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.
Much of Canada is lifting lockdown measures and reopening risky indoor settings while experts warn fast-spreading coronavirus variants threaten to jeopardize recent progress and trigger a brutal third wave.
On the same day Manitoba announced its first case of the variant initially detected in the United Kingdom, the province also said it would reopen restaurants, gyms, places of worship, museums, art galleries, tattoo parlours, nail salons and libraries.
That variant, also known as B117, is estimated to be at least 50 per cent more transmissible and potentially more deadly and led to strict lockdowns in countries like Denmark, Ireland and the U.K., where it quickly became a dominant strain.
Alberta, which already has 149 cases of B117 and seven cases of the variant first identified in South Africa, also decided to reopen restaurants, bars and gyms this week despite the rapid rise in variant cases.
“It’s kind of like we’re playing chicken with COVID, which never struck me as being a great idea,” said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton.
“There’s been enough demonstrated risk from the variants being able to become dominant strains over a period of time in multiple jurisdictions that I would have preferred to hold steady and monitor for a period longer.”
Meanwhile, those variants have caused a surge in cases so rapid in Newfoundland and Labrador, the province has imposed new lockdown measures and cancelled in-person voting for today’s election.
Balancing return to ‘normal’ with threat of variants
Saxinger says that while Alberta and other provinces have done an effective job of monitoring for the variants as they emerge, she expects the number of variant cases will no doubt continue to grow as the economy reopens.
“Opening indoor dining is a mistake — plain and simple,” said Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at Unity Health Toronto.
“It’s pretty obvious that if we just went back to normal there would be a third wave and it would be absolutely brutal.”
Dhalla says officials are trying to answer the tricky question of how close to normal they can get, while trying to balance keeping cases low in the face of fast-spreading variants.
“Nobody knows the answer to that question with certainty, but I think everything we’ve seen over the last year tells us it’s better to err on the side of caution,” he said.
“The prudent thing to do would be to go slow and see what happens after a few weeks.”
Despite keeping its provincewide curfew in place, Quebec has also begun reopening businesses, museums, hair salons and malls — even though gathering in them will not be permitted.
Ontario also began rolling back restrictions this week, lifting stay at home orders in much of the province, allowing for non-essential businesses and even ski hills to reopen, while committing to further loosening measures in the coming weeks.
“This is not the time to really begin pulling back on restrictions,” Dr. Gerald Evans, chair of infectious disease in the department of medicine at Queen’s University in Kingston, Ont., told The Current this week.
“Our expectation, when we look at the experience of other countries that have had that variant introduced, is we’re going to see a rise up in numbers and so you don’t want to complicate that by now suddenly rolling back restrictions.”
The decision to loosen restrictions in Ontario came at the same time health experts warned in a provincial scientific briefing that the spread of variants threatened to trigger a third wave of the pandemic, which could in turn lead to a third lockdown.
“We need to be watching how this unfolds and how it plays out before we make too many changes all at once,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto.
“The overall numbers look to be going down, but these variants are emerging and they will likely emerge rapidly and our ability to control transmission might change with that.”
Outbreak in Newfoundland sparked by B117
In a cautionary tale for the rest of the country, health officials in Newfoundand and Labrador confirmed late Friday that a massive outbreak of COVID-19 in St. John’s this week was caused by B117, leading strict lockdown measures to be reimposed.
The province reported 50 new cases of COVID-19 Friday, with the vast majority in the St. John’s region. Thousands of people are in isolation, while others faced renewed lockdown measures that shuttered schools and non-essential businesses.
Bruce Chaulk, the province’s chief electoral officer, announced during a press conference Friday that in-person voting in all 40 districts across the province had been suspended and the election would be solely by mail due to the outbreak.
“We know that if not controlled, it becomes a predominant strain within weeks of first appearance,” said Dr. Janice Fitzgerald, the province’s chief medical officer of health.
“This is concerning and serious. But we have the ability to overcome it.”
There are 260 active cases in the province, with 244 of those reported in the last five days. In contrast, the province had 395 total cases of COVID-19 in all of 2020.
“I actually worry more about those areas that have been spared through most of the pandemic,” said Hota.
“You don’t know what it’s like to deal with COVID until it hits you — and it hits hard.”
WATCH | Provinces reach for mix of reopening, COVID-19 precautions:
‘Mixed messaging’ between health experts, provinces
All of the provinces that moved toward reopening this week cited reduced caseloads as reasoning for their strategies, despite the fact that cases of the variants continue to rise.
