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Why we need to rethink COVID-19 risk as the weather warms up – CBC.ca

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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.


It’s been almost a year of “Stay home. Do nothing. Save lives.” And people are tired. 

Pandemic fatigue has turned to pandemic restlessness as the weather shows signs of improving and vaccines gradually roll out across the country.

Hope is on the horizon, but if last spring is any predictor of what lies ahead we can expect to see Canadians flocking outdoors in search of safe ways to gather as temperatures rise. 

And with good reason. 

After a surge of cases after the holidays, Canada has seen a significant decline in COVID-19 levels across the country following lockdowns in hard-hit regions — even with frigid temperatures driving people indoors and more contagious variants spreading.

As more people get vaccinated, cases (hopefully) continue to decline and society slowly reopens, it may be time to shift our messaging away from strict one-size-fits-all public health guidelines.

There’s no doubt people will want to congregate more as the weather improves, and experts say we should transition from an abstinence approach to one of harm reduction. (Evan Mitsui/CBC)

Allow small risks to counter fatigue

Experts say officials need to start to shift their messaging and set out realistic parameters for socializing safely over the next few months or risk losing the room — or worse, pushing people to more dangerous behaviour.

Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare in Hamilton, Ont., says guidelines need to shift in Canada to educate people on how to see their friends and family safely. 

“Now that transmission is down, we need to start making some discussions on the trade offs,” he said.

“Can you really realistically think that people can wait it out at home without any interactions outside of their household for another three months? Or can you at least start prioritizing and building in low risk stuff, so that you give people the sense of normalcy?” 

Chagla says recent negative reactions to outdoor activities like tobogganing and skating rinks mirror concerns at the start of the pandemic, when outdoor gatherings in places like parks were seen as dangerous even with no evidence of transmission occurring. 

In Ontario, reservations for provincial parks have surged in anticipation of warmer months ahead, nearly doubling in the first few weeks of this year. Cottage rentals are also in high demand, with bookings at levels never seen before.

Finding practical ways to alleviate pandemic fatigue and allow for some level of safe interaction in the coming weeks and months will be essential to keeping Canada on a downward trajectory with COVID-19 levels. (Evan Mitsui/CBC)

There’s no doubt people will want to congregate more as the weather improves, and experts say we should transition from an abstinence approach to one of harm reduction. 

“If you gave people that opportunity to do things appropriately outside, how many cases would you then save from indoor activity?” said Chagla.

“If you allow them to take that small risk, you’re preventing the people that are going to fatigue and say, ‘Well, I’m just going to have my family over, we’ve been fine, we’ve been isolating for weeks, I deserve this,’ and then have COVID transmission that way.”

Outside is better than inside

Finding practical ways to alleviate pandemic fatigue and allow for some level of safe interaction in the coming weeks and months will be essential to keeping Canada on a downward trajectory with COVID-19 levels. 

“People are tired of the sacrifices they’ve made, and for their mental health and physical health want to see other people and want to socialize,” said Linsey Marr, an expert on the airborne transmission of viruses at Virginia Tech.

“Doing it outdoors is very low risk if you avoid face-to-face conversation with people, maintain your distance and avoid crowds.” 

Prof. Linsey Marr says going for a walk side-by-side, taking an exercise class or even having a beer with friends are all relatively safe outdoors when more than two-metres of space is maintained. (Ben Nelms/CBC)

Marr says going for a walk side-by-side, taking an exercise class or even having a beer with friends are all relatively safe outdoors when more than two-metres of space is maintained. 

New research from the U.S. Centers for Disease Control and Prevention shows the risk of indoor activities when proper precautions aren’t taken. 

In Hawaii, 21 cases were linked to a fitness instructor during a class where physical distancing measures were in place, but masks weren’t worn and airflow wasn’t prioritized. 

A similar situation occurred in Chicago, where 55 people were infected with COVID-19 after attending indoor exercise classes despite physical distancing and some mask use. 

The missing element in both of those outbreaks was ventilation. 

“We should be opening up park spaces, we should be encouraging outdoor activities where people can gather and gather safely and converse and talk and just be with people,” said Erin Bromage, a biology professor and immunologist at the University of Massachusetts Dartmouth who studies infectious diseases.

“Recognizing that there is a small risk associated with it — but it’s better than the alternative.” 

