Nanaimo infectious disease specialist says vaccinate frontline health care staff first

Essential hospital units could be crippled if health care staff aren’t given priority for full ­vaccination against COVID-19, and any delay of the second dose is unwise and unethical, a ­Nanaimo infectious disease specialist is arguing.

Dr. David Forrest, who works as a physician at Nanaimo Regional General Hospital where there is an ­outbreak, said he understands the province’s rationale to ­immunize people according to age and to vaccinate more people with a first dose by delaying the second given the limited supply — he just doesn’t agree with it.

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“You would think that I and others taking care of COVID‑19 patients would be first to get vaccinated,” Forrest said, “but like many of our nurses and respiratory therapists, we have been given a lower priority than visitors to long-term care or staff not directly managing COVID-19 patients.”

First up in the province’s four-phase immunization plan are long-term care and assisted living residents, staff and up to 8,000 essential visitors, as well as hospital health-care workers providing COVID-19 care, and remote First Nations ­communities.

Forrest argues it’s not ­shaking out that way, and health-care workers without any connection to COVID patients are in the same grouping.

He agrees that dentists, teachers and other essential workers make a good argument for being among the first to receive the vaccine, but he said if he were off sick with COVID — and moreso nurses or ­respiratory therapists — it would affect the ability to care for the sickest patients on the Island.

“It doesn’t matter how many ventilators you have if there are no staff to provide the care,” Forrest said.

“The healthcare workplace is a high risk for transmission,” Forrest said.

“The No. 1 thing you have to do is protect the integrity of your health care system.”

Forrest received his first dose of the COVID-19 vaccine on the weekend more by luck than design — an extra batch became available, he said.

There are contingency plans to ensure that no COVID-19 doses are wasted, meaning if a high-priority person misses their appointment, the Pfizer vaccine, which arrives frozen and has a six-hour lifespan once thawed, is administered to the next person in line.

The province says it will roll out vaccinations largely based on age given it is the greatest indicator of who has underlying health conditions and is more likely to have severe illness or die from COVID-19.

On Monday the plan was adjusted to delay the second dose to 42 days from 35 days after B.C. officials learned that there will be less vaccine than expected in February.

In clinical trails both the Pfizer-BioNTech and Moderna vaccines have shown about 95 per cent effectiveness after two full doses within the manufacturers’ specified ­intervals — 21 days for the Pfizer vaccine and 28 days for the Moderna.

Henry has said after one dose the effectiveness is still more than 90 per cent.

The province has taken guidance from the National Advisory Committee on ­Immunization in Canada. Recommendations from immunization committees in the United States, United Kingdom and other ­countries have also been reviewed.

Trial data show no difference between those who received a second dose after 19 days compared to 42 days, Henry said, adding that the World Health Organization and National Advisory Committee on ­Immunization have extended the recommended interval for COVID-19 vaccine doses to 42 days.

But Forrest said there’s no peer-reviewed published evidence to support the second-dose delay.

“It may be beneficial, it may be harmful, we don’t know,” Forrest said. All that’s been demonstrated and scientifically proven is what the manufacturers have recommended, he said.

ceharnett@timescolonist.com

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