Canada’s Telehealth Services

Over the past few years, we’ve seen more and more Canadians opting for virtual healthcare services for help with non-emergency concerns. And it’s easy to see why: They grant access through your tech to doctors, mental health professionals and wellness experts who can answer your questions, help you feel better and give you a prescription when needed. The services are available through websites and apps on your phone, making telehealth a super convenient, effective and affordable care option. Plus, they offer a level of privacy some people preferin one study, patients said they felt more comfortable talking to a healthcare professionalat home than in a doctors office.But, not everyone is a good candidate for telehealth. If you have an emergency, the best way to receive treatment is by visiting the emergency room, says Dr. Howard Ovens, Chief Medical Strategy Officer, Sinai Health System and staff emergency physician at Mount Sinai Hospital. Some people are really sick, either related to COVID or all the other things we always see in the emergency department (appendicitis, broken bones, heart attacks), and they need attention, he says. We want them to feel safe and come in to get assessed.For emergencies, whether physical or mental health-related, call 911 immediately. If you or someone you know is considering suicide, call Talk Suicide Canada at 1-833-456-4566 for support 24 hours a day, 7 days a week. You can also text 45645 from 4 p.m. to midnight ET for immediate care. Residents of Quebec can call 1-866-277-3553 or visit suicide.ca.Below, a list of telehealth services available in Canada.

Provincial Telehealth Services

There are a variety of free and confidential telehealth services run by public health authorities in each province and territory. Services differ slightly from province to province, but in general, these government-run programs link users with healthcare professionals (such as public health nurses) through the phone. Once on the phone, users can ask for medical advice on a range of non-emergency topics such as whether or not to handle the situation at home or if the issue requires a visit to the doctors office. Many of these provincial services also have COVID-19 self-assessments which can help determine next steps if youre experiencing symptoms of COVID-19. To learn more, visit your province or territory’s government website.

Inkblot Therapy

Inkblot is an online mental health and wellness platform that offers video counselling sessions. Through talk therapy, hundreds of licensed counsellors and life coaches are available to help you navigate through mental health concerns including depression, anxiety, bipolar disorder, post-traumatic stress disorder, grief and addiction. Costs $50 per half hour.

(Related: The Pros and Cons of Digital Therapy, According to an Expert)

Focus

Focus is an eCounselling service that allows users to access a therapist via video call, phone call, or text message at any time. It also hosts unlimited Text Therapy for $29-39 per week, so that users can have 24/7 access to their therapist and receive daily feedback and support. Hour-long phone or video call sessions cost $120-150 per hour.

Mindbeacon

This mental health app is available across Canada in both French and English and is suitable for those with mild to moderate symptoms of depression, generalized anxiety, social anxiety, panic, PTSD, and insomnia. Mindbeacon works by first assessing users through a comprehensive questionnaire and then assigning cognitive behaviour therapy-based programs that match the users needs. Mindbeacon also facilitates secure messaging with a registered therapist. The service is free for Ontario residents and is covered by employers across the country. Otherwise, rates start at $525.

Tia Health

Tia Health allows patients to connect with Canadian doctors via phone, video or messaging. You can choose your own doctor, and even one who speaks the language youre most comfortable with. Aside from prescriptions, referrals, requisitions, and mental health services, it also offers COVID-19 screening. Tia Health is covered in Ontario, Alberta and British Columbia (fees start at $30 for other provinces.)

Ontario Telemedicine Network

TheOntario Telemedicine Network(OTN) is a not-for-profit organization funded by the Government of Ontario. During your eVisit, you can speak to a healthcare provider via video using a computer, smartphone or tablet. OTN has a plethora of other services including retinal screening fordiabetics, virtual palliative care program, Indigenous services, and virtual mental health coaching. Visit otn.ca for more info.

Virtual Clinics

Like the name suggests,Virtual Clinics offer virtual appointments in which patients can connect to a doctor via phone, video or messaging. Their services include lab test results on demand as well as prescriptions and renewals delivered to your doorstep. Virtual Clinics is free for British Columbia, Alberta, and Ontario residents and starts at $30 for Canadians in other provinces. To book your virtual appointment, visit virtualclinics.ca.

Livecare

Livecare is the only telehealth company owned and operated by physicians. It offer virtual visits with a medical provider with various specialties such as mental health, cardiology, endocrinology, pain management, sleep disorders and many more. Through video, you can discuss prescription refills, lab and test results, follow-up care and general questions. Livecare also has online journals, health trackers and calendars to help you manage your health. Call Livecare at 1-855-599-8817 on weekdays from 9 to 5 p.m. PST.

Maple

WithMaple, you can talk to a doctor in less than two minutes using your smartphone, tablet or computer 24/7. Doctors can help with various medical issues such ascough/cold/flu,urinary tract infections,sexual health, mental health, general prescription renewals, and more. Maple also offers online dermatology, pediatrics, oncology, naturopathy and other specialties. Pricing starts at $69 per visit or $30 per month. To get started, visit getmaple.ca or download the Maple app.

Felix

Felix offers a way for Canadians to getlifestyle medications such as ones for birth control, acne and hair loss. First, you complete your online visit ($40 fee) by answering questions about your medical history. Then, based on your consultation, you can get a prescription within 24 hours. The medication is shipped to your door at no extra cost.

(Related: Its Time to Revisit Your Birth Control Optionsin the Name of Self-Love)

Tulip Health

Tulip Health is an Ontario-based phone service that links users with Ontario MDs. Doctors on Tulip provide a range of services including cold and flu assessments, prescription renewals, referrals to specialists, and COVID-19 assessments. The services on Tulip are free for Ontario residents with a valid OHIP card.

TELUS Health MyCare

TELUS Health MyCare is a mobile app for Canadians living in British Columbia, Alberta, Saskatchewan, and Ontario. It gives users access to virtual consultations with physicians for prescriptions (which can be sent to your pharmacy of choice), assessments, and referrals for diagnostic tests at an in-person lab or clinic. It also has a built-in symptom checker that asks users questions and provides relevant health and triage information, a health check that allows users to get a broader sense of their current health, and a monitor to track health indicators like mood and energy levels. Patients covered under provincial healthcare plans can access the services on the app for free and each consultation is $65 without insurance.

Cover Health

Powered by Telehealth Ontario, Cover Health gives users access to a same-day appointment with an Ontario doctor. Doctors on Cover are able to provide the same services as any in-person walk-in clinic like cold and flu symptoms, sick notes, medication renewals, reproductive health, prescriptions, and more. All appointments are covered for Ontario residents, even without OHIP.

GOeVisit

GOeVisit is a free app that allows users to describe their symptoms and receive a diagnosis and treatment plan from a Canadian medical practitioner. The app works best for minor illnesses like coughs, cold and flu symptoms, and minor injuries. Prices start at $10 per month for individuals and $15 per month for families.

Next: The 5 Best Apps for Soothing Your Mind

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Can you explain to me how the product works? Ive got two little kids, and weve all had a cough we cant seem to shake. It doesnt seem serious enough to bother our family doctor about itat least not yet. But at what point would I decide to go to your website and order up a test?

Everybody gets sick at least once or twice during the typical cold and flu season, so some people are electing to purchase the test kits in advance to have them on hand. Or, if you wake up sick or your child wakes up sick, and you don’t have a family doctor or can’t get an appointment, you can order the kit. Depending on where you are, you can get either an overnight courier or a same-day DoorDash delivery. The kit comes with a barcode that you can scan and get an appointment with a telehealth practitioner who will walk you through every step of the test. Then you get your results in 20 minutes. It’s very simple.

Then what happens?

Depending on the results, we’ll provide some recommendations or information on how to manage the illness. And then if you decide you need more information or want to ask questions, we coordinate a telehealth appointment with a physician on the same day. There may be treatment availabledepending on the illnessif you get the diagnosis soon enough.

Okay, and what does it test for?

The kits include the tests for Covid, influenza A and B and strep throat. We also have an RSV product that’s in development, and that should be out in the next week.(Related: Should You Get Another COVID Vaccine?)

Are the testing methods the same ones that we’re familiar with from using at-home Covid rapid testsa cheek swab or a nasal swab, and a cartridge you drop the liquid into?

Yes, the cold and flu kits are the nasal swab and a throat swab. The RSV test is just a nasal swab. It’s very convenient. For kids especially, going to the ER or urgent care can be a scary environment, so being able to do it at home with a simple nasal swab is preferable.

Right. These days, you don’t want to be in the ER for hours and hours in the middle of the nightit’s always a judgment call whether to go in and brave it or not. And lots of family doctors, or even walk-ins, are booked up for weeks and weeks.

Its a challenge to get in, and our goal is to provide people with information and to help them make decisions. Because that’s really what’s lacking: You don’t know what’s going on. You don’t know if your kid’s going to get worse or not. And with RSV, at some hospitals, the only way you get an RSV swab is if you get admitted. Were providing people with more information.The important thing, though, is that at no point do we want people to stay home if youre really sick, or your kid is sick and needs to go to the hospital. This product shouldn’t get in the way of that. For those who can’t get to a physician, this is a way to access more information.

In a way, this also helps those with mobility challenges, childcare duties or limited access to transportationit can be very hard to drop everything, take time off work and get to the doctor, especially if the doctor is far away. Or if you get sick at night, and your family doctor isnt answering the phone.

Yes, we have people who fall ill on Friday and need to know whether they should cancel their business trip on Monday. If you’ve got a cold or sniffles, it’s probably going to get better in a day or two. But if you’ve got COVID or influenza, that’s going to be five to seven days.The other thing that people aren’t aware of is that there is treatment available for influenza [antivirals like Tamiflu], and certainly there’s treatment available for strep throat [antibiotics]. At your doctors office, the swab for strep throat takes three days to come back and by that time you’re either worse, or they’ll prescribe antibiotics whether you needed them or notand then we’re exposing people to antibiotics that they don’t need. Being able to get a proper diagnosis quickly enables more efficient and appropriate treatments.(Related: 14 Virtual Care Services in Canada You Need to Know About)

How does the telehealth appointment work? You pay for the kit, but you don’t pay for the telehealth appointment after the test?

The telehealth appointments are covered by the provincial health plans. We try really hard to work within the public systemwe’re trying to be complementary to the public system at all times. We’re providing service that’s adjacent to the system. Were facilitating you getting an appointment when maybe you can’t get one elsewhere.

Theres been a lot of talk about the privatization of the Canadian healthcare system, and how its been chronically underfunded and neglected. So some people might look at this and think, this is an equity issue. Not everyone can afford this test, and thats not okay. But theres also the inequity of what happens when you can’t access health care at all, or dont have a family doctor, or cant wait in the ER for hours. I’m sure you’ve thought about that a lot.

Absolutely. The fact that these kits are available to anyone, anywhere, anytime, I think is an equity issue. It addresses it, as opposed to making it worse. The other way to look at this, actually, is that were increasing equity. And even in remote locationssince we ship the kits across Canada. In underserviced areas, these kits are providing people with information and the knowledge that they need.

That’s increasingly important as we see rural emergency rooms closing. In a small town, it can be a long drive to the nearest hospital.

Right. Were health care peoplewe work in the public system as well. I was an ER doctor in North Vancouver for almost 30 years. Were working towards developing solutions and improved care for everybody. We’re trying to figure these things out that nobody seems to be able to figure out. For the last 50 years of public health care in Canada, the innovation just hasn’t been there. Ive witnessed a lot of the challenges in the system and been really frustrated by the inability to effect change, for Canadians who can’t get the answers they need.

Pre-pandemic, the idea of doing a self-administered test like this at home just wasn’t really something Id ever imagined. But now, when I’m packing for a trip, I throw a box of tests in my suitcase, of course. And we test ourselves and our kids at home all the time. Without COVID, do you think consumers would have been ready for this kind of product?

Yeah, I think it’s accelerated the change. But it’s not just the test: It’s the support, it’s the information around the test and the ability to take the results to a family doctor. We try to enable them to get the information and the actual care that they need.Personally, I’m not interested in just selling people tests and saying, go for it. I’m trying to provide comprehensive care that meets all of the expectations and that’s complementary and collaborative with the system. You can do a test with us and then you get an emailed result, and then you can take your test results to your doctor if that’s what people want. We’re certainly not trying to poach people from their doctors or encourage them to go with our system, versus another way. It’s just providing information and choice so that people can make their own decisions on how they manage their health. With COVID [restrictions and telehealth], people are recognizing that there’s other ways to do it, and that they don’t always need to go into the doctor in person. In some ways, we can offload the family doctors to look after the people who really need it. And if we can be part of the solution, that’s awesome.This interview has been condensed and edited for clarity.Next: The Best Over-the-Counter Cold and Flu Meds

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Who is eligible for a fourth dose?

If youre in the 44 percent of the population over the age of 12 who hasnt gotten their booster (a.k.a. the third dose), experts advise doing so now. Itll help keep you protected as the country goes through the new wave.As for the fourth dose, eligibility varies from province to province. In Ontario, Quebec, Yukon, Nunavut, Alberta and New Brunswick, anyone over the age of 18 is eligible for their fourth dose. In PEI, anyone over the age of 12 is eligible. In British Columbia, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador and the Northwest Territories, only people in vulnerable groups such as seniors, those with compromised immune systems and those living in group settings are eligible to receive their fourth dose.Did you recently receive your third dose? Some provinces require at least three months between your third and fourth dose, while other provinces require six. A recent COVID infection will also prevent you from getting another shot: Most provinces require that you be three months post-infection before rolling up your sleeves.

Why are some provinces allowing the general population to get fourth doses and some arent?

There are two philosophies around who should get vaccinated and when, says Bowdish. Public health agencies in some provinces believe only those who are at a high risk of getting seriously ill, such as older adults and immunocompromised people, need a fourth dose. Others believe vaccinating the general public can reduce the total amount of infections and prevent infections from reaching vulnerable communities.

Are fourth doses effective, particularly against Omicron?

