Health·Second Opinion

Canada is 'playing chicken' with COVID-19 by reopening while variants are spreading widely

Much of Canada is lifting lockdown measures and reopening risky indoor settings while experts warn fast-spreading coronavirus variants threaten to jeopardize recent progress and trigger a brutal third wave.

Canada's top doctor says to be 'very cautious' about easing restrictions as provinces move to re-open

A bar is set up by staff in preparation of re-opening as some COVID-19 restrictions are lifted in Winnipeg on Friday. Experts say the number of variant cases will likely continue to grow as the economy, including restaurants, reopen. (John Woods/The Canadian Press)

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven't subscribed yet, you can do that by clicking here.

Much of Canada is lifting lockdown measures and reopening risky indoor settings while experts warn fast-spreading coronavirus variants threaten to jeopardize recent progress and trigger a brutal third wave.

On the same day Manitoba announced its first case of the variant initially detected in the United Kingdom, the province also said it would reopen restaurants, gyms, places of worship, museums, art galleries, tattoo parlours, nail salons and libraries.  

That variant, also known as B117, is estimated to be at least 50 per cent more transmissible and potentially more deadly and led to strict lockdowns in countries like Denmark, Ireland and the U.K., where it quickly became a dominant strain. 

Alberta, which already has 149 cases of B117 and seven cases of the variant first identified in South Africa, also decided to reopen restaurants, bars and gyms this week despite the rapid rise in variant cases.

"It's kind of like we're playing chicken with COVID, which never struck me as being a great idea," said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton. 

"There's been enough demonstrated risk from the variants being able to become dominant strains over a period of time in multiple jurisdictions that I would have preferred to hold steady and monitor for a period longer." 

Meanwhile, those variants have caused a surge in cases so rapid in Newfoundland and Labrador, the province has imposed new lockdown measures and cancelled in-person voting for today's election.

An election campaign sign is shown in St. John's on Thursday. The outbreak has led to a lockdown of Newfoundland and Labrador, and the suspension of in-person voting across the province. (Paul Daly/The Canadian Press)

Balancing return to 'normal' with threat of variants

Saxinger says that while Alberta and other provinces have done an effective job of monitoring for the variants as they emerge, she expects the number of variant cases will no doubt continue to grow as the economy reopens.

"Opening indoor dining is a mistake — plain and simple," said Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at Unity Health Toronto. 

"It's pretty obvious that if we just went back to normal there would be a third wave and it would be absolutely brutal."

Dhalla says officials are trying to answer the tricky question of how close to normal they can get, while trying to balance keeping cases low in the face of fast-spreading variants. 

"Nobody knows the answer to that question with certainty, but I think everything we've seen over the last year tells us it's better to err on the side of caution," he said. 

"The prudent thing to do would be to go slow and see what happens after a few weeks."

Despite keeping its provincewide curfew in place, Quebec has also begun reopening businesses, museums, hair salons and malls — even though gathering in them will not be permitted.

Ontario also began rolling back restrictions this week, lifting stay at home orders in much of the province, allowing for non-essential businesses and even ski hills to reopen, while committing to further loosening measures in the coming weeks. 

"This is not the time to really begin pulling back on restrictions," Dr. Gerald Evans, chair of infectious disease in the department of medicine at Queen's University in Kingston, Ont., told The Current this week.

Signs for COVID-19 protocols are displayed as skiers and snowboarders hit the slopes at Mount Pakenham ski hill in Eastern Ontario as the business reopens on Thursday. (Sean Kilpatrick/The Canadian Press)

"Our expectation, when we look at the experience of other countries that have had that variant introduced, is we're going to see a rise up in numbers and so you don't want to complicate that by now suddenly rolling back restrictions." 

The decision to loosen restrictions in Ontario came at the same time health experts warned in a provincial scientific briefing that the spread of variants threatened to trigger a third wave of the pandemic, which could in turn lead to a third lockdown.

"We need to be watching how this unfolds and how it plays out before we make too many changes all at once," said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto. 

"The overall numbers look to be going down, but these variants are emerging and they will likely emerge rapidly and our ability to control transmission might change with that." 

Outbreak in Newfoundland sparked by B117

In a cautionary tale for the rest of the country, health officials in Newfoundand and Labrador confirmed late Friday that a massive outbreak of COVID-19 in St. John's this week was caused by B117, leading strict lockdown measures to be reimposed.

The province reported 50 new cases of COVID-19 Friday, with the vast majority in the St. John's region. Thousands of people are in isolation, while others faced renewed lockdown measures that shuttered schools and non-essential businesses.

