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So a little over a year ago, just after getting my regular blood tests to monitor my rheumatoid arthritis, I got a call from the rheumatologist's office indicating that I didn't have immunity to hepatitis B. I should arrange with my family doctor to get vaccinated.

I contacted my doctor and she suggested that to be extra cautious, I might want to consider the Twinrix vaccine, which protects against both hepatitis A and B. This involves a series of 3 shots: the second shot is usually a month after the first, and the third one five months after that. It's a case of the vaccine has to be fresh and refrigerated until use.

For my first shot, which I got on March 8, 2022, I ordered the vaccine through my usual pharmacy, picked it up and brought it to the doctor's office to be injected.

My second shot should logically have been April 8, but real life intervened. On March 24, I got my biennial mammogram (which was actually about 2.5 years after my previous one, due to pandemic-induced delays) and that gave rise to some additional health issues that loomed a little larger than continuing my course of Twinrix injections.

Nonetheless, I did make an appointment for Twinrix injection #2 for May 3, 2022. I duly ordered the vaccine in advance from my friendly local Shoppers Drug Mart...

After initially telling me they would get it in within 48 hours, they then phoned me to say there was a delay. Then there was another delay. Long story short, it would not be available for my May 3 appointment. I phoned my doctor's office and learned I could buy it right at their office and get it injected then and there. That seemed like the best option, even though it was slightly more expensive than it had been through Shoppers.

So my third and final shot should have happened in October. Once again, more urgent matters intervened.

On October 6, I got a lumpectomy at the Civic. I went under the knife again on November 9, this time at the Riverside (there's quite the shortage of available operating rooms, not to mention staff, but that's another story) as my oncologist wasn't confident they had got it all the first time around. Then there were the follow-up appointments, the radiation treatments and so on.

Twinrix #3 still hasn't happened, but not for want of trying! I got quite excited when I read this recently in an e-mail from Shoppers Drug Mart:

Get your next dose of hepatitis A/B
vaccine (TWINRIX)
3 doses of TWINRIX are required for maximum protection
against hepatitis A/B. The second dose is usually
given I month after the first dose and the third dose is
usually given 5 months after the second.
Question: If it has been more than 1 month since my first (or more than 5
months since my second) dose of hepatitis A/B vaccine, is it too late to get
the second/third shot?
Answer: The second dose is usually given I month after the first dose and the
third dose is usually given 5 months after the second. However, if it has been
more than 1 month since the first dose or more than 5 months since the second,
you should get the second/third dose as soon as possible. You do not need to
restart the vaccine series'.

So I thought I'd try again. If I could get my third dose at a neighbourhood pharmacy, that would be quicker and easier than arranging something at the doctor's office, which is a fair piece away. I clicked on the "book now" button and looked for an appointment time at my usual Shoppers where I get all my prescriptions.

There weren't any times available there so I tried the location just around the corner at Merivale Mall. They had quite a few appointment times available so I chose one at 10AM on March 4. I was directed to a portal where I provided all my details: OHIP number, contact details for my family doctor, and so forth. I foolishly assumed that if they were scheduling appointments for TWINRIX vaccinations, they must have a stock of the vaccine on hand and I merely had to show my health card when I arrived.

Turns out I was wrong.

Oh, and we have this thing called weather around here too. Those of you who live in the Ottawa area will know that yesterday was a rather snowy day. In spite of that, though, we have winter tires on the car and my partner was willing to drive me the short distance to my appointment. I got there with plenty of time to spare.

That's when I found out that they didn't in fact have any Twinrix in stock. (Are you seeing echoes here of the Monty Python cheese shop that didn't have any cheese?) Moreover, they didn't have any access to my file of active prescriptions at the Shoppers just around the corner. The pharmacist was actually quite nice about it and did offer to phone them to see if they could supply the vaccine. I waited while she did this, but unfortunately they didn't have any either. So I left empty-handed and empty-armed.

Back home, I returned a message from my local Shoppers (the one I get my prescriptions from). I explained the situation as best I could and now when I log into my Shoppers account I see that the vaccine has been ordered. It also indicates that this will be my third dose, not my second. On the other hand, it's still showing one of my other prescriptions as being "Ready for pickup" even though I explained to the pharmacist that I'd already picked it up.

