December 15 LTC Town Hall: Q&A

The following Town Hall questions were answered with information that was current at the time. Information around COVID-19 and our response continues to evolve. If you are unsure if the information below is still current, or if you can’t find the information elsewhere on the website, please talk to your leader or email: COVID-19@providencehealth.bc.ca

What is the difference between the two doses? What is the science behind receiving the vaccine in two doses?
For both the Pfizer/BioNTech and Moderna vaccines, the first and second doses are administered 21-28 days apart in the studies. They content of the first and second doses are the same. The second dose elicits a more robust immune response and the studies found that the efficacy in protection is higher 14 days after the second dose.
Will immunocompromised staff be able to get the vaccine? If they want to get it is there an opportunity to join a study testing its safety with this population?

The term “Immunocompromised” is a large catchment catch term. For the vaccine, the only groups that were excluded are those who have primary immune-deficiencies, or acquired immune-deficiencies either through treatment or through infection.

The recommendation is that if you have what you consider an immunocompromised state to discuss that with the vaccine provider. If you're immunocompromised depending on which condition you have, you might be more susceptible to severe disease. So weighing the risks and the benefits will be the key. And that would be discussion on an individual case by case basis.

In terms of opportunities join study to assess the safety of this in this population. There are ongoing trials, but none currently that are enrolling in BC, that I'm aware of. If there are studies that are enrolling different populations. That will be communicated to widely so that people can consider joining.

In general, the vaccine would be safe in most conditions if you feel that there's a specific state that you have, then to discuss that and have that assessed so that the pros and cons can be weighed down a little bit more detail.

Will non-direct patient care staff receive the vaccine this round (e.g Allied Health)?
Right now, only those providing care in long term care settings or those who spend a fair amount of time in long term care facilities (eg. Housekeepers, food service workers). So this includes those who are an allied health professional and spend a great deal of time within a long term care facility or unit.
Do we know the vaccine distribution plan for the LTC residents?

I'll start with that one right now because of the logistics, we are holding off on using that for the long term care residents. The Moderna vaccine is now going through the Health Canada approval process that one. The Moderna vaccine is a little easier to move around, so this will likely be the vaccine used for long term care residents. When that will happen isn't entirely clear, although we hope for clarity in the next few weeks.

Our staff are the critical ones to receive immunizations because our residents aren't going anywhere. The first go round needs to be our staff because our staff are mobile and coming in and out of the facility on a regular basis.

Can staff on LTC casual lists also get vaccinated?
As long as you work in the long term care facility, you will you are eligible to get vaccinated in the first round.
Am I eligible for the vaccine if I’m currently on leave (medical/maternity/paternity) but due to come back in the next few months? My base site is a LTC home.
Currently, because we don't have a huge abundance of the vaccine we are immunizing the staff who are currently at work. We will assess this as vaccine arrives but in this first round right now it's reserved for the staff that are currently at work.
Is this the same vaccine as the one that caused the allergic reaction in couple people in Britain? If so, should those staff with such allergies decline? Will a list of additives be available for those staff with severe allergies? Will a person with severe allergic reaction be able to get the vaccine anyway?

Those individuals in Britain who experienced allergic reactions have recovered, so that's good news. These individuals were known to have anaphylaxis reactions before and had prescriptions for epinephrine or epi-pens. So if you have a known allergy to one of the vaccine components, and you carry an epi pen, that would be one of the signals to reassess.

But if you have allergies, for example to other medications or intolerances in the past to vaccines, more, more kind of immunogenic responses such as fever pain at the site those would not be reasons to decline as those are not true allergies. So the only type of allergy is if you have a known reaction to the ingredients, or if you have anaphylaxis and are carrying an epi pen. That would just require just a few further questions to assess whether it's appropriate for you to receive the vaccine introduction.

Next question, are there two shots, one now and one in three weeks, what happens if we go to shot now and then have a reaction to it. Should we get the second one?

This vaccine is given in two doses. The second dose is given between 21 and 28 days after the first dose.

The reason for the two doses is to ensure that there's an adequate efficacy as studied in the trials.

If you have a reaction to the first dose, it depends on what that reaction is. For example, if it's just natural kind of immune responses such as localized pain in the injection site, muscle soreness, etc then you would be eligible to receive the second dose. Some individuals have more of a prominent response after the second dose, so for example the localized pain or fever might be more prominent after the second dose and that's expected based on the immune response, be more robust the second time around.

So, you are eligible if you have a reaction. It depends on what that reaction is.

What happens if your COVID positive but don't know it and then get the vaccination, will it get rid of the COVID virus or will you still get sick with it.

We don't know with certainty how the vaccine will respond to those who have had COVID and since recovered because these individuals who were enrolled in the study were not checked for previous exposures to COVID before being enrolled in the study. Theoretically, there shouldn't be any adverse events if you've previously had COVID and are now getting the vaccine.

