B.C. must alter its approach to Omicron and make third doses more widely available in order to help prevent the health care system from being completely overwhelmed, doctors say.
Currently, individuals 65 or older, Indigenous people aged 18 and over, health care workers and those in long-term care or acute care settings in British Columbia are eligible for their third dose — often called a booster shot — of vaccine.
Dr. Amy Tan, a palliative care doctor in Victoria and member of Protect Our Province, a collective of health care workers advocating for “evidence-based policies” with a goal of ending the pandemic, said the government needs to make third doses more widely available immediately.
“I’m looking at the train coming off the tracks and thinking why are we not protecting everybody?” she said.
Data released last week by the B.C. government shows that the Omicron variant could result in anywhere from around 25 people hospitalized per day to as many as 100 people per day by early 2022 – depending on how infectious the strain is and how serious the situation becomes.
Preliminary data from around the world has shown that existing vaccines offer significantly less protection against Omicron, prompting many jurisdictions to offer third doses of vaccine.
Yet despite the government’s own projections, Dr. Bonnie Henry, the provincial health officer, has remained firm that B.C. will not be expanding third doses to a broader segment of the population until early next year, arguing that many people are already a few weeks away from their six-month interval.
“For most of us, it’s going to be six months after your dose two,” said Henry during Friday’s press conference. “That’s what our goal is now, that is what we are ramping up for and for most people that means in the next few weeks you will be getting your invitations and we will be getting booster doses into people.”
Dr. Lyne Filiatrault, who is also a member of the Protect Our Province BC, said she can’t understand the government’s logic right now, pointing out that even after receiving a third dose, it still takes two weeks for the vaccine to begin providing an individual with proper protection. She also said the sooner more people get an extra shot, the better for everyone, particularly health care workers.
“There’s going to be a lot of people that are going to get infected with Omicron and we need to protect health care workers because we are going to be low on staff if we don’t do that,” Filiatrault said. “We are already short-staffed and if more people are going to get infected, we’re going to be even more short-staffed.”
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Cases have soared dramatically on Vancouver Island — there has been a 460 per cent in cases on the South Island alone since Dec. 8 — in the days and weeks since the Omicron variant arrived. Furthermore, of the 302 Omicron cases reported in B.C. so far, nearly half of them are on Vancouver Island.
Dr. Baldev Sanghera, a family physician and medical director at Edmonds Urgent and Primary Care Centre in Burnaby, said with data showing that Omicron is seven times more transmissible than Delta, there is a real concern that a wave of infections could overwhelm the health care system – which is already dealing with labour shortages and burnout.
“We need to minimize the impact that could potentially happen to our health care system by being proactive,” said Sanghera, who is not a member of Protect Our Province BC.
“If we wait until a lot of people are infected to see how this is working out, the health care system will be overwhelmed and we won’t be able to handle that. At that point, we won’t be able to ramp up the vaccination program at the rate that we need to right now.”
He also said B.C. is being “a little more” selective with those third doses and feels the province is not administering them fast enough to mitigate any risks to its health care system, even though cases in the province have been rapidly increasing.
“If we keep getting doubling rate every two days it’s going to be about 18,000 to 36,000 [new cases] by next weekend and we have the potential to hit that milestone by Christmas and even if we assumed that this variant is mild and only one per cent become severely sick, that is still 40 patients per day requiring hospitalization.”
Dr. Amit Arya, a palliative care physician who has a faculty appointment at the University of Toronto, believes a greater sense of urgency is needed when it comes to third doses, especially considering how quickly Omicron has already spread.
“We can’t keep up with Omicron. If we think about this as a race between the Omicron variant and third doses, to be honest, Omicron has already won because it is doubling every two to three days across the country. But at the same time, we know that we can protect very quickly with a third dose,” he said.
“I do absolutely agree that we need to get into many doses into as many people’s arms as quickly as possible at this point in time.”
Health care workers still waiting for their third dose
Although the B.C. government says health care workers are eligible for third doses, that isn’t exactly the case according to Tan. She said not all health care workers are able to get their third dose of vaccine because B.C. has prioritized those in long-term care and assisted living facilities as well as those in hospital settings over family physicians and other caregivers.