So we'll see. What I expect to happen is that they'll eventually tell me I can pick up the vaccine - just HOW eventually I've no idea - and then I'll go through the process all over again of booking my injection site and time.

Yes, my health care team is working for me - except that the head doesn't know what the tail is doing!

Things have moved quickly lately on the vaccination front. Dianora and I had both signed up on the Ontario website as soon as it opened up to our age group and managed to get actual appointments at the Nepean Sportsplex for the (probably) Pfizer vaccine, though the slots available were not at very convenient times. Our previous registrations a couple of weeks earlier via the Shoppers Drug Mart site to get the AstraZeneca vaccine at a pharmacy had only yielded "confirmation numbers" (not actual appointments) informing us that we qualified for the vaccine and would be offered an appointment time (I assumed via e-mail) when it was available and would then have 24 hours to accept or reject the proposed time. Then silence.

Until Saturday, when someone actually PHONED me (the display read "Private Caller") and offered me an appointment at the pharmacy in our local Independent Grocer for 12:20 PM on Monday. Since the location and time were far more convenient than the Sportsplex ones, I said yes.

Dianora still hadn't heard anything but drove me to the Monday appointment. There at the grocery store entrance were tables and a sign indicating "COVID-19 vaccination registration". I informed them I had an appointment and Dianora indicated she didn't but was interested in signing up - she was offered an appointment for 1:55 the same day.

We had to fill out 2-page consent forms but it went pretty smoothly.

Today my arm is still sore, bruised and swollen and I'm feeling quite out of it... but then, I didn't sleep very well last night. She's looking less swollen but reports soreness and some fatigue. Not a bad tradeoff for getting vaccinated, although I've heard the side effects of the second dose can be more pronounced. We'll see.

So I phoned a 1-800 number this morning to cancel our Sportsplex appointments, as per the instructions in our e-mails. Frankly I can now understand why some people fail to cancel, resulting in a lot of no-shows. They simply get fed up listening to all the blather before the system even gives you the option of pressing a digit to cancel or re-schedule your appointment... moreover, the first time I pressed the number it didn't actually "take" so I had to listen to a substantial portion of the blather again! But I persisted, good upstanding Ontario citizen that I am... I mean, gimme a break - I know health care workers' time is incredibly valuable but OUR time is worth something too! Remember the good old days of flying "student standby"? How about a Seniors' Standby or a Priority Vaccinatee Standby?

The funny thing was that when the agent submitted the information into the cyber-yonder, the system found MY Sportsplex appointments right away and duly cancelled them; but with Dianora's info, the system somehow already "knew" she'd gotten her first dose yesterday and had already removed the Sportsplex appointments from the system! It's quite bizarre, since we BOTH received Ontario e-mail certificates from the pharmacy right after getting vaccinated and I had in ADDITION to that been handed a paper certificate after waiting my requisite time after the shot.

Methinks there are still a few glitches in the whole process...

Today is International Women's Day. A year into the pandemic, there's already talk of a "she-cession" and we know that on average, women have been more severely affected by lockdowns and other restrictions.

With a limited supply of vaccines now available, it falls to policymakers (a majority of them men) to set priorities as to who should be first in line to receive them. Are the priorities appropriate?

For Phase 1, I'd say for the most part they are. People over 80. and those living in congregate settings. The homeless and those living in financially strapped neighbourhoods. Front-line health care workers.

I don't necessarily think women should take priority over men when it comes to their place on the vaccination waiting list, although just satisfying the other criteria like age, poverty and personal caregiving duties will no doubt mean that more women qualify in Phase 1.

But what about children and teens under 18? While their symptoms are typically less severe, some do become seriously ill with the virus. They may be asymptomatic spreaders of Covid-19. The collateral damage in terms of their mental health tends to be quite severe too, especially in terms of older children and teens in the intermediate and secondary grades. Under non-pandemic conditions (the old normal), they would be at the stage of establishing a life and a future outside their immediate household. Not just full-time in-person schooling but all the extracurricular stuff - sports, ski trips, theatre, movie nights, part-time jobs, drop-in centres and community centre events, rock concerts, coffee houses, parties... their lives have been turned upside down. For people in their thirties, forties or fifties, a year or two may be fairly trivial in the grand scheme of things. Not so for young people at a crucial stage in their personal and social development.

