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A person walks past a COVID-19 mural designed by artist Emily May Rose on a rainy day during the COVID-19 pandemic in Toronto on April 12, 2021.Nathan Denette/The Canadian Press

More Canadians are being treated for COVID-19 in intensive-care units than at any time in the pandemic, a situation that underscores the threat of the highly contagious variants that contributed to Ontario’s decision on Monday to close schools indefinitely.

The rising rate of new coronavirus infections in Canada is putting extraordinary pressure on hospitals, particularly in the Greater Toronto Area, the epicentre of the third wave. There is also a record number of COVID-19 patients in intensive-care units in British Columbia.

Although the total number of people fighting COVID-19 in hospitals across the country has not yet eclipsed the peak of the second wave, the number requiring critical care has. At least 1,040 Canadians with COVID-19 were in intensive-care units as of Monday, nearly twice the number at the beginning of March and about 150 more than at the height of the second wave, according to The Globe and Mail’s tally of provincial data.

Canada reported 8,536 new infections on Monday, down slightly from a record high of 9,254 on Friday. The seven-day average of new cases a day – a measure that smooths out day-to-day blips in the data – reached 8,091, nearing the previous peak of 8,217 on Jan. 10.

Which COVID-19 ‘variants of concern’ are in Canada? Alpha, Beta, Gamma, Delta and Lambda explained

COVID-19 is caused by a virus called SARS-CoV-2, and as it spread around the world, it mutated into new forms that are more quickly and easily transmitted through small water droplets in the air. Canadian health officials are most worried about variants that can slip past human immune systems because of a different shape in the spiky protein that latches onto our cells. The bigger fear is that future mutations could be vaccine-resistant, which would make it necessary to tweak existing drugs or develop a new “multivalent” vaccine that works against many types, which could take months or years.

Not all variants are considered equal threats: Only those proven to be more contagious or resistant to physical-distancing measures are considered by the World Health Organization to be “variants of concern.” Five of these been found in Canada so far. The WHO refers to them by a sequence of letters and numbers known as Pango nomenclature, but in May of 2021, it also assigned them Greek letters that experts felt would be easier to remember.

ALPHA (B.1.1.7)

  • Country of origin: Britain
  • Traits: Pfizer-BioNTech and Moderna vaccines are still mostly effective against it, studies suggest, but for full protection, the booster is essential: With only a first dose, the effectiveness is only about 66 per cent.
  • Spread in Canada: First detected in Ontario’s Durham Region in December. It is now Canada’s most common variant type. Every province has had at least one case; Ontario, Quebec and the western provinces have had thousands.

BETA (B.1.351)

  • Country of origin: South Africa
  • Traits: Some vaccines (including Pfizer’s and Oxford-AstraZeneca’s) appear to be less effective but researchers are still trying to learn more and make sure future versions of their drugs can be modified to fight it.
  • Spread in Canada: First case recorded in Mississauga in February. All but a few provinces have had at least one case, but nowhere near as many as B.1.1.7.

GAMMA (P.1)

  • Country of origin: Brazil
  • Traits: Potentially able to reinfect people who’ve recovered from COVID-19.
  • Spread in Canada: B.C. has had hundreds of cases, the largest known concentration of P.1 outside Brazil. More outbreaks have been detected in Ontario and the Prairies.

DELTA (B.1.617 AND B.1.617.2)

  • Country of origin: India
  • Traits: Spreads more easily. Single-dosed people are less protected against it than those with both vaccine doses.
  • Spread in Canada: All but a few provinces have recorded cases, but B.C.’s total has been the largest so far.

LAMBDA (C.37)

  • Country of origin: Peru
  • Traits: Spreads more easily. Health officials had been monitoring it since last August, but the WHO only designated it a variant of concern in June of 2021.
  • Spread in Canada: A handful of travel-related cases were first detected in early July.

If I’m sick, how do I know whether I have a variant?

Health officials need to genetically sequence test samples to see whether it’s the regular virus or a variant, and not everyone’s sample will get screened. It’s safe to assume that, whatever the official variant tallies are in your province, the real numbers are higher. But for your purposes, it doesn’t matter whether you contract a variant or not: Act as though you’re highly contagious, and that you have been since before your symptoms appeared (remember, COVID-19 can be spread asymptomatically). Self-isolate for two weeks. If you have the COVID Alert app, use it to report your test result so others who may have been exposed to you will know to take precautions.

