TORONTO — As COVID-19 case levels rise across Canada, prompting new shutdowns in several provinces and causing doctors to ring alarm bells over ICU capacity, one question is front of mind: what will it take for Canada to rise out of this third wave?
Experts are split on which strategy is best, but a common thread is the feeling that governments need to be doing more than they currently are, both in planning and communicating with the public.
“We’ve got two to three months of hard work,” Dr. Michael Warner, an ICU physician at Michael Garron Hospital in Toronto told CTV News Channel this week.
“That means public health measures, supporting people, protecting people, making [sure] that people at the highest risk for exposure get the vaccines that are available.”
These are some of the things experts have said we could do as we move forward in the battle against the third wave.
RECOGNIZE VACCINES ARE ONLY PART OF THE SOLUTION
Three vaccines are currently being distributed in Canada and the Johnson & Johnson vaccine is coming at the end of April. But the vaccines on their own do not herald the swift end to the virus that many had hoped for.
“We’re not going to be able to vaccinate ourselves out of this because of supply issues, distribution issues — we simply don’t have enough,” Warner said.
Claire Cupples, a microbiologist and professor at Simon Fraser University, pointed out that countries with robust vaccine distribution haven’t seen the type of third wave that Canada has, but that supply is a problem here.
“We don’t have, or haven’t had anyway, a really good pipeline for vaccines coming into the country because they’re all made outside the country,” she told CTVNews.ca in a phone interview.
A shipment of five million doses of the Pfizer vaccine was moved up to arrive in Canada in June, according to an announcement this week, meaning there will be nine million Pfizer doses arriving in that month — welcome news, Dr. Zain Chagla, an infectious disease specialist, told CTV News Channel this week.
“Nine million doses is a good third of the population that can get vaccinated by June, which is exceptional to get us out of here,” he said.
“I don’t think we’ve reached the point where the vaccines are going to slow down growth over the next month or so, and we really do have to talk about how to do that from a systemic standpoint to buy time. But I think there is hope.”
When it comes to the race of vaccines versus variants, “the variants have won,” Warner said.
“Especially in the hot zone regions. Every single one of my patients has [a] variant. Almost all their family members have it too. This is a different pandemic with the variant.”
CONSIDER VACCINATING WHERE THE SPREAD IS
Dr. Brian Conway, medical director of the Vancouver Infectious Disease Centre, told CTVNews.ca in a phone interview Wednesday that in order to tackle this third wave, we “need to deploy vaccines differently.
“Most of the vaccine plans that were put into place, maybe as recently as six weeks ago, did not take into account the variants, the fact that they were going to spread more rapidly within a specific demographic and that they were going to cause more severe disease,” he said. “So we need to redeploy vaccines to aim them at populations that are responsible for most of the transmissions.”
Most of the vaccine rollouts across provinces and territories have focused solely on age as the first indicator of who gets the vaccine next, outside of high risk groups that were prioritized first, such as long-term care, health-care workers and remote communities.
But younger people seem to be contracting the virus in higher numbers now, driving spread.
Warner said he has patients “in their 30s, in their 40s, who are right now, in my ICU on their bellies, prone, breathing through a machine, paralyzed, barely holding on right now. This can take down younger people for sure.
“And the people who are being infected right now are people who would not meet the criteria for being vaccinated right now in our province, because either they’re not old enough, or they’re not in the right category.”
In Ontario, daily case numbers have been above 2,000 for more than a week. Chagla pointed out that while Ontario has seen high daily case numbers in other waves, the first and second wave contained a high proportion of cases from long-term care.
But with most long-term care residents having been vaccinated, the transmission now is predominantly “in the community.
“There’s nine patients in long-term care in Ontario currently with COVID-19, meaning those 2,000 patients are 2,000 patients in the community,” he said.
STOP PLAYING THE BLAME GAME AND PROTECT AT-RISK POPULATIONS
With case counts growing among those in their 20s, 30s and 40s, it hasn’t been unusual to hear officials imply that young people are simply being careless and not following the rules.
B.C. Premier John Horgan angered many on Monday when he told “the cohort from 20 to 39” to “not blow this for the rest of us.”
But ICU doctors like Warner say this perception does not reflect the reality of who is getting sick.
“These are people who drive for ride share companies, work at checkout counters at stores, work in factories and warehouses — these are not people partying, these are people who can’t be protected from COVID-19 because their exposure risk is simply too high based on the nature of the work they do,” Warner said.
Dr. Kali Barrett, a critical care physician for the University Health Network, echoed these sentiments on CTV News Channel on Thursday.
“It is the people who don’t have the privilege of being able to stay at home or work from home who are getting sick and ending up in our hospitals,” she said. “And so these measures need to be there to protect those people.”
One of the measures advocates have been pushing for is paid sick leave for more people, so that those who do feel symptoms or are concerned they might have been exposed can take time off of work without fearing financial losses — something particularly important considering that those who cannot work from home tend to be in lower income brackets.
Warner said that ICU doctors have been seeing “racialized, marginalized people getting nailed by this.
“We saw it in wave one, we saw it in wave two, we’re seeing it in wave three. We’re the ones who see the essential workers who don’t have benefits getting infected and dying.”
Conway said that while paid sick leave is a difficult thing to implement quickly, it’s something that people have been calling for for a while.
“It has been mentioned for months and months now that people need to feel that if they’re sick, they can stay home and there’ll be no consequences financially or otherwise,” Conway said. “And I think in that context, that’s a broader question that needs to be addressed carefully going forward.”
