JEFFERSONVILLE Life is precious, especially as people get older.
Jeffersonville resident Renie Schuble would know. After she lost six weeks of her life to Respiratory Synctial Virus, an illness that affects children but is becoming more prevalent in older adults.
I felt like a 500-pound rock was laying on me, she said. I couldnt work, I couldnt move, I couldnt do anything. Its either breathe or eat and I chose to breathe, so I wasnt eating and I wasnt sleeping.
Schuble battled the disease without having to be hospitalized and by being treated by her personal physician.
Schuble was 69 when she got the illness and now at 74 shes hitting the road with NBA legend Magic Johnson to help make others aware of the dangers from the virus.
The pair have visited Chicago and Los Angeles spreading the word about a new RSV vaccine for older adults, and the pair plan to hit other cities with their message next year.
She said her symptoms felt like the worst cold of her life, but doctors werent able to pinpoint the cause at first.
It took numerous tests and doctor visits before she was diagnosed with RSV.
Once she had healed from the illness she was invited to participate in a study about older people contracting RSV.
Now I became really interested at why in the world did I catch RSV at 69 years old, she said, when years ago I had a great-granddaughter in the hospital with RSV.
Representatives from GlaxoSmithKline, the makers of the RSV vaccine, reached out to Schuble after she participated in the study and asked her to be a consumer spokesperson for the Sideline RSV vaccination campaign alongside Johnson.
My first event was in Chicago, and they flew me up. I stayed 24 hours, Schuble said, adding these events are typically at YMCAs with programs for older adults. She spoke alongside Johnson and a doctor about the illness.
I was like, Oh my gosh, Magic Johnson is here, and he would talk, the doctor would talk and I would tell my story.
A University of Louisville infectious disease doctor, Mark Burns, said the RSV vaccines are new this year and recommended for seniors.
Its usually for people over the age of 60 or those who may be immunocompromised, Dr. Burns said, adding that people with chronic illness, those with heart problems, liver problems and kidney problems also qualify.
Dr. Burns said RSV affects people in two age groups, children with smaller airways and people aged 60 and older. The virus is seasonal and usually shows up in the fall and winter months.
The person with a good, working immune system, (for them) its usually very mild symptoms, Dr. Burns said. It usually doesnt cause major issues.
Although RSV infections will be present this season, Dr. Burns said he hasnt heard anything about them being particularly bad this year.
Doctors are, however, gearing up for an influx of RSV, influenza and COVID infections.
Dr. Burns said those who qualify for the RSV vaccine should get it and recommends people with apprehensions about vaccination should speak to their doctors.
This is what I tell people about vaccines in general: vaccines have helped us through many severe, severe illnesses, Dr. Burns said. I go all the way back to polio, measles, mumps, rubella, tetanus. All those types of illness out there, vaccines have made a world of difference.
Schuble said she remembers those illnesses as well and wishes the RSV vaccine had been around five years ago when she got sick.
She said its important to not believe misinformation about vaccinations.
(Im doing this campaign) because it is the correct information, she said. Back when we started with COVID we heard all this, Im not going to take it because theyre going to put a chip in me or theyre going to do this to me. This is a very safe vaccine.
Katie Couric Media, the production company owned by television journalist Katie Couric, has taken an interest in Schubles story as well.
The team arrived in Jeffersonville Monday morning to shoot content with her for an upcoming project.
Schuble said shes not sure when the project will come out, but its been quite the experience to be part of this campaign.
I was in awe of the whole thing (with Katie Couric Media), she said. They arrived at 8:30 a.m. and started carrying equipment in...they were the nicest people...they had me do a little walking in the neighborhood with my little dog, showing me as a normal human being.
And, I am a normal human being.
Nurses, like this critical care nurse, play a critical role in health care.
Courtesy of Oregon Health & Science University
The Oregon Health Authority would like 90% of health care workers to be vaccinated against the flu, but the state lags far behind that goal.
The agency issued an alert last week saying that 64% of health care employees are vaccinated against the virus, compared with 85% during the 2019-20 flu season. But as the pandemic deepened and spread, and people stayed home or masked in public places, vaccination rates among health care workers plummeted, and theyve yet to recover. Last flu season, 63% of health care workers got a flu vaccine.
The proportion of those declining a shot has grown from 8% during the 2019-2020 flu season to 15% now, agency data shows. The health authority doesnt know why another one-fifth of health care workers arent vaccinated. The state needs about 35,000 health care workers to get vaccinated to meet its 90% goal.
State health officials worry that infected health care workers could further sicken already ill people.
Health care workers are the first line of defense in protecting vulnerable patients and preventing a severe respiratory virus season from becoming a catastrophic one, said Rebecca Pierce, who tracks hospital infections for the agency. Thats why influenza vaccination of health care workers is a key strategy for infection control in health care facilities.
Related: Health care workers must get vaccinated or tested
The states alert coincides with the start of the flu season. Infection rates were low during the pandemic but the virus came roaring back last year, peaking in the first part of December. Health authority spokesman Jonathan Modie expects illnesses to increase in coming weeks.
Given (the) severity of last season and the potential for compounding effects of concurrently circulating respiratory viruses, it is important for health care workers to get up to date with vaccinations as soon as possible, Modie said in an email.
The state collects vaccination data from hospitals, surgery centers that provide same-day care, nursing homes and dialysis centers. Vaccination rates were lowest in in-patient psychiatric facilities and dialysis centers at 35%. Nursing home rates were also low at 41%. Hospitals had the highest rate 69% followed by surgery centers at 67%.
Modie called the rate in nursing homes especially worrying.
Nursing home residents are among the most vulnerable to developing flu-related complications, Modie said. It is critical to improve uptake in these settings.
Related: A seasonal viral stew is brewing with flu, RSV, COVID and more
Health care officials also worry about COVID, which appears to be here to stay, and another respiratory virus, RSV or respiratory syncytial virus. The latter usually causes mild cold-like symptoms. Health care officials recommend that people over 60 get an RSV vaccine, and that anyone older than 6 get a COVID booster if you can find them.
Unlike COVID, asymptomatic transmission of flu is less common, with infected people becoming the most contagious on the third and fourth day of illness. Health officials advise anyone who develops symptoms to stay home.
While most people recover from the flu in days, those with weak immune systems, including the elderly and very young, risk hospitalization and even death. The federal Centers for Disease Control and Prevention said that 12,000 to 50,000 people die each year from the flu and 9 million to 41 million get sick. State health officials dont track adult deaths, but they do log pediatric figures. Two Oregon children died from the flu last season.
With the season just starting, Modie said now is a good time to get a shot to ensure protection throughout the season.
This story was originally published by the Oregon Capital Chronicle.
Oregon Capital Chronicle is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501(c)(3) public charity. Oregon Capital Chronicle maintains editorial independence. Contact Editor Lynne Terry for questions: info@oregoncapitalchronicle.com. Follow Oregon Capital Chronicle on Facebook and X.
The obituary spelled out the cause of death for the Lake Forest resident in the first sentence: The 83-year-old passed away from complications of COVID pneumonia a few weeks ago.
Despite Illinois and the federal government declaring this summer the pandemic over, folks are still dying from the virus. Others are leery and continue to question the safety and effectiveness of the vaccines, and the billions of dollars made by their manufacturers.
Last week, no Lake County residents died from the deadly virus, while three were hospitalized, according to federal data. The countys vaccination rate remains high at 84%, with 95% of those 65 and older being vaccinated.
As of the week of Oct. 21, Illinois overall had 119 residents ages 20 to 59 hospitalized. The crest for death counts during the pandemic was about 16,000 the week of Jan. 16, 2021, according to federal numbers.
