It is difficult – indeed impossible – to predict exactly how Canada will fare in the fourth wave of the COVID-19 pandemic. Looking for clues from other countries only gets you further.
Again, this virus overwhelms some areas; Others are largely avoiding disaster thanks to the uptake of the vaccine and other precautions. Different policy decisions and different levels of restrictions also mean that there is no one-size-fits-all outcome.
So what will define Canada’s experience in the coming months?
Several experts told CBC News that there are a few key factors in how the pandemic will unfold as the delta variable continues to spread.
According to Matthew Miller, Associate Professor of Infectious Diseases and Immunology at McMaster University in Hamilton, there is also good reason to hope that Canada will fare better than many other countries with similar public health measures, thanks to a high vaccination rate and our unique approach. to immunize the population.
“People vaccinated in Canada will do much better than people vaccinated almost anywhere else because of the reliance on mRNA, mixed vaccine schedules, and long durations,” he said.
“It is clear, though, as infectious disease experts and public health experts rightly point out, that a combination of measures is still required to effectively control the epidemic — and those measures will have profound effects on how we as a people experience the fourth wave.”
1. Vaccine absorption
Despite a slow start, Canada quickly became one of the most vaccinated countries in the world against COVID-19.
Nearly 63 percent of the total population is now fully vaccinated, and the number is slowly increasing.
While millions of people across the country remain unprotected, virologist Alison Kelvin said Canada’s relatively high rate of immunization bodes well.
“We have fairly good coverage,” said Kelvin, who works with the Vaccines and Infectious Diseases Organization (VIDO) at the University of Saskatchewan in Saskatoon.
“And the stats have shown that we seem to have better coverage compared to other countries – that will be the biggest source of protection, since we have been able to vaccinate a lot of people and, again, stop this chain of transmission of the virus.”
While higher vaccination rates have not completely reduced the incidence of COVID-19 in other regions of the world, they have significantly reduced the incidence of severe disease compared to previous surges of the coronavirus.
In Spain, which has a vaccination rate of about 66 percent – slightly higher than Canada – the country’s latest wave of infections has led to a spike in daily virus deaths, but not close to levels seen in previous waves.
The heavily vaccinated UK also saw a rise, then a decline before seeing another increase in cases this summer, but throughout it all, hospitalization and death rates have been much lower than they were earlier in the pandemic.
And in Iceland, where nearly 72 percent of the total population has been fully vaccinated, hospitalization rates from COVID-19 have remained low even as infections have risen — and the country has not recorded a virus death since May.
McMaster University’s Miller said it’s critical for Canada to get the highest possible level of vaccine uptake possible by improving access, encouraging those who are still hesitant and even mandating vaccinations in certain places – particularly when it comes to persuading younger age groups.
“A little bit of pain with vaccine passports to do certain things the demographic loves to do — go to clubs, eat indoors at restaurants — that would be enough to get these people to get vaccinated,” he said.
“That’s really where the vaccine mandate is going to make the biggest difference, I think, in that younger group that’s a little bit behind now.”
Already, there is a patchwork of vaccination policies and mandates in place at health care institutions, concert venues, universities and various levels of government across the country — but it is not yet clear how much these efforts will increase uptake.
2. Delaying and mixing different vaccines
Canada’s vaccination strategy was quite unconventional in many ways, giving Canadians the ability to mix different forms of vaccine technologies and space out doses.
Born out of necessity during a shortage of supplies, this approach sparked controversy and even derailed some Canadians’ travel plans after Some countries and cruise lines refused to accept people who received two different shots.
But Miller – who is affiliated with the Canadian National Advisory Committee on Immunization but does not speak on behalf of the advisory body – said the recommendations are rooted in decades of vaccinology and could have a “profound impact on the longevity of the immune response”.
He said Canada’s unique route — allowing people to get second doses beyond manufacturing guidelines, up to a maximum of four months — would now likely be better than sticking to the fast-track schedules used in clinical trials.
“We know mixing and matching, and we know that late primary booster schedules actually give an overall better protective effect than vaccination,” Kelvin said, although she noted that more research is still needed.
Emerging studies are beginning to support early recommendations about mixing different vaccine technologies, with an emphasis on the use of highly potent mRNA-based options, said Dr. Alison McGuire, a University of Toronto professor and infectious disease physician. At Mount Sinai Hospital in Toronto.
“From what we know about T-cell and antibody immunity, the best two doses are probably AstraZeneca followed by one of the mRNA vaccines,” she said, referring to the Pfizer-BioNTech and Moderna vaccines. “So this was a really good choice for Canada, I think, to make that recommendation – definitely better than two doses of AstraZeneca.”
McGuire said that while Canada’s unique approach has helped get more shots into the guns, she’s not convinced it will necessarily make much of a difference in how the country performs in the fourth wave.
Not every Canadian got his shot the same way, Miller acknowledged, which makes it difficult to know how to implement the country’s strategies.
“One of the complications, of course, is that at the ends of our vaccine rollouts, there are exceptions, right?” He said. “A lot of health care providers and long-term care residents got their vaccine in the recommended period.”
3. Public health procedures and restrictions
To buy time while more Canadians are vaccinated, many experts point to the need for some public health measures to prevent cases from growing – not necessarily a complete lockdown but some level of restrictions.
This means maintaining the basic daily precautions Canadians know all too well now: wearing masks, social distancing, and avoiding large gatherings and crowded places.
“We really need to think about our current situation and how having layers of precaution really keeps everyone safe,” Kelvin said.
“We are now in a different situation where a lot of public health measures have been lifted.”
Restoring some precautions will be especially critical as millions of unvaccinated children return to school this fall, according to Miller, who also said this is the problem that brings the most uncertainty into the coming months.
Many experts agreed that both vaccines and some level of restrictions should be used in tandem to put Canada in the best position as Delta-driven cases continue to rise.
“If we’re really concerned about protecting vulnerable populations — people in long-term care facilities, those who are immunocompromised, like transplant recipients — these multiple layers will help protect them,” Kelvin said.
“So all of our jobs are involved in this.”