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JointHealth™ express   April 4, 2022


Update on COVID-19 Vaccination

As provinces and territories end mask and vaccine mandates, immunocompromised people, such as those living with a type of inflammatory arthritis, are naturally concerned what “getting back to normal” means for them while we are still in a pandemic and waiting for the next variant – BA.2 – that is currently sweeping across Europe and other countries around the world.

Many ACE members and subscribers who are immunocompromised have been asking what the lifting of COVID restrictions means for them and what should they be doing in response. For many of us, the message from public health officials across Canada is confusing and, at times, appears to almost be ignoring the present and constant threat COVID continues to pose not just for immunocompromised individuals but also for older adults and people living with other chronic diseases such as cancer or heart disease. For those people, it’s not a “return” to a pre-pandemic normal; it’s about taking precautions as we approach the “next normal” and continue to live and deal with COVID.

On March 25, 2022, the Canadian Rheumatology Association (CRA) updated its position statement on COVID-19 Vaccination. Here are the key takeaways:

Vaccination

Although 85 per cent of Canadians eligible have had at least two shots, fewer than 47 per cent have received a third dose of COVID-19 vaccine. This is particularly critical for people living with inflammatory arthritis. Studies has shown that the immune response to two doses of COVID-19 vaccines decreases. Health Canada and the CRA urge that people, particularly those on anti-CD20 agents (e.g., rituximab) mycophenolic acid and/or glucocorticoids as well as other immunosuppressive treatments such as abatacept, JAK inhibitors, and antimetabolites (e.g., methotrexate), should receive a third dose.

The CRA also now recommends that in adults, 18 years and older, who are on immunosuppressive medications should receive an additional booster dose at least 3-6 months after their last COVID-19 vaccine.

Antiviral Medications

On January 17, 2022, Health Canada approved nirmatrelvir/ritonavir, Canada’s first oral antiviral treatment for adults who have tested positive for COVID-19. Clinical trials have shown nirmatrelvir/ritonavir treatment can reduce severity of COVID-19 symptoms and reduce hospitalization and death. However, therapy must be started within 5 days of symptoms.

The Public Health Agency of Canada (PHAC) has taken on a procurement role with the treatments to ensure provinces and territories could have timely and equitable access. The Government of Canada has procured an initial quantity of 1 million treatment courses of nirmatrelvir/ritonavir and deliveries of limited quantities started the week of January 17, 2022. (Supply has incrementally increased since.)

Because of the limited supply of nirmatrelvir/ritonavir, Health Canada has recommended guidelines for prioritization of treatment:
  • Moderately to severely immunocompromised individuals not expected to mount an adequate response to COVID-19 infection, regardless of vaccination status.
  • Individuals over 80 years of age whose vaccinations are not up to date.
  • Individuals over 60 years of age residing in underserved, rural or remote communities, residing in a long-term care setting, or those living in or from First Nations, Inuit and Métis communities whose vaccinations are not up to date.
Based on Health Canada’s guidelines and clinical trial results, the CRA in its updated position statement recommends that adults living with inflammatory arthritis, who may have a reduced response to COVID-19 vaccines, should be considered for nirmatrelvir/ritonavir treatment.

It is important for immunocompromised people living with an inflammatory arthritis to not delay and let symptoms worsen if they test positive for COVID-19. If you test positive and have symptoms that started within five days or fewer, contact your healthcare provider and follow the guidance from your province or territory.

In cases where IV administration is feasible, people with inflammatory arthritis may consider sotrovimab as an alternative monoclonal antibody treatment. Sotrovimab infusions are recommended within seven days of symptom onset and currently being delivered through provincial health authority-based clinics.

As with the COVID-19 vaccines, each province and territory is ultimately responsible for determining eligibility and access and defines who is at highest risk for hospitalization (based on age, vaccination and health status etc.). Currently, access to nirmatrelvir/ritonavir is available at no cost for eligible patients.

For more information on how people can obtain nirmatrelvir/ritonavir or sotrovimab, please click on the links below: