Category Archives: COVID

What does it mean to ‘Roll the Dice’ on COVID?

A few days ago, I posted about some chilling COVID statistics[1], and said that each time you get COVID, you and your children ‘roll the dice’ (referring to the relatively high probability of death and/or organ damage/disability).

A friend of mine commented that this was ‘loaded language and emotional rhetoric’, and it came ‘across as an attempt at manipulation or a genuine reflection of fear felt by the author’.

Setting aside the obvious ‘loaded dice’ pun[2], I’d like to interrogate the meaning of ‘rolling the dice’ (and also the use of such rhetorical flourishes in a Health and Safety context).

“Rolling the dice” is generally[2] defined as “…something could have either a good result or a bad result”, or “to take a risk in the hopes of a fortunate result or gain“[3].

Colloquially, I’ve always thought of it in the second sense given by Miriam-Webster: “It’s a roll of the dice whether we succeed or fail.”, meaning that we are not in control of the outcome, and you should be prepared for the high chance of negative outcome.

Of course, ‘high chance’ is defined differently by different people, and in different situations, people having different risk thresholds than each other, and at different times. For example, a 1 in 10 chance of the bottom of your sock becoming wet[4] is very different than a 1 in 10 chance of being hit by a car.

For the sake of argument, let’s compare the above usage of ‘rolling the dice’ with the most popular[5] dice betting[5a] game ‘Craps‘. In Craps, the two most well known[6] sets of odds are ‘Pass’, or ‘will you win this set of rolls’, and winning on the first roll.

‘Pass’ has a win rate very close to 50%[7], perhaps the origin of the term ‘crapshoot’.

Winning on the first roll in Craps requires rolling either a ‘7’ or an ’11′[8], for a total probability of 8/36, or about 22%. Many might think that rolling a 7 is the way to win in Craps (it’s also one way to lose, if your first roll was 4,5,6,8,9,10). Rolling a 7 has a probability of 6/36, or about 17%.

17-22% is within the range of values found in the literature for the prevalence of Long COVID (currently listed as 5-50% by Wikipedia), and is not dissimilar to the 1 in 7.7 (about 13%) deaths in Canada in 2022 attributed to COVID.

One could also argue that ‘a roll of the dice’ is rolling one six-sided die[9], but that just gives us the 1 in 6 or ~17% chance above again. Higher (or lower) order polyhedral dice[10] (or larger numbers of dice) can give us arbitrarily different odds, but let’s stop here.

Today, Statscan reported on the prevalence and ‘Experiences of Canadians with long-term symptoms following COVID-19’.

"As seen in Chart 2, Canadians reporting two known or suspected COVID-19 infections (25.4%) were 1.7 times more likely to report prolonged symptoms than those reporting only one known or suspected infection (14.6%), and those with 3 or more infections (37.9%) 2.6 times more likely. "
“As seen in Chart 2, Canadians reporting two known or suspected COVID-19 infections (25.4%) were 1.7 times more likely to report prolonged symptoms than those reporting only one known or suspected infection (14.6%), and those with 3 or more infections (37.9%) 2.6 times more likely. ”
# of inf. 	% LTS 	95% Confidence Interval (lower, upper)

1+ infections 	19.0 	17.3 	20.9
1 infection 	14.6 	12.8 	16.7
2 infections 	25.4 	21.5 	29.7
3+ infections 	37.9 	29.5 	47.0

Source: Statistics Canada, Canadian COVID-19 Antibody and Health Survey - Follow-up Questionnaire, 2023.

This shows that about 14.6% reported long-term symptoms after one infection (about 1 in 7), then of the remaining 85.4%, about one in 8 developed long-term symptoms after a second infection, then of the remaining 74.6%, about one in 6 developed long-term symptoms.[11]

Each of these is pretty close to ‘a roll of the dice’, as we defined above.

Perhaps more disturbing is that more than half of those who reported long-term symptoms reported no improvement in those symptoms over time:

"Almost half of Canadians who reported that they continue to experience long-term symptoms also reported no improvement over time" "Many Canadians with long-term symptoms experience a protracted symptom duration. As of June 2023, 58.2% of infected Canadians who ever reported long-term symptoms continue to experience them. Among Canadian adults who continued to experience long-term symptoms, 79.3% had been experiencing symptoms for 6 months or more, including 42.2% with symptoms for one year or more (Figure 1)."
“Almost half of Canadians who reported that they continue to experience long-term symptoms also reported no improvement over time” “Many Canadians with long-term symptoms experience a protracted symptom duration. As of June 2023, 58.2% of infected Canadians who ever reported long-term symptoms continue to experience them. Among Canadian adults who continued to experience long-term symptoms, 79.3% had been experiencing symptoms for 6 months or more, including 42.2% with symptoms for one year or more (Figure 1).”

Also, more than 1 in 5 of those with persistent symptoms (600,000 Canadians) missed days of work or school, missing an average of 24 days each.

Having shown that this is a reasonable use of the phrase ‘roll of the dice’, I also wanted to address the idea of using emotional appeals in public education about health and safety.

Here is an example of the phrase being used in a brochure by the Australian National Electrical and Communications Association

A number of years I had the privilege of attending safety training run by Minerva Canada, where a talk was being given by a representative from a car manufacturing company that you’ve heard of. He was talking about their ‘getting to zero’ workplace accidents project, and he mentioned that at some point, after you’ve tried asking people nicely enough times, you have to get the ‘300 lb gorilla to go tell the guy to wear his @#$%ing safety harness’.

That was my sixth and this will be my seventh post talking about the dangers of COVID. At some point, using stronger (but still accurate) language to educate people about the dangers they and their children face due to action or inaction becomes necessary if we actually want to solve the problem.

Thank you for reading, and stay safe out there.

Get boosted, mask (with an N95 respirator) when you’re indoors with others. Get COVID as few times as you can, and if you get it, rest up longer than you think you need to. Push for better (HEPA) air filtering and ventilation (more air interchanges per hour).

[1] “tl;dr: About 1 in 8 deaths in 2022 in Canada were caused by COVID-19. Organ damage caused by COVID seems to be persistent. Each time you get COVID, you and your children roll the dice again as to whether you die or get Long COVID. Get boosted, mask (with an N95 respirator) when you’re indoors with others. Get COVID as few times as you can, and if you get it, rest up longer than you think you need to. Push for better (HEPA) air filtering and ventilation (more air interchanges per hour).” link to post

[2] In this case, specifically by Miriam-Webster
[3] Idioms Online

[4] Captain Minor Annoyance (abbreviated MI’) is the creation of Ryan George, one of my favourite Youtubers

[5] In North America. Apparently, Craps, and its predecessor ‘Hazard’ are nowhere near as popular in the rest of the world.

[5a] I mention the ‘most popular dice betting game’ partially because most people will have a passing familiarity, I know some of the odds, and those odds are easy to explain. Compare with the games on the ‘top 10 all-time best-seller list‘: Monopoly (3), Clue (5) (uses one six-sided die for movement, but the deduction and knowing your opponents is far more important for gameplay), and Backgammon (8)

[6] I admit, most well known to me, based on learning about Craps during a probability module in high school. There are a large number of ‘standard’ betting options in Craps, but I suspect most people will not have heard of most of them.

