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1.
Vaccines ; 10(5):722, 2022.
Article in English | MDPI | ID: covidwho-1820455

ABSTRACT

There have been reports of cases of myocarditis and pericarditis as rare complications following mRNA COVID-19 vaccinations among young adults. While most reported cases are mild, this potential vaccine safety signal should be closely monitored. Using data from the CDC and the Vaccine Adverse Event Reporting System (VAERS), we calculated the combined reporting rate of myocarditis and pericarditis stratified by age group, sex, vaccine dose, and manufacturer, and compared these rates to the crude background incidence rates. Compared to the general population prior to the administration of the first COVID-19 vaccines in December 2020, we identified a higher-than-expected reporting rate of myocarditis and pericarditis following mRNA vaccination;the risk was higher after a second vaccine dose, higher in males than in females, and decreased with age. The highest risk was seen in males 12–17 years of age with approximately 6 cases per 100,000 s doses. Our findings suggest an increased risk of myocarditis and pericarditis in young males following a second dose of an mRNA COVID-19 vaccine. Since these findings are based on safety signals derived from passive surveillance data, confirmatory epidemiological studies should be undertaken.

2.
SSRN; 2021.
Preprint in English | SSRN | ID: ppcovidwho-333484

ABSTRACT

In this report five leading experts in health law and medicine at the University of Ottawa examine vaccine passports in the context of Charter rights, privacy rights, and implementation. The paper first explores whether a vaccine passport regime would infringe Charter rights, including mobility rights, rights to liberty and security of the person, freedom of religion and conscience, and rights to equality and non-discrimination. Broadly speaking, the authors conclude that a well-designed vaccine passport regime, backed by an equitable vaccine distribution scheme, will likely withstand a Charter challenge. The paper then turns to an in-depth discussion of privacy issues, first exploring key aspects of privacy compliance in the design of vaccine passports before turning to an analysis of their use conditions. Again, the paper’s broad contention is that privacy issues raised by vaccine passports can be adequately addressed through careful design and regulation. The authors then discuss potential avenues for the implementation of vaccine passports, within the framework of Canadian federalism and its fragmented jurisdiction over healthcare and public health. As part of this discussion, we suggest some broad principles for the design of a vaccine passport regime, arguing that passport gating should be limited to non-essential services, and that wherever feasible, the unvaccinated should be accommodated with rapid testing.

3.
JAMA ; 2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1756509

ABSTRACT

Importance: There is limited comparative epidemiological evidence on outcomes associated with COVID-19 vaccination during pregnancy; monitoring pregnancy outcomes in large populations is required. Objective: To evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Design, Setting, and Participants: Population-based retrospective cohort study in Ontario, Canada, using a birth registry linked with the provincial COVID-19 immunization database. All births between December 14, 2020, and September 30, 2021, were included. Exposures: COVID-19 vaccination during pregnancy, COVID-19 vaccination after pregnancy, and no vaccination. Main Outcomes and Measures: Postpartum hemorrhage, chorioamnionitis, cesarean delivery (overall and emergency cesarean delivery), admission to neonatal intensive care unit (NICU), and low newborn 5-minute Apgar score (<7). Linear and robust Poisson regression was used to generate adjusted risk differences (aRDs) and risk ratios (aRRs), respectively, comparing cumulative incidence of outcomes in those who received COVID-19 vaccination during pregnancy with those vaccinated after pregnancy and those with no record of COVID-19 vaccination at any point. Inverse probability of treatment weights were used to adjust for confounding. Results: Among 97 590 individuals (mean [SD] age, 31.9 [4.9] years), 22 660 (23%) received at least 1 dose of COVID-19 vaccine during pregnancy (63.6% received dose 1 in the third trimester; 99.8% received an mRNA vaccine). Comparing those vaccinated during vs after pregnancy (n = 44 815), there were no significantly increased risks of postpartum hemorrhage (incidence: 3.0% vs 3.0%; aRD, -0.28 per 100 individuals [95% CI, -0.59 to 0.03]; aRR, 0.91 [95% CI, 0.82-1.02]), chorioamnionitis (0.5% vs 0.5%; aRD, -0.04 per 100 individuals [95% CI, -0.17 to 0.09]; aRR, 0.92 [95% CI, 0.70-1.21]), cesarean delivery (30.8% vs 32.2%; aRD, -2.73 per 100 individuals [95% CI, -3.59 to -1.88]; aRR, 0.92 [95% CI, 0.89-0.95]), NICU admission (11.0% vs 13.3%; aRD, -1.89 per 100 newborns [95% CI, -2.49 to -1.30]; aRR, 0.85 [95% CI, 0.80-0.90]), or low Apgar score (1.8% vs 2.0%; aRD, -0.31 per 100 newborns [95% CI, -0.56 to -0.06]; aRR, 0.84 [95% CI, 0.73-0.97]). Findings were qualitatively similar when compared with individuals who did not receive COVID-19 vaccination at any point (n = 30 115). Conclusions and Relevance: In this population-based cohort study in Ontario, Canada, COVID-19 vaccination during pregnancy, compared with vaccination after pregnancy and with no vaccination, was not significantly associated with increased risk of adverse peripartum outcomes. Study interpretation should consider that the vaccinations received during pregnancy were primarily mRNA vaccines administered in the second and third trimester.

