Ask the Pharmacist

Q) Everyday there appears to be information about COVID on the news. At the risk of making me feel like I want to bang my head against the wall, what are the latest updates about the virus and the vaccines?

A) Ahhh COVID, the topic that never seems to end, but will one day, although not anytime soon.

Among the latest news is that Pfizer’s new bivalent vaccine has been approved for use in Canada. As of October 17th it will be made available in Ontario (once they supply pharmacies and other administrators with the requisite supply). This bivalent vaccine differs from the Moderna version, which is already available, in two important ways.

First, it can be used in individuals as young as 12 years of age whereas the Moderna version was only approved for those 18 and older. However, the Moderna bivalent vaccine can be used in those 12 and up who are moderately to severely immunocompromised if, in the clinical judgement of the doctor, the benefits outweigh the risks.

Secondly the Pfizer version more closely resembles the variants that are currently causing the majority of COVID case in Canada, (0ver 90%) BA.4 and BA.5. If you can recall, the Moderna version does offer some protection against these as well but is based upon the BA.1 variant which represents less than 1% of current cases.

Data from the States, based on blood samples, shows that recipients of the new boosters show substantially higher antibody response across the board to the BA.4 & BA.5 subvariants, just as the researchers had hoped would be proven true.

The Ontario Ministry continues to advocate that most individuals should wait six months from their previous booster in order to maximize their immune response. This may be subject to change as there is no longer any doubt that the 8th wave of this despicable virus is currently crashing down upon us. The numbers bear this out. Hospitalizations due to COVID are up 11.5% week over week and are at the highest levels that we have experienced here in Ontario since early last May.

Looking at the country as a whole, there were 5,070 patients hospitalized in Canada as of October 3rd, more than double the number from a year ago. Children, in particular, are overwhelming hospitals, not only from COVID-19 but other respiratory viruses as well. This is a surprise since mid October is earlier than normal for our more traditional viruses to gain momentum. These numbers are not likely to get better any time soon as both the U.K. and Singapore are reporting increased COVID-19 activity this week as well. Traditionally this has meant that we will see a similar rise in the next two to three weeks.

Adding to the concerns about the increasing strain that we are putting on our already over-burdened hospital system is the knowledge that Australia simultaneously experienced a surge in COVID-19 along with their worst influenza season in five years. Australia frequently serves as the proverbial “canary in the coal mine” when it comes to predicting our future experiences with the flu.

On the good news front, finally, there have been some recent updates regarding long COVID. Early in the pandemic, the WHO estimated that between 10 to 20% of all people infected with COVID-19 would go on to develop long COVID (loosely defined as lingering symptoms such as fatigue, shortness of breath, brain fog and many others lasting at least three months after the initial infection).

More recent estimates indicate that the Omicron variants are far less likely to cause this debilitating syndrome and it is now suggested that only between 2 and 10% will suffer from this. There is also now a growing body of evidence that indicates vaccines do help to prevent long COVID from taking hold. This should hopefully give people even more reason to consider updating their booster status. Do remember, the vaccines are only “okay” at preventing you from getting infected. So yes, even having 4 or 5 doses of the vaccine does not mean that you will not get COVID. But, they are extremely effective at reducing hospitalization or worse!! And they do seem to help you recover more quickly and fully than you might otherwise have done so.

The latest data from the Public Health Agency of Canada shows that unvaccinated people are about seven times more likely to be hospitalized and eight times more likely to die than those who have had three shots.

In other news, the Omicron variant continues to mutate rapidly proving that we are still a long ways away from the “pinnacle” version of the virus that will eventually dominate for the long-term. BA.5 is the current dominant form in Canada. It tends to cause more nasal and upper airway symptoms than the deep lung infections caused by earlier variants.

New variants to keep an eye on include BA.4.6. which accounted for 8.7% of test samples sequenced in Canada during the week of September the 11th and BA2.75.2 which is on the rise in India and seems to combine multiple mutations. There is some thought that BA2.75.2 could well be both the most infectious variant yet as well as the best at escaping damage from the antibodies that most of us have accumulated from either previous COVID infections or via the various vaccines. We probably will not have to wait long to find out whether this is just fear mongering or yet another blow from a virus that never seems to rest. For more information about this or any other health related questions, contact your pharmacist.