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Provincial health workers perform COVID-19 tests on residents of the remote First Nations community of Gull Bay, Ont., on April 27, 2020. As a new surge takes hold in rural and remote areas, some experts say they have real concerns over the ability of smaller centres to cope.DAVID JACKSON/Reuters

Cases of COVID-19 are surging in rural and remote parts of Canada, bringing infection rates to levels many smaller communities have not experienced so far during the pandemic.

Doctors say they’re worried the pandemic’s shift toward more isolated regions could pose serious risks to the health care systems in smaller communities, which are already stretched and geographically distant from other hospitals that could help with a patient surge.

“The risk is now real,” said Lucas Castellani, an infectious-diseases physician in Sault Ste. Marie, Ont. “We’re at a place I don’t think we’ve ever been in this community before.”

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Experts say a number of factors – including people who remain unvaccinated and fewer people immune from prior infections because of a smaller number of cases in those remote areas – are helping to drive this new surge.

“There’s some significant pockets of people who have yet to get even a first dose” of a COVID-19 vaccine, said Nazeem Muhajarine, professor of community health epidemiology at the University of Saskatchewan.

For instance, only 58 per cent of residents in Alberta’s Cold Lake district have received two doses of a COVID-19 vaccine, according to provincial data. The active case rate in Cold Lake is 571 per 100,000. In Calgary, the active case rate is 84 per 100,000.

Dr. Muhajarine said he’s seen similar trends in northern B.C. and in remote parts of Saskatchewan and Manitoba, where vaccination rates are far below the provincial averages, leading to a spike in cases.

As a new surge takes hold in rural and remote areas that are hundreds of kilometres away from the nearest hospital, some experts say they have real concerns over the ability of smaller centres to cope with an influx of patients.

“Those are health systems that are already stressed, that have to deal with huge referral bases,” said Zain Chagla, an infectious-disease physician in Hamilton. “If you fill up those hospitals with COVID patients, it’s going to have really damaging effects.”

A rise in cases prompted Sault Area Hospital, the Algoma region’s main hospital, to close its doors to visitors last week in Sault Ste. Marie. Three hundred kilometres away, Sudbury health officials announced last week they were reinstating some public-health measures, including reduced capacity limits and stricter masking rules at indoor and outdoor events, as the region contends with a surge in cases.

Public Health Sudbury and Districts now has one of the highest active COVID-19 case rates in Ontario, at 143 cases per 100,000. Toronto, by comparison, has about 22 active cases per 100,000 residents.

Dr. Castellani in Sault Ste. Marie said even though vaccination rates in his region are high – 86 per cent of those 12 and older have received two doses, compared with the provincial average of 85 per cent – the area had very few cases of COVID-19 up to this point, meaning fewer people have any immunity, which could also explain part of the surge.

The U.S. land border reopening and loosening of other restrictions could further complicate matters, he said, as Sault Ste. Marie shares a border with Michigan.

Experts say people who have received two doses of a COVID-19 vaccine (or those who have already received a third dose, based on eligibility) should feel assured they are protected against severe illness linked to COVID-19. But when community transmission is high, there will be some breakthrough cases that could cause vaccinated individuals to feel unwell. And added stress on the health system could affect everyone in a community if procedures are cancelled and beds are fully occupied.

“Nobody is entirely safe as long as the virus is lurking somewhere among us,” Dr. Muhajarine said.

Getting children vaccinated should help reduce overall community transmission. A vaccine for children aged 5 to 11 is expected to be approved in Canada this month and many experts say achieving a high vaccination rate in that age group could help bring an end to major case surges.

In the meantime, Dr. Muhajarine said it’s clear more outreach is needed to reach those individuals who have yet to be vaccinated. Governments should tap community leaders to talk to local residents about the importance of getting vaccinated, he said.

“It has to be very personal and door-to-door even,” he said.

Since there will always be a small number of people who refuse vaccines, experts say now is the time to think about how to use some of the new treatments being approved to prevent severe infections and keep hospitals from being overwhelmed.

Monoclonal antibody treatments, which can keep some from getting very sick if taken shortly after testing positive for COVID-19, are being adopted by some provinces in Canada. But it’s not happening quickly enough, given the concerning surges in remote regions, said Andrew Morris, an infectious-disease physician at Toronto’s Mount Sinai Hospital and University Health Network. For instance, the only place in Ontario where monoclonal antibody treatments are currently available is Hamilton.

“Our systems are designed to support people who live in urban settings,” said Dr. Morris. “That itself is also a real challenge.”

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