Brooks Fallis is a critical care physician and the former medical director and division head of critical care at the William Osler Health System.
Canada sits at a pandemic crossroads. Second waves are receding thanks to successful lockdowns and restrictions. Reopening of schools and economies without meaningful improvements in surveillance or containment is set to intersect with emerging variants of concern and vaccine shortages, creating a perfect storm for a massive third wave.
We are now familiar with the SARS-CoV2 we have faced to this point in the pandemic – how it spreads, where it spreads, the impact on different age groups and how to treat those who become critically ill. Despite all this knowledge, for most provinces, the second wave of the pandemic has been deadlier than the first.
This fact should be considered totally unacceptable to all Canadians.
Unfortunately, the pandemic response has become increasingly politicized. In-fighting between different levels of government is now commonplace and directing blame seems more frequent than finding solutions to help us out of the crisis. At government press conferences, wishful thinking is sometimes presented as scientific fact.
In December, the end of the pandemic felt within reach. Vaccines were successfully and safely developed at record speed and huge volumes were promised by pharmaceutical companies. Canada had apparently locked-in an excess of doses. Individual COVID-19 patient mortality was dropping, and many provinces believed they were equipped to navigate second waves with a strategy of graduated restrictions.
Since then, much has changed. The pandemic is clearly far from over and has become decidedly more complex. Governments that failed to leverage appropriate scientific expertise risk being further exposed as unprepared and rudderless as this complexity mounts.
The new variants of concern (VOCs) present two major new challenges. The first is a more difficult virus to control and contain. The B.1.1.7 variant is about 60 per cent more transmissible. Early evidence suggests it might also cause more severe disease, and have a higher mortality rate, though we do not yet know this with certainty. Variants are spreading in many communities across Canada. Unfortunately, most jurisdictions lack the ability to identify VOCs in real time.
The second is concern around immune evasion. Some VOCs (B.1.351 and P.1) could cause disease in people with natural immunity from prior COVID-19 infection or immunity from vaccination. Again, more data is needed, but the mere possibility is frightening.
The vaccine supply has been slower than expected. Even with unlimited vaccines, we would never have been able to rapidly vaccinate enough people to both reopen from lockdown and prevent a third wave. Tragically, this shortage means many of the most vulnerable, as well as some frontline healthcare workers, will likely be left unvaccinated as the third wave strikes.
As second wave cases trend down in response to lockdowns, we are left with a natural but misplaced sense of optimism. Some provincial governments have begun to loosen restrictions based on this downward trend, despite ongoing high daily case counts and hospitals remaining full, plus delayed surgeries and tests stacking up. Meanwhile, the VOCs gain a further foothold in our communities.
Canada is sleepwalking into a third wave, which could be the worst one yet.
But there is one path forward that will save lives, minimize medical disability and allow our economy to reopen once and for all: COVID suppression. Once the VOCs have taken over, a suppression strategy will become much more difficult, perhaps impossible. All of Canada must follow the Atlantic provinces and strive for maximal COVID suppression now.
Do not lift lockdowns yet. Deepen them for a short period so that every person who can remain at home does so. Continue to support struggling businesses, but also begin to support individuals with paid sick leave. Control the borders with enforced hotel quarantine for travellers and use rapid testing plus self-isolation for cross border transport of essential goods. Deploy rapid testing in locations at high-risk for outbreaks, like factories and warehouses. Focus contact tracing efforts on high-risk areas that continue to drive transmission and properly invest in local public health units so we can rapidly trace every contact. Enact regional travel restrictions to keep some regions free of VOCs.
Simply put, control the import of cases from outside and drive cases down as close to zero as possible inside. Be decisive in attacking the virus from all angles. Then maintain the perimeter and bring back personal freedoms on the inside.
This strategic shift requires non-partisan leadership and a transition from acceptance to complete intolerance of the virus. An ethically grounded goal-directed COVID-19 strategy led with conviction is something most Canadians can support.
Science supports a COVID-19 suppression strategy. Unfortunately for Canadians, our leaders do not.
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