TORONTO —
Canadians need to use all public health tools available, including masking, physical distance and testing, to avoid lockdowns and protect the unvaccinated as a fourth wave of COVID-19 grips the country, infectious disease experts say.
With more than 10 million Canadians unvaccinated against COVID-19, the chances of more widespread lockdowns are possible as some provinces’ hospital systems remain strained from earlier waves of the pandemic.
“We can’t ignore that there are literally millions of people in Ontario, and in Canada, that are unvaccinated,” Dr. Isaac Bogoch, an infectious disease specialist and member of Ontario’s vaccine task force, told CTVNews.ca in a phone interview on Tuesday.
Even if all eligible Canadians got their shots, there would still be nearly five million Canadians who are not eligible to be vaccinated who would be at heightened risk, especially as the more transmissible Delta variant takes hold.
“We’ll do OK if we can limit the pace of community transmission, but that’s tough to do,” he said. “If we have a lot of people get infected in a short period of time – that could happen with the Delta variant – we will put pressure on our health-care system, we will stretch our health-care system, there are literally millions of people that can be infected.”
With millions of people still at risk of infection, and many of them children, Bogoch said that Canadians should use all tools available to protect the unvaccinated, in order to avoid more full-scale lockdowns.
Preventing our hospitals from getting overwhelmed will be a key factor in preventing lockdowns across the country.
“Unfortunately, when we compare Canada to other comparable countries, our ICU capacity per capita is not very robust,” said Bogoch.
This is what resulted in lockdowns during the third wave, he added, referencing the “dire” situation earlier this year in which ICUs in some provinces hit capacity, patients were sent to other cities, adult patients were in pediatric ICU beds, and surgeries were cancelled.
“We can’t let this wave get out of control because the more cases there are, the more hospitalizations, the more ICU [admissions] and tragically, the more deaths we will see this fall,” Craig Jenne, Canada Research Chair in infectious diseases at the University of Calgary told CTVNews.ca in a phone interview on Tuesday.
With infections already on the rise, Jenne says this wave could have more cases than previous waves if public health measures aren’t enforced.
“If you look back to last year’s cases, they really didn’t start rising sharply until we got into September with people back indoors at school,” he said. “This year, the cases really have started to go up in a number of places – Alberta, Ontario and British Columbia in early August, basically the wave has a month head start.”
Similar to Ontario, Alberta approximately 1.5 million unvaccinated people in the province, so while vaccinated people have a lower risk of severe illness, hospitalization and death, there are still many Canadians who don’t have that protection, which could send the fourth wave off the rails.
“We have millions of Albertans who are not vaccinated, and if we think of the total number of people that have been infected as well under a million, we still have more people who are unvaccinated that could be infected than have been infected at any point during this pandemic,” said Jenne. “So, if we let this virus run unchecked and the majority of those unvaccinated do get infected, we will see unmanageable numbers in the hospital.”
ICU occupancy in Alberta has more than doubled since the start of August, he added. Earlier this month, there were fewer than 20 COVID-19 patients in Alberta hospitals; as of Aug. 24, there are 57.
The speed at which COVID-19 spreads adds more fuel to the fire, experts say. By the time case numbers reflect exponential growth, it’s difficult to claw things back.
“A lot of people see the numbers and think it’s not a big deal, but it is like a freight train, it picks up momentum, and changes we make now can take several weeks to have an effect, so you have to be prepared for those curves to respond slowly to changes,” said Jenne.
With over 60 per cent of Canadians fully vaccinated, many people have full protection, but there is still a small risk of breakthrough cases. As of Aug. 7, more than 80 per cent of infections, hospitalizations and deaths have been among non-vaccinated populations since vaccinations started in December 2020. Fully vaccinated people represent less than one per cent of new infections, 1 per cent of hospitalizations and 1.4 per cent of deaths in Canada.
“The risk of a breakthrough case is quite low, and most breakthrough cases that do occur, still result in very minor disease,” said Jenne. “The severity of illness is reduced dramatically among the vaccinated.“
While a high rate of vaccinations will make this wave different from previous ones, so will relaxed public health measures and more travel.
“We’d love to think of ourselves, our provinces, as little islands but we’re not. What happens in one part of Canada and one part of the world affects all of us, particularly as we’re starting to travel more and more frequently, across different domains,” Dr. Lisa Barrett, a Halifax-based infectious disease specialist, told CTVNews.ca in a phone interview on Wednesday.