The vaccine we are using is based on the first COVID-19 virus, Bach says, but, the virus has gone through several rounds of evolution. So the vaccine isnt as protective against the newer variant, Omicron, and its subvariants.A recent study from the CDC found that fourth doses were 80 percent effective against severe illness from Omicron. Although the newer BA.4 and BA.5 subvariants that are driving the current wave of cases in Canada werent part of this study, Bowdish says a fourth dose is indeed effective at reducing infections. But, theres a catch: Its time limited, she says. You get only three months of really good protection and then it starts to wane.

What if youve already had COVIDwhen should you consider a fourth dose?

Both Bach and Bowdish say its unclear exactly how long immunity from a COVID infection lasts, and BA.5 is good at dodging the immune system.Bowdish recommends that people whove recently had COVID (within the last three months) wait to get their fourth dose. The antibodies their body produced to fight the virus when they were sick can help keep them protected until they get another dose, which would provide an additional three to six months of protection, she says. All provinces advise waiting about three months before getting their next dose.

Are there any risks to getting another dose?

Bowdish and Bach agree there are no downsides to getting a fourth dose. While theres been some worry were boosting too much, thats actually a misconception, says Bowdish. Theres no evidence in the history of vaccination of that ever happening.And, while earlier concerns around vaccine supply mightve prompted people to worry about jumping the vaccine line,were no longer in a situation where the demand for vaccines is outpacing supplytheres enough for everyone who wants one.

Whats this I hear about the Omicron-specific vaccine? Is it worth waiting for?

mRNA vaccines, which are the type of COVID vaccine that most of us already have, can be tweaked to target the Omicron variant. Currently, Pfizer and Moderna are both testing retooled versions of their vaccines to include the Omicron variant and are on track to be ready by the fall. But it could be as late as December.Bowdish says instead of waiting, we should consider getting another dose three to six months after our last booster or infection.

What else should people consider when thinking about getting their fourth dose?

If theres some big event or trip coming up, Bowdish recommends getting a vaccine two weeks before you leave. Thats a pretty good insurance policy to ensure that your trip isnt disrupted by being ill.Next:What You Need to Know About COVID Vaccines for Kids 5-11

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Why I still worry

Looking back, the statistical footprint of two years of COVID in Canada is staggering3.34 million cases, more than 37,000 deaths and over 81.5 million doses of vaccines administered. Looking forward, new variants of concern, waning vaccine effectiveness and the prospect of living with some form of COVID for the foreseeable future makes it hard to let our collective guard down.As an internal medicine physician in Toronto, Ive spent a good part of the last two years on the frontline. COVID has impacted every clinical and administrative aspect of my job from wearing PPE for all patient encounters to moving care to virtual platforms to training the next generation of health professionals for future pandemics. I continue to be amazed by the sheer grit, work ethic and determination of my colleagues provide the best care possibleeven when we went from being hailed as heroes to combating misinformation and fearing harassment from anti-vaccine protesters. But my worry now shifts to whats to come because the full effects of COVID on our health care system and health care workers wont be known until this crisis is behind us.(Related: I Need You to Know: Vacation Doesnt Solve Burnout)My colleagues are experiencing unprecedented burnout. Its been a relentless two years, and Im not surprised that nurses and physicians are ramping down their work and responsibilities and even leaving the profession in droves. This exodus could not be more ill-timed. There is a massive backlog of medical assessments, procedures and surgeries that have been deferred for two years. There is the urgent need to fix the broken systems the pandemic laid barelike our long-term care homes, lack of mental health infrastructure and extensive care access issues for the people most at risk. And COVID has created new demands on the health care system, like patients with long COVID, that weve yet to fully figure out how to triage.With the relaxing of mask mandates on the horizon and reopening plans firmly in place across multiple provinces for the spring, you would think this would be a time to be hopeful and optimistic for the future. But it doesnt really feel this way, partly because there are so many unknowns. Will opening up drive case counts up? Will we need to reintroduce restrictions? Will there be some new summer variant that sets us back again? Will we need more vaccine doses? Its hard to envision what the future looks when its not clear if and how the pandemic will end.

Where to find hope

To others that are feeling fatigued and numb at the prospect of another abnormal year, I do strongly believe this year will be better than the last.From a scientific perspective, we have a much larger and evolving body of COVID knowledge to guide us. There are multiple large Canadian-led studies, including the Canadian COVID-19 Prospective Cohort Study (CANCOV), that are helping us better understand the long-term effects of COVID and how to help patients experience lingering symptoms. We also have new treatments, like antiviral medication, that can hopefully mitigate some of the risks of COVID.(Related: What You Need to Know About Long COVID, According to a Long COVID Researcher)There is also much more public recognition of the evolving workforce crisis and burnout among nursing and personal support workers, forcing a political will to make meaningful system changes. For example, the Ontario government plans to invest $342 million over the next five years to add 13,000 nurses and personal support workers (PSW) to the province. While this is not a solution, its at least a start. Im optimistic we can use the learnings from COVID to galvanize a coordinated effort to improve other large systemic issues like elder care, mental health access and systemic inequity.Where Im personally finding hope right now is in the small steps I will get to take toward normalcy as things open up, especially those activities Ive either forgotten or taken for granted. I look forward to attending weddings. Planning a baby shower for the arrival of my second child. Seeing a movie. Going to a gym. Planning a vacation. Im grateful that, unlike last year, we have all the tools available to uslike rapid testing kits, N-95 masks and booster vaccine dosesto make gatherings and activities as safe as possible. Rather than worry about the things I cant do, Im trying to find joy in the things we are able to do safely. Embracing our new, and ever-evolving reality.So, on this second pandemic anniversary, maybe we should stop aspiring to go back to the way things were before. This pandemic might not have a distinct end. Instead, think of the pandemic as a major life event, like a birth or a death of a loved one. After those milestones, there is no going back to the way things were. The best we can do is to find joy and meaning in our new reality.Next: Everything You Need to Know About COVID Antiviral Pills

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What are some of the most common long COVID symptoms?

Fatigue, shortness of breath, cognitive impairment or dysfunction, sleep issues, and tachycardia or heart palpitations. Those are some of the common symptoms, but there are as many as 200 symptoms.

What are some of the less common symptoms?

Change in smell and taste. Muscle aches and pains, joint pains as well are other issues. But I think the most concerning thing is that a number of these patients can’t go back to their usual activities. Some studies are saying that around 10 percent of people experiencing long COVID have symptoms that are severe enough they cant go back to their usual activities.

And what might that mean for someones quality of life and livelihood?

Theres a wide range of severity [of symptoms]. For some people, it’s more of a nuisance and they continue to do their daily activities. Other people can’t work, they can’t look after their families, they are debilitated and spend the day in bed.

Aside from the physical symptoms of long COVID, how is this condition impacting mental health?

As you can imagine, it can be quite scary. We have some highly physically active people, like people who’ve been running marathons, who now have trouble walking a block that can be very scary and can cause anxiety and depression. Plus, theres the unknown of not knowing if this will be for their whole life. For some patients, they’ve lost their whole family and they have post-traumatic stress disorder (PTSD). And the sicker you were, the higher the likelihood of having anxiety, depression and PTSD. When someone is confronted with an unknown and unexpected disease, like cancer for example, people have similar [mental health] symptoms.(Related:How to Embrace Your Sexuality After a Cancer Diagnosis)

Theres been a lot of discussion around the burden that the pandemic has put on women, particularly mothers. What might long COVID mean for womens recovery after the pandemic?

Its definitely harder for women because women often have multiple roles that affect both the workplace and the home front. When a patient tells me they don’t see improvement in their symptoms, I ask them what theyre doing at home. Because if they’re not working outside [because of their symptoms], what they may be doing is looking after kids more and doing more housework and looking after their parents and not resting.

We are still understanding the scope of this problem, but what could long COVID mean for Canadas health care systems down the line?

So, we know how many people have had COVID in Canada, its estimated that thats more than 3.1 million people across Canada. If we take the low end of the 10 percent estimate [of long COVID occurrences] thats more than 300,000 people with long COVID. But we think its more than that.Its going to increase health care utilization. People will want to see specialists and there will certainly be many issues. Not only in terms of accessing health care, but the loss of productivity and loss of salary and livelihoods.

Can you tell me about some of the research you and your colleagues are working on right now?

There are multiple studies were working on. One is called CanCovits a study thats been going on now for over a year. Weve recruited more than 2,000 participants across five provinces and 18 centres across a severity of illness and were following them. What we have learned is that one, our first COVID patient in Canada was diagnosed on January 25, 2020. But through antibody testing, we found a COVID-19 case on December 25, 2019. The second thing that we learned is that those who have more severe diseases, like those who have survived the ICU, have the highest antibody levels compared to those who were not hospitalized.We also have a randomized adaptive platform trial called RECLAIM (Recovering from COVID-19 Lingering Symptoms Adaptive Integrative Medicine), and we are testing various therapies for long COVID.From what weve learned, we have developed some treatments and have been using them in rehab across the country and testing out if there are better ways than what were currently doing to treat COVID patients so they can recover faster.

What can you tell us about these long COVID treatment programs?

For COVID-19, we want them to move, but we don’t want to push them too much because they can relapse or have flare-ups. We have adopted some pathways for rehabilitation, depending on how much a person can do and where their threshold is as well, in terms of trying to do things under that threshold. In general, people do improve over time if they do it right though there can be bumps on the way if people exert too much and relapse.There are self-management programs. Because there’s so many people, you can’t really get them all into rehab, so we focus on education. So, for example, we teach patients that they have a pot of energy and physical, mental and emotional exertion takes energy from this pot. Then, if they relapse, they have to look back and see what they did the last few days. Some patients have said, watching a sad movie makes me totally exhausted because it taps into the emotional piece.

Are there any in-patient treatments being done right now?

Yes, there are in-patient treatments that work with physiotherapists and occupational therapists. The principles are quite similar. [Professionals] have to gauge what [patients] can do, and then try to progress them but keep under that [energy] threshold. Usually, we try to do the activities of daily living first. That means if someone takes a shower and they feel exhausted and have a flare-up after, then we try to teach them what to do so that theyre not exerting themselves to take that shower.

The treatments weve been talking about so far are mostly targeting energy and fatigue. Are there treatments to help with other symptoms?

For sure. So, for example, with shortness of breath, we teach people to take deep breaths in slowly and expand their lungs. At the maximum end of an inhalation, you take a little bit more in. And then slowly let it out, and at the end of the exhalation, try to squeeze the last piece of air out. And you want to do that cycle for six to 10 seconds. It gives you a sense of slow breathing and strengthens the breathing musclesyou have muscles in between your ribs and muscles in your diaphragm that help move your lungs. For most people [the shortness of breath is] a muscle issue, not a lung issueunless they have prior lung disease. The additional advantage of the breathing exercises is that it modulates your autonomic system.

Weve been talking through the pandemic about how our health care system isnt built this level of demand. What will it take to accommodate all this future need?

We need to advocate for more long COVID clinics that can look after patients. We need family physicians to be on board and to know how to treat long COVID patients. We need to open rehab facilities.Our health care system on a good day prior to the pandemic was a bit stretched. I’m a general internist and I work in an acute care hospital, so every year, especially in the winter when there’s flu and we are very stretched, we have patients in the hallway. The problem is most rehab is not funded by the government in most provinces, so are these [costs] going to come out of pocket for the patient? How are people going to access care? There are many, many questions.This interview has been edited for length and clarity.Next, here’s what you need to know about whether you’ll need a fourth COVID vaccine dose.

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Does the new federal COVID passport work for iPhones users?

Proof of vaccination has varied from showing the printed or emailed records received after a vaccine appointment to physical vaccine cards and more recently QR codes. In late October, the federal government announced new standardized proof of vaccination in the form of a downloadable QR code.All Canadian provinces and territories are now following the SMART Health Cards Standards, a digital method of presenting verified health records created in response to COVID-19. It can be downloaded on a mobile device, computer or mobile wallet for iPhone users, and it’s designed to be globally accessible. Individuals outside of Canada, or who were vaccinated outside of Canada, can download and access their health records on the Apple’s Health and Wallet apps as long as their vaccine provider supports the SMART Health Cards standard.

How to add COVID-19 vaccine records to the Apple Health app

These steps are only applicable for devices using iOS 15 or later so before starting, make sure your software has been updated.

1. Access your vaccine records online. With the Canadian COVID-19 proof of vaccination plan, Canadians can access their vaccine history via the Government of Canadas website. This will require your provincial health card and some personal information, such as your date of birth.
2. Print your QR code or download it to your desktop. At this stage, your vaccination records can also be stored in your iPhone files as a PDF.
3. On your iPhone, open the photo app and point the camera at the QR code. The phone should scan the code prompting a link to appear.
4. Click the link and follow the prompts to save the records to Apple Health. These records will be stored in the “health records” section of the Health app under “Immunizations.”

These records are now stored and ready to present at restaurants, gyms and other venues, along with personal identification.(Related: Flu Season Is Going to Hit Hard. Heres How to Prepare)

How to add COVID-19 vaccine records to Apple Wallet

In order to add a vaccine passport to Apple Wallet on iPhone or iPod touch, devices must be updated to iOS 15.1. The vaccination card will detail your full name, type of COVID-19 vaccines received, the date of each dose, where it was issued and a QR code. None of these details will be accessible without the use of Face ID, Touch ID or a passcode and the vaccination card cannot be shared with other devices. When presented at a public venue, the QR code can be scanned to verify vaccination status.

1. If you have previously added your vaccination record to the Health app, open the Health app, tap summary and there will be a prompt under the vaccination record to add this record to your Apple Wallet. One tap is all it takes.
2. If you are downloading your QR code for the first time, access your vaccine records via the Government of Canadas website.
3. Open the photo app and position the camera as if to take a photo of your QR code. Your iPhone will recognize the QR code and show a Health app notification, offering an option to add these records to Wallet and Health apps. Follow the prompts to add the record to both apps.

