Calm before a new storm?

Officials warn third COVID-19 wave coming

It is not what anyone wants to hear at this point in the pandemic, but a growing chorus of health officials believes Ontario is in the calm before the storm of a third wave of COVID -19 unless something changes. And, because it will be driven by more contagious variants, this one could be bigger and harder to control than previous waves.

That gnawing concern about what is coming has been heard in recent warnings from numerous health officials and organizations that Ontario is relaxing restrictions too soon.

“We certainly appreciate the need to support the recovery of our economy, being fully aware of its role as a key driver of so many of the determinants of physical and mental health,” wrote the association that represents medical officers and boards of health in Ontario to Health Minister Christine Elliott and Chief Medical Officer of Health Dr. David Williams.

“On balance, however, we believe that the timing of loosening the restrictions and the degree to which they have been relaxed in many areas underestimates the imminent and considerable threat posed by the VOCs (variants of concern).”

Last week, modelling from the province's science table predicted exponential growth in COVID-19 cases by mid-March if the status quo continues. Steini Brown, who heads the science table, agreed with a reporter that the model seemed to be predicting disaster.

Last Friday, federal government modelling warned that the variants will drive a sharp resurgence of COVID-19 cases without more stringent public health measures.

This week, with looser restrictions in place across much of the province, the number of variant cases is slowly beginning to increase. At the beginning of February, variants made up three to four per cent of all positive COVID-19 cases in the province. As of Feb. 20, that number was 19 per cent. Variants are expected to dominate by sometime in March.

Case numbers, meanwhile, have stopped dropping and are now plateauing or increasing. Ottawa, which moved into the Orange-Restrict category when the post-Christmas lockdown ended, is now getting close to the more restrictive Red category.

“The writing is on the wall,” said Dr. Doug Manuel, a senior scientist at The Ottawa Hospital Research Institute and professor at uOttawa's School of Epidemiology and Public Health.

“There is a high likelihood that we are going to see increased cases until we do something to reduce transmission.”

Modelling by Manuel and others predicts daily new cases will move up into the mid-80s in Ottawa by later this week after being significantly lower, which could be the start of a drift upward.

Manuel says it will take aggressive public health restrictions to prevent that resurgence. At the very least, he said, the province's colour-coded pandemic control model needs to be tightened. It was developed last summer, before the more aggressive variants were known.

“Orange didn't work in the fall, so why is it going to work now? If our plan is to control it, doing something that didn't work in the fall isn't going to work in February with the variants coming.”

The beginning of vaccine rollout in Ontario means some of the most vulnerable in the province should be protected from serious illness and death in a new wave, but many more will remain unprotected if cases begin a predicted exponential rise by mid-March. That is when people over 80 are to begin getting vaccinated in Ontario, a process that will not be complete until May, at least.

Dr. Alison McGeer, an infectious-disease specialist at the Sinai Health System in Toronto, agreed that the rapid spread of variant cases is coming in Ontario.

“We know what happened in the U.K. It is not going to be different.”

And, while she understands concerns about the dangers of keeping the economy locked down, she would have liked to see a bigger drop in Ontario cases before restrictions were loosened.

“I would be much more comfortable facing this at 500 cases a day than I am at 1,100. It is going to be bad and it is going to be much worse than if we started at half that number.”

Ontario reported just under 1,000 cases Tuesday. Cases have been higher than 1,000 for almost a week.

Meanwhile, images of shoppers lined up at a HomeSense store in the York region, which has just moved out of lockdown, have health officials across the province pleading with people to double down on public health guidelines to prevent the spread of COVID -19.

Dr. Paul Roumeliotis, the top doctor in the Eastern Ontario Health Unit and head of the Association of Local Public Health Agencies, said he and other public health officials believe the province should have moved more slowly in loosening restrictions, given the threat of variants.

He said people should not be lulled into a false sense of security by relatively low case counts in recent weeks. Those numbers have now plateaued and are heading up in two-thirds of health units across the province. And more mobility will mean more cases.

“Eastern Ontario and Ottawa went from everything closed to people going to movies and playing hockey with 50-member leagues. Yes, we recognize the economy is suffering and mental health is suffering, but we also recognize we don't want what happened in Britain.”

He believes the province can avoid that fate, if careful.