At least three provinces have confirmed community spread of the variants and there have been more than 450 variant cases in Canada to date.
But at the federal level, dire warnings about reopening amid the spread of variants seems to conflict with what’s happening on the ground.
“Resurgence will happen really fast, so this is the time to be vigilant against the variants,” Canada’s Chief Public Health officer Dr. Theresa Tam said during a press conference Friday.
“We need to really be very cautious about easing public health measures at this time while vaccination is just beginning to accelerate.”
Dhalla says there’s a growing disconnect between provincial politicians and medical officers of health across the country, which is only adding to confusion for the public.
“I think what we’re also starting to see is a little bit of mixed messaging again,” he said.
For example, in Toronto — where a stay-at-home order is in place until at least Feb. 22 — the medical officer of health said this week the city was on the verge of a “new pandemic” due to the spread of variants in the city, which has already found cases of variants first identified in the U.K., South Africa and Brazil.
“It was inevitable the variants of concern would emerge in Toronto,” Dr. Eileen de Villa said during a press conference.
“We are in a position of great uncertainty with respect to variants but what we know is alarming. I understand the value of preparing for the time we can lift restrictions. From a public health perspective in Toronto, that time is not now.”
Threat of variants kept restrictions in some provinces
British Columbia said last week it would be extending its public health restrictions indefinitely, despite recent signs that the province is driving transmission down even with at least 40 cases of variants detected.
“Right now, we need to stay the path,” Provincial Health Officer Dr. Bonnie Henry said. “We need to protect the progress we have made and not squander our progress.”
New Brunswick is another province sticking with strict public health measures despite having just four confirmed cases of B117. Parts of the province are under lockdown and non-essential travel discouraged in other regions.
“They are going to come to New Brunswick, if they’re not already here,” said chief medical officer of health Dr. Jennifer Russell of the variants late last month after measures were imposed.
“We are in the middle of the second wave right now, but the third wave is going to be upon us very soon and that third wave is much worse than the first and second combined and this third wave is as a result of these new more transmissible, more contagious variants.”
Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, says Canada is already starting to see the early warnings of a surge driven by variants and his research predicts a third wave could come as early as March.
“[B117] is doing here what it’s done in Denmark and the U.K. — the new strains are starting to outcompete the old strains,” he said. “Even though it’s a small minority of strains, they’re spreading better here than the old variants are spreading.”
Saxinger says stronger action needs to be taken “extremely early” to prevent a devastating third wave from variants in Canada and hesitating to act could jeopardize our ability to drive case numbers down — even with strict public health measures that have worked in the past.
“The leash just has to be very, very short,” she said.
“Because there’s no way we’re going to have enough vaccines into all the vulnerable populations over the next few months to be able to avert preventable deaths if there’s another big surge.”
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Island Health to start taking calls Monday for first group in mass-vaccination drive – Times Colonist
Island Health officials are hustling this weekend, getting ready to vaccinate remaining high-risk groups next week and preparing to open phone lines Monday for seniors 90 and older to register for their COVID-19 shots.
“Excited, nervous,” said Richard Stanwick, chief medical health officer for Island Health, on the “unprecedented” scope of the immunization effort, which, he said, is bound to have a few hiccups. “I think we’re willing to perhaps make a few missteps to make sure that people get vaccinated earlier rather than later.”
The health authority performed a major pivot this week, postponing second-dose clinics to give more people first doses, after provincial health officer Dr. Bonnie Henry announced booster shots will be given after 16 weeks instead of six. First doses have been shown to be about 90 per cent effective.
That newly freed-up vaccine supply is being used next week to vaccinate the last of the high-risk seniors in independent living, those receiving home support and seniors awaiting placement in long-term care, as well as long-term care residents, visitors and staff who were missed in the first round.
Also being vaccinated are Indigenous communities, hospital staff, community doctors, medical specialists, vulnerable populations living and working in group settings, and staff in community home support and nursing services for seniors.
Joseph Nestor, 95, a resident in independent living at The Peninsula in Sidney, got his first dose Friday.
“I couldn’t sleep all night thinking about it,” said Nestor, who woke up at 3:30 a.m. for his appointment at 6:45 a.m. “I just lay there.”
Noting about 3,700 people were vaccinated on Thursday, Stanwick said Island Health may get a four-week jump on its vaccination schedule because of the longer gap between shots. Vaccines will be administered at clinics as well as via mobile units that will go to the residences of house-bound seniors.
