Canada

Cardiologists join call for urgent second doses for health workers

“We are particularly concerned with the incomplete vaccination of health care workers.”

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The head of cardiology at the University of Ottawa Heart Institute and chief cardiologists from across Canada have added their voices to the call to fully vaccinate patient-facing health workers immediately.

“We fear that our public health organizations and governments have underestimated the negative impact of incomplete vaccination on the health care workforce, which has a direct negative effect on the health of Canadians from both COVID and non-COVID related illness,” wrote members of the Canadian Cardiovascular Society in an open letter to “health leaders and decision makers.”

They want front-line health workers to be exempted from the protocol of pushing back second doses of COVID-19 vaccines by as much as four months — well beyond the three to four weeks recommended by manufacturers. Some front-line workers had received two doses before the practice began early in March, but others had second dose appointments postponed.

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The letter from the cardiovascular society echoes an earlier call by Dr. Thierry Mesana, president and CEO of the heart institute, which has experienced an ongoing COVID-19 outbreak in recent weeks among patients and staff. All of the 14 staff members who became infected had been given at least one dose of COVID-19 vaccine. One patient died in the outbreak and at least 15 became infected.

Mesana said one dose provides adequate coverage for people who are not in high-risk jobs, but the 80 or so per cent reduction in infection it offers is not enough for front-line health workers and that threatens patients and the entire health system.

At The Ottawa Hospital, 10 patients have died in a series of outbreaks that began in February, which have included staff who received one dose of COVID-19 vaccine.

Among those signing the letter from the cardiovascular society was Dr. Rob Beanlands, head of cardiology at the heart institute.

“We applaud the recent acceleration of vaccination of vulnerable populations and continued emphasis on preventive public health measures to reduce the spread of the COVID-19,” the letter said. “However, we are deeply concerned regarding the shift in policy whereby there is now an unprecedented 4 months delay in the second dose of vaccines. We are particularly concerned with the incomplete vaccination of health care workers.”

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Last month, on the recommendation of the National Advisory Committee on Immunization (NACI), Ontario pushed second doses of COVID-19 vaccines beyond the recommended three or four weeks to as much as four months. The action was taken in order to vaccinate as many people as possible with one dose.

On Wednesday, NACI confirmed the earlier recommendations, saying it stands by its guidance on extending second doses by up to four months and vaccinating as many people as possible does more good than fully vaccinating a smaller number.

NACI said the decision will be “continually assessed” as new evidence comes to light and some doses will likely be moved up as more vaccines become available.

Ontario’s Health Minister Christine Elliott and Ottawa’s Medical Officer of Health Dr. Vera Etches have both said they support the NACI recommendations, including for front-line health workers.

The cardiovascular society said recent data from the New England Journal of Medicine supports the “timely administration” of a second dose because of the significant difference in infection rates with two versus one dose.

Other emerging data suggests that delaying the Pfizer and Moderna mRNA vaccines would lead to inadequate immunization, could increase the risk of variant spread and could exacerbate vaccine hesitancy when people become infected after one dose, said the letter.

“We all agree that vulnerable populations should be vaccinated as soon as possible and that public health preventive measures are key even with vaccination; but protecting health-care workers has the compounded benefit of protecting the public from both COVID and non-COVID illness and keeping hospitals and long-term care facilities less vulnerable to outbreaks,” they wrote.

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