UNVACCINATED CANADIANS UNDER 12
Since the outset of the pandemic, one message has prevailed: children don’t get very sick from COVID-19. Mounting cases among children in the U.S. show otherwise, so letting COVID-19 spread like wildfire among those too young to vaccinate isn’t a safe option, for both children and adults.
Controlling community spread of COVID-19 will be key to keeping children safe this fall as a fourth wave surges on.
“At the end of the day, vaccines still work, but we do have to keep in mind there are a significant number of Canadins who are not eligible for vaccines, again those under 12,” he said. “There is no way right now to protect them from the virus, other than physical distancing, wearing a mask, and ensuring the people around them are vaccinated.“
For Barrett, the unknowns of the Delta variant are cause for concern, and it’s too early to have a business-as-usual approach, until experts learn more about the long-term impacts of COVID-19 in children.
“Maybe in six months, we’ll say: ‘that was a drop in the pan, these new variants, they don’t have the same long-term side effects in one in 10 people,’” she said. “But until we know that I’m really, really, really strongly and firmly opposed to going back to a business-as-usual respiratory season.”
Just because kids likely won’t get as sick as adults doesn’t mean they can be left out to dry, unprotected while vaccinated adults try to resume normal life, she added.
“Kids get multi-system inflammatory syndrome that can almost kill them, and everyone says ‘well you know every disease kills a few people,’” said Barrett. “But, measles didn’t give everyone encephalitis and severe brain damage, but enough of them that we [now] vaccinate everyone.”
And protecting kids from COVID-19 will add an additional layer of protection for vulnerable adults, to whom children can spread the virus.
The doctors agree that a safe return to school will be one of the biggest factors in keeping unvaccinated children safe during the fourth wave of COVID-19.
“It’s so important to actually implement smart school strategies that focus on better-ventilated rooms, masking in the school, limiting class sizes, as well as cohorting,” Bogoch said. “There’s all these steps, different provinces have different plans, and some I think are stronger than others, but one of the key issues is at the level of the school: how is it that they plan implementation is key.”
For parents who are worried about the school year, Bogoch suggests reaching out to the school being attended as not all schools are created equal. Some schools may be in communities already at higher risk for COVID-19, these same schools may not have all the resources available to them.
HOW TO CONTROL THE FOURTH WAVE
With so many Canadians vaccinated, getting control of the fourth wave can likely happen without the use of widespread lockdowns, instead regions can opt for more simplified public health measures that can be put in place relatively easily.
“Some of these public health measures we’ve been using for the last 18 months are really not that invasive, really simple to comply with and quite effective in slowing viral spread,” said Jenne. “Wearing masks, reducing overall capacity for some indoor events, I think, are really simple things that can happen, that will dramatically impact numbers.”
Even without those mandates in place, individuals can take it upon themselves to wear a mask and distance from others.
“If we take those approaches to a population level, not that we’ll get to zero COVID, but we will be able to at least limit transmission in the community, and prevent our health-care system from getting stretched,” Bogoch added.
Provinces have already begun to respond to the increase in COVID-19 cases. Ontario has paused in stage three of its reopening, Nova Scotia has tightened border restrictions with New Brunswick, and Quebec has extended the reach of its vaccine passports.
“We have seen masks come back in parts of British Columbia, we have seen British Columbia opt for a vaccine passport-type system,” said Jenne. “We have seen even Alberta delay dropping asymptomatic testing and self-isolation. I think those are very clear markers that provincial health authorities are appreciating there is still risk, and that risk needs to be managed.”
While some provinces have implemented various forms of vaccine passports and certificates, Barrett said they can help, but could further marginalize unvaccinated populations.
“We know that people who are not vaccinated, especially in Canada where access has been better, those folks may have other systemic and very challenging reasons for not getting vaccinated yet, and we don’t want to further marginalize people in any way by restricting them from being able to do things that other people do,” she said.
Controlling the fourth wave will rely heavily on testing both vaccinated and unvaccinated populations, so that public health units have much-needed data to determine where spread is happening and what activities are leading to major spreading events. While vaccinated individuals may have good protection, they should still get tested if they show signs of COVID-19 symptoms or have high-risk contacts, said Barrett. As has been the case for the last 18 months, the experts agree that anyone who has symptoms of COVID-19 should get tested and isolate.