UTILIZE TESTING STRATEGICALLY
Another way to help those at risk is to find where hotspots are by using more strategic testing.
“It really is more testing that will help us to identify and interrupt transmission networks,” Conway said. “We need to introduce rapid testing more broadly, where we can protect certain environments, such as schools and workplaces.
“In places where we think there’s going to be more risk of transmission, having more frequent, targeted testing in asymptomatic individuals is probably a great idea.”
He pointed out that aggressive testing has kept things like the National Hockey League functioning.
“If it’s important enough to us to protect professional hockey, I think it needs to be important enough to us to protect our young people in there and allow them to work on a daily basis and prevent the operations from shutting down due to COVID.”
MAKE LOCKDOWNS REAL LOCKDOWNS
On Thursday, Ontario announced a new provincewide “emergency brake.” But while it introduces restrictions for the entire province, people quickly noticed that it made very few changes to hotspots such as Toronto and Peel Region, where there is exponential growth in COVID-19 cases.
“It’s really disappointing,” Barrett said, speaking of the announcement. “While I appreciate that the Premier is changing measures in other regions of the province, unfortunately, he’s relying on measures that are not working [in Toronto].”
Dr. Nathan Stall, a researcher and geriatrician at Mount Sinai Hospital and a member of Ontario’s COVID-19 Science Advisory Table, told CTV News Channel on Wednesday ahead of Ontario’s announcement that when officials delay shutdowns, it just makes things worse.
“I think it was incompetent to wait this long, and I frankly don’t know why, when […] we’ve done this twice already, we needed to be in this situation where people are dying, surgeries and other people’s procedures are going to be cancelled, in-class learning is at jeopardy, businesses are going to be closed again — this wasn’t necessary had we acted earlier,” he said.
“We’ve pushed our health-care system not just to the brink, but over the brink in many instances.”
B.C. is also undergoing a circuit-breaker lockdown right now in an attempt to curb cases in the province. But according to Cupples, it is “a fairly lightweight lockdown in [that] the things that are affected are fairly minor.”
The restrictions introduced include new rules regarding indoor dining, group fitness and worship services. Cupples said these types of restrictions have been seen before and may not go far enough.
“We bring in these measures every now and then, they’re pretty lightweight,” she said. “Based on some other countries like Australia and New Zealand, Taiwan, China, […] if we had done a really heavy duty lockdown a year ago, we might be in a different situation, but now I think we’re all just tired of it. People aren’t really paying that much attention anymore. And the lightweight lockdowns are probably more of an irritant than anything else.”
Barrett said one of the problems is that government officials are often trying to balance warring interests and concerns, such as economic worries.
“I think the really important thing is we can recover from economic downturn, businesses can recover, but when you’re dead, you’re dead,” Barrett said.
BUT BE CLEARER WITH WHAT IS ALLOWED
One of the things that make people feel downtrodden with various announcements on restrictions is that governments rarely specify what the public actually can do during shutdowns, Conway pointed out.
He said he spent the winter trying to make it clear that skiing was largely safe, in order to give people an outlet. As weather warms up, governments should be emphasizing activities that people can do outside in order to have some aspect of their social lives back.
“Let’s give people a very long list of things that they’re allowed to do and encourage them to do them, so that the rules that we really need to have followed to limit disease, transmission, are perhaps followed more rigorously,” Conway said.
Stall said that the outdoors could be a crucial part of how we handle the current wave of COVID-19.
“We need to be embracing the outdoors in a way I would argue we didn’t last summer when we did silly things like […] closing parks and restricting outdoor activities,” he said. “I think that’s one of the ways we can change how we restrict our high risk contacts.”
UNDERSTAND PEOPLE ARE TIRED
“There’s no doubt that people are fatigued, worn out, have had enough of this,” Stall said.
“Doctors, scientists, nobody wants to be in a lockdown. The problem is, what are we supposed to do at this point?”
“People are now more tired than they were a year ago,” Conway said, adding that this is one reason why seeing the same type of lockdowns that didn’t work before is frustrating for the public.
BUT MAKE IT CLEAR THIS IS SERIOUS
“A week ago I’d say that I had one patient in my ICU with COVID-19 on a ventilator. And today we have ten,” Warner said.
“In the Greater Toronto Area, which is the area hardest hit by COVID-19, most hospitals are approaching capacity. When I say capacity, I mean staffed beds in the ICU. There might be physical beds, but there aren’t people to take care of them.”
“We have been talking about this looming third wave for weeks now,” Barrett said. “The writing was on the wall on January 20th when we identified the VOCs in the province of Ontario.”
With variants driving transmission, patients are getting sicker, and they’re getting sicker faster.
“These are twice as transmissible, and we’re now understanding that they are causing more severe disease,” Conway said. With a more transmissible virus circulating, even mild transgressions of the public health rules that may have been safe before could be driving transmission now.
“That’s what the variant has done, it has made somewhat safe behaviours more unsafe, and it has led to more widespread community-based transmission.”
Conway said he wanted “to emphasize the fact that there will be an end.”
“In Canada, we have the fundamentals pretty much, right. We have the tools available to us to get us out of this,” Conway said. “It’s just not happening today or tomorrow. And if it deteriorates over the next week, we need to adapt our behaviour to the circumstances of that day. Trusting that at some point in the future, by the fall or something, things will be better.”
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