Saturday, January 8, 2022

Juris My Diction Crap

This Matrix clip has been at the front of my mind since I started looking into how to get a booster for my youngest, who's 17, because I question if recent orders around delaying boosters for the 12-17 and around getting kids back to school in nine days are really for our protection! 

My oldest caught the covid from their partner who got it from an ill-advised trip into Shoppers Drug Mart, and my little bunny is very sick, and it sucks so much!! (Wear N95 masks, and wear your googles, too, kids!!) But we've been lucky that the oldest's bedroom is in the basement with their own bathroom, so they're relatively easily contained, and the rest of us made it to day five unscathed and testing negative. My biggest worry aside from the well being of my triple vaxxed oldest, who doesn't have the strength to get out of bed, is my unprotected teenager getting it. 

In Ontario, the 5-11 age group has been prioritized for accelerated 2nd doses at 21 days instead of being made to wait the full 56 days, which is fantastic! And the 18+ group is being pushed to get their boosters as soon as possible with tons of clinics opening up. Most of my family got dose 3 before Christmas! Unfortunately, the booster for the under 5 groups hasn't been found to be effective yet, so they're still working on that, leaving our tiniest Ontarians vulnerable. And, for the 12-17 age demographic, the boosters are safe and very effective according to the FDA and CDC, but not the NACI. In the United States, dose 3 for 16-17-year-olds has been available since December 3rd and for 12-15 since January 3rd, and they're now accelerating dose 3 to just 5 months after dose 2. In Canada, the NACI still won't approve the booster for use by teens. 

So, let me get this straight: if you're 18, you absolutely must get boosted in order to be considered fully vaccinated since dose 2 effectiveness wanes significantly after 6 months, but if you're 17, you're fine to be 7 months past your second dose?? Did I get that right?? My daughter can't get a booster shot until her birthday, which is after school ends!  

I looked into crossing the border for a shot, but it requires a PCR test for re-entry, which is just impossible to get right now. And that, right there, is such a privileged position to be in to even be able to think about driving two hours for a booster. NOBODY should have to fight to get necessary health care in Canada, and that's exactly what these booster shots are: necessary health care. We need simple access for everyone, not Hunger Games fights for survival. We can't survive until everyone is vaccinated, here and around the world. 

But right now, I'm focused on my children and my students. I don't want to lose a single one. (NEW: teens with covid have 2.5 times the risk of diabetes!). And Ford wants teenagers back in the building NINE days from now. Boosters be damned!!

So I wrote to my MP, Bardish Chagger, who responded that it's entirely a provincial matter. I wrote again with a link to this CBC article that says, "Here in Canada, a booster dose is not approved by Health Canada for youth under 18." She responded by explaining what I had just told her,

"NACI has not yet recommended the booster for adolescents--only for 18+. Dr. Tam mentioned that the American and Canadian processes are different which could be a factor."

But left me with a glimmer of hope:

"This question came up at the press conference today [January 5], and the Minister of Health said he would get the reporter more information."

And then some more "not it" language:

"The Government of Canada takes advice from NACI but does not direct them. We also have shared your comments with the Minister of Health's team. We acknowledged that we understand they cannot tell NACI was [sic] to do and wanted to see if NACI is working with the company to obtain all the information they need to make a recommendation." 

Or, I guess, it's really saying that the feds have no control over any of this and can't do anything about this as your children remain largely unprotected because the NACI's standards are just so darn high!! Their standards are SO HIGH that teens will definitely get sick and become disabled or die waiting for a booster. But, I'm thankful that my MP at least looked into it. That's something.

So then I wrote to the Public Health Agency of Canada ( who ALSO said vaccinations are all decided provincially, which makes me very, very worried that the 12-17s have been lost in a federal/provincial shuffle. I responded, again, with evidence that, no, it's the NACI holding things up. 

Just in case it's a provincial thing, I also wrote to my MPP who sent an inquiry to the Ministry of Health, but I haven't heard back from them.