Twenty-five percent of the county has been vaccinated with the bivalent jab, which boosts immunity against the original COVID-19 virus, along with the Omicron variant and two subvariants. Sixty-one percent of those vaccinated are senior citizens.
So far, a mere 7% of U.S. adults and 2% of children have gotten the new shots. One health professional called the vax figures abysmal.
Those numbers are at least better than a few weeks ago, when 3% of the U.S. population, about 10 million of us, received the updated coronavirus vaccine. Health experts estimate it takes about two weeks after receiving a vaccination to develop adequate immunity and protection.
The figures are minor compared to the peak coronavirus years of 2020 and 2021, when hundreds were dying of the dreaded virus. Still, Lake County health department officials continue to urge residents to get flu shots, the latest COVID-19 bivalent booster to fight current strains and vaccination for RSV, respiratory syncytial virus.
RSV is a common respiratory virus that causes cold-like symptoms, but can be deadly for infants and senior citizens. Officials say now is the time to get vaxxed to prevent serious respiratory illnesses. The Centers for Disease Control and Prevention strongly recommended in mid-September the upgraded vaccines from Moderna and Pfizer/BioNTech for everyone 6 months and older.
But Americans are disregarding the health warnings. Maybe were focused on football, or Republican presidential debates, or the Israeli-Gaza War.
We do so at our peril, health experts caution. Federal officials recommended last month that Americans get new versions of COVID-19 vaccines. Medical studies have consistently shown that COVID-19 vaccines lower the risk of getting the disease and improve protection against serious illness, hospitalization and death, health officials say.
With the worst of COVID behind us, guess we forgot what happened during the pandemic. Zoom calls, in-home schooling, masking requirements, closed movie theaters and restaurants.A few folks still wear their masks, but that number dwindles daily. Unlike the nations mortality rate during the pandemic.
Health officials point out viruses change, and vaccine effectiveness can wane over time. They say it is important to stay up-to-date on our shots.
Take it from one who came down with COVID in the spring: Its no fun.
Fever and throat pain like you gargled with razor blades, or perhaps broken glass. And I was fully vaxxed. Previous bouts with the coronavirus also mean you have some immunity from infection.
In mid-August, the Illinois Department of Public Health said wastewater surveillance detected rising COVID-19 activity. That has waned, however.
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State health officials say without widespread vaccinations, we could face a tripledemic of respiratory illness caused by COVID, the flu and RSV. November and December are prime times for upper respiratory diseases.
More than three years since the pandemic began, we need to keep vigilant for our own health. Political leaders should heed counsel from public health professionals if COVID infections begin increasing this winter.
As we saw beginning in spring 2020, the U.S. wasnt ready for the major outbreak which eventually killed more than 1.1 million Americans, and more than 1,000 Lake County residents. Lets make sure were ready if another catastrophic health emergency in is our near future.
As Benjamin Franklin said, An ounce of prevention is worth a pound of cure.
Charles Selle is a former News-Sun reporter, political editor and editor.
sellenews@gmail.com
X @sellenews
November 01, 2023
1 min read
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Scientists have successfully developed the first vaccines against malaria and respiratory syncytial virus, but other vaccine targets remain.
We asked Robin C. Colgrove, MD, FIDSA, attending physician in infectious diseases at Mount Auburn Hospital in Cambridge, Massachusetts, and assistant professor of medicine at Harvard Medical School, what tops his list.
Colgrove: If you had asked the same question 10 years ago, a malaria vaccine might well have been the consensus answer. Now that there are two WHO-endorsed malaria vaccines, the answer depends on what you are trying to accomplish.
I go back with HIV to the beginning when I was a medical student in the early 1980s in San Francisco, when the virus was isolated. HHS Secretary Margaret Heckler made a famous comment that we would have an HIV vaccine in 2 years. Now, we are 40 years in, and there is still not a successful HIV vaccine, although we do have very good testing and very good treatment. With testing, treatment and PrEP, epidemiological models suggest that we could eliminate HIV even without a vaccine, although it would be very helpful and it is extremely disappointing that after so many trials, we still do not have one. I would put that at the top of the list in a qualified way because we have tried so hard and failed.
If you ask, in a global sense, what would make the biggest difference, though, it still would be a tuberculosis vaccine. The bacille Calmette-Gurin vaccine for TB was first administered in 1921 and is moderately effective, but it certainly has not been effective enough to drive rates of TB down. A really effective TB vaccine would make an enormous difference, but it is a very difficult task because of the biology of TB and the difficulty of getting a good immune response. Also, testing and public health-related issues make it very challenging. If you could wave a magic wand, though, and get a 100% effective vaccine against any pathogen, numerically, a TB vaccine would probably make the biggest difference.
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November 01, 2023
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Patients with asthma, COPD and interstitial lung disease have reduced SARS-CoV-2 vaccine-specific antibody, B-cell and T-cell responses, which signals poorer protection against COVID-19, according to results published in ERJ Open Research.
R. Lee Reinhardt
The findings suggest that what we understand about how the vaccine protects healthy individuals may not be broadly applicable to patients with underlying lung conditions, R. Lee Reinhardt, PhD, associate professor in the department of immunology and genomic medicine at National Jewish Health, told Healio. This highlights a need for clinicians to consider varied vaccination schemes to ensure their patients with asthma, COPD or ILD maintain sufficient anti-SARS-CoV-2 antibody and/or memory B cells and T cells to protect against severe COVID-19.
Using blood samples and deep immune phenotyping, Reinhardt and colleagues assessed humoral and cell-mediated responses to a SARS-CoV-2 vaccine in nine patients (mean age, 58 years; 56% women) with asthma, eight patients (mean age, 64 years; 62% women) with COPD and 15 patients (mean age, 62 years; 60% women) with ILD against 31 healthy patients (mean age, 50 years; 45% women).
Researchers found lower antibody titers to the vaccine antigen in about half (48.3%) of all those with a lung condition 3 to 4 months after the last vaccine administration compared with those observed in the healthy controls. Specifically, those with asthma (P < .035) and those with COPD (P < .022) showed significantly lower antibody titers, as did 40% of the patients with ILD.
We did not expect that a majority of patients with underlying lung conditions (asthma, COPD, ILD) would exhibit an impaired vaccine response, Reinhardt told Healio.
Three to 5 months after vaccination, fewer patients with a chronic lung disease achieved good blocking of ACE2-mFc compared with healthy patients (22% vs. 94%), demonstrating the possibility of poor humoral protection in these patients, according to the researchers.
Notably, a reduced vaccine-specific antibody response corresponded to fewer vaccine-specific memory B cells in patients with asthma, COPD or ILD. Those with ILD (P < .012) and asthma (P < .032) showed significantly fewer receptor-binding domain B cells than healthy controls, whereas patients with COPD on average showed fewer of these B cells than healthy controls.
When evaluating memory T cells, patients with a lung disease vs. patients classified as healthy had decreased responsiveness (asthma: CD8+, P < .004; CD4+, P < .023; COPD: CD8+, P < .008). Among those with ILD, researchers found limited CD8+ T-cell responses in 21.4% of the cohort and weak CD4+ responses in 42.9% of patients.
Researchers additionally observed heterogeneity between the groups in terms of their cytokine profiles, such that bulk CD8+ T cells that were interferon gamma-competent were only significantly elevated among patients with COPD compared with controls (P < .012) and the percentage of IL-2-producing bulk CD8+ T cells were significantly lower among patients with asthma compared with controls (P < .014). Researchers noted even greater heterogeneity in vaccine-specific follicular T-helper cells.