Stanwick is hoping the glee some are feeling about being protected earlier than anticipated offsets the disappointment of others who had second doses cancelled.
“The community will be safer because there’ll be less virus spread,” Stanwick said. “This is actually to the benefit of everyone.”
On Monday, Island Health will begin booking appointments for the first group of people in the general population eligible for vaccines: those 90 and older, and Indigenous people 65 and older.
Don and Joan Hepburn of James Bay, both 90, plan to call on Monday, which also happens to be their 69th wedding anniversary, to register for their shots. Vaccinations for the 90-plus group will begin March 15.
Those born in or before 1936 can start calling March 15 for shots beginning March 22, while those born in or before 1941 can start calling March 22 to make appointments for vaccinations that will start March 29.
Those whose age window comes up are asked to call Island Health at 1-833-348-4787 to make an appointment. The health authority says it has 50 agents ready to start Monday, a number that will increase in coming weeks. The call centre will operate 7 a.m. to 7 p.m. daily.
The province has staggered the call-in dates in hopes that people will call only when it’s their turn, rather than risk crashing the call lines, as has happened in other jurisdictions. The lines will only hold a certain number of calls in the queue before asking people to call back. “We know some people may experience long wait times when they call to book an appointment,” the health authority said. “We are confident in our levels of vaccine supply … we are asking people to be patient when possible.”
No one loses their priority to book an appointment, regardless of when they call, said Dr. Penny Ballem, executive lead for B.C.s immunization plan.
The list of vaccination sites in Island Health is expected to be released next week.
On Friday, Health Canada announced it had approved use of the Johnson & Johnson vaccine. The availability of a fourth vaccine —along with the Pfizer-BioNTech, Moderna and AstaZeneca vaccines — will help accelerate protection of British Columbians, said a joint statement by Henry and Health Minister Adrian Dix.
Island Health reported 26 new cases of COVID-19 on Friday, out of 634 new cases province-wide.
The number of new cases remains higher than “where we want it to be,” said Henry and Dix , who called for British Columbians to continue to follow public health orders and restrictions.
The reproduction rate of the virus — how many people an infected person will pass the virus on to — is now about 1.2 in the Island Health region. Henry has said the province wants to keep the number below one.
There are now 256 active cases in the Island Health region, 139 of which are in the central region, 62 in the north and 55 in the south.
Another four COVID-19 deaths were reported Friday, for a total of 1,380 to date in B.C.
The province has administered 311,208 doses of vaccine, of which 86,865 were second doses.
B.C. records more than 600 new cases of COVID-19 – News 1130
VANCOUVER (NEWS 1130) – There are 634 new cases of COVID-19 recorded in this province, bringing the total to 83,107.
B.C. also recorded four more deaths linked to the virus, for a total of 1,380.
BC #covid19 Mar 5
Variants: 4 new confirmed – total 250, 12 active
Vaccine: 311208 doses, +12357 – 86865 2nd doses
Today’s statement says: “the number of new cases remains higher than we want it to be.”
(today BC has highest new cases here since January 7th)#bcpoli @news1130 2/2
— LizaYuzda (@LizaYuzda) March 6, 2021
The numbers, released Friday, came on the heels of B.C.’s top doctor offering hope that people in this province might return to some sense of normalcy by summer.
“Maybe I’m too optimistic, but we’re going to be in our post-pandemic world by the summer, if things continue to go the way that we want them to,” Dr. Bonnie Henry said Thursday.
On Friday, the province announced four more confirmed cases of variants of concern.
Related article: COVID-19 vaccinations in B.C.: What you need to know
The province says 311,208 doses of COVID-19 vaccine have been administered, 86,865 of which are second doses.
Health-care workers, those living and working in long-term care homes, and people living in remote and isolated Indigenous communities have so far been the only ones eligible for the vaccine.
But as of Monday, Indigenous people age 65 and up, and other British Columbians age 90 and up can book an appointment to get a shot.
New B.C. infections well above national average, with one-third likely COVID-19 'long-haulers' – CTV News Vancouver
As British Columbia records its highest single-day case count in two months, the province is second only to Saskatchewan in new infections per capita over the past two weeks. Experts are warning more must be done soon, especially with thousands of people facing long-term symptoms.
