Where are we at with Covid?

Covid-related concerns from a Barrie gastroenterologist.

 

I used to try and write, intermittently, to provide "medical news" for my website.  At one point, about 2 years ago, I thought I could interpret the information about the Covid situation, and provide guidance, especially to my IBD patients.

I rapidly discovered that the information is complex, changes over time, and the situation is usually not stable or predictable.

I think we have all discovered, in addition, that there is a range of opinions, there is some misinformation and disinformation, and there is a significant minority of the population, including some medical experts, who have chosen to interpret various observations or statistics in a way that ends up quite different from the "mainstream approach".

Over these past 2 years, we have discovered a number of problems, and what the World Health Organization has called not only a pandemic but an "infodemic".  There are websites and experts devoted to trying to combat "misinformation", and at the same time, there are a significant number of people, mostly using social media, to try and combat what they think is misinformation from government, politicians, doctors, and medical experts.

I would just like to make the following comments, which relate to any patients connected to my practice, and especially IBD patients:

1)  The Covid pandemic continues, as of the date of this posting, April 1, 2022, (and this is not an "April 1^st joke").  Ontario is looking to be on the rapid upstroke of the sixth wave, if not already IN THE MIDDLE – some of the projected numbers look worse than anything we have seen previously.

2)  Covid represents a significant risk to all members of society, but obviously a markedly reduced risk to young healthy people, with "youth" defined, arbitrarily, as aged under 50.  Unfortunately, a number of members of society cannot receive the vaccine, even if it would be recommended or desired, and this would be particularly important for children under the age of 5.  While children under the age of 5 frequently do not suffer severely from Covid, there are deaths in children of this age group, and a number of those children had no pre-existing medical conditions.  Of course, children under the age of 5, and from 5-18, can contribute, and possibly are contributing, to a major spread of the disease, in the childcare environment, in the classrooms, and in their homes, and to their parents and grandparents, who may not do so well with Covid.

3)  There is a current recommendation, which is widespread and based on solid science, that a third, or booster, shot should be given to all patients in Ontario, over age 50, and also to all patients who have either diseases or treatments that suppress or affect the immune system.  The third shot is also recommended (ie can be given) for all Canadians over 18.  There is even a recommendation that a fourth shot should be given to patients on significant immunosuppressive medications, or who have diseases that might cause reduced immunity response.

4)  I understand that the decision to take the third shot is/was slightly more difficult than the decision that led more than 90% of Ontarians to get 2 shots.  The decision is based on risk/benefit, and the perception appears to be i)reduced risk of Covid after 2 shots, ii)  risk from the third shot of the vaccine might be higher, and iii) further benefit of a further shot after 2 shots appears to be reduced.  

Depending on one's observations, one’s research, and possibly one's own belief systems, information sources, and philosophy, a significant number of Canadians have made the choice that they will not go for the third shot.

5) As of April 2, 2022, it looks like several provinces in Canada, including Ontario, and several countries in the world, are experiencing a rapid resurgence of Covid infection and illness.  This is linked to the new variant, BA.2, and at the same time, the withdrawal of public health mandates.

6) Even newer variants have been identified in other Western countries.

7) There is ongoing confusion related to government announcements, public health announcements (that seem to be occurring with reduced frequency), and as usual, the difficulties sorting out the science, which usually lags behind the reality in the community.

8) I am very concerned for the health of my patients, and other people in the community, who may be affected by my patients, or others who may provide increased risk to my patients, related to reduced vaccine uptake.  In my opinion, the mandates should have been lifted when the uptake of the third shot/booster was greater than 80%, not while it seems to be stuck at about 50%.

9) I am very concerned that the Ontario Minister of Health has stated publicly that she thinks the healthcare system can “handle the expected surge of cases", but I am not sure she understands fully the past, current, and near-future stresses on the healthcare system.  It has been said by experts that the Covid pandemic has been a "stress test" on the Canadian healthcare system, and the system has failed.

It has also been said that some public health experts appear to be influenced by governments, and as usual, politics, especially with upcoming elections, plays a major role, and politicians seem to have little concern with the incredible numbers of patients getting sick with Covid, dying with Covid, and developing potentially long Covid.  We have become "immunized" (numbed?) to the numbers of hospitalizations, community illnesses, and deaths.

It is also said by some public health officials that we are now “empowered” to make our own decisions, but this is really propaganda, and not fact.  A wise Internal Medicine physician (Dr Jill Horton) published in the Globe and Mail yesterday suggesting that we are not "being empowered", but some people are "being sacrificed".

Please continue to inform yourself from many independent sources, try and sort out who you can trust, and try and identify independent and unbiased medical or scientific sources of advice.

The regulatory authorities, such as the College of Physicians and Surgeons of Ontario, have told us (physicians) that we must continue to provide excellent care to those who have not been vaccinated, and also those who choose to no longer wear masks, or follow other basic public health measures, but it will be increasingly difficult to follow these recommendations.  Yes, you could interpret this as a threat, but in fact it is a basic reality, when it comes to limited resources, exhaustion (both physical and moral) of healthcare workers, and the potential for "triage", ultimately meaning (from the history of warfare) choosing to treat those who have the best chance of survival, if there is an inability to treat everybody equally.