Lastly, vaccine-elicited antibody responses did not correlate with T-cell responses, and this was an unexpected finding, Reinhardt told Healio.
Specifically, some individuals mount a productive antibody response to the vaccine but do not mount a similarly protective T-cell response, Reinhardt said. In contrast, some patients appear to mount a productive T-cell response but lack protective serum antibodies. This suggests that the immune response to the vaccine may vary in individuals with underlying lung conditions that are distinct from what has been observed in healthy individuals.
I think this work highlights that more heterogeneity exists in the vaccine response to SARS-CoV-2 than was previously appreciated, Reinhardt added. Clinical trials and research efforts must take into account how patients with underlying medical conditions may respond differently after vaccination. With more deep immune phenotyping of both B-cell and T-cell responses after vaccination, the research can better inform clinicians on how best to care for unique patient populations.
In terms of future studies, Reinhardt said two ideas need to be investigated to help those with respiratory conditions.
First, we need to understand why individuals with underlying lung conditions are not responding to the SAR-CoV-2 vaccine in the same manner as healthy controls, he said. This will help in the development of better clinical care. Second, we need to understand if the impaired vaccine response to SARS-CoV-2 extends to other vaccines critical to the welfare of these patients such as the seasonal flu vaccine and the respiratory syncytial virus vaccine. This could provide long-term insight into how best to approach vaccination of more vulnerable patient populations.
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Disclosures: Reinhardt reports receiving support from a National Jewish Medicine department of medicine MOOR microgrant award. Please see the study for all other authors relevant financial disclosures.
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Officials at Marthas Vineyard Hospital are warning of the potential for respiratory illnesses as the Island heads into the heart of fall.
Covid-19, the flu and respiratory syncytial virus, known as RSV, can all flare up as the weather cools and people head indoors. In a press conference Wednesday, hospital leaders urged people to get their vaccines updated.
Making predictions about when theyre likely to start circulating, or how severe the season will be is very challenging. We dont have a crystal ball, said Claire Seguin, the hospitals chief nurse and vice president of operations. I can say that in the fall of 2022, in particular, we had a very severe and early RSV season with a large impact, especially on the pediatric population.
Ms. Seguin anticipated an uptick in respiratory illnesses around Thanksgiving, but said reported cases of the flu and RSV are currently low. A Covid-19 spike from the end of the summer has also come down.
The U.S. Centers for Disease Control and Prevention, however, is forecasting a similar number of hospitalizations this year when compared to last season. From October 2022 to September 2023, Marthas Vineyard Hospital saw 139 cases of Covid, 48 cases of RSV.
RSV is a common respiratory virus that usually causes mild, cold-like symptoms, but can be serious for infants and older adults.
Vaccinations remain a critical tool to protect against these diseases, said Dr. Ellen McMahon. She encouraged people to get an annual flu shot and the updated Covid vaccine. There are two new RSV vaccines, including one for people over 60 and those who are pregnant, as well as an antibody prophylactic treatment for newborns and high risk older infants and toddlers.
The single best way to prevent flu and to reduce the risk of severe disease and hospitalization is to get an annual flu vaccine, said Dr. McMahon. When you get vaccinated, you also protect people around you who are at higher risk for complications from the flu.
People who receive care through the hospital can sign up for both vaccines through the hospitals online portal or by calling the hospital call center. Hospital officials suggested patients who get care elsewhere to contact retail pharmacies and community clinics for vaccine appointments.
Vaccines generally have no out-of-pocket costs at the hospital, Ms. Seguin said.
Updated 5 hours ago
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Martin Reynolds tells the Covid inquiry he was "deeply sorry for my part in those events"
The UK's top civil servant told colleagues in private that Boris Johnson "cannot lead" at the height of the Covid pandemic.
In WhatsApp messages from September 2020 disclosed to the Covid inquiry, Simon Case said the former PM "changes strategic direction every day".
He added that he was making government "impossible," and "we cannot support him in leading with this approach".
"I am at the end of my tether," he wrote, calling other ministers "weak".
In a day of explosive evidence, one of Mr Johnson's former aides also said he thought Mr Johnson had questioned why the economy was being destroyed "for people who will die anyway soon".
The aide, Imran Shafi, told the inquiry he believed the former PM had made the remark during a meeting with then-chancellor Rishi Sunak in March 2020, around the time of the UK's first lockdown.
A diary note by Shafi stated: "We're killing the patient to tackle the tumour. Large ppl [taken to mean large numbers of people] who will die - why are we destroying economy for people who will die anyway soon."
Asked who had made the remark, the aide replied: "I can't say for sure, I think it was the former prime minister."
Tensions at the top of government were laid bare in a series of WhatsApps, emails and diary entries.
Mr Johnson's principal private secretary Martin Reynolds emailed around 200 staff to a "bring your own booze" drinks event in the No 10 garden during May 2020, at the height of the pandemic.
Mr Reynolds apologised for sending the email, adding it had been "totally wrong".
He also spoke about the difficulties in Downing Street in the early months of the pandemic, adding there was "divergent internal politics" because of Mr Johnson's former top adviser Dominic Cummings.
He added that the government had been unable to cope with the scale of the crisis, and the Cabinet Office at the time had failed to properly co-ordinate the role of different departments.
In other evidence heard by the inquiry:
A key piece of evidence came in the form of a September 2020 WhatsApp exchange between Mr Case, Mr Cummings, and Lee Cain, Mr Johnson's former director of communications.
In the thread, Mr Case, the cabinet secretary, writes that he is "at the end of my tether" with changes of policy coming from the prime minister.
"Monday we were all about fear of the virus returning as per Europe, March, etc. - today we were in 'let it rip' mode 'cos the UK is pathetic, needs a cold shower, etc.," he wrote.
"He [Boris Johnson] cannot lead and we cannot support him in leading with this approach. The team captain cannot change the call on the big plays every day."
He added that the "weak team" at the heart of the Covid response - including then-health secretary Matt Hancock and then-education secretary Sir Gavin Williamson - "cannot succeed" in the circumstances.
"Government isn't actually that hard, but this guy is really making it impossible".
Mr Case also said the government needed a reshuffle and a "totally new approach".
In an earlier exchange from July 2020, when he was No 10 permanent secretary, Mr Case said Mr Johnson wanted to "declare that we are over Covid and that it is going to just all be fine".
Referencing the presidents of the United States and Brazil at the time, he added: "This is in danger of becoming Trump/Bolsonaro level mad and dangerous".
Image source, Covid-19 Inquiry
A note from Imran Shafi recorded a March 2020 meeting between Boris Johnson and Rishi Sunak
Mr Cummings is due to give evidence on Tuesday, alongside Mr Cain - who was due to testify on Monday but the evidence session overran.
Elsewhere, the inquiry heard that Mr Johnson's aides tried to get the country's top scientific advisers to take part in a press conference with Mr Cummings about his lockdown trip to Barnard Castle in County Durham.
In diary entries, Sir Patrick said that the advisers tried to "strong arm" him and England's chief medical officer, Sir Chris Whitty, into taking part - but this was apparently overruled by Mr Cummings himself.
Mr Case, who has been cabinet secretary since September 2020, is expected to give evidence to the inquiry but is currently on medical leave.
A Cabinet Office spokesman said earlier this month he was taking a "short period of leave" and was "due to return to work in a few weeks".
Mr Johnson, as well as his successor Rishi Sunak, are also due to give evidence to the inquiry later this autumn.
A group representing families bereaved by Covid said it was "was hard to keep up with the number of horrific revelations" that had emerged from the inquiry.