‘Get creative’ with public health messaging

Timothy Caulfield, a Canada Research Chair in health law and policy at the University of Alberta in Edmonton, said public health officials are walking a “tightrope” in communicating public health guidelines in the coming months. 

“We have to figure out ways that we can allow people to live their lives, while still making sure that we’re reducing the risk,” he said. “And I think we need to engage people as part of the solution.”

A recent research article published in SAGE surveyed several hundred Italian and French citizens under strict lockdown and found there was significantly less adherence to public health guidelines when people’s concern about COVID-19 was waning, along with their trust in officials.

WATCH | Dealing with stress in this leg of the pandemic:

Physical distancing may save lives and protect people’s health in a pandemic, but it has its own health impacts. With isolation and apprehension comes sleeplessness and stress. And the advent of new virus variants and the slow progress of vaccinations are making things even worse. 2:01

The World Health Organization released guidelines for fighting pandemic fatigue, focused on understanding people, allowing them to live their lives while reducing risk, engaging with them to find a solution and acknowledging the impact of the pandemic on their lives.

Caulfield says officials need to evolve their messaging with emerging scientific research and avoid being tuned out by the public by setting realistic guidelines for safely interacting. 

“We need to recognize that we’re really getting to a point where there’s going to be profound complacency,” he said.

“There is profound fatigue, and not just fatigue about the lockdown. I think there’s fatigue about the messaging — people are sick of hearing about this stuff. So I think we need to get creative.” 

Variants make noncompliance higher risk

Bromage said he’s concerned transmission could soon skyrocket due to increased interactions with warm weather amid the spread of variants. 

“We’re heading into March very soon, and March is when the pandemic really took off last year,” he said. “I’m holding my breath, just sort of hoping that it’s not a repeat of 2020 given the changing mobility that comes with the weather.”

COVID-19 levels have risen by about five per cent globally in the past week, after significant declines since the beginning of the year, with recent upticks in parts of Canada and the U.S. concerning officials.

“What comes next is really uncertain. Do we roll back up again? Do we just stay at this level?” said Bromage. “Nobody really knows.”

Chagla says we need to give people more low risk activities to do together in the near future, or risk people hiding their interactions with each other behind closed doors. 

“A Zoom call versus seeing a very close friend with a mask in the park is slightly higher risk,” he said. “But I think using it to allay fatigue is probably a whole lot better than the implications of just keeping people at home.” 

WATCH: The impact of stress, a year into the COVID-19 pandemic:

A physician and psychiatrist talk about the impact that stress is having on mental and physical health a year into the COVID-19 pandemic and what the longer-term effects might be. 6:10

Caulfield says officials need to re-evaluate public health messaging and explain clearly to people what’s safe and what isn’t. 

“I do want to see recommendations on what they can do outside now and how they can enjoy the weather,” he said. “Let’s put a positive spin on this, letting them know that there are steps that can be taken.”

With the emergence of variants, Chagla says the risk of people letting their guard down now is incredibly high. 

“You’ve got to get people on your side for the next few months,” said Chagla. “And realistically offering things to them, rather than taking things away, is going to be the way to do it.”


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Window narrowing for Canada to hit COVID-19 vaccination targets needed to avoid worst of fourth wave – The Globe and Mail

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Chief Public Health Officer Dr. Theresa Tam provides an update on the COVID-19 pandemic during a press conference in Ottawa, November 2020.

Sean Kilpatrick/The Canadian Press

Canada is in a race against the clock to vaccinate enough people to avoid the worst-case scenarios of a fourth wave of the coronavirus pandemic, driven by the highly contagious Delta variant.

Chief Public Health Officer Theresa Tam and her deputy Howard Njoo presented the monthly modelling update at a news conference on Friday, showing an uptick in COVID-19 cases. They outlined the potential for numbers to surge in the next month past those seen in the last wave of the pandemic, even if vaccinations increase. However, they said the increase may not lead to a comparable surge in hospitalizations and deaths.

“I think we are in a slightly precarious period at the moment in between these people trying to get the vaccines in and reopening,” Dr. Tam said.

The five-week countdown to Labour Day is the key focus for the government’s vaccination push, she said. The modelling from the Public Health Agency of Canada says more than 80 per cent of eligible people need to be fully vaccinated to avoid overwhelming hospitals in the case of a fourth wave. According to COVID-19 Tracker Canada, 81 per cent of eligible Canadians have received their first shot and 66 per cent are fully vaccinated. Health Canada has approved vaccines for people 12 and over.

Experts warn of a resurgence in COVID-19 cases as New Brunswick prepares to lift nearly all restrictions

The unofficial end of summer in Canada is also when colder weather and a return to classrooms will start driving more people inside. “This time is crucial for building up protection before we gather in schools, colleges, university and workplaces,” she said.

Some infectious disease specialists have said Canada should aim for at least a 90 per cent vaccination rate for eligible people in order to limit the impact of the fourth wave. Dr. Tam said her agency put the focus on protecting hospitals, but added vaccination shouldn’t stop at 80 per cent coverage.

“If we can get to 90, I’ll be popping open the champagne,” Dr. Tam said.

Getting to that level is no easy task and will require much more targeted outreach, said Noni MacDonald, a professor of pediatric infectious diseases at Dalhousie University and Halifax’s IWK Health Centre. Dr. MacDonald, who researches vaccine safety and hesitancy, said Canada has come close to but never fully hit the targets for other vaccines, but noted the context for COVID-19 is different because of how front-and-centre the disease is in daily life.

About 5 per cent of adults are hardliners who won’t get the vaccine, Dr. MacDonald said, but there is a “movable middle” group of people – including those looking for more information and others who face barriers owing to a disability, lack of trust in the the system, geographic challenges, irregular work schedules and even needle phobias. All those issues can be addressed, she said, pointing to B.C.’s effort to send mobile vaccination clinics to where people already are – namely beaches and summer camps.

“Barriers of access is a big deal … you’ve got to actively think about those barriers, and how as a health care program you can overcome them,” Dr. MacDonald said.

To reach higher vaccination levels, peer groups and neighbours can also play an important role in normalizing vaccinations and helping others access the shot, she added.

The Friday modelling also showed that even with 85 per cent full vaccination coverage, cases could surge to about 7,500 a day by the start of September if individual contacts increase by 25 per cent. If the number of people we come in contact with stays unchanged, the modelling predicts about 1,300 daily new cases by September. The trajectory will depend on how high Canada can push its vaccination coverage and “the timing, pace and extent of reopening,” Dr. Tam said.

Of the provinces, Alberta is taking the most aggressive approach to reopening, already ending the majority of its COVID-19 health measures and no longer requiring masks indoors. It will soon lift the self-isolation mandate and stop widespread testing and contact tracing. On Friday, Ontario said once it has met its remaining vaccination targets, it will end the vast majority of public-health measures, including capacity limits at events. However, it will still require masks indoors.

When asked about Alberta’s decision, Dr. Tam said she firmly believes in isolating cases and that the province’s decision puts more onus on individuals.

In June, the public-health agency’s modelling said Canada needed to hit 83 per cent full vaccination coverage to avoid overwhelming hospitals. On Friday, Dr. Tam didn’t explain why that figure was removed from the latest update. She said it was a “very granular number,” but added she does expect that Canada’s vaccination coverage will pass 83 per cent.

Younger people have had less time to book vaccine appointments than older populations who are more vulnerable to COVID-19 and were prioritized earlier in provincial and territorial vaccination campaigns. The Friday modelling underscored the need for many more 18-to-39-year-olds to get their jabs to protect hospitals in the next wave of the pandemic.

If only 72 per cent of that age group are fully vaccinated, then hospitals could again be overwhelmed. According to the models, that risk is greatly reduced if full vaccination coverage in that age group hits 80 per cent.

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COVID-19 vaccines and travel: What Canadian-approved vaccines are accepted abroad – CTV News

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EDMONTON —
As Canadians begin to embrace a return to normalcy, many are considering the exciting prospect of travelling once again. But those who choose to go abroad may soon realize that picking a destination isn’t as straight forward as it was before the COVID-19 pandemic.

While a negative PCR test before departure is still required by most destinations, many countries also require foreign visitors to provide proof of vaccination against COVID-19 when entering.

Others may require travellers who aren’t fully vaccinated to quarantine before they’re allowed to travel freely within the country.

The problem is some countries do not currently recognize travellers with mixed vaccine doses as being fully vaccinated – which could create serious hiccups for millions of Canadians whose doses don’t match.

Why is this the case?

Well, despite being recommended by Canada’s National Advisory Committee on Immunization (NACI), not all countries recommend the mixing-and-matching of COVID-19 vaccine doses.

Similarly, vaccines that have been approved for use in this country by Health Canada – like the AstraZeneca vaccine – have not been approved in other countries, like the U.S., further complicating matters.

TRAVELLING TO THE U.S.

While the U.S. land border remains closed to Canadians, you can fly to the U.S. pending proof of a negative molecular or antigen COVID-19 test taken no more than three days before your flight.

There are currently no vaccination requirements in place for Canadian visitors to the U.S. But those with mixed doses could eventually find themselves in a pickle thanks to the country’s stance on mixing and matching.

“Only people who have received all recommended doses of an FDA-authorized or WHO-listed COVID-19 vaccine are considered fully vaccinated for the purpose of public health guidance,” a U.S. Centers for Disease Control (CDC) spokesperson told CTVNews.ca in an email.

“COVID-19 vaccines are not interchangeable; the safety and effectiveness of receiving two different COVID-19 vaccines has not been studied.”

Some cruise lines that dock in the U.S. – like Norwegian Cruise Line – have said they will not recognize international passengers who’ve mixed and matched vaccinations.

Princess Cruise Lines guests who have received a vector vaccine, including AstraZeneca, as their first dose, followed by an mRNA vaccine “will not be considered fully vaccinated.” However, the company will allow for passengers who received mixed mRNA vaccine doses, such as Pfizer and Moderna.

Holland America Line and Carnival Cruise Line also currently have similar policies in place.

Keep in mind that proof of vaccination may be required for certain activities within the U.S., including concert venues and sporting events. All 41 Broadway theatres in New York City will require proof of vaccination for all performances through the month of October.

CARIBBEAN DESTINATIONS

Mixed vaccinations won’t be a problem for Canadian travellers heading to popular destinations like Jamaica – which considers anyone with two doses of a World Health Organization (WHO) recognized vaccine to be fully vaccinated – or Cuba and the Dominican Republic, which are not making any distinction between vaccinated or unvaccinated travellers.

But the issue has already caused confusion for those headed to Barbados, which reversed its policy to recognize travellers with mixed doses on July 15.

Trinidad and Tobago’s policy is also limiting for those with mixed vaccines.

“For 2-dose series COVID-19 vaccines, passengers must have received 2 doses of the same vaccine OR the first dose of the AstraZeneca vaccine followed by the second dose of the Pfizer vaccine,” reads the country’s travel requirements.

“Passengers with any other combination of vaccines would NOT be considered fully vaccinated, at this time.”

EUROPEAN DESTINATIONS

Canadians who have been vaccinated with one or more doses of the AstraZeneca vaccine may run into another issue when travelling to Europe.

While the European Union has approved Vaxzevria, the European-manufactured version of AstraZeneca, it has not authorized COVISHIELD, the Indian-made version of the same vaccine that some 80,000 Canadians have received at least one dose of.

Because of this, countries like Italy, Portugal, Poland and Germany do not recognize COVISHIELD, preventing Canadians who received the vaccine from taking advantage of privileges offered to fully vaccinated travellers, such as being exempt from quarantine.

Luckily, a growing number of European countries have recently accepted the COVIDSHIELD vaccine, including Austria, Spain and France.

The United Kingdom also recognizes COVISHIELD. However, fully vaccinated Canadians travelling to the region still must quarantine no matter what type of vaccine they have, unlike American visitors.

No matter where you plan on travelling, be sure to read the fine print of the travel requirements for the country you plan on visiting, as each country differs in terms of vaccination and testing requirements. Most countries list this information on a government website under coronavirus information and entry requirements.

What vaccines are and aren’t recognized is also likely to change regularly as countries approve new vaccines and more data is collected on the efficacy of mixing and matching vaccines.

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Here's what Canada's business leaders think about heading back to the office – CBC.ca

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It’s been more than 500 days since millions of Canadian employees were forced to suddenly work from home because of COVID-19.

While the pandemic is far from over, some workplaces are starting to tackle the tough questions of when and whether to come back into the office again — and what work life will look like for people, no matter where they do it.

CBC News reached out to dozens of business leaders across the country for their thoughts on the return to work.

In responses from across Canada, from tiny non-profits with a handful of employees, to tech startups, energy firms and financial giants with tens of thousands of workers, one sentiment was echoed again and again: Things definitely won’t be exactly how they used to be.