4.
BMJ Open ; 12(3): e057024, 2022 03 03.
Article in English | MEDLINE | ID: covidwho-1723817

ABSTRACT

INTRODUCTION: COVID-19 has caused morbidity, hospitalisations and deaths worldwide. Despite four approved vaccines for COVID-19 in Canada, there is still a need for effective treatments, especially for people in the community. Vaccine efficacy is not 100% and long-term efficacy is still unknown. Furthermore, there are challenges to herd immunity including vaccine hesitancy and underlying conditions preventing vaccination. We aim to explore if the nutrients vitamin C, vitamin D, vitamin K2 and zinc are an effective treatment option for outpatients diagnosed with COVID-19. The primary outcome is the difference in participant-reported overall health; secondary outcomes include the effect on health status, symptom severity and duration, frequency and length of hospitalisations and mortality. METHODS AND ANALYSIS: This study is a two-arm, parallel-group, double-blind, placebo-controlled, phase III randomised controlled trial. 200 patients will be recruited remotely from COVID-19 test centres in Ottawa, Canada associated with The Ottawa Hospital. Overall health will be measured using the EuroQol Visual Assessment Scale; health status will be measured using the EuroQol 5-dimension 5-level questionnaire; symptom severity and duration will be measured using an independently developed questionnaire; analyses will use an area under the curve approach and compare mean scores using unadjusted t tests. Study data will be recorded on electronic case report forms using the Research Electronic Data Capture platform. An independent data safety and monitoring board will perform ongoing review of the study for feasibility and safety. ETHICS AND DISSEMINATION: This study has received ethical approval from the research ethics boards of the Canadian College of Naturopathic Medicine and the Ottawa Health Sciences Network, as well as regulatory approval from the Therapeutic Products Directorate and Natural and Non-Prescription Health Products Directorate of Health Canada. Results will be published in a peer-reviewed scientific journal with open access. TRIAL REGISTRATION NUMBER: NCT04780061.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/prevention & control , COVID-19 Vaccines , Canada , Dietary Supplements , Humans , Randomized Controlled Trials as Topic , Treatment Outcome
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-319900

ABSTRACT

Background: The media play a critical role in informing the public about the pandemic. International travel is a highly contested subject in the media during the COVID-19 pandemic at both the international and national levels. We examined Canadian media reporting on international travel restrictions during the pandemic, how these restrictions aligned with the IHR (2005), and how the narrative around international travel evolved for the pandemic. Methods: We analysed Canada’s top three national newspapers by circulation, namely – The Globe and Mail, The National Post and The Toronto Star, published between Jan 1, 2020 - May 31, 2020. Our search yielded a total of 378 articles across the three newspapers. Upon removing duplicates and screening the remaining articles, we included a total of 62 articles for the analysis. We conducted a qualitative media content analysis by using the inductive coding approach. Results: Three major themes were identified within the articles. These included: 1) The role of scientific and expert evidence in implementing travel restrictions;2) Federal legislation, regulations and enforcement of international travel measures;and 3) Compliance with WHO guidelines in travel restriction policy- and decision-making. The federal government relied on scientific evidence for implementing international travel restrictions. The federal government fully exercised its powers under the Quarantine Act to enforce travel regulations and comply with the IHR (2005). The government embraced rules-based international order by following WHO recommendations on international travel, contributing to delaying border closure and travel restrictions until mid-March. Conclusion: The media focussed significantly on international travel related issues during the early phase of pandemic. The dominant media narrative remained the need for earlier travel restrictions against international travel.

