We’ve been here before, but the main difference between this year’s reopening gameplans and last, is knowledge, according to Ashleigh Tuite, an epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health.
Vaccines are Canada’s newest and biggest tool, but Tuite and other experts say the metrics used to signal the severity of the pandemic are worse now than they were this time last year.
“We understand a lot more about the circumstances in which the virus transmits well and where it doesn’t. That’s built into some of the reopening guidance we’re seeing, which is more nuanced than it was last spring and last summer,” she said.
“There is huge value in having that roadmap and having something to work towards, but we also need to recognize it may change.”
Reopening plans from provinces like Alberta, Ontario and British Columbia are entirely contingent on low case counts, fewer hospitalizations and high one-dose vaccination rates.
There are target dates for certain lockdown measures to be rolled back — like indoor dining and gyms — but they’re not “hard dates,” said Omar Khan, a biomedical engineering professor at the University of Toronto. He said this indicates that provinces are still weighing other extenuating factors, like virus variants.
Variants like the highly infectious B.1.617.2 variant, first identified in India, may have the ability to escape vaccine immunity. Studies are increasingly showing that two doses of vaccines by AstraZeneca and Pfizer are more effective at protecting against the variant than one.
“People want to be free now, but the main message is still that this is a one-dose vaccine plan, not two,” Khan said. “We still have these variants of concern (VOC), so until this is stabilized globally, we need to respond to the global threat and not just what we’re seeing hyperlocal.”
That’s not to say the reopening plans from provinces so far are wrong, both experts agree, but they require caution.
Ontario’s new three-phase COVID-19 reopening plan is estimated to begin around June 14, or around two weeks after 60 per cent of all eligible residents have received their first jab. The first phase will see the long-awaited return of outdoor dining and retail, with limits. About three weeks later, once 70 per cent of Ontarians have one dose, the second phase will open up personal care services and small indoor gatherings, among other things.
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That two to three-week buffer built into Ontario’s plan is a key aspect that Tuite believes will be effective.
“It gives you time to open things up and reevaluate,” she said.
But that three-week gap may not account for the time it takes to reach “mature immunity” for single-dose recipients, said Khan. That’s the part that worries him.
While data shows that the protective immunity begins to develop around two weeks after getting the shot, it still takes time to fully optimize, he said, adding that protection is considerably better after four weeks.
“The challenge now becomes, when you look at your population, you have to figure out when they were vaccinated and whether they’ve had enough time to develop that full immunity,” he said.
Just because a numeric vaccine target is reached, it may not mean the full protection and coverage is what it should be, according to Khan.
“It’s one of the reasons why it’s hard to give a definitive number,” he said. “So loosening restrictions doesn’t mean you can go out and do whatever you want, you still need to be distanced and wear a mask until appropriate.”
B.C. dangled a more ambitious plan on Tuesday, which said if 70 per cent of adults have at least one vaccine dose by Sept. 7 at the earliest, virtually all public health orders could be removed and masks could become what was described by provincial officials as a “personal choice.”
But without second-dose coverage, people need to remember they’re not fully protected, said Khan.
“We have to make up the last bit of (that protection) by continuing on with appropriate measures until we get second doses out there,” he said.
Will history repeat?
Hot spots in Ontario, B.C. and other provinces are, in fact, cooling off and hospitalizations are “hitting a low they haven’t hit in a long time,” said Zain Chagla, medical director of infection control at St. Joseph’s Healthcare Hamilton.
It shows that vaccines are working, he says, but we’re not in the clear yet.
“We’re not seeing the ICU capacity reset as fast as we would like,” he said. There were 672 people in Ontario ICUs due to COVID-19 as of May 26. While that’s down by 20 patients from last week, it’s still high.
There has been a greater push to accelerate second-dose vaccinations for Canada’s most vulnerable populations, particularly those aged 80 and older living in community settings, as a way to offset any potential resurgence that could be aligned with the gradual loosening of restrictions and increasing cases of variants.
There’s also a case to be made about getting Canadians working in vulnerable sectors fully vaccinated sooner, said Chagla. In some provinces, retail and restaurant industries could be open within days or weeks, he said, opening up opportunities for more contact between unvaccinated or single-vaccinated adults and essential workers.
“Restaurants and other establishments have been closed for a while. There’s something to be said about making sure the adult population is well protected at this point, as we’re going to open up,” he said.
“Otherwise we’re going to be reading into troubles with schools and other things coming into the future.”
There’s still work to be done. On a federal level, officials target a safe summer reopening if 75 per cent of those eligible for vaccines have one dose, and 20 per cent have a second. Restrictions could be safely loosened further in the fall if cases remain low and 75 per cent of Canadians are fully vaccinated.
The difference between this summer and last is that Canadians “stand a much better chance of having an outdoor summer that doesn’t lead to a resurgence in an indoors fall,” Canada’s top doctor, Theresa Tam, said at a COVID-19 briefing on national modelling data.
Experts were torn on whether the reopening plans emerging provincially were intrinsically right or wrong. They said its possible provinces are feeling influenced by countries already enjoying the benefits of an advanced vaccination campaign, like the U.K. and the U.S.
But they’re not necessarily a fair comparison, said Khan.
“They’re doing better with second doses, that’s a big difference,” he said.
With a one-dose strategy — though it’s gradually being reduced — Canada has to reinvigorate other public health tools in order to “continue on a path of getting cases down low” while simultaneously restarting economies, said Tuite.
“We have to supplement with contact tracing. It’s not particularly helpful when you have thousands of cases a day, but when you have manageable cases, it becomes really important,” she said.
“Places like the U.K. and Israel, they didn’t just rely on vaccination, they did that along with other public health measures.”