Tag Archives: COVID-19

Autoimmune-disease drugs may reduce vaccine response; antibody treatments ineffective vs Brazil variant

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Autoimmune disease treatments may reduce vaccine responses

Immunosuppressive drugs for inflammatory diseases like rheumatoid arthritis, multiple sclerosis, and ulcerative colitis can impair the body’s response to the COVID-19 vaccines from Pfizer/BioNTech and Moderna, according to new data. In 133 fully vaccinated people with such conditions, antibody levels and virus neutralization were about three-fold lower than in a comparison group of vaccinated individuals not taking those medicines, researchers reported on Friday on medRxiv ahead of peer review. Most patients in the study “were able to mount antibody responses in response to SARS-CoV-2 vaccination, which is reassuring,” said coauthor Alfred Kim from Washington University School of Medicine in St. Louis. It is not clear yet whether reduced antibody levels will result in decreased protection from infection or hospitalization, Kim said. Particularly concerning, he said, is the 10-fold reduction in vaccine-induced antibody levels seen in patients who routinely use steroids such as prednisone and methylprednisolone and a 36-fold reduction seen with drugs that deplete B cells, including Roche’s Rituxan (rituximab) and Ocrevus (ocrelizumab). Reductions in antibody levels were more modest with widely used rheumatoid arthritis drugs in the class known as TNF inhibitors such as Abbvie’s Humira (adalimumab) and Amgen’s Enbrel (etanercept); antimetabolites like methotrexate and sulfasalazine; JAK inhibitors like Pfizer’s Xeljanz (tofacitinib), gut-specific agents such as Takeda Pharmaceutical Co’s Entyvio (vedolizumab), and IL-12/23 inhibitors including Johnson & Johnson’s Stelara (ustekinumab).

Most antibody drugs ineffective against Brazil variant

The coronavirus variant first identified in Brazil, known as P.1, is resistant to three of the four antibody therapies with emergency use authorization in the United States, according to a laboratory study. In test-tube experiments, researchers exposed the P.1 variant to various monoclonal antibodies, including the four currently being used to treat U.S. COVID-19 patients – imdevimab and casirivimab from Regneron Pharmaceuticals, and bamlanivimab and etesevimab from Eli Lilly and Co. Only imdevimab retained any potency, researchers found. The neutralizing ability of the other three were “markedly or completely abolished,” according to a peer reviewed report available on bioRxiv and provisionally accepted by the journal Cell Host & Microbe. The researchers also exposed P.1 to plasma from COVID-19 survivors and blood from recipients of vaccines from Pfizer/BioNTech or Moderna. Compared to their effects against the original version of the coronavirus, the plasma and the vaccine-induced antibodies were less effective at neutralizing P.1. In earlier studies, however, they were even less effective against the B.1.351 variant first identified in South Africa. This suggests that the Brazil variant might not pose as great a threat of reinfection or decreased vaccine protection as the South Africa variant, said coauthor David Ho from Columbia University. Real-world evidence is needed to confirm the lab results, he said.

South Africa variant can ‘break through’ Pfizer vaccine

The B.1.351 coronavirus variant discovered in South Africa can “break through” Pfizer/BioNTech’s COVID-19 vaccine protection to some extent, Israeli researchers have found. They compared almost 400 people who had tested positive for COVID-19 after one or two doses of the vaccine, against the same number of similar people with COVID-19 who were unvaccinated. The prevalence of the variant in Israel is low, and overall, it accounted for about 1% of all the COVID-19 cases in the study. But among those who received both doses of the vaccine, a larger proportion of COVID-19 infections were caused by B.1.351. The “disproportionately higher rate” of the South African variant in the fully vaccinated group (5.4%) compared to the rate in the unvaccinated group (0.7%) “means that the South African variant is able, to some extent, to break through the vaccine’s protection,” said Tel Aviv University’s Adi Stern. In a report posted on Friday on medRxiv ahead of peer review, Stern’s team said the research was not intended to deduce overall vaccine effectiveness against any variant, since it only looked at people who had already tested positive for COVID-19, not at overall infection rates in the community.