All vaccination cards will be grouped together in Wallet and there is no limit to how many vaccine passports can be stored in the app. These vaccination records can be deleted out of Wallet at any time, but if deleted, will still exist in the Health app. Both records need to be deleted separately.In the event that vaccination records need to be updated or changed, for instance after receiving a booster shot, download the new updated vaccination records to the Heath and Wallet apps. Records will not update automatically.For more detailed info on storing health records and troubleshooting, see Apple’s COVID vaccine passport support page.Next: Could Protection from COVID Soon Be Available Through a Nasal Spray?

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What’s the difference between a third dose and a COVID booster?

Before Omicron, the average person who received two doses of an approved COVID-19 vaccine was considered fully vaccinated.Data quickly emerged that immunocompromised individuals, like transplant patients on anti-rejection drugs, had a lower antibody response with two doses and needed a third dose. These third doses were not considered boosters because these individuals needed all three doses for protection.Last summer, we learned from Israeli data that a significant part of our antibody immune response wanes about six months after our second vaccine dose. When combined with winter Delta variant surges followed by the highly-mutated Omicron strain exploding in numbers, we started to see many more breakthrough infections in people with two doses of vaccine.While two doses seem to provide enough protection to prevent recipients from needing hospitalizations and ICU admission, it is not enough to reduce transmission of Omicron, especially in higher risk indoor settings. Because of this, many experts are now thinking of Pfizer and Moderna COVID vaccines as three-dose vaccines, with all three doses needed to be fully vaccinated. Many existing vaccines come in a similar three dose series, like the hepatitis B vaccine or the HPV vaccine.With mounting evidence that three doses are better than two, the Public Health Agency of Canada plans to revisit the number of doses required to be considered fully vaccinated once more Canadians have had a third dose.(Related: COVID-19 Vaccines Are VitalAnd So Are These)

If this is a three-dose vaccine, why are some people now getting a fourth dose?

Canada, along with the U.S. and the U.K. are offering a fourth vaccine doses to people in high-risk groups and people who are immunocompromised. Individuals who are immunocompromised require more COVID vaccine doses to generate an immune response and COVID antibodies.Because third doses were rolled out much earlier for high-risk individuals, their immunity is likely waning now, amid a surge in COVID cases. The hope is that four doses will induce a robust immune response to Omicron in those that are at the highest risk of complications, like long-term care residents, cancer patients, seniors who live in congregate settings and transplant patients.Israel is one of the only countries that is already offering fourth vaccine doses to people over 60 since and is likely to start offering fourth doses more widely in the near future. On Jan. 3, Israels prime minister announced, based on the results of a small unpublished study of hospital staff, that antibody concentrations increased fivefold a week after a fourth vaccine dose. Though research is still ongoing, no data has been published yet and it remains to be seen what the value add of a fourth dose might be.

So, could we need another booster eventually?

It is possible, but not certain. There are many factors at play here. First, we need to better understand how much protection third doses give us and for how long. We also need to continue to collect any available data we have on fourth doses. It will take several months for researchers to know whether people who received fourth doses had more protection against infection, severe illness and hospitalizations than those with three.Second, the amount of virus circulating in the community matters. If Omicron spread settles down and case counts decrease, we might not need the immunity boost from a fourth dose. But if a new variant emerges in the summer that is just as prevalent as Omicron, we may need that boost in immune response to curb the spread.Israel has been several months ahead of us when it comes to vaccinating their population. Their data on fourth doses will hopefully help us understand if there is a benefit to larger sections of the population.

Why would we no longer need additional doses? It seems like that is where we are headed.

It has been notoriously difficult to predict the future during this pandemic. We simply dont know exactly what will happen six months from now, whether its emerging variants or waning immunity.Canada, along with the U.S. and U.K., is waiting for more data on waning immunity and effectiveness of vaccination in reducing hospital admission before it decides on offering a fourth jab to a wider group of people.Researchers willbe studying people’s antibody levels in the months following a third dose. While those levels are expected to drop in four to six months, the degree to which it will drop is unknown. If the drop is minimal to moderate, we may not need more doses.There are also some new factors to consider, like how the outpatient antiviral treatment Paxlovid could impact hospitalizations and severe illness numbers as it becomes more widely available in Canada.(Related: Everything You Need to Know About COVID Antiviral Pills)

Are we likely to see variant-specific boosters in the future?

In theory, COVID vaccines can be adapted and updated as variants emerge. But it still might not be fast enough.Both Pfizer and Moderna made Beta- and Delta-specific vaccines, but it was found that the original vaccine had an equivalent response so there was no need to make a change. Pfizer is working on an Omicron-specific booster that could be ready for use as early as March. But with the speedy spread of Omicron, many people may experience an Omicron infection before the booster is ready. Also, third doses of the existing vaccine neutralized Omicron in preliminary studies, stunting the benefit of an Omicron specific booster.If new variants continue to emerge, they could evade parts of our existing immune response from the vaccine, as we saw most recently with Omicron. At some point, more of the same vaccine may not be better and we may need to update the vaccine. We could also see the vaccine evolve in other ways. Moderna announced in the fall it was working on a new mRNA-based influenza vaccine that is combined with a booster COVID-19 dose.We all hoped the pandemic would have ended by now. But the good news is that as the pandemic evolves, so have our tools to protect ourselves.Dr. Seema Marwahais a general internal medicine physician in Toronto and an assistant professor at the University of Torontos Department of Medicine. She is also the editor-in-chief ofHealthy Debate.Next: Could Protection from COVID Soon Be Available Through a Nasal Spray?

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Yes. Now, more than ever, we need to celebrate annual rituals. Even if we cant be together, especially if cant be together, we need to mark the passing of this terrible year. After all, familiar holiday favourites are the epitome of comfort food, and if there ever was a year when we needed comfort. But that doesnt mean you need to worry about starting today or buying antacids in bulk a holiday meal can still feel special without causing stress.(Related: 14 Ways to Celebrate the Holidays at Home)

How do I begin?

Talk to your immediate family and see this as your chance to make the holiday meal you want. Hate turkey? Always wanted to try an elaborate vegetarian pie, an Italian seven-fish feast or a big brunch instead of an evening meal? This is your year!Consider which meals say “holiday to you. I have so many that I plan to stretch them out over a few days. I need to have my moms tourtire, roast beef with all the trimmings and plum pudding. Which dishes will make it feel like the holidays for you? Dont forget to think about your leftover wishes. (A ham or turkey, which a crowd will pick to the bone, may feed you for a week this year. Fish, on the other hand, is more of a one-shot deal.)Once youve settled on a rough menu, fill out the margins. Write down all the snacks, side dishes, sauces and desserts you want to round out the meal. This planning will pay off in the stress department. Looking for guidance on how to make those sides or desserts for the first time? Lean on trusted resources that include recipe reviews or cookbook authors (hi!) whose recipes are tested.

What if, now that Im not bound by tradition, I feel paralyzed by choice?

Keep it simple and go with a stripped-down version of a basic but awesome holiday meal: a roast plus gravy, potatoes or stuffing (if your roast is a bird), two veg and one dessert. For instance, try turkey, mashed potatoes, Brussels sprouts and peas, plus pumpkin pie. Or choose the brunch version: a broccoli-cheddar quiche with tomato chutney and bean salad, plus an amped-up dessert, like pavlova.

What can I skip, without the guilt?

Now that youve figured out what matters to you, take some time to think about the routines or traditions that are done out of habit, not because they actually bring you joy. This year Ill be skipping our usual homemade appetizer spread (its a ton of work), my brothers favourite tinned peas (which Ive always hated) and my moms eggs Benedict Christmas breakfast (Ill relax with raisin toast and coffee on the couch instead and skip the hour of work). If creating a spectacular tablescape makes you happy, then have at it. If not, maybe just light a dozen candles (my fail-safe atmosphere creator). If a roast turkey stresses you out, forget it! There are plenty of foolproof oven-ready options available in the grocery store for mains and sides (and for the record, this is not cheating in any way dont let anyone tell you otherwise).(Related: 10 Ways to Stay Calm Amid the Holiday Chaos)

How do I adjust my menu for a much smaller group?

If turkey is your jam, order the smallest one possible (usually about 11 pounds). Or ask a butcher for half a turkey, and theyll cut it down the backbone so you get one leg, thigh, wing and breast. A five-pound ham will feed six with lots of leftovers. At our house, I budget for two potatoes per person because we love them, and the same goes for all green vegetables (I can never get enough). If you want to live off the leftovers for a week, increase the quantities accordingly.If any of your favourite recipes are designed to feed a much bigger crowd, and it feels risky to halve or quarter them, just make the whole thing and freeze the extras. My great-grandmothers plum pudding recipe makes two big puddings and doesnt halve well, so Im going to pop one in the freezer for my birthday in March.

Im still worried about getting it all done without losing my mind.

Heres a simple if deadly boring trick that always works wonders for reducing our familys overall stress: Write up a work-back schedule. That magical slip of paper that tells me to put the potatoes in the oven at 3:30 p.m. and to start the gravy at 4:45 p.m. pours a soothing balm over my entire day. Get as specific as possible (what time do you need to preheat the oven?), and dont forget that big roasts like turkey, beef and ham can and should rest for at least 30 (and as much as 90) minutes before carving.Also figure out what you can get done one and two days beforehand, like dessert, sauce or salad dressing and some veggie sides, plus the table decor. (Who says the kids cant have a bowl of Cheerios for breakfast at a beautifully set table?)(Related: 3 Ways Mindfulness Can Help You Get Through the Holiday Season)

What about dinner on allll the other days?

My advice, which I intend to take, is to bask in simplicity this year. Leftovers, takeout and easy 15-minute suppers are all wonderful options. Im thinking about pushing our traditional Christmas Eve feast back a day and taking December 24 off to have a movie and charcuterie night. To make a great family charcuterie board, start with three cheeses (something simple, like cheddar or havarti; a creamy option, like brie or Boursin; and a funky one, like Stilton or Grey Owl) and three cured meats (such as salami, mortadella and prosciutto). Add grapes, toasted nuts, some jarred fig jam and a ton of plain crackers.

It feels like I’m forgetting something.

Do a pre-mortem and think of yourself on January 2. What kind of holiday will you have wished for? A little forethought will make everything more special and less stressful.Keep a few tricks up your sleeve and in your pantry for nights when you need an easy pick-me-up. Prosecco (or sparkling grape juice), frozen mini quiches and a box of chocolates to eat all at once makes a quiet Tuesday dinner weird, fun and unforgettable (your kids will want to make it an annual tradition!).Take advantage of some of that found time to connect with the people who cant be beside you at the table. Watch a movie together in separate locations, set up an online carolling party or share a recipe for mulled wine and host a virtual family cocktail party. And dont forget about all the other ways to get into the holiday spirit: Donate to the local food bank, give blood or shovel someones walk. Because ultimately, the holidays should pack some serious happiness. In my opinion, obligation and stress get way too much airtime and if theres anything we need this year, its more joy.Next: The Importance of Making Memories During Pandemic Life

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We’ve already seen multiple COVID variants of concern, what makes this one different from the others?

Omicron sparked immediate concern because of the sheer number of genetic mutations it hasover 50 mutations in total. There are more than 30 mutations to the spike protein alone, the part of the virus that binds to human cells and helps it to gain entry. As a comparison, the Delta variant has only two mutations to the spike protein. The spike protein is the main target of the antibodies we produce to fight a COVID-19 infection. The worry is that Omicrons mutated spike protein might be able to somewhat evade our antibodies.Scientists are also worried these mutations might give Omicron the potential to be more transmissible.

What makes this a new COVID variant and not a completely new virus?

For the COVID virus to cause infection, it must hijack a human host cell and use the cells machinery to reproduce itself. Errors often occur during the process of duplicating the viruss RNA, causing changes to the virus genetic code. This results in viruses that are similar (i.e. variants), but not exact copies of the original virus.Even though each variant has a slightly different genetic code, they all can be traced back to a common ancestor, the original SARS-CoV-2 virus. This is what makes it a variant and not a new virus.

With Delta, the concern was about how easily it could be transmitted. What do we know about Omicron? Is it more infectious?

Early reports from South Africa indicate theOmicronvariant of coronavirus may be more contagious than previous variants. This is because Omicron has quickly become the dominant strain of COVID-19 in South Africa’s Gauteng province, where cases are doubling every day. A Hong Kong study publicized in mid-December found that the Omicron variant infects and multiplies 70 times faster than the Delta variant and original SARS-CoV-2 virus. Researchers from the faculty of Medicine at the University of Hong Kong say that these results explain the explosive increase in COVID-19 cases in countries around the world.

Does Omicron cause more severe illness? Are the symptoms the same as COVID or are we seeing new symptoms from this variant?

It is still too early to determine how virulent Omicron is relative to other variants of COVID. And for context, there is still debate as to whether the Delta variant causes more severe disease than previous strains.That said, there is currently no information to suggest that symptoms associated with Omicron are different from those from other variants. Of the cases seen so far in Europe, South Africa and the U.S., fatigue, headache and body aches are commonly reported in those who test positive for Omicron. Symptoms like loss of smell and shortness of breath have been less prevalent.More definitive data is needed to make any firm conclusions about illness severity, hospitalization rates and other symptoms.

Are certain demographics more susceptible to Omicron infections or worse outcomes?

And it is too early to be sure how the variant might affect the elderly, children or other members of high-risk groups. But what we do know is that, as with all strains of COVID, being unvaccinated puts you at a significantly increased risk for contracting and spreading infection. Very early reports out of South Africa suggest a higher pediatric hospitalization rate in children under 5 who are ineligible to get the vaccine.In terms of vaccine coverage, around 56 percent of the eligible global population have received at least one COVID-19 vaccine dose as of the end of November. But for low-income countries, at time of publication, the rate was just 7.5 percent.As long as poorer nations still struggle to obtain vaccines, there will be ample opportunity for SARS CoV-2 to replicate and mutate among the unvaccinated around the world, leading to more variants. And as evidenced by the rapid spread of Delta around the world, a dangerous new variant is unlikely to remain in one place for very long.