From the Government of Canada's website:

The National Advisory Committee on Immunization (NACI) is a national advisory committee of experts in the fields of pediatrics . . . and public health. NACI has been providing guidance on the use of vaccines currently or newly approved for use in Canada to the Government of Canada since 1964.

They provide guidance. Surely the approval by so many other agencies would count for something. There's no means to contact them directly that I could find, but I did try to reach out to chair and vice-chair Dr. Shelley Deeks and Dr. Robyn Harrison. FFS, what is the hold up with these boosters??? Geesh!

ETA: More information from the very helpful Professor Josh Greenberg. Here's our Twitter exchange:

JG: Unless I’m mistaken, Pfizer has not submitted a request for booster approval (12-17) to @GovCanHealth yet. Boosters were approved by FDA under emergency auth (i.e. there’s limited trial data on safety and efficacy). I expect NACI/HC watching U.S teen booster rollout very closely. 

MS: Can you clarify? What provokes emergency authorization? Do we need more teens to get sick or more of a market for company or is it a supply issue? Israel already reported no safety concerns with 12-17 booster; does that count? 

JG: Pfizer must submit application to HC for approval of boosters. "Interim order" pathway that allowed initial vaccines to be approved here came into effect Sept '20, expired Sept '21. My understanding is FDA can compel vaccine manufacturers to submit even w/o complete trial data. The U.S. is essentially generating clinical data so I'd expect that when there is enough evidence to show clear benefits, Pfizer will file for full auth to HC. Canada's review process is independent (thank goodness) so won't approve just b/c FDA, Israel or elsewhere has done so. 

MS: Independent review is great when there's a problem, but there appears to be no problems, and the wait for MORE evidence could cause more illness/disability/death to teens about to go back to school together. (Israel gave 3rd dose to teens since August.

JG: We don't just turn the lights off one of the best regulatory review systems in the world and expect they can be turned back on again when the pandemic ends. I'd be very troubled hitching Canada's wagon to the FDA (e.g. Vioxx, Aducanumab, and its role in the opioid epidemic). It would be fair Q to ask why interim order path is no longer avail. It expired Sept '21 so why not extend to Sept '22 to permit accelerated approvals? I don't have a good answer. But there are many other interventions besides boosters that could be used to make schools safer. 

MS: Thanks for your clarification!

NOTE: Here's the interim order #2, created in March 2021, but I can't find an expiry date, and it appears to replace interim order #1, which was drafted Sept 2020 and expired Sept 2021, which also added amendments to "ensure that the review, authorization and oversight of COVID-19 drugs, including new drugs, can now be conducted under the Regulations." It sounds like Health Canada is testing the safety of the boosters themselves, but trials aren't listed on their Authorized Clinical Trials page. Don't tell me they haven't even started!! One bit of good news is that people 16-18 who identify as Indigenous or who work in health care HAVE been approved in Waterloo Region, but, curiously, not elsewhere. So someone must have cleared it for safe application, and perhaps it's down to a concern with supply. And here's the NACI's most recent update,

"Some studies have shown decreases in protection against serious disease in some populations since the completion of a COVID-19 primary vaccine series. Evidence on the potential benefit and safety of booster doses of mRNA COVI-19 vaccines has evolved and no safety concerns have been note following the booster doses." 

They recognize it's safe and effective, so it appears the delay is caused by an attempt to ensure the most at risk groups are vaccinated first. Had they rolled out boosters at 6 months for everyone, this wouldn't have been an issue, as the rules already queued people by risk index last spring. The NACI links to a page for updates on 12-17 boosters, and it looks like this:

That doesn't look promising! And it's a concern too that, from what Greenberg said, it sounds like we're waiting for Pfizer to ASK us if we want to approve their boosters, as if we don't do anything until the company makes a move! Wha....?!? So our teens stay unprotected until Pfizer decides they want to tap that market - is that accurate? This has been very difficult to piece together.

