Friday, April 8, 2022  |  Category: COVID-19, Eduvation Insider

Sixth Wave or Tidal Wave?

Good morning, and TGIF!

Today is a day for Silence, Zoo Lovers, and Pygmy Hippos – none of which inspire today’s subject. (Tomorrow is National Unicorn Day, which sounds pretty inspiring, especially compared to Sunday’s International Safety Pin Day. But no. If you want inspiration, check out the UofA video below, ICYMI.)

More to the point, yesterday was the WHO’s World Health Day, and believe it or not, just as you think the pandemic is in the rear-view mirror, there’s enough happening on that front to warrant our attention again. Several ONpses have announced that they will extend vaccine and mask mandates through the Spring and Summer, even as provincial governments and most other PSEs relax. Cases and hospitalizations are soaring, just in time for the biggest explosion of in-person convocations EVER.

So today we pivot from the metaphorical “Spring Fever” of April Fool’s Day to a much more literal one…

“COVID is not in the rear-view mirror. We’ve let our guard down so much we are making it easier for COVID to spread.” – Brian Conway, medical director, Vancouver Infectious Disease Centre

Omicron Evolves

You may recall that I took a whole month off the topic of COVID19 between Feb 28 (when I described the gradual “Pandemic Twilight”) and Mar 28 (when unfortunately it was becoming clear we would see a “Spring Wave”). Over the past 2 weeks, things have moved just a tad faster than I expected, thanks to a combination of irresponsible public behaviour and some incredibly capable new strains of the virus…

Omicron Can Recur

Quite a few cases of COVID19 reinfection have been explained as a result of new, more contagious variants like Delta and Omicron. Those most at risk from Omicron BA.2, besides those with no vaccination or previous infection, are those previously infected by the Alpha or Delta variants. But more and more evidence is surfacing that Omicron infection provides only short-lived immunity against reinfection – and moreover, some researchers believe small, undetectable amounts of the virus may hide dormant in the body and “reactivate” if the person gets run down. “It’s not like the chicken pox. It is not a one-and-done situation,” warns Winnipeg epidemiologist Cynthia Carr. But at least the good news is that most reinfections are milder cases.  Winnipeg Free Press  |  CBC

“People think because they had Omicron at Christmas they are OK, but the immunity provided by Omicron infection is not great and decreases over time.” – Julie Lajoie, virology research associate, uManitoba

Omicron XE

COVID19 updates are being released more often than those for Microsoft Windows, and the naming conventions are starting to sound like Jaguar sportscars. We’ve gotten used to the idea that Omicron BA.2 is a more transmissible sublineage that has quickly become dominant around the world, and a booster shot is required to stave off infection. (BA.3 has been spotted in the wild, but doesn’t seem to be spreading far.) But now, Omicron XE is a recombinant strain that mixes the BA.1 and BA.2 subtypes. It was first detected in the UK back on Jan 19, and by mid-March some 600 XE cases had been identified. The WHO warns that XE appears to have a 10% growth advantage over BA.2. (Researchers have also recently named 2 other recombinants, XD and XF, which combine Omicron and Delta.) As we’ve said before, most new variants do not substantially change the direction of the pandemic, which could still have 3 possible outcomes: COVID19 as a flu-like seasonal illness, as an endemic cold-like virus, or as a recurrent threat requiring updated vaccines and widespread boosters. (That third, worst-case scenario, could mean up to 300,000 more US deaths over the coming year.)

Lowering our Defenses

It’s been a confusing month across Canada as the timing of changes to health rules has varied across provinces, regions and institutions. Overall, though, it’s safe to say – as the Montreal Gazette puts it – “people have let their guard down.” (Heck, even Tim Horton’s is back to allowing reusable cups…)

Relaxing Mandates

Every Canadian province except Quebec and PEI has now lifted blanket mask mandates. I stopped tracking and reporting on CdnPSE announcements when it seemed inevitable that they would all drop vax and mask mandates by May. Ontario universities made a collective announcement that vax and mask mandates would continue until the end of the Winter 2022 term, but most have since indicated they will be dropped in May. (Lately we’ve seen such announcements from Algonquin College, uGuelph, La Cité, Laurier, uOttawa, Queen’s,uToronto, Ryerson, and Carleton.) Some institutions are dropping vaccine mandates, but not maskingrequirements, for the Summer 2022 term – including uManitoba. Somewhat paradoxically, at the same time that vax mandates are dropping coast to coast, we hear that uWaterloo fired 49 unvaxxed employees (at least 1 a faculty member).