(Reporting by Nancy Lapid and Maayan Lubell; Editing by Bill Berkrot)

More therapeutics but no surge in vaccine for Michigan, Biden administration says

By Jeff Mason and Carl O’Donnell

WASHINGTON (Reuters) -The White House said on Monday it was prepared to send additional therapeutic treatments to the state of Michigan, which is experiencing a worrying number of COVID-19 cases, but declined to promise more vaccine as the state has sought.

White House coronavirus adviser Andy Slavitt told reporters the U.S. government would work to ensure that states such as Michigan were ordering the full amount of vaccine that was available to them but said that shifting distribution was not in line with the administration’s public health strategy.

“We have to remember the fact that in the next two to six weeks, the variants that we’ve seen … in Michigan, those variants are also … present in other states,” he told reporters on a conference call.

“So our ability to vaccinate people quickly … (in) each of those states rather than taking vaccines and shifting it to playing Whack-a-Mole isn’t the strategy that public health leaders and scientists … have laid out,” he said.

Michigan Governor Gretchen Whitmer, a Democrat, has pleaded with the federal government to increase the number of vaccines allotted to her state to address a dangerous surge in cases but, despite close ties to the White House, has been rebuffed.

Whitmer was on President Joe Biden’s list of potential running mates before he chose now Vice President Kamala Harris. Michigan is a political battleground state that Biden won in 2020, helping to secure his victory over former President Donald Trump, a Republican. It is likely to be decisive in the 2024 White House race as well.

The Biden administration has highlighted an increase in vaccination rates across the country while warning Americans to continue wearing masks, maintain social distance, and follow other health protocols to prevent another major COVID-19 surge.

U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said more vaccine was not the answer to Michigan’s problem. She said the state needed to “go back to basics” and shut down.

“I think if we tried to vaccinate our way out of what is happening in Michigan we would be disappointed that it took so long for the vaccine to work,” she said. “Similarly we need that vaccine in other places. If we vaccinate today we will have, you know, impact at six weeks and we don’t know where the next place … is going to be that is going to surge.”

Whitmer has faced fierce political backlash from conservatives in her Midwestern state for her COVID-19 restrictions, including armed groups entering the state capitol and a foiled plot to kidnap her. She was a frequent target of criticism from Trump.

Slavitt said that Johnson & Johnson is on track to deliver around 24 million COVID-19 shots to the United States in April whether or not it receives U.S. regulatory clearance for its Baltimore vaccine production plant, which is owned by contract manufacturer Emergent BioSciences Inc.

J&J has faced delays on vaccine shipments because of challenges at its Emergent plant, which ruined 15 million doses in recent weeks due to manufacturing error.

Jeff Zients, the White House’s COVID-19 response coordinator, said last week J&J would ship relatively few shots each week until the Emergent plant received authorization from the U.S. Food and Drug Administration.

(Reporting by Jeff Mason and Carl O’Donnell; additional reporting by Susan Heavey and Caroline HumerEditing by Chizu Nomiyama and Marguerita Choy)

Ontario hospitals may have to withhold care as COVID-19 fills ICUs

By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada’s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

(Reporting by Allison Martell and Anna Mehler Paperny; Editing by Denny Thomas and Grant McCool)

Coronavirus pandemic ‘a long way from over’, WHO’s Tedros says

GENEVA (Reuters) -Confusion and complacency in addressing COVID-19 means the pandemic is a long way from over, but it can be brought under control in months with proven public health measures, WHO Director-General Tedros Adhanom Ghebreyesus said on Monday.

“We too want to see societies and economies reopening, and travel and trade resuming,” Tedros told a news briefing.

“But right now, intensive care units in many countries are overflowing and people are dying – and it’s totally avoidable.”

“The COVID19 pandemic is a long way from over. But we have many reasons for optimism. The decline in cases and deaths during the first two months of the year shows that this virus and its variants can be stopped,” he added, saying transmission was being driven by “confusion, complacency and inconsistency in public health measures.”

India has overtaken Brazil to become the nation with the second highest number of infections worldwide after the United States, as it battles a massive second wave, having given about 105 million vaccine doses among a population of 1.4 billion.

WHO team leader on COVID-19 Maria van Kerkove told the news briefing the pandemic was growing exponentially, with a 9% increase in cases last week, the seventh consecutive week of increases, and a 5% rise in deaths.

