National Post (National Edition)
Restrictions, not just vaccines, helped countries avoid third waves
EVEN WITH CONCERTED IMMUNIZING EFFORT, VARIANTS CONTINUE TO TEST PUBLIC METTLE
Ontario's ICUs are breaking under the strain of a third wave. Alberta is putting new restrictions in place. Residents in Quebec remain under a daily curfew and British Columbia is prepared to fine people caught travelling outside of their region.
After more than a year of fighting COVID-19, the disease is going down swinging, with new variants pushing case counts to new highs and leaving many to wonder if this all could have been avoided with a faster vaccine rollout.
The answer is complicated. Even with a robust vaccine campaign, some U.S. states are seeing cases soar again. Michigan, Minnesota and Washington are all grappling with a third wave even as infection rates drop across the country.
But where vaccination rates are lower like Germany, France and India, hospitals are swamped with a new variant-driven surge.
Two countries that appear to have escaped the third wave, the United Kingdom and Israel, made two critical moves. They combined their impressive vaccine efforts with public health measures that drove down cases and set them up to eventually return to normal.
Israel, usually considered among the best countries at dispensing vaccines, has undoubtedly been helped by a robust vaccine campaign, which has reached more than 60 per cent of the country's population with at least a first dose.
But Israel has also had tight restrictions. From December to early February, Israelis were prohibited from going more than 1,000 metres from their home and all non-essential businesses were closed. The restrictions gradually eased, but it was only this past Sunday that a rule requiring mask use outdoors was lifted and they are still required indoors.
Canada's population is four times the size of Israel's, but at this point the two countries have dispersed roughly the same number of vaccines. Israel's campaign has been underway since late December and in the 121 days since they have injected 10.3 million vaccines.
If they had been injecting 300,000 doses a day, Israel's campaign would have reached the same figures in 34 days.
When he imposed new restrictions last Friday, Ontario Premier Doug Ford blamed the Liberal government's failure to procure more vaccines for overflowing ICUs and a buckling health-care system.
“The pace of our vaccine supply has not kept up with the spread of the new COVID variants,” he said.
Canada's vaccine deliveries have surged in recent weeks, but the country is still well behind many countries, 38th in the world on the percentage of people who could be covered by the available vaccine supply, according to Bloomberg's vaccine index.
Ford said his government could be administering 300,000 doses a day if they had the vaccines but said the federal supply has been inadequate and will cost lives.
“More people are going to die. More people are going to be in ICUs,” Ford said.
In questions to Prime Minister Justin Trudeau last week, Conservative Leader Erin O'Toole suggested it was the lack of vaccines that left Canada vulnerable to the variants.
“Will the prime minister admit that his failure to secure sufficient vaccines is leading to a catastrophic third wave?” O'Toole said.
Trudeau responded that vaccines alone can't solve the crisis and pleaded with Canadians to follow public health restrictions.
“We know that, for example, the U.K. is ahead of just about everybody else on vaccinations, and yet they maintain very strong restrictions and are facing a very serious third wave,” he said. “Vaccines alone are not enough to keep us safe.”
Trudeau's comment that the U.K. is in a third wave is not true and he was criticized by British newspapers for suggesting it. Cases in Britain reached a terrifying high of nearly 60,000 cases a day in January, but they have been in steady decline since.
The U.K. has reached about 49 per cent of its population with a first dose, according to Bloomberg's vaccine tracker, and about 16.1 per cent are fully vaccinated. The U.K. has followed a similar strategy to Canada, delaying the second dose of the vaccine for three months to get more doses into arms.
But Prime Minister Boris Johnson has said that the country's world-leading vaccine rollout was not what brought down cases.
“It is very important for everybody to understand, the reduction in these numbers, in hospitalization, and in deaths and in infections has not been achieved by the vaccination program,” he said to Sky News earlier this month.
The U.K. has been under a strict lockdown for months, restaurants are closed to indoor dining and won't reopen in England until the middle of May and schools were shuttered from December to March in much of the country.
The restrictions were on clear display this past weekend when the Queen buried her husband, Prince Philip. She sat alone and wore a mask during the service as restrictions require for indoor gatherings.
Johnson said in the interview it was those restrictions that helped his country drive down cases.
“It is the lockdown that has been overwhelmingly important in delivering this improvement in the pandemic,” he said. “Of course the vaccination program has helped, but the bulk of the work in reducing the disease has been done by the lockdown.”
England isn't going to lift the restrictions on indoor dining until mid-May and plans to ease all restrictions in June.
Dr. Steini Brown, the co-chair of Ontario's COVID-19 Science Advisory Table, released modelling last week on the expected course of the virus. It showed vaccines will drive the cases down and more vaccines will do so more quickly, but he said public health measures are essential to the fight.
“Public health measures make a significant difference and have already made a significant difference,” he said. “More vaccines, if possible, help significantly with the duration of this wave and the overall trajectory in the long run.”
Dr. Zain Chagla, an infectious disease physician and associate professor at McMaster University, said just having vaccines isn't enough, they have to be focused on specific groups.
“The implementation of the vaccine strategy actually probably defines whether or not you could use it to interrupt transmission and vaccinate your way out of a wave.”
He said in Ontario's case that would have required diverting vaccines from elderly populations, who are at severe risk from the disease, to those most likely to spread it in their communities. But that would have left the elderly at more risk of more serious outcomes for longer.
“They would have been, unfortunately hospitalized more, died more, with these variants probably, overwhelmed the health-care system more.”
Dr. Isaac Bogoch, an infectious disease specialist and member of Ontario's vaccine task force, said Canada's vaccination strategy has changed the demographics of the third wave, reducing deaths by vaccinating the elderly.
Case counts are higher now than they have ever been during the pandemic, but at the peak of the first and second waves of the virus, deaths averaged around 160 per day, but now average around 44.
Bogoch said the vaccines weren't enough to do more than prevent the worst outcomes and while supply is growing, it will take more than just shots in arms to end the pandemic.
“We didn't have enough vaccine mobilized to prevent the third wave and we don't have enough vaccines to end the third wave. We have to policy our way out of the third wave.”
He said obviously if Canada had enough to have vaccinated everyone with a single dose in the first months of this year it would have avoided the outcomes today, but that is unrealistic.
“Look at everywhere in the world. Apart from the U.K., Israel and the U.S., no other country on the planet has realized that because no one else has had that degree of access to vaccination.”
He said provincial governments took their foot off the brake too soon and opened up too widely.
“Obviously, there was just too much open too soon and we saw these explosive cases.”
VACCINES ALONE ARE NOT ENOUGH TO KEEP US SAFE.