Tuesday, October 12, 2021  |  Category: Eduvation Insider

Inching Back to Normalcy?

Good morning! 

I hope you enjoyed a pleasant weekend, whether Canadian Thanksgiving, Columbus Day, or the first-ever Indigenous Peoples’ Day. (Sunday was also World Mental Health Day and World Homeless Day.) Who knows, perhaps you or someone you know ran the Boston Marathon yesterday, too.

Today, though, is apparently “Face Your Fears Day.” Maybe that means it’s time to check out the Maclean’s University Rankings 2022. Face your fear of a meteorite strike in your bed. Or perhaps you should join William Shatner, as he becomes the world’s oldest person (and the first graduate of both McGill U and Starfleet Academy) to go to “space” tomorrow. (Then again, I’m probably with those who argue Bezos’ Blue Origin tourist venture is a dystopian capitalist development unworthy of the idealistic values of Star Trek.)

But here, since it’s the beginning of a new week, it’s time to revisit the pandemic prognosis…

 

 

Pandemic Précis

Since my last Précis on Monday Oct 4 (“The Bigger Iceberg”), we’re seeing concerns of a post-lockdown surge down under…

 

Bated Breath in Australia

In Australia, New South Wales appears to be past the pandemic peak, while Victoria continues to struggle. As vaccination rates rise, NSW plans to reopen restaurants and schools this month, and raise caps on gatherings. (Sydney eased restrictions yesterday.) Queensland hit 70% vaccination and has reported zero community cases this week, but hospitals in small communities are nonetheless sounding “code yellow” capacity alarms. If state governments lift all COVID19 restrictions once they achieve 80% vaccination, uSydney modellers project that Australia could hit 40,000 new cases a day, and exceed 500,000 cases within a month. (Epidemiologists are urging a slow, gradual reopening.)

 

“It’s just so irresponsible to have an open slather approach when your health system is already under terrible strain, and you have a large number of people who are not vaccinated. The idea of letting COVID rip is utterly ridiculous and completely irresponsible.” – Sandy Donald, VP Together Union Hospitals, Queensland Australia

 

 

Disaster Delayed in NZ

Jacinda Ardern did an exemplary job guiding New Zealand through much of the pandemic, pursuing a “COVID Zero” policy of extreme lockdowns and airtight borders, enforced quarantine and aggressive contact tracing. Unfortunately, though, with 80% of the population still unvaxxed, any lessening of border restrictions was guaranteed to unravel the approach once the Delta variant came ashore. In effect, she has only postponed the health disaster. (China is now the only major country still pursuing COVID Zero.) New Zealand has now announced it will introduce vaccine passports next month, for large events and high-risk settings.

 

Hope in Brazil?

Throughout this pandemic, the only politician I have criticized more than Alberta premier Jason Kenney and Florida Governor Ron DeSantis is Brazilian president Jair Bolsonaro, who continues to rant against lockdowns and masks, and spread vaccine misinformation. Brazil surpassed 600,000 COVID19 deaths on Friday, but finally the infection curve is easing as 70% of the population has received a first dose, and daily deaths from COVID19 have dropped 80% since their peak in April. Apparently the disastrous spread of the Gamma variant (P.1) provided some protection to Brazilians when the Delta variant finally arrived.  National Post

 

 

Things have been looking up (or less bleak, anyway) across most of Canada, just in time for Canadians to feel thankful…

 

Reason to Give Thanks?

For the first time in months, new COVID19 case counts are declining across Canada overall, thanks largely to Ontario and Quebec, and widespread adoption of vaccine passports and mandates. (Challenges remain in some provinces, though – see below.) The fourth wave of the pandemic appears to be receding, and the reproductive rate (Rt) has fallen below 1 for the first time since July. CMOH Teresa Tam credits a successful vaccination program, and continued public health restrictions. “The efforts we’ve made give us reason for optimism, but we must remain mindful for the need for continued caution in the months ahead.”

