This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Canada will likely face a fourth wave of the pandemic as the highly contagious delta variant continues to spread ahead of borders and schools reopening, but there’s growing optimism another surge won’t bring the country back to a crisis point.
Canadian immunologists, virologists and infectious disease specialists say we could fare better than in previous waves, with a lower rate of serious infections, due to the effectiveness of COVID-19 vaccines and the willingness of Canadians to get vaccinated.
But our rollout is plateauing and there are still huge swaths of the population that are unvaccinated — either by choice or due to a lack of access or eligibility — including millions of Canadian kids who are heading back to school in just over a month.
“We’re going to see rises in case counts at some point again,” said Matthew Miller, an associate professor of infectious diseases and immunology at McMaster University in Hamilton.
“Probably similar to last year, as we head into the fall and the cold weather arrives. But those bumps are hopefully just that — tiny hills, and not mountains like the earlier waves.”
People walk in downtown Montreal on June 3 after the city lifted public health restrictions. (Jean-Claude Taliana/CBC/Radio-Canada)
How bad will Canada’s 4th wave be?
The severity of Canada’s fourth wave will largely be determined by levels of COVID-19 immunity in the population from vaccines or prior infection, which can prevent community transmission from rising and stop severe cases from overwhelming hospitals.
“The question is — is there sufficient population immunity? No,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.
“And the reason for that is because we measure population immunity by recovered cases and vaccinations.”
More than 80 per cent of eligible Canadians aged 12 and up have received at least one shot, and more than 60 per cent have had two. But that number drops to about 70 per cent with one dose and just over 50 per cent fully vaccinated when you consider the country’s entire population.
Although Canada has “nowhere near enough” immunity yet, Deonandan says we can “artificially create” adequate protection by using interventions like masking indoors to help with “building walls” around unvaccinated Canadians as COVID-19 becomes more seasonal.
“We’re seeing the arrival of the endemic phase of this disease in places around the world,” he said. “Because mostly they don’t have enough people vaccinated — it comes down to that.”
Maria Rey, 27, gets her first dose of the Pfizer-BioNTech COVID-19 vaccine at an overnight clinic at the International Centre in Mississauga, Ont., on May 16. (Evan Mitsui/CBC)
Delta threatens to drive COVID-19 surge
Another key factor in Canada’s ability to fend off a severe fourth wave is the spread of the more contagious, potentially more deadly delta variant, which is driving COVID-19 levels back up in countries around the world.
“We know from watching the U.K., for example, that delta is very, very capable of tearing through unvaccinated people very quickly,” said Dr. Dominik Mertz, an infectious diseases physician and associate professor of medicine at McMaster University.
“Any percentage of unvaccinated people in the population are leaving themselves at very, very high risk.”
A new study in the New England Journal of Medicine (NEJM) this week found two doses of the Pfizer-BioNTech vaccine were 88 per cent effective against the delta variant, while two shots of the AstraZeneca-Oxford vaccine were 67 per cent effective.
But there are conflicting reports from the real world about vaccine effectiveness against delta, including new data from Israel’s health ministry that suggests the Pfizer shot is only 39 per cent effective against infections — but far better at preventing severe illness.
WATCH | Why the delta variant is different from others:
A respirologist breaks down what is known about the coronavirus delta variant, including what makes it different, how dangerous it is and whether vaccines protect against it. 4:26
Dr. Anthony Fauci, director of the U.S. National Institute for Allergy and Infectious Diseases, told CBC’s Power & Politics Friday that the U.S. still has a “substantial proportion” of the population that is unvaccinated and at highest risk from delta.
“That is absolutely something we need to correct, because when you are dealing with a variant like the delta variant that is so efficient in spreading from person to person, you are going to see a kind of surge in cases,” he said.
“And for those who are vulnerable, like the elderly and people with underlying conditions, the chances of their getting hospitalized increases.”
A nurse tends to a patient suspected of having COVID-19 in the intensive care unit at North York General Hospital in Toronto in May 2020. (Evan Mitsui/CBC)
Reopening borders, schools leaves unvaccinated at risk
Canada could also be at increased risk of exposure to delta due to the reopening of the border to U.S. travellers next month and international travellers in September, along with the return of school, which could put unvaccinated Canadians at higher risk of COVID-19 exposure.
“It absolutely will. In addition, the greater travel that we’re doing inside the country is going to increase the risk of variants,” said Dr. Allison McGeer, a medical microbiologist and infectious diseases specialist at Toronto’s Mount Sinai Hospital.
“We should not be surprised if the delta variant starts to increase quite substantially and we should not be surprised if we have to go back to some level of travel and other restrictions.”
The single biggest cohort of unvaccinated Canadians are children under 12, who are not yet eligible for COVID-19 vaccines despite ongoing clinical trials. Experts say the reopening of schools in September could put them at higher risk.