“We can now sense that spring’s arrival is upon us, and that nature, including us, is emerging from the winter blanket we call the Big Sleep.” – Claude Brulé, president, Algonquin College

No Longer Reporting Cases

In December, as the Omicron wave overloaded PCR testing capacity in Ontario, the province told most people to start using rapid antigen tests – which are so unreliable that the government doesn’t even bother collecting data about their results. (Some preprint studies have found rapid tests are just 37% accurate at detecting Omicron.) As a result, daily case counts are almost meaningless, and campus reporting is problematic. uOttawa was among the CdnPSEs that stopped reporting campus cases back in January.  Carleton U stopped reporting cases last week – after tallying 270 cases in March – “in line with most Ontario universities.” (Across town though, Algonquin College was still reporting as of Apr 7.) Carleton faculty and staff union leaders are “surprised and concerned” by the decision, which makes it difficult for people to assess their own health risk on campus.  Ottawa Citizen  |  The Charlatan

“Society hasn’t been through an informed consent process for the mass infection event we are presently undergoing.” – Joe Vipond, Kashif Pirzada, & Malgorzata Gasperowicz, ER doctors and biology researcher

Keep those Dashboards!

Likewise, the ACHA urges institutions to keep their COVID19 reporting dashboards going, to provide transparency when reinstatement of mask mandates or testing is required. “With a dashboard, the numbers are clear, showing severity, spread and safety protocols across many data points.” Princeton U (NJ) has just streamlined its site to provide 8 weekly indicators, despite having 98% of its campus triple-vaxxed. (Princeton recently softened its mask mandate and dropped to monthly testing.)  University Business

“We talk about wanting to learn to live with COVID, but you can only do that if you’ve learned something and you use what you’ve learned.” – Dick Zoutman, infectious disease specialist, Queen’s U

Convocations In-Person

Back on Mar 18, I observed that a torrent of 21 CdnPSEs from coast to coast had announced in-person convocation ceremonies for this Spring (albeit sometimes with contingency planning should PHO restrictions change). Not only that, but many were planning 3x as many ceremonies, to accommodate postponed celebrations for the classes of 2020 and 2021 – making April-July 2022 one of the busiest convocation seasons ever!  In the past 3 weeks, I’ve seen at least 9 similar announcements at UBC, Brock U, Dalhousie, uManitoba,Mohawk College, NAIT, Red River College, Ryerson U, and Yukon U. (TBH I was ignoring these much of the time, so we’re up to at least 30 CdnPSEs and counting.)

I’d like to believe those convocations will be able to proceed as planned, and that we won’t come to regret our embrace of the return to “normal,” but the pandemic has repeatedly frustrated all efforts at optimism…

The Sixth Wave

Two weeks ago, I warned that Canada’s 6th wave of the pandemic was coming this Spring, and sure enough it’s here…

The Inevitable Surge

We knew that lifting masking requirements and capacity limits would inevitably cause a surge in COVID19 infections, and the rapid spread of the Omicron BA.2 variant has fuelled it even more. Back on Mar 30, Quebec’s Institut national de sante publique confirmed a 6th wave had already begun in that province. Ontarioexperts called the 6th wave even earlier, and now Peter Juni estimates that Ontario is seeing 100,000-120,000new cases a day, based on wastewater monitoring results (even though only 4,224 positive PCR tests are being reported). But elsewhere, much of the country remains in denial. Alberta is seeing rising wastewater levels and hospitalizations, and many doctors and scientists are declaring it a 6th wave – but the government says it’s too early to say for sure. Saskatchewan, likewise, remains in denial: CMOH Saqib Shahab will admit only to “a bit of a resurgence.” Despite what sure looks like a wave, BC experts say no 6th wave is in the offing either. New confirmed cases in Nova Scotia are up 67% this week. The latest projections are that Canada could see 300,000 new daily infections in May, assuming that all health restrictions remain dropped. In theory, hospitalizations and fatalities should not rise commensurately – they have been “decoupled” by vaccination and prior infection. But of course, without reliable data it’s impossible to predict the 6th wave precisely. Experts in BC are concerned that the province’s primary early-warning system now depends on either weekly wastewater testing, or hospitalization numbers themselves. (Which is hardly an early warning!)

