Why warnings of a deadly 3rd wave in Canada may have gone unheeded

If premiers had heeded warnings about variants and exponential growth, public health experts say, Canada wouldn’t be seeing this record-breaking third wave of COVID-19.

'The writing was on the wall,' said epidemiologist Kirsten Fiest

Chief Public Health Officer Theresa Tam looks on at the start of a technical briefing on the COVID pandemic in Canada, Friday, January 15, 2021 in Ottawa.
Chief Public Health Officer Theresa Tam looks on during a briefing on the COVID-19 pandemic in Ottawa on Jan. 15, 2021. Tam warned in February that new variants of the novel coronavirus could cause a third wave. (Adrian Wyld/The Canadian Press)

It was a Friday in February and Canada's COVID-19 situation seemed to be improving. The second wave had crested. Just over 3,000 cases were reported countrywide that day, Feb. 19, down from a peak of 8,766 six weeks earlier. 

Dr. Theresa Tam, however, came to a virtual news conference with a warning. New variants of the novel coronavirus threatened the country's progress.

"We've been saying all along that if we ease measures too soon, the epidemic will resurge even stronger. But with highly contagious variants in our midst, the threat of uncontrolled epidemic growth is significantly elevated," Canada's chief public health officer said.

"These variants have been smouldering in the background and now threaten to flare up."

Tam released modelling that took variants into consideration for the first time. One graph showed cases growing exponentially. It said that the number of new cases could shoot up to 10,000 per day by late March if provinces kept the same restrictions in place, or increase even further and faster to 20,000 per day by mid-March if restrictions were relaxed even more. 

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Coronavirus variants spread as 2nd wave eased, analysis shows

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But some businesses shuttered during the second wave — including restaurants and bars in Alberta and retail stores in much of Ontario — had already reopened. And despite Tam's warnings, those two provinces and Quebec loosened restrictions throughout March.

All were forced to quickly backtrack by late March or early April. One of the possibilities forecasted in Tam's modelling had materialized: variants spread widely and cases skyrocketed.

Lockdowns and public opinion

This may have happened because politicians weigh the advice they get from scientists with public opinion, according to Mark Pickup, an associate professor of political science at Simon Fraser University who's studied the politicization of COVID-19 in Canada and the U.S. 

"Public opinion is not always going to be lined up with the best scientific advice. And so the politicians are trying to balance those things off," Pickup told CBC News. 

"And, of course, politicians are fallible. That's known by everyone."

Wherever there is ambiguity — like with mathematical models that forecast a range of different possibilities — there's room for policy-makers to insert their own opinions and ideology, he added.

But epidemiologists say the situation was avoidable.

"The writing was on the wall," said Kirsten Fiest, assistant professor and director of research and innovation at University of Calgary's Department of Critical Care Medicine.

"It was almost inevitable that what we're seeing now was going to happen. Warnings weren't heeded early on and they haven't been since, frankly."

A mobile health unit is shown on the grounds of Sunnybrook Hospital during the COVID-19 pandemic in Toronto on April 30, 2021. (Nathan Denette/The Canadian Press)

In a media interview in February, Fiest cautioned that a third wave was possible in Alberta if businesses were opened up too soon and the spread of new virus variants was not controlled.

"I did, didn't I? And here we are."

Ontario and Alberta are now the provinces hit hardest by third waves, with cases and hospitalizations coming close or surpassing peaks seen in December and January.

Canadian Armed Forces teams and out-of-province health-care workers have flown into Ontario to relieve pressure on hospitals. And Alberta health-care workers are being briefed on triage protocol in case they need to ration life-saving care.

While daily death counts haven't come close to the highs seen in December and January, about 2,000 more Canadians have died since March 1.

Spokespeople for Alberta Premier Jason Kenney and Health Minister Tyler Shandro did not respond to questions sent by email. 

A spokesperson for Ontario's Ministry of Health said the government has "never hesitated" to take action to stop COVID-19. 

"The third wave is driven by variants, which continue to enter the country and province through international travel and represent a significant threat to the health and wellbeing of Ontarians. Our government continues to request that the federal government take immediate action at Canada's international borders," Christian Hasse said by email.

Policy caused third wave: epidemiologist

Dr. Nitin Mohan, a physician-epidemiologist and assistant professor at Western University's Schulich School of Medicine and Dentistry, said policy decisions, "or lack thereof," created Canada's third wave. 

Restrictions were lifted too early, Mohan said, and some provincial governments failed to bring in policies like paid sick leave that would suppress workplace outbreaks.

On March 1, Alberta announced that libraries could open and fitness studios could host low-intensity classes like tai-chi and yoga. A week later, restrictions were also eased on malls, retail stores and youth sports.

Quebec announced on March 3 that restaurants, gyms and houses of worship would open everywhere except greater Montreal. Three weeks later, gyms in Montreal were allowed to follow suit.

One gym in Quebec City went on to become the site of one of the largest superspreading events in Canada. More than 220 people were infected at the gym, another 356 cases were linked to the outbreak, and one member died.

Patrons dined in at Hunter's Country Kitchen in Carstairs, Alta., as the province began easing restrictions in February. (Jeff McIntosh/The Canadian Press)

Ontario lifted a stay-at-home order and opened retail stores in the hard-hit areas of Toronto and Peel on March 8. Premier Doug Ford's government also upped restaurant capacity in red and orange zones, and allowed restaurants to serve on patios in Toronto and Peel. 

Within weeks, doctors and experts were calling for urgent action.

Epidemiologists with Quebec's public health agency said new rules were needed to control the spread of variants at a media briefing on March 26.

Ontario was "being led down a very dangerous path," 153 intensive care unit (ICU) doctors wrote in a letter to Ford, his health minister and chief medical officer of health, on April 1. 

An association of Edmonton-area health-care workers also wrote to their premier that day. 

"The recent rapid increase in active COVID cases in Alberta represents the predicted third wave which will dwarf what we saw in December if urgent and competent action is not taken," the letter said. 

It was happening because of the more transmissible B117 virus variant, because individuals weren't following rules, and because of the government's "premature relaxation of existing COVID-19 precautions which has encouraged super-spreader events," the doctors said.

Restriction whiplash

It wouldn't be long before loosened restrictions were tightened again.

Quebec put three regions into strict lockdowns April 1 and strengthened rules in Montreal and other red zones April 6. Gyms in Montreal were only open for 12 days before being forced to shut their doors again. 

Also on April 1, Premier Kenney acknowledged that the third wave had started in Alberta, saying that in the race between variants and vaccines, "variants are winning." 

Five days later, he said that Alberta would move back to step one of its reopening plan. And on Thursday, Kenney announced even more measures, like the closing of junior and senior high schools in some communities, as cases hit a new high.

In Ontario, the story was the same. The whole province moved back into lockdown April 3.

Even British Columbia, which had allowed indoor dining since May 2020 and hadn't tightened any restrictions since November, had to change course. The province announced a three-week lockdown on March 29, which the government now says will last until May 25.

Mohan said he believes provincial leaders either don't understand the information they're given or willfully disregard scientists' warnings. 

"It's one of those two scenarios," he told CBC.

"We knew what was coming here. There's no surprise. So we know what is going to help us prevent a fourth wave. And that is almost entirely related to the public health measures."

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