"While No. 10 squabbled over power, they resigned themselves to a staggering scale of deaths across the country," a spokesperson added.
Abstract
Background: Population-based cross-sectional serosurveys within the Lower Mainland, British Columbia, Canada, showed about 10%, 40% and 60% of residents were infected with SARS-CoV-2 by the sixth (September 2021), seventh (March 2022) and eighth (July 2022) serosurveys. We conducted the ninth (December 2022) and tenth (July 2023) serosurveys and sought to assess risk of severe outcomes from a first-ever SARS-CoV-2 infection during intersurvey periods.
Methods: Using increments in cumulative infection-induced seroprevalence, population census, discharge abstract and vital statistics data sets, we estimated infection hospitalization and fatality ratios (IHRs and IFRs) by age and sex for the sixth to seventh (Delta/Omicron-BA.1), seventh to eighth (Omicron-BA.2/BA.5) and eighth to ninth (Omicron-BA.5/BQ.1) intersurvey periods. As derived, IHR and IFR estimates represent the risk of severe outcome from a first-ever SARS-CoV-2 infection acquired during the specified intersurvey period.
Results: The cumulative infection-induced seroprevalence was 74% by December 2022 and 79% by July 2023, exceeding 80% among adults younger than 50 years but remaining less than 60% among those aged 80 years and older. Period-specific IHR and IFR estimates were consistently less than 0.3% and 0.1% overall. By age group, IHR and IFR estimates were less than 1.0% and up to 0.1%, respectively, except among adults aged 7079 years during the sixth to seventh intersurvey period (IHR 3.3% and IFR 1.0%) and among those aged 80 years and older during all periods (IHR 4.7%, 2.2% and 3.5%; IFR 3.3%, 0.6% and 1.3% during the sixth to seventh, seventh to eighth and eighth to ninth periods, respectively). The risk of severe outcome followed a J-shaped age pattern. During the eighth to ninth period, we estimated about 1 hospital admission for COVID-19 per 300 newly infected children younger than 5 years versus about 1 per 30 newly infected adults aged 80 years and older, with no deaths from COVID-19 among children but about 1 death per 80 newly infected adults aged 80 years and older during that period.
Interpretation: By July 2023, we estimated about 80% of residents in the Lower Mainland, BC, had been infected with SARS-CoV-2 overall, with low risk of hospital admission or death; about 40% of the oldest adults, however, remained uninfected and at highest risk of a severe outcome. First infections among older adults may still contribute substantial burden from COVID-19, reinforcing the need to continue to prioritize this age group for vaccination and to consider them in health care system planning.
Accumulating evidence indicates that people with a history of both vaccination against SARS-CoV-2 and SARS-CoV-2 infection are at lower risk of severe outcomes from COVID-19 than those with neither or either exposure alone.15 Even in the context of high vaccine coverage, understanding the residual fraction by age that remains uninfected is important to ongoing risk assessment. Early in the pandemic, older age and male sex were identified as independent predictors of severe COVID-19,68 but surveillance-based estimates of per case risk of hospital admission or fatality may be skewed by differential health careseeking behaviours, testing and case finding. Seroprevalence estimates enable better capture and quantification of infections,9 but their interpretation and generalizability depend on the source population (e.g., blood donors, prenatal screening), which can sometimes exclude relevant groups of the population (e.g., young children, older adults, males).
Between March 2020 and August 2022, the British Columbia Centre for Disease Control (BCCDC) conducted 8 cross-sectional, population-based SARS-CoV-2 serosurveys using a longstanding protocol that was first developed for emerging and pandemic influenza risk assessment.915 Sampling included people of both sexes and all age groups (< 5 yr to > 80 yr) residing in the Lower Mainland, BC. By the sixth (September 2021, mid-Delta wave), seventh (March 2022, following the winter 20212022 Omicron epidemic) and eighth (July 2022, Omicron) serosurveys, about 10%, 40% and 60%, respectively, had serological evidence of SARS-CoV-2 infection (Figure 1 and Appendix 1, Supplementary Figure 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.230721/tab-related-content). 9,16,17 Although at least 70% of children and young adults had been infected by the end of the 8 serosurveys, more than half of adults older than 60 years remained uninfected.9 To understand subsequent changes in infection-induced seroprevalence, notably among older adults, we conducted ninth and tenth serosurveys in December 2022 and July 2023, respectively. Using data on cumulative infection-induced seroprevalence, population census and severe outcomes, we sought to estimate age- and sex-specific hospitalization and fatality ratios (IHRs and IFRs) of first-ever SARS-CoV-2 infection during specified intersurvey periods.
Provincial surveillance case reports by epidemiological week and timing of serosurveys, British Columbia, Canada, January 2020 (epidemiological week 3) to August 2023 (epidemiological week 32). Weekly surveillance case reports of SARS-CoV-2 infections confirmed by nucleic acid amplification test (NAAT) were reported to the British Columbia Centre for Disease Control (BCCDC) from the Fraser Health Authority (HA) and Vancouver Coastal HA in the Lower Mainland, as well as other provincial HAs (combined).17 Case tallies are grouped by epidemiological week (7-d period) as per standard surveillance methods for comparing data by period from year to year. Serosurveys exclude those identified as assisted living, independent living or long-term care facility residents but provincial case tallies do not apply those exclusions. Epidemic waves are indicated with the predominant variant of concern (VOC).16 Changes in publicly funded access to NAATs or rapid antigen tests (RATs) are displayed below the x-axis.9
Figure 1 shows the timing of all serosurveys, overlaid on surveillance case reports of SARS-CoV-2 infections (confirmed by nucleic acid amplification test [NAAT]).9,16,17 Table 1 provides details pertaining to the sixth to tenth serosurveys that we used in the current analyses. The source population was patients presenting for bloodwork to a LifeLabs diagnostic service centre, the only outpatient laboratory network serving residents of the Lower Mainland, which includes the Fraser and Vancouver Coastal Health Authorities.9 Under legal order of the Provincial Health Officer (B.H.), LifeLabs provided BCCDC investigators with a convenience sample of 2000 anonymized, residual sera from Lower Mainland residents collected during the designated serosurvey period, including 200 samples per age group (04 yr, 59 yr and by 10-yr category through 80 yr), with equal numbers by sex. Specimens collected for SARS-CoV-2 testing and those from long-term care, assisted living or prison residents were excluded. Stored residual sera collected during the designated serosurvey period were pulled concurrently and consecutively by the LifeLabs central processing centre until age- and sex-specific quotas were met.
Timing of SARS-CoV-2 serosurveys contributing to cumulative and period-specific seroprevalence estimation, Lower Mainland, British Columbia, Canada
Detection of SARS-CoV-2 antibody was based on commercial chemiluminescent immunoassays to detect anti-spike (S1) or anti-nucleocapsid (NP) antibody (Table 1).9,1825 In a previous publication of the sixth to eighth serosurveys, we applied 3 chemiluminescent immunoassays per serosurvey and defined seroprevalence by dual-assay positivity, interpreted orthogonally.9 Orthogonal approaches were initially required in the context of low seroprevalence to address specificity issues (i.e., to minimize false positives); those concerns are less important in the context of high seroprevalence.2628 We therefore used nonorthogonal testing for the ninth and tenth serosurveys and, for consistency, similarly reanalyzed findings from the sixth to eighth serosurveys. We used the findings of 2 chemiluminescent immunoassays per serosurvey, omitting findings of the third (anti-S1) assay previously applied during sixth to eighth serosurveys (Table 1).9 We defined infection-induced seropositivity by detection of anti-NP. We defined any seropositivity (vaccine- or infection-induced) by detection of anti-NP, anti-S1 or both (Table 1). We estimated seroprevalence with 95% credible intervals (CrIs) by Bayesian analysis, adjusting for age, sex and health authority, with median summaries of the posterior presented (rather than the mean, as in our previous publication) to address the potential for extreme values (Appendix 1, Supplementary Material 1).9,2931
As detailed in Appendix 1, Supplementary Material 1, we estimated the number of first SARS-CoV-2 infections based on the intersurvey difference in cumulative infection-induced seroprevalence, representing the fraction of the whole population acquiring a first-ever infection during the specified intersurvey period. We simulated first infection risks from a binomial distribution by age, sex, health authority and intersurvey period, with Bayesian-adjusted median estimates applied to 2022 estimates of the Lower Mainland population to generate the number of first infections.32 We censored negative intersurvey risks of first infection as implausible. We aggregated results by age and period, and to further explore risk estimates by sex, we aggregated at the level of age, sex and period.