“This sixth wave is going to be a rockier wave, unfortunately I think, than the fifth wave that we’ve just been through.” – Noel Gibney, prof emeritus of critical care medicine, uAlberta

Hospitalizations are Rising

COVID19 hospitalizations are up 40% in Ontario this week, significantly exceeding projections that were based on only “moderate changes in behaviour.” Quebec is forecasting up to 265 new daily hospital admissions within weeks. While Alberta hospitalizations have subsided slightly, they remain about as high as any previous peak in the pandemic. Across Canada, there is definitely the potential for hospitalizations to spike, considering that half the population still doesn’t have a third shot, and those most at risk were boosted first – so their protection will also wane first. (There will be a mad dash to get our 4th doses just as soon as we can, but governments are still pretending that 2 doses make someone “fully vaxxed” – which is of course nonsense in a time of Omicron.)

Hospital Staff Shortages

Canada’s healthcare system may be overwhelmed soon, not just because an exponential spike in infections will drive hospitalizations shortly – but also because many of the frontline hospital workers are coming down with COVID19 themselves. In Quebec this week, ~11,600 healthcare workers were off work due to COVID19. Eight Toronto hospitals are already facing staffing challenges due to illness or quarantine. The Ontario Hospital Association says “widespread illness among health care workers due to community spread of COVID19 is directly impeding the ability of hospitals to operate normally at this time.” Here in London, infected hospital staff jumped from 53 to 273 in a single day – far more than the number of infected patients they treat. While premier Doug Ford insists “we have the beds,” the problem is “we don’t have the staff,” according to health experts. “There is no way we could ramp up to 3,000 ICU beds.” And morale is suffering even more, as hospital staff struggle with burnout and overwork: “the governments don’t really have our back anymore. This is kind of a do-it-yourself pandemic.”

Years of Backlogged Surgeries

Ontario hospitals will have to start postponing or cancelling surgeries again, creating a pent-up crisis for months or even years to come. Analysis from Australia concludes that pandemic disruptions will triple elective surgery waiting lists in New South Wales for the next 5 years, even without any further cancellations. It won’t be sufficient to simply return to pre-pandemic operations: “if we want to clear this monster elective surgery bottleneck, it will require a huge injection of new funding.” (Ambulance shortages have also been critical in Australia this month.)

Playing it Safe

In response to skyrocketing case counts and rising COVID19 hospitalizations, many voices have urged a return to mandates, and some PSEs have done just that…

Opposition Demands Masks

In Ontario and Nova Scotia, opposition politicians and healthcare professionals are calling on their governments to reinstate mask mandates and expand on PCR testing, as case counts rise. Peter Juni, of Ontario’s COVID19 Science Advisory Table, has been calling loudly for the mask mandate to be reinstated, and warns that we’ll have a “tidal wave” of infections without widespread masking.

Provinces Refuse to Backtrack

Under Ontario’s “Reopening Act,” local PHOs no longer have the authority to impose restrictions without permission of the provincial CMOH. So PHOs and medical experts across the province are publicly saying “removing the mask mandate was a mistake to begin with,” and that masks should be mandatory in public spaces effective immediately. But with an election mere weeks away, the Ford government unsurprisingly will not entertain talk of reimposing health restrictions unless hospitalizations spike. “Let’s talk about that – if God forbid that ever happens – at the time,” says Doug Ford. (The province recently released its “Plan to Stay Open,” whose title pretty much says it all.) More than 100,000 new cases a day were “not unanticipated,” and this is just “a little spike” – although it’s exponentially larger than at any previous time in the pandemic. CMOH Kieran Moore hasn’t held a press conference, nor responded to media inquiries, in a month. And of course, Ontario is not unique: provincial governments across the country claim to be confident their hospital systems can cope with this spike – although they also won’t specify the threshold at which that might change. Nova Scotia premier Tim Houston asserts he’s “not anywhere near… hitting the panic button” to start requiring masks again.

