Fourth Waves & Fourth Doses

Good morning, and welcome to November!

Today the world celebrates?Vegans?and?Vinegar, and marks the beginning of?Marzipan Week?and?Manatee Month. You can also expect more overgrown facial hair to bring awareness to men’s health issues during “Movember” (although 18 months of Zoom meetings has already done plenty of that).

For the Insider, though, it’s Monday and time for another...

Pandemic Précis

Since my last summary a week ago (“Time to Loosen Our Belts?”) here’s how the COVID19 pandemic has evolved…

Global Hotspots

Worldwide, the COVID19 pandemic officially?surpassed 5M deaths?this weekend (although many suspect that undercounts what could be more like 8-12M deaths). Unvaccinated regions of the northern hemisphere are heading into the roughest part of the year. Eastern Europe continues to wrestle with its worst outbreak since the start of the pandemic, and a cumulative case count of more than 20M. Record-high case counts (or at least, highs since spring) have been reported this past week in?Russia,?Ukraine,?Poland,?Bulgaria, and?Germany, as well as?Britain,?New Zealand,?Singapore?and?Papua New Guinea.?

“I’m strongly asking you to switch off social networks and switch on your brains. The only way to prevent a collapse is to increase the share of vaccinated people. I’m asking regional authorities to wake up and go to bed with that thought.”?-?Volodymyr Zelenskyy,?President of Ukraine

Fading Fourth Wave

Where vaccination uptake has been widespread, or springtime is bringing welcome relief, the pandemic outlook is much more rosy. Infections in the?US have declined by half?since the summertime peak driven by the Delta variant, to about 72,000 new cases daily. (The biggest drops have been in the southern states, where it’s not vaccination but widespread infections that are providing improved immunity. The price has been enormous, of course.) Today,?Australia?is reopening its international borders for the first time in 18 months, finally allowing vaccinated residents to travel again, and families to reunite without the need for quarantine. (Tourists are welcome only from New Zealand.) Western Australia has kept its state and international borders closed, on the other hand, to try to prevent COVID19 infections from returning.?

Cooling Case Counts in Canada

With November, the Canadian winter is set to start in earnest (and certainly the past week of cool temperatures – and even?snowfalls?in some places – confirms it). Here’s a quick summary of notable trends…

BC:?An independent COVID19 modelling group says?infections in BC have been dropping?about 2% a day, signaling a “largely stable” emergence from the Fall’s fourth wave. Case counts are expected to continue dropping over the next 3 weeks, although the report warns that infections could rise again if people become lax about precautions.?

AB:?Although case counts are?also dropping in Alberta, pressure on the healthcare system remains high and the situation remains “precarious.”?More pregnant women?have been admitted to Alberta ICUs in the fourth wave than in all 3 previous waves. Polls find that Albertans have “a?deep-seated anger” at Jason Kenney’s government for mismanaging the pandemic, and yet also many pockets of anti-vax resistance persist, such as some defiant?restaurants in smaller Alberta towns.?(See below for some of their reasons for vaccine hesitancy.)

SK:?In?Saskatchewan, some burned-out physicians report they are considering leaving the province as they watch the healthcare system collapse, and up to half of registered nurses are considering leaving the profession entirely, due to premier Scott Moe’s refusal to take medical advice.?(Perhaps they should look at Atlantic Canada – see below.)?And despite some mixed signals,?at least 22 ICU patients?have been moved from SK to Ontario hospitals, often without warning.?

MB:?Like parts of AB,?southern Manitobans?“have a different belief system” than the rest of the province, with widespread pushback against vax mandates, COVID19 testing or even the simplest of precautions. Half insist “the whole COVID19 issue is overblown.”?(Sigh.)

ON:?Ontario?is continuing to confidently relax restrictions, announcing Thursday that it will allow music venues to reopen standing room only concerts at full capacity (with masks and proof of vaccination), and lifting all capacity?restrictions on outdoor events?like Remembrance Day ceremonies and Santa Claus parades. Still, the province reports?1,760 breakthrough infections?of fully-vaxxed Ontarians in the past 2 weeks, although most had mild symptoms.

