The R-value has climbed to peak COVID-19 levels in Alberta, even as daily case numbers remain fairly low, prompting the question: What constitutes a fourth wave of the pandemic in a country that has enough vaccines to inoculate everyone?
The R-value of COVID-19, or the “effective reproduction number,” is a way of measuring an infectious disease’s capacity to spread. It represents the number of people who will become infected by one infected person.
Alberta’s value was logged around 1.48 over the weekend according to provincial data, whereas at the peak of the third wave of the pandemic in the province when daily cases were around 1,500, the R-value fluctuated around 1.15.
“If your ‘R’ is greater than one, you’re obviously growing. If the ‘R’ is less than one, you have a shrinking epidemic,” explained infectious disease expert Dr. Isaac Bogoch in a telephone interview with CTVNews.ca Wednesday. “A growing epidemic’s values are greater than one – a shrinking epidemic’s value are less than one.”
Alberta Health reported 194 new COVID-19 cases Wednesday, making the active case count stand at 1,334, the highest it has been in weeks. Eighty-four people are getting treated for COVID-19 in the hospital including 18 that were admitted to the ICU.
On Wednesday, in her first COVID-19 update in nearly a month, chief medical officer of health for Alberta Dr. Deena Hinshaw said “cases have risen recently, almost entirely in those who have not been fully vaccinated, as we expected would likely happen, as people come in close contact with each other again… I am pleased that overall hospitalizations continue to decline. And we will keep watching these closely.”
Hinshaw also reported that since July 1, people who were not fully immunized made up 95 per cent of all cases of COVID-19 in the province, 94 per cent of all those who have needed hospital care for COVID-19, and 95 per cent of all COVID-19 deaths.
Adjunct professor at the School of Public Health at the University of Alberta and former chief medical officer of health for the province Dr. James Talbot says the numbers are cause for concern.
“The numbers are going in the wrong direction,” Talbot said in an interview with CTV National News. “We were down to 30 to 50 cases a day…[it’s] a significant increase, and as predicted the Delta variant is now dominant.”
Talbot said the highly transmissible variant is “causing 90 per cent of the cases” and could cause an “exponential growth” of daily cases especially amongst those who are unvaccinated.
“It’s bad news for the province,” he said, adding that in light of Alberta lifting most public health restrictions on July 1, “the absence of any kind of control measures in place except immunisation, what you’re left with is 25 per cent of people over the age of 12 who can serve as fuel for this fire – and then you have all the kids under 12 who, of course, haven’t been immunised, who will also be transmitting the virus.”
In an emailed statement on Wednesday, the Alberta provincial government stated that “nearly 75.6 per cent of eligible Albertans have now received at least one dose of COVID-19 vaccine, and 64.3 per cent are fully immunized.”
“Vaccines dramatically reduce the risk of severe outcomes and the risk of infection. While COVID-19 cases may rise in the coming months, a surge of hospitalizations and other severe outcomes is much less likely thanks to vaccines,” the statement continues.
Canada now has enough COVID-19 vaccines to fully inoculate every eligible person over the age of 12, with more than 66 million doses received as of Tuesday, but despite the glut of vaccines and Alberta’s vaccination rate, Talbot said the province’s vaccine number announcement leave out a crucial piece of context.
“The key thing here is that 25 per cent are unimmunised; they have no protection,” he said, adding that that number has not budged in six weeks. “In the past, they were protected by the fact that there were people who were wearing masks, social distancing, et cetera, that they have no protection now.”
Alberta has the second-lowest vaccination rate in the country after Saskatchewan.
Talbot said with the Delta variant, unvaccinated Albertans and a rising R-value, the exponential growth of cases or “doubling time” could conservatively be between “a week to two weeks.”
“Take 10 days. So if we’re at 100 [cases]… 10 days from now, 200, 10 days after that, 400, 10 days after that… by the end of the month, 800 cases per day,” he said.
“I mean, we were hoping to really get back to normal for schools and workplaces in September, and this is potentially going to put that in jeopardy,” Talbot said.
A FOURTH WAVE OR ‘AN EXPECTED RISE IN CASES’?
But where Talbot sees a potential fourth wave, Bogoch said it’s important to “change the narrative.”
“You know, I know everyone’s trying to focus on Alberta, but I think the important point here is that it’s not just Alberta, it’s Canada,” he said. “As you open up, which everybody is doing, to some extent, you’re going to see a rise in cases — we know that’s going to happen.”
Bogoch said “it should come as no surprise” that if you give a virus like COVID-19 an “opportunity to be transmitted, it will be transmitted.”
B.C., which reported 185 new cases of COVID-19 Wednesday, has made masks mandatory again in indoor public places as parts of the interior see a spike in cases.
Ontario reported 158 new COVID-19 cases, as the seven-day rolling average of daily COVID-19 cases stands around at 160, up from 155 the previous week.