On Friday, B.C. health officials announced 634 confirmed cases of COVID-19. A federal infobase shows B.C. infections at a rate of 141 per 100,000 residents when averaged over the past two weeks. Saskatchewan posted 186 per 100,000 residents, while the national average was just 108. And, while the majority of provinces showed a continued decline or flattening of infections, only the westernmost province showed significant growth.
“Obviously what we’re doing in British Columbia is not having the desired effect. We cannot have 650 cases a day and we cannot tolerate it until the vaccine kicks in and produces community-based immunity, we’re weeks and months away from that,” said Dr. Brian Conway, president of the Vancouver Infectious Disease Centre.
“All of this is suggestive of less-controlled, if not uncontrolled, community-based (rather than institutional) spread and this is the part of the pandemic that is of most concern,” Conway said. “If that occurs, then we need to intervene in a way that is different from what we are doing now to control (it).”
Only a handful of long-term care and assisted-living facilities declared outbreaks in February, and there haven’t been any in March so far.
While vaccine availability is ramping up and the number of deaths continues to decline, one of the experts on the front line is warning those numbers tell only part of the story.
Many thousands of “long COVID” cases in B.C.
As the months wear on, more and more people are reporting COVID-19 symptoms that persist well beyond their infectious period. Medical professionals treating them at three specialty clinics in Metro Vancouver say B.C. statistics mirror what other countries are observing.
“We don’t know what the absolute prevalence of the ‘long COVID’ disease is now, but we know from the data 75 per cent of hospitalized patients are having ongoing symptoms at 3 months,” said Dr. Zachary Schwartz, who leads the Post-COVID-19 Recovery Clinic at Vancouver General Hospital.
“For outpatients, probably upwards of 30 per cent of people can be still symptomatic at 6 months or 9 months after their infection.”
There isn’t a definition yet of what would qualify someone as a “long-hauler.” Symptoms can be mild to severe and range from tightness or pain in the chest to coughing and trouble breathing. Concussion-like symptoms – such as brain fog and fatigue – and mental health problems have also been reported.
“We do have psychiatrists involved in our networks that are seeing individuals relatively rapidly because we’re seeing both a new onset of mental health disorders like PTSD, anxiety, depression and – in people who have previously been diagnosed – we’re definitely seeing decompensation in some of their mental health as well,” he said.
In Surrey, they’ve only seen 18 patients at the Post-COVID-19 Recovery Clinic at Jim Pattison Outpatient and Surgery Centre, which opened Jan. 8.
A total of 130 patients have been accepted at VGH, where applications are now open for referrals.
St. Paul’s Hospital has provided the lion’s share of the treatment, with 328 seen by doctors. Providence Health says the hospital is “building capacity both virtually and actually.”
With limited space, patients need a referral for treatment and the facilities are currently only accepting the most severe long-haulers. For those with mild to moderate symptoms, they’re increasingly providing online resources for them to manage their symptoms.
Warnings from doctors as complacency becomes more common
As the weather warms up and pandemic fatigue has people desperate for company, Conway believes more targeted restrictions may be needed to avoid disaster.
“I’m hoping it’ll be the Whistler approach,” he said, noting that targeted business closures, emphasizing household bubbles and some changes to living situations slashed transmissions by 75 per cent in a month.
“My sense is, what’s going on in Surrey and the surrounding areas in the Fraser Valley is community-based transmission is occurring, so either it’s living situations that need to be changed or people are making decisions in their day-to-day lives that ‘this one time, this one evening, it’s OK to not follow the rules.’”
Conway praised public health officials in other provinces who moderated restrictions based on infections and allowed communities with few cases to carry on, while hotspots in Toronto and Montreal saw crackdowns that brought transmission under control.
“Broad restrictions (in B.C.) are probably not appropriate and people wouldn’t necessarily follow them anyway, they would be resistant, so I think a targeted approach is where we need to pay attention,” he suggested.
With 76,752 people who tested positive for the disease have now classified as “recovered,” Schwartz said it may be more accurate to call them “recovered from acute disease” or “no longer contagious,” since a third of them could still be experiencing symptoms; that’s roughly 25,000 people who could be feeling a faint tightness in the chest, or struggling to get out of bed.
“You don’t want to end up with these symptoms long-term because they’re debilitating … people who cannot get back to school full time, people who cannot get back to work full time,” he said, noting that aside from the personal and family toll that’s taking, it’ll increasingly have an impact on our economy and health-care system.
“When you apply that to a population health level, when you apply that to 500 cases a day just to British Columbia, it starts becoming significant,” Schwartz said.
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