That doesn't mean they should be at the head of the lineup for getting vaccinated but I do think we should at least be thinking about it and planning for it. And yet with rollout of vaccination schedules already underway, the under-18 set has been getting remarkably short shrift. Here's one of the few Canadian articles I've read about it:

https://globalnews.ca/news/7588097/covid-19-vaccine-children/

And then there's the New York Times take on things:

https://www.nytimes.com/2021/02/12/health/covid-vaccines-children.html

And finally from Oxford, this study in the U.K. being conducted on kids aged 6 and up:

https://www.webmd.com/vaccines/covid-19-vaccine/news/20210214/oxford-launches-covid-vaccine-study-in-children

They say it's not a question of IF we get another pandemic but WHEN. Let's keep in mind that those who make decisions about future pandemics for future generations are the children of today.

Shouldn't we at least try to do right by them?

Despite all the bad news of politicians behaving badly, Covid numbers surging in Ottawa, scary new virulent virus variants, ill-advised or inconsistent lockdown protocols and forecasts of a brutal winter ahead of us, I want today to turn the spotlight on the light instead of the potentially long tunnel preceding it. Folks, vaccination days are here to stay, for as long as it takes.

I don't think too many people would quibble about who's on first to get the vaccinated: front-line health care workers and those in congregate living situations. After that, there's considerably more disagreement on where people rank in the order of vaccination priority. Do we reward what some see as bad behaviour and target super-spreaders ahead of the ones patiently waiting their turn? Do we employ sarcasm and blatant insults against the vaccine-hesitant and out-and-out vaccine-averse, without first taking their pulse and listening to their concerns?

I think informational and emotional appeals both have their place but the experts do need to respect the public. They need to frankly admit what they know and don't know, what they are considering as reasonable provisional assumptions, and which of their projected scenarios are pure speculation. A communications strategy designed around a couple of simplistic "key messages", treating citizens as pawns to be manipulated at will according to partisan political goals, is bound to fail in the end.

As far as my own health care is concerned, I've been quite pleased by communications from my family doctor's office, the Riverside South Medical Centre. They've been keeping in touch with me by e-mail on a regular basis both before and after lockdown and some time during the second wave, I got an e-mail invitation from them to register for the "Health Myself" portal. On December 30, I got an e-mail with general information for their patients about COVID-19 vaccination. It listed the first-tier priority groups and promised to contact me again as further information became available. There was also a helpful list of FAQs, including the following link to the product monograph for the Pfizer-BioNTech vaccine:

https://covid-vaccine.canada.ca/info/pdf/pfizer-biontech-covid-19-vaccine-pm1-en.pdf

It's quite comprehensive and I'll be referring to it again. I haven't seen anything comparable for the Moderna vaccine or the Astra Zeneca (Oxford) vaccine; and there will of course be others to come. In the initial stages, it doesn't look as if we'll have a choice of which one we get.

Then of course there's the thorny issue of vaccine passports, which is rather more controversial than those little yellow booklets that some of us may remember from our school days. That's definitely a topic for another time!

While the arrival of vaccines against Covid-19 is certainly a good news story, we now face the minefield of establishing who gets vaccinated in the first tier, second tier and beyond. There are so many things to consider. But whoever said medical ethics was simple? It's not rocket science, it's much more complex than that!

So what about children? The people involved in the clinical trials were generally from those groups least likely to become seriously ill with the virus. Children fall into that category but were excluded for other very valid reasons. They often have stronger reactions to vaccines than adults. The question of informed consent is much murkier. Children may exhibit different symptoms from those of adults, or they may be asymptomatic carriers of the virus. And yet...

We have prioritized getting children back to school, in person where possible, because we know that education is important. We also know that for younger children especially, online learning may be difficult or inappropriate. They may also need to use public transportation to get to school, and may have more trouble than adults as far as mastering protocols like mask-wearing, hand washing and physical distancing. Their parents, on the other hand, may be better positioned to work from home, depending of course on the type of work they do.