[7] Wikipedia says the Craps ‘Pass’ house edge is less than 2%, similar to that of Blackjack, also well-known for have a very slim house edge.

[8] TIL that ’11’ is often called ‘Yo-leven’, to prevent confusion with ‘seven’.

[9] You’d be wrong, as I define ‘die’ as one die, and ‘dice’ as two or more, but many people disagree.

[10] Most common are 4 (tetrahedron, don’t step on these!), 6 (the familiar cube), 8 (octahedron), 10 (not a platonic solid, but a ‘Pentagonal Trapezohedron‘ #til), 12 (dodecahedron), 20 (icosahedron)

[11] Here, I’m assuming that each time a person catches COVID, they either progress into Long COVID, or stay ‘long-term unaffected’. This allows modeling of each subsequent infection independently. With the numbers above, 1st infection has a ~14.6% chance of leading to Long Covid (1 in 6.85), of the remaining 85.4 people, 25.4-14.6=10.8 of them or 10.8/85.4 = 12.6% or 1 in 7.9, then of the remaining 74.6 people, 37.9-25.4=12.5 of them or 12.5/74.6 = 16.8% or one in 5.97. Note that the last number includes those with more than three infections, so one would expect the number for 3 infections to be less than that. Also note that biology is often not linear, and a linear model such as this one may be simplistic, and should only be used for illustrative purposes, no matter how well it fits the curve.

Unless Something Changes, Nothing will Change

tl;dr: About 1 in 8 deaths in 2022 in Canada were caused by COVID-19. Organ damage caused by COVID seems to be persistent. Each time you get COVID, you and your children roll the dice again as to whether you die or get Long COVID. Get boosted, mask (with an N95 respirator) when you’re indoors with others. Get COVID as few times as you can, and if you get it, rest up longer than you think you need to. Push for better (HEPA) air filtering and ventilation (more air interchanges per hour).

It’s been three and a half years since COVID-19 burst into the world consciousness, and ten months since I last wrote about it.

With cases dramatically increasing in North America , and numerous people being ‘surprised that COVID-19 is still a thing‘[1] the time seemed right for an updated review of what we know.

Ontario COVID-19 Wastewater Signal, showing the current (November 2023) peak as the highest in the past 13 months.
Ontario COVID-19 Wastewater Signal, showing the current (November 2023) peak as the highest in the past 13 months.

What is COVID-19 and how do you get infected??

COVID-19 is an airborne contagious disease caused by the coronavirus SARS-Cov-2, transmitted from an infected person through inhaled aerosols. These aerosols can linger in indoor air for hours.[2]

How does COVID-19 work?

The SARS-Cov-2 virus affects numerous parts of the body, by attaching its ‘spike protein’ to the ACE2 receptor found in the lungs, heart and cardiovascular system, gastro-intestinal system, and kidneys, causing issues and organ damage in all of those areas.

Longitudinal studies have shown that this organ damage is persistent, with 80-100% of damage present at 6 months still being present at 12 months[2a].

SARS-Cov-2 is also known to have effects on the brain, causing loss of taste/smell and vertigo.[3] Last time, I also reported the UK ‘Brain Bank’ study[3a] which showed ‘detected damage to areas of the brain associated with taste and smell, along with measurable cognitive impact, even when COVID cases which required hospitalization were excluded’, suggesting that even ‘mild’ COVID cases cause brain damage.

In 2022, StatsCan[4] shows that there were about 43 thousand ‘excess deaths’ in Canada (compared to 2019 and earlier), with 18 thousand people specifically confirmed to have died from COVID.

COVID Deaths:

	2018	2019	2020	2021	2022		1/x cause
Cancer	79,726	80,372	81,242	82,822	82,412	24.67%	4.05
H & Str	67,750	67,081	68,191	68,762	71,272	21.33%	4.69
COVID19			15,890	14,466	19,716	5.90%	16.94
Accid.	15,855	15,527	16,818	19,257	18,365	5.50%	18.19
All:	285,704	285,301	308,412	311,640	334,081	100.00%	
Excess:	0	0	16,334	21,718	43,378	12.98%	7.70

Given the inaccuracies and delays in reporting deaths[5], and the steadiness of the death rate before 2020 (compare the ‘All:’ line in the table above for 2018/2019 with the much greater variability in 2020/2021/2022), it is generally accepted that ‘Excess Deaths’ is the correct way to measure deaths caused by COVID-19.

With that being said, the numbers paint a sobering picture. While 43,378/38 million (0.11%) may not seem like a large number, 43,378/334,081 is 12.98%. That means that for each person that died in Canada in 2022, there was about a 1 in 8 chance that their death was caused by COVID-19.

Also note that there is a substantial uptick in cardiac (Heart & Stroke) related deaths, especially in 2022. COVID is known to increase the risk of heart attack and stroke, and the ~3,000 excess Heart & Stroke-related deaths in 2022 in Canada help us understand the magnitude of the issue.

COVID-caused chronic diseases ‘Long COVID’:

The prevalence of ‘Long COVID’ is generally accepted to be ‘at least 10%’ , with an estimated 65 million people affected worldwide, with that number increasing daily.[2a1]

Last time, I shared a study[2b] done with data from Veteran’s Administration patients from the U.S., showing that COVID reinfection is just as dangerous (equal chance of death) or more dangerous (increased chance of hospitalization).

While this clearly showed additive effects from second COVID infections, this was a very specific (and not very healthy) cohort.

Since then, there was a study in the UK which looked specifically at the incidence of Long COVID after first and second infections. Among those >=16yo, ‘Activity-limiting’ Long COVID was reported by 2.8% after first infection, with an additional 1.6% after second infection, showing that the effects are either additive, or somewhat random with each infection. Those <16yo had an incidence of 0.6% after first infection, with an additional 0.4% after second infection. The above show that second (and subsequent) infections are still dangerous, still causing life-changing illness, including in children. Even if children may not show the effects as often, they are still affected, and subsequent infections can and do still cause Long COVID in children. So, given the current high COVID rates (see the Ontario graph above), what actions should you take to protect yourself? Wear a good mask: The chart below is from a study performed pre-Omicron, but the general message holds. A cloth or surgical or KN95 (earloop) mask is better than nothing, but not really very helpful unless everyone is wearing one. Specifically, the times below should be revised downward, probably significantly, but even the author has not done so because they don’t know how far to revise them.

COVID Masking Quality Table
COVID Masking Quality Table

If you want to actually protect yourself, you need an N-95 or better (ideally fit tested). My favourite is this one from 3M, as the headloop bands are a mixture of cloth and elastic, and are thus less likely to break.

Check (and improve) the ventilation:

A CO2 monitor such as the Aranet can very quickly tell you how well-ventilated your area is. Anything around 500ppm means that the air in your space is ‘like outside’.

The CDC recommends at least 5 air changes per hour. You can ask your local HVAC expert for the stats on the system where you live or work.

Continue to get vaccinated/boosted:

Vaccinations have been shown to reduce the likelihood of death and long covid[6]

Should you get the next COVID booster?