 

“I think you can envision a world in 2022 where things start normalizing… those signs are there that we’re slowly inching back to where we want to be, but we still have a ways to go.” – Nitin Mohan, Global Health Systems prof, Western U

 

 

Stalling Vaccinations

As of Sunday, 72% of the Canadian population is fully vaccinated against COVID19 (82% of those eligible), but the picture varies from a low of 56% to a high of 76% (in NL and the Yukon). Most provinces are between 71-75% (in ascending order: MB, ON, NB, BC, NWT, QC, NS, PEI), but the laggards include Alberta and Saskatchewan (at just 64%) and Nunavut (at 56%). Low-vax regions (typically rural) are particularly at risk for more outbreaks, as are those that vaccinated earliest (see below).  Canada Vaccine Tracker

 

Setback in NWT

The Northwest Territories reported zero COVID19 cases for most of the summer (May 22 – Aug 15), but since restrictions started to lift in mid-August, cases have “exploded” and overwhelmed a healthcare system that “wasn’t up to par.” Last week, NWT was reporting record-high COVID19 case counts and the highest rate of active cases in the country. By the weekend, cases were rising 10% per day, at a rate higher than every US state(except Alaska). The bulk of cases are in the Yellowknife region, and the CMOH suspects waning immunity is a driver (see below). Yesterday, an outbreak of 8 cases was declared at the NWT legislature, too.

 

BC Gets Defensive

Premier John Horgan admits that British Columbia has “unacceptably high case counts and disconcerting numbers of hospitalizations,” but insists the surge was “unavoidable” – even though Ontario managed to minimize the fourth wave by leaving mask mandates and capacity limits in place. Deena Hinshaw, Alberta’s CMOH, admitted that BC, AB and SK worked together on summer reopening plans that dropped masks, removed gathering limits, and celebrated victory over the pandemic. (Prematurely, I would argue.)

 

“All of the stuff works better if you do it proactively rather than reactively, and that seems to be a big problem for BC, attitudinally.” – David Fisman, Epidemiology prof, uToronto Dalla Lana School of Public Health

 

 

AB “Turning the Corner”?

New modelling suggests that the fourth pandemic wave may finally be cresting in Alberta, and that COVID19 infections and hospitalizations may continue to decline – so long as existing restrictions remain in place, and vaccinations continue apace. (Contact tracing was largely dropped in early August, but hospitalizations have started to improve in the wake of the state of emergency declared Sep 15. Vaccinations have increased since premier Jason Kenney finally announced a vaccine passport program.) Hospitals are still operating well over their normal ICU capacities, some 8,500 surgeries have been postponed, and demand for rehabilitation services is surging. Alberta Health Services reports that 80% of discharged COVID19 patients returned within a month this summer, and ~17% were readmitted to hospital – suggesting a potential increase in “long-COVID” cases.

 

Vaccinopia in Saskatchewan

As we entered the Thanksgiving weekend, Saskatchewan was adding new COVID19 cases faster than any province in the country, stretching ambulance services thin, cancelling ~3,000 surgeries, and breaking records for hospitalizations – but the government nonetheless refused to impose caps on gathering sizes, despite pleas from epidemiologists and Saskatoon city council. (Critics accuse Scott Moe’s government of “vaccinopia,” an inability to look beyond vaccines as the sole solution.) In the past 2 weeks, the per capita death rate in SK has been 21x higher than NS.

 

“Scott Moe has not been responding to COVID19 as a public health crisis or a public emergency. He’s responding to an economic inconvenience.” – Murray Mandryk, Columnist, Regina Leader-Post

 

 

Misinformation in MB

Maxime Bernier’s People’s Party of Canada managed to increase its share of the popular vote in the federal election, despite being overtly anti-mask, anti-vax, anti-science and even physically violent toward Justin Trudeau. The PPC gained ground in particular in small communities in southeastern Manitoba – the same regions where vaccine uptake has been particularly slow (like, 25% or even less). The PPC gained 50% or more of votes in some historically Mennonite communities, and saw a substantial increase from the 2019 election thanks to pandemic pushback. Family doctors in southern MB are reporting invasions of privacy, “veiled threats” and confrontations with anti-vax patients who have fallen prey to misinformation and “ludicrous conspiracy theories,” and are demanding unjustified medical exemptions. “It’s become a very, very hostile community to work in.”

