By Cecilia Nasmith
That faint cry of “I told you so” that you hear is coming from COVID-19 – which, in spite of the lifting of public-health restrictions, is far from done with us.
“Just in case we forgot that, the COVID-19 virus is here to remind us,” Haliburton Kawartha Pine Ridge District Health Unit Medical Officer of Health Dr. Natalie Bocking said at Wednesday's media scrum.
Dr. Bocking spoke of “the continued moving pieces of this pandemic” which, over the past two weeks, are adding up to higher numbers in the key indicators they rely on. For example, wastewater-surveillance data show increased viral presence in both the Lindsay and Cobourg monitoring sites.
“Cobourg wastewater surveillance has demonstrated a very steep climb in virus activity to the point that it is at the highest point since we started monitoring for viral signals,” Dr. Bocking stated.
“It is actually five times higher than what it was at the peak of the Omicron wave in January.”
Then there are the lab-confirmed tests that are only available to such qualifying individuals as front-line health-care workers. Two weeks ago, they might see 15 a day. That number has virtually doubled to 25 to 30 a day.
And because lab-confirmed tests are not available to the general public, she added, that can be considered “just the tip of the iceberg of actual case activity,” since it takes no account of individuals testing positive on home tests (or those who are experiencing symptoms but have no access to a home test).
The number of outbreaks they are monitoring has grown to five from two – and Dr. Bocking reminds everyone that this does not take into account any outbreaks in settings that they do not monitor.
Test positivity rate, which had fallen to 8%, is back up to 12-13% - “not as high as some of the regions that are back up to 20%, but it's another indicator that it's on the upward climb.”
Hospital admissions had slowed. Current indications show they are starting to increase again.
“We fully expect over the next three or four weeks, we will continue to see an increase in hospital admissions across our whole geographic region,” she predicted.
The rise is fueled by two main drivers – the loss of preventive public-health measures as the province lifts capacity limits and masking mandates, and the new BA2 subvariant that has mutated to become even more transmissible than the Omicron variant. And it's well on its way to becoming the dominant variant in Ontario.
“While we certainly all hoped the fifth wave would be our last big wave and we would have a longer period of time to catch our breath, I think it's fair to say we have entered another wave,” Dr. Bocking said.
“We are seeing a surge equivalent to a wave, and the question now is how large will this wave be.”
The big difference between this and previous waves is that no provincial public-health mandates are in place, and it is up to individuals to use what tools there are to blunt its impact on the health-care system.
“None of these things are surprises – vaccinations, staying home when sick, masking, avoid or limit social gatherings, and the basic other routine measures like hand washing and covering coughs,” she listed.
“Without a doubt, vaccines continue to be one of the most important tools we have available to prevent severe illness from COVID-19. Of the 29 deaths (in HKPR jurisdiction) since January 1, over 50% were among individuals who were unvaccinated,” Dr. Bocking said.
“We know that the vaccines do work well at preventing severe illness, and we have very good data locally, provincially, nationally and globally to demonstrate this.
“We do have good coverage, but there's always room for improvement.”
The scrum came only a few hours after the province announced the more general availability of a fourth shot (or second booster dose) for the population beyond those most vulnerable (due to risk factors such as congregate living conditions or immune-compromising health conditions).
The guidance is that anyone over the age of 60 (as well as anyone aged 18 and older who is of the First Nation, Inuit or Metis community) is eligible. A five-month interval since the initial booster (or third shot) is recommended, but there should be a three-month gap in any case.
Pharmacies and some primary-care providers will offer the shots, and health-unit clinics are being organized that will be announced on their website.
And Dr. Bocking hopes individuals will choose to protect themselves and others – the aged or immune-compromised people you may live with or who are family members of people you work with – by getting up to date on your shots and keeping those other tools in mind.
Stay home if you are sick, “even if it's just a tickle or you're not sure what it is. Stay home and do a rapid antigen test. If it's negative, wait 24 hours and do another one before engaging in any broader gatherings,” she recommended.
“Masking continues to be a very easy and effective tool that we have to prevent COVID-19 transmission.
“And I strongly encourage people to reconsider what social gatherings you are currently attending, and try and limit or avoid larger gatherings which are bringing a large number of people from different households together in an indoor space. We know there's a lot of COVID-19 activity in our community. If you live with someone who's more vulnerable to severe illness, if you work with individuals who are more vulnerable to severe illness, then please be aware and consider what gatherings you are attending.”
As we begin to wrap our heads around living alongside COVID and recognizing that it won't be going away, we can't disregard the harm it can do or its ability to stress our health-care system to the point that surgeries are cancelled and desperately needed treatments are unavailable.
And now we have to find an accommodation that does not include provincially directed public-health measures.
“It behooves all of us to be aware when COVID activity is high, and taking those steps to protect each other. And when it goes down, we can back off on some of those measures,” Dr. Bocking said.
In answer to a question that was raised, she recalled the time when two shots might qualify one as “fully protected.” The the Omicron variant hit, and the best protection came with a booster on top of that.
She avoids the term “fully protected” in favour of “up to date,” which she defines as being as fully protected as it is possible to be with the current vaccines we have and current official guidance as to their administration.
“Until now that meant booster doses. Now, for many individuals, it's a second booster dose,” she said.
Dr. Bocking said data they have access to is mostly no help in confirming the widely reported news that the new variants are increasing pediatric cases of COVID-19. But she does know that the HKPR district has seen five hospitalizations of children since January 1, “which is more than what we have seen in previous waves.”
Vaccine uptake among 5-to-11-year-olds is necessarily drive by their parents. In Northumberland County, only 32.64% of this age group has both shots.
“We know access wasn't the defining challenge here. Many parents were wanting to wait until they felt more comfortable with this vaccine and to understand its impact in this age group,” Dr, Bocking said.
“I think our challenge a health-care providers, moving forward, is to continue to communicate with parents in a way that makes sense and continue to build confidence in this vaccine.”
