For the COVID-vaccinated in Canada, a void in public health advice: ‘They seem to be working on it’

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Canadians needed advice weeks ago about what people can do once vaccinated, infectious disease experts say. Yet federal health leaders insist it’s still too soon to issue any kind of guidance.

“The public needs to know what are recommended behaviours,” said infectious diseases physician and University of Toronto professor of medicine Dr. Andrew Morris.

“Otherwise they will make their own decisions, which is fine. But they should have their decisions made on the best available evidence.”

Even Ottawa’s expert vaccine advisors are awaiting guidance.

“We have asked that same question of the Public Health Agency of Canada. We’ve asked them when they’re going to be making their recommendation,” said Dr. Caroline Quach-Thanh, co-chair of the National Advisory Committee on Immunization. “They seem to be working on it, but we’re not part of that decision.”

With vaccinations accelerating, and a promised 9.5 million combined doses due to be delivered by the end of March, and a million or more weekly doses over April and May, many are, or will soon be wondering, I’ve had my shot, now what? What are the rules? What’s acceptable behaviour and what’s not?

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“With spring here and vaccines rolling out, we’ve got more daylight hours and much cause for optimism for the warmer days ahead,” Dr. Theresa Tam, Canada’s Chief Public Health Officer, told a media briefing Tuesday.

Despite the optimism, variants are escalating, Tam said. Community transmission remains high in many communities and we’re in the early days of vaccination coverage. While she expects the advice to evolve “as we go on,” for now, “it’s a little bit too early” to issue new directions on what people can or shouldn’t do once vaccinated, Tam said, though the issue is under “active discussion” with the provinces and territories, she said.

“I think for now the key message is that everyone needs to keep up with personal protective measures which is wearing a mask, handwashing, watching (your) distance and avoid close crowded conditions,” Tam said.

By contrast, the U.S. Centers for Disease Control and Prevention issued its first set of recommendations weeks ago on activities that people who are fully vaccinated against COVID-19 can safely resume, including visit with other fully vaccinated people indoors without wearing masks or distancing, and forgo isolation and quarantine if they are exposed to COVID but aren’t showing symptoms.

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People are considered fully vaccinated for COVID-19 two weeks after the second dose of a two-dose series (the Pfizer-BioNTech or Moderna shots) or two weeks after receiving a single dose vaccination, like the Johnson & Johnson vaccine.

Some prevention measures — masking and distancing in public, avoiding large indoor gatherings —  would still be necessary for everyone, regardless of vaccination status, the CDC said, at least until more is known about how the vaccines protect against the hyper-contagious variants, how long immunity lasts, and until more people are vaccinated.

But “taking steps towards relaxing certain measures for vaccinated persons may help improve COVID-19 vaccine acceptance and uptake,” as well as ease social isolation, the agency said.

It’s not an entirely fair comparison: More than 82.7 million people in the United States have received at least one dose and, of them, more than 45 million are fully vaccinated.

In Canada, by contrast, just 3.7 million Canadians have received at least one dose of an approved COVID shot as of Wednesday; 640,219 have been fully vaccinated.

Canada is stretching out doses as much as four months apart to get a first dose into as many people as quickly as possible.

Even though few are fully vaccinated, “I think Canadians want to know what are the next steps,” Quach-Thanh said. “My understanding is that provinces are also waiting to have some sort of guidance.”

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“If you’re able to have a clear understanding across the country, it’s easier for people to abide by it, whereas if you have Ontario saying one thing, and Alberta saying something else, people wonder why there are differences,” said Quach-Thanh, a University of Montreal pediatric infectious diseases specialist.

They are the same vaccines, and provinces are following largely the same priority rollout across the country, she said. “We are all using one dose on as many people as possible, giving the second dose within 16 weeks of the first dose,” Quach-Thanh said. “So ideally, everybody would have the same approach to public health measures, after that first dose of vaccine.”

Morris said the “still too early” messaging is yet another example of  an “unwillingness to trust the public with useful, practical information,” an approach throughout the pandemic that has been, and will continue to be, harmful, he said.

“We cannot ignore the realities of people being vaccinated, and so it is far better to give them scientifically sound information rather than leaving them to decide for themselves,” Morris said.

The vaccines are highly effective at keeping people from getting severely sick, being hospitalized or dying with COVID, but less is known about how well they keep people from spreading the virus to others. The U.S. Institute for Health Metrics and Evaluations estimates Moderna and Pfizer shots are likely 80 to 85 per cent effective at blocking transmission. However, that means up to 20 per cent of those vaccinated can still get infected and likely still transmit.

Still, “People who are fully vaccinated are fairly well protected,” Morris said. “We won’t have many people fully vaccinated yet. There are reasons to ask people to mask in public. But let’s give people the information.”

No advice will be perfect, Morris said. And there are going to be criticisms, no question.

“But they need to come out with something. And we really needed it, weeks ago.”

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