 

Ontario Lets Loose

In many ways, Ontario never did exhale this summer – we maintained mask mandates, physical distancing and capacity limits on most events and venues, and kept bans on indoor dining and fitness clubs longer than most provinces. But the upside of that cautious approach has been a relatively gentle fourth wave (so far), leading premier Doug Ford to relax some restrictions on retail and hospitality businesses. Just in time for the Thanksgiving weekend (and the premiere of the latest James Bond film, and the season openers for the Toronto Raptors and Maple Leafs), the province announced that theatres, sports venues and television studios could all reopen at full capacity, provided that proof of vaccination was provided by everyone there, and masks continue to be worn indoors. Indoor gatherings of up to 25 people were permitted for Thanksgiving, without masks or distancing, provided everyone was fully vaxxed. Restaurants and bars are outraged, of course, that they still cannot operate at full capacity. (While they require proof of full vaccination, nobody wears masks when they sit down to eat or drink.)

 

Locking Down NB

New Brunswick is now wrestling with 1,037 active cases of COVID19, leading premier Blaine Higgs to impose 2-week “circuit-breaker” lockdowns in 3 regions, and limiting Thanksgiving gatherings to single households. (Schools will stay open, but extracurriculars paused. Businesses can continue to serve those who show proof of vaccination.) The province also announced mandatory vaccinations for most government employees, and staff in LTC homes, schools and childcare facilities, by Nov 19. Hospitalizations in NB are projected to double within a month, if contact rates don’t drop “dramatically.” Two major health networks plan to move hospitals to “red alert” COVID19 levels this week, banning visitors.

 

Cases on Campus

Most CdnPSEs are reporting only confirmed COVID19 cases (not mere rapid tests), and only when transmission occurred on campus, or a cluster of cases suggests a possible outbreak. Since last Monday, though, more cases have been reported on campus at McMaster and UPEI, and at Cambrian College on Oct 4and Oct 7. (Fallout from Homecoming street parties across the country, and Thanksgiving travel and gatherings, is still surfacing.)

 

 

Pandemic Prognosis

Most CdnPSEs are outwardly hopeful that campus life will gradually return to some sort of quasi-normal for the winter term, starting in January 2022, with the majority of courses taught F2F. (Some recent announcements include uWindsor, Niagara College, and Fanshawe College, for example.) But how certain can we be about planning 3 months ahead in the turbulence of this pandemic? There are several reasons to suspect the marathon between vaccination and variants won’t be over by January…

 

Flu “Twindemic”

Thanks to COVID19 precautions, closed classrooms, and changes in social behaviour, influenza “practically vanished last year” across the US and Canada. (Almost 200 US children died of the flu in 2019-20, but just 1 died last year. Alberta saw zero confirmed flu cases last year.) Now, as restrictions lift, schools reopen and people relax, PHOs are sounding the alarm about a potential “twindemic” of COVID19 and influenza this winter. Because so few of us were infected last year, we’ll have less natural immunity, and hospital specialists already struggling to keep up with pediatric spikes in COVID19 and Respiratory Syncytial Virus, will be overwhelmed if flu and COVID19 infections rise together. The WHO is already reporting a clear rise in influenza cases worldwide. Experts urge the public to get vaccinated, not only against COVID19 but also against influenza. (At least, a new UK study has found that it is safe to administer both shots simultaneously.)  Washington Post  |  CBC  |  CTV

 

Nursing Shortages

Healthcare systems around the world have been strained by the COVID19 pandemic, particularly where ventilators, oxygen supplies, and respiratory therapists are concerned. Now, as hospitals and nursing homes begin to implement strict vax mandates and lay off thousands of vaccine-hesitant staff, the labour shortage is poised to become even worse. Hospitals in Ontario have already begun laying off unvaxxed workers. BC will begin unpaid leaves this week. Quebec has 25,000 unvaxxed healthcare workers, and is offering $15,000 signing bonuses to attract 4,300 nurses.  National Post  |  CP24  |  Global