“We need boosters at minimum to all of the health care workers in B.C. because that can help the system right now,” she said. “Community physicians, nurses, pharmacists are all part of the health care system … and they are exposed daily.”
Sanghera said if health care workers are in the community seeing patients, they should receive a higher priority for vaccination.
“Community health care workers provide 80 per cent of all care in the health care system. So, the acute care system, even though it gets more attention, only provides 20 per cent of the care.”
B.C. government documents provided to CHEK News show that community health care workers will be invited to receive a third dose of vaccine in sometime in early January. They will also be required to self-identify as a health care worker on the province’s Get Vaccinated system that places them into two categories — Category 4 and Category 5.
Category 4 includes health authority community staff, physicians and workers, including health authority care staff, health professionals and workers working in non-hospital areas as well as health authority administrative, and corporate staff, according to the document.
Category 5 includes “other community staff, physicians and workers,” including includes all non-health authority health providers, staff and other workers in the community health sector, including students.
Sanghera said while he received his third dose because of his work in nursing homes, not all the physicians at his office have been invited to get a third shot.
“There are other physicians in my office who don’t do nursing home work or hospital work just work in the community, they are still waiting and they are beyond the six-month interval.”
He also said he doesn’t agree that family doctors are at a lower priority for third doses than administrative staff at health authorities.
“Family physicians have been placed in a lower priority than admin staff that work in the health authority, which I don’t think is a good way forward because you want frontline people who are providing care to patients at a higher designation than people who are in an office and not face-to-face with patients,” he said.
Is a third dose of vaccine really necessary?
The simple answer is yes, according to Dr. Sanghera, who said based on data available, a third dose is necessary because it provides better protection against more severe illness or even death caused by the Omicron variant.
“We need to have a third dose for better protection against the Omicron variant. Even though they are more likely to be milder symptoms, people can become infectious and pass it on to somebody,” he said.
Multiple recent studies have shown that two doses of vaccine are far less protective against Omicron. One newly released study by Imperial College London suggests that Omicron can generally evade immunity that developed from either previous infection or from two doses of vaccine and also found no evidence that Omicron was any less severe than Delta.
“This study provides further evidence of the very substantial extent to which Omicron can evade prior immunity given by both infection or vaccination. This level of immune evasion means that Omicron poses a major, imminent threat to public health,” Neil Ferguson, professor at Imperial College London, said in a news article about the study that was posted on the school’s website.
Another recent non-peer-reviewed study from the Kirby Institute and UNSW Sydney suggested that Omicron resulted in a “substantial decrease” in antibody response among 16 samples from vaccinated individuals who had either received two doses of Oxford-AstraZeneca or two doses of Pfizer.
“Neither vaccination with two doses of AstraZeneca nor Pfizer were able to stimulate an antibody response strong enough to neutralize Omicron in our assays among the samples we tested. This is significant and supports the need for boosters to protect from infection,” said lead researcher, associate professor, Stuart Turville, in a press release on the institute’s website.
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Toronto-based palliative care physician Dr. Amit Arya said that for older adults and immunocompromised individuals, immunity wanes after three months, which is one of the reasons countries have been rolling out third doses in huge numbers.
“Data from the U.K. tells us that two doses now with the Omicron variant are just about 40 per cent effective against getting symptoms from Omicron while three doses increases that number to 70 or 75 per cent,” he said, adding. “Right now, the data is limited in terms of the severity of the Omicron variant. We do believe that some doses will still protect from hospitalization and death, but we’re relying, to be very honest, on hope.”
A third dose is also necessary because it will help prevent people, particularly those who are younger and healthier, from becoming symptomatically ill, which makes them more likely to spread COVID-19 around the community, according to Arya.
“That’s what we’re really worried about,” he said.
That worry is based on existing data that says when large amounts of COVID-19 transmission occur within the community, it will “undoubtedly” lead to increased hospitalizations, even in a good scenario, according to Arya.
