Wednesday, August 04, 2021

Opinion: Alberta playing Russian roulette by removing public health measures

Author of the article: Ubaka Ogbogu, Lorian Hardcastle

Publishing date:Aug 03, 2021

Effective August 16, 2021 mandatory masking orders on public transit, taxis and ride sharing will be lifted in the province of Alberta. Alberta is the first province in Canada to end these orders. PHOTO BY LARRY WONG /POSTMEDIA

Last week, Dr. Deena Hinshaw, Alberta’s chief medical officer of health announced that by mid-August, Alberta will remove public health measures, including contact tracing, masking in public transit, isolation for those who test positive, and testing for those who are asymptomatic or with mild symptoms. This announcement comes at a time when the province is riding a fourth wave of the pandemic, with cases and hospitalizations rising and a significant proportion of the population partially vaccinated or unvaccinated, including children under 12.

This latest move is nothing like the earlier easing of restrictions such as limits on gatherings, business closures, and physical distancing. The latter were controversial largely because they affected economic and personal well-being. Now that the more contentious restrictions are gone and the province is “open for summer” and beyond, it is unclear why the government chose to abandon basic public health measures like contact tracing and isolation, which do no more than serve to detect and stop the spread of COVID-19 and which have limited impact on the economy and individual liberties.

Alberta is the only jurisdiction in North America, and perhaps even globally, that has eliminated all of these “boots-on-the-ground” public health measures. The approach makes zero sense for a virus that has killed or affected millions and which has the potential to mutate into deadlier, more contagious variants. Worse, it is even more nonsensical from a public health surveillance perspective. By not tracking and mitigating spread, the government has given a deadly virus free rein to live undetected and undisturbed among us. Bluntly, it is government-approved Russian roulette.

The government rationalized this decision based on our vaccination rate. However, Alberta is among the provinces with the fewest number of people who have received their first dose and we are nowhere near achieving herd immunity. There are many who remain unvaccinated, including children under the age of 12. Several American jurisdictions are currently struggling under the weight of pediatric COVID cases following the relaxation of public health restrictions, which could be a sign of things to come in Alberta. There are also questions surrounding the efficacy of available vaccines against variants.

Yet, the government is blazing a trail that other jurisdictions with similar vaccination rates and lower disease incidence have not even considered. This is not just irresponsible and irrational, it reflects utter disregard for the well-being of many, including children and those ineligible for vaccination, and businesses, which rely on these basic public health measures to meet their legal responsibilities to provide safe workplaces.

Besides, even if we achieve herd immunity through vaccination, it makes eminent sense to keep tracking the disease for public health surveillance purposes, to prevent spread to those who cannot be vaccinated, and to detect the emergence of variants.

Another interesting development has been a passing of the baton from the minister of health and premier to the CMOH to manage the pandemic. While they have all insisted throughout the pandemic that Dr. Hinshaw is merely an advisor and that final decisions on public health measures and restrictions are made by the government, Minster Shandro did an about-face at a press conference last week.

He repeatedly referred to Dr. Hinshaw as independent and stated that the decision to remove public health measures was hers. This appears to be an attempt to present the decision as scientific rather than politicized, albeit a needless distinction for a decision that is evidently contrary to common sense and to well-established fundamentals of public health science.

Many public health experts are understandably outraged by the government’s decision to eliminate basic public health measures. This is because we all understand one thing: you cannot manage a global pandemic with little more than hubris and a role of the dice. The government must reverse course, or the consequences will be dire for Albertans.


If there is a lesson the pandemic has taught us, it is that we do not do enough to protect the most vulnerable in our society. The UCP government has clearly missed the class and lesson, and has shown repeatedly that it is unfit to lead the province through and past this pandemic.

Ubaka Ogbogu is an associate professor in the Faculty of Law at the University of Alberta. Lorian Hardcastle is an associate professor in the Faculty of Law and Cumming School of Medicine at the University of Calgary.


EVEN RIGHT WING TALK RADIO CHALLENGES KENNEY
Breakenridge: Why the rush in casting aside Alberta's remaining COVID-19 safety net?

