Is a fourth wave likely or preventable?

Dr. Rey D. Pagtakhan

	Prime Minister Justin Trudeau visits Pfizer Manufacturing facility in Brussels, (Photo by Adam Scotti – PMO June 15, 2021)
	Prime Minister Justin Trudeau visits a vaccine clinic at Lansdowne Park, Ottawa on July 2, 2021. (Photo by Adam Scotti – PMO)

Three waves of the COVID-19 pandemic have come and flattened, but Homo sapiens and SARSCoV-2 have remained at war for more than a year and a half now. The community battlefields are scattered at the local, national, and international levels. Most national economies have been stretched. Many, many households have been stressed physically, emotionally, and financially. Children have suffered enormously in their education and emotional growth. Cumulative counts of ill health and deaths in Canada stand at over 1.43 million cases and 26,000 deaths.

Globally, this week’s number compared to the previous week showed an 8 per cent increase in new cases and a 21 per cent increase in deaths. The cumulative number of cases and deaths is almost 196 million and over four million, respectively.

“If these trends continue, it is expected that the cumulative number of cases reported globally could exceed 200 million in the next two weeks,” says the World Health Organization (WHO Weekly Epidemiologic Report. July 27, 2021).

The world was not prepared

The world, it seemed, was not prepared when the virus arrived in December 2019. Worse, some political leaders actively worked against scientists and scientific data. Some citizens got entangled in myths and misinformation about the disease and its scope of calamity. Hopelessness deepened.

Then, science triumphed. Safe and efficacious vaccines were developed with speed and due diligence. The ensuing mass vaccination campaigns that started a little over half a year ago, in December 2020, have significantly reduced the acquisition of new cases, the need for hospitalization and intensive care units, and the magnitude of deaths. Vaccinations helped to control the gravity of the pandemic in Canada and around the developed world.

Mixed developments in the metrics of progress

However, the last half month, has shown mixed developments in the metrics of progress globally and in certain areas with our southern neighbour where “nearly two-thirds of US counties have high or substantial transmission of COVID-19. ” This is due in large part to the Delta variants – so much so that the US Centers for Disease Control and Prevention (CDC) has urged vaccinated people in those areas of the country to resume wearing masks indoors in public areas. CDC Director Dr. Rochelle Walensky said, “This weighs heavily on me… It is not a welcome piece of news that masking is going to be a part of people’s lives who have already been vaccinated.” (CNN News, July 27, 2021).

Meanwhile, provinces like Alberta, Saskatchewan, British Columbia, and New Brunswick have essentially lifted all public-health measures, travel restrictions, and mask mandates before the virus is completely under control.

The country and its provinces and territories have yet to articulate clear guidance regarding vaccine certificates and mandatory vaccination for special designated settings, such as: health care and educational institutions.

Characteristics of Delta variants

Eleven versions of the original SARSCoV-2 virus have since emerged, four of which are of concern, with the Delta variant being most threatening. Why? Because it is a super spreader. That is to say, an infected person infects more than one person (R-value is 1.48). This has been the most recent observation in Alberta where the disease is once more on the rise (CBC News, July 26, 2021).

Dr. Angela Rasmussen of the Vaccine and Infectious Disease Organization at the University of Saskatchewan observed, “If people are shedding 1,000 times more virus, the probability that a close contact will be exposed to an infectious dose is much higher. If people become contagious more quickly after exposure, they can have more opportunity to infect others.” These define the characteristics of this variant – greater viral shedding from an infected person, a faster replication rate, and a reduced incubation period in the infected. These translate to Delta’s increased infectiousness and transmissibility.

In fact, it has spread to more than 90 countries and has become the most dominant variant, especially where vaccination rates are low. In the US, less than half of the residents in a geographic area had been vaccinated where case rates of patients were the highest. Moreover, 99.5 per cent of people who died from the disease were unvaccinated. Thus, deaths are preventable with a vaccine.

But only a complete series of the dose-regimen can protect against this variant. Full vaccination is effective at preventing serious illness from the Delta.

Vaccination status in Canada

As of July 27, 56.25 per cent of the total Canadian population have been fully vaccinated, that is 21,377,946 residents. Conversely, 16,627,292 have yet to be fully vaccinated.

If we look at the proportion of fully vaccinated among the eligible population only – those 12 years old and over for whom vaccines are approved for use – the figure rises to 63.99 per cent. This means 24,319,552 Canadians are protected, but 13,685,686 remain unprotected. Add back to the latter figure, the number of children for whom no vaccine is yet available (approximately six million), and the non-vaccinated group increases in numbers close to 20 million. This swath of the population is a fertile ground for infection and transmission.