“It’s important that we start reporting our percentage vaccinated, including kids, because that’s our actual number,” said Alyson Kelvin, an assistant professor at Dalhousie University and virologist at the Canadian Center for Vaccinology and the Vaccine and Infectious Disease Organization.
“Considering we want to have herd immunity be above 85 per cent, we’re not going to get there without kids.”
Wearing masks to prevent the spread of COVID-19, elementary school students walk to classes in Godley, Texas, on Aug. 5, 2020. (LM Otero/Associated Press)
Until children under 12 are eligible for vaccination in Canada, Kelvin says those who have less effective immune responses from COVID-19 vaccines — including older Canadians and the immunocompromised — will continue to be vulnerable.
“Children can’t be vaccinated and variants such as delta are more highly transmissible — and there seems to be case reports of increased disease severity in kids when they do get infected,” she said. “That’s something that we need to be watching going forward.”
Future variants pose unknown threat
One unknown threat Canada faces is the possibility of more transmissible variants emerging in the weeks and months ahead that could be worse than delta, as COVID-19 continues to ravage undervaccinated countries around the world.
Canada was hit hard by the alpha variant at a time when our vaccination campaign had not yet picked up steam, and new and more dangerous variants have repeatedly appeared in countries that continue to be hit hard with each passing wave.
“Definitely we’ll see other variants. If they will be more severe or a variant of concern is another question,” said Kelvin. “But it is an interesting trend that … there seems to be an increase in transmissibility with each as time goes on and we see new variants.”
That’s not typically something that is seen with other circulating viruses like influenza, said Kelvin, meaning the unpredictability of this virus leaves its future an open question.
Miller says COVID-19 will likely become endemic in Canada and around the world, returning each year like the flu, and our ability to control it is contingent on our ability to get more people vaccinated.
“It’s going to keep evolving for decades, presumably. It’s not going anywhere. But we have astoundingly successful vaccines,” he said. “The truth is, there is light at the end of the tunnel. This will end as all things end.
“But if you’re not vaccinated, you’re definitely — at some point — going to get infected.”
This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Demands for government intervention in Air Canada labour talks could negatively affect airline competition in Canada, the CEO of travel company Transat AT Inc. said.
“The extension of such an extraordinary intervention to Air Canada would be an undeniable competitive advantage to the detriment of other Canadian airlines,” Annick Guérard told analysts on an earnings conference call on Thursday.
“The time and urgency is now. It is time to restore healthy competition in Canada,” she added.
Air Canada has asked the federal government to be ready to intervene and request arbitration as early as this weekend to avoid disruptions.
Comments on the potential Air Canada pilot strike or lock out came as Transat reported third-quarter financial results.
Guérard recalled Transat’s labour negotiations with its flight attendants earlier this year, which the company said it handled without asking for government intervention.
The airline’s 2,100 flight attendants voted 99 per cent in favour of a strike mandate and twice rejected tentative deals before approving a new collective agreement in late February.
As the collective agreement for Air Transat pilots ends in June next year, Guérard anticipates similar pressure to increase overall wages as seen in Air Canada’s negotiations, but reckons it will come out “as a win, win, win deal.”
“The pilots are preparing on their side, we are preparing on our side and we’re confident that we’re going to come up with a reasonable deal,” she told analysts when asked about the upcoming negotiations.
The parent company of Air Transat reported it lost $39.9 million or $1.03 per diluted share in its quarter ended July 31. The result compared with a profit of $57.3 million or $1.49 per diluted share a year earlier.
Revenue totalled $736.2 million, down from $746.3 million in the same quarter last year.
On an adjusted basis, Transat says it lost $1.10 per share in its latest quarter compared with an adjusted profit of $1.10 per share a year earlier.
It attributed reduced revenues to lower airline unit revenues, competition, industry-wide overcapacity and economic uncertainty.
Air Transat is also among the airlines facing challenges related to the recall of Pratt & Whitney turbofan jet engines for inspection and repair.
The recall has so far grounded six aircraft, Guérard said on the call.
“We have agreed to financial compensation for grounded aircraft during the 2023-2024 period,” she said. “Alongside this financial compensation, Pratt & Whitney will provide us with two additional spare engines, which we intend to monetize through a sell and lease back transaction.”
Looking ahead, the CEO said she expects consumer demand to remain somewhat uncertain amid high interest rates.
“We are currently seeing ongoing pricing pressure extending into the winter season,” she added. Air Transat is not planning on adding additional aircraft next year but anticipates stability.
“(2025) for us will be much more stable than 2024 in terms of fleet movements and operation, and this will definitely have a positive effect on cost and customer satisfaction as well,” the CEO told analysts.
“We are more and more moving away from all the disruption that we had to go through early in 2024,” she added.
This report by The Canadian Press was first published Sept. 12, 2024.