Author of the article: Rob Breakenridge 
 • for the Calgary Herald
Publishing date: Aug 03, 2021 • 
Dr. Deena Hinshaw, Alberta's chief medical officer of health, gives a COVID-19 pandemic update from the media room at the Alberta legislature in Edmonton, on Wednesday, July 28, 2021. PHOTO BY IAN KUCERAK /Postmedia

While no one expected last week’s reappearance of Alberta’s chief medical officer of health to signal new restrictions, it still came as a surprise to hear of the further repealing of public health measures.


There is no doubt that vaccination has fundamentally changed the impact of COVID-19 and how we respond to it. But the Alberta government is being unnecessarily hasty in casting aside the measures we have in place to contain the virus.

We are only a month into this phase of no health restrictions and we are only about two weeks into this period of Delta establishing itself as the dominant variant in Alberta. It’s really hard at this point to make assumptions about what the next few months are going to look like. Nonetheless, we are pressing ahead with changes that seem rooted more in hubris than in common sense.

As of last week, we are no longer requiring isolation for close contacts of those who test positive for COVID-19. That was already the case for close contacts who are fully vaccinated, but it’s hard to understand why we’d be so indifferent about unvaccinated individuals exposed to a more contagious variant.

Later this month, however, we’ll be going much further. Never mind close contacts, there will no longer be a requirement for those who test positive for COVID-19 to isolate. This is baffling. Mind you, with the changes coming to testing, many infected with the virus won’t know for sure whether they have COVID-19.

In fact, we’re going to be ending most COVID-19 testing. All assessment centres will close by month’s end and testing will only be made available to those with severe symptoms. This is in stark contrast to efforts underway in the United Kingdom to sharply increase its testing in response to its current Delta wave.

It’s certainly the case that hospitalizations and severe outcomes are much more important metrics at this point. However, the case count, the R-Value and the positivity rate are all reliable indicators as to where things are headed.

We know that thanks to vaccines we will see fewer hospitalizations than we would have previously on a certain number of cases. But with enough infection, those numbers can still creep into problematic territory. Hospitalizations in Florida, for example, have now matched the peak from this past winter.

As much as Hinshaw was pleading last week for folks to get vaccinated, it’s somewhat at odds with the notion here that vaccine protection is sufficient enough to shed most remaining pandemic response measures.

It would have been much more sensible to link these plans to a target. There would have been much more buy-in if Hinshaw had announced, for example, “once we hit 80 per cent of eligible Albertans fully vaccinated, then we can drop most remaining testing and isolation measures.”

This would significantly bolster the odds of success of such a plan and also provide some additional incentive to ensure we can increase our vaccination rate.

There’s also some legitimate concern over timing here. We’ll be sending kids to school, unmasked (and unvaccinated for those under 12), just a couple of weeks after all of these changes have taken effect. At the very least, we should get a clear sense of how the return of school is going amid the spread of the Delta variant before making such decisions. Why is it so important that these changes occur in August rather than, say, October?

It’s not as though we can look to other jurisdictions to see how such an approach has worked, because it doesn’t seem like anyone else has gone down such a path. Maybe there’s a reason for that.

This is not to argue for the re-introduction of restrictions or lockdowns. That case simply isn’t there at the moment. Neither, though, is there a case for flying blind when it comes to this virus right now.

“Afternoons with Rob Breakenridge” airs weekdays 12:30-3 p.m. on 770 CHQR rob.breakenridge@corusent.com Twitter: @RobBreakenridge


THE CONSERVATIVE MIDDLE
Braid: With end to isolation and other measures, UCP takes risks for no good reason


In effect, the government is abandoning speedy pre-emptive effort to control local outbreaks

Author of the article:Don Braid • Calgary Herald
Publishing date:Aug 03, 2021 • 3 hours ago • 3 minute read • 36 Comments
Calgarians protesting the recent Alberta Health Services changes ending testing and restrictions for COVID-19 rallied at the McDougall Centre on Sunday, Aug. 1, 2021. PHOTO BY GAVIN YOUNG/POSTMEDIA

This is a COVID-19 story I know to be true because it happened to a close relative.

Several months ago he was working on a job site in Edmonton.

A fellow employee came to work one day after being tested. He received a positive result while still on the job — but stayed at work.

The majority of workers on the night shift caught COVID-19. The job was shut down.

Our relative was extremely sick for two months. Even now he has significant symptoms and has not been able to return to work.

That’s the cost of one inconsiderate person who ignored all the mandatory rules on self-isolation.

By Aug. 16, everything he did — and didn’t do — will be quite proper.

