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People line up outside an immunization clinic to get an Oxford-AstraZeneca COVID-19 vaccine in Edmonton. Alberta was one of the first provinces to lift pandemic-related health restrictions over the summer.JASON FRANSON/The Canadian Press

The latest report from Ontario’s pandemic science table led with good news – cases, hospitalizations and people in intensive care are not on the rise – but the most important information was contained in three words: “the fragile situation.”

From Canada’s biggest province, which struggled through previous waves of the pandemic, one need only look west or east – or south, or overseas – to know that what seems stable today can suddenly lurch into crisis.

The severity of the fourth wave has varied from province to province, but there is a common factor among the hardest-hit places: Preventative public health measures were too quickly abandoned over the summer. In Canada, this is especially true in Alberta and Saskatchewan, but also in British Columbia and New Brunswick.

On the Prairies, the Canadian Medical Association this week called for new measures, including short lockdown-type restrictions to help save “two crumbling health care systems.” Prepandemic, Alberta had 173 ICU beds. That’s been bolstered to 370 and, as of Monday, almost three-quarters were occupied by COVID-19 patients. The ICUs haven’t yet been totally overwhelmed for the tragic reason that patients are dying.

In New Brunswick, the province returned to a state of emergency last Friday, and the virus has forced the shuttering of some schools.

B.C. was lauded for its handling of the first wave last year, but struggled after that. Yet in late May it was ready to declare victory and outlined stages of reopening that included “recommended” masks as of July 1 and “personal choice” as of Sept. 7. A surging fourth wave forced B.C. into retreat in late August, and masks were again required. It helped, but not enough. Cases this week eclipsed the peak of the second wave. Meanwhile, it also emerged last week that B.C. obscured how many people are in hospital because of COVID-19.

Ontario never rescinded its mask mandate, and it opened up cautiously. Even when the province moves past its current third stage of reopening, it says it will maintain “a small number of measures” to “minimize the risk of COVID-19.” This includes masks indoors.

Prevention makes a difference. Over the past month, the rate of new cases in Ontario has been steady between four and five per 100,000 people per day. In Alberta, over the same time, cases shot up 50 per cent to close to 40 per 100,000. Alberta has more than five times the ICU patients as Ontario, adjusted for population.

Ontario’s science table this week said continued public health measures are key to preventing a fragile situation from shattering. It also said people need to limit their day-to-day travels, and that vaccination rates need to rise more quickly.

Alberta and Saskatchewan have the lowest vaccination rates among the provinces, and while B.C.’s is higher than average, pockets of the province lag behind. Overall, Canada has fully vaccinated 81.2 per cent of the eligible population of people 12 and over – well below the 90-per-cent threshold this page has long advocated. And if you count the entire population, the fully vaxxed rate is 70.7 per cent. Alberta and Saskatchewan have just eclipsed 62 per cent.

In short, there are a lot of unprotected people out there for the COVID-19 Delta variant to infect.

The pending approval of vaccinations for children aged 5 to 11 will be a big step forward. Toronto’s board of health wants the vaccine to be mandatory for all eligible students.

But there are still reasons to worry. After vaccine mandates pushed the rolling average of first shots across Canada to close to 55,000 a day last weekend – almost double a low ebb in mid-August – the number as of Thursday dipped towards 44,000, according to the COVID-19 Vaccination Tracker.

And vaccinations aren’t everything. Look at Guam: Almost 90 per cent of the population was fully vaccinated but, after reopening, its rate of new cases and deaths shot higher than currently elevated levels in the United States.

It is clear vaccinations alone cannot battle back Delta. Public health measures play a critical role. This pandemic has been long and grinding, but places like Ontario that are currently doing relatively well cannot gamble with a fragile situation. Look around: It can get worse. Everyone needs to hold the line.

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