The severe outcomes we studied were hospital admissions for COVID-19 and deaths from COVID-19. We tallied severe outcomes across intersurvey periods, which spanned the period from the beginning of 1 serosurvey to the end of the complete epidemiological week of a referent date 2 weeks before the last serum collection date of the next serosurvey, accounting for the typical 1014-day span of serum collection and comparable lag to antibody development (Table 1).9 We extracted data on severe outcomes from the BC COVID-19 Cohort (BCC19C), a public health surveillance platform that integrates various administrative data sets, including the discharge abstract database (DAD) for hospital admissions,33 the provincial vital statistics database for deaths34 and the BCCDC integrated COVID-19 case surveillance data for notifiable (NAAT-confirmed) case reports (Appendix 1, Supplementary Table 1). We extracted all data on Aug. 24, 2023. We could not estimate IHR and IFR for the ninth to tenth intersurvey period because of incomplete data on hospital admissions and deaths.
We restricted hospital admissions for COVID-19 in the BCC19C to acute care admissions among Lower Mainland residents for whom the main DAD diagnostic field was specified as codes U07.1 or U07.3 (i.e., due to virologically confirmed COVID-19 or multi-inflammatory syndrome), from the Canadian version of the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CA); we similarly restricted deaths by underlying cause in the vital statistics data set.3338 To correspond with the denominator of first-ever infections, we excluded people admitted to hospital for COVID-19 with codes U07.1 or U07.3 in a previous DAD record since Jan. 1, 2020, or who had a NAAT-positive specimen collected 90 days or more before admission or death (potential reinfections) identified through patient master key linkage with the BCC19Cs integrated case surveillance data set (Appendix 1, Supplementary Table 1).
We derived period-specific IHR and IFR percentages with 95% CrIs by age group and sex as the tally of hospital admissions and deaths because of COVID-19 divided by SARS-CoV-2 infections. As derived, IHR and IFR estimates represent the risk of severe outcomes from a first-ever SARS-CoV-2 infection acquired during the specified intersurvey period. In addition to the sampled age groups, we explored other categorizations; we omitted infants younger than 1 year (considering maternal antibody) and substratified adults aged 6069 years as 6064 years and 6569 years, given that Canadian vaccine recommendations emphasize people aged 65 years and older.39 We also explored the effect of not censoring negative infection likelihoods, and of not excluding hospital admissions or deaths that may have been reinfections.
The study was approved by the University of British Columbia Clinical Research Ethic Board (H20-00653). Analyses of severe outcomes were undertaken under the BCCDC population health surveillance and risk assessment mandate, with review waiver provided by the University of British Columbia Clinical Research Ethic Board.
We describe provincial vaccine availability, deployment and coverage in Appendix 1, Supplementary Material 2.40 Overall, 1- and 2-dose vaccine coverage was already high by the sixth serosurvey at about 80% and 75%, respectively. This varied by age, with more than 95% of adults aged 70 years and older vaccinated twice.
Of 2000 participant serum samples collected during each of the ninth (December 2022) and tenth (July 2023) serosurveys, 1374 (69%) and 1332 (67%), respectively, were from Fraser Health Authority residents, which is comparable to previous serosurveys,9 the distribution within the Lower Mainland source population (61%)32 and reported cases of NAAT-confirmed SARS-CoV-2 infection within surveillance data (68%).17 Participant median age (39.5 yr) and sex (50% female) were also representative of the Lower Mainland source population (Table 2 and Appendix 1, Supplementary Table 5 and Supplementary Table 6).9,32
SARS-CoV-2 cumulative seroprevalence estimates, Lower Mainland, British Columbia, Canada
We show crude tallies and cumulative seroprevalence estimates based on nonorthogonal analysis of the sixth to tenth serosurveys in Appendix 1, Supplementary Table 7. Compared with previous orthogonal analysis,9 the absolute difference in overall and age-specific Bayesian-adjusted estimates of cumulative infection-induced seroprevalence was less than 2% absolute, with most differing less than 0.5% (Figure 2 and Table 2).
Cumulative vaccine- and infection-induced SARS-CoV-2 seroprevalence by age group, sixth to tenth serosurveys, in the Lower Mainland, British Columbia, Canada (September 2021July 2023). (A) Side-by-side comparison of the sixth to ninth serosurveys to illustrate seroprevalence progression. (B) Ninth and tenth serosurveys, presented separately for comparison of recent age-related patterns. Detailed findings are provided in Table 2. Darker bars indicate infection-induced seroprevalence. Lighter bars, combined with the darker bars, indicate overall (vaccine-induced, infection-induced or both) seroprevalence. Infection-induced estimates were defined by anti-nucleocapsid positivity. Overall estimates were defined by anti-spike or anti-nucleocapsid positivity. Estimates were based on Bayesian analyses, standardized for age, sex and health authority. Estimates from the sixth to eighth serosurveys are updated from our previous study,9 consistently applying the same nonorthogonal approach. Note: CrI = credible interval.
By the ninth serosurvey (December 2022), cumulative infection- induced seroprevalence reached 74% overall; seroprevalence was highest (> 80%) among people younger than 30 years, decreasing thereafter by 10-year age group, and lowest (< 50%) among adults aged 80 years and older (Figure 2 and Table 2). Estimates increased only slightly by the tenth serosurvey (July 2023) to 79% overall, with the highest seroprevalence (> 80%) seen in all age groups younger than 50 years, decreasing by 10-year age group thereafter, and the lowest seroprevalence (< 60%) seen among adults aged 80 years and older (Figure 2 and Table 2). Seroprevalence did not meaningfully differ when we simultaneously stratified by age group and by health authority or sex (Appendix 1, Supplementary Table 5 and Supplementary Table 6). Seroprevalence estimates did not meaningfully differ with further age substratification of those aged 6069 years nor among children younger than 5 years with exclusion of infants younger than 1 year (Appendix 1, Supplementary Table 8).
Period-specific changes in cumulative infection-induced seroprevalence and estimated first infections are displayed in Appendix 1, Supplementary Table 9. Figure 3 shows a flowchart of included hospital admissions with their distribution by age group and period shown in Table 3.