Since this variant is so different, are the vaccines we have going to be less effective?

Both the Pfizer and Moderna vaccines have remained effective against all other known variants identified so far during the pandemic, with some variability in effectiveness depending on the particular variant. We are not back to square one when it comes to vaccines. There is no reason to believe Omicron will be completely vaccine-resistant and many experts believe we will still see good protection against severe illness and death.Across Canada, provinces are making Moderna and Pfizer-BioNTech booster shots available. Evidence is increasingly showing that three COVID vaccine doses better protects against the Omicron variantso once eligible, it is highly recommend to get that third dose.Vaccines are expected to provide some protection against Omicron because they stimulate not only neutralizing antibodies but other immune cells that attack virus-infected cells. While mutations to the spike protein can hinder our antibody response, the other parts of our immune system are unaffected by these mutations and are likely instrumental in preventing serious illness and death.Vaccine makersincluding Moderna and Pfizer-BioNTechare studying vaccine effectiveness against Omicron and believe they can make tweaks to their vaccine formulation to better target emerging variants. Pfizer recently announced a three-shot course of their vaccine was able to neutralize the Omicron variant in a laboratory test, suggesting rolling out third doses could improve our response to Omicron.

Does the Omicron variant show up on existing COVID tests?

The available commercial diagnostic PCR (polymerase chain reaction) and antigen COVID tests still appear to work to identify the omicron variant. We will know more in the coming weeks about how well the rapid at-home tests perform to detect the new variant. Provinces including Nova Scotia, Ontario and Alberta have taken steps to provide free take-home tests to the public.

How can Canadians protect themselves?

The key right now is to stick with the toolbox of defences that we have developed over the last almost two years.Encourage all of your eligible family members to get fully vaccinated as soon as they can. It is crucial for unvaccinated individuals to get their shot and eligible individuals to get their booster dose.Be sure you have a well-fitting mask and wear it in indoors when outside of your home. In addition, maintaining our other key public health measures is also essential. This includes social distancing, ensuring adequate ventilation of indoor spaces and hand hygiene. Avoid potential super-spreader situationslike crowded places with unvaccinated or unmasked individuals.And even if you are fully vaccinated and healthy, consider using rapid antigen testing prior to attending any gatherings before and after the events as an added precaution.Dr. Seema Marwahais a general internal medicine physician in Toronto and an assistant professor at the University of Torontos Department of Medicine. She is also the editor-in-chief ofHealthy Debate.Next: Everything You Need to Know About COVID Antiviral Pills

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Based on the current research, what do we know so far about the connection between the COVID vaccines and shingles?

Both chickenpox and shingles are caused by the same virus, the varicella zoster virus (VZV). After a person has had chickenpox, the virus rests in the bodys nerves permanently as it cannot be eliminated. For many people, it remains dormant in the nerve roots, but approximately 30 percent of all people who have been infected with chickenpox will later develop herpes zoster, commonly known as zoster or shingles.The two biggest risk factors for reactivating the virus is age (particularly after the age of 50 years) and people with an immune system that is not working properly because of their medical conditions or medications. These two categories of individuals are also the ones we are targeting with the COVID-19 vaccine because they are also at risk of complications from the COVID-19 virus.In other words, the populations who are receiving the COVID-19 vaccine are also the ones who are at risk for shingles reactivation, and so its possible that they would have reactivated anyway. Another hypothesis which has yet to be proven by science, is that activation of the immune system after getting the COVID-19 vaccine triggers the shingles flareup. This phenomenon can occur with other autoimmune diseases as well such rheumatoid arthritis.(Related: Shingles Appears to Be on the Rise in Canada. Heres Why.)

So, is it fair to say that shingles is a possible side effect of COVID vaccines?

Yes, shingles is considered a side effect of the vaccine. As a recent systematic review of research on COVID-19 vaccination and shingles concluded: There is not yet an established definite link but there may be possible association between COVID-19 vaccine and shingles. Large-scale studies may help to understand the cause-effect relationship.

Does it matter what COVID vaccine, or what mix of vaccines, people receive?

No. Shingles reactivation post COVID-19 vaccine have been reported after most of the current available vaccines on the market. The United States Vaccine Adverse Event Report System (VAERS) reported 2,607 cases after Moderna, 3,786 cases after Pfizer-BioNTech and 336 cases after Janssen. That is a total of 6,774 cases of shingles out of 453.9 million doses given (incidence 14.9 per million). The majority of cases were reported after the first dose and on average, after seven days post-COVID19 vaccination; cases have occurred in men and women equally.

As Canadians prepare for a possible third dose, what can Canadians do to limit their risk of shingles after COVID vaccines?

As you prepare for your third dose, you may want to talk to your health-care professional about getting the Shingrix vaccine. This product, which is given as two doses, has been shown to reduce the risk of getting shingles and post-herpetic neuralgia (a type of severe pain that lasts months to years after shingles) by more than 90 percent. The National Advisory Committee for Immunization (NACI) recommends the shingles vaccine for everyone over the age of 50 years, including those who have had shingles disease and those who are not sure if they had chickenpox infection in the past. Your health-care provider can recommend when you should receive the vaccine around your COVID-19 shotNext: I Was Vaccine Hesitant. This Is What Changed My Mind.

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Is the vaccine safe?

Yes. We are fortunate in Canada to have both Health Canada and the National Advisory Council on Immunization (NACI) closely follow the evidence. They did this with adult and adolescent vaccines and are continuing the process with children. Not only do they monitor the trial data, they also look at real world data as well. For pediatric vaccines, both bodies have reviewed all available data, had the opportunity to go back to Pfizer with questions and have also been monitoring what is happening with the pediatric vaccine campaign in the U.S., where as of last week almost three million children had received their first doses since the Food and Drug Administrations authorization in late October. We should be confident in this process and know that the benefits of the vaccine outweigh any potential risks.

Is it effective?

Yes. The Pfizer trial looked at about4,700 children who got the vaccine versus a placebo, their immune response, their antibody levels and how well it worked to ward off the virus. It was found to be 90 percent effective in preventing symptomatic COVID compared to a placebo. This includes the Delta variant.

What are the benefits?

While it is true that children are less likely to get severely ill than adults, it can happen and its tragic when it does. It is very difficult to predict who will get critically sick and who will not. In children aged 5 to 11 in the U.S., there have been more than 146 COVID related deaths and almost 8,300 childrenhave been hospitalized. Many of these children were completely healthy with no pre-existing conditions. In Canada, we havent seen this degree of pediatric illness, but as we loosen restrictions, children will be at higher risk as they are unvaccinated. As a parent, if you can protect your children from any risk, you do it.Not only is severe illness prevented, the vaccine also can reduce transmission to other groups. You might not have to worry as much about going to school, seeing friends or disruptions in routine. However, this depends on your family unit. If there are older adults or people who are immunocompromised, you need to be mindful of your and your childrens activities and the risk to others.Vaccinating your child may not be a bulletproof vest. But there is a significant reduction in getting and spreading COVID. And each person in the community that gets vaccinated gets us one step closer to ending the pandemic.

If children have only one vaccine dose, are they still protected enough to see loved ones?

So far, we do not have a breakdown of the difference between doses. In the 21-day waiting period between doses in the trial, there were no infections so its hard to know the exact level of protection at that point. Two weeks after the first dose, children have some protection, but we dont know how much yet. Again, we need to look at the local situation: who you live with; what their situations are; and what steps you are taking to determine the risk. Ideally, if everyone you are visiting is healthy and vaccinated and you are being carefulavoiding crowded areas, getting tested, avoiding contact if symptomatictogether with one dose of a vaccine, this can significantly reduce risk for all involved, including children. Rapid testing might be useful before gatherings. But the vaccine is the quarterback here and makes all the other public health measures work better.

Can you get a flu shot and COVID shot before the holiday?

In children aged 5 to 11, Health Canada recommends the COVID vaccine be separated fromother vaccinations by 14 days. This is out of an over-abundance of caution to see if there are possible side effects to the COVID vaccine specifically. However, the U.S. Centres for Disease Control has not made this recommendation for young children. And for all people 12 and up, you can get it at the same time or separately. Because there is more COVID circulating than influenza, I would recommend children under 11 get the COVID vaccine first and then get the flu vaccine.(Related: Flu Season Is Going to Hit Hard. Heres How to Prepare)

Is it true that Pfizer added a heart attack medicine as an ingredient to the childrens dose of the vaccine? If so, why is this?

There is a very small amount of tromethamine in the vaccine for children. But it is not to treat heart attacks. Rather, it is used to regulate acidity in body fluids in cases of metabolic acidosis, which can be the result of various conditions, including bypass cardiac surgery and cardiac arrest. Itsalso a common stabilizing ingredientin a lot of medical and non-medical products. It helps the vaccine resist degradation and improve its shelf life. Its also not new or experimental. Tromethamine has been safely used in many products, including the Moderna COVID-19 vaccine, Humalog insulin and other vaccines.All changes in formulation to the pediatric vaccine also needed to be specifically reviewed and approved by Health Canada.

Keeping in mind that the U.S. has used shorter intervals than Canada (for adults AND children), what is an acceptable interval between shots one and two for children?

Health Canada has approved the doses to be given 21 days apart. ButNACI is recommending eight weeks between dosesbecause longer intervals could make the vaccine slightly more effective with lower side effects. The specific dosing interval used will be up to the individual provinces.

What are the side effects? What should we expect?

The most common was a sore arm that resolved in 24 to 48 hours. Headache, fever and muscle aches were also common and all passed within 24 to 48 hours. The lower side-effect profile is partly because of the way childrens immune systems develop and partly because of the lower dose they get.You might want to take it easy the next day if you are worried about side effects, but most kids wont need to miss school.

What about cardiac side effects like myocarditis?

We expect that the rates of myocarditis and pericarditis will be very low. The aged 12 to 15 group was at lower risk than the 16 to 24 group so we expect it to be lower still for the 5 to 11 group. Those aged 5 to 11 generally have a lower baseline risk of myocarditis from other viruses. And they are getting a lower dose of vaccine.Its also much less severe than COVID-related myocarditis which makes you quite sick with possible long term health effects.We also have the luxury of the U.S. being a few steps ahead since it has administered millions of doses to those aged 5 to 11. The U.S. is also giving second doses at three-week intervals. So, we will know much more based on American data as many children will have two doses there before our children get one.

What are the symptoms of myocarditis?

If your child has chest pain, difficulty breathing, lethargy or fever that does not breakseek medical attention. A non-invasive ultrasound test will be done if myocarditis is suspected though it would be exceedingly rare. Parent instincts are also very strong. If a child seems lethargic or ill, have the child checked even if just for reassurance.

What about long-term side effects?

We do not expect any long-term side effects. To understand why, its important to understand how the vaccine works. In the first few days, there is an immediate response to the vaccine in your system and local effects from the injection. This is why you get a sore arm, fever, malaise, etc. In the second phase, you get your immune response that peaks over weeks. Your body no longer increases the immune response to the vaccine after four-to-six weeks. This why we would see all serious side effects within six weeks. The vaccines are limited in what they do and disappear from the body quickly. They cant change how your body responds to other things.

Were these developed fast?

mRNA technology is not new. Weve been studying it since the 1960s and doing vaccine trials since 2013. We do have some long-term data on safety of other mRNA vaccines. Some vaccines for COVID (other than AstraZeneca and Johnson and Johnson) were built on this research, which is in part why we could develop them so quickly.

Why would my almost 10-year-old get one third of the dose a 12-year-old gets when they are basically the same size? Does this smaller dose provide enough protection?

Children get 10 mcg (micrograms), or one-third of the dose for 12 and up. The trial looked at 10/20/30 mcg doses and with 10 mcg, there was the same effect with less side effects. Vaccine dosing is not based on weight or size of child, but maturity of the immune system. The study examined immunogenicity for all age groups. In the 5 to 6, 7 to 8, 9 to 11 ages and in aggregate, all had a similar and robust immune response.

If your child is on a cusp year, what should you do?

This might differ province to province. Anyoneturning 5 years old in 2021 in Ontariois eligible to get the vaccine now. What we dont know is what to do with children turning 5 in 2022. Trials studying children 4 and under with different doses are ongoing so I suspect we may have to wait for the trial results.On the older spectrum, dont wait for the adult and over 12 dose. Get the dose available as soon as possible if your child is of the age to get it. The study included 11- and almost 12-year-olds and that cohort had a good immune response. When they turn 12, they can get the adult dose as their second shot. Going into the holidays, with COVID rates increasing, get them the dose.

Can you apply a numbing cream pre shot?

Yes, we do it with other vaccines. Some places have it on hand. This is a great idea if a child is afraid of needles.

My child has anaphylactic allergies to other things. Should I worry?

There is no increased risk of reaction if you have other allergies, including eggs, penicillin, peanuts, etc. Weve seen very little severe allergic reactions with this vaccine. In the trial of almost 4,700 children, there were zero severe allergic reactions. In the U.S., there have been no severe allergic reaction reports since children have been eligible.There are no pre-existing health conditions that put a child at a higher risk either. They would actually be at higher risk from COVID complications, so the benefit-to-risk ratio is even greater for this age group.

How long can the vaccine stay in our body?

Vaccines are rapidly broken down and removed from the body. mRNA vaccine contains a fatty shell surrounding mRNA particles. Once it enters the cell, the lipids get broken down, the mRNA is used to make spike proteins and then it also is broken down. Once its done its job of getting cells to produce spike proteins, our immune system starts making antibodies to it. If our immune cells ever see this protein again in the form of a viral infection, it will be able to recognize and fight it much faster. It does not cause an alteration in our DNA. The spike proteins are immediately recognized as foreign and destroyedthis is how our immune system army trains to kill the real virus. Antibodies to spike proteins stick around for months and eventually are replaced by memory immunity.

How will vaccinating children affect the pandemic?