Tedros said that in some countries, despite continuing transmission, restaurants and nightclubs were full and markets were open and crowded with few people taking precautions.

“Some people appear to be taking the approach that if they’re relatively young, it doesn’t matter if they get COVID-19,” he said.

(Reporting by Silke Koltrowitz and Stephanie Nebehay, Editing by William Maclean)

‘How can we not be tense?’ Turkey’s coronavirus infections soar

By Daren Butler and Tuvan Gumrukcu

ISTANBUL/ANKARA (Reuters) – The red letters scrolling across the front of Fikret Oluk’s bus say: “Stay Home Turkey.” But the Istanbul driver said passengers are ignoring rules and overcrowding, sometimes without masks, even as coronavirus infections rocket.

Turkey – which has the highest level of daily new COVID-19 cases in Europe and the Middle East – again tightened measures last week to contain the rapid spread after calls for action by doctors and opposition politicians.

Among the rules are a limit of 69 passengers on Oluk’s busy urban bus route. When 89 are aboard, he says he draws the line.

“But unfortunately people do not listen. They attack us and put us in a difficult position,” said the driver of 10 years.

“How can we not be tense? Our lives are currently dependent on these masks. But unfortunately, just like people don’t think about themselves, they don’t think about us either,” he said.

Interviews with Turks who have received a vaccine and those waiting for one show a mix of fear and frustration with record COVID-19 deaths and infections, which neared 56,000 on Thursday alone, and an uneven adherence to the rules.

The head of the Turkish Medics Association told Reuters she believed the biggest misstep of President Tayyip Erdogan’s government was broadly easing restrictions in March as daily case numbers fell below 10,000. She said this sacrificed the gains made over the winter, calling the approach “social murder.”

“We called this a ‘social murder’ because they already know what will cause these deaths, they do not have any preventative measures,” Sebnem Korucu Fincanci said, adding that intercity travel, manufacturing and public transportation should be halted.

Erdogan and his government came under fire last month for a party congress with thousands of people, many of whom were seen violating social distancing rules and not wearing or improperly wearing masks. Opposition parties and critics accused Ankara of undermining efforts to curb infections.

‘BE REALISTIC’

Nurettin Yigit, head doctor at a specially-built pandemic hospital in Istanbul, said the impact on the health system of the latest surge had been less than in previous waves and called the timing “unlucky.”

“The moment we began this controlled normalization, the entry of other mutations from other countries started,” he told Reuters as medical staff administered vaccines to patients. He attributed the rise partly to people travelling domestically.

Ankara has blamed coronavirus variants for the surge in infections, saying some 85% of total cases across the country are from the variant first identified in Britain, as well as a lack of commitment to measures such as social distancing and mask wearing.

On Friday, Health Minister Fahrettin Koca told the Hurriyet daily that the solution to the “serious rise” in infections was to speed up vaccinations, adding he aimed to have all citizens over 20 years old vaccinated by July.

Fincanci called Ankara’s vaccination goals unrealistic and criticized what she called the inaccurate reporting of case and death numbers. “They have to be realistic, they have to be transparent,” she said.

Turkey has administered around 18 million doses of COVID-19 vaccines so far, roughly enough to cover about 11% of the population, according to a Reuters tally.

The government has dismissed criticisms over its handling of the pandemic and the measures it has implemented, saying public health is the priority.

It has adopted fresh stay-at-home orders for weekends and will halt dining at restaurants starting Tuesday for the Islamic fasting month of Ramadan.

But the country has remained largely open for business since last June and many have hit the streets and cafes as the weather has warmed – worrying some who have stayed home.

“I haven’t drank tea in a café for 11 months. I don’t leave the house,” said Mehmet Tut, 62, sitting outside a hospital treatment room after receiving his first vaccine shot on Friday.

“We will still be careful as we wait for the second dose” even as others are not taking enough precautions, he said. “They expect everything from the state but it is up to us. If we are careful we won’t get sick.”