 

Unvaxxed Kids

The biggest gap between the “total” and “eligible” populations are children under 12 – who may not be as likely to suffer severe COVID19 illness, but are nonetheless potent little incubators and transmitters. Children are responsible for growing infection rates in many jurisdictions, and as cases rise, more suffer chronic “long COVID” consequences. Pandemic modelling in BC shows children are now most at risk, and account for “nearly 50% of unvaccinated residents in the province.” (That’s why the province reinstated a K-12 mask mandate, and why the BC Teachers Federation is asking the premier for a provincewide vax mandate for teachers – although premier John Horgan is still rejecting that idea, leaving the decision up to local trustees.) Alberta has reinstated contact tracing and rapid testing in K-12 schools, and will resume public reporting of school outbreaks. (Edmonton Public Schools are calling on the province to close all schools for 2 weeks as a “firebreak.”) In Hamilton ON, ~39% of active COVID19 cases are among children and youth, and 120+ cases have been confirmed at public schools. McMaster Children’s Hospital is already running at over 100% capacity, and has been planning for ICU expansion and a potential surge in admissions. In New Brunswick, “more than a dozen schools” were closed last week due to COVID19 infections. So far, no vaccine has been approved for Canadian children, but Pfizer/BioNTech has now submitted paperwork for emergency use authorization of “Comirnaty” in children aged 5-11 to the US FDA, and plans to submit to Health Canada “in just days.” (Their clinical trial data is drawn from 2,268 volunteers aged 5-11.) The FDA could grant EUA for children “within a matter of weeks,” but it will take time to roll out – and half of US parents remain reluctant to vaccinate their children. In BC, parents can now register their children for COVID19 vaccination, “although it is unclear when the shot for children will be approved.”

 

“This school year is different from the last thanks to the power of vaccines… But the fourth wave of COVID19 continues to threaten our healthcare system – and our youngest residents cannot get vaccinated yet.” – Jason Kenney, Premier, Alberta

 

 

Short-Lived Immunity

I’ve already mentioned that third “booster” shots of the COVID19 vaccine have been authorized for many at-risk populations, based on studies that demonstrate waning immunity after about 6 months. Last week The Lancet published new data looking at waning immunity in 3.4 M recipients of the Pfizer vaccine. Overall, effectiveness against infection declined from 88% in the first month to just 47% after 5 months – not because of the Delta variant, but simply because of waning immunity over time. (Effectiveness against severe illness and hospitalization remained high, though, at 90%.) The CMOH claims the Northwest Territories, an early vaccine success story, was already seeing breakthrough infections drive cases back up in mid-September, due to waning vaccine effectiveness. The Ahousaht Nation in Maaqtusiis BC may also be experiencing waning immunity: 92% of eligible people were vaccinated back on Jan 6, but now (8 months later), the community has been back in lockdown for 2 weeks with 50+ cases of COVID19. (Alberta has already approved booster shots for First Nations, Inuit and Métis people aged 65+.)

 

The rest of Canada may face resurgent infections due to waning immunity by late October, depending upon the date of vaccine uptake. Within weeks, we may no longer be able to consider 2 doses “fully vaccinated”…

 

“When you look at Israel, when you look at the UK, when you look at the US, you have to factor in, unfortunately, waning immunity 6-8 months after people who received the second dose. Be prepared.” – Kami Kandola, CMOH, Northwest Territories

 

 

Delta is Deadlier

uToronto researchers report that, compared to the original COVID19 strain, the Delta variant caused more serious disease among Ontarians, increasing hospitalizations 108%, ICU admissions 235%, and deaths 133%. (The Alpha, Beta, and Gamma strains were 52% more likely to require hospitalization, 89% more likely to require ICU care, and 51% more likely to cause death.) Hospital physicians have been reporting that COVID19 patients are arriving much sicker with Delta this year than last year. Waning immunity and evolving variants are “dimming the light at the end of the pandemic tunnel,” but on the bright side, “Delta probably contains the seeds of its own destruction.” (Because it is so virulent, Canadians will either have been infected or immunized by Christmas.)  CBC  |  National Post