“It won’t be a one-size-fits-all,” said Guy Cormier, CEO of the Montreal-based financial services giant Desjardins.

Desjardins doesn’t plan on flipping a switch and calling everyone who used to be in the office to come back in. Instead, the company plans to allow for all sorts of arrangements. Many people will come back into the office basically full time, if they want to and it makes sense to, while some former office dwellers will stay at home permanently. Others will adopt the so-called hybrid model, where they switch between the two.

“We will adapt with our staff and be sure that there’s … balance between their lives and their work,” Cormier said.

It’s a similar story at the big banks; both TD and CIBC say they plan to incorporate a lot more work from home into their business from now on.

“The majority of our team can work from anywhere, be productive and do incredible work. But there are also things we do best in person and together,” said CIBC’s group head of people Sandy Sharman. “The future of how and where they work will blend the best of both worlds.”

The pandemic that started in March 2020 forced millions of Canadian office workers to work from home, but that will likely not be the case forever. (Evan Mitsui/CBC)

“We anticipate that colleagues will continue to enjoy more work-life flexibility, including remote work and hybrid options where it is possible. However, we believe that most roles will require some presence in the office, in order to foster collaboration, innovation and strengthening of our culture,” said TD’s chief human resource officer Kenn Lalonde.

Cenovus Energy will be going the hybrid route, allowing people to work up to two days a week from home — if they want it and if the job realistically allows.

“We’re planning to use a hybrid workplace flexibility model — with office staff able to work from home up to two days a week, role permitting,” the Calgary-based company’s executive vice-president, Sarah Walters, said in an email. “The new model will be implemented in September to coincide with the majority of our office returns and we will be assessing this approach over time to ensure it’s the best fit for our workplace.”

Hybrid approach

Staffing firm Manpower knows better than most that tailoring the arrangement on a case-to-case basis works best, so that’s what they’ll be doing with their own employees. “We need to be flexible in order to attract and retain some of the top talent in the market,” said Darlene Minatel, Manpower’s country manager for Canada.

Marketing agency Brand Momentum will be similarly flexible, but they will require staff to make an appearance in the office in either Toronto or Montreal at least three days a week, said CEO Hesham Shafie.

Insurance giant Sun Life, meanwhile, is open to anything that gets the job done. “We’re not imposing any minimum or maximum in terms of being in the office,” president Jacques Goulet said. “In fact, we don’t talk about return to office — what we’re talking about is opening our offices for work.”

Businesses of all stripes are struggling with how to operate in the middle of a pandemic — and beyond. (Stefanie Loos/Bloomberg)

St John’s-based software company Celtx says it plans to proceed with whatever system works best for its employees — and above all, whatever they decide to do, it will roll out slowly. “We’re not going to do anything sudden, it’ll be done with a lot of consultation,” CEO Mark Kennedy said, adding that, ultimately, keeping his employees happy is good for business. “If you have a happy employee, usually you have a productive employee.”

Indeed, if there’s one lesson the pandemic disruption has taught Canadian business leaders, it’s that there can be a better way than what they were doing.

Lessons learned

Celtx employed a good chunk of remote workers even before COVID-19 hit, so the company had a bit of a leg up in terms of making it work for everyone. “We actually leaned on our remote workers to tell people who were used to working in an office what were some of the tips they could employ,” Kennedy said. “We just put some of those best practices into use for everyone.”

While Brand Momentum will want its staff to be in the office at least part time, Shafie says they have no intention of forcing people back. Far from it; he says working from home has actually made the company more productive.

Business leaders say smart companies will come up with arrangements that work best for their employees’ life situations, to keep them happy and productive. (Nathan Denette/The Canadian Press)

“Because many of our people were driving half an hour, an hour each way to get to the office, now these two hours they’re able to use [that] productivity for the family, for the life. So they’re happier as a result,” he said. “It’s been a transformation.”

Ultimately, no company should expect things to go back to how they were before — and any ones that do are likely to suffer for it.

Montreal-based marketing firm helloDarwin plans to go the hybrid route of having office space there for those who want it, home work for others, and a mix-and-match for everyone else. The system has worked well through the pandemic, says CEO Mathieu Plante, so they have no plans to change it.

And he has a warning for any corporate executives who long to get back to the days of valuing face time in the office over everything.

“If an employer cannot accommodate his workforce in 2021, for sure, [they] will see departures, people leaving the company.”

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