Why some docs think Alberta's reopening should factor in second COVID-19 shots
EDMONTON -- The plan to turn Alberta from the COVID-19 hotspot of North America to fully open in eight weeks is aggressive, some Edmonton doctors believe.
They used that word – aggressive – individually and repeatedly during interviews with CTV News on Wednesday after hearing the province's plan to ease restrictions according to vaccination and hospital rates.
The plan could see Alberta fully open by July if 70 per cent of its eligible population is vaccinated with one dose – or leave its hospital system and public vulnerable to a fourth wave in the fall, the doctors said.
"It's senselessly aggressive in terms of the timing, and it's reckless in terms of the reopenings that are being discussed," Dr. James Talbot commented, speaking on behalf of the Edmonton Medical Zone Staff Association's pandemic planning committee.
In part, he and his committee co-chair, Dr. Noel Gibney, think that because of the pace at which the plan moves through phases while the public is only partially protected by either a first dose of vaccine or prior infection.
Premier Jason Kenney expects demand for first doses to fall halfway through June, but no part of his government's reopening plan is dependent on the number of Albertans fully immunized.
- READ MORE: 'Truly near the end': Alberta announces 3-stage reopening plan linked to vaccinations, hospitalizations
However, the doctors noted, only Stages 1 and 2 of reopening are tied to decreasing hospitalization numbers and the Edmonton zone continues to take COVID-19 patients from northern communities with lower hospital capacity. They pointed to the presence of the B.1.617 variant first identified in India in four of Alberta's five health regions. The B.1.617 variant is considered 50 to 60 per cent more transmissible than the variant first identified by the United Kingdom, and less responsive to currently available vaccine.
"Put that into a situation where a significant proportion of the population haven't had their second shot, and really people are not taking any precautions, and at the same time, we're moving into this best summer ever," Gibney said, "this is an ideal situation where I think we would find ourselves sometime late September, October, dealing with the start of a fourth wave."
- READ MORE: Alberta doctors call province's reopening plan 'reckless,' predict a spike in cases
- READ MORE: Easing restrictions with a partially vaccinated population will be 'tricky,' expert says
ALBERTA'S PLAN COMPARED TO OTHER PROVINCES
"I don't think that's it's made up," infectious diseases specialist Dr. Lynora Saxinger said of Kenney's plan, "but I do think that it seems fairly, I guess, either optimistic or aggressive – depending on how you want to phrase it."
Alberta's plan appears among the most ambitious of the Canadian provinces. To the west, British Columbia has already kick started the reopening process. Like Alberta, its plan unfolds according to first-dose vaccination rates, but unlike Alberta, doesn't publicly specify COVID-19 hospitalization targets. And whereas Alberta projects the earliest it could be fully open – without mask mandates or gathering caps – is July, the earliest B.C. predicts this happening is after the September long weekend.
Saskatchewan is eyeing moving to the second step on June 20 – which will mark three weeks since having 70 per cent of its population 30 or older vaccinated with one dose.
Meanwhile, Ontario plans to move much slower and enter Step 1 mid-June. Each step will be separated by at least three weeks. Similar to Alberta and B.C., Ontario's Step 1 will be triggered by a 60 per cent first-dose vaccination rate amongst adults. The plan differs at Step 2, whose threshold is a 70 per cent first-dose vaccination rate and 20 per cent of the adult population fully vaccinated. A quarter of adult Ontarians would need to be fully immunized before it would relax most rules.
Ontario's plan most aligns with advice from the Public Health Agency of Canada earlier in May that Canadians could resume normal summer activities, save events with large crowds, if 75 per cent of the population had received one dose and 20 per cent had received a second shot.
And Manitoba – which the Edmonton doctors pointed to as an example of being struck by a surge in variant cases – on Thursday brought in new public health orders.
Saxinger said, "Looking at the experience elsewhere, once you get above 50, 60 per cent immunized, it does change the shape of things fairly significantly, but I think there's a couple of wild cards we need to keep in mind."
Variant strains are one such wild card, she said, as are geographical pockets of lower vaccine uptake. Using hospitalization admissions as a trigger, which can lag two weeks, Saxinger said, may also create a situation of higher community transmission while the plan moves forward.
'IT'S NOT A RACE': DOCTOR
That Alberta will potentially reopen faster than other provinces – perhaps in time even to welcome international guests at the Calgary Stampede – was criticized by the NDP.
Kenney said vaccine and hospital rates are just the public-facing metrics of his plan, which also takes into account occupied ICU beds and natural immunity at an estimated 14 per cent.
"It's very important for us when we're putting out a policy framework like this to, as much as possible, keep it simple. Underlying these two metrics of hospitalizations and first dose vaccination is a lot of other statistical analysis," the premier told reporters on Wednesday.
His health minister, Tyler Shandro, also defended the plan by asking the public to not overlook the phased process.
"Let's talk facts here and remember that Step 1 is a thoughtful and safe and moderate step," he told CTV News.
"It strikes me as being very political rather than being scientifically based," Gibney told CTV News Edmonton.
His colleague, Talbot, added: "I can't speak to the motivation or the private thoughts of people but I can tell you what the virus thinks."
"To put it in terms that as a microbiologist make sense to me, we were the last jurisdiction except for Manitoba to bring this thing under control and we're going to be the first to hand the reigns back to the virus so it can take control again."
They suggested Alberta could have separated its stages with more time, like four weeks, or taken more steps before fully opening, or included second dose rates in the step triggers.
Gibney said: "It's not a race as to which province can do this the fastest. And I'd remind any viewers out there that three weeks ago, Alberta had the highest rates of new cases per day of a population of any province or state in North America."
- READ MORE: 'It'll crash tremendously': Alberta now leads Canada and U.S. in per capita COVID-19 cases
- READ MORE: 'We're in a lot of trouble': What's happening in Alberta as it shatters multiple COVID-19 case records?
He is skeptical Alberta can hit the reopening plan's targets even as they are outlined.
"And I suspect that if they don't meet those targets, rather than not move to the next step, they'll change the targets."
On Thursday, Chief Medical Officer of Health Dr. Deena Hinshaw said Alberta could announce the rollout of second doses as early as next week.
"We are looking closely at our available supply and shipments and we expect to be in a position soon to shorten the wait time between first and second doses," Hinshaw said. "I expect that by early summer we will be able to offer second doses to the majority of Albertans in order to have not just that first dose but second dose."
She explained the Open for Summer plan — which she says she supports — focused on first doses because that is Alberta's immediate target but called full immunization an "essential and integral part of the plan."
As of Thursday, Albertans at risk not having a protective response after one dose, like people on regular dialysis treatment, can book their second dose, Hinshaw announced.