By Cecilia Nasmith
The sheer numbers of COVID cases produced by the all-but-unstoppable transmissibility of the Omicron variant has forced the province and the Haliburton Kawartha Pine Ridge District Health Unit to attempt new ways to handle a pandemic that will soon enter its third year.
The currently active 550 cases in Northumberland County might easily be twice that, Medical Officer of Health Dr. Natalie Bocking said at this week's media scrum, though that is only her gut feeling. With the change in testing protocols and capacity, there is no way to know accurate numbers. And whatever is reported is almost certainly a significant underestimate.
But judging from the information they do have access to, the HKPR region is looking at the highest rolling seven-day average it has ever seen – 509 per 100,000 population. Test positivity is also the highest it has ever been at 18%, which is slightly under the provincial number and significantly lower than the 30% seen at some health units.
The 16 current outbreaks that do fall within health unit jurisdiction include eight in long-term-care or retirement homes, two in correctional institutions and four in group homes or congregate-care settings.
“We are not declaring general community outbreaks or other community-location outbreaks, just higher-risk settings,” Dr. Bocking said of the shift forced by the Omicron numbers.
Each media scrum brings a spotlight on the disease's epidemiology over the past 14 days – which, in this case, covers the period of time in which Omicron became the dominant variant.
Over that time, nine people have been admitted to HKPR hospitals and only four patients are known to be in ICUs.
Eight of the nine admissions were people who had two shots, Dr. Bocking said.
“We know two doses of COVID-19 vaccine, while still providing some protection against severe illness, does not provide the same level of protection as it did against the Delta variant,” she said – hence the need for booster doses.
These are early days for boosters, with a rate of just 37.5% for those eligible recipients aged 18 and over. The percentage rises to 60% when you look at the population aged 70 and older.
Because Pfizer is being recommended for those aged 12-29, anyone aged 30 and older getting a booster will get Moderna unless they can prove a solid reason for getting Pfizer (such as an allergy situation). This is not a bad thing, Dr. Bocking said.
“There is data indicating a booster dose of Moderna might actually have slightly better protection of longer duration.”
Changes in policy direction for both PCR testing – done at a proper assessment centre with actual lab work done to determine results – and the rapid tests are the result of a vast shortfall in the capacity to provide both kinds.
The rapid tests have a lower level of accuracy than PCR testing, Dr. Bocking recalled, so their advice for a long time was, “get the gold standard – go for the PCR.” Now both kinds of test are almost exclusively reserved for priority populations, such as severely immunocompromised individuals and frontline essential workers.
And while a COVID-positive rapid test once would customarily require the subject to have the diagnosis confirmed with a PCR test, she added, this is no longer possible except in certain specific cases.
While Dr. Bocking is waiting to hear when the province might expect a more reliable supply of rapid tests – and how they will prioritize and strategize their distribution – she shared the updated case- and contact-management guidelines.
There are no longer enough health unit staff to do the level of case and contact management that would be needed in a time when more than 100 new cases pop up each day. And this does not even take into account those who get a positive result on a rapid test at home, where there is no requirement to report the case to public health and no mechanism to do so.
Nowadays, health-unit staffers focus on cases in high-risk settings and outbreaks. If you get a positive diagnosis and it does not fit these criteria, the case goes to a provincially supported system for follow-up.
For the average person who does not work at a hospital or long-term-care setting, who does not have another immune-compromising medical condition, and who is fully vaccinated, the current direction is to isolate at home for five days – you and everyone in your household, regardless of his or her vaccination status. If you are not vaccinated, isolation time increases to 10 days.
And you are asked to do your own contact tracing, reaching out to anyone you were in close contact with over the 48 hours prior to your experiencing COVID symptoms to let them know of their exposure. These high-risk contacts do not have to stay home, but at least should be self-monitoring
“The guidance around this is continuing to evolve, and we want to make sure all the resources on our website are updated and clear for the different scenarios people are facing,” Dr. Bocking said.
Health-unit-led mass-immunization clinics are gearing up, and 40,500 appointments will be made available through Feb. 4 on the provincial booking site, along with 8,900 appointments for five-to-11-year-olds – a population that currently can only boast a one-shot rate of 39%.
And if for any reason you cannot book one of these appointments, Dr. Bocking reminds you that pharmacists are offering the shot (as are certain health-care practices) so look around.
The doctor commented on the new provincial restrictions that went into effect on this day of the health unit's 46th weekly media scrum.
“I know this was very challenging and disappointing for people to hear,” she acknowledged.
“Nobody wants to be in this situation, and unfortunately these measures, we do know, will help stop and interrupt the transmission of COVID-19 in the community.
“At this point in time, we are not looking to stop the transmission. At this point in time, we are looking to mitigate or decrease the impact on our acute-care system.”
This impact is not solely a matter of increased patients but also a problem of increased health-care worker absences.
When Delta was the big worry, Dr. Bocking recalled, there was good vaccine coverage and a dominant variant that was not nearly as transmissible. Omicron spreads at a rate that makes things totally different.
The nine admissions to HKPR hospitals is not a big number, but these are smaller rural hospitals so – proportionately – it adds up quickly. And in urban hospitals that serve a large, dense population, large numbers can be expected there as well.
Dr. Bocking always goes back to the basic measures we all know by now, such as physical distancing, hand hygiene and well-fitted masks.
“If you don't need to be going out, you should be staying home,” she declared.
Along with adherence to these proven behaviours, Dr. Bocking also encouraged hope.
“From what I have heard and understand from other jurisdictions, we hope it will peak within the next two or three weeks. By the end of January, it really should start to come back down.”
It all hits at a gray time of year, she said, which makes it seem worse.
“But we know a number of weeks from now, it's going to look very different. Day by day, things are going to look different.
“Get outside if you are able to. Go for a walk if you are able to. Find other ways to connect with family – we have all become very good at virtual. Go back to those things that help you feel healthy and well.
“We have demonstrated and proven we can get through this.”