(Additional reporting by Yesim Dikmen, Bulent Usta and Mert Ozkan; Writing by Jonathan Spicer; Editing by Rosalba O’Brien)

WHO warns on Brazil COVID-19 outbreak as Bolsonaro blasts Senate inquiry

By Eduardo Simões

SAO PAULO (Reuters) – Brazilian President Jair Bolsonaro on Friday blasted a pending Senate inquiry on his handling of a record-breaking COVID-19 outbreak, which global health officials compared to a “raging inferno.”

Supreme Court Justice Luis Roberto Barroso ruled late on Thursday that enough senators had signed on to a proposed inquiry on the government’s pandemic response to launch the probe despite stalling by Senate leadership.

“It’s a stitch-up between Barroso and the leftists in the Senate to wear out the government,” Bolsonaro told supporters outside his residence, accusing the judge of “politicking.”

A Senate investigation represents the most severe political consequence to date for Bolsonaro’s approach to the coronavirus, which he compared to a “little flu” last year as he ignored health experts calling for mask wearing and social distance.

Bolsonaro has backed off his criticism of COVID-19 vaccines, but he continues to attack governors attempting lockdowns and even milder measures, accusing them without proof of killing more with those restrictions than the virus itself.

COVID-19 has taken more than 345,000 lives in Brazil, second only to the United States. One in four deaths from the pandemic this week were in Brazil, where a brutal wave is overwhelming hospitals and setting records of more than 4,000 deaths per day.

“What you are dealing with here is a raging inferno of an outbreak,” said Bruce Aylward, senior adviser to the director general of the World Health Organization, in a public briefing.

Yet fatigue and political pressure from Bolsonaro have pushed some governors to ease restrictions despite record deaths.

The state of Sao Paulo, whose governor has been a critic of the president, announced that it was loosening some restrictions next week even as its hospitals struggle to manage case loads.

Sao Paulo officials said a downtick in hospitalizations had justified the decision to restart soccer matches without spectators, reopen stores selling building materials and resume take-out service at restaurants.

(Reporting by Eduardo Simoes; Additional reporting by Tatiana Bautzer; Editing by Brad Haynes and Dan Grebler)

Climate change, rich-poor gap, conflict likely to grow: U.S. intelligence report

By Jonathan Landay and Mark Hosenball

WASHINGTON (Reuters) – Disease, the rich-poor gap, climate change and conflicts within and among nations will pose greater challenges in coming decades, with the COVID-19 pandemic already worsening some of those problems, a U.S. intelligence report said on Thursday.

The rivalry between China and a U.S.-led coalition of Western nations likely will intensify, fueled by military power shifts, demographics, technology and “hardening divisions over governance models,” said Global Trends 2040: A More Contested World, produced by the U.S. National Intelligence Council (NIC).

Regional powers and non-state actors may exert greater influence, with the likely result “a more conflict-prone and volatile geopolitical environment” and weakened international cooperation, it said.

The report by top U.S. intelligence analysts, which is produced every four years, assessed the political, economic, societal and other trends that likely will shape the national security environment in the next 20 years.

“Our intent is to help policymakers and citizens … prepare for an array of possible futures,” the authors wrote, noting they make no specific predictions and included input from diverse groups, from American students to African civil society activists.

Challenges like climate change, disease, financial crises and technological disruption “are likely to manifest more frequently and intensely in almost every region and country,” producing “widespread strains on states and societies as well as shocks that could be catastrophic,” the report said.

It said the coronavirus pandemic that has killed more than 3 million people marked the greatest “global disruption” since World War Two, with the consequences likely to last for years.

COVID-19, it said, exposed – and sometimes widened – disparities in healthcare, raised national debts, accelerated nationalism and political polarization, deepened inequality, fueled distrust in government and highlighted failed international cooperation.

In the process, it is slowing – and possibly reversing – progress in fighting poverty, disease and gender inequality.

Many problems caused by the pandemic are forecast by the report to grow by 2040.

“There is a certain set of trends that we’ve identified that seem to be accelerating or made more powerful because of the pandemic,” said an NIC official, speaking on condition of anonymity.

The report posed five scenarios for what the world might look like in 2040.

The most optimistic – a “renaissance of democracies” – found that democratic governments would prove “better able to foster scientific research and technological innovation, catalyzing an economic boom,” enabling them to cope with domestic stresses and to stand up to international rivals.

