As Canada-wide coronavirus case counts gradually fall, talk of reopening plans has risen again.
Quebec is set to loosen restrictions next week, Alberta will ease some restrictions on gyms, restaurants and bars in the coming days, and Ontario is on pace to reopen more schools.
But the hope of regaining some businesses and activities is being overshadowed by the latest pandemic threat — variants.
One strain of concern making its presence known in Canada is the B.1.1.7 variant, first found in the U.K. It’s not the first new variant of COVID-19 to emerge but is said to be up to 70 per cent more transmissible than the “normal” strain.
Experts say it warrants more consideration and care as we move forward.
“We’ll be using the same metrics to decide how to open things up locally,” said Alon Vaisman, an infection disease physician at the University Health Network in Toronto.
“But you’ll be using a little bit more caution this time around.”
Benchmarks don’t change
Just like in the first wave of the pandemic, numbers will be the first sign of an opportunity to peel back certain rules.
While daily case counts are the easiest for people to understand, experts say they aren’t the best indicator.
Hospitalizations, ICU admissions, and deaths will be key numbers and should help guide whether or not it’s safe to ease restrictions, said Vaisman.
“Whatever direction they go in, we need to use that information to guide us,” he said.
Experts say the variant being more transmissible means cases will grow quicker and outbreaks will be larger. As regions consider opening up more places people can gather — particularly indoors — the “room for error is smaller,” said Vaisman.
“We have to be more confident that these things are declining than perhaps we were before.”
It’s why provinces need to be prepared to take steps back as quickly as they step forward, added Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.
“We either delay it, do it slowly, or focus on policy that you can pivot if you’re headed in the wrong direction,” he said.
Alberta has taken on the latter. The province’s chief medical officer of health said its road map to reopening will focus on monitoring key indicators, such as new case numbers, test positivity rates and how many new infections result from each case.
Hospitalization rates are also a focus, despite it being a less-than-current snapshot of how the virus is spreading.
“If we meet those hospitalization numbers, but all of our leading indicators are escalating in a concerning way, then we would pause our move forward — and we may indeed need to move backward.”
It’s the right idea, experts say, but for some provinces, the concept is still potentially premature.
Ontario, for example, is still experiencing a high burden of cases and has multiple outbreaks linked to the B.1.1.7 variant.
The province anticipates the variant from the U.K. will become the dominant strain by March. That is only four short weeks away, as Vaisman points out.
“If we anticipate that kind of spread as of now, we need to know what that means for transmission in March before we consider opening things up,” he said.
“But that’s not to say the measures we take to control it will be different. We can look to the U.K. and see that’s not the case.”
Lessons from Britain
The variant was first seen in southern England in September. In London and nearby Kent county, it quickly became linked to a spike in hospitalization rates.
By the week of Dec. 9, 62 per cent of COVID-19 cases in London were due to the new variant. That compared to 28 per cent of cases three weeks earlier.
To tackle it, Britains simply reinforced the tried-and-true public health interventions. By Jan. 22, the country’s reproductive number or “R rate” — the average number of new cases generated by a single infected person — had dropped sharply to below one, meaning the burden of infection risk had declined. Some estimates suggest the R rate of the variant needs to be kept below or at 0.8 to ensure cases still decline in the community.
That same day, health officials estimated the pandemic was shrinking by as much as four per cent a day.
England still remains on a stringent nationwide lockdown, but a plan to ease the measures is expected around Feb. 22. There are hopes schools there will reopen at the beginning of March.
The takeaway? Even with a more transmissible virus, it’s possible to keep infections down, Bogoch said.
“It’s a lot harder to do, but it’s not an insurmountable task,” said Bogoch.
“It can be done. It’s just going to take more work.”
More cautious, more thoughtful
The extra effort needs to happen both on an individual level and policy level, Bogoch continued.
Vaccination rates will blend into the other metrics provinces are measuring to determine how to ease restrictions, he said, but they won’t be applicable on a large scale for many months.
So without a large proportion of Canadians vaccinated, Bogoch said provinces need to take steps to create safer indoor spaces while more contagious variants circulate.
“If you don’t and you reopen, you’re just going to get more cases more quickly, and you’re just going to have to shut it down again,” he said.
Part of that includes improving ventilation in schools and indoor settings and creating safer workplaces, he said.
These variants might also require provinces to reassess some reopening priorities, the experts agree.
Many provinces have set up a ranked system of stages or phases to indicate which businesses and activities can reopen, when, and to what degree.
“If we know from data from the first wave that there’s a lot of cases coming from one particular sector, that needs to help guide how you’re going to open things up this time,” said Vaisman.
One of those prioritize will be schools, he added.
“That is kind of like testing the water,” he said. “As you start to open up things at the top of your priority list, you will see what effect that has on the case counts.”
He summed it up:
“We’re doing essentially what we did in the first wave, just that much more carefully.”
–With files from Reuters and the Canadian Press