And let's not forget that some children do get very sick and even die of Covid-19, particularly if they already have fragile immune systems and/or live in poorer neighbourhoods.

If we can't immediately vaccinate children directly, we should at least prioritize vaccination of those adults who work closely with them - teachers, child care workers, school bus drivers and maintenance staff, for example.

Once a safe and reliable vaccine for children is available, it's ultimately the parents who decide when their kids will be vaccinated. A U.S. study suggests that while a majority of parents do want their children vaccinated, uptake is higher amongst older, more highly educated parents:

https://www.usnews.com/news/health-news/articles/2020-11-23/parents-age-key-to-whether-kids-get-vaccinated-against-covid-study-finds

https://www.cbc.ca/news/health/kids-vaccine-covid-19-1.5826606

So today I got my flu-shot and it all went surprisingly smoothly. I booked an appointment online for 2:20 PM today, at the Mary Pitt Centre (part of the old Nepean City Hall). I printed off a consent form, filled it out and brought that along with me too. I arrived early and they admitted me right away, where I answered the usual series of questions and did the hand-sanitizing routine (the squirter thing kept on squirting wide of the mark) and followed the arrows. There was a nurse available to administer the shot and then I went into the waiting area where I was asked to wait for 15 minutes before leaving. I was also asked if I'd be willing to fill in a short survey about my experience. OK by me, I said. It was mostly multiple-choice, but with a section for free-form comments too. The only thing that was slightly unnerving was when I heard an alarm go off and worried that I might end up staggering outside with my sore arm and without proper outdoor clothing on - but then someone told us it was just a test of the emergency system and we didn't really need to do anything.

So I actually got out of there before my appointment was even due to start. They didn't have any of the high-dose vaccine designed for older people but that was what I had expected - they don't even anticipate getting more stock in the near future, maybe not even this season. That said, there has been very little flu in Ottawa so far this season and the regular vaccine is supposed to be almost as good anyway. And I certainly don't expect to be doing any festival- or conference-going or traveling or even much socializing over the next few months.

There's been some encouraging news about Covid-19 vaccines in the last little while too. Three serious contenders, all looking pretty effective at this stage. Of course there are stumbling blocks too. Since all of them require two dosages at 3-to-4 week intervals, many doctors worry that even if people get the first dose, they may not bother to show up for the second one. And then there are the potential side effects, which look like they might be more unpleasant and more prevalent than those we may be used to from other vaccines - I mean, consider that the human volunteers in the trials would all be low-risk patients, younger people with no serious pre-existing medical conditions. I guess we have to weigh all that against the seriousness of the disease itself.

Please, sir - I want some more. Information, that is. About Covid-19.

Maybe that sounds completely ludicrous. Aren't we already bombarded with Covidformation every time we pick up a newspaper, turn on the TV or radio, or tune into a podcast?

Well, no. Getting data-bombed is not the same thing as informing oneself. Here are some of the areas where I would like more information:

1. Symptoms of Covid-19

2. Solutions

3. Testing - What kinds of tests are available, and when are they useful?

I'm going to discuss each in turn, although I know I'll only be scratching the surface of what needs to be considered.

First, the symptoms. Fever, dry cough, trouble breathing, loss of senses of smell and taste, double-lung pneumonia. All of those sound like the symptoms of a pretty serious disease. Yet in the next breath, officials tell us that in many (perhaps most) cases, the symptoms are mild and resemble those of the common cold. In my experience, when you get a cold, you don't usually have a fever, or not a very high one anyway. Dry cough? Maybe, but usually it's a rather wet, phlegmy one, at least in the initial stages. And they say that a runny nose is not usually a symptom of Covid 19. Trouble breathing and loss of senses of smell and taste? Well, yes - up to a point. If your nose is all stuffed up and you have to breathe through your mouth, you're not going to be able to smell things very well. And you probably won't taste much either, because the senses of smell and taste are interconnected. Double-lung pneumonia? That's definitely not the same thing as a cold, although certainly a cold can lead to more serious diseases while your resistance is lowered.