Perhaps no news is good news: Quebec and Atlantic Canada didn’t hit my news radar nearly so much over the past week…?

Origins & Outcomes

As always, I’m particularly interested in the future trajectory of the pandemic, and what COVID19 can tell us about the potential for future disruptions…?

Back to that Wuhan Lab…

A declassified report from the US Office of the Director of National Intelligence has reignited questions about the lab leak origins of COVID19, by dropping the “bombshell” that dangerous experiments at the Wuhan Institute of Virology, and a lack of safety precautions, may have allowed the virus to jump from animals to humans. “It is plausible that researchers may have unwittingly exposed themselves to the virus without sequencing it… possibly resulting in asymptomatic or mild infection.” (At least the ODNI report?does?dismiss the idea that COVID19 originated as a bioweapon.) At the same time, the US National Institutes of Health says an American company connected to Wuhan, EcoHealth Alliance, violated the terms of its NIH funding by failing to disclose findings from an engineered bat coronavirus study that resulted in a more aggressive strain. The NIH has ordered EHA to surrender any unpublished coronavirus research data it may have. For its part, EHA denies any wrongdoing. But Republican senators are attacking Anthony Fauci for testifying under oath that the NIH “has not ever and does not now fund gain-of-function research in the Wuhan Institute of Virology.” The NIH explains that gain-of-function was “an unexpected result of the research.” (I mentioned several weeks ago that a newly?uncovered DARPA proposal?has sparked?a new WHO investigation?into the origins of COVID19, although many doubt it will achieve much clarity.)??Australia Nationwide News??|??Newsweek??|??Washington Post

Delta+ Spreads

The novel coronavirus continues to evolve, and in particular the WHO is vigilantly watching the mutations of the most successful Delta variant. The AY.4.2 strain (one of several called “Delta Plus”) is the fastest-growing strain in the UK, now accounting for ~10% of samples, but it still hasn’t been declared a variant of concern, or even of interest, by the WHO.?Preliminary UK data?suggest it has a slightly higher “household secondary attack rate,” but is only mildly more infectious than the Delta variant itself. The variant has been detected in at least?40 other countries, but does not seem to be spreading quickly. The?first Australian case?has now been detected in a quarantine hotel.?2 Alberta cases?have been confirmed – although most genome sequencing stopped in early September.?

“As long as this virus has opportunities to keep infecting people, we’re going to see more variants popping up. We can’t be panicking every time we see a few more mutations.”?–?Megan Steain,?uSydney virologist

A Race to Boosters

Delta and its descendants are prompting more emphasis on booster shots in the developed world, even as much of?Africa still lacks first doses?for its frontline healthcare workers. Led by Israel, one of the earliest countries to get its citizens double-vaxxed, more and more countries are announcing plans for COVID19 booster shots in the face of waning immunity over time. Over the past week,?Australia?announced plans to roll out booster shots, and the?EU has approved?Moderna’s booster shot for anyone age 18+, at least 6 months after their second dose. Here in Canada,?NACI announced expanded eligibility?guidelines for booster shots on Friday (after?weeks of deliberation), to include those who received AstraZeneca or J&J vaccines, those aged 70+, front-line healthcare workers and people in First Nations communities. NACI and chief PHO Theresa Tam don’t believe the general public needs boosters yet, but nonetheless provinces and territories have been announcing third doses for some residents since August.?

Actual vaccine policies still vary by province.?Yukon?will start offering boosters to residents aged 50+, at least 6 months after their second dose, starting today. On Thursday, the?Northwest Territories?began offering boosters to anyone age 18+.?BC?announced last Tuesday boosters for everyone age 12+ by May 2022, roughly 6-8 months after their second dose, and for some vulnerable groups now.?Manitoba?is now recommending boosters for elderly residents of LTC homes and congregate living centres, front-line healthcare workers, the immunocompromised and those living in First Nations communities.?Ontario?has been offering third shots to vulnerable populations since August, including the immunocompromised, organ transplant recipients, and seniors in congregate living settings. Doug Ford’s government says it will announce this week a plan to roll out booster shots to all Ontarians.?