The most pessimistic scenario – “tragedy and mobilization” – posited how COVID-19 and global warming could devastate global food supplies, leading to riots in Philadelphia that kill “thousands of people.”

(Reporting by Jonathan Landay and Mark Hosenball in Washington; Editing by Tim Ahmann and Peter Cooney)

Moderna vaccine antibodies last at least 6 months; lung transplant can save some COVID-19 survivors

By Nancy Lapid

(Reuters) -The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Moderna vaccine antibodies last at least 6 months

A follow-up study of 33 people who received Moderna Inc’s COVID-19 vaccine in early trials show the antibodies it induced are still present six months after the second dose. “Antibody activity remained high in all age groups,” researchers said. They confirmed the findings using three different tests, according to a report on Tuesday in The New England Journal of Medicine. Earlier this month, Pfizer Inc and partner BioNTech SE said their vaccine using similar messenger RNA (mRNA) technology remained highly effective for at least six months.. The researchers conducting the Moderna vaccine study will continue to follow the same volunteers to see whether the antibodies last longer than six months. They are also evaluating the potential for a booster dose to extend the duration of the antibodies and improve their potency against new more contagious variants of the coronavirus.

Lung transplants can save some COVID-19 survivors

Surgeons worldwide have been performing lung transplants in COVID-19 survivors with irreversible lung damage, and an international group of transplant experts has proposed guidelines for selection of eligible patients. To possibly qualify for a transplant, COVID-19 survivors with complete lung failure should be younger than 65, nonsmokers, and have no pre-existing medical conditions, or only manageable ones, they advise. They said transplants should be performed at least four weeks after a diagnosis of irreversible lung damage. In the United States alone, more than 50 double lung transplants have been performed on COVID-19 survivors, and all the patients are alive, said Dr. Ankit Bharat of Northwestern Medicine in Chicago, who has performed a dozen of them. A study published in The Lancet Respiratory Medicine that examined 12 of the first double-lung transplants performed in COVID-19 patients in the United States, Italy, Austria and India showed that all but two survived and are doing well, said co-author Bharat. “It’s a really remarkable outcome, given how critically ill these patients were,” he said. “Without the possibility of transplant, the medical team and the families were ready to withdraw care.”

Pfizer/BioNTech vaccine safe during cancer immunotherapy

The mRNA COVID-19 vaccine from Pfizer and BioNTech is safe for patients being treated with cancer immunotherapies like Merck & Co’s Keytruda and Opdivo sold by Bristol Myers Squibb, Israeli physicians said in a report published in The Lancet Oncology. They studied 134 vaccine recipients who were being treated with the so-called immune-checkpoint inhibitors, including some who were also receiving chemotherapy. The vaccine was “safe from both sides: we did not see immunotherapy-related side effects and did not see severe side effects from the vaccine itself,” said the report’s co-author Dr. Ido Wolf of the Tel Aviv Sourasky Medical Center. “We believe that the vaccine should be given to these patients … especially in areas of an active COVID-19 outbreak.” However, questions still need to be answered for these patients, including whether there are any long-term issues. “We looked at our patients only a few weeks from the second dose and cannot rule out the possibility of long-term side effects,” Wolf said. His team is also looking into whether other cancer drugs, such as chemotherapies, may reduce the efficacy of the vaccine.

Skin reactions to mRNA vaccines have not been serious

A wide range of skin reactions has been documented in recipients of the mRNA vaccines from Pfizer/BioNTech and Moderna, but none have been serious, according to researchers who analyzed 414 cases in a registry run by dermatology societies. The majority (83%) were associated with the Moderna shot. Most started the day after, or often several days to a week, after vaccination, said Dr. Esther Freeman of Massachusetts General Hospital in Boston, who coauthored a report published on Wednesday in the Journal of the American Academy of Dermatology. Fewer than half of patients who experienced a delayed skin reaction after the first dose experienced a recurrence with the second dose. Furthermore, no patients in the registry developed serious adverse events after the first or second dose. “If the patient develops a delayed-onset rash more than four hours after vaccination, while the rash may be uncomfortable, our data suggest they … should feel comfortable proceeding with the second dose of their vaccine,” Freeman said. However, she added, hives that start within four hours after vaccination “should be taken very seriously,” as that may be a sign of an immediate allergic reaction. The U.S. Centers for Disease Control and Prevention recommends referral to an allergist-immunologist in those cases.