By using all of these measures: masking, physical distancing, improved ventilation, vaccinations, hand-washing, testing and isolating, Canadians will have a good safety net if one of the safety measures isn’t quite enough. Jenne likens it to getting in a car – seat belts, speed limits and airbags are there to keep us safe on the roads, but drivers and passengers don’t just pick one, they use them all. There are even laws in place to ensure they do so.
COVID-19 is now a preventable disease, said Barrett, and it needs to be treated as such.
“I’m mindful of the fact that this is now a preventable disease, and I don’t think we say that enough – but that’s not just vaccines, that’s all the tools in that toolbox.”
PHOENIX (AP) — Arizona voters have approved a constitutional amendment guaranteeing abortion access up to fetal viability, typically after 21 weeks — a major win for advocates of the measure in the presidential battleground state who have been seeking to expand access beyond the current 15-week limit.
Arizona was one of nine states with abortion on the ballot. Democrats have centered abortion rights in their campaigns since the U.S. Supreme Court overturned Roe v. Wade in 2022. Abortion-rights supporters prevailed in all seven abortion ballot questions in 2022 and 2023, including in conservative-leaning states.
Arizona for Abortion Access, the coalition leading the state campaign, gathered well over the 383,923 signatures required to put it on the ballot, and the secretary of state’s office verified that enough were valid. The coalition far outpaced the opposition campaign, It Goes Too Far, in fundraising. The opposing campaign argued the measure was too far-reaching and cited its own polling in saying a majority of Arizonans support the 15-week limit. The measure allows post-viability abortions if they are necessary to protect the life or physical or mental health of the mother.
Access to abortion has been a cloudy issue in Arizona. In April, the state Supreme Court cleared the way for the enforcement of a long-dormant 1864 law banning nearly all abortions. The state Legislature swiftly repealed it.
Voters in Arizona are divided on abortion. Maddy Pennell, a junior at Arizona State University, said the possibility of a near-total abortion ban made her “depressed” and strengthened her desire to vote for the abortion ballot measure.
“I feel very strongly about having access to abortion,” she said.
Kyle Lee, an independent Arizona voter, does not support the abortion ballot measure.
“All abortion is pretty much, in my opinion, murder from beginning to end,” Lee said.
The Civil War-era ban also shaped the contours of tight legislative races. State Sen. Shawnna Bolick and state Rep. Matt Gress are among the handful of vulnerable Republican incumbents in competitive districts who crossed party lines to give the repeal vote the final push — a vote that will be tested as both parties vie for control of the narrowly GOP-held state Legislature.
Both of the Phoenix-area lawmakers were rebuked by some of their Republican colleagues for siding with Democrats. Gress made a motion on the House floor to initiate the repeal of the 1864 law. Bolick, explaining her repeal vote to her Senate colleagues, gave a 20-minute floor speech describing her three difficult pregnancies.
While Gress was first elected to his seat in 2022, Bolick is facing voters for the first time. She was appointed by the Maricopa County Board of Supervisors to fill a seat vacancy in 2023. She has not emphasized her role in the repeal vote as she has campaigned, instead playing up traditional conservative issues — one of her signs reads “Bolick Backs the Blue.”
Voters rejected a measure to eliminate retention elections for state Superior Court judges and Supreme Court justices.
The measure was put on the ballot by Republican legislators hoping to protect two conservative justices up for a routine retention vote who favored allowing the Civil War-era ban to be enforced — Shawnna Bolick’s husband, Supreme Court Justice Clint Bolick, and Justice Kathryn Hackett King. Since the measure did not pass, both are still vulnerable to voter ouster, though those races hadn’t been decided by early Wednesday morning.
Under the existing system, voters decide every four to six years whether judges and justices should remain on the bench. The proposed measure would have allowed the judges and justices to stay on the bench without a popular vote unless one is triggered by felony convictions, crimes involving fraud and dishonesty, personal bankruptcy or mortgage foreclosure.
OMAHA, Neb. (AP) — Nebraska voters supported a measure Tuesday that enshrines the state’s current ban on abortions after the 12th week of pregnancy in the state constitution, and they rejected a competing measure that sought to expand abortion rights. Nebraska was the first state to have competing abortion amendments on the same ballot since the U.S. Supreme Court overturned Roe v. Wade in 2022, ending the nationwide right to abortion and allowing states to decide for themselves. The dueling measures were among a record number of petition-initiated measures on Nebraska’s ballot Tuesday.