“What we’re seeing now on the ground here is breakthrough [infections] in the older people who went first. So that’s why we needed to be more proactive to try to get out booster doses to those people right away.”?–?Bonnie Henry,?BC PHO

Next Up: 4th Doses

But lest you think that third doses will be the end of it, the CDC has already admitted a?fourth shot may be necessary?for immunocompromised individuals. Studies have found them responsible for up to 44% of breakthrough cases, and up to 485 times more likely to require hospitalization. It remains too early for health authorities to speculate about when the general public might require fourth booster shots, but as we grapple with COVID19 becoming endemic, the prospect of annual vaccine formulations (like flu shots) is looking more likely.

Kid-Sized Vaccines

They didn’t come in time for Hallowe’en, but by Christmas it looks like we’ll see kid-sized doses of COVID19 vaccine available in many countries.?Moderna?has now reported strong results from its low-dose vaccine in children aged 6-11, although it is still waiting for FDA approval for use in teens.?An FDA panel?reviewed earlier data and recommended the Pfizer/BioNTech vaccine for children aged 5-11 last week - and the company has already signed an agreement to supply?50M doses for US children. Health Canada says it won’t make a decision until late November, but when it does,?Ontario?will be prepared to vaccinate children aged 5-11, likely after hours at school sites and doctors’ offices. But even though Ontario and New Brunswick mandate many immunizations already for schoolchildren, on Friday Ontario’s CMOH said the province will?not?add COVID19 vaccination to the list of?mandatory shots for K-12 students?(although the decision could be reviewed if the virus remains an “ongoing threat”).?

Vaccine Hesitation

Much of the pandemic news lately hasn’t been about medical research or public health, but about legal battles, politics, and labour struggles…?

Mandates Win in Court

Court challenges against employer vaccine mandates seem to be meeting defeat almost everywhere, from the?Ontario Superior Court?and the?New York Federal Appeals Court, to the?Chicago Federal?District?Court?and even the?US Supreme Court. (A little bit surprising, since SCOTUS remains loaded with Trump appointees.) A?Manitoba court has ruled?the temporary ban on religious services a reasonable public health response, dismissing the case of some defiant church groups. 4 Alberta doctors have launched?legal action against the AHS?over “being forced against their will to be vaccinated,” but a uCalgary law prof observes that the courts will likely find these limits on individual rights to be “reasonable.” And?anti-vax doctors?are getting censured or suspended by regulators. So in the courts of public opinion and labour law, vax mandates are winning out…?

Frontline Worker Shortages

Of course, in the short term those legal victories won’t mean much if emergency services staffing gets decimated.?Alberta?moved back its deadline for healthcare workers to be vaxxed to Nov 30, but the AUPE warns that the system could be “in a crisis” if vaccine uptake doesn’t improve. (Just 76% of casual workers at AHS have submitted proof of vaccination so far.) HSAA,?Alberta’s paramedics union, has already declared a state of crisis as EMS services are “stretched beyond their limits” and 290 paramedic shifts were unfilled last week.?New York City?was bracing for a shortage of fire, police and other emergency workers this weekend, as a mandatory vax deadline came into effect on Friday and unions warned that up to one-third of their members might be put on unpaid leave in this “inevitable disaster by design.” In a slightly different kind of labour shortage,?Newfoundland & Labrador?reports that 98,000 residents lack a primary care physician, and premier Andrew Furey (who is himself a doctor) admits the province’s healthcare system is “broken.” NL has launched financial incentives to recruit and retain healthcare professionals, and some towns are paying for a wide range of perks – but Atlantic provinces are ultimately fighting a zero-sum game to compete with each other. As one patient puts it, with 6,000 people on the waiting list, “you better pray you don’t get sick.”

Hesitant about Mandates?

