Now is not the time to let our guard down

“With 21 per cent of residents now fully vaccinated as Team Ontario sets new records in daily shots, we can be confident that the worst of the pandemic is behind us.” – Premier Doug Ford

Can he really be so certain? In much of Canada, the COVID-19 pandemic seems to be on the wane. New case counts are down 90 per cent since mid-april and are comparable to those last September. The seven-day average for new deaths from the virus dropped 61 per cent. As of July 5, fully vaccinated Canadians returning to the country will no longer require a 14-day period of quarantine.

In Quebec, since early January, the COVID-19 test positivity rate has decreased from 11.2 to 1.1 per cent. Hospitalizations are less than half what they were a month ago, and new case counts are similar to last August. The province has moved all regions to the yellow level.

Ontario has cancelled border controls with Quebec and Manitoba. Alberta plans to lift all restrictions on July 1 and will hold the Calgary Stampede. Several other provinces have announced reopening plans.

Yet we can never let down our guard. As Dr. Theresa Tam noted, cases of the delta (Indian) variant increased 66 per cent in a three-day period. She warned, “If the variant takes hold and we don’t have high enough vaccine coverage, what you will see is probably a resurgence in the fall period.”

For most of the pandemic, Nova Scotia had been in the “Atlantic Bubble” and had restricted visitors from other parts of Canada; it also received no direct international flights. However, by mid-may, there was a peak of 227 new cases per day.

In early May, Manitoba had few cases compared to Alberta and Ontario. Several weeks later, it became the epicenter of North America. As of June 22, Yukon had 100 active cases; in Whitehorse, 80 per cent of persons had received the first dose of vaccine and 72 per cent the second. Yet only 10 days later, an outbreak of 21 cases was reported – largely due to the gamma (Brazilian) variant in unvaccinated persons. By June 17, there were 54 active cases.

Kashechewan First Nation, a James Bay community of 1,800 residents, managed to vaccinate most of its adults, but just reported 232 cases – half in children. This is largely due to the overcrowded housing, lack of isolation centres, and the fact that children could not be vaccinated.

Much of this is due to the delta variant, which is 50 per cent more transmissible, causes double the rate of hospitalization, and is more resistant to vaccines with only 30-40 per cent protection after one dose. It already accounts for over half of new cases in Ontario., with ten “hot spots.”

After a slow start, about 75 per cent of Canadians age 12 and over have received at least one vaccine dose – the highest in the world. However, except in the territories, only 20 per cent of eligible persons have been fully vaccinated and an Ipsos poll found that nearly 20 per cent are hesitant or refuse to get the vaccine.

If recurrent waves of this and any future pandemics are to be avoided, the premiers cannot rely entirely on vaccines; they must use all the potential tools in their toolboxes. This requires increased rapid testing and contact tracing, adequate paid sick benefits, increased numbers of isolation centres, and greatly enhanced temporary funding from Ottawa, If there is significant airborne transmission (Dr. Joe Vipond et al, Toronto Star, June 19, 2021), then there should probably be greater use of N95 masks in hospitals and high-risk workplaces.

For many months, Doug Ford and Jason Kenney blamed the problems on a poor supply of vaccines and lax border controls. However, they largely ignored workplace infections and inadequate paid sick leave.

Ford relied on the federal Canada Recovery Sickness Benefit. However, the CRSB pays only $450 per week after taxes (less than minimum wage), persons must apply every week, it does not cover shorter leave times, and remittance may take several weeks. As the CRSB was not improved in the federal budget, Ontario provided three paid sick days; businesses would pay up to $200 daily and be reimbursed by the WSIB. As I outlined in a previous letter (June 7), Yukon, BC, Manitoba, and nova Scotia have initiated a variety of short-term supplemental sick benefits plans. However, in all of them, sick employees when needing 10-14 days off would also have to apply for the federal CRSB, with all its defects. Across Canada, there is patchwork of inadequate, overly-complicated plans; this deters ill workers from staying at home. There is no seamless, easy way to obtain sick benefits without incurring an interruption or loss of income.

Alberta NDP leader Rachel Notley has proposed ten days of paid sick leave. Isolating workers would continue to be paid through their employer, who would be reimbursed by the province, which would be ultimately paid by Ottawa.

Legault and the other premiers should mandate sufficient paid sick leave for all workers. Ottawa should immediately agree to reimburse provinces and territories for funding businesses and the self-employed for this leave. It should also pay provinces and territories to provide adequate sick benefits to MDS, nurses, and all health professionals. Many have still not received their second vaccine dose.

Throughout the pandemic, Ottawa has played a role in procuring and distributing vaccines and personal protective equipment to the provinces and territories. During surges, it sent 265 Canadian armed Forces persons to five LTC facilities in Ontario in April 2020 and in May 2021 sent personnel to Nova Scotia, Ontario, and even offered to do so for Alberta. Although many Quebecers regard themselves as a “Nation,” they all benefit from being part of Canada. Recall that in April 2020, some 1,350 Canadian military personnel assisted in 20 Quebec CHSLDS.

Even if many premiers are willing to overhaul the national pandemic sick benefit program, sadly, this seems to be a low priority for Justin Trudeau. Although the US Congress is on vacation only during August, the last day of our Parliament is June 23. An election is likely in the fall. Will this issue simply “fall off the radar”? With the delta variant in one territory and every province, and soon to become the predominant strain in several, we need as many Canadians as possible to be fully vaccinated. Yet at present, 80 per cent are not, and nearly 20 per cent are reluctant to do so. In overcrowded “hot zones” children are victims and also vectors of the virus, but currently are not eligible for any vaccines. We all need leadership, better coordination, and the immediate promise of sufficient funding by Ottawa now, and cannot wait until a new session of Parliament resumes after the election.

Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-chair of the Section on General Internal Medicine of the Ontario Medical Association.

The views here are his own.