“It’s not just Alberta,” Bogoch said. “It’s actually a bigger issue. And the question is to what extent will we be able to mitigate that rise in cases? To what extent will we be able to keep the pressure off of our health care system amongst amidst an expected rise in cases?”
“Cases are going to go up. We know that’s going to happen. Alberta is just the first,” he said.
Bogoch also pointed out after well over a year of the COVID-19 pandemic, the country knows “how to keep this under control.”
“We can vaccinate, we can create safer indoor spaces like schools, places of work, restaurants, et cetera, so it’s not like we don’t know how,” he said, adding that “now, a lot of the decisions are really political decisions, not just medical and scientific and public health.”
Alberta announced Wednesday it will lift much of its remaining COVID-19 restrictions in the coming days, despite the rise in cases – for example, on Aug. 16, people who test positive for COVID-19 will not be mandated to quarantine anymore, but the province will recommend it.
“You know, the pandemic isn’t over, we’re doing really well and this is a great opportunity to strike while the iron is hot,” Bogoch said. “We’ve got enough vaccines to vaccinate every eligible Canadian, we’ve got health-care systems that are not overwhelmed at the moment, we’ve got a population that’s quite willing to be vaccinated, and we’ve got very low rates of community transmission at the moment. So this is this is an opportune time to really get everything in order to prepare for an expected rise in cases that we’re going to see later in the summer, probably in the fall.
“We can’t ignore that we’re way better off now than we were weeks and weeks and months ago.”
With files from CTV National News’ Heather Butts
Canadian wastewater surveillance expanding to new public health threats: Tam – CP24
Laura Osman, The Canadian Press
Published Friday, August 12, 2022 2:53PM EDT
Last Updated Friday, August 12, 2022 4:53PM EDT
OTTAWA – Plans are underway to sift through Canadian sewage to test for and measure monkeypox, polio and other potential health threats, the country’s chief public health officer said Friday.
Over the course of the COVID-19 pandemic, wastewater detection became a key way to track the spread of the virus, especially as free lab tests for individuals were phased out for all but a few in later waves.
Dr. Theresa Tam said the experts at the National Microbiology Lab have now discovered a promising approach to detect monkeypox in wastewater and will use the infrastructure developed during the pandemic to look for it.
“Moving forwards, it could form part of our monitoring of the disease activity going up and down across the country,” Tam said at a media briefing.
Tam said the method is complicated, but they’ve landed on something that can “probably” be used more broadly. How that monitoring fits into the Public Health Agency of Canada’s surveillance efforts on monkeypox is not yet clear.
The monkeypox disease comes from the same family of viruses that cause smallpox, which the World Health Organization declared eradicated around the globe in 1980.
Cases of monkeypox began to appear around the world in non-endemic countries in May.
Just this week the number of Canadian cases surpassed 1,000, though there are early signs the virus may now be spreading at a slower rate, Tam said.
The Public Health Agency of Canada also intends to start testing for polio as “soon as possible” after U.S. health officials found the polio virus in New York City’s wastewater.
The devastating virus was eradicated from Canada in 1994 and until very recently has not been found in the United States since 1993. Cases have now freshly emerged in Western nations with traditionally high rates of vaccinated people.
A positive case was discovered in New York last month.
The presence of the polio virus in the city’s wastewater suggests the virus is likely circulated locally, health authorities from the city, New York state and the U.S. federal government said Friday.
“We’re already starting to look at what the options are,” Tam said of monitoring for polio in Canada.
Polio tests are just now coming online in Ontario, said Eric Arts, a microbiology and immunology professor at Western University.
The COVID-19 pandemic proved how useful waste can be compared to person-by-person tests, he said, especially when it comes to early detection.
“Instead of testing hundreds of thousands of people kind of randomly to determine if they’re infected with a specific pathogen, or one that we don’t even know is circulating, you can just get a wastewater sample and test 100,000 people with one test,” he said.
Wastewater surveillance can be adapted for other things as well, she said. Even before the pandemic, Tam said the public health agency was looking at ways to scan for antimicrobial resistant organisms, or superbugs as they’re often called.
Wastewater detection is still imperfect though, Tam warned.
“You’re dealing with a slurry of many things with a lot of DNA, RNA, all sorts of things,” Tam said, putting it politely.
That slurry includes countless viruses and virus mutations. Some vaccines, like the oral vaccine for polio given in some countries that includes a live, attenuated virus, can also be confused with the real thing in a wastewater sample.
“It’s not terribly easy,” she said.
Different countries use different methods, Tam said, and even within Canada there’s a lot of innovation happening.
“I think one of the roles of our lab is to then look at the best methods and try and bring some standardization and guidance to that testing,” she said.
This report by The Canadian Press was first published Aug. 12, 2022.
– With files from Adina Bresge in Toronto and The Associated Press
Foreigners flock to Canada for monkeypox vaccine – Medical Xpress
With the monkeypox vaccine in short supply in the United States, thousands of foreigners, including Americans are flocking to Montreal to get their shots.
