With 31 of the province’s 34 public health units on track to be in Stage 3 of reopening by the end of the week, epidemiologists are urging caution now that two Western provinces — which are further ahead in their reopening plans — have more COVID-19 cases per capita than Ontario.
Alberta has been noted for its aggressive stages of reopening, which included gyms, movie theatres and pools. It now has 19.3 active cases per 100,000 people, nearly double that of Ontario, which currently sits at 10.11 per 100,000.
Saskatchewan, which allowed restaurants, gyms and stores to reopen in June and recently moved to open museums, movie theatres and casinos, has a per capita rate of active cases of 11.54 per 100,000.
Todd Coleman, an epidemiologist and assistant professor in health sciences at Wilfrid Laurier University, said this isn’t the first time we have witnessed scenarios in which increases in cases coincide with a loosening of restrictions.
“We’ve seen a number of other countries where they start easing restrictions, and it just climbs right back up,” Coleman said. “This is a very easy infection to pass on, and we need to make sure that everything is really locked down in terms of our public health response.”
By the end of this week, seven more regions in Ontario will move to Stage 3 of reopening: Durham, Halton, Hamilton, Niagara, Haldimand-Norfolk, Sarnia-Lambton and York. That will leave just three regions at Stage 2: Toronto, Peel and Windsor-Essex. Facilities allowed to reopen in Stage 3 include dine-in restaurants, convention centres, casinos, gyms and outdoor playgrounds.
“Continued messaging is important,” said Dr. James Kellner, a professor of microbiology, immunology and infectious diseases at the University of Calgary. “People are tired of COVID. Everyone wants it to go away. Finding a way to positively message without haranguing people, encouraging people to be prudent — it’s easier to say, but harder to do.”
To give a sense of how Ontario and some other provinces are faring, we asked experts to give us their thoughts on several data points.
GTA cases versus the rest of Ontario
While the number of new cases outside the Greater Toronto Area remains lower than those within the GTA, a concerning trend has emerged over the past several days: the rolling seven-day average for new cases of COVID-19 outside the GTA has risen from 33 on July 7 to 51.4 on July 19. Similarly, in the GTA, the rolling seven-day average for new cases has increased from 76.9 on July 12 to 97.1 on July 19.
It’s a trend that’s “concerning,” says Raywat Deonandan, an associate professor and epidemiologist at the University of Ottawa.
“Two weeks ago was when things started opening up more and people started spending more time together with their families and friends,” Deonandan said, adding that an uptick in cases means we can’t let our guard down.
“I think we have to keep our foot on the pedal, as it were. We cannot slow down in our desire to make things safe.”
He added that society’s focus now should be on trying to find ways to open schools safely in the fall.
“Opening up parts of our economy that are luxuries, like bars, is I think a disservice to the ultimate goal of school openings, especially if it results in things like (increases in new cases),” he said.
What about Toronto, Peel and Windsor-Essex?
On Monday, Premier Doug Ford asked residents of Toronto, Peel and Windsor-Essex for patience when he announced the additional regions that will enter Stage 3 later this week.
“For the other regions who entered Stage 2 later in the process, please be patient. We’ll get there very shortly,” the premier said. “We know as a province that we can’t ease up. We can’t give this virus an absolute inch.”
In the three days leading up to Monday, Toronto saw 107 new COVID-19 cases, according to the city’s medical officer of health Dr. Eileen de Villa, who acknowledged Monday that some may be disappointed that Toronto isn’t moving to Stage 3 yet.
She noted that cities that were a few weeks ahead of Toronto in their outbreaks and have since reopened “are now seeing increases in COVID-19 activity linked to reopening of restaurants and bars. In some cases, cities that previously had very low or no COVID-19 activity are now seeing increases in cases linked to these settings.”
Peel reported another 22 new cases on Saturday, 38 on Sunday and 29 on Monday. Its public health unit said multiple household members are testing positive for the virus, a trend in recent weeks where the virus spreads throughout families.
“In terms of introduction to the virus within households, we’ve seen residents who may acquire the infection at work and then spread to their household members,” said the health unit. “The infected person may unknowingly carry it to their workplace settings, thereby commencing transmission chains.”
The median age of those infected is 37, which is unchanged in the last few weeks.
And in Windsor-Essex, 18 new cases were reported Monday, seven of them in the agri-farm industry and one in manufacturing.