Health Canada & Toronto Public Health recommend staying up to date with your vaccines (Health Canada says every 6 months, others may recommend more frequently).

If so, which one?

The updated XBB-specific vaccine is known to give a stronger immune response to the more recent variants. Toronto Public Health also has more detailed guidance based on the age of the individual and which vaccines/boosters they have already received.

Should you get the flu shot? If so, how do you time it vs. the COVID booster?

Health Canada recommends getting both the flu shot and the COVID vaccine, and says that it is fine to receive them in either order, or at the same time.

Thanks for reading this far. Working together, we can get through this, but it might get worse before it gets better, until we as a society decide that we actually want to solve this. Stay safe out there.

[1] Twitter announcement that Colbert will be isolating for a few more days.

[2] “Small saliva aerosols (<50 μm) may remain suspended in the air for hours, during which any viable virus is estimated to gradually decrease. Insights into the evaporation characteristics of saliva droplets and aerosols: Levitation experiments and numerical modeling, Christian Lieber, Stefanos Melekidis, Rainer Koch, Hans-Jörg Bauer

[2a] Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study
Andrea Dennis, Daniel J Cuthbertson, Dan Wootton, Michael Crooks, Mark Gabbay, Nicole Eichert, Sofia Mouchti, Michele Pansini, Adriana Roca-Fernandez, Helena Thomaides-Brears, Matt Kelly, Matthew Robson, Lyth Hishmeh, Emily Attree, Melissa Heightman, Rajarshi Banerjee, and Amitava Banerjee
Journal of the Royal Society of Medicine, Volume 116, Issue 3

[2a1] Long COVID: major findings, mechanisms and recommendations, Hannah E. Davis, Lisa McCorkell, Julia Moore Vogel & Eric J. Topol, Nature Reviews Microbiology volume 21, pages 133–146 (13 January 2023)

[2b] Acute and postacute sequelae associated with SARS-CoV-2 reinfection, Benjamin Bowe, Yan Xie & Ziyad Al-Aly, Nature Medicine volume 28, pages 2398–2405 (Published online 2022 Nov 10)

[3] “The Prevalence of Dizziness and Vertigo in COVID-19 Patients: A Systematic Review“, George Korres,1,* Dimitrios K. Kitsos,2 Diego Kaski,3 Anthi Tsogka,2 Sotirios Giannopoulos,2 Vasileios Giannopapas,4 Giorgos Sideris,1 Giorgos Tyrellis,1 and Konstantine Voumvourakis2

[3a] SARS-CoV-2 is associated with changes in brain structure in UK Biobank, Gwenaëlle Douaud, Soojin Lee, Fidel Alfaro-Almagro, Christoph Arthofer, Chaoyue Wang, Paul McCarthy, Frederik Lange, Jesper L. R. Andersson, Ludovica Griffanti, Eugene Duff, Saad Jbabdi, Bernd Taschler, Peter Keating, Anderson M. Winkler, Rory Collins, Paul M. Matthews, Naomi Allen, Karla L. Miller, Thomas E. Nichols & Stephen M. Smith, Nature volume 604, pages 697–707 (07 March 2022)

[4] Most recent full-year data, sources: Excess Deaths, Excess Deaths detailed data, Confirmed Deaths by Cause of Death (including Confirmed COVID Deaths).

[5] Many sources, but the most official one:

[6] Effect of covid-19 vaccination on long covid: systematic review
Oyungerel Byambasuren,corresponding author1 Paulina Stehlik,1 Justin Clark,1 Kylie Alcorn,2 and Paul Glasziou1
BMJ Med. 2023; 2(1): e000385.
Published online 2023 Feb 1. doi: 10.1136/bmjmed-2022-000385
PMCID: PMC9978692
PMID: 36936268

Why we Still Cannot go back to Normal

tl;dr: Get COVID as few times as you can. Getting COVID the second time is just as likely to kill or disable you as the first time. COVID killed more people in Canada in 2022 than 2020 or 2021, and is disabling many more in an ongoing way. Use masks and better-filtered air to get COVID as few times as you can, and if you do get it, rest up for as long as you can while recovering.

It’s now been more than three years[1] years since COVID-19 entered the world stage, and it’s worth a few minutes to take stock of what we know, where we are, and what we should be doing next.

What is COVID?

COVID is a contagious disease caused by the SARS-CoV-2 virus.

Acute symptoms vary widely, from respiratory such as cough, fever, shortness of breath, and congestion/sputum, to musculo-skeletal with muscle & joint pain, headache and fatigue, to gastro-intestinal with abdominal pain, vomiting and/or diarrhea. Neurological (separate from nasal congestion) loss of taste and smell is perhaps the most well-known distinctive COVID symptom, made famous by online reviews of scented candles.

These acute symptoms also include death, although the exact number is difficult to measure for a number of reasons[2]. The official ‘Case Fatality Rate‘[3] is generally measured to be around 1%, for example by the John Hopkins dashboard. Taking estimated numbers of non-tested and asymptomatic individuals into account, the actual overall ‘Infection Fatality Rate’ is generally calculated to be between 0.5-1% for ‘wild type’ virus. This rate is modified by age, risk factors, variant of interest (Alpha/Delta/Omicron/XBB1.5/etc), and vaccination status.

As I previously reported, based on a study from the University of Toronto, Case Fatality Rates are somewhere between 1.5x and 2x worse for Alpha/Beta/Gamma & Delta variants. Omicron, as I previously reported, is significantly more contagious, but about 0.2x as bad as wild type was in 2020, in the current vaccinated population. XBB1.5, the most recent ‘Variant of Concern’ seems to be replacing Omicron and other variants, but its fatality rate has not been well-measured yet.

In Canada, just over 50000 people have been confirmed to have died of COVID as of Jan 30/2023, representing about a 6% increase in total mortality. The overall death rate from March 2020 to August 2022 was measured to have increased by about an additional 1.6%, or 7.6%. This reduced life expectancy by 0.6 years, the largest single year decline since 1921.

This data from the CDC suggests that vaccination reduces the likelihood of death by about 5x, or about 13x with an up to date relevant (bivalent at time of writing) booster. One would expect this, along with Canada’s vaccination rate of about 80% (and up to date booster rate of about 25%) to be reflected in the numbers above.

COVID is also known to have chronic effects, known as ‘Long COVID‘. ‘Long COVID’ is not yet well defined, and presents with a wide array of symptoms depending on the individual (Nature Paper).

Long COVID effects.  Source:
Long COVID effects. Source:

Whether well-defined or not, Long COVID is common, and is still debilitating for many. Estimates range from 10-12% Long COVID incidence for ‘Break Through Infections’ for vaccinated individuals to 10-30% for non-hospitalized cases to 50-70% for hospitalized cases.