Canada’s second-largest city, located about 70 kilometers (43 miles) north of the US border in Quebec province, has decided to make the vaccine available to all those who consider themselves to be at risk.
ackRobb Stilson, an art director from Denver, Colorado, took advantage of the opportunity during a visit to Montreal last week.
“It’s very difficult in the States to get vaccinated,” Stilson said as he lined up to get a shot at a pop-up vaccination center together with his husband and two daughters. “I’ve friends who have waited 8 or 9 hours to get in.”
Because contact tracing is difficult, authorities in Montreal decided to offer the vaccine to all those who are at risk to stem the spread of the virus.
“As tourists, they may participate in activities that may expose them and so in a way, we’re combatting the pandemic by letting them become vaccinated here so that they don’t transmit the infection either here or when they go back home,” Donald Vinh, infectious disease specialist at the McGill University Health Center, told AFP.
Since the vaccination campaign was launched in mid-May, as soon as the first cases of monkeypox were detected, Montreal has inoculated 18,500 people, 13 percent of them foreigners.
The goal is to administer 25,000 doses and vaccinate some 75-80 percent of the population deemed to be at risk, in particular men who have sex with men or with multiple partners.
“I hope the strategy used by the public health agency of Montreal is a beacon for other public health agencies to use as a vaccination strategy,” Vinh added.
In the western province of British Columbia, health authorities decided last week they will no longer offer the vaccine to foreigners citing limited supplies and the fact that it was becoming more available in the United States.
Faced with a lack of available doses, American health authorities on Tuesday authorized a new injection procedure which will make it possible to inoculate five times the number of people with the same amount of the drug.
As of August 11, Canada has registered 1,059 confirmed cases of monkeypox, but authorities see signs of infections beginning to slow.
© 2022 AFP
Foreigners flock to Canada for monkeypox vaccine (2022, August 12)
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Elevated risk of Monkeypox in Saskatchewan: SHA – CTV News Regina
The Saskatchewan Health Authority (SHA) has alerted the public to the elevated risk of acquiring Monkeypox through anonymous sexual contact.
“So far we’ve had three cases, who were exposed out of the province,” said Saskatchewan’s Chief Medical Health Officer, Dr. Saqib Shahab.
“We think the situation has changed now, in the last week. Where we have had evidence of exposures happening in Saskatchewan, in many cases happening through anonymous sexual contacts with people who have been coming into the province.”
Shahab noted that the exposures were happening almost exclusively to those in the gay, bisexual and men who have sex with men (gbMSM) community.
“We think now that there is a higher risk that we may see ongoing transmission within Saskatchewan … particularly in this community.”
Shahab noted that these trends were similar to what is being seen across Canada. He urged those in Saskatchewan at risk not to hesitate and reach out.
“If you belong to the gbMSM community it’s really important that at the first sign of illness you do contact the Healthline (811) for advice and seek testing and isolate till the diagnosis is made.”
INCREASED ELIGIBILITY FOR VACCINES
The SHA announced that Monkeypox vaccine requirements would be expanded to both post and pre exposure, following the alert.
The Public Health Agency of Canada has set aside 99,000 doses of the vaccine, with 50,000 doses being given to provinces so far, according to Shahab.
Those eligible for vaccinations include select high-risk contacts 18 years and older who are identified ideally within 4 days and up to 14 days after an exposure. Those who are at a high risk of exposure are also eligible. The SHA’s criteria includes:
- Are transgender or self-identify as two spirit, bisexual, gay or men who have sex with men (MSM)
And one or more of the following:
- Have had a recent sexually transmitted infection (in the past six months);
- Report having had two or more sexual partners in the past six months;
- Had (in the past six months) or plan to have sexual contact involving an exchange of money or other goods for sexual services;
- Report having had (in the past six months) or planning to have sexual contact at an event or social gathering where there is MSM-themed sexual activity (sauna, bath house, club);
- Have had (in the past six months) or plan to have sexual contact with an anonymous partner (at an event or via a hook-up app);
- Planning to travel in the next three months to an area in Canada or internationally currently reporting monkeypox cases;
- Individuals 18 years and older who work or volunteer at an event or social gathering where there is MSM themed sexual activity (sauna, bath house, club).
The SHA has outlined how to properly isolate and protect others while contagious with Monkeypox on its website.
Monkeypox is a rare viral illness that causes fever, headache, swollen lymph nodes and lethargy, followed by the development of a rash over a person’s body. The disease is not easily spread from person to person according to the SHA. Monkeypox is spread through:
- Close, personal, often skin-to-skin contact.
- Touching bodily fluids or lesions of a person who is sick with the disease.
- Exposure to contaminated objects such as bed linens or clothing.
There are currently around 30,000 Monkeypox cases globally, with approximately 1,000 of those occurring in Canada.
Saskatchewan’s current criteria for vaccination and its overall approach has been informed by other provincial responses such as in Ontario and Quebec, according to Shahab.
“We really hope that by this approach in Saskatchewan we can try to avert a quick or high surge of cases and also prevent further transmission.”
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