In many states and provinces, right-leaning governments are reluctant to impose vaccine mandates at all. (To put it mildly.) And the labour shortages they might spark either intensify their resistance, or provide a convenient excuse.?Quebec’s health ministry?announced last Wednesday that it will?not?impose a vaccine mandate on K-12 or PSE employees, since the epidemiological situation is improving and most staff are already vaxxed (89% of K-12 staff, and 92% of PSE staff). Likewise, Ontario’s education minister warns that a mandatory vaccine policy could mean?firing 50,000 unvaxxed school workers?across the province, which already faces staffing challenges. (As I said above, unless the pandemic grows considerably worse,?Ontario won’t mandate?COVID19 vaccinations for students either.)

Albertan Hesitancy

Survey research out of uAlberta has attempted to understand the drivers of vaccine hesitancy in that province. The authors observe that online misinformation was compounded by Jason Kenney’s “Open for Summer” debacle, and the political emphasis on civic freedoms above social responsibility. Unvaxxed Albertans were more likely to earn less than $40,000 a year, having difficulty covering expenses and have no savings for emergencies. Naturally, the lowest vaccination rates were among supporters of the Wildrose Independence Party, and those at the far right of the political spectrum. Vaccine hesitant respondents claimed vaccine safety and side effects were their primary concerns, although some also cited distrust of government and the pharmaceutical industry.??The Conversation

Cognitive Biases

A new paper published by Concordia U researchers explores the cognitive biases that shape the positions of the vaccine hesitant. (The study began months before the COVID19 outbreak in Wuhan that started this pandemic.) They found that overly-detailed reports of side effects can intensify those cognitive biases, including availability bias (vivid recall of serious adverse effects), optimism bias (about one’s own health risks), authority bias (the power of celebrity misinformation), and confirmation bias (ignoring information that challenges one’s pre-existing position).??Concordia News

Southern Resistance

COVID19 vaccine uptake in the US can be mapped along partisan lines: “red covid” afflicts republican-leaning states like Texas, Mississippi, Florida and Kentucky. “The Delta variant hit the former Confederacy hard.” A uArkansas politics prof, Angie Maxwell, has written that the “white south” has a collective inferiority complex that primes it for backlash, particularly when combined with poverty, poor education, and authoritarian religion. She says the “sci-fi apocalypse” of reconstruction after the Civil War, when “formerly enslaved workers [became] their senators,” felt like the ultimate northern critique. Generations later, Southerners have a lingering resentment and distrust of media, “coastal elites,” and even public education, and have retreated into a private space of religious education, conspiracy theories, and alternative politics. As the “blue states” criticize states below the Mason-Dixon Line for vaccine hesitancy, southerners retrench in their “defensive compensations.”??Slate

#ICYMI

On Friday I shared examples of Hallowe’en hijinks across CdnPSE and higher ed globally (see “Bats in the Belfry”), but of course many more examples rolled out later in the day, and on the weekend.?

Higher Ed Hallowe’en

My?Halloween 2021 playlist?now includes 30 videos. While I still admire the?uRichmond Ghost Hunters?series, and multiple?mini-documentaries about bats, and there are some pretty cool?pumpkin carving vids, here are 2 new additions you might want to check out…

uStirling?released another suspenseful, amusing Hallowe’en vid for 2021 that deserves a watch. Instead of being set in residence (like the 2019 vid), this one starts out in the library in broad daylight…?YouTube

uGuelph?released the first episode of “The Science of Things Reel or Unreal,” focused on “The Science of?Ghostbusters.” The tone is a bit zany and fun, but ultimately focuses on ionizing energy and the logic of detecting ghosts with EMF meters.??YouTube

As always, thanks for reading. I hope your week (and month) gets off to a splendid start!? Stay safe and be well,

Ken

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Ken Steele?is Canada's leading higher ed futurist and strategic consultant, through his company?Eduvation. He delivers virtual presentations and facilitates virtual retreats or workshops centred on emerging trends, enrolment management, pedagogical innovation, and strategic planning.?

Ken has developed?9 new topics?specifically to help institutions cope with the?post-COVID19?“new normal.”

For more information, please reach out to?[email protected]