[Dr Dina News] Signs of a 4th wave as back-to-school approaches!

Hello friends!

I hope you are enjoying the sun and outdoor time and had a fantastic long weekend!

As we do each week, we will review the bad news and the good news. Then, I will answer the most common questions of the week and end with a silver lining.

 

Dr. Dina, what is the bad news?

There have been more than 197 MILLION confirmed COVID-19 infections reported worldwide and 4.2 million deaths. There have been over 1.4 million cases in Canada, with over 26,500 deaths.

Last week, the Public Health Agency of Canada warned that thousands of COVID-19 infections are predicted if contacts aren’t contained. The new modeling shows that we may see 2,700 – 11,800 NEW cases over the NEW WEEK! There is a growing concern we are heading into a serious fourth wave.

How is this possible? The highly contagious Delta variant is posing a significant risk, particularly to unvaccinated and partially vaccinated people. The concern stems from a dramatic increase in contact rates with the ongoing reopening.

According to Chief Public Health Officer Dr. Theresa Tam, “The updated longer-range forecast shows how the epidemic trajectory may evolve through early September. It suggests that we are at the start of the Delta-driven fourth wave, but that the trajectory will depend on ongoing increases in fully vaccinated coverage and the timing, pace, and extent of reopening.”

Notably, the modeling predicts that if Delta continues to spread, hospital capacity may be exceeded this fall or winter if vaccination rates don’t increase even more.
The modeling states the predominant circulation of the Delta strain “underscores the need for high vaccination coverage and continued caution as restrictions are eased.”

Across Canada, we have seen some climbing of cases. For example, British Columbia’s seven-day average for new COVID-19 infections went over 100 and had the most significant single-day increase since early June, at more than 200 new cases. Most of these infections are among unvaccinated or partially vaccinated people. Less than 5% of these infections are in fully vaccinated people.

Alberta, Saskatchewan, and Quebec last week saw a rise in cases as well as hospitalizations. In Ontario, we saw two back-to-back days of over 200 cases. Alberta is lifting restrictions, including scaling back isolation and testing protocols, which has many experts very worried. Close contacts of COVID-19 cases will no longer have to quarantine starting this week, and come mid-August, people who test positive won’t need to quarantine either. By September, people will only access a COVID-19 test if they see a doctor in a hospital.

The Delta variant is hitting the United States hard, with Dr. Anthony Fauci saying the U.S. is headed “in the wrong direction.” And the “pandemic is spiraling out of control yet again” as not enough people are vaccinated.

The CDC says that the Delta variant causes more severe illness and can spread as easily as chickenpox. As a result, there is concern the U.S. could see as many as 200,000 new cases a day in the next couple of weeks. As a result, the CDC changed its guidance last week, recommending that everyone, including fully vaccinated people, wear a mask indoors again in areas with a high COVID-19 burden.

Japan has expanded its state of emergency to 4 new areas as cases soar. Cases in Tokyo alone have doubled.

Cases continue to rise in the United Kingdom while restrictions are lifting. Quarantine rules are easing for thousands of essential workers, including garbage collectors, veterinarians, and correctional officers, to improve the economy and ease staff shortages.

Indonesia continues to battle a significant wave, with almost 50,000 new cases and nearly 2,000 deaths a day.

Despite a world-renown vaccination strategy, cases rise in Israel. Anyone over 60 who received their previous vaccinations more than five months ago can get a third booster vaccine. A team of expert advisors agreed by a 56-1 margin that it made sense to start providing booster shots. According to Prime Minister Naftali Bennett, “the findings show that there is a decline in the body’s immunity over time, and the purpose of the booster is to re-strengthen it, thus significantly reducing the chances of infection and serious illness.”

 

What’s the good news?

Cases, hospitalizations, and deaths remain relatively low in much of Canada.

Thank you, Dr. Jennifer Kwan, for this lovely representation.

More than 80% of eligible Ontarians are at least partially vaccinated. This is Ontario’s key target to allow us to exit Step 3 and ‘return to normal.’ To reach this goal, 75% of all eligible people much be double vaccinated.

For now, masks are mandatory indoors, even post Step 3. We await back-to-school plans, hopefully coming this week.

Whisperings of the plan came last week, which look like this:

1. Fully vaccinated people exposed to COVID-19 or are symptomatic will require one negative COVID-19 test to return to school or the workplace.

2. Unvaccinated people will need two COVID-19 tests. They will be off work or school for at least ten days. If the second test (done around day 7) is negative, they can return to school or work.

3. If the second COVID test is positive, they must stay at home an ADDITIONAL 10 days.

This will provide a “terrific advantage of being two-dose immunized by being able to stay in school and attend sports and participate fully in all of the social activities of the school setting,” Dr. Kieran Moore said last week.

 

Questions of the week:

How do we know Canada’s case counts are heading up?

One sign that cases are going up is the national “Rt,” or effective reproduction number. Rt>1 dramatically increases the likelihood of logarithmic (exponential) growth of cases. This number started trending above 1 in mid-July. This indicates that there are early signs of “epidemic growth” in some areas. “If the ‘Rt’ remains persistently above one for several weeks, with the predominance of the highly contagious Delta variant, we could expect to see a return to rapid epidemic growth, particularly as measures that slow the spread are eased,” Dr. Theresa Tam said.

Thank you to the brilliant Ryan Imgrund, who summarizes this nicely.

If more people are getting vaccinated, will the rate of severe illness go down?

We know vaccines work, and even with the spread of the Delta strain, the new PHAC modeling predicts that the rate of deaths will not increase at the same speed as new cases.

Hospitalization rates remain low, and fewer than 1% of people with confirmed COVID-19 and less than 1% of hospitalized cases being in fully vaccinated people. Vaccines work!

Interpreted another way, though, is that almost 90% of all cases are occurring in unvaccinated but vaccine-eligible people. 85% of people who are hospitalized are unvaccinated. Around 5% of cases are in those who are not yet eligible for a vaccine, and 5% are in partially vaccinated people. It is primarily unvaccinated who are dying from COVID-19 in Canada.

When is the best time for my 12–17-year-old to get a COVID-19 vaccine?

It seems far away, but school resumes in 6 weeks. So, if you get a vaccine today, the second will be given at least a month from now, and immunity is reached 14 days later. For parents wishing to vaccinate their children, or become vaccinated themselves, with protection against COVID-19 for the start of school, now is the time.

If you are considering having your child vaccinated and wish to discuss this with your doctor, please schedule an appointment for an in-person or virtual appointment. We are happy to help provide guidance.

 

The silver lining of the week

This week my two oldest kids headed to sleep away camp for a month. To say I am excited for them is an understatement. They have been home since March 2020, and they were eagerly anticipating a chance to hang out with friends, and after two weeks, do so without masks and distance. Though it will be a short time of living without fear of COVID-19, it will be savored.

I hope you and your family are enjoying this Summer as much as we are.

I am soaking in all the sunshine and time with loved ones I can get.

Have a great week!