The ‘Brain Bank’ study in the UK was lucky enough to have done brain scans before and after COVID infection, and it detected damage to areas of the brain associated with taste and smell, along with measurable cognitive impact, even when COVID cases which required hospitalization were excluded. This suggests that there is damage caused to parts of the brain even by ‘mild’ COVID cases:

Fig. 3: Significant longitudinal differences in cognition. from SARS-CoV-2 is associated with changes in brain structure in UK Biobank.  Shows cognitive impairment by the difference in time required to do a task.
Fig. 3: Significant longitudinal differences in cognition. from SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Shows cognitive impairment by the difference in time required to do a task.

More concerning is this study, which shows that the second COVID infection is just as dangerous as the first. For example, 6 months post-reinfection, all-cause mortality doubled, hospitalization more than tripled, and the likelihood of Long COVID symptoms more than doubled.

COVID Reinfection is just as dangerous or more dangerous than the initial infection.  Source: The COVID 'acute' phase doesn't really end until 90-120 days post-infection. Source:
COVID Reinfection is just as dangerous or more dangerous than the initial infection. Source: The COVID ‘acute’ phase doesn’t really end until 90-120 days post-infection. Source:

Also, while vaccination might help reduce your chance of catching COVID, vaccination status does not seem to substantially decrease your likelihood of developing Long COVID once you do.

So, knowing all of this, what should you do?

1) Get COVID as few times as you can. Each time you get COVID adds to the danger. Some people who seemed fine at first, developed life-altering and debilitating symptoms.

2) Protect yourself like a Billionaire; get and use HEPA filters, and use COVID tests if you must gather: At the Davos World Economic Forum this year, there were stringent and multi-layered anti-COVID precautions, including masking, improved ventilation and filtration, and mandatory testing with immediate revocation of access on positive test.

3) Get as good as mask as you can, and use it whenever you are inside with people. COVID is airborne, and the quality of your mask matters! An N95 is substantially better than a KN-95, which is substantially better than a surgical mask or cloth mask. We recommend this specific N95, as it has good reliable straps, and seems to fit us well. YMMV.

COVID Masking Quality Table
COVID Masking Quality Table

4) Rest! Long COVID seems to have many things in common with Chronic Fatigue Syndrome(ME/CFS). ‘Pacing’, or resting for longer than you might expect, to allow your body to heal has been shown to help in ME/CFS. Also, the data of the after-effects of COVID infection seem to show that the ‘acute’ phase of COVID doesn’t fully pass until somewhere between 90-120 days (3-4 months) post-infection, whereupon people have settled into a new (often worse) ‘normal’:

The COVID 'acute' phase doesn't really end until 90-120 days post-infection. Source:
The COVID ‘acute’ phase doesn’t really end until 90-120 days post-infection. Source:

The end to COVID may still not be in sight yet, but we now have a lot more information about how to protect ourselves from it, and maybe, just maybe lighten the load on our overloaded and buckling healthcare system. It is possible to get back to the low case counts of mid-2021, we just need to work together and make sensible decisions. Stay safe out there.


The best current review on Long COVID: “Long COVID: major findings, mechanisms and recommendations” in Nature Reviews Microbiology, Jan 13, 2023

The best current study on the dangers of reinfections: “Long COVID after breakthrough SARS-CoV-2 infection”, Nature Medicine, 25 May 2022

Some quotes from the above two references:

“The organ damage experienced by patients with long COVID appears durable, and long-term effects remain unknown.”

“Cognitive impairments in long COVID are debilitating, at the same magnitude as intoxication at the UK drink driving limit or 10 years of cognitive ageing73, and may increase over time, with one study finding occurrence in 16% of patients at 2 months after infection and 26% of patients at 12 months after infection74”

“Few people with long COVID demonstrate full recovery, with one study finding that 85% of patients who had symptoms 2 months after the initial infection reported symptoms 1 year after symptom onset143. Future prognosis is uncertain, although diagnoses of ME/CFS and dysautonomia are generally lifelong.”

“The findings highlight the clinical consequences of reinfection and emphasize the importance of preventing reinfection by SARS-CoV-2.”

Other references and links in-line

A final word from r/wallstreetbets and the Bureau of Labor Statistics:

r/ Wall Street Bets drawing trend lines on the Bureau of Labor Statistics chart, showing the greatly increased number of people out sick from work in an ongoing way.
r/ Wall Street Bets drawing trend lines on the Bureau of Labor Statistics chart, showing the greatly increased number of people out sick from work in an ongoing way.

[1] First known case discovered in December 2019, hence the ‘-19’

[2] Reasons why the number of deaths from COVID is difficult to measure include undercounting for reasons such as due to delayed or incomplete reporting of deaths due to institutional overload, delayed annotation of cause of death, and the fact that ‘coroners’ are a profession with inconsistent regulations and training requirements. Overcounting can occur when a person would have died anyway, or COVID is counted as one of a group of causes of death for that person. For this reason, ‘excess deaths’ are typically used in case of pandemic or war.

[3] ‘Case Fatality Rate’ is generally measured as (# of deaths confirmed attributed to COVID)/(# of cases of COVID detected). Incorrect attribution of cause of death can move this number in either direction (although measuring ‘excess deaths’ can help), and reducing the level of testing can lead to this number being overstated (you can look at the ‘test positivity rate’ to get a sense of how under-tested the population is (or how bad the outbreak is)). ‘Case Fatality Rate’ is generally assumed to be an overstatement of the fatality rate, if there are a large number of undiagnosed cases in the population, which are taken into account in the probably more accurate ‘Infection Fatality Rate’.

Omicron is not so mild…and then there’s Long COVID

Early on in the pandemic, a blogpost came out entitled “Coronavirus: The Hammer and the Dance“. It talked about how, in a pre-vaccine world, to avoid overwhelming our healthcare system, but to allow as much semblance of normalcy as possible, we would need to have successive implementations and releases of various non-pharmaceutical interventions (read: lockdowns, public mask wearing, quarantines, etc.)

As difficult as it was to deal with the reality of that (no matter how much I thought I was mentally prepared for it), it’s perhaps even more tiring now, that in a COVID vaccine world, that with substantial anti-vaccination movements and vaccine hesitancy, and with a new variant (Omicron), that we have to continue this ‘Hammer and Dance’.

A month and a half ago, when I wrote the above, the healthcare system where I live was being overwhelmed. Yesterday (Saturday January 8th), there were no paramedic units available to answer calls. (Toronto Star) (CTV News)

No Paramedic Units available
No Paramedic Units available

More Links.[1]

So, that tells you something about the population-wide effects of Omicron, but population effects are equal to individual effects times overall virulence[2]…and what are the individual effects of Omicron, and how is it different from ‘wild-type’, ‘Alpha’, and ‘Delta’?

(Pre-Omicron) Chart showing COVID variant prevalance over time
(Pre-Omicron) Chart showing COVID variant prevalance over time

Thankfully, a wonderful group from the University of Toronto published a paper on the relative likelihoods of hospitalization, ICU admittance, and death for wildtype, Alpha, and Delta.[3][4]

To put it bluntly, Alpha is about 1.5x more deadly than wild-type, and Delta is another about 1.5x more deadly than Alpha.

On top of this, Alpha is also about 30-50% more transmissible than wild-type, and delta is about 50% more transmissible than Alpha.

All three of these variants have much better outcomes if the patients are vaccinated (about 5x better, according to this paper).