Deonandan said it’s likely that the probability of being exposed to COVID-19 is higher in these regions, which helps explain why they aren’t at Stage 3 yet.
“There’s also something to be said for the kinds of neighbourhoods and economic situations and jobs that maybe people in these areas have,” he added. “This disease has a way of revealing the truth of inequities in our society. Look at the way that it’s revealed the way certain ethnicities are more likely to get the disease. It has nothing to do with biological susceptibility and everything to do with social susceptibility. I suspect we’re seeing a bit of that here.”
The Western provinces
Alberta has experienced a gradual increase in cases since the province’s “permissive” Phase 2 reopening in the middle of June, says Jim Kellner, an infectious disease expert and professor at the University of Calgary’s Cumming School of Medicine.
The province was down to a single-digit rise in cases in early June, but in the past week, Alberta reported 120 new cases on Thursday and another 105 on Friday.
“We haven’t seen numbers like that since May,” said Kellner. “The most striking thing is the age distribution.”
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Overall, 36 per cent of Alberta’s cases have been in the 20-to-39 age group, but in the last week, he said that figure has risen to 44 per cent. In Canada, it’s 27 per cent.
“A lot of the more permissive recommendations and guidelines have especially been taken up by the younger population, especially at social gatherings,” said Kellner.
In Phase 2, Alberta opened businesses including massage parlours, movie theatres, gyms, swimming pools and bingo halls.
But the biggest change was the size of gatherings, says Kellner, including “household cohorts” — as the province calls them — of up to 15 people and outdoor gatherings of up to 200 at events such as weddings, festivals or sporting events, as long as social distancing was maintained.
The province also allowed some groups such as sports teams and artistic performers to be in cohorts of up to 50 people, with the idea that social distancing would be maintained but recognizing that wouldn’t always happen, says Kellner.
“And I’m sure maintaining social distance, going to restaurants and in outdoor gatherings and indoor gatherings, has been a challenge,” he said.
The province has universal testing and tests anywhere from 7,000 to 9,000 people a day. Results for symptomatic people are received in 24 hours, while those who are nonsymptomatic get results in about four days. Alberta also has robust contract tracing.
The government has divided the province into 42 areas, based on population; an area goes on a “watch” if active cases exceed 10 or if the number of cases exceeds 50 per 100,000, says Kellner. The government hasn’t said what restrictions it will reimpose if the number of cases gets too high, he says.
“The only way we could tolerate having such a high number,” he said, referring to the number of cases based on population, “is to have good testing and contract tracing.”
In the last 10 days, Saskatchewan has also seen an uptick in cases, which have been as high as 50 on a recent day, a big number for a province with a total of just 943 cases to date.
“That is a concern,” said Nazeem Muhajarine, an epidemiologist and professor in community health and epidemiology at the College of Medicine at the University of Saskatchewan. “That does tell us that we have to be vigilant and the virus is out there.”
The province hasn’t been as forthcoming with data as Alberta or Ontario, and Muhajarine said that makes it difficult to know where the outbreaks are occurring and in what age groups.
But as of last week, Saskatchewan introduced universal testing and he says there is aggressive contract tracing when cases are identified.
As in many other jurisdictions, Muhajarine said the fall and school reopening are still a big concern. The province has organized a small think tank of experts to comb through emerging evidence around the world for best practices in places where schools have reopened.
Cases have remained low in B.C. and Manitoba.
Around the world
Brazil now has 2,098,389 cases of the virus, second only to the U.S., but the actual number may be much higher because of a lack of testing, according to media reports.
The outbreak began in the northwest part of the country, where it affected Indigenous communities, before spreading to major cities such as Rio de Janeiro on the coast and nearby São Paulo, the country’s financial centre, where a number of makeshift hospitals have been built.
Nearly 80,000 people have died in Brazil, compared to more than 140,000 in the U.S., which has more than 3.8 million cases.
South Africa is now the fifth most affected country by COVID-19, after India and Russia, with 364,328 cases, after being ranked eighth less than a week ago. Close to 23,000 new cases have been identified in the last two days.
The World Health Organization said Monday that cases increased by about 30 per cent in the last week, according to media reports.
Large increases are also occurring in Madagascar, Namibia and Botswana, although the numbers there are lower than South Africa’s, and WHO experts fear it’s the start of an acceleration of the disease in Africa.
This content was originally published here.