s a wide range of reports, from your short-form daily bulletins to long-form assessments,” he said.

“It’s important to know that this is different from, say, the World Health Organization because the NCMI has access to all-source intelligence, meaning they have access to the most secret levels of intelligence, including clandestine human reporting, satellites, signals intelligence and … open  reporting.”

The information gathered through such intelligence channels would be knowledge “that other traditional health care and public health agencies” don’t have, he added. It’s also the kind of knowledge that would have informed the Canadian military’s medical intelligence branch as the pandemic was gathering momentum.

‘A terrible failure’

The fact that PHAC didn’t track what the military medical intelligence branch was seeing, coupled with changes to the federal government’s own Global Pandemic Health Information Network (GPHIN), represent “a terrible failure,” said Wesley Wark, a University of Ottawa professor who studies intelligence services and national security. He requested the documents through the access to information law.

The auditor general is reviewing what went wrong with the country’s early warning system, including the risk assessments. Flaws in those assessments may have affected the introduction of anti-pandemic measures such as border closures and mask mandates.

A second, separate independent review of Canada’s early pandemic response has been ordered by Health Minister Patty Hajdu.

CBC News first reported last spring that the military medical intelligence branch (MEDINT) began writing reports and issuing warnings about COVID-19 in January 2020. At the time, a spokesperson for MEDINT would not comment “on the content of intelligence reports that we receive or share.”

A follow-up investigation by CBC News has shed more light on the long-established secret network the allies use to warn each of health threats.

It’s governed by an obscure forum going by a rather clunky name: the Quadripartite Medical Intelligence Committee (QMIC).

A ‘Five Eyes’ network for pandemics

Originating in the Second World War, the forum allows the American, Canadian, British and Australian militaries to exchange classified global health data and assessments about emerging health threats.

Clemente describes it as the medical equivalent of the better-known Five Eyes intelligence-sharing alliance between Canada, the United States, Great Britain, Australia and New Zealand.

Clemente said that, through U.S. freedom of information law, he has compiled a comprehensive, declassified portrait of the deep health intelligence ties between allies — especially between Canada and the U.S.

He said he also has collected reports and analyses on how NCMI tracked and assessed previous pandemics and disease outbreaks, including SARS, H1N1 and Ebola.

Those assessments — copies of which were obtained by CBC News — are very precise and complete. The U.S. military’s assessments of the novel coronavirus and the disease it causes remain classified, but Clemente said it’s certain that NCMI was doing similar surveillance on COVID-19 which would have been shared with allies.

Wark said Canada’s public health system was redesigned almost two decades ago with the aim of preventing “strategic surprise,” but many of initiatives planned or implemented following the SARS outbreak were allowed to wither away and die.

One 2004 proposal which fell by the wayside was to find a mechanism that would allow PHAC to seamlessly incorporate classified intelligence into its system of reporting.

Greg Fyffe, the former executive director of the Intelligence Assessment Secretariat in the Privy Council Office (which supports the prime minister’s office), said military medical intelligence assessments rarely came across his desk during his tenure a decade ago.

He said that when intelligence reports reach the highest levels of government, they often arrive in summary form and analysts occasionally have to seek out more details.

“There’s so much intelligence information out there that it’s not a matter of saying … ‘I have a little bit of something that you’d like to see,'” said Fyffe. “We’re talking about huge volumes of material which can’t all be shared.”

In a year-end interview with the CBC’s Rosemary Barton, Prime Minister Justin Trudeau dismissed the suggestion that better early warnings could have stopped COVID-19 from spreading to Canada.

“I think we used all the resources that we always have to follow and monitor,” he said. “I don’t know that it would have made a huge difference for us to have extra reporting on top of what we were getting.”

The prime minister said that, in hindsight, there were things “we probably would have wanted to have done sooner in terms of preparing,” such as bolstering stocks of personal protective equipment (PPE) and other medical supplies.

‘We could have been much better prepared’

Defence Minister Harjit Sajjan indicated in a year-end interview that he shared the information he had and there were “many conversations” within the government.

While he cautioned that military intelligence alone can’t cover global disease surveillance, he did acknowledge that Canada’s early warning mechanisms need a serious review “from a whole-of-government perspective … making sure we have the right sensors out.”

Preparation is the whole point of early warning, said Wark, who agreed with Trudeau’s assessment of the volatility of the novel coronavirus’s transmission.

“We wouldn’t have stopped it from coming to Canada,” said Wark. “That would have been impossible. But we could have been much better prepared to meet its onslaught, and we were not. We suffered a terrible failure of early warning, of intelligence, of risk assessment.