Need more answers? Email audience@globeandmail.com

One hopeful note in the otherwise grim statistics is the national COVID-19 death count, which remains low compared with previous waves – a testament to the effectiveness of immunization for vulnerable Canadians, including residents of seniors’ facilities. The country is currently logging 34 COVID-19 deaths a day, on average, compared with peak seven-day averages of 177 deaths a day in the first wave and 162 in the second.

However, deaths are a lagging indicator, and the full story of Canada’s third wave has yet to be written.

The Atlantic region continues to be a beacon of COVID-19 control, with no new cases reported Monday in Newfoundland and Labrador, a province that recently beat back an outbreak caused by the B.1.1.7 variant first identified in Britain.

The B.1.1.7 variant is the driving force in the spike in Ontario, where daily case counts topped 4,000 for three of the past four days, and where 619 COVID-19 patients were in the ICU as of Monday.

Ontario Premier Doug Ford announced Monday that all students in the province would return to virtual learning when April break ends in a week. He gave no date for when students might return to their classrooms.

Local medical officers of health in Guelph, Peel Region and Toronto had already closed schools before the break.

On Monday, Toronto Medical Officer of Health Eileen de Villa briefed the city’s board of health and released new modelling showing Toronto on course for approximately 2,500 daily cases if transmission rates remain unchanged. The city reported 1,296 new cases on Monday.

The city later confirmed that 20 per cent of Torontonians have now received a first dose of vaccine.

Toronto’s latest available data show that the city’s racialized and lower income residents continue to bear a disproportionate weight of COVID-19 infections and hospitalizations.

Based on data collected through the end of February, 76 per cent of Toronto’s COVID-19 cases have been among its racialized residents, even as they make up only about half of Toronto’s population. Poorer Torontonians who caught COVID-19 have also fared badly. Those deemed lower income were three times as likely to be admitted to hospital than those who are not, after adjusting for age.

In B.C., the province reported a record 121 patients in critical care as of Monday. The total number of COVID-19 patients in B.C. hospitals – 368 – is not a record, but it is close, B.C. Health Minister Adrian Dix said.

However, he said that, “hospital occupancy across the system is manageable,” even though Vancouver General, Lions Gate Hospital and Surrey Memorial are nearing 100-per-cent capacity.

Saskatchewan is now just below the peak of ICU patients it reached last week, while in Quebec, Manitoba and Alberta, the number of COVID-19 patients requiring critical care in the third wave is so far well below the peak of the second.

Cases began rising in Quebec two weeks ago, reaching about 1,500 a day in the past week, driven by major outbreaks in Gatineau, Quebec City and nearby regions. Montreal, the city that has been a constant national hot spot, has had a slower rise. Hospitalizations have risen 23 per cent in a week in the province and ICUs are at just less than half their COVID-19 capacity.

In Alberta, front-line doctors are starting to see the effects of the third wave.

Neeja Bakshi, an internal medicine specialist, worked on a COVID-19 ward in Edmonton over the weekend. The team admitted four or five patients over 24 hours, she said, compared with one or two in the same time period a week ago. Patients averaged around the age of 50, she said, making them younger than those admitted to hospital in the first and second waves.

“I think the ICU is going to get overrun because these are all young patients so we want to give them absolutely everything we possibly can to try to reverse it,” Dr. Bakshi said.

Her Edmonton hospital does not feel as chaotic as it did in December, but admissions are rising and the variant strains put pressure on the system in the way the original did not. In Alberta, patients infected with the P.1 or B.1.351 variants first identified in Brazil and South Africa, respectively, must be isolated from others with COVID-19. Patients with B.1.1.7 are permitted to share a hospital room with patients infected by the original variety.

“Capacity is a problem and it is going to be a bigger problem this time around,” Dr. Bakshi said.

Alberta counted 390 COVID-19 patients in hospital as of April 11, filling 86 per cent of the beds available to people infected with the virus. Of those in hospital, 90 are in intensive care, up from 76 patients a week prior. Alberta’s ICU occupancy peaked during the second wave on Dec. 28, 2020, with 151 patients.

With reports from Chen Wang, Les Perreaux and Xiao Xu

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