COVID-19 – deonandia

by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)

A major newspaper asked me to write an op-ed on mandatory vaccination for schoolchildren. But that was a week ago and it looks like they’re not going to run with it after all. So I guess I’ll just publish it here on my blog instead….

We Need A Vaccine Policy For Ontario Schools

There are four tools for making schools as COVID-safe as possible: ventilation, masking, screening, and vaccination. Ontario’s back-to-school plan relies on three of those. The glaring omission is any effort to maximize vaccine uptake among staff and students.

Mandating vaccination among some professions has widespread public support. Health care workers, first responders, personal care workers, and teachers are daily exposed to scores of people, many of whom are unvaccinated or vulnerable. The benefits of compelling vaccination for such professions far outweigh the risks, both physical and philosophical. Frankly, if you don’t want the jab, then get another job.

Adults in key jobs are one thing. But vaccinating children against COVID is quite another. For adults, the risk vs reward computation is straightforward. While vaccination poses a vanishingly small risk, the likely negative outcomes of actual COVID infection are so dire that vaccination is clearly the best choice.

Children, on the other hand, do contract the disease, but less commonly. And some will develop “long COVID”, be hospitalized and even die, though seemingly at lower rates than adults. So for kids, the risk vs reward calculation is not as clear, since a tiny proportion of vaccinated children will experience serious, though treatable, adverse events, like mycocarditis.

For kids, the personal risk and personal reward are both small. The tie-breaker might be the reward to society: getting a significant step closer to herd immunity. It might be mathematically impossible to get to that magical threshold without immunizing children.

This distinguishes COVID vaccination from the nine jabs that are presently mandatory for attending Ontario schools. They include tetanus and diphtheria and other diseases that were once societal scourges but that have been tamed by technology. In all nine, vaccination is intended primarily for personal protection. But for COVID, it would be mostly for the protection of others.

While the COVID vaccine will likely be added to the list of compulsory shots eventually, now is not the time. This is because of the tightrope that public health communicators must presently tread to win the hearts and minds of the vaccine hesitant. Making this particular vaccine mandatory for children might drive the hesitant in to the arms of the hardcore anti-vaxxers who equate public health with authoritarianism. We would thus increase the behaviour we seek to suppress.

And make no mistake, we cannot afford to lose the battle for hearts and minds. We will need the cooperation of the entire populace in months to come, as booster shots become likely and as the struggle against COVID enters an endemic phase.

But not compelling student vaccination doesn’t mean having no vaccination policy at all. The price for exercising one’s bodily freedoms can include more stringent masking requirements, mandatory regular asymptomatic testing, and restriction from certain high risk extracurricular activities.

We can cajole, incentivize, and educate our way to higher student vaccine uptake. Vaccine hesitancy is fueled by fear, misinformation and apathy. Making vaccination compulsory addresses the apathy, but accentuates the fear and creates vulnerability to misinformation.

As has been the norm these past 15 months, I’ve been getting a slew of regular COVID- and vaccine-based questions from the general public. There are a few I’d like to answer in this public space.

And I want to start with questions asked by a class of 5th graders who recently invited me to do a Q&A in their school.

1. Does Covid 19 deserve the title “a plague”?

Well, there is no scientific definition for “plague”, but it’s generally understood to be a bacterial infection. And most people think of the Bubonic Plague, which was definitional a bacterial thing. One online definition says a plague is, “a contagious bacterial disease characterized by fever and delirium, typically with the formation of buboes ( bubonic plague ) and sometimes infection of the lungs ( pneumonic plague ).”

Since COVID is caused by a virus, I would say the answer is…. no.

2. Do you think the vaccine will completely get rid of Covid 19

The answer is no. I gave my reasons in this earlier post, “Can We Eradicate the Virus?”

3. What was the worst pandemic in human history?

Well, that depends on what you mean by “worst”. The most impactful? The longest lasting? The most damaging? The one that infected the most people? Or the one that killed the most people?

Focusing on the last, we see that COVID has killed about 3 million people that we know of. But HIV/AIDS has killed over 35 million. The Plague of Justinian might have killed 100 million. And maybe the Black Death killed 200 million. So your guess is as good as mine.

4. How long did it take for the Spanish Flu to stop affecting people? Why did it stop if there were no vaccines?

In order for a pandemic to end, the disease has to reach a point at which it is unable to find enough hosts to catch it, i.e. susceptible people. We usually reduce the number of susceptible people by vaccination. But it could happen through infection, recovery and/or death as well.

By the end of the Spanish Flu pandemic, maybe a third of the world’s population had caught it. So the number of susceptible people might have been small enough to halt its spread. But another thing also happened. The 1918 strain began to evolve via a process called “antigenic drift.” Versions came back in the winters of 1919-1920 and 1920-1921, but they were much less deadly.

Every so often, direct descendants of the 1918 flu combined with bird flu or swine flu to create powerful new pandemic strains, which is what happened in 1957, 1968 and 2009.

So the Spanish Flu was likely stopped by a combination of mutation and population immunity through recovery.

5. If you were born and your mom had Covid 19, will the baby have antibodies?

There are limited data. But it looks like at least some will.

6. Will it make my dad’s farts smell different?

Yes. Because your Dad will lose his sense of taste, and will therefore eat blander foods, thus changing his farts qualitatively.

Now here are some questions sent by a concerned citizen who forwarded to me some of the things he is hearing in his community:

1. I’m young and healthy and have a good immune system, I will handle Covid 19 just fine. Why should I take the vaccine and risk any side effects?