6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-317150

ABSTRACT

Background: Globally, measures such as lockdown, quarantining, and physical distancing have been implemented to curb the spread of COVID-19. As the vaccines are now available and reintegration into the society is beginning, measures such as vaccine certificates are being implemented around the world. Objective: The objective of the scoping review is to identify the initial digital solutions available globally for COVID-19 vaccine certificates and evaluate them on the basis of purpose and use case, technological architecture, and ethical and legal implications. Methods: : We conducted a Google search on November 18 and 19, 2020 as well as a search of Embase on November 26, 2020, Ovid MEDLINE and preprint servers (MedRXIV, BioRXIV). The search terms used were “coronavirus”, “COVID-19”, “SARS COV2”, “immunization passport”, “immunization certificate”, “vaccine certificate”, “vaccination certificate” and “digital”. Articles were included for review if they included any discussion of a digital solution for vaccine certificates and English language. Data was extracted using an electronic data extraction form and included date, location, type of article, source, companies identified, technology used, type of evidence provided, digital architecture, security and privacy measures, and use cases. The articles were categorized based on the following six pre-identified themes: 1) legal, 2) technology, 3) ethics, 4) travel, 5) policy, and 6) science. Results: : A total of 70 articles were included in the final analysis. Technology emerged as the most dominant theme, appearing in 58.5% (n=41) articles followed by ethics (n=22, 31%), travel (n=21, 30%), legal concerns (n=10, 14%), public policy (n=9, 13%), and scientific concerns (n=1, 1.5%. Our review identified 8 global solutions that are working towards COVID-19 vaccine certificate, all optimizing blockchain technology. COVID-19 vaccine certificates are being considered in 13 countries and are in place in 3 countries. All the solutions we identified are using blockchain technology. Conclusion: Several countries have implemented or are considering COVID-19 vaccine certificates. Many issues concerning the themes we identified remain to be addressed to facilitate successful implementation.

7.
Nat Microbiol ; 7(3): 379-385, 2022 03.
Article in English | MEDLINE | ID: covidwho-1671571

ABSTRACT

SARS-CoV-2 variants of concern (VOC) are more transmissible and may have the potential for increased disease severity and decreased vaccine effectiveness. We estimated the effectiveness of BNT162b2 (Pfizer-BioNTech Comirnaty), mRNA-1273 (Moderna Spikevax) and ChAdOx1 (AstraZeneca Vaxzevria) vaccines against symptomatic SARS-CoV-2 infection and COVID-19 hospitalization or death caused by the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1) and Delta (B.1.617.2) VOC in Ontario, Canada, using a test-negative design study. We identified 682,071 symptomatic community-dwelling individuals who were tested for SARS-CoV-2, and 15,269 individuals with a COVID-19 hospitalization or death. Effectiveness against symptomatic infection ≥7 d after two doses was 89-92% against Alpha, 87% against Beta, 88% against Gamma, 82-89% against Beta/Gamma and 87-95% against Delta across vaccine products. The corresponding estimates ≥14 d after one dose were lower. Effectiveness estimates against hospitalization or death were similar to or higher than against symptomatic infection. Effectiveness against symptomatic infection was generally lower for older adults (≥60 years) than for younger adults (<60 years) for most of the VOC-vaccine combinations. Our findings suggest that jurisdictions facing vaccine supply constraints may benefit from delaying the second dose in younger individuals to more rapidly achieve greater overall population protection; however, older adults would likely benefit most from minimizing the delay in receiving the second dose to achieve adequate protection against VOC.


Subject(s)
/immunology , COVID-19/prevention & control , SARS-CoV-2/immunology , /administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , /genetics , COVID-19/epidemiology , COVID-19/mortality , COVID-19/virology , /genetics , Female , Humans , Male , Middle Aged , Ontario/epidemiology , SARS-CoV-2/classification , SARS-CoV-2/genetics , Young Adult
9.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295584

ABSTRACT

ABSTRACT SARS-CoV-2 variants of concern (VOC) are more transmissible and have the potential for increased disease severity and decreased vaccine effectiveness. We estimated the effectiveness of BNT162b2 (Pfizer-BioNTech Comirnaty), mRNA-1273 (Moderna Spikevax), and ChAdOx1 (AstraZeneca Vaxzevria) vaccines against symptomatic SARS-CoV-2 infection and COVID-19 hospitalization or death caused by the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2) VOCs in Ontario, Canada using a test-negative design study. Effectiveness against symptomatic infection ≥7 days after two doses was 89–92% against Alpha, 87% against Beta, 88% against Gamma, 82–89% against Beta/Gamma, and 87–95% against Delta across vaccine products. The corresponding estimates ≥14 days after one dose were lower. Effectiveness estimates against hospitalization or death were similar to, or higher than, against symptomatic infection. Effectiveness against symptomatic infection is generally lower for older adults (≥60 years) compared to younger adults (<60 years) for most of the VOC-vaccine combinations.