Flowchart of hospital admissions for COVID-19 attributed to first-ever SARS-CoV-2 infection. We used the British Columbia COVID-19 Cohort. All data were extracted on Aug. 24, 2023. Where step-specific tallies of U07.1- and U07.3-coded hospital admissions do not sum to the displayed total, it is because both diagnostic codes were specified. In addition, but not displayed here, of 1346 deaths identified within the vital statistics database since Jan. 1, 2020, among Lower Mainland residents with underlying cause specified as U07.1 (none specified as U07.3) during the span of intersurvey periods, we excluded 59 (4.4%) with a SARS-CoV-2 NAAT-positive test 90 days or more before date of death. Fewer than 1% of hospital admissions identified provincially were missing information to assign health authority to the Lower Mainland. We did not exclude any hospital admissions or deaths on the basis of missing age or date of admission or death. We did not exclude any hospital admissions on the basis of missing sex, and excluded fewer than 10 fatalities on this basis, handled as indicated in Appendix 1, Supplementary Material 1. Note: FHA = Fraser Health Authority, NAAT = nucleic acid amplification test, VCHA = Vancouver Coastal Health Authority.
Estimated period-specific risk of hospital admission and death from first-ever SARS-CoV-2 infection, by age group, Lower Mainland, British Columbia, Canada
Estimates of IHR and IFR in the 3 periods studied were consistently less than 0.3% and 0.1% overall. By age group, IHR and IFR estimates were less than 1% and up to 0.1%, respectively, except among adults aged 7079 years during the sixth to seventh intersurvey period (IHR 3.3% and IFR 1.0%) and among adults aged 80 years and older during all periods (IHR 4.7%, 2.2% and 3.5%; IFR 3.3%, 0.6% and 1.3%) (Figure 4 and Table 3). The risk of severe outcomes consistently followed a J-shaped age pattern. Risks were higher among those aged 80 years and older compared with all other age groups each period except those aged 7079 years, with whom CrIs overlapped during the sixth to seventh period.
Estimated risk of hospital admission and death from first-ever SARS-CoV-2 infection acquired during the specified intersurvey period, by age group, Lower Mainland, British Columbia, Canada. (A) Period-specific infection hospitalization ratios (IHRs) and (B) infection fatality ratio (IFRs) by age group. Panels A and B do not show 95% credible intervals (CrIs) (but are provided in Table 3) for better resolution, given that upper CrIs extended past 10%. (C) Period-specific IHRs (log10 scale) and (D) IFRs (log10 scale) with 95% CrIs.
Among children younger than 5 years, most (60%65%) hospital admissions for COVID-19 were among infants younger than 1 year (Appendix 1, Supplementary Table 10). With the exclusion of infants in sensitivity analyses, IHR estimates among children aged 14 years were consistently halved but were still higher than among those aged 59 years. We lacked sample size to reliably model estimates for infants, but because about one-third of admissions among those younger than 5 years occurred among those aged 14 years, compared with two-thirds among infants younger than 1 year, we anticipate infant IHRs could be about 8-fold higher than those aged 14 years. Compared with adults aged 6064 years, the IHR and IFR estimates were somewhat higher among those aged 6569 years; in the eighth to ninth intersurvey period, the IHR was 0.07% and the IFR was 0.01% among those aged 6064 years, compared with 0.21% and 0.04%, respectively, among those aged 6569 years (Appendix 1, Supplementary Table 10). By sex, we observed a consistent pattern of higher IHR and IFR estimates among males compared with females, although CrIs largely overlapped when simultaneously stratified by age and sex (Figure 5 and Appendix 1, Supplementary Tables 1113). Finally, we observed minimal change from primary estimates in sensitivity analyses with and without censoring of negative infection likelihoods and with and without exclusion of hospital admissions and deaths potentially owing to reinfection (Appendix 1, Supplementary Table 14 and Supplementary Table 15).
Estimated period-specific risk of hospital admission and death from first-ever SARS-CoV-2 infection by sex, overall and by age group, Lower Mainland, British Columbia, Canada. (A) Period-specific infection hospitalization ratios (IHRs) and (B) infection fatality ratio (IFRs) with their 95% credible intervals (CrIs), using log10 scale. Because of fewer severe outcomes, we did not stratify IHR and IFR estimates by sex for separate age groups younger than 50 years. All ages refers to all age groups combined from younger than 5 years to 80 years and older. Details are provided in Appendix 1, Supplementary Tables 1113.
To inform population risk assessment and response to the COVID-19 pandemic, we used seroprevalence estimates and severe outcome data to derive estimates of the risk of hospital admissions and death per first-ever SARS-CoV-2 infection. By the end of the third year of the pandemic (ninth serosurvey, December 2022) and middle of the fourth year (tenth serosurvey, July 2023), at least 75% and 80%, respectively, of Lower Mainland residents showed serological evidence of a previous SARS-CoV-2 infection. Whereas more than 80% of children and adults younger than 50 years had been infected and were at low risk of hospital admission or death, nearly half of adults aged 80 years and older remained uninfected and at highest risk of severe outcome upon first infection.
Our seroprevalence findings align with a report from Canadian Blood Services, which stated that about 80% of donors nationally were infected by June 2023.41 They also found that infection rates were highest at 90% in their youngest cohort (1724 yr) and lowest at 70% in their oldest cohort ( 60 yr). A recent compilation of Canadian studies similarly reported that 76% of participants had evidence of infection by March 2023.42 Our seroprevalence approach offers the advantage of serial and simultaneous sampling of both sexes across the life span, including the extremes of age, both the very young and very old, which are under-represented in other serosurvey approaches. Moreover, by combining population seroprevalence estimates and severe outcome statistics, we can directly compare their age- and sex-specific risks of severe outcomes.
As previously reported for influenza,43 we observed a J-shaped pattern of age-related risk of severe outcomes that started to increase at about 50 years of age, although risks of hospital admission and fatality from COVID-19 were consistently low at less than 1% and up to 0.1% or less, respectively, until 80 years of age (age 7079 yr during the sixth to seventh intersurvey period). Very old adults were at highest risk, contributing half of all hospital admissions for COVID-19 and two-thirds to three-quarters of all COVID-19 deaths during the final 2 analysis periods. During the eighth to ninth intersurvey period between July and December 2022, estimated IHRs among children younger than 5 years, and adults aged 7079 years and 80 years and older correspond with about 1 hospital admission for COVID-19 per 300, 100 and 30 newly infected people, respectively, indicating at least a 3- to 10-fold higher risk for the oldest adults. During the same period, no child or young adult died, whereas estimated IFRs correspond with about 1 COVID-19 death per 900 newly infected adults aged 7079 years and about 1 per 80 newly infected adults aged 80 years and older, indicating a risk at least 10-fold higher for the latter group. Earlier seroprevalence-based studies documented higher risk for males,4447 notably older males.46,47 In our study, older males also tended to be at highest risk of severe outcome, although CrIs largely overlapped when analyses were stratified by both age and sex.