Plenty of young, healthy people with good immune systems end up in the hospital for this disease, and some die. So you’re not bulletproof.

But the biggest reason to get jabbed is that you will contribute to herd immunity. If you get infected, you can pass it on to someone else who might not be young and healthy. Getting vaccinated greatly reduces your chances of getting infected and passing it on to someone else.

And if protecting others doesn’t motivate you, keep in mind that as long as the disease is circulating to a high extent, things will be closed, masks will be normalized, and life will be crappy. We need as many people as possible –even young, health ones– to become vaccinated so the disease goes away and everything can go back to normal.

So this is how you get your fun things back. Get jabbed.

2. What are the long term effects of the vaccine? I’m very scared that it will cause cancer or something in the future.

Well no one knows because we’ve only had the vaccines for about a year. But hundreds of millions of people have been jabbed, and nothing bad has happened to the overwhelming majority of them.

If you eat fast food or breathe city air, your risk of cancer from those things is thousands of times greater than the risk posed by the vaccine. So if you don’t feel a great urge to only eat organic vegan food and walk around with your own oxygen mask, then I question the consistency of your fear calculus.

I don’t mean to minimize your anxiety…. but I kind of do mean to. There is always some risk here. I just ask that you look around your life and honestly appraise whether you apply the same conservative thinking consistently.

3. We are being told that even if we are vaccinated we still have to wear masks, social distance, etc. So there’s nothing in it for me. Why then would I take the vaccine?

What you’re not being told is that you only have to wear masks and distance for a short period of time after getting jabbed. Here’s why. Vaccination doesn’t offer 100% protection, but something closer to 95%. That only matters if the disease is highly prevalent. If it’s all around us, then it will find holes in our defences and capitalize on that 5% failure.

So we get vaccinated to slow transmission and wear masks, etc, to get protection up to 100% while the incidence rate drops. Once the rate has dropped, it becomes unlikely that the disease will find holes. Then we doff the masks permanently.

How long will that take? Weeks to months. Depends on where you’re starting from.

I describe this in more detail in my earlier post, “Why The Vaccinated Can’t Throw Caution To The Wind”

4. The side effects of the vaccine are worse than Covid 19, so I won’t take that risk.

Really? Let’s look at Ontario data. As of May 15, 2021, we’ve given about 5 million Pfizer shots, out of which there were a mere 57 serious adverse events. Of those, there were 3 deaths, none of which were thought to have been caused by the vaccine.

But even if you do believe that they were caused by the vaccine, that works out to a risk of death of 0.00006% from the vaccine, and a risk of serious side effects of 0.001%.

Now, the infection fatality rate of COVID the disease is controversial. Most of us peg it at around 1%. But some people who downplay its seriousness would say it’s more like 0.2-0.4%. That’s your chance of dying if you get COVID.

Okay, if the latter are correct (and they are not), then the risk of death from COVID is over three thousand times greater than the risk of death from vaccine. Frankly, it’s probably more than twice that amount.

5. The government is using the vaccine to control us.

Guess what? The government has better tools to control us. Ever heard of taxes, speed limits, and the police force?

6. We don’t know what the plan is, if we will need to keep getting these shots or how often. How can I trust this when they don’t even know what we will need to do in the future?

This is the price of being an adult. Sorry if that comes across as flippant, but scientists don’t know everything. Doctors can’t cure everything. There is uncertainty in the world. This is has always been the nature of life.

We are faced with an unprecedented global emergency, and by some miracle the smartest people on this planet have found us a solution. But those same smart people aren’t gods. They don’t know the future.

I understand that you want certainty; we all do. But this is what real life is about: making important decisions based on imperfect and incomplete information.

No one can promise you everything will be okay. We can only give probabilities and our best guesses.

7. The vaccine is EXPERIMENTAL. It’s not registered and anyone who takes it is a guinea pig and participating in a big experiment. I’m going to wait and see what happens.

I’m not sure what “registered” means. The vaccines are the most scrutinized medical products in the history of human civilization. They have gone through all the same steps as every other drug your doctor has prescribed to you. No corners were cut.

The only difference is that because of the acute public scrutiny, you are aware of this vaccine and its regulatory path. You aren’t aware of the flimsy regulatory and testing process around your workout supplements, hair conditioner or chocolate bar. I guarantee you that those products did not go through multiple clinical trials of tens of thousands of people in dozens of countries, and had their data pored over by teams of scientists and journalists publicly in every corner of the world. The COVID vaccines did undergo that level of scrutiny.

How long do you want to wait? The vaccines have been injected into hundreds of millions of people now, with over six months worth of post-market data, and over a year of total clinical data.

There is nothing “experimental” here. The experiments were done a year ago, on animals and on tens of thousands of clinical trial subjects. Th mRNA and viral vector vaccine platforms have been years in the making; they just culminated this year as a result of intense resource allocation and budgetary focus.

Frankly, I’m much more terrified of the long term cancer, heart disease and diabetes-causing impacts of processed foods than I am of the miniscule risk posed by COVID vaccines.

Having said that, the risk is not zero. Everyone wants certainty of absolute safety, and that does not exist. Again, it’s the price of being a grown-up in a modern world: we have to make difficult decisions without guarantees.

So I am sympathetic to people’s fears. And I don’t want to minimize risk. But do consider all mindless risks we take on an hourly basis that we accept reflexively. And take some time to read the warning label on a bottle of aspirin or some other over-the-counter medication you happily accept.

Man, I sound irritable this evening!