As an individual, take a deep breath to know your child is safer as the risk of serious health outcomes is low. In terms of the world, it will further decrease the cases. If we reach a high level of vaccine uptake, there wont be a large reservoir for transmission. We wont see explosive outbreaks and it will lower the risk of activities. We dont have a crystal ball but hopefully it will make life a little easier.

If you have more questions, where do you go?

Go to trusted sources.Social media, blogs, Google could lead you to sites that are deliberately spreading disinformation. So stick to sources that you can trust, such asScienceUpFirst. Refer to hospital hotlines likeSickKids, TEGH. Reach out to your primary care doctor, get the answers you need and then share the information.This story originally appeared on Healthy Debate.Next: Everything You Need to Know About COVID Antiviral Pills

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How do antiviral COVID-19 medications work?

Generally speaking, viruses are tricky to treat because they hijack host cells and then use them to replicate. The problem is, its hard to interfere with the virus without harming human cells in the process. Viruses also mutate very quickly, making antiviral treatments less effective overtime. Thats why its much more likely you have been prescribed an antibiotic, but not an antiviral.Antiviral drugs are generally not entirely new or even COVID specific. Mercks pill, molnupiravir was originally developed to treat influenza. The antiviral treatment is a nucleoside analog drug, meaning it inserts errors into COVIDs genetic code, disrupting its ability to replicate. Theoretically, it only disrupts the virus RNA, leaving the DNA of human cells alone.The Pfizer pill, Paxlovid, is a protease inhibitorsimilar to drugs used to treat HIV and hepatitis C. It blocks an enzyme that the virus needs to multiply, but does not disrupt the genetic code of the virus. It is taken in combination with ritonavir, an older HIV drug that helps the Pfizer pill remain in the body longer.

Who could the Pfizer pills and Merck pills help?

In their trials, both Pfizer and Merck enrolled unvaccinated adults with COVID-19 who had at least one risk factor for severe illness, like advanced age or a pre-existing health conditions. As a result, these antivirals are currently intended for adults who are in the early stages of COVID-19 (within five days or less of symptom onset) with mild to moderate symptoms and who are well enough to remain home, but at risk of deteriorating and needing hospitalization.These antiviral pills are currently being studied in different patient groups, like vaccinated patients, and in different contexts, like for post exposure prophylaxis. Depending on the results, the drug may be offered to more people in the near future.(Related: If Omicron Is Rampant and Less Severe, Why Bother With Prevention at All?)

How well these COVID pills work?

For both the Pfizer pill and the Merck pill, preliminary results appear really promising for treating early COVID-19 and keeping patients out of hospital. Especially considering we currently dont have any other options for treating early COVID-19.Pfizers Phase 2/3 trial involving 2,246 adults showed a reduction of 89 percent in hospitalization compared to placebo when taken within three days of getting symptoms. Molnupiravir reduced hospitalization in at-risk patients by 50 percent when given within five days of the onset of symptoms. No deaths occurred in the treatment groups of both trials.Though its tempting to compare the two drugs, its important to remember the different designs and timing of the Pfizer and Merck trials make head-to-head comparisons imprecise. Also, these results are specifically relevant for unvaccinated, high-risk patients. Anyone who was vaccinated, low risk or exposed without a proven infection was excluded from these trials. Anyone who was sick enough to need hospitalization was also excluded. So while these drugs show immense promise, these results are not applicable to everyone.

Are these COVID treatments safe?

Both Merck and Pfizer have reported minimal side effects, but neither has released detailed data to confirm these results.That said, both drugs have features that limit who can safely take them.Molnupiravir makes changes to the viral RNA. Even though human cells have DNA, there is some concern that molnupiravir could cause mutations in human DNA. If this occurs during fetal development, there is a potential risk of birth defects. Pregnant and breastfeeding women were excluded from the Merck trial. When authorizing the use of molnupiravir, U.K. health officials recommended it not be used in women who are pregnant or breastfeeding.According to Health Canada, “While the benefits of Paxlovid were found to outweigh the risks, it can cause interactions with other medications for some patients. As such, patients should discuss the risks and benefits of treatment with their healthcare provider.”Specifically, ritonavir, the drug given together with Paxlovid, has many possible drug-drug interactions and could interfere with many heart disease, pain and immune modulating medications. But because antiviral drug regimens are only five days, working around some of these drug interactions may be possible.

Are there any additional barriers?

These drugs work if they are given within days of developing symptoms. This might be a challenge to do in our existing system. Canada needs to ramp up access to testing and have accessible pathways to get a prescription for these drugs to work in a real-world setting.Cost is a potential barrier. Because this is an outpatient medication, it might not be covered. For instance, a course of molnupiravir costs over $700 USD in the U.S.

Will these treatments work against COVID variants?Could the virus become resistant?

Theoretically, these drugs should be effective against known coronavirus variants. Merck has indicated that molnupiravir is effective against the delta variant. Researchers still need to demonstrate that these drugs will work against future variants.Drug resistance is a common problem. In HIV, a combination of antivirals is used to combat resistance. We may need a similar strategy with COVID antivirals. Researchers will need to look closely at individuals who dont respond to the drug and those who are immunocompromised to better understand if resistance is a major concern.(Related: What Makes Omicron Different Than Other COVID Variants?)

Are COVID pills available in Canada?

Health Canada conducted an expedited review of Paxlovid in December 2021 and on Jan. 17 approved the antiviral drugs to treat Canadian adults with mild to moderate COVID-19. Officials are hoping to make the pills available “as soon as possible.”

(1/5) Health Canada has authorized the first #Covid19 treatment in pill form that can be used at home to help prevent serious disease. https://t.co/GbaFDrnAA2

Health Canada and PHAC (@GovCanHealth) January 17, 2022

Mercks Health Canada request for approval is still under review.Remdesivir, an intravenous antiviral, is approved for use in Canada but is generally for sicker patients that are hospitalized.

With the COVID-19 pills available in Canada, do people still need to get vaccinated?

YES!This antiviral COVID pill is not a substitute for vaccination. Vaccines prevent infection from happening in the first place and can stop or slow transmission. Because of this, immunization remains our most important defence.

(4/5) No drug, including PAXLOVIDTM, is a substitute for vaccination. Vaccination remains the most important tool in preventing serious illness from #Covid19 infection.

Health Canada and PHAC (@GovCanHealth) January 17, 2022

These pills also dont remove the need for other proven and effective public health measures, like masking, social distancing and ensuring adequate ventilation in indoor spaces.Antiviral pills, as they have been studied so far, are given to prevent severe illness after someone has already contracted COVID. Where this would have the biggest impact is in the treatment of unvaccinated people. If we truly can prevent them from being hospitalized, we can conserve health care system resources and avoid delaying care or shutting down services for non-COVID patients. COVID pills are also a potential game changer for the large parts of the world that have minimal vaccine coverage.So, while antiviral pills will be available to Canadians, its important to remember that these COVID treatments are not miracle cures. Instead, these treatments will be a helpful complement to vaccines and an important tool in our larger toolbox of COVID-19 defense.Dr. Seema Marwaha is a general internal medicine physician in Toronto and an assistant professor at the University of Toronto’s Department of Medicine. She is also the editor-in-chief of Healthy Debate.Next: Could Protection from COVID Soon Be Available Through a Nasal Spray?

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Shingles in Canada seems to be on the rise

Like sleepless nights and hair loss, getting shingles looks to be another knock-on effect of living under chronic stress during the pandemic.I can relateI developed shingles on my left inner thigh in September 2020, when I was 49, likely due to the nervous anticipation of sending my kids back to school (with the vaccine still months away from reality) after a summer of zero breaks from them. I was the third case of shingles the doctor at the walk-in clinic had seen that day.Shingles seems to be more rampant this year than previous years, says Dr. Craig Jenne, an associate professor in the Department of Microbiology, Immunology and Infectious Diseases at the University of Calgary.Data isnt available on the percentage of increase in shingles cases in Canada over the course of the pandemic, but anecdotally, Jenne is hearing a lot more about it from colleagues commenting on the number of cases theyve seen. And it makes sense given the nature of the virus that causes it.Shingles typically presents as an itchy, tingly or painful skin rash with blisters on one side of the body, usually the trunk or face. Its caused by a reactivation of the varicella zoster virus, the same virus that gives you chicken pox, so anyone who experienced that childhood illness is susceptible. Basically, after you recover from chicken pox the virus never entirely leaves your bodyit goes dormant and lives in your nerves, kept in check by a healthy immune system. Its like a ticking time bomb, waiting for the right combination of immune distress (or high stress!) to resurface as shingles.Shingles is very much a disease that activates or re-activates if the patients immune system begins to fade, and the principal cause of that in most people is things such as stress, says Jenne. So if you get stressed, we know that suppresses your immune system and that allows the shingles virus to reactivate.(Related:The Other Virus Thats Putting Those 50+ at Risk)

Decline in shingles vaccines

Adults over age 50 are more susceptible to developing shingles (our immune systems weaken naturally as we age), which is why a shingles vaccine is available to that group.But fewer Canadians are getting routine vaccinations during the pandemic, which is another factor that could be playing into shingles prevalencean estimated four million adults in Canada have missed or delayed shots during COVID, according to a poll conducted by the Neighbourhood Pharmacy Association of Canada. Whats more, internal market data shared by GlaxoSmithKline, the pharmaceutical company that manufactures the Shingrix vaccine for shingles, suggests a 22 percent decline in shingles vaccinations in Canada from Sept. 2019 to Sept. 2020, worsening to a 30 percent decline by Sept. 2021.Though the majority of shingles cases appear in older Canadians, younger adults can get it, too, especially when shouldering the worries of the worldand juggling our work and personal life from homelike weve all been doing since March 2020.Its not run-of-the-mill stress that triggers it, either, Jenne clarifies. Were talking prolonged stress thats amplified by things such as dysregulated sleep, perhaps diet changes, he says. Not to mention the closed gyms and spas that have made it that much harder to de-stress these past 20 months.(Related: COVID-19 Vaccines Are VitalAnd So Are These)

How to protect against shingles

For Kelowna entrepreneur Jules Taschereau, the onset of both bouts of her ophthalmic shingles was undeniably stress-related. Taschereau, the proprietor of Limey, The British Shop, owns and runs three businesses and works 100-hour weeks. On top of that, Taschereau and her fianc had to postpone their wedding five times during the pandemic due to gathering and event restrictions.It was brutal. It was stress beyond what youd expect, she says. Living in a pandemic has pushed people over the edge.Taschereaus second round of shingles this fall was so painfuleven the weight of her hair hanging from her head hurtthat the 48-year-old does not want to get it a third time and plans to get vaccinated as soon as she turns 50.For those under 50, the best advice for keeping shingles at bay is to keep stress levels down. Get enough sleep. Exercise. Eat a balanced diet.Thats the same advice were giving people to avoid colds and flus, says Jenne. If youre stressed and overtired, all sorts of infections can take advantage of that.Beard has taken that advice to heart. Since recovering from shingles in the summer, shes made a conscious effort to slow down.Im not as busy as before and Im saying no to a lot more things, says Beard. Its really important to take care of yourself. Next: Flu Season Is Going to Hit Hard. Heres How to Prepare

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My turning point

My thinking started to shift in June 2020. We had been shutdown for two and a half months. I thought, theres no way this is a hoax because its not economical for anyone other than Jeff Bezos. My family was also being hit so hard financially. My husband was a bartender, I was a stay-at-home mom and our savings were dwindling. I wanted to be more solution focused, like, how do we get out of this?I decided to be curious and open-minded to a vaccine. People always say to see both sides, and I actually decided to do it. I started following scientists on Instagram, like infectious disease specialist Laurel Bristow and science communicators Samantha Yammine (@science.sam) and Sabina Vohra-Miller (@UnambiguousScience). They made science accessible and easy to understand. Instead of sounding condescending or saying, This is what you should do, they said, Heres a bunch of information. Heres what we know so far. They talked about real stats and real studies. I started to realize that my idea of research wasnt actually research. I was just reading blogs and opinion pieces based on personal experiences. I learned how to think more critically.

 

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Even before the pandemic, I started disconnecting from some of the groups I helped found because I just couldnt keep up with the perfectionism it required. Then during the pandemic, I started unfollowing or muting more people on social media because they were sharing misinformation. Reading that content could make me start second-guessing myself. It wasnt worth it. By the end of 2020, when doctors and health care workers were first starting to get the vaccine, I didnt cringe the way I usually would have. By early 2021, when my grandparents got their COVID-19 vaccines, I was ready to get mine, too.I got my first dose in May 2021. I felt so ready by that time. Me, my friends and family were sending selfies with the I got my COVID shot posters. We were all celebrating. It felt like we could finally be together again.(Related: The Quick and Easy Way to Save COVID Vaccine Passports on an iPhone)

Advice for communicating with vaccine hesitant people

Based on my experience, and what Ive seen in the online groups, a lot of people who are vaccine hesitant fear that vaccinations will cause some kind of debilitating chronic issue. The thought is: I’ve had the flu. It sucks, but it’s not as bad as being chronically ill your whole life.For a lot of people, once theyve made up their mind, they stop looking for answers. And so just even presenting some facts in a patient, kind way can make a big difference. I remember when people told me, You’re stupid, you’re endangering your child, it made me think, You dont know anything about me then because I live for my children. And if you dont know anything about me, I dont need to listen to your opinions.If youre trying to communicate with hesitant people, I encourage curiosity instead of anger. Ask them why theyre feeling hesitant and maybe youll be able to get to the root of one of things theyre worried about and help them find sources that isnt just news being shared on social media.If youre feeling vaccine hesitant, reflect inwards on why youre feeling this way and be open and willing to just look. Theres no commitment. Read from sources beyond shared posts, go beyond the general headlines and follow some real scientists and experts online.Earlier this month, I took my daughter to the emergency room for croup. She woke up in the middle of the night and she couldnt breathe because her throat was closing up. It was the most scared I’ve ever been. On the way to the hospital, I decided that as soon as she’s better, I’m booking all the kids in for their vaccines. Theres no vaccine for croup, but I couldn’t bear the thought of something like this happening to her because of a simple thing I didn’t want to do. I dont want her to ever suffer from something that is preventable with a vaccine.Once the COVID vaccine is approved for ages five to 11, Im planning to get my kids vaccinated. I want my kids to get their lives back, to be able to do activities again, see their friends and have parties. For parents who are hesitant, I understand, because when do we ever make any choice about our child where we dont worry if were doing the right thing? For me, I found some sources I trusted and made me feel like I can make a better choice for my kids.Next: A Province-by-Province Guide to Vaccine Passports in Canada

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Federal

The federal government has announced a standardized proof of vaccination in an effort to facilitate domestic and international travel. Unlike some provinces which have physical proof of vaccination cards, the federal vaccine passport will be in the form of a digital QR code. All of Canada’s provinces and territories will be moving forward with the federal vaccine passport, meaning that eventually Canadians will be able to present their federal QR code as proof of vaccination, no matter where in Canada they received their vaccinations.On October 21, Prime Minister Justin Trudeau announced the pan-Canadian proof of vaccination is now available to residents of Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Quebec, Saskatchewan and Yukon. The vaccine passport is expected to be available in more provinces soon. The federal standardized proof of vaccination went into effect on October 30 and is required by travellers 12 and over boarding domestic flights or trains. Canadians travelling internationally will be required to present their passport along with their federal QR code, which can also be used with the ArriveCan mobile app when returning to Canada.

British Columbia

Starting September 13, proof of vaccination will be required for residents aged 12 and up accessing social events like ticketed sporting events, indoor concerts, indoor theatre/dance/symphony events, and indoor organized events like conferences and weddings. Proof of vaccination will also be required when visiting non-essential businesses like patio and indoor dining at restaurants, fitness centres, casinos, night clubs, and movie theatres.A secure weblink was provided by the B.C. government granting access to proof of vaccination and allowing users to save the info to their phones.Under the new policy, any out-of-province Canadian visiting B.C. have to show proof of vaccination and valid government ID from their home province to access non-essential businesses and activities.

Alberta

On September 15, Alberta declared a state of public health emergency and announced a “Restrictions Exemption Program.” As of September 20, the measure required people aged 12 or older to provide government-issued proof of vaccination or a negative COVID-19 test in order to access restaurants, indoor gatherings, retail and gyms. Those opting to get a COVID-19 test instead of vaccinations must present proof of a negative privately paid test, either PCR or Rapid Test, from within the previous 72 hours. Those with medical exception are required to provide documentation.Effective November 15, Alberta now requires proof of vaccination to be presented as a QR code. Alberta COVID-19 vaccine records with a QR code are available online, and can be easily saved on a smartphone or printed out. Albertans can also receive a free printed vaccination records and QR code via a registry agent office or by calling 811. Businesses require patrons to present their proof of vaccination QR code along with a valid ID.

Saskatchewan

After a surge in cases, and some of the lowest vaccination rates in the country, Saskatchewan announced plans to implement a proof of vaccination program by October 1. As of that date, all Government of Saskatchewan employees were required to be fully vaccinated and show proof of vaccination must be shown to access public spaces, such as indoor dining, entertainment venues and fitness centres. Unvaccinated individuals are able to access these spaces by providing a negative PCR or rapid antigen COVID-19 test. Proof of vaccination is not be required for private gatherings, places of worship or retail businesses, including grocery stores.

Manitoba

Manitoba launched its vaccine card in June, which allowed fully immunized Manitobans to skip the mandatory quarantine after international travel. Now, as of September 3, fully immunized individuals will have to show their vaccine card to enter indoor and outdoor ticketed sporting events and concerts, indoor theatre/dance/symphony events, restaurants (both indoor and outdoor dining), nightclubs, casinos and bingo halls, movie theatres, fitness centres and organized indoor group recreational classes and businesses.Residents can visit this website to request a free vaccine card and a digital QR code. A hard copy of the card will be sent to residents in the mail.(Related: What You Need to Know About COVID Variants in Canada)

Ontario

As of September 22, Ontario required residents aged 12 and older (excluding those with medical exemptions) to show proof of their COVID-19 vaccination and a piece of government-issued ID to access gyms, restaurants, bars, movie theatres, event spaces, and concert halls. Proof of vaccination is not required for access to banks, retail shopping, salons and barbershops, places of worship, essential services, workplaces and outdoor spaces like patios. Vaccine receipts are available at the provincial portal, and residents with red-and-white health cards can call the Provincial Vaccine Booking Line (1-833-943-3900) for their vaccine receipt.There are some specific exceptions to the proof of vaccination rules: anyone entering the inside of a restaurant or bar only to get takeout, to pay or to use the washroom, kids under 18 entering a recreational facility to participate in an organized sport (including dance, martial arts and swimming classes) and people entering an event facility solely to attend a wedding or funeral ceremony (the exception doesn’t apply to a reception or social gathering associated with the ceremony).As of October 22, Ontario residents are required to use a QR code for proof of vaccination. On October 15, the Ontario government announced that Ontarians can download the province’s revamped proof of vaccination, which includes a scannable QR code. The province also launched “Verify Ontario,” a mobile app that will allow businesses to scan QR codes to verify patrons’ vaccination status.(Related:Could Protection from COVID Soon Be Available Through a Nasal Spray?)

Quebec

On September 1, Quebec became the first Canadian province to require residents aged 13 or older (who aren’t granted an exemption for a medical reason) to show proof of vaccination to access non-essential businesses and events. These spaces include gyms, restaurants, bars, events, movie theaters, casinos and more. Proof of vaccination can be downloaded by the provincial portal (or requested over the phone at 1-877-644-4545) and uploaded to the VaxiCode smartphone app, in a PDF on your phone or on paper. By September 15, violators of the health order could be fined. Visitors of Qubec are required to show photo ID and proof of full vaccination by their country or province.

Nova Scotia

Starting October 4, individuals over the age of 12 are now required to show proof that they are fully vaccinatedmeaning they received two doses, or a combination, of approved COVID-19 vaccines (Pfizer-BioNTech, Moderna, AstraZeneca or Johnson & Johnson) at least 14 days priorin order to get into non-essential events and businesses. Proof of vaccination will be required at restaurants, both indoors and on patios, casinos, museums, leisure facilities like arcades or dance studios and for indoor or outdoor sports leagues, for both participants and spectators. Proof of vaccination will not be required at banks, hair salons, clinics, places of worship, schools or other places deemed essential. Nova Scotia’s proof of vaccination policy is part of the final phase of the province’s reopening plan.Those who received their COVID jabs in Nova Scotia should receive a digital copy of their ‘Nova Scotia COVID-19 Proof of Vaccination’ by email. Proof of vaccination info can also be accessed onlineor by calling 1-833-797-7772 (Monday to Friday, 7 a.m. to 7 p.m.).

Newfoundland and Labrador

Newfoundland and Labrador’s vaccine passport comes in the form of two applications, the NLVaxPass for residents and NLVaxVerify for businesses. These apps are available for free on Google Play and in the Apple App Store. Through the app, Newfoundlanders and Labradorians can access their proof of vaccination, or approved medical exemption, in the form of a QR code. This code is then scanned to access specific businesses and settings such as restaurants and bars, cinemas, bingo halls, car dealerships and long-term care homes. The app can store proof of vaccination records for multiple individuals, such as family members. Alternatively, residents can access their QR code through the provincial COVID-19 Vaccine PortalorMyGovNL.Along with proof of vaccination record, residents will also need to provide identification. Those without access to technology can call 1-833-951-3859 to request a printed copy or visit their local public library.

Prince Edward Island

P.E.I. has the P.E.I. Pass, which is only for people travelling to the province from outside of P.E.I. The Pass allows both visitors and returning Islanders who have had one or both vaccine doses to forgo self-isolating after arriving in the province. Individuals must be fully vaccinated to be eligible for the P.E.I. Pass. Those who are not fully vaccinated, including those who have only received one dose, will need to self isolate for eight days.Next: Post-Pandemic Emotional RecoveryHow Are You Doing?

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What are myocarditis and pericarditis, exactly?

Myocarditisis is the inflammation of the heart muscle, and pericarditis is the inflammation of the membranethe bag that surrounds the heart. About half a million people around the world die from myocarditisis every year, and it causes 20 percent of the sudden deaths in young people.

What causes myocarditis?

In the Western world, myocarditisis is mainly caused by a viral infection, and in the developing world, it’s mainly due to parasites.A COVID infection can also cause myocarditisis. There are around 450 cases of myocarditisis per million infections of COVID-19. It can be due to either infection of the heart or stimulation of the immune system to attack the heartwhich causes things like autoimmunity, where the immune system attacks some of the surrounding tissues.With the mRNA vaccines, were seeing myocarditisis at the rate of around 67 cases per million. So to directly compare myocarditisis rates after the COVID-19 vaccine with the virus, you look at 67 versus 450 cases per million.(Related: What You Need to Know About Blood Clots and COVID-19 Vaccines)

How do COVID vaccines affect the risk of these heart conditions?

When people develop myocarditis from the vaccine, it’s a milder form of the condition. The vaccines are believed to somehow be stimulating the immune system to attack the heart. There have been no reported deaths with myocarditis from the vaccine, and it tends to resolve on its own or with drug treatments. Steroids may be used to quiet the immune system, and immunoglobulin (IVIG) is often given to people who are suspected to have an infection. IVIG is basically a pool of antibodies from the donated blood of many peoplea collection of their immunity.People who get myocarditis from the mRNA vaccines resolve in a couple of days. They are sometimes hospitalized with those treatments, but they go home without damage.

Who is most impacted by these risks?

Young men in their teens and 20s are most likely to get myocarditis after the COVID vaccine. I’m not sure if there’s a men versus women difference in myocarditis due to COVID-19 disease, but women have a stronger immune system than men, and stronger immune responses, so that may help them survive the COVID-19 disease.[Edmonton Oilers player Josh Archibald, 28 and unvaccinated, was recently put on leave after being diagnosed with myocarditis after contracting COVID-19.]

What are the symptoms to watch out for?

Often theres chest painheart painand difficulty breathing, which require immediate medical attention.After the COVID vaccine, myocarditis symptoms appear from three to four days to a couple of weeks. After contracting the COVID-19 virus, symptoms will appear within the first eight days.This interview has been edited and condensed.Now that you know about myocarditis and COVID vaccines: Could Protection from COVID Soon Be Available Through a Nasal Spray?

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Whats the latest with COVID in Canada?

A year and a half into the pandemic, Canada has over seventy percent of its population fully vaccinated and about four thousand new cases of the virus a daydown from its peak of nearly nine thousand. Recently, cases of COVID have been on the rise, theres been debate over the necessity of COVID booster shots, and the country is up to four variants of the virus.

Whats SaNOtize nasal spray all about?

The SaNOtize nasal spray is the only nasal spray that has actually gone through a proper placebo control phase two trial, says Regev. The blinded trial used saline as the placebo and SaNOtize spray used as the treatment. We have shown that we reduced viral load 16 times more than the control after using the spray for 24 and 72 hours, says Regev.The spray releases nitric oxide into the nose to prevent a potential infection and eradicate a viruswhether that be COVID, influenza, or another respiratory virus. Regev says SaNOtize can be used twice a day to prevent the virus, and up to six times a day to reduce the viral load of those who have already contracted the virus.SaNOtize has been approved to sell in Europe, Israel, Bahrain, and Thailand, and Regev says shes hoping it will be approved by Health Canada by the end of the year.

Why a nitric oxide spray?

Nitric oxide is a compound that the body naturally produces, says Regev. It’s our first line of defense against infection in the body. Nitric oxide has antimicrobial properties, so its able to kill bacteria, viruses and fungi.

Is nitric oxide safe to use every day?

The dose of nitric oxide in the spray is so low, says Regev. We haven’t seen any significant side effects at allnot in the trials, and not in the report from the market.SaNOtize trials have included 200 participants and the company has sold about 100,000 units to the market. We’re still doing testing with specific populations and children, but because we’re using compounds that are allowed in food, there shouldn’t be any issues, says Regev.(Related: Moderna vs. PfizerWhy Were Not Playing Favourites with COVID-19 Vaccines)

What about the COVID nasal spray vaccines that are being researched? What are their benefits?

Researchers are working to create vaccine nasal sprays for COVID. Although intermuscular and nasal vaccines are equally effective, the added benefit of a nasal spray is that they are administered directly into the respiratory system, so they stimulate immunity at the exact place the infection typically occurs, says Miller. Nasal spray vaccines may also generate a more immediate immune response than intramuscular injections, according to Slavcev.Another benefit of a nasal spray is that much less of the vaccine is typically needed to stimulate the same level of protective immunity. Its what’s called a dose-sparing effect, says Miller. That means one dose of an intramuscular injection can vaccinate as many as 100 people through a nasal spray.

How can a vaccine nasal spray fight COVID-19 exactly?

Nasal sprays that elicit an immune response in the respiratory tract are not new, says Miller. For example, there’s a seasonal influenza nasal spray vaccine currently available, particularly for children.Vaccine nasal sprays work by simulating and growing the immune cells and responses in the nose to fight the infection in a localized area, says Slavcev. Stopping the virus directly at the entry can suppress it right away or help prevent symptoms from worsening.The nasal spray vaccine Slavcev is working on at the University of Waterloo is a full vaccine, while Millers at McMaster is a booster.Boosters will likely be needed since COVID is a virus that evolves into different variants, says Miller. The vaccine we’ve been designing would be taken just once, and it would boost the pre-existing immunity that’s already been confirmed by the first generation vaccines that most people have receivedthe mRNA vaccines, the AstraZeneca vaccine or a combination of the two, says Miller.(Related: Do You Need to Get a COVID-19 Booster Shot?)

Are COVID nasal spray vaccines being used in other countries?