 

Long COVID

Drawing on data from 274,000 US COVID19 patients, Oxford U researchers have found that one-third of those infected continued to experience symptoms 3-6 months after diagnosis. The “long tail” of 9 symptoms varied significantly depending on age, gender, and initial disease severity, but impacted heart, lungs, liver, kidney, spleen, pancreas, blood vessels, GI tract, and brain. Men were more likely to experience breathing difficulties and “brain fog,” while women and younger patients were more afflicted by headache, muscle pain, abdominal symptoms and anxiety or depression.  World Economic Forum

 

 

I’ve been reluctant to lend any oxygen to conspiracy theories, but increasingly mainstream media outlets have been reporting on the “Wuhan Lab” hypothesis lately. (As The Atlantic puts it, “suspicions that the outbreak started from a laboratory accident remain, shall we say, endemic.”)

 

Lab Leak Leak?

An unsuccessful $14M DARPA grant application, leaked last month, shows that an international team of researchers was proposing to create an artificial coronavirus in 2018 by synthesizing consensus candidate genomes from a panel of closely related viruses and essentially creating “an average genome” that would appear natural. DARPA apparently rejected the proposal, in part, for inadequate ethical and regulatory safeguards for “gain-of-function” research. The research consortium was to include UNC, Duke NUS in Singapore, and the Wuhan Institute of Virology – and notably, Peter Daszak, who has ridiculed lab leak hypotheses and participated in 2 major investigations into the pandemic’s origins. (The US National Institutes of Health did approve $3.3M to fund a 2014-19 study into bat coronavirus, by the WIV and Daszak’s EcoHealth Alliance, although that grant was abruptly cancelled in spring 2020.) One anonymous WHO genetics expert says that if SARS-CoV-2 was in fact produced artificially, it could explain why no close ancestor to the virus has yet been found in nature, and why there were zero pre-pandemic infections found in animals in Wuhan. Other virologists disagree, saying that the DARPA proposal could not have resulted in a novel coronavirus at all. The document fits the “gain-of-function experiment gone wrong” story so well that it might just be “too good to be true.” Regardless, we should remember that “not all virologists are comic book villains” – the goal might have been to create an “average” virus as a starting point to ultimately develop a pan-coronavirus vaccine.  National Post  |  The Atlantic  |  New Yorker  |  UK Times  |  Wall Street Journal  |  Newsweek  |  UK Daily Mail  |  UK Telegraph

 

 

Readers Write

 

Competing Service Areas

I mentioned last week the large service areas of the College of New Caledonia (117,500 sq km in BC), and later added that Collège Boréal serves much of Ontario, from Timmins through Toronto. (Not sure what the sq km would be, but the province is 1.076 million, according to Google.) That prompted reader Rachel Ouellette to remind me that Northern Lakes College serves 164,000 sq km in northern Alberta, from 25 locations!

 

(So OK, who’s next?)

 

 

#ICYMI

uMontréal released 2 new commercials last week, in French and English versions, worth a look…

 

Icon for the World

uMontréal released a 1-min spot last week (this is the English version) that integrates dynamic shots that emphasize a high-tech institution full of “people driving change” and the UM brand as a “symbol of unity, growth, and ambition.” Images of a runner and a lesbian kiss seem to underscore the freedom of brand Canada and “a space to find your path,” and uMontréal as “an icon for who we are, what we do, and where we want to be. An icon for the world.”  YouTube

 

 

As always, thanks for reading. (Sorry this was another long one!) I hope your (short) week gets off to a smooth start!

Please do drop me a line if you spot something interesting, thought-provoking or cool happening on your campus, or elsewhere in the world!

Stay safe and be well!