So, on to solutions. A vaccine is touted as the ultimate solution, the holy grail, the elixir of life. And I absolutely agree - we definitely should and must work towards developing a vaccine. But is it necessarily the ONLY solution? Are there other options we could explore? What about anti-viral or other drugs, for example? You might say they're a cure rather than a prevention, but it ain't necessarily so - drugs are used preventatively as well as to alleviate symptoms and provide (along with time and TLC) a cure. What about birth control, for example? Or arthritis drugs? For rheumatoid arthritis, I am taking both NSAIDs (Non Steroidal Anti-Inflammatory Drugs) and DMARDs (Disease Modifying Anti Rheumatic Drugs). One of the DMARDs that has been prescribed to me is Hydroxychloroquine, often known as Plaquenil. And interestingly enough, that's one of the drugs that seems to be showing some promise in the treatment of coronavirus too. I'm rather hoping that my own supply line doesn't dry up, although luckily it's not the only weapon in my personal arsenal as I fight the war on arthritis.

Now, about testing. Apparently we need to test far more people than we have been. But when we do test, are we relying on just one type of test?

As I understand it, we are conducting swab tests. Results take time. The usefulness of the results is limited, too. I gather a person tests either positive or negative for the virus, meaning they either a) definitely do have it at time of testing; or b) don't have it, or are only within the first couple of days of contracting it so it may be a false negative that needs to be re-tested.

But are there, for example, other tests that test for having already HAD the virus, or having had a virus similar enough to Covid-19, or having ANTIBODIES to the virus for whatever reason? And if so, would a positive test result for them also mean that they would NOT be a carriers who could put others at risk? Maybe we could issue some sort of certificate to these people (sort of akin to a vaccination certificate) and they could get back out into the community, freed from physical distancing restrictions themselves and also in a position to help those still suffering? If there were enough of them, think what a boon to society that could be, both from a medical and an economic standpoint!

Remember those TB patch tests we used to get? After a family trip to the UK in 1962, my brother always tested positive on those and sometimes got sent off for a chest X-ray. He hadn't had an active case of tuberculosis but evidently he had been exposed to it. I, on the other hand, continued to test negative - I was a fair bit younger and probably not as free to mill about the streets of London.

On the other hand, I DID get pneumonia in the mid-1980s. And then in the summer of 2018, I contracted a nasty lung ailment. My doctor initially decided to treat it as if were pneumonia, even though she had already given me the vaccine, which (unlike the flu vaccine) is supposed to be a one-time thing. I went through the usual diagnoses and treatments - the chest x-ray, the inhaler, the meds, some breathing tests. The symptoms were similar to those of diseases which typically plague smokers, even though I am not a smoker.

I'm not sure she ever did pinpoint what exactly I had had. The good news is that I recovered, although it took a few months. I'm pretty sure I picked it up during Music and Beyond, in early July (lots of crowded venues at a festival like that). It wasn't until some time in October that I got my final breathing test and a clean bill of health.

Could it have been something akin to Covid-19, even if they hadn't identified it yet? And if so, is there a possibility that it could have conferred on me some immunity from, or at least resistance to this nasty virus? I guess I can always hope.

So those are some of the questions uppermost in my mind at the moment.

You know, I have a sweatshirt with this slogan on it: Google can find you 100,000 answers. A librarian will find you the right one.

During this pandemic, people are relying on Google like never before, but libraries are closed. Will people be able to find the right answers before googols and googolplexes of people get infected? Or do I mean googols and googolplexes of the virus since I know there are only a few billion people in the world?

I guess maybe I'm a failure as a librarian because right now, I certainly haven't found the answer. I'm not at all confident that there IS just one right answer - there rarely is.

But right now, I'd settle for a half-decent answer - even if it's multiple choice.