There will no longer be a mandatory 10-day order for self-isolation — just a limp encouragement to stay at home if sick.

The very thought goes against everything the government has been preaching for 16 months.

Even in the vaccine era, this strikes me as absurdly dangerous. It’s also unnecessary because the isolation rule does nothing to slow economic recovery.

In fact, mandatory isolation probably helps the economy by keeping work sites from shutting down. With the exception of characters like that employee, most people adhere to the rule as best they can.

The effectiveness of vaccines is the UCP government’s rationale for lifting all but a few very limited restrictions on Aug. 16.

But hundreds of thousands of Albertans are not vaccinated. They are vulnerable to a possible fourth wave of Delta variant infections that the government suddenly seems determined to discount and even ignore.

Young adults are among the least vaccinated. Eager for some enjoyment after all this (who isn’t?), many behave as if there’d never been a pandemic at all.

The watering holes along 17th Avenue S.W. were jammed shoulder-to-shoulder every night over the long weekend. It’s the busiest I’ve ever seen these familiar spots.

But why not, when the UCP normalizes COVID-19 as equivalent to seasonal flu because it has been tamed by vaccine? On Tuesday, Premier Jason Kenney called it “COVID flu.”

Starting Aug. 16, mass testing will also stop, even though it’s the only way to effectively keep track of daily cases.

People feeling sick will be urged to stay home but “testing will no longer be recommended for those with mild symptoms for whom a result will not change their treatment.”

By Aug. 31, public testing centres will shut down and responsibility will shift to “primary care centres including doctors’ offices.” Hospitals will continue to test acute cases.

Daily case numbers will obviously shrink along with the lower count. Useful comparisons between previous mass testing and the new counts (if they’re even released) will be impossible.

The only meaningful indicators will be COVID-19 hospital and ICU admissions. Those lag weeks behind infections.

Contact tracing has already been sharply curtailed. Those in close contact with sick people are no longer notified — the infected themselves are asked to do this. Tracing will only occur in high-risk settings.

In effect, the government is abandoning speedy pre-emptive effort to control local outbreaks.

The NDP is calling for a public inquiry. The startling changes have prompted four days of a new phenomenon — demonstrations in favour of continued measures.


Every one of these actions — cuts to testing and tracing, the end of mandatory isolation — could be reversed without hurting the economy or the drive to open society.


The government is embarked on a flat-out effort to diminish the pandemic in the public minds. Every question about the moves is dismissed as an effort to deny the science, even though many scientists are appalled.

And if the UCP turns out to be wrong, there will be far less public information to prove it.

Everyone wants this dreadful time to end. But ignoring and forgetting at a critical moment will only increase risks that are still with us.


Don Braid’s column appears regularly in the Herald
dbraid@postmedia.com



 DOUBLE TROUBLE

Alberta, Saskatchewan removing public health restrictions 'a bad mistake' right now, experts say

Neither province has reached herd immunity, lifting restrictions sends message pandemic is over

Saskatchewan lifted all public health restrictions on July 11. Alberta plans to phase out its restrictions by Aug. 16. (Graham Hughes/The Canadian Press

Getting rid of provincial COVID-19 restrictions and protocols is a mistake right now, public health experts say.

Saskatchewan was the first Canadian province to lift all public health restrictions last month, while Alberta plans to phase them out by mid-August.

But neither province has reached herd immunity, and the move sends the message that the pandemic is over — despite children not being immunized and data showing the delta variant is spreading among vaccinated people in other jurisdictions, experts say.

"This is a bad mistake at this time," said Dr. Ali Mokdad, professor and chief strategy officer of population health at the University of Washington.

Saskatchewan lifted all public health rules on July 11. Premier Scott Moe went all in on vaccines, saying his government doesn't want to control the spread of the novel coronavirus through government regulation.

Saskatchewan's health minister backed the move and urged residents to hold themselves accountable when it comes to self-isolating.

Saskatchewan Premier Scott Moe, left, and Chief Medical Health Officer Dr. Saqib Shahab, right, shake hands at the final regularly scheduled COVID-19 update on July 7, 2021. (CBC)

Alberta, meanwhile, lifted most of its public health restrictions on July 1. Since then, COVID-19 cases have increased and the R-value — rate of people infected per infected person — has eclipsed the peak of the third wave.