“And the main lesson that has to be drawn … from the experience of COVID-19 is that we have to fix all of those things. We have to have a better early warning system.”

Source: Military medical intelligence warnings gathered dust as public health struggled to define COVID-19

What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

Good practical suggestions;

Never in history have we gone from identifying a pathogen to creating and disseminating a safe and effective vaccine in under a year, however, we have not done a good job of explaining how we have been able to utilize scientific innovation without compromising on safety. Terms such as ‘Operation Warp Speed’ have not helped with hesitancy. Decades of mistrust towards pharmaceutical companies have also exacerbated this.

So, we must discuss vaccine hesitancy. What is it? It describes people who are not flat out against vaccinations, but who are anxious and afraid of vaccines, or sometimes one specific vaccine. Over the past few years, it’s a term that has gained traction even before the COVID-19 pandemic. These are individuals who may be continuously bombarded with fear-based and conflicting misinformation on vaccines.

In a Nov. 2020 poll from Ipsos and Radio-Canada surveying 3,000 Canadians on whether they were willing to take the COVID-19 vaccine when available, a large per cent reported they would get the vaccine, but less than 40 per cent said they would be willing to get it immediately.

This speaks to ongoing underlying hesitancy that must be addressed. Importantly, hesitancy involves not just refusal of vaccines, but delay despite availability.

Given that our health care workers are part of our communities, we can extrapolate that hesitancy may also be prevalent among those employed in vulnerable sectors such as our long-term care (LTC) homes. Several factors may impact their decision making, from concerns and fears around safety and effectiveness of the vaccines, to social, cultural and political influences, as well as logistical barriers that decrease access. Moreover, we must acknowledge that personal support workers (PSWs) in Ontario LTC homes largely belong to racialized communities that may harbour mistrust in the health care system, impacting vaccine uptake. Therefore it is not surprising that in many LTCs, anecdotally, around a third have refused or delayed vaccination. A poll undertaken at Windsor Regional Hospital found that more than 20 per cent of staff from seniors’ facilities are refusing or delaying vaccination.

As part of the scientific community, it is our job as the vaccines roll out to discern these workers’ concerns, fears and to acknowledge their mistrust or skepticism in a compassionate manner. Filling knowledge gaps and busting myths will only go so far. Black and Indigenous communities have had long-standing histories of abuse within our system and if we are to reach these communities, which are disproportionately affected by COVID19, we need to involve community leaders to engage and encourage widespread vaccination.

There is a long legacy of racism and discrimination resulting in significant mistrust in health care by BIPOC communities. And with good reason. If you feel you or your life is not valued, then how can you trust them? This is where tailored trauma-informed messaging is critical. Telling a racialized minority that Health Canada has reviewed the efficacy and safety of the vaccine and considers it safe is almost meaningless to a community that has mistrust across several systems of government whether it be educational, judicial or health care.

Currently, visible minorities are overrepresented among PSWs, making up 42 per cent in Ontario based on a CRNCC/PSNO survey, of which 18 per cent self-identify as Black and 5 per cent as Indigenous. Looking at the broader group of nurse aides, orderlies and patient service associates in Toronto, almost 79 per cent are immigrants. So it really should come as no surprise that this group has been hesitant to be the first in line to get vaccinated. However, little is being done to alleviate their fears and concerns.

We must prioritize collection of data. If we don’t see the problem, we cannot fix it. We have minimal data in Canada on vaccine hesitancy in general, and also no data on vaccine hesitancy in BIPOC communities. We know that the number of people refusing the vaccine is not insignificant, but we are not collecting this data.

What is driving their concerns? We know that PSWs are often racialized women; in fact, women account for the majority of nurse aides, orderlies and client service associates. Many are in their child-bearing years and are concerned about impact on fertility. There has been reluctance because the National Advisory Committee on Immunization guidelines as well as the Ontario Ministry of Health did not recommend the COVID-19 vaccine in those who are pregnant, breastfeeding or trying-to-conceive. While our obstetricians and gynecologists are rightfully advocating for this group to be able to receive the vaccine, as historically trials have excluded this population, changing messages without adequate discussions may not instill confidence.

We need to increase education, but encourage this information to also come from someone they trust. That could be their primary care providers, a partner community health organization or leaders they work closely with at their LTC homes. We need to be proactive and increase access to culturally sensitive, multi-language trauma informed educational materials.