(Reporting by Nancy Lapid, Marilynn Larkin, Megan Brooks, and Ronnie Cohen; Editing by Bill Berkrot)

Israel honors Holocaust victims as COVID-19 vaccines keep survivors alive

By Jeffrey Heller

JERUSALEM (Reuters) – A memorial siren brought traffic to a halt in Israel on Thursday as it honored six million Jews killed in the Nazi Holocaust, and gave thanks for its swift rollout of COVID-19 vaccines as a lifesaver for elderly survivors.

With around 57% of the population having already received at least one vaccine dose, Israel’s infection rate has dropped dramatically.

That has allowed care and nursing homes to open their doors to visitors again, reuniting many of the country’s 180,000 survivors with their loved ones.

Prime Minister Benjamin Netanyahu said 900 in that community had died as a result of the coronavirus. But many times more had been inoculated in time. Overall, Israel has recorded 6,270 deaths from the virus.

“Some we did not manage to reach with vaccines in time, but writ large, the vaccine succeeded,” he said, addressing the survivors at a ceremony marking the start of the annual Holocaust Martyrs’ and Heroes’ Remembrance Day. “You got vaccinated at a record rates.”

Israel’s three national lockdowns, “were difficult for us all, but among many of you, they awakened painful memories of the terrible loneliness of your childhood”.

As the sirens sounded nationwide, traffic stopped and motorists stepped out of their vehicles to stand for two minutes in honor of the Holocaust dead.

In a ceremony in parliament, legislators lit memorial candles and read aloud the names of relatives who perished in the Holocaust.

In Bahrain, one of four Arab countries that established official ties with Israel last year, the Association of Gulf Jewish Communities planned a Holocaust remembrance event on the Internet.

(Reporting by Jeffrey Heller; editing by John Stonestreet)

Ontario issues stay-at-home order, closes most stores as COVID cases rise

(Reuters) -Ontario will begin a four week-long stay-at-home order and close in-store shopping for non-essential retailers as of Thursday, Premier Doug Ford said on Wednesday, as the Canadian province battles a surge of COVID-19 cases.

“The situation is extremely serious. We need to hunker down right now,” Ford said at a briefing in Toronto.

“What we do until we start achieving mass immunization will be the difference between life and death for thousands of people.”

The order requires people in Canada’s most populous province to stay in their residences except for essential reasons, including exercise, vaccination appointments or grocery trips.

Last week, Ontario shuttered all indoor and outdoor dining, a move that fell short of what the government’s expert advisory panel said was necessary to avoid catastrophically high case numbers.

All retailers except those selling grocery, pharmacy and gardening goods will close for four weeks, except for curbside pickup. Big box stores can remain open, but with capacity limits and only certain products including groceries, pharmacy and gardening materials available for in-store purchase.

Industry groups had criticized Ford for allowing big box stores to remain open during past lockdowns while shutting small businesses.

Retailers considered essential can open for in-store shopping by appointment only. These include medical device supply and repair shops, optical stores and auto mechanics.

On Tuesday, Canada reported 6,520 cases, the most recent data publicly available. Prime Minister Justin Trudeau warned of a “very serious” third wave of the virus, with more young people going into hospital and on ventilators due to more lethal variants.

Hospitals in Ontario are becoming more stretched. Provincial data showed more COVID-19 patients in intensive care units than at any point since the pandemic began.

ICU admissions are rising faster than the worst-case scenario modelled by experts, Ford said.

The province also announced that all teachers and education staff in Toronto and the suburb of Peel would be eligible for vaccination beginning during the school districts’ April break.

On Tuesday Toronto Public Health shuttered the city’s schools for in-person learning, sending the country’s largest school district of around 247,000 students back to remote learning from Wednesday until April 18.

Hours earlier Ford had told reporters that schools were safe and closures would be unnecessary.

Ontario reported 3,215 new cases on Wednesday, according to government data.

(Reporting by Moira Warburton in Vancouver Editing by Chris Reese and David Gregorio)