At the moment, there arent any approved COVID-19 vaccine nasal sprays in any country, says Miller, but there are several in development.

Will nasal sprays be effective against variants?

Miller says the nasal spray his team is currently developing appears to be effective at protecting against the virus as it evolves and creates new variants. Delivering vaccines, by inhalation or nasal spray, do tend to stimulate immune responses in the lung that are better suited for dealing with variants, he says. We are designing with the idea in mind that we want to be able to protect against variants in the future and avoid the need for frequent booster shots.Slavcev says his vaccine nasal spray is intended to protect against variants, although well have to see how successful.(Related: What You Need to Know About COVID Variants in Canada)

When will COVID vaccine nasal sprays be available in Canada?

It still has a reasonably lengthy developmental path ahead, says Miller. During the pandemic, there is urgency, and so we can expect an accelerated timeline, but the vaccine still needs to go through three phases of clinical trials. Expect to wait a year or more for a nasal spray vaccine to be approved as a booster shot.Next: A Province-by-Province Guide to Vaccine Passports in Canada

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It’s hard to quantify, but theres data from two different areas that drive this decision. In the laboratory, it’s clear that individuals who have compromised immune systems just don’t mount the same degree of an immune response to these vaccines, in contrast to people that are not immunocompromised. But also, when you look at people who end up hospitalized with COVID-19, its people with compromised immune systems that are more likely to be in that scenario.Okay, but their chance of being hospitalized after getting two shots is still way lower than with no vaccine, right?Absolutely, thats an important point. They are indeed already getting significant protection from COVID-19 with two shots. But, in order to optimize their protection, a third dose would be very, very helpful.Are there any more specifics about who fits within the immunocompromised group?Yes, in general it’s people with various types of cancers undergoing chemotherapies. It’s also people with organ transplantation and people who are on various types of immunosuppressive medications. NACI did a pretty reasonable job defining who is immunocompromised.Are elderly people included?No, theyre not included, but that doesn’t mean the elderly don’t require a booster vaccine. NACIs purpose wasn’t to define the entire population who needs a booster vaccineit was just to define those who are immunocompromised, who would require a third shot. And in fact, many provinces in Canada are giving booster vaccines to frail, elderly individuals who live in long-term care or chronic care facilities. Over the next month or so we might see an expansion of that program.(Related:What You Need to Know About COVID-19 Vaccines and Your Period)Okay, so lets talk booster shots for people who are not immunocompromised. We already take boosters for other vaccines, so the concept is familiar. In the case of the COVID-19 vaccine, is the reason for a booster shot that the original series of two shots is wearing off?Thats a question that hasnt yet been fully answeredand theres been different data from different places.One of the issues is what kind of immunity youre talking about. If its immunity to getting infected, we know that these vaccines aren’t perfect. We know they aren’t a bulletproof vest. You can still get COVID-19 if you’re vaccinated. And we knew this before the Delta Variant even emerged. We saw this in the very first clinical trials.That said, while they dont eliminate the risk of getting the infection, the heavy lifting of the vaccines is to prevent you from getting very sick, needing hospitalization, going into an ICU and dying. And when you look across all age groups, the vaccines continue to hold up with around 90 per cent effectiveness. Even when we look at the oldest age groupsthose over the age of 70vaccinated individuals have a markedly reduced probability of getting severely ill or dying.So does everybody need a third dose of a vaccine right now in September of 2021? The answer is no.(Related:What You Need to Know About COVID Variants in Canada)Could some people never need a booster shot?Yes, thats certainly a possibility. But it’s very hard to be overconfident about the need for a third dose, based on all the data that we have now, especially for younger cohorts. We might need one. We might not need one. When we look at the age group of 12 to 30 who have two doses, for example, the risk of severe COVID-19 in that age group, after receiving two doses of a vaccine, is about zero per cent.Speaking of younger people, clinical data for the 5-12 age group is supposed to be released soon. Do you think vaccine shots for those children will be available soon?It’s hard to know. After clinical trials finish up, the ball will be in the regulatory agencies court. And it’s hard to predict how long that process is going to take. The key thing here is we shouldn’t take shortcuts. We can’t artificially speed up science. We have to take the time to do the right clinical trials, and to have the regulatory agencies pore over them to make a meaningful decision. This should not be rushed. We have to have a good understanding of their safety and of the immune reactions and immune responses.When will all that happen? Likely, it’s going to be later in 2021, or early in 2022.In the meantime, how dangerous is COVID-19 right now for kids?When you compare younger age groups to older age groups, kids just don’t get as sick. They certainly can get sick, and they can require hospitalization and intensive care, but it’s much less common compared to adults.That said, you cannot let this virus run amok in any population, including the pediatric population. When we look at some of the southern states in the United States, we see pediatric hospitals that are overwhelmed, bursting at the seams because there are so many kids that require hospitalizations. It’s still fair to say that serious outcomes, like the need for hospitalization, is very rare in children, but a small percentage of a very large number ends up being a lot of kids that are sick in hospital. So, multiple things can be true and I think we have to take that into account. We should take steps to protect kids, and keep this virus at bay, especially in school environments.(Related:Here’s What You Need to Know About COVID-19 Vaccines and Infertility)And what about vaccine passports, which are now rolling out in some places in Canadahow effective will they be in keeping COVID-19 at bay?I think we have to remember what the goal of the vaccine passport is. The vaccine passport is not going to end a fourth wave, that’s not what they do. They are going to help create a safer indoor environment. That’s all. If you ensure that everyone who is in a restaurant or bar is vaccinated, you have added a significant layer of protection and safety to that indoor environment. Again, people who are vaccinated can still get and transmit COVID-19, but its just less likelyand so vaccine passports lower the risk of introducing or transmitting COVID-19 in that space.Of course, we can still have other measures in place to keep the virus at bay, like masking, good ventilation and crowd control in those indoor environments to create additional layers of safety and protection. But, essentially, the vaccine passports mean that we can start to do things that we weren’t doing during waves one through threelike going to restaurants, going to movies, going for a drink with your friends at a pub. They can be a tool to help prevent shutdown of non-essential businesses, especially during a rise in COVID-19 cases.(Related:A Province-by-Province Guide to Vaccine Passports in Canada)How long will vaccine passports be needed? And how long do you think this fourth wave will last?Vaccine passports have to be a time-limited initiative with clear metrics for when their use will stop. When we look at where we’re at right now, I would imagine that they might be something we’ll see through this fall and winter.Pandemics have a beginning, a middle, and an end. My guess is that were in the late middle of the pandemic. It’s not over, but were closer to the end given that we have widely available vaccines. We have millions of Canadians who are eligible but not yet vaccinated, a very transmissible Delta variant, and now innumerable opportunities for the virus to be transmitted given that people are congregating indoors in colder weather. We are going to see higher case numbers than we did throughout the summer, but if enough people are vaccinated, maybe we can work our way out of it by the tail end of the winter and the spring of next year. That, along with some people who get infected and have immunity related to recovery from natural infection, may help us reach a critical threshold where the virus is still around, but it’s not going to disrupt our society as significantly as it is now.Next,A Province-by-Province Guide to Vaccine Passports in Canada

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Preparing for the unprecedented

Our hospital was hit hard early in the pandemic. Our hospital had some of the highest numbers of admitted COVID patients in the GTA. Patients stopped coming to the emergency department due to fear, so our waiting rooms were eerily empty except for the sickest patients who couldnt avoid coming. We were rapidly changing how we worked to respond to an ever-evolving situation, all in absence of guidelines.We realized that we needed to learn and implement new best practices quicky, so we created simulation scenarios and practiced, for example, how to resuscitate a patient when they have COVID. Usually, when a patient is being resuscitatedmeaning treating a patient whos stopped breathing or doesnt have a heartbeatmedical staff are going in and out of the room constantly. But that wasnt safe during COVID. We couldnt just open the door because it would allow germs to come out. So how do we pass equipment and talk to the team inside the room?Starting March 6, 2020 we ran over 20 simulations in nine weeks. We created new protocols using a two-door system so staff could enter a patients room without allowing germs to escape. We used the three-way calling function on dedicated cellphones so we could consult all the team members even if they werent in the same room. We had whiteboards on hand in case there was a phone failure, so at least you could show what you needed through the glass. These solutions were crowdsourced in several ways: consultations with colleagues, ideas shared on social media and trial and error.(Related:What You Need to Know About COVID Variants in Canada)

Responding to the rise in anti-Asian racism

There was an incident at our hospital where a patient expressed extremely hateful anti-Asian sentiments to everyone near him, including an Asian health care worker, who remained calm and professional. There werent any specific protocol in place for dealing with this; however, as a result, we created a system to start tracking these incidents and started working on a more robust protocol to respond to future incidents.In my new position at Torontos St. Josephs Health Centre, Im the first woman of East Asian descent to be a lead an Emergency Department (ED) in the GTA. I feel a lot of pressure not to fail, so that can be overwhelming. To cope with this, I try to take the focus off myself, and I remember how its not about me; its about all the women that are coming right behind me. I think representation is so important and I was reading about Kim Ng, whos major league baseballs first East Asian General Manager, as well as MLBs first woman GM, and she always says, you cant be it if you cant see it.(Related:How to Be an Ally to the Asian Canadian Community)

Constructing new health care spaces

When I accepted the role of ED Chief, I took all of my experiences with me. The hospital has plans to renovate the emergency department starting this month and I was happy to arrive before demolition began. It meant that my team and I could use what weve learned from the pandemic to inform the changes we wanted to make and reshape emergency care.A lot of the changes were planning have to do with infection prevention and control. For example, your typical emergency department has a bay with lots of stretchers that are separated by curtains. Ideally, stretchers will be separated by walls that can be wiped down and that keep viruses contained. Walls also have the added benefit of reducing background noise. Noise adds up, especially in the ED where we have alarms, equipment and people talking, and that can create a chaotic environment for both patients and health care workers. Our hope is that having separate patient rooms will create a calmer environment.During COVID-19, we also learned how proper ventilation can help decrease virus transmission indoors. In our new emergency department, were making sure the HVAC system standards are met, including making sure that we have sufficient airborne infection isolation rooms (AIIR) to safely care for our patients. AIIR rooms are under negative pressure, meaning the air pressure inside the room is lower than outside the room. When the door opens, potentially contaminated air inside the room wont flow outside, and is instead vented through an exhaust system that cleans the air before it is pumped outside the building.Were also boosting our internal communications by building in an intercom system so we dont need to MacGyver a solution with iPhones or baby monitors, which are used in many emergency departments.(Related:Going the Distance: How Covid Has Remapped Friendships)

How the pandemic is changing patient care

Going forward, its entirely possible health care staff will wear a mask for every patient encounter. SARS did change masking protocols, and many health care workers don a mask when its more likely a patient is infectious, but now health care workers may do this for all patients, rather than for select patients.The need for need for good translation services came to the forefront during the pandemic. Over 140 languages and dialects are spoken within the city of Toronto alone and normally, we were almost always able to have a family member or friend present to translate. With COVID, we didnt permit any visitors to accompany patients, so we had to have a family member translate over the phone, which is not easy.The pandemic made me more aware of the importance of connecting with patients and how I took that for granted. Like, the ability to shake a patients hand, or to discuss an issue with the patient and their loved ones.During the pandemic, we had to call loved ones to get information and keep them informed, instead of being able to speak with them in-person. That meant learning a new form of patient communication on the fly. We had to be very intentional. What do I need to tell this person in a very simple and precise way? How can I do this in a sensitive way since they cant see my facial expressions? I found myself apologizing a lot more. Apologizing for having to talk to them about a very serious problem over the phone instead of face-to-face. Apologizing for having a frightening discussion without any warning over the phone. Specifically, apologizing for telling them their loved one was struggling to breathe and that we would have to intubate them in the next few minutes and asking if we have permission to do so.(Related: First Person: I Am Astounded That I Survived)

The toll on health care workers

Its been really, really tough for so many health care professionals. Our staff are so dedicated and its hard for them to leave work because theyre so worried about their colleagues and the workload they need to shoulder. But you can only overwork yourself so long before your reserves run out, so Im worried that well see significant healthcare provider shortages as people retire early or switch careers. Right now, as theres capacity in the hospitals, we need to allow health care providers to just take a break and reenergize and hope that theyll come back to work. I was lucky enough to take two weeks off this summermy first break since March of 2020.

How the pandemic has changed me

The pandemic made me reflect on my priorities in life and how to make sure I spent time on people and on things that were meaningful to me. As a physician, I was able to witness the skill, compassion and dedication of my colleagues. It was hard, and still is hard, to see how the brunt of this pandemic has fallen on the shoulders of my nursing colleagues, and I struggle to find meaningful ways to support the incredible people who do this very difficult job.Ive learned that in times of new uncertainty, its important to always be honest about what you do and dont know. No one is expecting anyone to have all the answers, and in situations where you dont have the answers, adopt the precautionary principle meaning that complete evidence of risk isn’t necessary to take action to mitigate risk until you get more information. Once the evidence is available, let it guide your decision making. Always prioritize and value your people, theyre the backbone of any organization. Frontline workers are the expertslisten to them. And dont be married to being rightif your initial decision was wrong, thats OK, but be humble enough to admit it and nimble enough to change your course as needed.Can we ever be completely prepared for the unknown? No, but these guiding principles, and lessons from the pandemic, are helping me and my team better prepare for whatever comes next.Next, here are four ways the pandemic has taken a toll on our bodies.

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How will the fourth wave be different than what we’ve seen before?

The big game-changer this time around is the vaccines. According to Chow, most of the cases that are accounting for our recent uptick are in the unvaccinated population. In Ontario, for example, an August 16 report from the Ministry of Health found that 67 percent of all new cases in the province were in unvaccinated people. But, thanks to the majority of eligible Canadians being vaccinated (as of August 7, 71 percent of the total population has received at least one dose while 61 percent are fully vaccinated), the rate [of transmission] is slower than earlier waves, when we had no protection and hardly any immunity and low vaccination rates, says Chow.One concerning difference between the fourth wave and previous ones, though, is the loosening of public health measures, particularly border restrictions, says Banerji. Places in the United States really dont have COVID under control, so were opening that up and unvaccinated people can come in and dont need to quarantine, she says. Thats a concern.(Related:Moderna vs. Pfizer: Why Were Not Playing Favourites with COVID-19 Vaccines)

Who is at risk during the fourth wave?