Our estimates of the risk of hospital admission or death from a first-ever SARS-CoV-2 infection were low overall but derived in a highly vaccinated population. Risks are anticipated to be greater among unvaccinated and lower among previously infected groups of patients, with the lowest risk among those who are both vaccinated and previously infected.15 Before Omicron, when vaccine coverage was lower, severe outcome risks estimated by others were higher than we report here;4453 IFRs by single-year of age were estimated to reach 1% from age 60 years, 3% from age 70 years, 8% from age 80 years and 20% from age 90 years.48 Post-Omicron, fewer seroprevalence-based estimates are available, but among Danish blood donors aged 1772 years, more than 95% of whom were vaccinated twice, the IFR from January to March 2022 was 0.02% among the oldest adults (6172 yr).54 Danish estimates are lower than our IFR for adults aged 6069 years (0.11%) during our overlapping sixth to seventh intersurvey period (September 2021March 2022), when we observed the highest period-specific risks, notably among adults aged 80 years and older (3.3%). Unlike the Danish context, however, our sixth to seventh intersurvey period spanned both Delta and Omicron circulation, with other studies showing that, independent of other variables, Delta was more severe than Omicron.5558 Thereafter, during our seventh to eighth intersurvey period of mostly Omicron BA.2 followed by BA.5, severe outcome risks were lower but increased again among older adults during the eighth to ninth intersurvey period of mostly BA.5 followed by BQ.1. Greater severity of BA.5 infections than BA.2 infections has been noted by others and may have influenced the pattern we observed.59
Other factors may have contributed to the higher risk among older adults during the autumn of 2022. By the eighth serosurvey in July 2022, more than half of older adults had received 4 doses of mostly monovalent, ancestral SARS-CoV-2 vaccines, increasing to more than two-thirds by the ninth serosurvey in December 2022, when as many as one-third of older adults had received 5 doses (bivalent BA.1 or BA.4/5) (Appendix 1, Supplementary Material 2).40 Earlier receipt and repeat doses of monovalent or bivalent products containing antigenically distinct (e.g., original or BA.1) strains may have contributed to reduced or waning cross-protection, especially against more immune-evasive BQ.1 subvariants.6069 The extent to which original priming and its booster reinforcement may affect response to subsequent antigenically distinct variants, and the capacity to overcome that through updated antigen or other approaches, remain under debate for both influenza and SARS-CoV-2.70,71
To date, recommendations for prioritization of updated vaccines by age for the fall of 2023 have varied, with some jurisdictions in Europe targeting people aged 60 years and older,72 and other countries, including Canada and the United Kingdom, targeting those aged 65 years and older.39,73 Our exploratory analyses showed some gradation in the risks of hospital admission and fatality per first infection between those aged 6064 years (about 1 per 1400 and 10 000, respectively) versus 6569 years (about 1 per 500 and 2500, respectively). The 65-year threshold aligns more closely with seasonal influenza immunization programs in most provinces.74 The greatest risk of severe outcomes from SARS-CoV-2 infection, however, was among patients aged 80 years and older. Ultimately, in addition to the risk of severe outcomes, the population impact of COVID-19 by age is also determined by the absolute size of the age cohort and the likelihood of having been, or becoming, infected.
All serosurveys are subject to potential biases and, as previously discussed,9 our use of residual clinical specimens will have tended, on balance, to underestimate seroprevalence. The intersurvey differences in cumulative infection-induced seroprevalence we report de facto subtract previous infections, thereby representing the risk of first-ever infection as acquired during the specified period. Our serial, cross-sectional, population-based approach does not follow the same cohort of people longitudinally and cannot predict or account for antibody waning or its complex variation by, for instance, age or vaccine status. As such, our estimates are best interpreted as indicating at least that number infected between serosurveys. Risks of hospital admission and fatality per infection would then conversely be overestimates. Even though our estimates of the risk of severe outcomes were low, they are likely even lower for most of the population, particularly among those both previously vaccinated and infected who are now the majority overall.15 In that context, and given lower likelihood of previous infection among older adults, the overall J-shaped age pattern we reinforce is likely robust. To identify severe outcomes and assign attribution to COVID-19, we used the DAD and vital statistics databases, allowing sufficient lag (> 37 wk) to ensure completeness of data (typically requiring up to 6 mo). Although we used well-established DAD and vital statistics data sets, including validated ICD-10-CA codes for COVID-19 outcomes,3338 we have no official standards against which to verify our data. Reassuringly, the 47% of hospital admissions we identified as for COVID-19 (Figure 3), is comparable to the proportion (45%) assigned as for (v. with) COVID-19 based on more limited chart review within the Vancouver Coastal Health Authority.7577 The proportion we excluded (11%) on the basis of potential reinfection is similar to the proportion with multiple hospital admissions (n = 1906, 12%) among 16 333 total hospital admissions for people with a positive SARS-CoV-2 test as identified in a separate BCCDC review between Apr. 1, 2022, and Mar. 31, 2023.78 We cannot rule out some misclassification or omission, and given targeted NAAT testing, our efforts to further reduce potential reinfections among hospital admissions or deaths, could not capture those not tested. Reassuringly, our estimates did not vary with or without exclusion of identified potential reinfections. Our findings address severe acute outcomes but do not take into account longer-term post-COVID-19 conditions, nor did we factor reasons for or durations of admission, which likely vary by age. Finally, we did not have data on ethnicity, socioeconomic factors or comorbidities, and our use of sex as specified within available data sets may or may not represent peoples self-identified gender.
By July 2023, around 80% of Lower Mainland, BC, serosurvey participants had been infected with SARS-CoV-2. In the context of high vaccine coverage contributing to hybrid protection, most children and adults were at low risk of severe outcomes from COVID-19. A substantial proportion (> 40%) of the oldest adults, however, remained uninfected and at highest risk of hospital admission or death. First-ever SARS-CoV-2 infections among older adults may still contribute substantial COVID-19 burden, reinforcing the importance of their continued prioritization for vaccination and their consideration in health care system planning.
The authors wish to acknowledge the serological testing oversight and contribution of the British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory and Providence Health Care Special Chemistry Laboratory, including Julia Dyer, Tamara Pidduck, Jesse Kustra, Mandana Shamlou, Laura Burns and Marc Kour. They thank Rhonda Creswell and Iva Tong of LifeLabs for supervision of serum collection. They also thank Hind Sbihi, Brent Gabel, Solmaz Setayeshgar, Yayuk Joffres, Hannah Caird, Mieke Fraser, Sharon Relova, Jimmy Lopez, Joy Ding and Ayisha Khalid of the BCCDC for their supportive input, consultation or analyses. Finally, they thank the many other frontline, regional and provincial practitioners, including clinical and public health providers, epidemiologists, Medical Health Officers and others for their contributions to surveillance case reporting in British Columbia.
Competing interests: Danuta Skowronski reports grants from the Canadian Institutes of Health Research and the BCCDC Foundation for Public Health, paid to her institution, for other SARS-CoV-2 work. Romina Reyes is chair of the British Columbia Diagnostic Accreditation Program committee. As the Provincial Health Officer with authority under the emergency provisions of the Public Health Act, Bonnie Henry authorized the provision and analysis of the anonymized sera used in this study; the study was separately reviewed and approved by the University of British Columbia Clinical Research Ethics Board. No other competing interests were declared.
This article has been peer reviewed.
Contributors: Danuta Skowronski, Samantha Kaweski, Michael Irvine and Kate Smolina conceived and designed the study. Samantha Kaweski, Shinhye Kim, Suzana Sabaiduc, Romina Reyes, Bonnie Henry and Inna Sekirov acquired data. Danuta Skowronski, Samantha Kaweski, Michael Irvine and Erica Chuang analyzed data. Danuta Skowronski, Samantha Kaweski and Michael Irvine drafted the manuscript. All of the authors revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
Funding: Funding was provided in part by the Public Health Agency of Canada (no. 2021-HQ-000067) and the Michael Smith Foundation for Health Research (no. 18934).
Data sharing: Aggregate serological data are provided within the manuscript and the supplementary material. Any further data sharing of seroprevalence data will be considered upon reasonable request to the corresponding author with appropriate review and aggregation, as required to comply with the provincial legislation under which the data were assembled and respecting privacy and confidentiality requirements. Severe outcome and integrated case surveillance data sets used for hospital admission and fatality estimates were accessed through the British Columbia COVID-19 Cohort (BCC19C), a public health surveillance platform integrating COVID-19 datasets with administrative data holdings for the BC population. The BCC19C was established and is maintained through operational support from Data Analytics, Reporting and Evaluation (DARE) and the BC Centre for Disease Control (BCCDC) at the Provincial Health Services Authority. The authors are not permitted to share these data; BCC19C data are only available to researchers who request and meet the criteria for access.