10.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-294487

ABSTRACT

ABSTRACT Objectives To estimate the effectiveness of mRNA COVID-19 vaccines against symptomatic infection and severe outcomes. Design We applied a test-negative design study to linked laboratory, vaccination, and health administrative databases, and used multivariable logistic regression adjusting for demographic and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness (VE) against symptomatic infection and severe outcomes. Setting Ontario, Canada between 14 December 2020 and 19 April 2021. Participants Community-dwelling adults aged ≥16 years who had COVID-19 symptoms and were tested for SARS-CoV-2. Interventions Pfizer-BioNTech’s BNT162b2 or Moderna’s mRNA-1273 vaccine. Main outcome measures Laboratory-confirmed SARS-CoV-2 by RT-PCR;hospitalization/death associated with SARS-CoV-2 infection. Results Among 324,033 symptomatic individuals, 53,270 (16.4%) were positive for SARS-CoV-2 and 21,272 (6.6%) received ≥1 vaccine dose. Among test-positive cases, 2,479 (4.7%) had a severe outcome. VE against symptomatic infection ≥14 days after receiving only 1 dose was 60% (95%CI, 57 to 64%), increasing from 48% (95%CI, 41 to 54%) at 14–20 days after the first dose to 71% (95%CI, 63 to 78%) at 35–41 days. VE ≥7 days after 2 doses was 91% (95%CI, 89 to 93%). Against severe outcomes, VE ≥14 days after 1 dose was 70% (95%CI, 60 to 77%), increasing from 62% (95%CI, 44 to 75%) at 14–20 days to 91% (95%CI, 73 to 97%) at ≥35 days, whereas VE ≥7 days after 2 doses was 98% (95%CI, 88 to 100%). For adults aged ≥70 years, VE estimates were lower for intervals shortly after receiving 1 dose, but were comparable to younger adults for all intervals after 28 days. After 2 doses, we observed high VE against E484K-positive variants. Conclusions Two doses of mRNA COVID-19 vaccines are highly effective against symptomatic infection and severe outcomes. Single-dose effectiveness is lower, particularly for older adults shortly after the first dose.

13.
Global Health ; 17(1): 128, 2021 11 06.
Article in English | MEDLINE | ID: covidwho-1505455

ABSTRACT

BACKGROUND: A special session of the World Health Assembly (WHA) will be convened in late 2021 to consider developing a WHO convention, agreement or other international instrument on pandemic preparedness and response - a so-called 'Pandemic Treaty'. Consideration is given to this treaty as well as to reform of the International Health Regulations (IHR) as our principal governing instrument to prevent and mitigate future pandemics. MAIN BODY: Reasons exist to continue to work with the IHR as our principal governing instrument to prevent and mitigate future pandemics. All WHO member states are party to it. It gives the WHO the authority to oversee the collection of surveillance data and to issue recommendations on trade and travel advisories to control the spread of infectious diseases, among other things. However, the limitations of the IHR in addressing the deep prevention of future pandemics also must be recognized. These include a lack of a regulatory framework to prevent zoonotic spillovers. More advanced multi-sectoral measures are also needed. At the same time, a pandemic treaty would have potential benefits and drawbacks as well. It would be a means of addressing the gross inequity in global vaccine distribution and other gaps in the IHR, but it would also need more involvement at the negotiation table of countries in the Global South, significant funding, and likely many years to adopt. CONCLUSIONS: Reform of the IHR should be undertaken while engaging with WHO member states (and notably those from the Global South) in discussions on the possible benefits, drawbacks and scope of a new pandemic treaty. Both options are not mutually exclusive.