If you currently have COVID with symptoms, then you should not be traveling to go get the vaccine until you've been cleared by public health and are deemed recovered, so that you don't expose others. We don't want to mix up the type of symptoms that you have so if you have prolonged symptoms, we don't want to attribute that falsely to the vaccine when it could just be COVID active infection.

There are individuals that might have asymptomatic COVID infection, but we won't be testing for that. Unless you're part of the long term care rapid antigen screening pilot. If you have COVID, potentially you're harboring it in the respiratory tract and you're asymptomatic.

We don't know what this vaccine will do, however, we know that the vaccine effects don't occur right away. So we would not expect that the vaccine would be used to treat an active COVID infection if you have it. If you're asymptomatic, you may still get sick with the COVID virus because the vaccine is not meant to be treatment it's meant to be prevention for future infections.

In summary, if you're known to be COVID positive, wait till you've recovered. If you don't know that. And you're asymptomatic that you would be eligible for the vaccine if you're in the long term care worker category.

Can I catch COVID between the first and second shots?

Yes, you can get infected with the virus between the first and second shots and you could still get infected with the virus after the second shot. We know that the vaccine is not 100% protective. That's why we still have to maintain our other interventions that we're practicing now.

After getting the vaccine, you still need to wash your hands, wear PPE, and physically distance, because firstly it's going to take time for you to develop an immune response. Even after that, we can't be sure that it's 100% protective. So until we have a large portion of the population vaccinated, most of the measures we practice now will stay in place.

Will there be enough vaccines in this first shipment to vaccinate all PHC LTC employees?

The short answer is probably not, but within a few weeks if all goes well, we should be able to vaccinate all Long Term Care employees in the Vancouver Coastal region. That is the goal.

And just in case you have friends who work in other sites. Long Term Care employees are the first priority. After that will be acute care and some other groups, such as rural and remote communities.

And then subsequently people over 80.

Will there be a pre-assessment or screening form to fill out before the vaccine?
You will be screened similarly as you would for COVID-19. We cannot say for certain, however there will be some screening.
What if some staff refuse to get the vaccinations for personal reasons (not allergy/medical reasons)? Can they still work in long term care homes?
This is not a mandatory vaccination just as our flu vaccine. If you do not get the vaccine, please continue to wear PPE. It’s critical during this next year while we try and get enough of our society and our staff immunized to get what we would call herd immunity. It's important that you continue to follow all of the PPE protocols and all of the IPAC protocols that we currently have in place that will  keep people safe.
Can you please clarify, does the vaccination site have our names? Or do we need to bring proof that we work in a LTC site?
Both. We have provided staffing lists to Vancouver Coastal Health, but you will also need to take your hospital ID and your personal health number. If you forget your personal health number, you will not be vaccinated, so it's critical that you have that piece with you. And yes, please take proof that you work in a long-term care site.
If I've received my shot and I live with someone who becomes COVID positive, will it be OK for me to still come to work (either after 1st or 2nd shots)?
If you live with someone who's COVID positive, you would stay home and wait until public health contacts you to give you further direction. In general, household members are told to quarantine. After the first dose and the second dose – it's not 100 per cent effective – so this is still in the works from public health as to what they make a decision on. It will probably be based on what risk, because we don't have a plan to specifically measure everyone's immune response at this time. I anticipate that the quarantine and self-isolation guidelines will not change at this time.
What special precautions will I need to take between my first and second shot? Should I avoid any other shots (i.e. shingles, etc.)?
With vaccine co-administration for other vaccines, there's generally no contraindication. This is a newer vaccine, and when it was studied individuals did not receive other vaccines at the time so side effects or immunogenic response wouldn't be confounded. The recommendation would be that if you received the vaccine, in general, you should not get other vaccines until the vaccine schedule is completed. It wouldn't disqualify you if you ended up getting a vaccine of another type, but the recommendation is to stay with the schedule between the first and the second dose.
I just got my flu shot less than a week ago, am I OK to get the COVID vaccine on top of that?
Yes, you can still get the COVID vaccine if you've had the flu vaccine a week ago. If it's separated by time between your influenza dose and your first dose of COVID vaccine, that's fine. It's recommended that you don't get a COVID vaccine, then get a flu vaccine, then get a COVID second dose.
How long will this vaccine be effective? Do we know yet if we'll have to get COVID vaccines every year or every two years?
We don't know. The vaccine effectiveness has been studied in large randomized control trials. We have some follow-up data, and all of that follow-up data will continue. We know that at four weeks’ time, people have protection. After that, we are not sure, but based on other vaccines and the robust immune response that people have developed within a short timeframe, it's expected that it should have longer protection. Precisely how long that protection will last is unknown.
Students working in LTC and provide directing care to residents. Are they eligible for the vaccine?
What we're looking at is how long you are actually there. In this very first week, it really is our long-term care staff who are going and who we've provided the list for. If you are a student who has, for example, started a practicum in long-term care, and you're working directly with our residents, then I would say yes, you should get vaccinated because you, as well as our staff, are the ones who are moving about. I don't think they're going to say no, as long as you're in a long-term care site.
Will a list of additives be available for those staff with severe allergies?
We’ve provided the additives in the Pfizer vaccine. Regarding the Moderna vaccine, those details will be available. In Canada, both Health Canada and NACI review the details and they will be posted once we have that information after review. We'll make that available, just like we have for the Pfizer vaccine.
How about a person with a history of cancer or in remission. Will they be able to get the vaccine?
It depends on the history and remission versus treatment. For every kind of immunocompromised condition, if it's unsure, it should be assessed to see what the current status is. It’ll be a risk versus benefit. In general, I would not see this as a contraindication and it's not listed as a contraindication, but there are some conditions that require further assessment, whether it's immunocompromised from medications or immunocompromised from procedures or transplant, for example, that would need further assessment. In general, people with a history of cancer that have recovered, there should be no reason you would not be eligible for the vaccine.
Is there a risk of getting Bell's Palsy after the vaccination?
The incidence of Bell's Palsy and lymphadenopathy, based on some of the original signals, suggests that it's there. But Bell's Palsy can be caused by many conditions, some of which are known and others are idiopathic, meaning we don't know the cause. The incidence of Bell's Palsy, based on the limited absolute numbers, was higher. But we don't know if that's necessarily higher in terms of population-based baselines. If adverse effects such as Bell's Palsy are noted, it's important that you seek medical attention so the effect can be assessed and recorded to give us better information as this vaccine rolls out.
Can we opt to wait to receive the vaccine provided by Moderna? Or will we have difficulty getting access to any vaccine if we decline this round?
If you choose not to get vaccinated currently and you want to wait for the Moderna, then you continue to wear your PPE. Moderna will be offered as well. There's a lot of stuff that we just don't know at this point in time because it's happening so quickly. Public Health and the Ministry will guide a lot of what we do, but I would say that you will likely have access to another vaccine.

