N.W.T. rolls out early RSV program, bivalent COVID boosters to head off potentially 'severe' season

As flu season approaches, the N.W.T.'s health department is moving early to fight back a mixture of viruses RSV, COVID-19 and influenza.

Dr. Kami Kandola, the N.W.T.'s chief public health officer, issued a public health advisory Tuesday for what she warned could be a "severe" season for respiratory viruses.

She said her office has started to see lab-confirmed cases of RSV, or respiratory syncytial virus, in young children. It is also seeing more severe respiratory issues and hospitalizations of young kids under five, and the territory has now recorded its first lab-confirmed flu case of the season.

That means her department is launching its antibody program to protect infants at risk of RSVon Nov. 1 earlier than usual. Flu vaccines are also available, and health workers have begun giving out bivalent COVID-19 vaccinations to anyone 18 and older, with more bivalent options on the way.

Kandola joined CBC's Loren McGinnis Thursday morning onThe Trailbreakerto discuss the program.

This interview has been edited for clarity and length.

Let's start off with RSV. Can you explain what it is and why you're raising the concern about it now?

RSV is a respiratory virus, and typically it can present with mild symptoms for the majority fever, runny nose, cough. But in young children, especially those under two, it can lead to pneumonia and inflammation of their small airways, which we call bronchiolitis, and it can lead to hospitalizations.

What's of concern for myself is, in the Northwest Territories, typically we have a limited RSV season it's in the winter months. Typically, we start to see RSV in December and then it starts to fade out in April. What was unusual last year is that in our wastewater monitoring,we were seeing RSV all the way up until late July and RSV is starting early now. We've seen cases since October. So our RSV season is starting early and we've already noted a few hospitalizations.

We are rolling out our Synagisprogram, which is a monoclonal antibody. We target the very, very vulnerable, which are our premature infants, infants with chronic lung diseases and those with unstable significant heart disease. So we're going to roll that out on Nov. 1.

The season lasted a long time, where it hung around late last season, and it's starting early now. Do you have any sense of why that might be?

This is not just happening in the Northwest Territories. We've seen it in the U.S. For two years, we had COVID-19 measures we had mandatory masking, limited gatherings in terms of size. So we had all these precautions that protected us from the COVID-19 virus, but it also protected us from the flu, the common coldand RSV. Now that we've lifted the measures, kids are going back to daycares and schools, and are interacting. And now they're experiencing these viruses all at once, at the same time.

In terms of RSV, based on how it spreads, what do we need to do?

Take the same precautions that will protect you from the flu, from the common cold and from COVID. First of all, parents, if your child is sick, stay home until they're better so it doesn't spread in daycares or to other kids. Practise good hand-washing. Wear a mask when appropriate. Cover your coughs and sneezes.

Unfortunately, for RSV, there is no vaccine yet. But you can still get vaccinated against influenza, and you can get vaccinated against COVID-19.

There are also protective factors. Breastfeeding is a protective factor, and mothers can pass on the antibodies to their children.

You named a medical intervention that you are going to roll out on Nov. 1 for the most-at-risk. Can you explain what that is?

It's pre-formed antibodies, Synagis, and we use it for our highest risk children. We roll it out as a preventative measure, to prevent serious complications from RSV which is pneumonia, bronchiolitis and hospitalization.

Typically, we've never rolled it out as early as Nov. 1, and we tend to stop around April or May. But this year, westopped late and now we're rolling it out early so those babies that are at highest risk for hospitalization can get this pre-formed antibody ahead of time. That way, if they get exposed to RSV, they have these antibodies to fight it.

This antibody has to be provided once a month.

How has dropping public health restrictions affected our risk for severe respiratory illness, influenza and stuff like RSV?

If you look at the reason why we started masking and we're looking at our COVID-19 infections if you look at our wastewater monitoring, COVID-19 has started to decrease in our wastewater. I feel that we have more population immunity. So with respect to COVID-19, as more and more people have been exposed, we're seeing less and less.

The problem with influenza and RSV is that in the past two years, we sawhardly any influenza. There were no influenza hospitalizations. RSV was relatively quiet, it wasn't causing as much of a problem as what we anticipate right now, and so basically kids do not have the same immunity. They were pretty much protected, so in this fall season, as we go back to our regularapproach to the winter season, there are a lot morepeople who don't have immunity against RSV. So they'll pick it up and spread it quickly.

With flu, the good news is that we are rolling outflu clinics. We really encourage parents to get their children vaccinated. Typically, people think of the elderly or people of chronic conditions, but everyone should get vaccinated against the flu. It is available free of charge, and the only group not eligible for that vaccine is those under six months.

Can you talk about the rollout of the bivalent COVID vaccine?

On Oct. 25, we rolled out the Moderna bivalent vaccine, which protects against BA. 1 and has the ancestral strain. That is available as a booster for everyone 18 and older.

Starting in early November, we will also have the Pfizer bivalentavailable, and that's the BA. 4/5strain and the ancestral strain, and that will be available for residents 12 and older.

It's a bivalent only given as a booster. You need to be at least six months since you had your last dose of a COVID-19 vaccine and at least three months since a COVID-19 infection.

What's important is that ... some people are particularly at higher risk for severe disease or outcomes than others. And so if you're an older adult, especially if you're 60 and older, if you haven't been vaccinated or have not received the booster or been partially vaccinated, you're at more risk. If you're pregnant, moderately or severely immunocompromised, and anyone who haschronic conditions, such as receiving an organ transplant, undergoing cancer treatment, having high blood pressure, heart disease, lung disease, kidney disease, liver disease they're at higher risk, as well as those with dementia, stroke, diabetes and those who are severely obese with a body mass index of 40 or more.

Anything to add?

We've all learned over the last two years, what healthy habits are.And so continue practicing your healthy habits. Stay home if you're sick, don't spread it to others. Get your vaccinations up to date,and we'll get through this.