So, what does that mean about Omicron?

According to this article, Omicron is 2.7-3.7 more infectious than Delta among vaccinated & boosted individuals, but about the same as Delta among the unvaccinated, suggesting that some sort of ‘immune evasiveness’ is at play.

This article suggests that: “Compared with patients who had the delta variant, omicron patients had a 53% reduced risk of hospitalization, a 74% reduced risk of ICU admission and a 91% reduced risk of death.” (Original paper)

The following chart bears this out:

Chart showing COVID cases and deaths in Canada from the start of the pandemic until Feb 2022.
Chart showing COVID cases and deaths in Canada from the start of the pandemic until Feb 2022.

Please note that since the Ontario provincial government has made the decision to scale back testing, the above numbers lose accuracy from December 31st, 2021.

Here, on the lower chart, you can clearly see the five peaks[5] of the (so far) five waves of the pandemic (in Canada). The first peak, in early 2020, of (probably) exclusively wild-type, hitting the entirely unvaccinated population hard, then a (relatively) calm 2020 summer, followed by the second peak in late 2020 and early 2021 likely brought on by winter forcing people indoors, relaxation of restrictions, and complacency. Vaccines began to be approved in December, and were rolled out through the first part of 2021, blunting the third wave (mostly Alpha) and the fourth wave (mostly Delta) in the fall and early winter. As you can see, the fifth wave was quite different, with Omicron blazing through the population, multiple times more contagious than Delta, but also less deadly on a per-case basis, but overall leading to a wave about as large as the initial first early 2020 pre-vaccine wave.

COVID is known to increase the likelihood of pulmonary embolism, strokes, and myocardial infarctions (heart attacks).

So, we’ve all heard about the acute COVID symptoms that are included in the above[6], and there have been some issues with people taking a while to recover from these, but more serious, and less talked-about is the phenomenon of ‘Long COVID’ or ‘Post-COVID syndrome‘.

(It’s relevant to note that we only remember the ‘Long Polio’ part of Polio, simply calling it ‘Polio’. It’s entirely possible that COVID will have a similar long-term impact.)

COVID is known to attack the lungs, the heart, the kidneys, and the brain, among other organs.

As a respiratory disease, it is perhaps not unexpected that COVID would attack and damage the lungs. However, much of the attack on organs done by COVID is thought to be because of extracellular expression of ACE-2[7], the doorway that COVID uses to get into cells and multiply.

As far as neurological symptoms, in addition to the above, there are disturbing indications that COVID’s ‘brain fog‘ has disturbing similarities to alzheimer’s.

So, we know that all kinds of things can happen, but how often do they happen? This study, performed in the highly-COVID-tested population Faroe islands, is likely to have included all of the relevant population that contracted COVID (from April to June 2020, so pre-vaccine, all wild type variant). Four months ‘after’ COVID, half of the population studied continued to have at least one symptom (most often fatigue, lost of smell/taste, and/or joint stiffness).

This much larger study of 270,000 people in the U.S. used six months of HMO data, and found that “over 1 in 3 patients had one or more features of long-COVID recorded between 3 and 6 months after a diagnosis of COVID-19. This was significantly higher than after influenza.” In addition, “[f]or 2 in 5 of the patients who had long-COVID features in the 3- to 6-month period, they had no record of any such feature in the previous 3 months.”

This last feature is especially troubling, considering the large number of reinfections that are occurring, for example. the 650,000 in the UK who likely have been infected twice.

Many who currently have Long COVID are terrified of Omicron, as even mild cases of pre-Omicron variants have had the following effects for some, for more than a year afterwards:

“You might have a mild case,” Laurie Bedell, 42, of Pittsburgh, said. “But most people that have long Covid had mild cases.”

She caught the virus in December 2020 and continues to have debilitating pain, fatigue and other symptoms that have transformed her from a healthy, physically active woman to a chronically ill person unable to walk or do any form of exercise for more than 5 to 10 minutes at a time.

“I am terrified,” she said. “I don’t know that I would survive another infection.”

There is currently only anecdotal evidence, but studies are sure to follow, but:

People with long Covid “have good reason to be worried, unfortunately,” said Dr. John Baratta, founder and co-director of the UNC Covid Recovery Clinic in Chapel Hill, North Carolina.

“We have seen people in our clinic who have been reinfected with Covid with the other variants,” he said. “They have new or worsened long Covid symptoms after their reinfection.”

So, what do you do?

First and foremost, get vaccinated and boosted (and if you’re eligible, get your second boost). Vaccines remain effective in reducing the effects of acute COVID, even in the age of Omicron.

Vaccines might also reduce the likelihood of long COVID, but research is still inconclusive and ongoing.

Second, get a good mask. A properly fitted N-95 is substantially better than a cloth, surgical, or even KN-95 mask.

Third, continue to limit the amount of time you spend sharing air with people outside your ‘bubble’. COVID is an airborne disease, and transmits much more easily indoors, where ventilation is poorer. Consider contactless delivery, masked curbside pickup, and socially distanced and/or masked walk’n’talks.

The end to this thing may or may not be in sight, but it’s probably not Omicron, and you want to get Omicron as few times as possible.

Stay safe out there.

[1] This is a heart-breaking first-hand account of what hospital front line workers are going through.

[2] Modulo demographics.

[3] There are limitations on the precision of PCR and the classification of variants, but any study that didn’t do whole genome sequencing would have the same limitations. It increases my confidence in the study that they were very precise about what they were measuring.

[4] thanks, Global News!

[5] Eerily similar to the ‘Hammer and the Dance’ article linked above. But it’s very different living through it.

[6] From Johns Hopkins:

What are symptoms of COVID-19?

The most common symptoms are:

Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
Sore throat
New loss of taste or smell
Nausea or vomiting
Congestion or runny nose

Some of these symptoms are very common and can occur due to many conditions other than COVID-19, the disease caused by the coronavirus called SARS CoV-2. If you have any of the symptoms, contact a doctor or other health care provider, who can assess your risk and help you determine the next steps.
Emergency Warning Signs of Severe COVID-19 — When to Call 911

If you or someone in your household is experiencing any of the following symptoms, call 911 or your local emergency room right away and let the operator know that you are calling for someone who might have COVID-19:

Difficulty breathing
Persistent pain or pressure in the chest
New confusion
Inability to wake up or stay awake
Bluish lips or face

There are other possible symptoms of COVID-19. Call your doctor or health care center regarding any symptoms that are severe or concerning to you.

[7] Angiotensin Converting Enzyme 2, a transmembrane protein involved in blood pressure regulation, and extensively studied because of its relation to hypertension.

COVID: “So you have your first shot. What’s next?” (A primer on the COVID vaccines)

[Disclaimer: I am not a doctor, and this is not medical advice. I’m writing this to process my vaccine timing and choice decision, as well as feelings about the world slowly opening up.]