“Even if those people in a good scenario, which we are hopeful for, don’t end up in the hospital, what this means is that the sheer speed and the spread of COVID-19 will end up overwhelming hospitals anyway,” he said. “We know that the virus will find its way to health workers, health workers will get sick, and they’ll have to stay at home and isolate. So, who will be left to look after patients, whether it’s in long-term care facilities, retirement homes, or in hospitals?”
What are other provinces in Canada doing with third doses?
Health Canada authorized the use of Pfizer and Moderna vaccines as “booster” or third doses in those 18 years of age and older at least six months after completion of the primary series back in early November.
Since then, a handful of provinces offer boosters to anyone 18 or above — although the timeline for eligibility varies depending on the province.
For example, both Ontario and Saskatchewan’s booster programs are open to anyone 18 years or older given they’ve received their second dose of vaccine three months ago. But in Manitoba, Newfoundland and Labrador, Prince Edward Island, third doses are only available to those 18 years or older six months after receiving their second dose.
The only provinces — aside from British Columbia — where third doses are not available to those 18 and above are Alberta, New Brunswick, Nova Scotia, and Quebec.
In Alberta and New Brunswick, third doses are available to anyone 50 years of age or older while in Nova Scotia it’s only available to those 60 and above.
Earlier this month, the National Advisory Committee on Immunization (NACI) updated its guidance, which B.C. follows, to say that a booster dose of an authorized mRNA COVID-19 vaccine “may be offered” to adults 18-49 years of age at least six months after their second dose.
“Evidence on the potential benefit and safety of booster doses of mRNA COVID-19 vaccines has evolved and no safety concerns have been noted following the booster doses beyond those recognized after the primary series,” the NACI said in its update.
While the term “booster dose” is used, NACI states that it will continue to monitor emerging scientific data on whether this dose is indeed a booster dose or should be considered part of the primary series.
Arya said the reality is that the COVID-19 vaccine will be a three-dose vaccine, not a booster as it has been labelled by many.
“We need to reframe how we think of the COVID-19 vaccine and we need to face the fact that this is a three-dose vaccine,” he said. “A three-dose primary series, which is the case with many other illnesses that often require childhood immunization.”
Multi-layer approach needed, say doctors
There is no singular answer to dealing with the Omicron variant or even the pandemic itself, according to Arya, who said that while every single day matters, unlike the first wave back in 2020, public health has the tools available this time around to deal with Omicron.
“This is not March 2020, this is nowhere close to that situation,” he said. “We have all the tools to protect us and we are experienced in these situations now.”
However, Arya stressed that a multi-layer approach is needed which includes rapidly accelerating third doses of the vaccine, distributing rapid tests to break chains of transmission in the community, and communicating that the COVID-19 is airborne.
“Honestly, the science has been telling us, even for previous variants as well, that we need to provide airborne precautions for people working in health care, but also in the general public,” he said. “We need to think of COVID-19 like smoke. It is airborne and we need to be providing people with N95 or KN95 masks.”
Filiatrault, who is now retired but was heavily involved in the province’s SARS response in 2003, said public health officials have wasted so much time that it might be too late and believes the health care system could collapse if a more multi-layered approach isn’t adopted soon.
“If they do not address third doses, ventilation, air filtration, masks and they don’t protect health care workers, that is what is going to happen,” she said. “More and more people are going to need to go in isolation and there won’t be enough staff available.”
Meanwhile, Sanghera said B.C. needs to find a way to blend the proactive approach of minimizing as much risk to the health care system while anticipating the system could get overwhelmed and doing everything it can to protect those who are vulnerable.
“It’s hard to say let’s just focus on vaccinations because we need to do all the other things as well. We need to look after all the cancer patients, and all the kids that haven’t been vaccinated for their regular stuff,” he said. “Ideally, in a perfect world, we need to be employing both approaches at the same time.”
For Tan, the message is simple: get as many third doses in as many people as possible as soon as possible, or at the very least, get them in all health care workers, before it’s too late.
“We don’t have a few weeks to wait,” she said.
B.C. health officials were expected to provide an update on COVID-19 measures on Tuesday.
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Nicholas Pescod