Subject(s)
International Health Regulations , Pandemics , Global Health , Humans , International Cooperation , Pandemics/prevention & control , World Health Organization
14.
Hum Vaccin Immunother ; 18(1): 1-12, 2022 12 31.
Article in English | MEDLINE | ID: covidwho-1455119

ABSTRACT

Globally, measures, such as lockdown, quarantining, and physical distancing, have been implemented to curb the spread of COVID-19. As the vaccines are now available and reintegration into society is beginning, measures such as vaccine certificates are being implemented around the world. We conducted a scoping review to identify the initial digital solutions for COVID-19 vaccine certificates and evaluate them on the basis of purpose and use case, technological architecture, and ethical and legal implications. Articles identified from a Google search and a search of MEDLINE, Ovid and preprint servers were reviewed in duplicate, and data were extracted using a data extraction form. Data were extracted for date, location, type of article, source, companies identified for creating vaccine certificates, technology used, type of evidence provided (article quoting research study or an expert opinion), digital architecture, security and privacy measures, and use cases. Technology emerged as the most dominant theme followed by ethics, travel, legal concerns, public policy, and scientific concerns. Our review identified eight solutions that are working toward COVID-19 vaccine certificates world-wide, all optimizing blockchain technology. COVID-19 vaccine certificates are being considered in 11 countries and are in place in 5 others. Many issues concerning the themes we identified remain to be addressed to facilitate successful implementation.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Communicable Disease Control , Humans , SARS-CoV-2
15.
Can Public Adm ; 64(3): 458-484, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1388224

ABSTRACT

As the world continues to grapple with the COVID-19 pandemic, the preparedness of governments to respond to it will likely undergo review. A key component is the legislative capacity and authority that governments had in place or could rapidly introduce to address the social, economic and health consequences of the emergency. We review Canada's legal preparedness for public health emergencies and the use of federal legislation to address the pandemic. We provide an overview of the concept of legal preparedness, summarize the federal statutes, regulations and orders enacted, and analyze the coherence of federal activity and its relevance to provinces, territories and international health regulations. We determine that the federal government has relied on spending power rather than constitutional authority over public health or existing legislation on influencing the course of the pandemic.


Alors que le monde entier ne cesse de lutter contre la pandémie de COVID­19, le dispositif de veille et de préparation des gouvernements fera probablement l'objet d'un examen. La capacité et l'autorité législatives que les gouvernements avaient en place ou pourraient instaurer rapidement pour faire face aux conséquences sociales, économiques et sanitaires de l'urgence est un élément clé. Nous passons en revue la préparation légale du Canada aux urgences de santé publique et l'utilisation de la législation fédérale pour lutter contre la pandémie. Nous présentons un aperçu du concept de préparation légale, résumons les lois, règlements et décrets fédéraux adoptés et analysons la cohérence de l'activité fédérale et sa pertinence pour les provinces, les territoires et les règlements sanitaires internationaux. Nous établissons que, pour influencer l'évolution de la pandémie, le gouvernement fédéral a plus compté sur le pouvoir de dépenser que sur l'autorité constitutionnelle concernant la santé publique ou la législation existante.

16.
BMJ ; 374: n1943, 2021 08 20.
Article in English | MEDLINE | ID: covidwho-1367424

ABSTRACT

OBJECTIVE: To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). DESIGN: Test negative design study. SETTING: Ontario, Canada between 14 December 2020 and 19 April 2021. PARTICIPANTS: 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. INTERVENTIONS: BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. MAIN OUTCOME MEASURES: Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. RESULTS: Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. CONCLUSIONS: Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 Vaccines/therapeutic use , COVID-19/mortality , Patient Admission/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , Ontario/epidemiology , SARS-CoV-2 , Treatment Outcome , Young Adult
17.
Vaccine ; 39(37): 5265-5270, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1349600

ABSTRACT

BACKGROUND: Nursing home (NH) residents are prioritized for COVID-19 vaccination. We report monthly mortality, hospitalizations, and emergency department (ED) visit incidence rates (IRs) during 2010-2020 to provide context for COVID-19 vaccine safety assessments. METHODS: We observed outcomes among all NH residents in Ontario using administrative databases. IRs were calculated by month, sex, and age group. Comparisons between months were assessed using one-sample t-tests; comparisons by age and sex were assessed using chi-squared tests. RESULTS: From 2010 to 2019, there were 83,453 (SD: 652.4) NH residents per month, with an average of 2.3 (SD: 0.28) deaths, 3.1 (SD: 0.16) hospitalizations, and 3.6 (SD: 0.17) ED visits per 100 residents per month. From March to December 2020, mortality IRs were increased, but hospitalization and ED visit IRs were reduced (p < 0.05). CONCLUSION: We identified consistent monthly mortality, hospitalization, and ED visit IRs during 2010-2019. Marked differences in these rates were observed during 2020, coinciding with the COVID-19 pandemic.


Subject(s)
COVID-19 Vaccines , COVID-19 , Nursing Homes , COVID-19 Vaccines/adverse effects , Emergency Service, Hospital , Hospitalization , Humans , Ontario/epidemiology , Pandemics , SARS-CoV-2
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