As COVID outlook brightens, moderate messaging

The pace of Canadians being vaccinated is belatedly gathering steam. In the absence of further supply disappointments, all of the most vulnerable Canadians will be offered vaccination by the end of June.

Prime Minister Justin Trudeau is sticking to his commitment that everyone who wants a vaccine will have the opportunity by September. As we move toward loosening of restrictions, a different kind of messaging is required.

The number of newly detected COVID cases has been dropping rapidly in Canada, the United States, Western Europe and the world. This has happened despite the emergence of more transmittable variants. The reduction started before vaccinations began happening in large numbers.

The drop in Europe and North America started at the beginning of 2021 while largely Muslim countries like Indonesia and Pakistan started dropping a couple of months earlier.

Mostly Hindu India has dropped more than 85 per cent from a daily peak of almost 100,000 cases in September. This has not been because of strict public health measures. It may in part be because of the lack of them.

Fewer than one per cent of Indians have had positive COVID tests. Researchers tested a large population sample for antibodies, which would be evidence of prior undetected infection. The results suggest that a quarter of Indians have been exposed to the virus, more than half in some big cities. This provides them with a degree of immunity.

The United States exhibits a similar but less pronounced pattern, particularly in states that have had weak public health protocols resulting in high case numbers,

This happens because many people became exposed enough to produce antibodies but had few or no symptoms. It is probable that these are people most at risk of becoming infected because of their work, location, or disdain for public health measures.

Vaccination rates are picking up, with a focus on the most vulnerable. As of Feb. 26, the United States has vaccinated more than 40 per cent of its prioritized population and 15 per cent of the total. Virtually all vulnerable Americans wanting to be vaccinated will be by the end of April. Canada is on track to be there by the end of June.

The number that matters most is not case counts. Rather, it is the number of people who become seriously ill, leading to hospitalization and sometimes death. Older Canadians account for most of the vulnerable population. More than 70 per cent of hospitalizations and 96 per cent of deaths have been in people 60 and over.

There will be downward pressure on case counts, both from vaccinations and from growing numbers of previously undetected infections. The latter is not a big factor for Nova Scotians, but it is in other provinces and countries.

The number of seriously ill cases will be low because of a vaccination strategy prioritizing the most vulnerable.

Barring unexpected developments, a point should be reached by the end of this year that COVID infections in Canada are far fewer and of modest impact to the health-care system. A comprehensive program of vaccinations for care home residents and other high-risk groups will keep it that way.

At that point, the restraints on work and leisure currently prescribed — mandatory quarantines, masks, social distancing, limiting numbers in meetings, restaurants, and hockey games — should be lifted. Not because illnesses from COVID will have gone away completely, but because it has become part of a new normal that we learn to live with and the harms from restraint will outweigh the benefit of continuing restrictions.

If the experience of the next few months is consistent with this forecast, it will be appropriate for Nova Scotia to begin loosening its rules in late June, when schools are out. Case counts may go up, but the number of serious infections, which has been tiny for months, should remain low because the vulnerable part of the population will have been vaccinated.

Watching American experience will be instructive. They are well ahead of Canada in vaccinations, and far more Americans have protective antibodies than the 29 million who have tested positive. States, especially those that have been strict, will be loosening during spring and their results will tell us a lot.

Early steps here could include expanding the bubble beyond Atlantic Canada, eliminating quarantine for visitors and returning Nova Scotians who have been vaccinated, widening scope for professional sports and performing arts, looser restrictions on faith gatherings, and allowing larger groups in homes.

Nova Scotians occupy a spectrum, from those who are spooked by any rise in case counts to those who already feel that the restrictions are too tight. The challenge is to communicate a position that can be widely accepted. A gradual loosening of restrictions even as case counts rise will require more nuanced messaging than “Stay the blazes home.”

The starting point is to change which data to highlight. The headline number we have been getting is case count. Nova Scotia's numbers are commendably low, but what we should be happiest about is that, since Oct. 1, we have had very few hospitalizations and no deaths.

Those are where attention should be focused in the daily reports. After this week's bump in cases subsides, a gradual adjustment in reporting should start, so that the focus will be on the number of serious illnesses when restrictions begin to be reduced.

The timing may change if variants in the virus provide unexpected challenges or vaccinations have further delays. Regardless, thoughtful management of the transition will be required.