Generally, its the unvaccinated population who is most at risk. This includes both people who have not received their vaccine but are eligible and anyone under the age of 12 (or in Ontario, anyone who will not be at least 12 years of age by the end of 2021), as vaccines havent been approved for use in children under 12 yet. As well, young adults and teens are more at risk during the fourth wave because they have lower rates of vaccinationand because they’re more likely to be working in essential services like food serviceor retail, says Banerji.(Related:A Psychologist’s Guide to Preparing for Back to School 2021)

What could all this mean for our healthcare system?

During the previous waves, there was a lot of concern for our healthcare systems as hospitals filled up and surgeries were postponed when hospitals ran out of space. Banerji is hopeful thatthe fourth wave wont impact surgeries and other procedures because most people are vaccinated and wont get as sick.Chow also hopes high vaccination rates will translate to fewer hospitalizations. Vaccinated people still catch the virus, but they might not get sick or seriously ill, he says. But, transmission can still occur in the unvaccinated population, which is why social distancing and masking in spaces where you cant distance is still very important.

Could we be headed for more lockdowns?

Possibly. But Banerji notes that most people would rather have mask mandates to keep workplaces and schools safe, not lockdowns. Were also seeing vaccination mandates and vaccine passports be discussed (and, in Quebecs case, be implemented) as a way to, hopefully, avoid the worst of the fourth wave. Some medical professionals see mandatory vaccination for everyone as a way to address vaccine hesitancy and boost vaccination ratesand its already a key election issue for the upcoming federal election.Getting vaccinated is the best way to avoid lockdowns and keep businesses open, says Banerji. Plus, it’ll keep workers and customers safe when things are open. Thats really how were going to keep things open. The best way to prevent lockdowns is to get more people vaccinated.(Related: What You Need to Know About COVID-19 Vaccines and Your Period)

What can Canadians do to stay protected?

First of all, get vaccinated if you havent already. The majority of cases contributing to the current surge are in the unvaccinated populationaccording to a recent government of Canada count, as of July 31, 89 percent of those who contracted COVID-19 in Canada were unvaccinated while 0.6 percent were fully vaccinated. And even if you do contract COVID-19, youre a lot less likely to get severely sick or be hospitalized if youre vaccinated. According to that same count, 84 percent of those hospitalized with COVID-19 were unvaccinated and 0.8 percent were fully vaccinated.Continuing with public health guidelines like masking, avoiding crowds and physically distancing will also help protect you during the fourth waveeven if your local public health unit has done away with masks and capacity limits. Its better to be super safe. Even if youre vaccinated or partially vaccinated, theres still a small chance you can get or spread COVID, says Banerji. I would say, hold on tight a little bit longer.Next,this is what you need to know about online dating and vaccines.

The post Experts Advise Being ‘Super Safe’ as Canada Enters the 4th Wave of COVID appeared first on Best Health.

Your vaccination status is not hot

So says Toronto-based sexual health and consent educator, Samantha Bitty.”When vaccines first became available, many people boasted about their vaccination status, and it functioned like a class marker, she says, referencing Ontario, where vaccines were not initially distributed in an equitable way to racialized populations and low-income neighbourhoods. We definitely need to be having the conversation [about vaccine status and dating], because it is a health benefit to know, particularly for those who are at risk or live with family. But it is another layer of desirability politics, while so many are already navigating racism, transphobia, ableism, etc.”And that’s where it gets thorny. Sure, many of us posted vaccine selfies and shared our status proudly as a way of celebrating and supporting vaccine efforts in Canada. Adding vaccine status to dating apps is different, Bitty explains, because “leveraging it to get to have sex is messy, and presents as a virtue signal depending on how you share it.” In other words, while it advertises whats important to the personwhich can be helpfulit can also communicate that vaccine status is all that matters and inherently implies that a vaccinated person is superior (read: wealthier, smarter, more attractive).(Related: I Was Ashamed I Tested Positive for COVID-19)

But at this point, does vaccine status reflect someones values?

When I asked friends of mine how they’ve been navigating dating during the pandemic, many said they refuse to meet someone unless they’re at least half vaccinated. Others said “establishing chemistry first is important” and some even “forget to ask” or decide to “just figure it out if we gel.”Which is worth noting, because at this point in Canadas pandemic response, not getting vaccinated is less an issue of access and more one of choiceor in some cases, a stance.Take, for instance, a recent conversation I had with a gorgeous, hilarious man on Bumble. We hit off and even made plans to meet. And then I remembered to ask: “Are you vaccinated?” He launched into an essay-length diatribe about why he doesn’t “believe” in vaccines and thinks they’re a scam for the government to gain more control over humanity. I debated this with him and encouraged him to please get vaccinated, but it occurred to me: this is not someone I feel safe going on a date with simply for my own health. So I unmatched him. And I felt guilty.(Related: What You Need to Know About COVID Variants in Canada)

Why guilty?

Thats the first question Angela Ivy Leong, a Vancouver-based sex and relationship therapist, asked when I called her about this conundrum. I explained that I feel as if I’m judging people in a new way, and it doesn’t seem fair. Her response? “It’s absolutely fair. You’re speaking your truth, you’re saying, ‘Well, this is what I’m comfortable with.As a sex and relationship therapist, Leong has seen several couples struggle in the past year because their ways of dealing with COVID-19 are so different. So it’s important that you know this person’s views and if they’re different from yours, because it can get really hard to add that layer to a relationship, she says.(Related: How the Pandemic Changed How We Feel When We Feel Left Out)

Vaccine status is a new facet of consent

We’re often told to avoid complicated subjects on first datespolitics, religion, moneybut during COVID, addressing the big vaccine question early on has become essential, and it opens the door to have important conversations about STIs and consent. And there’s no denying that vaccination status is political.”The dating pool has become extremely polarized, especially if you are someone who is politically engaged, if you’re racialized, if you’re a woman,” says Bitty. “I have screened people for shared values, and there’s nothing wrong with that. It’s about what your intention is when your profile photo is your vaccination card or the only line on your page. Is it truthful? Are you sharing it to be health conscious, or are you trying to make yourself more desirable?COVID-19 vaccines have spurred ongoing debate around privacy and public health, and things get even messier in the online dating world. But one thing is clear: informed consent in the bedroom is crucial for having a fun, healthy time. So, what is the smoothest way to do this in 2021?The answer, Ive realized, is asking what you want to know and doing what you can with the information you’re given, because ultimately, its about how safe you feel. The dating game has always been messy. The key is to protect yourself, practice informed consent, and remember that knowing someone’s vaccination status can give you some insight into their ideologies. And that’s essential when it comes to relationships.Next, read The Honest, Expert-Backed Truth About Having Sex While on Your Period.

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Human beings are creatures of habit. Generally, we much prefer to function in a state of control and predictability. Thats what keeps us comfortable; its what keeps us psychologically safe, says Taslim Alani-Verjee, a clinical psychologist and founder of the Silm Centre for Mental Health in Toronto. The pandemic, of course, upended all that, and governments further unsettled us with protocol that could be, as she says, a little flip-floppy. Church services would be allowed in B.C. over Easter weekendoh, wait, no, they wouldnt. Outdoor playgrounds were off limits in Ontarionope, never mind, play on.

We couldnt even know how to claim some control because we didnt know what was allowed or not, Alani-Verjee says. Can you get together with people outside without a mask on, or can you not? Small group indoors, yes or no? In the absence of clear, consistent guidelines from our leaderswho insisted that buying books in a shop with two other customers was perilous but cramming kids into a poorly ventilated classroom for six hours was totally finewe had to make our own calculations for what seemed sensible and what felt safe. Its exhausting to weigh those decisions, all day, every day, against our emotional needs, psychological bandwidth and tolerance for risk, especially when the consequences for getting it wrong are so high. That burden of individual responsibility fuelled more anxiety at a time when every single thingeating, sleeping, grocery shopping, parenting, obtaining routine medical carealready took so much work.Under normal circumstances, stress and anxiety are quite helpful to us, because they help us know when there is a harmful threat and we need to act for our physical or emotional well-being, Alani-Verjee says. But living on a knifes edge of panic for a prolonged period of time robs us of our ability to distinguish between an actual threat and our day-to-day existence. And that ends up affecting our ability to sleep, focus, connect with people and to recall even the basic contours of what was said at yesterdays morning meeting.(Related:Post-Pandemic: Coping With the Anxiety of a Changed World)The reason, Rajah says, is that the perpetual background drone of stress and uncertainty interferes with our memory systems, as well as our cognitive control systems, the mechanisms that allow us to focus and stay on or switch between tasks. We have been trying to juggle so much under such unusual circumstances, and its terrifically overwhelming to our working memory and our attentional capacities. Thats what causes the brain fog and distractibility that a lot of us feel, Rajah says. Thats the mental exhaustion.Then factor in the loss. Officially, more than 26,000 Canadians have died from COVID-19, but a recent Royal Society of Canada study found that the true tally could be twice as high, due to under-reported deaths, especially in lower-income and racialized communities. Princeton researchers calculated that each death leaves behind an average of nine close relatives: parents, siblings, spouses, children and grandchildren. Grieving is not a simple thing: It can take a year or more to get accustomed to the idea of the loss of a loved one, says Steven Taylor, a professor at the University of British Columbias department of psychiatry and author of The Psychology of Pandemics. The disruption of funerals, shiva and other mourning rituals can make negotiating that grief harder still.But Taylor points out that prolonged isolation, financial insecurity, and the total interruption of our social routines will produce a sense of sadness and loss as well. You dont need to feel guilty or self-critical, like, I didnt suffer, I didnt experience a loss, so I have no reason for feeling so blue every day, he says. You dont have to go out and earn a mood disorder. The accumulation of these stresses has an impact.In fact, the accumulation of these stresses has a name, as well: adjustment disorder. Characterized by anxious or depressive symptoms that develop as a result of stressfulbut not necessarily life-threateningevents, adjustment disorder is the little brother or sister of post-traumatic stress disorder, says Alain Brunet, a clinical psychologist at McGill University who studies the effects of traumatic stress on mental health. Everyone knows it exists, but its never talked about.While early research suggests that roughly a third of patients who have had a severe case of COVID-19 and a quarter of all health-care workers will develop PTSD, Brunet suspects many more of usperhaps tenfold moreare dealing with adjustment disorder. And all this euphoric talk of a Hot Vax Summer or rebooted Roaring Twenties can exacerbate these symptoms. Transitions are hard under the best of circumstances, and dining indoors or hitting up a concert may not seem like the best of circumstances, particularly after a year-plus of being told to fear crowded spaces and aerosol spread. Rajah acknowledges that struggling with melancholy as COVID-19 recedes in Canada might feel a little funnybut its definitely to be expected. Thats why its important to be just as kind to yourself when transitioning out of the pandemic as you were when you transitioned in, she says.(Related:How Rumination and Obsessive Thoughts Are Linked to Anxiety and Depression)

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Lets just get this bit out of the way now: Everyone I spoke with for this article assured me our pandemic brains will bounce back. Our memory will improve; our cognition will improve, Rajah promises. Im a big believer in the resilience and plasticity of the human brain. Though it can feel like this virus has been with us for roughly six centuries, its somehow only been 18 months. What I usually tell people is that weve had a lifetime of living in a certain way, so it takes us a significant time to learn different patterns, Alani-Verjee says. What we have on our sides right now is that the circumstances will change and the environment will changeand how were feeling is going to change as well.Not everyone will come out of this pandemic at the same speed. But the fact that we cant declare some COVID-19 Armistice Daywhere we put the threat behind us and go kiss strangers in the streetmight actually work to our emotional advantage. If there is that sort of declaration, we lose our ability to choose and negotiate with our family, friends and employers about what we do and dont feel okay doing, Alani-Verjee says. Gradually re-entering a world that shut down abruptly allows us to test drive our comfort levels.And if youre feeling apprehension? Or anger? Or sorrow? Or terror or vigilance or confusion or pain? Thats okay: Let yourself feel all of it. Theres no such thing as unreasonable when it comes to our feelings, Alani-Verjee says. If we allow ourselves to be in touch with our feelings, then we can figure out what we want to do with them. She concedes that when she recommends people journal, they tend to side-eye the suggestion, but she says its a good strategy for processing emotions.(Related:8 Women Share the Impact the Pandemic Has Had on Their Mental Health)If, however, journalling is not your jam, Alani-Verjee says, then going for walks, cooking or dancing around can all unleash those feelings into the world. If your mind is racing or youre grappling with intrusive thoughts, meditation can offer considerable help. Alani-Verjee recommends just being very present in whatever you already do. The next time youre in the shower, focus on the temperature of the water and how it feels on your skin. When your mind starts skidding elsewhere, bring it back to the smell of your shampoo.And for the love of Pfizer, dont be afraid to talk to people about what youre going through. When people talk to each other, when they give each other support, that makes times of crisis much more manageable, says Brunet, who expects a significant majority of Canadians will rebound from adjustment disorders without professional help. While none of us will have navigated the pandemic in precisely the same way, this has at least been a global event. Individual trauma can be isolating; it can be stigmatizing. But Rajah swears we are all contending with COVID exhaustion and anguish and grief. I worried that this sort of collective experience would compound our own trauma. Rajah has a different take: It can help us let some of it go.Individual trauma is often negative, because you dont feel you can talk about it and you dont feel understood, she says. But the pandemic isnt something that happened to you and not to other people. We are part of a larger community, and I think were better for it. I think we will heal faster as a result.Next, this is the toll the pandemic is taking on our bodies.

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