If you’ve been reading this blog, you will know that I got my first vaccine shot a couple of months ago, and that it was AstraZeneca. At the time, I mentioned that there were some known issues with blood clots, and the incidence was estimated to be about 4 per million by the United Kingdom Medicines and Healthcare Products Regulatory Agency. With more data, this number has been changed. The Canadian National Advisory Committee on Immunization (NACI) has now estimated that the VTT blood clot rate could go to as high as 1 in 55,000, with increased observation time. So far (as of June 4th), there have been 2,346,032 doses of AstraZeneca administered, and there have been 50 cases reported to PHAC[1] or Health Canada, including 31 with laboratory results showing VITT, including 6 deaths. This 50/2.3 million is about one in 47,000, 31/2.3 million is about one in 76,000, so one in 55,000 seems like a reasonable estimate. The death rate is about one in 390,000, similar to the ~19/9.5 million (or one in 500,000) we discussed last time. (Please also note that the NACI is now recommending that people watch for VITT for up to 52 days post-AstraZeneca dose.)

That being said, with more evidence from Canada and elsewhere, the NACI is now saying that:

“Due to the observed AstraZeneca safety profile and risk of VITT, offering an alternative product with a more acceptable safety profile and expected comparable immunogenicity profile, while enabling individuals to make an informed choice is ethically justifiable. This is expected to lead to increased accessibility and acceptability for those who were initially offered a first dose of the AstraZeneca vaccine, including those who are most at risk of COVID-19.”

In this, they are weighing the apparent increased risk of death from VITT against the dangers to an un-immunized individual (and of an un-immunized population), and the expected timeline for mRNA vaccine availability vs. the increased risks of COVID variants that are resistant to a single dose of a vaccine.

As always, your decision should be made in consultation between you and your doctor. I’m planning to get an mRNA vaccine (Pfizer or Moderna) for my second dose, but I don’t know when, yet. Likely within the next month or two.

So, with the NACI saying that:
– If you got Pfizer or Moderna for your first shot, you should get the same (or the other) for your second shot (strong recommendation)
– If you got AstraZeneca for your first shot, you can get AstraZeneca, or Pfizer, or Moderna for your second shot (and that they understand why people might prefer Pfizer or Moderna to AstraZeneca for their second shot)

The next question is ‘when do you get your second shot?’

There are a few factors at play here:
– The total local number of COVID cases
– The number of cases of more dangerous variants (and wanting to stamp the total local number of cases so as to avoid evolving more dangerous variants)
– Vaccine type & availability
– The waiting time for maximum effectiveness (and whether a third shot will be necessary/allowed/possible/etc…)

– The total local number of COVID cases:

Currently, in Ontario, the number of cases per day is trending downwards by 20-40%, week on week:


This is great news! However, there is also disturbing news that a new variant, ‘Delta’ (B.1.617.2), with about 60% greater transmissibility is starting to take over. (Some more Ontario-specific news on the Delta variant.) Specifically, it is estimated that while one vaccine dose is 60-80% effective against ‘wild-type’ COVID, and two doses are >85%, against the Delta variant, one dose is only about 30% effective, and it requires two doses to be about 80% effective.

– The number of cases of more dangerous variants (and wanting to stamp the total local number of cases so as to avoid evolving more dangerous variants)

So, people might want to get their second dose as soon as possible, in order to protect as much as they can against the new Delta variant (and any others that may arise). (This has the added side-benefit of reducing the total number of cases, and reducing the number of chances that COVID-19 has to mutate into other variants.)

– Vaccine type & availability

From the NACI: “Canada is anticipating large supplies of mRNA vaccines in the summer months that will be sufficient to complete the second dose in all age groups for whom immunization is recommended.”

So, availability of mRNA vaccines seems to no longer be a concern.

– The waiting time for maximum effectiveness (and whether a third shot will be necessary/allowed/possible/etc…)

So, here’s where it gets tricky. Because all of these vaccines are super-new, there is a limited amount of data on exactly when the ‘sweet spot’ is as far as how far doses should be spaced from each other for maximum effectiveness. Also, the presence of variants and vaccine mixing complicates matters.

The current recommendation from NACI is:
– Pfizer: 21 days to 16 weeks
– Moderna: 28 days to 16 weeks
– AstraZeneca: 28 days to 16 weeks

(The minimum number of days are based on general scientific understanding of how vaccines work, along with the number of days between doses in the clinical trial. The maximum number of days was based on ’emerging evidence of the protection provided by the first dose of a two-dose series’ and ‘limited COVID-19 vaccine supply and ongoing pandemic disease’.)

Based on increased vaccine availability, Ontario is now starting (Monday June 14th) to book second shots for those who had AstraZeneca for their first shot 8 weeks after their first shot (down from 12 weeks).

Ontario is also echoing the NACI recommendations:

“If your first dose was:
– AstraZeneca: you can get AstraZeneca, Moderna, or Pfizer for your second dose when you are eligible and it’s at least 12 weeks after your first dose.
– Moderna or Pfizer: you should get the same vaccine for your second dose when you are eligible and it’s at least 28 days after your first dose. You can switch between Moderna and Pfizer safely if the original vaccine you got is not readily available.”

The Ontario government specifically calls out that there is evidence that waiting 12 weeks ‘helps to ultimately provide more protection’:

“With informed consent, individuals can choose between a second dose of AstraZeneca or an mRNA vaccine, at an eight to 12-week interval, recognizing that while waiting 12 weeks helps to ultimately provide more protection, some may choose to receive their second dose sooner to have the increased protection provided by a second dose earlier. All of these options provide protection against COVID-19, including the Delta variant, and have been deemed safe.”

So, with some digging, I found this paper: “Single Dose Administration, And The Influence Of The Timing Of The Booster Dose On Immunogenicity and Efficacy Of ChAdOx1 nCoV-19 (AZD1222) Vaccine“, which talks about how the amount of time between vaccine doses correlates with overall effectiveness. This study includes data from the UK, Brazil, and South Africa (about 17 thousand participants, about half receiving the vaccine, half control). The upshot is that the effectiveness of the second dose goes from about 55% at <6 weeks to >80% after >12 weeks, with indications that the enhanced effectiveness starts to kick in somewhere between 9 and 11 weeks.

So, knowing all of this, which vaccine should you get for your second shot, and when? As I said above, this decision should be made between you and your doctor, but given the data above, it would make sense to weigh your perceived day-to-day danger level (along with mounting dangers from Delta and other variants) against the knowledge that waiting a bit longer could give you greater immunity overall. I’ll be 8 weeks out from my first immunization this coming weekend, and I can see myself waiting a couple of weeks after that for my second shot (which I intend to be a mRNA vaccine). (There is also some evidence that waiting 12 weeks leads to better mRNA vaccine effectiveness in older people.)

I’m still making my decision, though, as it may be that the extra overall vaccine effectiveness may not be meaningful, as the overall effectiveness may be ‘high enough’ (especially in reducing or eliminating serious COVID effects), and the extra security from emerging variants (and getting to enjoy more of the summer) may be worth it.

Let me know what you think for your own situation.

As always, thanks for reading, and stay safe!

P.S. If you want a more in-depth discussion of how the immune system works, and why vaccine mixing makes sense, let me know in the comments below! I had thought that this would be necessary to explain NACI’s vaccine mixing recommendation, but I think their ethical arguments are more directly relevant at the moment. (And this post is already quite long.)