Last week, Alberta's chief medical officer of health Dr. Deena Hinshaw announced the province plans to phase out COVID-19 rules by Aug. 16 in order to prepare the health-care response for the flu and other communicable diseases in the fall.

The transition started Thursday. Quarantine is now recommended instead of mandatory for close contacts of a positive case, and people who test positive are now the ones who have to notify close contacts — not contact tracers.

Quarantine may be required in some high-risk settings or for outbreak management. Contact tracers and outbreak management will focus on high-risk settings, while community outbreaks will be addressed as needed.

Testing asymptomatic close contacts is no longer recommended. Mask mandates for acute- and continuing-care facilities — as well as public transit, taxis and ride-share vehicles — are still in effect.

Saskatchewan and Alberta are the only places in North America taking these actions right now, said Mokdad.

Alberta chief medical officer of health Dr. Deena Hinshaw says the province is phasing out regulations and protocols in order to prepare health care for seasonal illnesses in the fall. (Chris Schwarz/Government of Alberta)

Decision-makers looking at fully reopening ought to consider how to improve ventilation in buildings, as the novel coronavirus is transmitted through the air, said Mario Possamai, a SARS researcher who worked on several reports and investigations related to COVID-19.

Precautions implemented to prevent airborne transmission have been effective in controlling the spread of the virus, and those efforts should focus on high-risk settings and ensuring people working there have proper respirators, he said.

"If you do that, you have a better opportunity to safely reopen," Possamai said, adding that the cost of improving ventilation is cheaper than a lockdown.

Herd immunity not yet reached: experts

Dr. Nazeem Muhajarine was surprised to hear Hinshaw's announcement last week.

"It is premature," said Muhajarine, professor of community health and epidemiology at the University of Saskatchewan.

"We haven't reached that level of collective immunity that we want to see before we can be thinking about an endemic situation."

Upward of 80 per cent of the population has to be immune from COVID-19, either through infection or vaccination, before herd immunity occurs, according to Mokdad and Muhajarine.

COVID-19 vaccines have only been approved for people aged 12 and up in Canada, so most children cannot be protected yet.

As of July 30, about 65 per cent of eligible Albertans have received both doses of a COVID-19 vaccine. Only 63 per cent of eligible people in Saskatchewan have received both doses.

About five per cent of Alberta's population — including children — have contracted COVID-19, while just over four per cent of Saskatchewan's population has tested positive for the illness, according to provincial data.

Neither province is near the herd-immunity threshold.

At some point, society will have to learn to live with COVID-19. But evidence suggests now is not the time for policy changes seen in Saskatchewan and that are planned to occur in Alberta, said Muhajarine.

Public health experts are concerned about completely reopening, in part because vaccinated in places like the United States are spreading variants of concern. (Evan Mitsui/CBC)

Part of the concern is that variant strains of the novel coronavirus — namely the delta variant — are more transmissible, and vaccinated people are contracting those strains of the virus in places such as the United States and United Kingdom, said Mokdad.

The Centers for Disease Control and Prevention in the U.S., for example, has changed its messaging for vaccinated people as a result. Fully-vaccinated people in COVID-19 hotspots are now advised to wear masks when inside public places, as they could spread the novel coronavirus.

"We need to be very careful," said Mokdad.

Vaccinated people who do test positive for COVID-19 are rarely admitted to hospital or die.

Reopening could lead to 4th wave, projections suggest

The Institute for Health Metrics and Evaluation (IHME), an independent population health research centre at the University of Washington, offers COVID-19 projections for countries around the world based on available data and factoring in public health measures.

COVID-19 cases in Saskatchewan are rising again, and 578 residents have died from the illness to date, provincial data shows.

But the province's complete reopening could lead to a fourth wave and the number of deaths could increase to about 657 to 690 by the end of October, IHME projections suggest.

If Alberta lifts restrictions as planned, projections suggest the province will be in a fourth wave in September, and deaths could spike to about 2,504 to 2,753 by the end of October.

There have been 2,328 Albertans who have died from COVID-19 as of July 29.

ABOUT THE AUTHOR

Nicholas Frew is an online reporter with CBC Edmonton. Hailing from Newfoundland, Frew moved to Halifax to attend journalism school. He has worked for CBC newsrooms in Manitoba and Saskatchewan. Prior to joining the CBC, he interned at the Winnipeg Free Press.







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