Both are messenger RNA vaccines. They should act the same way in terms of the mechanism; the efficacy is pretty similar between the two vaccines. The main advantage that we've seen so far from the Moderna vaccine is related to the logistics of delivery, as opposed to side effects or efficacy. Once Health Canada approval is done and complete, there will be very clear, transparent reporting of side effects and efficacy that individuals can look at. Personally I would not choose one over the other at this point. I would choose the first available one.

If I get the vaccine and I experienced some side effects, do I have to stay home from work until they resolve and/or get tested for COVID?
The potential side effects initially do mimic a lot of the COVID symptoms. Yesterday, what Dr. Henry said is that none of the side effects should be really big. You may have the pain in the arm, you may have some fatigue, you may have a headache, and that's OK, it should go away in a day. If they were to continue and get worse then you should definitely go and get tested, but she was very clear saying that any side effects you have should be fairly minor and should go away fairly quickly. She didn't think you would need to go get tested the first day if you had some kind of side effects.

The other types of symptoms we see with COVID, other than fatigue or body aches, are respiratory symptoms. If you develop a cough, shortness of breath, then I would go get tested sooner. But if you get some mild injection site pain, maybe some headaches that are transient within the first 24 hours, then the probability is that it's related to the vaccine and not to COVID. If they persist then definitely get tested, or if they're more severe and you have more symptoms such as respiratory symptoms or sore throat, then to get tested. If you've had significant exposure to someone who has COVID, then that's more likely to suggest that you go for testing.

Can you comment on any known risks from studies for pregnant or breastfeeding individuals? Or on fertility?
Individuals who are pregnant/breastfeeding were not included in the studies. This is not a live vaccine, but even with live vaccines and pregnancy there's not been studies showing major problems. Based on the mechanism, this vaccine should not cause problems. Those who are pregnant/breastfeeding should have a discussion with their health care provider to assess the known risks of COVID if they get it and the unknown risks of getting the vaccine. It's not an absolute contraindication, it does warrant discussion for those who are pregnant because we don't know what the possibilities are because it hasn't been studied.
Will I test positive for COVID in the future if I get the vaccine?
In the human studies for Pfizer they never assessed periodically whether people develop asymptomatic disease. The primary outcome was symptomatic lab-confirmed disease. So it's possible that you could still test positive for the virus after. Whether that's symptomatic disease or not is unpredictable, however we see that the number of individuals developed symptomatic disease after getting the vaccine were significantly lower than those who did not get the vaccine. So this is a possibility, and we'll be able to get more information into how effective this vaccine is in preventing asymptomatic disease as this gets rolled up. The vaccine should not interfere with the ability to detect the virus if the virus is there.
If I am going to LTC site in person for education support from Jan to Mar after the New Year, do I need to get vaccinated in this round?
If you will be at an LTC site for an extended period, I believe you should get vaccinated, however, when you go to the clinic, they will need to determine the suitability in this first round. 
This page last updated Dec 31, 2020 1:38pm PST