Volume 8 • 2021 • Issue 6

In the coming months, we’ll need to be cautious about what activities we do outside of our practices. Indoor spaces, even when people are masked, are higher risk than outdoor activities. The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. The take-away is that booster shots or additional doses for people over 65 about six months after initial vaccination are a good idea. Our immune systems need to “see” a snapshot of a virus fairly regularly to be able to recognize and be primed to fight it. We are seeing an increase in some of the common childhood illnesses right now, like respiratory syncytial virus (RSV), because our immune systems haven’t been exposed to them in almost two years. It can be helpful to think of our immune systems this way: they need to be primed. Q We expect that children between age 5 and 11 will soon be eligible for vaccination in Canada. What impact will that have? AB: It will be another helpful tool in the toolbox of managing COVID. In epidemiology, often the first population that gets vaccinated is children because schools tend to be a place where transmission happens. Children pick up viruses at school and then bring them home to other family members. Vaccinating children will help reduce transmission. And one of the fortunate aspects of COVID is that 99% of children don’t experience serious illness, if they are infected. Currently, about 8% of eligible Canadians are not vaccinated. It’s among this population of the “vaccine hesitant” that we are still seeing serious illness and hospitalization. Breakthrough infections can happen, but it mostly doesn’t result in serious illness. Q What can dentists expect in the coming months? AB: I imagine we’ll see a three-prong management approach as the pandemic transitions into an endemic disease. The first prong is vaccination of the population, including boosters. Second, we will need to continue public health protocols, such as masking indoors. Then third, the introduction of new medications that, if taken within three days of onset, can decrease the risk of hospitalization among individuals who are at greater risk and potentially as an adjunct to prevent hospitalization for those who are not vaccinated. In addition to GlaxoSmithKline’s Sotrovimab, a single-dose monoclonal antibody that has significant limitations for those more seriously ill, there are two medications for COVID infection, one from Merck and one from Pfizer. So far, the clinical trials are small; one of them only about 700 people. Also, it’s common that in early clinical trials conducted by pharmaceutical companies effectiveness appears to be higher than it actually would be in the general population. It’s good that we’ll have another tool in the toolbox that will be especially helpful for young children or people who can’t be vaccinated, as long as they can get tested and access care quickly. In the coming months, we’ll need to be cautious about what activities we do outside of our practices. Indoor spaces, even when people are masked, are higher risk than outdoor activities. Sadly for us Canadians, indoor hockey rinks are riskier than outdoor. Keeping indoor spaces at low capacity is smart. In Eastern Europe, the surge is happening partly because of moving indoors in cold weather and many buildings rely on the windows being open for ventilation. Q What would be your message to colleagues as we close out the year? AB: Ontario announced that it will lift all remaining COVID-19 restrictions by the end of March 2022. I wonder about the psychological impact of such a claim. It can make it easier to cope if you know that there is a limit and that the challenges we are currently experiencing will eventually end. But the pandemic has proven to be very unpredictable and I worry that if in March restrictions have to be extended, or even re-imposed, people will have a tougher time and feel as if a promise has been broken. For dentists, our protocols should stay the same for some time yet, and when we finally make changes, we should take each step forward slowly and cautiously. I like to keep in mind that a year ago we didn’t have vaccines or medications. Last year, we were headed back into lockdowns and we weren’t sure which public health protocols were most important and still debating about a virus that is transmitted by aerosols. So it’s comforting to know that despite everything, we are in a much better place and there is a clearer path ahead to the light at the end of the tunnel. Reference 1. Cohn BA, Cirillo PM, Murphy CC, KrigbaumNY,Wallace AW. SARS- CoV-2 vaccine protection and deaths amongUS veterans during 2021. Science . 2021Nov 4;eabm0620. doi: 10.1126/science.abm0620. 10 | 2021 | Issue 6 CDA atWork