In Ontario, the pandemic has had a punishing, stupid, enraging rhythm. The COVID-19 bathtub starts to fill up; the government doesn’t understand what’s happening, then doesn’t worry about it, and as the bathtub nearly overflows there is a lurch for the spigot. Sometimes, it takes more than one try.
But something may feel different now. Alberta and Saskatchewan are blowing the engine on their health-care systems, with seven or eight times the cases per capita over the past 14 days; Alberta is inches from activating triage protocols for care. B.C. has twice as many deaths per capita as Ontario in that time, too. Quebec is ticking up.
And Ontario’s case counts are relatively flat; positivity hasn’t exploded; vaccination levels are good if incomplete, and vaccine passports are theoretically the law of the land beginning on Wednesday. So far, the fourth wave is still a wavelet, and for a lot of people, your life probably feels closer to normal than it has for a while. It’s an odd feeling, in Ontario. That it might be OK.
“We’re holding, but we’re barely holding, right?” says Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto, the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network, and a member of the province’s independent volunteer science table. “The Rt (effective reproduction rate of the disease) is 1, and 1 is not great. But what it means is that we’re not totally out of control, and there will continue to be a steady rise in hospitalizations.
“What it probably also means is that there’s a reasonable likelihood that we will get to a situation where our Rt will be exponential will be greater than 1 at some point, as the weather gets colder. RT is dependent on a bunch of factors, right?”
That’s the strange, anticipatory limbo of Ontario right now, where deeper waters likely await. The seven-day case average has flattened for most of a month since a huge rise in August, and hospitalizations have stayed level. But school cases are beginning to rise, and child-care cases too. And beyond a shortage of pediatric ICU beds and staff, there were already 174 all-ages COVID patients in the ICU as of Tuesday morning.
Meanwhile, the hospitals aren’t overrun, but their ability to cope with the demands of a pandemic have been worn away. Absentee rates among nurses are a constant problem, staff are passing on the extra overtime shifts that used to fill gaps in the system, even doctors are considering an exit ramp from the profession, and the level of burnout is visible, and not just in the hospitals that have dealt with the most patients.
As one ICU doctor put it, “Remember when Headwaters (Health Care Centre in Orangeville) closed their ICU for the weekend because of no nurses? Welcome to my world. People are done. Anxieties are high, civility low, frustration high: the admins are done, front liners are done.”
There’s a flip side almost everywhere. Alberta and Saskatchewan declared victory over the virus over the summer, and that brand of heedless stupid governance is ruining them; Ontario head-faked in that direction, and likely desperately wanted to join them, but the province held back. We should appreciate that.
But it’s not over.
“OK, we absolutely cannot change our (cautious) behaviour,” says Dr. Peter Juni, the scientific director of the science table. “Right now we are on the right path on schools, on vaccination, on transmission. And then we’ll see really what the impact of vaccine certificates is, and we should absolutely talk about rapid testing.”
Chief medical officer of health Dr. Kieran Moore opened the door to rapid testing in schools Tuesday, though that should have been added to the pile ages ago. As for the current plateau, theories abound. Ontario is passing closer to the lower end of the science table’s modelling from three weeks ago: most of the experts believe the continuation of indoor masking and capacity limits, along with the other restrictions of Phase 3, are helping.
Morris also mentioned the weather — in July Toronto experienced 120 millimetres of rain, the most of any month this year, along with smoke from western wildfires and some extreme heat, and that may have driven more people to congregate indoors. August and September, by contrast, have been relatively glorious, and conducive to outdoor gatherings. Maybe the spike in August was partly weather-based behaviour, and the slowdown since then is the flip side of that.
Which, of course, means trouble when the weather changes, unless vaccination and behaviour blunt it. 85.2 per cent of eligible Ontarians have at least one dose, and 79.2 per cent have two. Vaccination efforts continue, and maybe a vaccine passport — the reality of one — pushes more people to get two doses. Most wonderfully, Pfizer announced the vaccine prompts a strong immune response in children five to 11, which is the kind of news that makes you let out a breath you didn’t realize you were holding.
The timeline on regulatory approval could be as early as Halloween, or within the first few weeks of November. With a 21-day dosing interval, that would mean kids between five and 12 could be fully vaccinated before Christmas. So absent a game-changing variant, assuming we are ready for boosters for any waning immunity — those mass immunization clinics may need to return — and with the largest unvaccinated group protected, that’s the timeline now. Ontario is holding on, just barely. But we need to be ready to get from here to there.
“I think it’s gonna be really hard for (the government) to argue for almost any (more restrictions right now). Because people will say, well, look at these numbers, why are we tightening up measures?” says Morris. “But I think this discussion will be very different in about three to four weeks, when the numbers will be starting to creep up. And then it’s going to be well, what can we do?
“A year ago, we white-knuckled it until Christmas, which was ridiculous. I don’t think they can white-knuckle it ’til Christmas this time.”
Let’s hope Ontario is ready, this time. Because maybe this time, it can be different.
Article From: The Star
Author: Bruce Arthur