P.P.S. Some more references I glanced at but only used for background:

These have a whole bunch of interesting graphs that I didn’t have time to get into:

Here are a bunch of articles that I didn’t have time to get into:

COVID Vaccines: They are Safe and Effective (What we know Right Now)

[This is a fast-moving and controversial topic, so if you’re reading this, you may disagree with what I say, or I may be wrong. Please feel free to read the sources linked throughout my post. If in doubt, please consult with your doctor. Also, I’m writing this as much for myself, to process all the things that I’ve been hearing and reading, so this may or may not address your specific case. #notmedicaladvice]

By the time you read this, if all goes well, I will have received my first vaccine dose. I’ll be getting the AstraZeneca-made vaccine, for a bunch of reasons, perhaps best summed up by this quote from our Prime Minister:

In the words of the Canadian Prime Minister: “The best vaccine for you to take is the very first one that is offered to you”

There’s a bunch to unpack here. In order for a vaccine to be offered to anyone, it needs to go through a number of steps, shown in this handy chart from UNC Healthcare:

Infographic from UNC Healthcare showing the FDA vaccine approval process, and how it differs under an 'Emergency Use Authorization'
Infographic from UNC Healthcare showing the FDA vaccine approval process, and how it differs under an ‘Emergency Use Authorization’

1) The initial R&D of the vaccine, including the conceptualization, and very likely in vitro (cell culture) tests and in vivo (animal) tests, both to show safety and effectiveness
2) Three phases of increasingly large clinical trials, to test for safety & effectiveness
3) Formal approval

The above process is the one for the U.S. FDA, but other jurisdictions will have similar processes. In Canada, the National Advisory Committee on Immunization (NACI) does a review of the evidence, and makes an approval decision. As vaccines can have risks as well as benefits, the NACI may approve vaccines for certain demographics, and not others. A common example of this might be restricting approval to adults 18 and over, due the difficulties and ethical restrictions of testing on children. Indeed, the current statement on the AstraZeneca vaccine includes such a statement:

“The AstraZeneca COVID-19 vaccine is authorized for use in Canada for adults 18 years of age and over. Health Canada has determined that it is a safe and effective vaccine.”

The availability of multiple approved vaccines has led to comparisons of the four vaccines currently approved for use in Canada: Johnson & Johnson, AstraZeneca, Pfizer, and Moderna

This being a fast-moving topic, affecting millions (really, billions) of people, science news is being reported on a daily basis in the popular press, which has a number of effects:

Because the topic is fast-moving, there is a lot of news, not all of it checked to normal standards of scientific rigor.

Because the topic is affecting millions of people, we see effects that we might not otherwise see in small populations. For example, of the approximately 9.5 million vaccine doses administered in Canada to date, there have been 3738 ‘adverse effects’ reported, with 529 of those being deemed ‘serious’, or about 55.5 per million. (For a breakdown by demographics, click here.)

(Apologies for the formatting below, but WordPress is tricky. You may want to rotate your phone to read the table in landscape.  The full description of each of the columns is available here, and the names of the columns appears before the abbreviations below.)

Here, you can see a summary of the adverse effects seen in Canada from COVID vaccines so far, as defined here. (Rotate your phone to landscape if the table does not display properly.)

Number of adverse event reports by vaccine name up to and including April 16, 2021 (n=3,738) Vaccine name Non-serious reports Serious reports Total reports Total number of doses administered Total non-serious report rate* Total serious report rate* Total report rate*
                 Non-S Ser Total   Total   Rate  R(ser) R(non-ser)
 Pfizer-BioNTech 1,762 395 2,157 7,183,048 24.53   5.50    30.03
 Moderna         1,311  83 1,394 1,843,805 71.10   4.50    75.60
 COVISHIELD        124  36   160   491,171 25.25   7.33    32.58
 AstraZeneca        11   9    20   615,582  1.79   1.46     3.25
 Unknown             1   6     7       N/A   NaN    NaN      NaN
 * Per 100,000 doses administered.

(‘COVISHIELD’ refers to the AstraZeneca vaccine, under a slightly different brand name.)

Overall, between all the vaccines administered, there have been:

“Up to and including April 16, 2021, a total of 38 reports identified deaths that occurred after the administration of a vaccine. Following medical case review, it has been determined that 19 of these deaths are not linked to a COVID-19 vaccine and the other 19 are still under investigation. As investigations are completed, the numbers are updated accordingly.”

(From the page, and the recommendations for on-site supervision immediately following vaccination[1], my guess is that deaths associated with vaccination are generally caused by anaphylaxis, but I don’t have good data on that.)

(Please note that this number of 19 per ~9.5 million may go up or down, but as it stands, it’s about at 2 per million, or 1/4 as dangerous as being a pedestrian, or 1/13th as dangerous as driving a car for a year. (2017 data))

Drivers: 985 (26/1e6) Passengers: 311 (8.5/1e6) Pedestrians: 284 (7.7/1e6)
Canada Population: 36,708,083 (approximate)

(Please also note that all of these vaccines seem to have similar rates of serious and non-serious side effects.)

The item at the top of the news at present is that there are currently specific questions about blood clots and the AstraZeneca vaccine. Health Canada performed a review, and determined:

Health Canada’s review of the available information concluded that a link between the use of AstraZeneca COVID-19 Vaccine and COVISHIELD and the risk of these blood clots with low platelets is possible. The risk of these events is very rare, and the overall benefits of the vaccine in protecting Canadians from COVID-19 continue to outweigh its potential risks.
Health Canada did not identify risk factors, such as age or gender, for these very rare events, and is not restricting the use of the vaccine at this time.
A potential mechanism for the combination of blood clots with low platelets is the triggering of an immune response by the vaccine, leading to a condition similar to that seen sometimes in patients treated with the blood thinner medication heparin.

(You can see the timeline of updates here. You can see the current ‘product details’ here.)

This article talks about the relative absolute risk of these blood clots vs. the population risk of COVID.

In the UK, this incidence seemed to be:

The potential risk of blood clots with low platelets is very rare. Based on their vaccination rate as of March 31, 2021, the United Kingdom Medicines and Healthcare Products Regulatory Agency estimated the overall risk of these blood clots to be approximately 4 people in a million who receive the vaccine. Reported cases of these adverse events have been seen after the first dose, usually within the first 14 days after immunization.

While the overall population risk seems low, when people have options, they will move to optimize their decisions with whatever information they have available, especially when there may or may not be demographic effects on these issues. At its worst, this leads to ‘vaccine shopping’, exacerbating outbreaks, but at its best, it involves people making educated decisions about their personal risks and benefits from taking a particular vaccine. Indeed, from the NACI April 23rd statement:

“At this time and based on current evidence, NACI recommends that the AstraZeneca COVID-19 vaccine may be offered to individuals 30 years of age and older without contraindications, if the individual does not wish to wait for an mRNA vaccine and the benefits outweigh the risk.”

This represents the fact that individuals between the ages of 30 and 40 are at reduced risk for COVID (compared to older individuals), and they may be at the same or increased risk for these blood clots.

