No Step 3 but where is Alberta headed when it comes to COVID-19?

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Alberta is not moving to Step 3 of reopening, but doctors are again sounding the alarm over rising COVID-19 numbers and what impact that will have on the health-care system. Julia Wong explains – Mar 23, 2021

Edmonton doctors are warning Albertans that rising hospitalizations and pressure on the health-care system are likely to be expected, even if the province is not moving into Step 3 of reopening.

On Monday, Health Minister Tyler Shandro said rising case counts, positivity rates, R values, variant cases, along with hospitalization numbers that were not declining were reasons why Alberta was not moving forward in its reopening strategy.

READ MORE: Alberta not lifting any COVID-19 restrictions amid rising hospitalization numbers: Shandro

The R value of the virus is 1.14 provincially, at 1.13 in the Edmonton zone, 1.23 in the Calgary zone and 1.05 in the rest of the province, meaning cases are growing.

Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta, said that R values in the 1.2 to 1.4 range would suggest that, if left unchecked, there could be “an aggressive uptick of cases over a fairly short period of time.”

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“We would be expecting increasing numbers of admission over the next, even week to week-and-a-half. Depending on what happens in community spread, we know there’s a fairly considerable lag time so we might actually start seeing increasing hospital pressure,” she said.

READ MORE: Alberta to begin Phase 2A of COVID-19 vaccine rollout March 15; plan for AstraZeneca vaccine released

Vaccines are rolling out in Alberta but the program is currently limited to those 65 and older; an initial batch of 58,500 AstraZeneca vaccines have been doled out to those 50 to 64 years old.

“There’s a lot of active, older people in the community who might not have gotten vaccine yet who would be at very high risk of needing hospital support and having severe outcomes,” Saxinger said.

“If we had a really large surge of community transmission, particularly if it’s fairly widespread, even age groups with lower likelihood of needing hospitalizations by sheer numbers – we might actually start running into more trouble in hospital again.”

Read more: ‘It can take off’: Variants could drive spike in severe outcomes for young people

Shandro said Monday that half of those hospitalized for COVID-19 and 90 per cent of those in the ICU are under 65 years old.

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“People we consider to be at more moderate risk of COVID-19 infection and hospitalization and death – if enough people get infected, we will be seeing that,” Saxinger said.

“I think it would be false to say we should feel protected enough and that we’ve done enough to protect the most vulnerable to lose caution at this point.”

Saxinger said clearly there is more transmission, but it is not clear where transmission is happening and the question now is whether the current restrictions are enough.

“Between variants of concern and where we are seeing transmission, I think it should be on the table that if we have to dial back some of the things that have had reduced restrictions, it should be on the table because we know it’s not for that long,” she said.

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‘We cannot take the risk of easing any measures’: Hinshaw explains decision to not ease more COVID-19 restrictions yet – Mar 22, 2021

Shandro, however, said Monday that the province would not move back to Step 1 but instead, depending on the data, could target specific activities where there is virus growth.

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Dr. Darren Markland, a critical care physician at the Royal Alexandra Hospital, said action needs to be taken now before history repeats itself.

“Once we do see numbers in hospitalization happen, we will go back to where we were. We can prevent that by doing it now. We can close down restaurants, bars, in-person worship now before it gets really bad,” he said.

“The bitter reality is: anyone who dies from COVID now is a preventable death. We have a viable vaccination strategy.

We have a viable timeline. We have a viable vaccine supply. Now it’s going to be younger and sicker people. When you’re young and you have a good immune system, the battle is far harder, you have a lot more to lose.”

Markland said hospitalization numbers started going up two weeks after restrictions were relaxed.

“Now that our frail population is safe – we use the metric of hospitalization – now the lag will be significantly higher because it takes longer for healthy people to come into hospitals. As long as you haven’t suppressed exponential virus growth rate, you are going to fill those beds with people who are younger and sicker,” he said.

Markland said the trend is that community spikes will lead to hospitalization and then it’s a numbers game.

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“A percentage of those will come to the ICU. A percentage of those will die as a result of the viral infection,” he said.

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COVID-19: what to look for in possible third wave in B.C – Mar 21, 2021

Dr. Neeja Bakshi is an internal medicine physician in the COVID unit at the Royal Alex Hospital.

She said that last December, there was a peak of six teams of physicians looking after COVID-19 patients; by mid-February, they were able to close down the final COVID-designated team.

But there has been a noticeable change the last few weeks.

“At all the different sites, we were starting to notice we were going from zero COVID admissions per day, sometimes one per week, to now one or two per day…Is this a little blip? Is this something that’s going to happen and it’s going to go down again?” Bakshi said.

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“I think what we’ve noticed over the last five days is it has been steadily increasing.

“While we’re not at a crisis at the moment in the hospital, we certainly are wary of the trend because the trend is very similar to what we saw in the fall.”

Bakshi said the hospital opened a designated COVID physician team on Tuesday and is planning to staff up in the coming weeks.

When asked whether the province is at the start of a third wave or could avoid it, Bakshi said her worry is that it might be too late.

Bakshi said the rollout of the vaccination campaign has not been fast enough and said that without changes to restrictions, nothing will change.

“I don’t see how we are going to curb this any further. Staying at where we’re at has put us in this position,” she said.

Click to play video: 'Alberta doesn’t relax COVID-19 restrictions amid rise in hospitalizations' Alberta doesn’t relax COVID-19 restrictions amid rise in hospitalizations
Alberta doesn’t relax COVID-19 restrictions amid rise in hospitalizations – Mar 22, 2021

Third wave of COVID-19

Markland said Alberta is now in a third wave.

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“This was always going to be the third wave because we haven’t done anything different from the first wave or the second wave, so to expect a different outcome, that’s not going to happen,” he said.

Read more: Have COVID-19 variants pushed Canada into a third wave of the pandemic?

Saxinger, however, doesn’t think the third wave is set in stone just yet.

“I think what we do right now will determine whether there’s kind of an unimpressive grumbly-looking hump of cases that come back down or if it actually really could become overwhelming.”

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