Vaccines, restrictions may ward off worst outcomes as delta spreads — but pressure on hospitals still possible
With COVID-19 cases rising in multiple provinces after a summer lull, more signs point to Canada entering an expected fourth wave of the pandemic — one which could be dramatically different from earlier surges, thanks to rising vaccination rates, but not entirely pain-free.
The country’s seven-day average for new daily cases is now close to 1,300 — an increase of nearly 60 per cent over the previous week, with cases ticking back up mainly in B.C., Alberta, Saskatchewan, Ontario and Quebec.
“We’re absolutely in the fourth wave,” said Dr. Peter Juni, who is the scientific director of Ontario’s COVID-19 Science Advisory Table. “There’s no doubt about that.”
But unlike previous waves, which overwhelmed various hospital systems and led to catastrophic death in long-term care facilities, there is hope this spike won’t be quite so dire.
High vaccination uptake across the country has changed the game: Roughly 60 per cent of Canadians are now fully vaccinated, and research continues to show leading vaccines offer high levels of protection from serious illness, even against the fast-spreading delta variant.
“We can effectively have more cases in our population without having as severe an impact on our health-care system,” explained Ashleigh Tuite, an epidemiologist with the University of Toronto’s Dalla Lana School of Public Health.
“But that doesn’t mean that we’re out of the woods.”
Multiple experts who spoke to CBC News stressed the need to keep precautions like mask-wearing in place to avoid the worst of what this wave could bring, while also striving to ensure as many Canadians as possible get their shots.
“The point is we can’t go back to normal,” said Juni. “Because we continue to have a challenge with the large proportion of people who remain unvaccinated.”
90% of cases among unvaccinated
Unprotected individuals around the world have proven vulnerable to the highly contagious delta variant in recent weeks, with surges of cases — including serious infections and deaths — in areas of low vaccine coverage, ranging from entire regions in Africa to certain U.S. states.
“This is going to overwhelmingly be a disease of unvaccinated Canadians and under-vaccinated populations,” said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force.
The latest available federal public health data shows roughly 90 per cent of all COVID-19 cases reported in Canada since the start of the country’s vaccination program in mid-December have been among unvaccinated individuals.
Just a tiny portion of cases — 0.5 per cent — have been reported among people who’ve been fully vaccinated, with a similar breakdown for hospitalizations and deaths in the same time period.
Compared to unvaccinated individuals, fully vaccinated COVID-19 cases were 70 per cent less likely to be hospitalized and 51 per cent less likely to die as a result of their illness, according to the latest federal update.
Bogoch stressed that as more and more people get vaccinated, the hope is the total number of people falling seriously ill or dying from infection will remain relatively low, even if overall COVID-19 cases continue to spike.
“We’ll still see positive cases in the vaccinated,” he explained. “But proportionally those won’t amount to hospitalizations.”
Pressure on health-care system still possible
Still, with around 40 per cent of the total population not yet fully vaccinated, that means millions of people — including all children in Canada under 12, who aren’t yet eligible — remain at risk.
“If a large proportion of those individuals get sick in a short period of time, our health-care system is going to get stretched and we’ll be in trouble,” Bogoch said.
His warning comes as Canadians are facing a patchwork of pandemic precautions, with some provinces ditching many precautions entirely.
Almost all public health restrictions in Alberta were lifted on July 1, for instance, and the province plans to scale back isolation requirements, contact tracing and asymptomatic testing next week. And Saskatchewan followed suit by lifting most of its restrictions recently.
Juni said with the delta variant circulating widely, it’s not time for other provinces, like Ontario, to further loosen its rules. That doesn’t mean shifting back to a full lockdown, he added, but rather maintaining day-to-day precautions, like wearing masks and curbing large gatherings.
“If we now just let things rip, and have an approach similar to what Alberta does now, we could have 20,000 ICU admissions happen in a relatively short time frame of six to eight weeks,” he said.
Dr. David Naylor, who led the federal inquiry into Canada’s national response to the 2003 SARS epidemic and now co-chairs the federal government’s COVID-19 immunity task force, said an overwhelmed health-care system is still “much less likely” given the clear weakening between case counts and hospitalizations, thanks to vaccines.
But he agrees there could be “serious pressure” on hospitals if case counts get high enough, at a time when front-line staff are already exhausted.
“That pressure will also impede efforts to clear a huge backlog of delayed health-care services right across Canada,” said Naylor.
Also concerning, he said, are unanswered questions around how COVID-19 can impact the human body — whether that’s lingering symptoms following an infection or potential long-term effects on children and teens.
Encouraging vaccinations ‘crucial’
Alongside basic precautions, what’s most crucial right now is encouraging more Canadians to get their shots, said University of Saskatchewan infectious diseases specialist Dr. Alexander Wong, in order to protect anyone who’s not yet vaccinated or at a higher risk — including children, older adults with weaker immune systems and immunocompromised individuals of any age.
That could mean implementing vaccine mandates or proof-of-vaccination certificates, he said.
Manitoba has already launched an immunization card and app, granting special privileges to fully vaccinated residents, while Quebec’s health minister announced Tuesday that a vaccination passport system will be implemented on Sept. 1 to combat rising cases.
“With early signs of a delta-driven wave beginning and the fall approaching, efforts to increase the proportion of fully vaccinated Canadians and reinforce individual precautions per local public health advice are crucial to reducing virus spread and lowering the risk of a resurgence that could lead to health-care capacity being exceeded this coming fall and winter,” said Dr. Theresa Tam, Canada’s chief public health officer, in a statement on Tuesday.
What’s not an option, multiple experts agree, is letting this virus simply run its course.
“The reproduction number in many places across the country is above one, and so that means that we are in a period of exponential growth,” said Tuite.
“What that tells us is that if we don’t do anything, we’re going to continue to have increased growth in cases.”