There has been speculation that this is auto-immune linked, but the current (not yet published) research has not found (or ruled out) a link yet. (Numbers are still very small, and this is a tricky determination to make.)

However, if you know that you are more susceptible to auto-immune issues (especially those with high estrogen levels), you might want to consult with your doctor, or wait if it remains safe for you to so, while the science is worked out. Ultimately, only you (with your doctor) can make this determination.


Overall, the title of this post still stands. There are a small number of rare side effects associated with these vaccines (mainly PEG allergic reactions for Pfizer & Moderna, and blood clots for AstraZeneca), both of which are detectable and generally treatable. I’m planning to get my shot tomorrow morning, and I believe that the vast majority should also, as soon as they can.

Stay safe.

-Nayrb 🙂

[1] “The Pfizer-BioNTech COVID-19 vaccine is contraindicated in:
– Individuals who have ever had a severe allergic reaction (i.e. anaphylaxis) to a previous dose of an mRNA vaccine or to any of its components (including polyethylene glycol (PEG) and/or polysorbate) or its container, should not get either mRNA COVID-19 vaccine. PEG can rarely cause allergic reactions and is found in products such as medications, bowel preparation products for colonoscopy, laxatives, cough syrups, cosmetics, skin creams, medical products used on the skin and during operations, toothpaste, contact lenses and contact lens solution. PEG also can be found in foods or drinks but is not known to cause allergic reactions from foods or drinks.
– Vaccination should be deferred in symptomatic individuals with confirmed or suspected SARS-CoV-2 infection, or those with symptoms of COVID-19.
– As a precautionary measure and in light of the need to be able to monitor for COVID-19 vaccine adverse events without potential confounding from symptoms of COVID-19 or other co-existing illness, it would be prudent to wait for all symptoms of acute illness to completely resolve.
– Individuals who have received another vaccine (not a COVID-19 vaccine) in the past 14 days.
– Individuals under the age of 16: The safety and efficacy in children under 16 years of age have not yet been established. The manufacturer plans to conduct clinical trials in children.
Considerations for other patient groups
– Guidance for special populations, including for example breastfeeding or pregnant individuals, individuals with allergies, individuals with autoimmune conditions, or individuals who are immunocompromised due to disease or treatment, is available in the Vaccination Recommendations for Special Populations guidance document.
Precautions during vaccination should be taken for:
– Patients who have a bleeding problem, bruise easily or use a blood-thinning medicine should receive the vaccine. Individuals receiving long-term anticoagulation with either warfarin or heparin are not considered to be at higher risk of bleeding complications following immunization and may be safely immunized through the intramuscular route as recommended, without discontinuation of their anticoagulation therapy.
– There is some evidence to suggest that instramuscular administration may be safer when given with a small gauge needle (23 gauge or smaller) and when firm pressure is applied to the injection site for 5 to 10 minutes
– Individuals with a history of severe allergic reactions (i.e. anaphylaxis) not related to vaccines or injectable medications—such as allergies to food, pet, venom, environmental, or latex, etc. should be offered the COVID-19 vaccines.
– An extended period of observation post-vaccination of 30 minutes is recommended for these groups
– For more detailed recommendations on people with allergies, please consult the Vaccination Recommendations for Special Populations guidance document.

2020: Processing How We Got Here I

It’s now been 11 weeks since we went into social isolation, somewhere between 12 and 13 weeks since S said “Perhaps we should stock up a little.” Since then, (our part of) the world has been upended, time has lost all meaning, even while the season has turned. Looking back at pictures that I took back then[1], there was snow on the ground, and today it was sunny and 19C.

But like I said, time has lost all meaning. It’s been difficult a couple of times the last couple of weeks remembering which day of the week it is, even taking into account a working-from-home[2] schedule. I keep coming back to ‘time has lost all meaning’. I’m one of those people for whom it’s easy to lose an hour[3], if I get into something, or get distracted by something. I can even lose weeks because I’m in the barely-slept now. But this is very different.

Some of you know that a main reason that I started blogging was because I was afraid of life passing me by, of the fear of looking back and not having anything tangible to show for all the time I had spent on this world. I successfully wrote every day for 7 months, and even after I fell off the wagon after falling sick, I was still able to gather myself and write intermittently. In fact, I was in the process of restarting a regular cadence[4]…then all of this happened.

How does one write a long series of in-depth articles about a phone strategy game that no one has heard of or cares about, when there’s a global pandemic that is the only thing on everyone’s mind? Is that even a remotely responsible thing to do? It took me a while to understand that I needed to write about this experience instead, and first, as a way of processing everything that I was feeling and experiencing. Some people say it’s important to document along the way, to help you (and others) understand later what it truly felt like. All I can say is that the allostatic load has been so high, that it took me this long to find the mental space to do this. But back to our story…

There was a flurry of activity, reading up every bit of information on Covid[5], preparing ourselves, seeing my mom one last time, going out to see friends one last time…then on March 9th, I went to the office for the last time, and then…waiting…waiting…waiting for people to take this seriously enough.

On the 11th, I shared this article “Why you must act now“. We had spent the previous week in a ‘hair-on-fire’ state, S had her last day in the office on the 6th, I told my team at work that same day to bring everything home that they needed for an extended stay.

So, we were personally ready (we thought) for this exponential threat that was coming at us, I was telling the people I knew that it was coming, and they seemed to be aware of the danger, but we weren’t seeing it in a bunch of the people as we walked around, and we weren’t seeing it in the media. The previous Thursday (March 12th), Doug Ford was saying that school would be closed for two weeks after March break, but still saying that people should ‘enjoy themselves’ over March Break. Later that day, Sophie Gregoire-Trudeau self-isolated (and eventually tested positive). I think this ended up being a good thing, as it put a human face on the pandemic, and perhaps helped convince people that everyone was susceptible (and perhaps put more of the fear into the politicians).[6]

This is getting long, so I think I will stop here, somewhere in the second week of March. We’re safely isolated and stocked up, (we think)[7] we know what this will feel like, some politicians (in Canada at least) are juuust starting to say the right things, but people are still getting ready to go for March Break, and we’re hunkering down for the long waiting period of ‘turning the ship’ of convincing tens of millions of people to change this seriously and change their behaviour.

Thank you for reading this. This feels cathartic in a good way, and really important to help me process this. 🙂

[1] In the ‘Before Times’.

[2] I have a lot of words to say here, but fundamentally, I feel so lucky and blessed to have a job/career that allows this easily.

[3] Or five.

[4] Huge thanks to L here, who suggested meeting up in a local cafe, where I got a lot of good writing notes in, that will be interesting posts some day, hopefully soon. 🙂

[5] I feel uncomfortable saying the word ‘Covid’. I’m not sure why. It may be that I have very strong and complex feelings about the word, and I assume others do too, and I very much want a specific and understood[5a] reaction to each word that I use, and words that are this loaded make me apprehensive.

[5a] To the extent that a human can ever be said to understand another human…

[6] This also eventually gave us this magical song: Justin Trudeau sings ‘Speaking Moistly’
(Original clip here: )

[7] Ha ha ha so wrong… 🙁