What were the competing abortion measures?
A majority of voters supported a measure enshrining the state’s current ban on abortion after the first 12 weeks of pregnancy in the state constitution. The measure will also allow for further restrictions. Last year, the Legislature passed the 12-week ban, which includes exceptions for cases of rape and incest and to protect the life of the pregnant woman.
Voters rejected the other abortion measure. If they had passed it by a larger number of “for” votes than the 12-week measure, it would have amended the constitution to guarantee the right to have an abortion until viability — the standard under Roe that is the point at which a fetus might survive outside the womb. Some babies can survive with medical help after 21 weeks of gestation.
Abortion was on the ballot in several other states, as well. Coming into the election, voters in all seven states that had decided on abortion-related ballot measures since the reversal of Roe had favored abortion rights, including in some conservative states.
Who is behind the Nebraska abortion measures?
The 12-week ban measure was bankrolled by some of Nebraska’s wealthiest people, including Republican Sen. Pete Ricketts, who previously served as governor and donated more than $1.1 million. His mother, Marlene Ricketts, gave $4 million to the cause. Members of the Peed family, which owns publishing company Sandhills Global, also gave $1 million.
The effort was organized under the name Protect Women and Children and was heavily backed by religious organizations, including the Nebraska Catholic Conference, a lobbying group that has organized rallies, phone banks and community townhalls to drum up support for the measure.
The effort to enshrine viability as the standard was called Protect Our Rights Nebraska and had the backing of several medical, advocacy and social justice groups. Planned Parenthood donated nearly $1 million to the cause, with the American Civil Liberties Union, I Be Black Girl, Nebraska Appleseed and the Women’s Fund of Omaha also contributing significantly to the roughly $3.7 million raised by Protect Our Rights.
What other initiatives were on Nebraska’s ballot?
Nebraska voters approved two measures Tuesday that will create a system for the use and manufacture of medical marijuana, if the measures survive an ongoing legal challenge.
The measures legalize the possession and use of medical marijuana, and allow for the manufacture, distribution and delivery of the drug. One would let patients and caregivers possess up to 5 ounces (142 grams) of marijuana if recommended by a doctor. The other would create the Nebraska Medical Cannabis Commission, which would oversee the private groups that would manufacture and dispense the drug.
Those initiatives were challenged over allegations that the petition campaign that put them on the ballot broke election rules. Nebraska’s attorney general said supporters of the measures may have submitted several thousand invalid signatures, and one man has been charged in connection with 164 allegedly fraudulent signatures. That means a judge could still invalidate the measures.
Voters also opted Tuesday to repeal a new conservative-backed law that allocates millions of dollars in taxpayer money to fund private school tuition.
Finally, they approved a measure that will require all Nebraska employers to provide at least 40 hours of paid sick leave to their employees.
WASHINGTON (AP) — Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans in one of seven victories for abortion rights advocates, while Florida, Nebraska and South Dakota defeated similar constitutional amendments, leaving bans in place.
Abortion rights amendments also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but they’ll need to pass it again it 2026 for it to take effect. Another that bans discrimination on the basis of “pregnancy outcomes” prevailed in New York.
The results include firsts for the abortion landscape, which underwent a seismic shift in 2022 when the U.S. Supreme Court overturned Roe v. Wade, a ruling that ended a nationwide right to abortion and cleared the way for bans to take effect in most Republican-controlled states.
They also came in the same election that Republican Donald Trump won the presidency. Among his inconsistent positions on abortion has been an insistence that it’s an issue best left to the states. Still, the president can have a major impact on abortion policy through executive action.
In the meantime, Missouri is positioned to be the first state where a vote will undo a ban on abortion at all stages of pregnancy, with an amendment that would allow lawmakers to restrict abortions only past the point of a fetus’ viability — usually considered after 21 weeks, although there’s no exact defined time frame.
But the ban, and other restrictive laws, are not automatically repealed. Advocates now have to ask courts to overturn laws to square with the new amendment.
“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control, and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, said in a statement.
