Toronto bets on vaccines, with no plan B
Lack of a backup plan raises fears of lockdowns and school closings
Toronto is banking on high vaccination rates this autumn to protect returning school kids and health-care capacity from the raging Delta COVID-19 variant.
There is currently no “Plan B,” officials say, in case vaccines aren’t enough to stop school shutdowns and strained hospitals, raising the spectre of yet another return to lockdown.
There are, however, multiple ways to prevent that nightmare scenario including one — a provincially issue vaccine certificate — about which Premier Doug Ford has reportedly had a change of heart.
“There’s no question that having as many people as possible vaccinated is really our ‘prevention of lockdown’ strategies — if you want to call it that — for this (pandemic’s) fourth wave,” said Dr. Vinita Dubey, an associate medical officer at Toronto Public Health.
“Our best strategy right now is to ensure every percentage point we increase (the local vaccination rate) is extremely influential,” in depressing infections as children head back to class and others mingle more indoors, she said.
About 76 per cent of Torontonians ages 12 and over are fully immunized, with 83 per cent having received at least a first dose of vaccine. That’s among the best rates in the world for a big city. Vaccine-toting teams are in neighbourhoods, subway stations, office buildings and other spots trying to push it higher.
But almost 700,000 Torontonians are not fully vaccinated — many of them children under 12 not currently eligible for vaccine and set to go back to classrooms Sept. 9.
The average number of new daily COVID-19 infections in Toronto has risen rapidly since July when Ontario loosened restrictions on businesses and gatherings. With school resuming and some workers headed back to offices, as cool weather pushes people indoors, experts expect that viral spread to accelerate.
Toronto Public Health is closely monitoring daily new COVID-19 hospitalization and intensive care admission numbers. Both have remained relatively low, not rising in tandem with increased infections.
That could be because new infections take time to develop into serious illness. But partially and fully vaccinated people who get COVID-19 despite their lower infection risk are rarely getting seriously ill enough to be hospitalized.
Dubey said she sees social media “misinformation” arguing that, because some vaccinated people still get COVID-19, vaccines are ineffective.
“That 16 per cent of people getting COVID who are vaccinated are getting the milder illness,” she said. “So that fourth wave — that pressure on the health-care system (with) severe illness and mortality — that’s what the vaccines are meant to prevent. So far, it’s holding up.”
She also notes the reproductive value — a key indicator of virus spread — has dropped in Toronto since late July.
Mayor John Tory said the city is “laser-focused” on getting local vaccination rates to the provincial goal of 90 per cent fully protected that Ontario’s public health chief said will replace pandemic waves with local manageable outbreaks.
Ontario’s first three pandemic waves followed a pattern — surges in infections, hospitalizations and deaths. That triggered restrictions on gatherings, school and business closures and then lockdown. Lower case counts then triggered the easing of those restrictions and eventually infections started to rise again.
Asked if vaccinations, along with public health measures including continued masking and distancing, as well as in schools, will be enough to prevent a lockdown this time, Tory told the Star: “I’m reasonably confident that it won’t need to happen … based on how things stand today.”
Tory also raised the spectre that pandemic-weary Torontonians might not be as obedient in a new lockdown as they were in the past.
“People by and large will obey the law but I think this summer a lot of people thought, with the vaccinations we had, that a lot of this was behind us,” Tory said.
Businesses reopened, people returned to a more normal life and, he said, “I think the viability of another lockdown, while you might have to do it — I’m not sure it would be as viable, that it would be as effective as it was before.”
The mayor had expressed frustration with Ford’s government for refusing calls to issue proof of vaccination certificates, along with guidelines to limit activities by unvaccinated people.
The Star’s Rob Ferguson on Friday quoted provincial sources as saying some kind of system is coming within weeks, to allow access to non-essential services and events where you will have to be vaccinated.
Coun. Joe Cressy, chair of Toronto Public Health, said that, in the absence of a vaccination certificate, the city has been doing everything it can to keep driving vaccination rates up.
That includes boosting the number of mobile vaccination teams from five to 22. Their efforts appear to be paying off, even if the vaccination rate isn’t jumping overnight.
“We saw on the first day at a clinic at one of the subway stations that nearly 50 per cent of the doses delivered were first doses,” Cressy said. “That shows that to reach everyone everywhere, you need that hyperlocal data-driven approach.”
Another focus is getting parents and caregivers of kids vaccinated. In previous pandemic waves, most of COVID-19 in schools and daycares was from kids infected at home, rather than child-to-child spread.
Asked how confident he is Toronto can get through the fall and winter without school closures or lockdowns, Cressy said: “Based on the good vaccine uptake thus far — and the infrastructure we have to quickly accelerate — the future is in our hands. But the vaccine mandates are a critical piece of getting rates up.”
Dr. Isaac Bogoch, a Toronto infectious disease specialist, said the city’s vaccination success is undeniable, but many variables are at play.
Many Torontonians remain unvaccinated, we’re heading into a period where people will increasingly mingle indoors, and infections will certainly rise.
“That stinks,” said Bogoch, as does the fact the previous waves showed Canada’s hospital intensive care capacity is lower than some comparable countries.
“Those are the features that make me rather nervous as we go into the fall with rising case counts,” involving the virulent Delta variant, he said.
“It’s true that younger people who get infected are less likely to be hospitalized than older people, but even if even a small percentage of them land in hospital — that’s still a lot of people.”
Vaccination is one important tool, along with others that, layer upon layer, reduce the risk of soaring hospitalizations and ICUs full of people on ventilators. They include, Bogoch said, mask wearing and distancing, including indoors and in schools, improved ventilation especially in schools, vaccination outreach to overcome barriers leaving many still at risk, and vaccine mandates that limit contact with unvaccinated people and encourage them to get protected.
“I hope that we can avoid lockdowns,” Bogoch said. “That would be an incredible failure if we had to lock down again.”
Omar Khan, a University of Toronto professor of immunology, said it’s hard to predict our fate in autumn and winter when the virus is constantly evolving and an entirely new strain could replace the nowdominant Delta.
Also unknown — whether the inevitable rise in infections will be spread fairly evenly across Ontario, or concentrated in under-vaccinated regions.
“If infected people requiring hospitalization are evenly spread out, we have a better shot at not compressing specific ICUs and of not needing restrictive measures to preserve health-care capacity,” Khan said.
“If hospitalizations are concentrated, we might need transfers of really sick people to other parts of the province.”
Local efforts are important, Khan said, but as long as many countries remain undervaccinated, waiting for precious shipments, Canada will be at the mercy of a virus that can mutate anywhere and find its way to global hubs like Toronto.
“We can mask, we can boost vaccine rates all we want, but if we really want to slow viral evolution down, so that our current vaccines remain effective and we can get on with it, we have to resolve this globally,” he said.
“It’s the only sustainable solution, period.”
“I hope that we can avoid lockdowns. That would be an incredible failure if we had to lock down again.” DR. ISAAC BOGOCH INFECTIOUS DISEASE SPECIALIST