We also need to break down barriers to vaccine distribution. Much light has been shed on PSWs needing to work multiple jobs as their positions are often part-time without benefits. Vaccine administration cannot just be during the day. Accessibility to on-site vaccinations in our LTCs homes is necessary. Paid sick time in the event of side effects should be mandated.

Lastly, we cannot be dismissive of fears. We must be empathetic, and provide factual information in an easy to understand manner, without any sensationalism or jargon. We must be respectful and compassionate. There is so much work yet to be done to ensure a successful uptake of the COVID-19 vaccine. Because after all, what good is a highly efficacious vaccine if people are too afraid to take it?

Sabina Vohra-Miller is the co-founder of the Toronto-based Vohra Miller Foundation, which aims to make health care equitable and accessible for all. Follow her at @SabiVM.

Dr. Anjali Bhayana is a family physician and staff hospitalist in geriatric rehabilitation at UHN TRI. Follow her at @AnjBhayana.

Source: What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

HASSAN: Pakistan’s particular second wave challenge

Given Pakistan one of our top five immigration source countries,  of interest, with similarities with some of the fringes in Western countries:

Pakistan’s management of the pandemic was initially lauded even by the World Health Organization. Not so, the second wave.

The latest outbreaks have wrought havoc across the world, and Pakistan is no exception. COVID-19 appears to be spreading rapidly in many parts of the country. The rest of the world is beginning to see the hope of ending the pandemic in the development of various vaccines.

But Pakistan poses a special challenge toward fighting the pandemic within its borders. According to Younis Dar, Pakistan’s situation is “far more dangerous” as a significant number of Pakistanis refuse to embrace the idea of inoculation because of rampant suspicion against the vaccines.

Source: HASSAN: Pakistan’s particular second wave challenge

Impact of Covid-19 on Immigration to Canada – Working Deck – October 2020 Numbers Updated with temporary resident data

This is an updated version, including the October numbers for temporary residents (International Mobility Program and Temporary Foreign Workers Program). The most interesting data point is the sharp increase in the number of post-graduate employment, which increased more than five-fold compared to September, and more than doubled compared to October 2019.

I went on Punjabi radio to share COVID information with my community. I learned that multicultural media has been kept in the dark

Ethnic media is often unappreciated at times like these:

“I would encourage listeners to not take medicine as there are lot of side effects.” These are the types of uninformed messages I heard being blasted on a Punjabi radio show as I awaited my turn to speak about COVID-19 precautions.

As a General Surgery Resident at the University of Toronto, I decided to personally reach out to this media outlet to promote awareness around COVID-19 in Punjabi. I had recognized the importance of dissemination of cultural and language specific information while working with my patients, and colleague physicians from different specialties including Public Health, and Infectious Disease.

I was also inspired to connect with Punjabi radio and TV shows after seeing the way my family and friends relied on information from these sources. As part of my social media campaign, Humans in Brampton, I also spoke to a few truck, and taxi drivers who sometimes go on long cross border trips and they informed me that their sole knowledge about COVID-19 is from Punjabi, Hindi, and Urdu radio shows.

Moreover, I came across multiple tweets from community advocates urging physicians and public health officials to speak to the community directly. These tweets were in response to conversations in national media about the rise of COVID-19 cases in specific communities such as North East Calgary in Alberta, and Peel region in Ontario. What emerged from these discussions was the role of socioeconomic status, language barriers, health care and workplace inequities that exacerbated the pandemic burden in such communities.

Speaking to some of the Punjabi Radio and TV media outlets, I was surprised to learn how underutilized these platforms have been throughout the pandemic. One of the spokesmen for such a media platform informed me, “We have hardly been approached by physicians, public health or government bodies to run COVID-19 specific messaging on a regular basis. We would be more than thrilled to have them on our shows,” they said.

In another live Punjabi TV discussion that was being broadcasted throughout North America, I received a question from a New York resident who had tested positive for COVID-19 regarding precautions, and this solidified my belief that these highly impactful public platforms have not been utilized during the pandemic to disseminate life-saving information even across the continent.

I was also shocked to learn that more homeopathy and alternative care providers used these language specific platforms to deliver health related information than government bodies, and physicians. The lack of information and even worse, misinformation, can be dangerous for the community members as they are essentially in the dark about how to protect themselves from COVID-19.

Based on 2016 Statistics Canada data, Peel region in Ontario for instance had the lowest percentage (60.92 per cent) of population speaking in English at home. 4 per cent of the Peel population had no knowledge of English or French. Language, on top of other inequitable factors is another barrier many of these communities face when it comes to inaccessibility to health care and information.