When we look at age sub-groups within the overall vaccinated group, we observe disparities in vaccination rates. Complicating the current situation is the extremely low vaccine coverage – less than two per cent – among the populations of the poor and middle-income countries of the world. These must be considered when we ascertain Canada’s vulnerability due to jet travel.

In my home province of Manitoba, vaccine uptake across is uneven with first-dose rates up to 66 per cent in some districts and as low as 20.7 per cent in others.

In short, the vaccine coverage in Canada and around the world to date makes our country still very much vulnerable to the Delta variant.

Dr. Joss Reimer, medical lead of Manitoba’s vaccine task force, observed, “We haven’t yet hit the point of that textbook herd immunity, where we have so much protection that the virus can’t circulate. The province must reach a minimum of vaccinating 80 per cent of eligible people to achieve herd immunity, although that number might be higher, as the effectiveness of the vaccines against more contagious variants of the coronavirus that causes COVID-19 remains to be determined. When the fourth wave of the pandemic arrives – likely to happen in the fall – it will hit hardest in areas with low vaccine uptake.” (CBC Manitoba Information Radio, July 27, 2021).

Makings of a fourth wave

Indeed, the makings for a fourth pandemic wave this fall and winter has been raised and may become inevitable in Canada and around the world. The following scenarios could spark another resurgence:

1. the Delta variants continue their virulent spread;
2. the vaccination rates plateau much below 90 per cent of the total population in segments of the country;
3. re-opening of national borders to international travel; and
4. low and middle-income countries continue to struggle to receive their vaccine supply.

Compounding scenarios could include:

1. reopening of schools and colleges without requiring full vaccination for all;
2. unavailability of approved vaccines for children under 12 years old;
3. public health measures failing to reckon with the intermingling of non-vaccinated and vaccinated populations in designated settings prone to crowding and large gatherings; and
4. clear protocols for safety in healthcare and related settings.

What would prevent a possible fourth wave?

The following considerations have been advocated:

1. Raise the vaccination rate with speed. We cannot risk having a third or fourth of non-vaccinated college and university students join their peers in every classroom and lecture hall.
2. Make vaccination mandatory in certain designated settings. It has been accepted practice in Canada to have mandatory vaccination against a list of infectious diseases for school-age children. Healthcare, long-term care homes for seniors, and childcare centres can reasonably demand staff and visitors to provide proof of vaccination to protect them and the people entrusted to their care.
3. Issue vaccination certificates. Proof of vaccination status would be reasonable to ask if we are to prevent serious outbreaks in settings that anticipate large crowds and longer togetherness.
4. Keep using the face mask. At least when indoors and gathering closely.
5. Enhance specific communication messages to persuade the vaccine hesitant, including counteracting disinformation.

Steps to mitigating a fourth pandemic wave seem to have begun with Prime Minister Justin Trudeau’s announcement on July 27, “Canada has now received more than 66 million doses of COVID-19 vaccines – enough to fully vaccinate every eligible person in Canada – two months ahead of the original goal of September.” A milestone, indeed!

The Prime Minister said, “The best way to end this pandemic is for everyone to get their shots as soon as they can. Today’s milestone is a clear sign that we are getting closer to this goal.”

Anita Anand, Minister of Public Services and Procurement, added, “This milestone was made possible by a true Team Canada effort across government, working closely with a broad range of vaccine suppliers and the immense efforts of dedicated public servants.”

Patty Hajdu, Minister of Health said, “If you haven’t been vaccinated yet, please make a plan to do so. Our families, communities and small businesses are relying on us to take care of each other and stop the spread. We are regaining so many of the things we enjoy – seeing our families, visiting with friends, and going out to eat. Let’s keep going together. Be safe, be sure. Get vaccinated today.”

In closing

We as a nation should agree to agree to accept the common good. Get vaccinated as soon as possible. Time is of the essence. The Delta variants continue to circulate and will successfully infect a less than fully vaccinated person. And it will continue to be super spreader.

For the sake of the common good, let us accept reasonable limits to absolute freedom to protect ourselves, our families, and our community. Please get fully vaccinated.

We have made great progress. Ending the pandemic is within sight, but the work is not finished. If we let down our guard, it could quickly return. We have learned our lessons; let’s use them.

There is no freedom when once more we fear being confined to bed ill and hoping to recover; being hospitalized for oxygen therapy while gasping for breath; and being admitted to ICU for intubation and attachment to a mechanical respirator to breathe and remain alive. There is no freedom in death except absence of human life.

A fourth pandemic wave is preventable!

Dr. Rey D. Pagtakhan, P.C., O.M., LL.D., Sc.D., M.D. M.Sc. is a retired lung specialist, professor of child health, author of articles and chapters in medical journals and textbooks, and a former health critic, Parliamentary Secretary to the Prime Minister, and cabinet minister, including Secretary of State for Science, Research and Development.

Have a comment on this article? Send us your feedback