Bruce Chaulk, the province's chief electoral officer, announced during a press conference Friday that in-person voting in all 40 districts across the province had been suspended and the election would be solely by mail due to the outbreak.

"We know that if not controlled, it becomes a predominant strain within weeks of first appearance," said Dr. Janice Fitzgerald, the province's chief medical officer of health.

"This is concerning and serious. But we have the ability to overcome it."

There are 260 active cases in the province, with 244 of those reported in the last five days. In contrast, the province had 395 total cases of COVID-19 in all of 2020.

"I actually worry more about those areas that have been spared through most of the pandemic," said Hota.

"You don't know what it's like to deal with COVID until it hits you — and it hits hard." 

WATCH | Provinces reach for mix of reopening, COVID-19 precautions:

Provinces reach for mix of reopening, COVID-19 precautions

3 years ago
Duration 2:39
Three provinces — Ontario, Quebec and Alberta — have announced the easing of restrictions, some immediate, some phased in. Strict measures have reduced COVID-19 caseloads and some experts warn relaxing them could bring another spike in cases.

'Mixed messaging' between health experts, provinces 

All of the provinces that moved toward reopening this week cited reduced caseloads as reasoning for their strategies, despite the fact that cases of the variants continue to rise. 

At least three provinces have confirmed community spread of the variants and there have been more than 450 variant cases in Canada to date.

But at the federal level, dire warnings about reopening amid the spread of variants seems to conflict with what's happening on the ground.

"Resurgence will happen really fast, so this is the time to be vigilant against the variants," Canada's Chief Public Health officer Dr. Theresa Tam said during a press conference Friday. 

"We need to really be very cautious about easing public health measures at this time while vaccination is just beginning to accelerate." 

Dhalla says there's a growing disconnect between provincial politicians and medical officers of health across the country, which is only adding to confusion for the public. 

Customers enjoy indoor dining at Hunter's Country Kitchen in Carstairs, Alta., Monday, as Alberta begins a plan to ease restrictions. (Jeff McIntosh/The Canadian Press)

"I think what we're also starting to see is a little bit of mixed messaging again," he said.

For example, in Toronto — where a stay-at-home order is in place until at least Feb. 22 — the medical officer of health said this week the city was on the verge of a "new pandemic" due to the spread of variants in the city, which has already found cases of variants first identified in the U.K., South Africa and Brazil. 

"It was inevitable the variants of concern would emerge in Toronto," Dr. Eileen de Villa said during a press conference.

"We are in a position of great uncertainty with respect to variants but what we know is alarming. I understand the value of preparing for the time we can lift restrictions. From a public health perspective in Toronto, that time is not now." 

Threat of variants kept restrictions in some provinces

British Columbia said last week it would be extending its public health restrictions indefinitely, despite recent signs that the province is driving transmission down even with at least 40 cases of variants detected. 

"Right now, we need to stay the path," Provincial Health Officer Dr. Bonnie Henry said. "We need to protect the progress we have made and not squander our progress."

A Vancouver waiter delivers wine to masked diners outdoors. In B.C., restrictions on gathering with people outside your household that were imposed in November remain in place with no end date. (Ben Nelms/CBC)

New Brunswick is another province sticking with strict public health measures despite having just four confirmed cases of B117. Parts of the province are under lockdown and non-essential travel discouraged in other regions.

"They are going to come to New Brunswick, if they're not already here," said chief medical officer of health Dr. Jennifer Russell of the variants late last month after measures were imposed.

"We are in the middle of the second wave right now, but the third wave is going to be upon us very soon and that third wave is much worse than the first and second combined and this third wave is as a result of these new more transmissible, more contagious variants."

Dr. David Fisman, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health, says Canada is already starting to see the early warnings of a surge driven by variants and his research predicts a third wave could come as early as March.

"[B117] is doing here what it's done in Denmark and the U.K. — the new strains are starting to outcompete the old strains," he said. "Even though it's a small minority of strains, they're spreading better here than the old variants are spreading." 

Saxinger says stronger action needs to be taken "extremely early" to prevent a devastating third wave from variants in Canada and hesitating to act could jeopardize our ability to drive case numbers down — even with strict public health measures that have worked in the past. 

"The leash just has to be very, very short," she said. 

"Because there's no way we're going to have enough vaccines into all the vulnerable populations over the next few months to be able to avert preventable deaths if there's another big surge." 

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Adam Miller

Senior Health Writer

Adam Miller is a senior health writer with CBC News. He's covered health and medical science news extensively in Canada for over a decade, in addition to several years reporting on crime, politics and current affairs throughout Asia.

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