Yesterday, my partner and I went to our friendly neighbourhood pharmacy and got our flu shots. It was relatively quick and painless and I'm glad it's over for another year. My rheumatologist has told me that as I have an autoimmune condition - rheumatoid arthritis - it's particularly important for me to get vaccinated every year, something that the pharmacist also mentioned. And as soon as we got home, we heard on the news that getting the flu vaccine seems to be linked to a 36% reduction in "cardiac events" - heart attacks, strokes, angina and the like. But of more immediate importance to me, I've never gotten the flu in a year when I've gotten the flu vaccine - although I haven't invariably come down with the flu in years when I HAVEN'T been vaccinated. So I'm reasonably convinced that there are at least SOME benefits to the vaccine.

What about vaccination against other diseases? Some folks I know are wont to disparage "anti-vaxers", regarding them as right up there with global warming deniers and creationists. But is vaccination unambiguously a Good Thing? Almost every procedure has some minor risks and side effects and even a very small likelihood of major repercussions. It's just a matter of deciding whether the risks - both to the patient and those the patient is likely to come into contact with - outweigh the benefits.

When I was a very young child, there was no polio vaccine. If I wasn't feeling well, my mother would sometimes get me to put my chin as far down upon my chest as possible. If I could sort of accomplish that manoeuvre, even awkwardly, she would say, "Well, I don't think you have polio, anyway." With the older kids, I guess it was a matter of discouraging them from frequenting crowded areas like public pools and beaches whenever there were rumours of a polio epidemic. I'm not sure that the recommended precautions really did any good, but I can certainly understand the fear that prevailed until the polio vaccine became readily available. And I agree that vaccinations against very serious diseases like polio, diphtheria or smallpox are essential, even if there are a few side effects. For example, I recall my daughter's DPTP shots when she was two months old: she awoke in the night quite fussy and unwell with a high fever, although it was over within 24 hours. Of course, it's better to use dead rather than live vaccine (in the case of polio immunization, the Salk injections rather than the Sabin oral vaccine), as is commonly done these days (and was with her).

Throughout my childhood, there were no vaccines against measles, mumps, rubella ("German measles") or chickenpox. As a result, I got at least one of those per year for the first few years I was in school. Measles and mumps are fairly major childhood diseases, although rubella rarely is. Still, it can be hazardous to pregnant women and fetuses, so perhaps vaccination is warranted in many cases. Chickenpox? I don't know. It's rarely all that serious in children, just uncomfortable and itchy. The prevailing wisdom used to be to give "chickenpox parties", exposing all the neighbourhood children to the disease in order to build up their immunity. Because chickenpox in adults can be pretty serious and often leads to shingles. That was another surprise question yesterday, to which I had to answer in the affirmative: "Are you over 50 and have never had a shingles vaccine?"

When I was between six and eight, I had to go and get weekly cold shots, because I caught innumerable colds when I started school. Did they do any good? They didn't seem to. And like most kids, I suppose, I hated getting a needle. Even though (or perhaps BECAUSE) there are zillions of strains of cold virus, I can't help wondering whether I might have done better just suffering through the less serious illnesses (and no doubt making everyone around me suffer too) and in the process, perhaps acclimatizing my body to all the germs and things out there so I wouldn't be quite so susceptible. After all, autoimmune conditions like mine are the result of the healthy body tissues attacking themselves. Maybe I grew up in an environment that was TOO clean and sheltered from disease!

Then there was the tuberculin "patch test" that I remember having every year all through school. I always tested negative, even after going to England with my parents and brother in the summer of 1962, but my brother tested positive from 1962 onwards. And in those days, kids who tested positive got sent off for chest x-rays. People were much more cavalier in those days about the possible risks of radiation from x-rays - shoe stores even let you look at x-rays of your feet, just for "fun"!

Anyway, did all those chest x-rays have a detrimental effect on my brother's health and life-span and contribute to his rather early death? It's doubtful, perhaps, but I guess we'll never know for sure.

I'm not with the folks who blame autism on vaccines - it seems any studies that might have linked them have been largely discredited. I don't think I even really buy the idea that autism is linked to food additives or toxins in the environment. I also think autism is vastly overdiagnosed nowadays, although the severe cases may be very severe indeed. Genetically modified foods? I don't know. I'm not necessarily against them per se, although I think consumers ought to know what they're getting and be able to make informed decisions.

But should we vaccinate everyone against everything just because we can?

In a word, no.