Roughly half of Missouri’s voters said abortion should be legal in all or most cases, according to AP VoteCast, a survey of more than 2,200 of the state’s voters. But only about 1 in 10 said abortion should be illegal in all cases; nearly 4 in 10 said abortion should be illegal in most cases.
Bans remain in place in three states after votes
Florida, Nebraska and South Dakota became the first states since Roe was overturned where abortion opponents prevailed on a ballot measure. Most voters supported the Florida measure, but it fell short of the required 60% to pass constitutional amendments in the state. Most states require a simple majority.
The result was a political win for Gov. Ron DeSantis, a Republican with a national profile, who had steered state GOP funds to the cause. His administration has weighed in, too, with a campaign against the measure, investigators questioning people who signed petitions to add it to the ballot and threats to TV stations that aired one commercial supporting it.
Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country,” praising DeSantis for leading the charge against the measure.
The defeat makes permanent a shift in the Southern abortion landscape that began when the state’s six-week ban took effect in May. That removed Florida as a destination for abortion for many women from nearby states with deeper bans and also led to far more women from the state traveling to obtain abortion. The nearest states with looser restrictions are North Carolina and Virginia — hundreds of miles away.
“The reality is because of Florida’s constitution a minority of Florida voters have decided Amendment 4 will not be adopted,” said Lauren Brenzel, campaign director for the Yes on 4 Campaign said while wiping away tears. “The reality is a majority of Floridians just voted to end Florida’s abortion ban.”
In South Dakota, another state with a ban on abortion throughout pregnancy with some exceptions, the defeat of an abortion measure was more decisive. It would have allowed some regulations related to the health of the woman after 12 weeks. Because of that wrinkle, most national abortion-rights groups did not support it.
Voters in Nebraska adopted a measure that allows more abortion restrictions and enshrines the state’s current 12-week ban and rejected a competing measure that would have ensured abortion rights.
Other states guaranteed abortion rights
Arizona’s amendment will mean replacing the current law that bans abortion after the first 15 weeks of pregnancy. The new measure ensures abortion access until viability. A ballot measure there gained momentum after a state Supreme Court ruling in April found that the state could enforce a strict abortion ban adopted in 1864. Some GOP lawmakers joined with Democrats to repeal the law before it could be enforced.
In Maryland, the abortion rights amendment is a legal change that won’t make an immediate difference to abortion access in a state that already allows it.
It’s a similar situation in Montana, where abortion is already legal until viability.
The Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion, opening the possibility of state Medicaid and government employee insurance plans covering care.
A New York equal rights law that abortion rights group say will bolster abortion rights also passed. It doesn’t contain the word “abortion” but rather bans discrimination on the basis of “pregnancy outcomes, and reproductive healthcare and autonomy.” Sasha Ahuja, campaign director of New Yorkers for Equal Rights, called the result “a monumental victory for all New Yorkers” and a vote against opponents who she says used misleading parental rights and anti-trans messages to thwart the measure.
The results end a win streak for abortion-rights advocates
Until Tuesday, abortion rights advocates had prevailed on all seven measures that have appeared on statewide ballots since the fall of Roe.
The abortion rights campaigns have a big fundraising advantage this year. Their opponents’ efforts are focused on portraying the amendments as too extreme rather than abortion as immoral.
Currently, 13 states are enforcing bans at all stages of pregnancy, with some exceptions. Four more bar abortion in most cases after about six weeks of pregnancy — before women often realize they’re pregnant. Despite the bans, the number of monthly abortions in the U.S. has risen slightly, because of the growing use of abortion pills and organized efforts to help women travel for abortion. Still, advocates say the bans have reduced access, especially for lower-income and minority residents of the states with bans.
The issue is resonating with voters. About one-fourth said abortion policy was the single most important factor for their vote, according to AP VoteCast, a sweeping survey of more than 110,000 voters nationwide. Close to half said it was an important factor, but not the most important. Just over 1 in 10 said it was a minor factor.
The outcomes of ballot initiatives that sought to overturn strict abortion bans in Florida and Missouri were very important to a majority of voters in the states. More than half of Florida voters identified the result of the amendment as very important, while roughly 6 in 10 of Missouri’s voters said the same, the survey found.
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Associated Press reporters Hannah Fingerhut and Amanda Seitz contributed to this article.
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This article has been corrected to reflect in the ‘other states’ section that Montana, not Missouri, currently allows abortion until viability.
