On July 31st Canada launched the national COVID-19 Alert app, which is designed to keep a record of phones your phone comes close to over the course of the day, so that in the event of you testing positive for COVID-19, you could send out a notice to anyone who may have been exposed by you, so they can better monitor themselves or also get tested. Since its release, the app has been downloaded approximately 2.2 million times across Canada. However, the app itself is only supported within Ontario, and more recently Alberta currently.
Unfortunately, only about 3.5% of people who test positive for COVID-19 in Ontario are using the app to warn people they may have come in contact with about the potential exposure. Dr. Tam, the chief public health officer of Canada, stopped short of calling the app a flop, and has said it is still too early to determine the app’s effectiveness.
So far the province of Saskatchewan has expressed plans to officially support the app eventually, whereas Quebec has specifically stated they will not. BC currently has no plans to adopt the app officially either, and has not mentioned any plans for offering a BC specific app as an alternative. More info can be found here.
Over the last several months of the pandemic many experts have said that the most likely way we can return to normal would be with the use of an effective vaccine. To that end Canada has been negotiating with several companies working on promising vaccine candidates, and currently has 4 agreements in place, and is working on a 5th. I’ll go over the vaccine candidates a bit here:
- Moderna (USA) – mRNA-1273 – In Phase 3 Human TrialsAs the name of the vaccine suggests, this is an RNA style vaccine candidate. With RNA vaccines, what’s injected into the body is simply the genetic instructions to make a viral protein such as the spike protein. Cells in your body then use the instructions to make the protein inside the body for your immune cells to see and respond to. The benefit of this method is it does not require a live virus in order to produce it, which allows mass production to be accomplished much quicker and easier. The downside is that this type of vaccine doesn’t always produce as strong an immune response compared to other vaccine types.
This vaccine candidate requires 2 doses, and has been shown to generate a strong immuno-response in the patients inoculated with it, within known age ranges of 18-55 years old. More info can be found here.
- Pfizer/BioNTech (USA) – BNT162b2 – In Phase 3 Human TrialsLike the Moderna vaccine candidate mentioned about, this one is also an RNA type, with the same strengths and weaknesses that come associated. Likewise, this candidate also takes 2 doses to be completely effective, especially in older patients. Previously, Pfizer/BioNTech had been working on 2 different candidates, but recently scrapped BNT162b1 in favour of BNT162b2 due to decreased negative reactions and comparable antibody response rates. More info can be found here.
- Novavax (USA) – NVX‑CoV2373 – In Phase 2 Human TrialsThe NVX-CoV2373 vaccine candidate is whats called a Protein subunit type vaccine. With this, the protein is made outside the body. Traditionally, this is accomplished by breaking whole viruses into pieces, or using “recombinant” genetic technology, where the gene for a protein is inserted into another organism to grow the protein in large quantities. Like RNA type vaccines, this can be made more quickly than live vaccines, but can’t be scaled up for mass production as quickly as RNA type vaccines. They also may not produce as strong immuno-responses as some other types of vaccine.
NCX-CoV2373 uses a proprietary adjuvant also developed by Novavax to help boost its immuno-response. One of the things that makes Novavax unique is their specific effort to test a significant group of HIV positive patients in their phase-2 trials, to help ensure that the vaccine will not interfere with their existing medical treatments. More info about NCX-CoV2373 can be found here.
- Janssen, a subsidiary of Johnson & Johnson (USA) – Ad26.COV2-S – In Phase 2 Human TrialsThe ad26.COV2S vaccine candidate is what’s called a Non-replicating viral vector type vaccine. Viral vectors are “carrier” viruses that don’t cause the disease you’re vaccinating against, but can be engineered to carry a piece of a viruses. The vaccine is essentially a virus that has been genetically engineered so it can’t replicate and cause disease. In addition, they are also modified to produce the protein for the disease you want, such as the coronavirus spike protein, and injected into the body to provoke an immune response. The benefit of this vaccine type is they produce powerful immune responses. The downside of this type is that people who have already been exposed to the viral vector being used may be resistant to it, and not produce the desired antibodies. As such, older generations may find this kind of vaccine less effective. Also, because live virus is required for producing the vaccine, it takes much longer to produce in mass quantities compared to other methods.
Despite this type of vaccine taking much longer to produce on a large scale than other types, Janssen has committed to ~1 billion doses through the course of 2021 by beginning mass production of their vaccine “at risk”, prior to receiving approval. What this means is that mass production has already begun, but should their vaccine prove unsafe or ineffective, their mass volumes of product will be useless and need to be destroyed. You can find out more about this vaccine here.
- (Pending Agreement) AstraZeneca (UK) – AZD1222 – In Phase 3 Human TrialsLike the Janssen candidate above, AZD1222 is a non-replicating viral vector type vaccine. So far this candidate has seen positive results, and has already received orders for 2 billion doses from countries all over the world. They are hoping to receive approval for their vaccine by the end of the year, but there are no guarantees. It also remains to be seen when Canada would receive any vaccine from this company if we do secure an order, if 2 billion doses are already spoken for. More info can be found here.
Additional information on Canada’s deals, as well as on each of the above vaccines can be found here.
Once we have a vaccine (or multiple vaccines), how effective they will be will also depend on how wide spread vaccinations are across Canada. If only a moderate percentage of people agree to be vaccinated, we may see COVID-19 continue to spread for years to come. You can read some of Dr. Tam’s remarks on this concern, and what to expect once we have a vaccine here.
In related news, Donald Trump has said that the USA will not work with the World Health Organization to develop and distribute a COVID-19 vaccine. Of course the US is still working on many vaccines, and the federal government is heavily funding several candidates in exchange for early access. Their efforts are primarily focused on their immediate benefit. More info can be found here.
It’s going to be a while before we see approved vaccines in Canada, so lets look at some upcoming possible treatments. First up is Vitamin D3. A recent study on 50 COVID-19 positive patients showed very compelling results. Only 1 out of 50 patients required hospitalization, and eventually recovered. Out of 26 similar patients who did not receive treatment, 13 required hospitalization, and 2 unfortunately died. These numbers are not enough to show conclusive proof of effect, but considering the ease of availability of vitamin D3 supplements (not to be confused with vitamin D2 however), it would be quite a lucky event if these results continue to hold true in future studies. More info can be found here.
And to keep the good news coming, 2 steroids have been shown over the course of 7 studies, to reduce the risk of death of COVID-19 in seriously ill patients by as much as 20%! The two steroids in question are dexamethasone and hydrocortisone, which are both extremely common and quite affordable compared to most treatments. The results have shown to be consistent regardless of the age or sex of the patient, and testing has now been done on 1700 patients to find these results. More info can be found here.
That’s all for now, stay safe everyone!