In a rare one-on-one interview and one of the first since penning a column trying to explain Alberta’s decision to ease COVID-19 measures, chief medical officer of health Dr. Deena Hinshaw said Thursday she didn’t do a good job explaining the rationale behind her recommendation.
“I think people heard last Wednesday a list of things that were being taken away,” Hinshaw said in an interview with Rob Breakenridge on the Corus Radio Network.
“I wasn’t clear about what is remaining or what that plan is going forward.”
Hinshaw also said she understands the reactions to the changes she announced on July 28.
“I do feel very bad about how this has played out,” Alberta’s top doctor said.
“I also think it’s hard because we are at the forefront of what I believe all of us are going to need to shift into learning to live with COVID-19. But because Alberta is moving into that space on the early edge, I think that that’s causing a lot of questions.”
Hinshaw said her approach isn’t about declaring COVID-19 over and no longer being a risk to Albertans’ health.
“It’s about the nature of that risk changing based on the wide availability of vaccines and the uptake that we currently have.
“I think people need to take it very seriously and I continue to do so. But again, we can’t look at COVID as the only risk that we face.”
Premier Jason Kenney and Health Minister Tyler Shandro have both said the “COVID cabinet” endorsed the recommendations Hinshaw made on July 8 “without modification.”
Hinshaw told Rob Breakenridge that recommendation is designed to address a “wicked problem.”
“COVID-19 is a wicked problem, which by definition means that even the definition of the problem is contentious, as we’ve seen over the past year and a half.
“There are no single answers, there’s no one right way to do this, as there has never been through the pandemic.”
Hinshaw said she spoke “in depth” with colleagues across the country about various approaches that could be taken with the pandemic through the summer and into the fall, adding there is consensus that COVID-19 will not be eliminated.
She described Alberta’s approach as on the leading edge of living with the virus long term.
“It’s my obligation to continue to assess the risks and benefits of every policy intervention and make recommendations based on that big picture,” Hinshaw said.
Being able to deliver other health care services is part of that “big picture” for the chief medical officer.
“The longer we look at COVID as the only thing that matters, the more we’re allowing the risks of, for example, babies dying from congenital syphilis and falling behind in vaccines for other vaccine preventable diseases — our routine childhood vaccination rates are dropping,” Hinshaw said.
“We have cancer screening rates that are dropping. People are not getting diagnosed as early as we otherwise would have.”
“With the resources in the system, the public health resources, we only have so many people to do the work.
“And if we allocate the majority of those people to COVID as the number one risk as that risk changes… I believe we’re not doing Albertans the best service.”
She also said that in the late July news conference, she didn’t articulate the risks of maintaining the status quo, adding vaccines have changed how COVID-19 will likely spread throughout the province.
“Our (COVID-19) cases will increase,” Hinshaw told Breakenridge on Thursday. “What’s different at this point in time is that those cases will not translate into the same kind of severe outcomes that we saw earlier.”
The chief medical officer noted that since mid-July, when the highly-transmissible Delta variant became dominant in Alberta, 95 per cent of new cases had been among the unvaccinated population, with similar percentages of new hospitalizations and deaths.
As of Aug. 3, 66 per cent of eligible Albertans have been fully vaccinated with two doses and 76.1 per cent have received one dose.
Children under 12 years old are still unable to be vaccinated.
Back to school
With schools starting in-class lessons in mere weeks, Hinshaw said she understands the concerns parents have about sending kids back to school.
But the mother of two noted that schools have not been a “dominant spreader“ of COVID-19.
“We’ve seen throughout the pandemic that schools have been impacted by community transmission, but have not been the dominant or a major source for spread,” Hinshaw said.
“For kids, it’s really important to think about not just the risk of COVID, but all of the other risks that our kids face, and to try to put that into context.”
Hinshaw said parents have to navigate risks everyday, and avoiding one risk can present other risks.
Alberta’s top doctor said there is no medical risk to children wearing masks in schools, but there may be some risks in areas of developmental, communication and social skills.
“That’s why it’s really critical that parents have the ability to make that decision and that schools support masking where that is what families want to do.”
She also said her team is working on a “bundle” of interventions for schools should cases of respiratory disease spike.
“If we’re looking at this in a sustainable way, what are the kinds of interventions that we could live with over the long term? What are the lessons from COVID that we can learn to improve our kids health?
“Those are the kinds of things that we want to be able to do, to go into schools when there is that surge and put in place measures that help mitigate transmission.”
While testing will be rolled back Aug. 16 for only those patients whose result would impact their medical-care decisions, Hinshaw said the province will be using other population-level COVID-19 surveillance through methods like wastewater testing.
“We know that, for example, in the U.K., where they’ve done widespread take-home testing in schools, that it didn’t necessarily have a huge impact on their ability to manage COVID,” she said.
“One of the things that I think COVID has taught us is we need to be thinking about staying home when sick.
“Making sure that we are supporting people to do that will have the biggest impact on keeping everyone safe.”
‘Wicked problem’ put Hinshaw in tough position
Toronto-based infectious diseases physician Dr. Sumon Chakrabarti read Hinshaw’s column.
“One of the things I think she really outlined very correctly was that this something called a ‘wicked problem;’ one that is very complex and no solution is perfect.”
While he doesn’t agree with every aspect of Alberta’s plan, he understands Hinshaw was faced with an incredibly complex issue.
“I do respect the points that she put out,” he said. “I think it’s a well-reasoned argument.
“I’ve heard a lot of people accusing this of not having any medical groundings, and that’s not true at all. I think it certainly does.
“But it is true that there is risk involved with this.”
Chakrabarti personally thinks it’s too early to remove these latest public public measures, but says he’s very happy to be wrong.
Whatever happens — good or bad — it’s important that other provinces learn from Alberta, he said.
“Her main message of moving forward with kind of adjusting things to live with the coronavirus is very important because this is not something that’s going to go away, acknowledging the fact that we have excellent vaccine coverage,” he said. “It’s different in different parts of Canada but overall very good.”
Chakrabarti said this is the path other regions will have to take eventually: widening the focus on overall health and removing some of the lower-yield COVID-19 interventions.
“If you look at the plan, this is certainly what our future looks like.
“For example, doing widespread community testing when the majority of people who get COVID are going to have literally cold and flu symptoms that are mild, it’s not a good use of resources.”
He also explained being hyper focused on COVID-19 has meant other issues have fallen through the cracks, like cancer diagnoses, wound infections and heart surgeries.
“What we worry about the most with COVID — apart from death of course — is severe illness that causes hospitalizations, which can then overwhelm health systems.
“When you focus on the numbers in the hospital and if you have outbreaks in the community — for example in a nursing home — really, really get on top of that, which is still going to be in place.
“There’s this impression that everything is being pulled back with no safeguards whatsoever. That’s not true.
“There is going to be ongoing surveillance going on in the background, wastewater testing, to kind of keep an eye on what’s happening in the community and high-risk places.”
Chakrabarti said Alberta easing these measures in the coming days makes him nervous, but adds vaccine coverage and efficacy has improved the overall outlook.
“There’s never going to be a perfect time to reopen. We have to do this to move on.
“I think right now, the risk calculator favours us — at least much more than a few months ago — because of vaccines.”
Hinshaw will be providing more information in an interview airing Thursday on Global News at 6 Edmonton.