Disclaimer: The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. All inferences, opinions and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Steward(s).
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
Last week, the Kansas City City Council allocated the remainder of its funds from the American Rescue Plan - federal funding that helped businesses recover from COVID-19.It's the final 20 million dollars going to the citys ReBuild KC neighborhood grants.Henry Wash is a part of one of the groups that will benefit, the High Aspirations Mentoring Program. Its a place for young men and boys between the ages of eight and 18 to go and have positive interactions and positive mentoring that will help keep them away from bad situations.They do need time and attention, socially, mostly academically and spiritually," Wash said. The city says High Aspirations is an example of how some Kansas City communities are being rebuilt from the inside out. That's why they were one of nearly 300 area projects receiving a grant from the two-year RebuildKC fund.A lot of times, it's a little bit of funding, a little bit of extra support from the city, that can get them to build and expand these great programs," City Manager Brian Platt said. Last week, the city officially allocated the rest of the money to 69 other programs.The goal is to get dollars into the hands of the people who are providing services and support for the people that need it the most," Platt said. High Aspirations started in 2003 with just 12 kids. Theyve grown to more than 200 in the program.They learn to care about their families and the people around them, Bill Dunn, a High Aspirations board member and donor, said. High Aspirations is receiving a $100,000 grant from the RebuildKC fund.
Last week, the Kansas City City Council allocated the remainder of its funds from the American Rescue Plan - federal funding that helped businesses recover from COVID-19.
It's the final 20 million dollars going to the citys ReBuild KC neighborhood grants.
Henry Wash is a part of one of the groups that will benefit, the High Aspirations Mentoring Program. Its a place for young men and boys between the ages of eight and 18 to go and have positive interactions and positive mentoring that will help keep them away from bad situations.
They do need time and attention, socially, mostly academically and spiritually," Wash said.
The city says High Aspirations is an example of how some Kansas City communities are being rebuilt from the inside out. That's why they were one of nearly 300 area projects receiving a grant from the two-year RebuildKC fund.
A lot of times, it's a little bit of funding, a little bit of extra support from the city, that can get them to build and expand these great programs," City Manager Brian Platt said.
Last week, the city officially allocated the rest of the money to 69 other programs.
The goal is to get dollars into the hands of the people who are providing services and support for the people that need it the most," Platt said.
High Aspirations started in 2003 with just 12 kids. Theyve grown to more than 200 in the program.
They learn to care about their families and the people around them, Bill Dunn, a High Aspirations board member and donor, said.
High Aspirations is receiving a $100,000 grant from the RebuildKC fund.
Vaccines contaminated with undisclosed ingredients. Manufacturers facing liability. In an Oct. 21 thread on X, entrepreneur and anti-vaccine activist Steve Kirsch made alarming allegations about mRNA COVID-19 vaccines.
You can now sue the mRNA COVID vaccine manufacturers for damages and the FDA is required to take the COVID vaccines off the market, Kirschwrote. Why? Adulteration. The plasmid bioactive contaminant sequences were NOT pointed out to the regulatory authorities. Its considered adulteration.
In Kirschs fourth X post in the thread, he specificallysaid, SV40 contamination was the basis for his claim. SV40 stands for simian virus 40, a monkey virus found to cause cancerous tumors in lab animals.
Experts say theres no evidence to support Kirschs claim that the mRNA COVID-19 vaccines are contaminated or contain ingredients that werent disclosed to regulators.
The U.S. Food and Drug Administration does not list details on its website about what, if anything, would constitute an adulterated vaccine, but the agency provides some information about other adulterated products. The FDA sayscosmeticsare adulterated if they contain any poisonous or deleterious substance that can make those products injurious to users. The FDA alsosaysthat economically motivated adulteration of food occurs when someone intentionally leaves out, takes out, or substitutes a valuable ingredient or part of a food.
We reached out to the FDA for comment, but did not receive a reply.
We asked Kirsch what evidence he had to support his claim, and he responded with several links, including to a nearly two-hourvideoon Rumble, a websiteknownfor spreading misinformation, and another to an Xthread. He also sent his Substackarticle, which claimed that officials admitted the vaccine is contaminated with SV40.
Drug manufacturers say that noninfectious parts of the SV40 DNA sequence are used to create COVID-19 vaccines, but its routine and not a sign of the virus contaminating the vaccine.
The SV40 virus is a naturally occurring virus and the virus itself is not included in either starting materials, plasmid DNA, or in the final product of the Pfizer-BioNTech COVID-19 vaccine, said Kit Longley, a Pfizer spokesperson. However, specific, non-infectious parts of the SV40 sequence, which are commonly used in the pharmaceutical industry, are present in starting material used by Pfizer and BioNTech.
Longley said Pfizers COVID-19 vaccine was reviewed by regulatory authorities, including the FDA and the European Medicines Agency, and met safety and quality control requirements. Those authorities also approved the development and manufacturing specifications for Pfizers COVID-19 vaccine, Longley said, including a method for assessing residual DNA that is outlined by the World Health Organization and the FDA.
Longley said that residual DNA quality standards are applied similarly to other vaccines.
Small amounts of residual DNA can be found in several approved vaccines, including influenza and hepatitis vaccines, which have been administered globally for more than 30 years, Longley said.
We also contacted Moderna but did not hear back.
The claims about SV40 contamination are linked to findings from apreprint paperthat has not undergone peer review.
AnAprilpreprint paper found elements of a DNA sequence known as an SV40 promoter apartof DNA thatinitiatesthe process of making an RNA copy of a genes DNA sequence in two expired Pfizer-BioNTech COVID-19 vaccine vials. Kevin McKernan, one of the authors of the paper,told PolitiFact in Junethat the whole SV40 virus was not found in the vaccines.
Dan Wilson, a senior associate scientist at Janssen which alsodevelopeda COVID-19vaccine said that the documents Pfizer submitted to the FDA included the full sequence of the plasmid. Wilson hosts Debunk the Funk with Dr. Wilson, a YouTubeshowthat covers science misinformation.
The SV40 promoter wasnt specifically highlighted in Pfizers disclosures to regulators and did not need to be, Wilson said, because it is a nonfunctional part of the manufacturing process and not a bioactive ingredient in the drug product.
Kirsch later amended his claim that the vaccine manufacturers failed to disclose the inclusion of an SV40 promoter DNA sequence in the vaccine.
The SV40 promoter is found in all the vials and it was in the gene sequence that was provided to the regulators, KirschwroteOct. 21 in the thread on X. The problem was that neither drug company ever pointed it out to the regulators.
Tiny amounts of ingredients that do not make a difference do not lead to a vaccine being declared adulterated or taken off the market, said Dorit Reiss, a law professor at University of California Law San Francisco who specializes in vaccine policy and legal issues.
Reiss pointed to examples:
But if a contaminant were found in a vaccine, the FDA would investigate and decide if it is a safety issue, Reiss said.
Kirsch said that the FDA is required to take the COVID vaccines off the market because they are adulterated.
Experts said theres no evidence that the mRNA COVID-19 vaccines contain previously undisclosed contaminants. Pfizer said noninfectious SV40 sequences were part of the starting material for the Pfizer vaccine, and the FDA and other regulators approved the vaccine manufacturing process.
Experts also said the FDA would not be required to take vaccines off the market even if something undisclosed had been detected. The agency typically would investigate the risks before making a determination.
We rate this claim False.
PolitiFact Researcher Caryn Baird contributed to this report.
This fact check was originally published by PolitiFact, which is part of the Poynter Institute. See the sources for this fact check here.