Also, unfortunately, the "many other interventions besides boosters" being provided for our return include giving CLOTH masks to students, offering no new ventilation strategies besides an open window, and allowing them to eat together in groups of 30 each day. We're just going to let it hit them hard. 

AND THEN... about that lunchtime situation... 

I was royally eviscerated on Twitter. 

How kids can safely eat at school during a pandemic is a huge conundrum. In a conversation with local teachers, it was widely suggested that, if we can't teach in person half days and then send kids home to eat, then we might think of getting more kids to eat outdoors. Then, in another forum asking the same question, I gave this same response to, unfortunately, a whole lot of people living in Northern Ontario, and I might never live it down. Whoops!

As soon as it was brought to my attention that it's a ridiculous solution, I responded that clearly we need a variety of regional solutions to this problem to take into account both the local case numbers and the weather. In my classes, a good 60-80% of kids eat outside already largely because they have to choose out or in (they can't go back and forth), and most want to buy food from nearby shops and fast food outlets. That solution could work where I live, on most day. And what other solutions are there? What's the answer??

I woke up to literally hundreds of notifications awaiting me. Surely an excellent answer would be among them, right?! Nope. All of them were outraged responses to my initial flub with some very bad words in the mix. There wasn't a single other suggested solution in the lot. 

Leaving people out of the conversation is a shitty thing to do, and Southwestern Ontario is pretty bad for forgetting the rest of Ontario in general, so the slight clearly cut deep. That's totally on me, and I'm really sorry for that. And we all get, and are terrified, that our children are being put in danger by sitting in a room of 30 people unmasked. There's no getting around the potential for spread in that situation. But we also want them to be in school to learn! It's such a dilemma and so important to figure out NOW!! Somehow learning in-person for mornings only isn't even on the table anywhere. I'm guessing it's a bussing issue (because scheduling is often affected by bussing). Personally, I just don't eat or drink for 8 hours (some medical staff stretch that to 12 or 16 hours), but these are growing kids, so that's not the answer. So what IS a better solution?? 


In light of current cases loads, a total lack of booster shots for teens, and the prospect of eating in class with 30 people who we don't know well enough to know their vaccination status or general cautiousness, I will be keeping my teenager home for the foreseeable future even though the government is being urged by the Canadian Paediatric Society to open up (liked by Lecce, of course - the fuckers are all in bed with one another). 

ETA this bit of gold from a Dr. Tyler Black. He's an expert on pediatric mental health. 
"BC has not been experiencing a spike in suicidality, emergency mental health presentations, or severe mental health admission rates during periods of school closure. In February to May 2021, with schools fully open here, yes, yes we did. . . . If [BC] saw the same spikes in mental health challenges in 2020-2021 with schools open that Ontario saw with schools closed, what does that suggest? . . .  Logic for pediatric societies: If A-B=C and A+B=C, then maybe B isn't as important to the equation as you thought. (In this equation, A=pandemic, B=school closure, and C=increased markers of distress and mental health challenges.) . . . In their statement, they reference three studies for their mental health claims. Two are studies of surveys of kids taken during the pandemic (no test of cause for school closure). For extra irony, the 3rd study is a reference to a large report that . . . references the Canadian pediatric society's concerns. The strongest evidence in the review (and trust me, by far and away this is me giving the review the best credit possible) is a study that showed an effect size of 'worsening mental health' of 0.08. That is completely negligible. . . . The entire data that was referenced in the political statement does not establish school closures are a cause and every one seems to conveniently use BC to prove covid school transmission is negligible but ignore our same mental health in kids issue. The CPS should hold itself to a higher evidentiary standard before releasing powerful political statements, not just lazily referencing articles that 'seem to' (but don't) support their argument."

ETA (January 12) -- Nobody seems to know NACI's timeline for approving the necessary 3rd dose for the 12-17 age group. They seem completely forgotten, and I hope that's not the case. Just got this email:

ETA: Feb. 15 - Ontario is allowing boosters to 12-17. No explanation for the delay. 



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