The number of COVID-19 patients in hospital is now 21 per cent higher than before the start of the province-wide lockdown in December.
That’s one of the insights from a new report by the province’s COVID-19 science advisory table that looks at the impact of fast-spreading variants of concern (VOC) during the third wave in Ontario.
The report found that VOCs are associated with a 63 per cent increased risk of hospitalization, 103 per cent increased risk of intensive care admission and 56 per cent increased risk of death. As of March 28, 67 per cent of all COVID-19 infections in Ontario were due to VOCs, and the B117 variant, which was first identified in the UK, accounts for over 90 per cent of those cases.
Intensive care unit occupancy is 28 per cent higher than at the start of the province-wide lockdown on Boxing Day, and the percentage of COVID patients in ICUs younger than 60 is around 50 per cent higher now than it was in late December.
“Because the increased risk of COVID-19 hospitalization, ICU admission and death with VOCs is most pronounced 14 to 28 days after diagnosis, there will be significant delays until the full burden to the health care system becomes apparent,” the report states.
The province’s science advisors conclude the third wave will place a higher burden on the Ontario hospital system than was seen during the second wave. They are calling for tougher lockdown restrictions to reduce virus spread.
Meanwhile, the Ontario Hospital Association said on Twitter that COVID-19 patients are “younger and sicker,” and warned of a surge in patient transfers and cancelled surgeries.
“The high-water mark for COVID-19 patients in intensive care in Ontario is 420 on January 15th,” the OHA said in a statement. “Ontario seems likely to reach and surpass this in the days ahead.”
However, Public Health Canada and Public Health Ontario have yet to provide updated guidance on preventative measures to combat the spread of COVID-19 variants. The epidemiologists NOW spoke with suspect that officials need more data on B117 and the other VOCs.
In the meantime, the weather is getting warmer and Ontario has loosened restrictions on outdoor dining and outdoor fitness in grey lockdown zones. The vaccination campaign is entering phase 2, but it could be weeks or months before vaccines start impacting daily case counts.
Ontarians may be looking for guidance on how to navigate the next few months of variant-heavy life before vaccinations become more widespread. We asked infectious disease experts a few key questions to understand what we should and should not do in daily life.
Is it safe to socialize outdoors?
“There are a lot of uncertainties; we do know that it’s more transmissible than previous types of COVID-19,” says Susy Hota, an infectious disease physician and professor at the University of Toronto. “But why it’s spreading more easily is not really clear.”
Hota says that even without clear information about why these variants are spreading more easily, such as whether they have a more viral load, there are ways we can update or monitor our own behaviours to be aware of risk.
Take outdoor gatherings, which are generally associated with a low risk of transmission, even with new variants.
“If you’re going to be outdoors, but you’re still going to be around 20 people, and within two metres of other individuals without masks, eating food and laughing,” Hota explains, “it’s not just about the environment, but the behaviours and the time that you’re going to be around other individuals, and what they do outside of that time as well.”
Prabhat Jha, epidemiologist and a University of Toronto professor in disease control at the Dalla Lana School of Public Health, says he’s still not recommending masking outside as a necessity, depending on whether you are two-metres distance from people around you.
“I try to do a daily walk and I don’t mask when I’m outdoors generally, but if I was walking up Yonge Street and happened to be in Dundas Square and there are lots of people around, then I would put on my mask,” he explains.
Despite increased risks, the “rules” remain largely the same: keep two metres distance, wear a mask if you are within two metres of someone, especially indoors.
“The new variant is more sticky, but the main protections we have to do is avoid crowded indoor settings with very little ventilation,” Jha says.
Risks are up across all demographics
Hota points to pandemic fatigue – the idea that people are getting so tired of following guidelines and enduring lockdowns that some are giving up on precautions – as a real challenge to limiting spread.
“I do worry that people feel that it’s been around for this amount of time, they haven’t been infected so far, so it’s okay [to let their guard down],” she says.
The risks associated with testing positive with these variants are considerably higher than previous strains of the virus. Ontario’s science advisors found people 59 years of age and younger accounted for 30 per cent of admissions between December 14 and 20, but that number is now up to 46 per cent in the previous week.
“If everyone just got a mild cold, fine, but some get really whacked and they nearly die from it or they get killed,” Jha says. “We still don’t know what determines why one person gets sick and another doesn’t.”
On Monday, people ages 39 and under accounted for 55 per cent of all new cases reported.
Jha says risk associated with the VOCs is high for young people.
“Their chances of getting infected is higher, but whether that person will drop dead or get hospitalized, we don’t know, that’s really uncertain,” he says.
What can Ontarians with one vaccine dose do safely?
With Ontario’s current vaccination plan entering phase 2, more people will have at least one dose , but not many will be fully vaccinated. So what does that mean for Ontarians as more people receive their first dose?
“You can add that one dose into the overall sort of risk assessment of what you’re going to be doing,” Hota says.
Hota says recipients have around 50 per cent effectiveness in terms of immunity two weeks after the first dose. Immunity increases to over 90 per cent after the second dose.
She says there are two components to the question of immunity with one dose – the existence of VOCs that are more resistant to the vaccine, and the populations who will still be more susceptible to the virus even with one dose.
Currently, the B117 variant is still responding well to the available vaccines, but P1 and B1351, of which there are over 100 confirmed cases in Ontario currently, are more resistant.
Hota also says that there have been a variety of studies showing that different groups, including older populations and people who are immunocompromised, are granted less immunity through a single dose.
“So you can’t even really apply a single estimate of how well people are protected across the whole population,” she says.
While there is public health guidance in different regions and countries about what people can do once fully vaccinated, there isn’t as much information out there for those with a single dose.
Israel, the world leader in vaccinations, did not start loosening restrictions until around 40 per cent of the population was immunized.
“There are a lot of moving targets, so it’s impossible to set any policy changes around a single dose kind of strategy.”
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