Why Canada is divided over reopening despite controlling COVID-19

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed tosubscribers every Saturday morning. If you haven't subscribed yet, you can do that by clickinghere.

The end of the pandemic may be finally within sight in Canada, after incredible progress has been made battling back the spread of COVID-19 with widespread vaccination uptake and dogged adherence to strict public health measures across the country.

More than 15 months of immeasurably hard work is now paying off, and we're poised to cross the finish line and possibly shift our focus to helping other countries get there sooner for the greater good of humanity.

Canadians should be rewarded for their efforts to end the third (and hopefully last)wave of COVID-19 and soon return to a somewhat normal pre-pandemic style of lifewithout the constant fear of the unknown that lies ahead with this relentless virus.

But nothing is set in stone with COVID-19, and that uncertainty in the coming weeks and months is dividing experts on what to do next leading some to call for reopening more quickly, while others suggest we move more cautiously as the pandemic recedes.

Delta variant poses new 'challenge'

One wildcard Canada has been dealt in recent weeks is the highly transmissible delta variant, also known as B.1.617.2, which could single-handedly disrupt our endgame plans and make our vaccination targets even more pressing.

"The issue is delta. We're obviously much better off than we were in March, but we're facing the same challenge," said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Toronto's Mount Sinai Hospital.

"Three months ago, before we had delta, it really did look like we were all going to get vaccinated and it was going to be fine but this virus is just more difficult than that."

Dr. Michael Gardam, an infectious diseases expert in Toronto and acting CEOfor Health PEI, says he's approaching the summer with "cautious optimism."

"If it weren't for the delta variant, I think there would be a lot more optimism. But I think that we still have the majority of Canadians who are not really protected," he said.

"It's bizarre, but we really haven't changed things that much yet because of that variant, and the fact that the vaccines, with only one dose, are only about a 30 per cent efficacy. So that's the challenge."

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What you need to know about the delta variant

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Federal health officials urge caution with reopening

Despite the spread of delta, Canada's COVID-19 cases, hospitalizations and deaths continue to fall week-over-week thanks to more than 37 million doses of vaccines given to date the equivalent of almost the entire population of the country.

Almost 80 per cent of eligible Canadians have at least one dose while about 35 per cent have twoand that number is growing rapidly by the day.

But top federal public health officials are still extremely cautious with their messaging to Canadians out of a fear of provinces and territories lifting restrictions too soon, seeing a surge in COVID-19 levels and prompting another brutal wave or devastating lockdown.

Canada's Chief Public Health Officer Dr. Theresa Tam says that while there is currently an average of fewer than 640 COVID-19 cases per day, under 1,000 hospitalized and less than 500 patients in ICUs,now is not the time to let our guard down.

"We do have to be quite cautious, because the provinces are just beginning to open up, and then we will see what happens," she said during a news conference Tuesday.

"Even though we have a good dose of coverage, we still need to, I think, go higher. And quite a number of people haven't had the full vaccination."

Deputy Chief Public Health Officer Dr. Howard Njoo even said he "would love to have 100 per cent coverage for both doses" in Canadaan almost impossibly high goal that is a far cry from the 75 per cent with one dose and 20 per cent with two set in late May.

Officials accused of 'moving goalposts' on reopening

Some experts are critical of the "pessimistic" messaging coming from federal health officials at a time when Canadians should be celebrating the progress we've made, the drop in COVID-19 levels the vaccines have provided and the safe activities available to us.

"Public health messaging has been pessimistic, both from the federal level and for us specifically in Ontario," said Dr. Sumon Chakrabarti, an infectious disease specialist at Trillium Health Partners in Mississauga.

He added that can havea negative effect on the general public's perception of the pandemic.

"We are in the best position we've been in and people are more scared than they were a year ago, when we had no vaccine."

Dr. Fahad Razak, an epidemiologist and internist with St. Michael's Hospital in Toronto, said the effectiveness of the vaccines has proven to be a "scientific miracle" and should be kept "front of mind in all of our public health messaging."

"We have had a very tough 15 months with this pandemic, we've had some of the longest durations and severities of public health restrictions in the world," he said.

"Canadians have accepted and followed those recommendations really admirably, and there should be a recognition that we've made incredible grounds in the last few months."

Chakrabarti says the persistent negative tone in messaging from some federal and provincial health officials has caused them to "lose the room" and is fuelling "the anxiety of reopening" while possibly "undermining vaccine efficacy."

"You have people that are fully vaccinated and still worried for their life;you have people that are going to say, 'What's the point of getting vaccinated?' So it actually feeds into vaccine hesitancy," he said.

"Others feel like the rug's been pulled out or that they're moving goalposts. People become dismayed, they don't see any hope."

'We're not closing again'

On the same day Tam said she was not in favour of lifting mandatory masking mandates despite the fact the 75-20 vaccine threshold had been surpassed, British Columbia announced masks would be recommended but no longer mandatory.

And while the Ontario Science Table estimated that delta now makes up more than 70 per cent of cases in the province and its reproduction value is above one, meaning it could cause exponential case growth, Ontario moved to Step 2 of reopening a few days early.

"Yes we want to release restrictions as quickly as we can, but the other side of it is that none of us, I don't think, want to be facing another wave with an increased number of deaths and hospitalizations and the potential to have to shut down again," McGeer said.

"It's really challenging for governments and public health to walk the line of what's the most relaxed we can be before we get into trouble, and how much worse is it to go slow versus having to go back?"

Gardam says that while some experts have said it's not possible to vaccinate our way out of the pandemic entirely, it is possible to get close to doing so with one caveat:If you relax restrictions too early, the virus will find vulnerable populations to infect.

Chakrabarti says that given the fact that seniors, long-term care residents and other populations at risk of severe outcomes have largely been vaccinated,a surge in cases driven by delta won't be nearly as severe as in the past.

But McGeer says there is still too much unknown about what impact the spread of delta in Canada might have in the coming weeks and months to relax restrictions entirely yet.

"We don't know how many people have to be vaccinated to slow this down. We don't know how well people are protected against severe disease from delta," she said. "We're really in a very uncertain time."

Gardam says his biggest concern right now isn't necessarily the spread of delta itself, but the inability of Canadians to endure another lockdown in the future.

"God help us if we get into a fourth wave where you have to shut everything down again. I mean, can you even fathom what the public would do with that? To me, that is an absolute no-go zone," he said.

"This is it. We're not closing again. So please, let's not do anything so rash that we actually force ourselves to close again."

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed tosubscribers every Saturday morning. If you haven't subscribed yet, you can do that by clickinghere.