“Ford’s government has painted itself into a corner, doubling down on a ‘manageable spike’, which several weeks ago I said would backfire: we’d get a raging wave just in the run-up to the election.” – Colin Furness, epidemiologist, uToronto

Quebec Extends Masking

This week, the Quebec government announced it will extend its mask mandate until at least Apr 30 (not Apr 15 as previously planned), due to rising infections and hospitalizations, and healthcare worker absenteeism. (No idea whether that decision was aided by premier François Legault testing positive back on Mar 24.)  Globe & Mail

“I’m not a psychic. What’s being predicted is that in the next two weeks, there will be an increase in cases, in hospitalizations. There may be a possibility that (cases) will go down after, but there are no guarantees, so we will follow the situation week by week.” – François Legault, premier, Quebec

uVic Struggles with Masks

uVictoria’s senate voted Mar 24 to reinstate the campus mask mandate, just 2 weeks after the administration lifted it – but the uVic board of governors ultimately rejected the senate recommendation. “This is literally a life and death situation for some people,” lamented a faculty association spokesperson. (The BC Human Rights commissioner has written PHO Bonnie Henry to urge a return to mandatory masking.)

Johns Hopkins Clamps Down

In response to ~100 new cases of COVID19 in less than a week since Spring Break, Johns Hopkins U (in Maryland) has reinstated a mask mandate in indoor common areas, and instituted twice-weekly testing for all undergraduates. (JHU is a top medical-doctoral university which has become the world’s go-to source for real-time data on the pandemic.)  Inside Higher Ed

Masks Stay on at ONtech

Ontario Tech U announced Apr 6 that masks will remain mandatory in campus buildings “until further notice,” although proof of vaccination requirements will “pause” on May 1. “If we need to extend or reinstate either or both of these directives at any given time, we will not hesitate to do so to keep our campus safe.”  Ontario Tech

Through Spring at Conestoga

Conestoga College announced Apr 6 that its campus vaccine and mask requirements will stay in place throughout the Spring 2022 semester, despite the decisions of the province and many ONpses to lift or pause them. Case counts are rising, COVID remains “a significant global threat,” and these measures will keep campuses and the most vulnerable safe. “We will continue to monitor conditions and re-evaluate requirements over the coming months.”  Global  |  CTV  |  Conestoga

“COVID is still a significant global threat. Key indicators suggest that Ontario has now entered a sixth wave resulting in up to 30,000 – 35,000 new infections each day.” – John Tibbits, president, Conestoga College

Until Fall at Brock

Brock U announced Mar 31 that its mask and vax requirements will remain in effect throughout the summer, due to rising infections and hospitalizations in the region. The decision “will be re-evaluated regularly in the coming months and a separate announcement regarding the Fall 2022 Term will be made over the summer.” Rapid antigen tests, procedural and KN95 masks will be provided to students, staff and faculty through the Spring and Summer terms. (Niagara College, however, plans to suspend its vax and mask mandates by Apr 30.)  Brock U  |  CTV  |  St Catharines Standard

“I hope Brock University can serve as a role model for other organizations in maintaining masking requirements and vaccination policies as we experience the current surge of infections.” – Mustafa Hirji, Acting MOH, Niagara Region

Normally I wouldn’t burden you with a pandemic précis on a Friday. (Heck, I thought I was done with this subject for months.) But I didn’t think this information could wait. To improve the mood, I urge you to check this out…

#ICYMI

As a tribute to the frontline healthcare workers who will be taking the brunt of this politically-fuelled sixth wave, here’s an outstanding music video from uAlberta Med students that underscores the challenges of the application process, while conveying their enthusiasm and support…

UofA for your MD-ee-ee

Last week, uAlberta Medical School released a brilliant 8-min Taylor Swift parody created by the MD Class of 2025, for incoming med students at their Multiple Mini Interviews weekend. “This video acknowledges the challenging path to medical school admissions and aims to bring light humor to the application process.” Parodying the refrain of “Wildest Dreams,” students sing about their “Med School Dreams” – “Will you consider me? I wanna wear a white coat, diagnose some strep throat, please.” Students anxious for their grades, and “checking their emails every day, day, day, day, day” just need to “Shake It Off” (of course). “Now can’t you see that we’re the school that understands you… You’re a doctor to be-ee-ee, UofA for your MD-ee-ee.” Full disclosure, I’m a Swiftie myself, but this vid gave me goosebumps repeatedly. And I’m not surprised it has 31,000 views already. Nicely done!  YouTube

As always, thanks for reading!

Have a great weekend, stay safe and be well,