Doctors fear COVID delta variant, say Manitoba reopening plan ignores it
Magical thinking on first-dose vaccination rates will not get us through this, doctors say
Manitoba will almost certainly face a fourth COVID-19 wave by fall if it follows through with its current reopening plan, says a group of doctors who expressed worry about the dangers of the delta variant.
The modelling the province has used as the basis for its reopening plan has not factored in the delta variant, say the doctors, who held a news conference Friday to urge the public and provincial government to seriously consider the dangers posed by the B.1617.2 variant, now called the delta variant.
They say the percentage of fully vaccinated people — those with two doses of vaccine — must be much higher before the health orders begin to be loosened.
"This is a big problem," said Dr. Dan Roberts, a critical care physician at Health Sciences Centre in Winnipeg and one of 11 signatories in a letter the group issued on Friday.
The delta mutation is twice as infectious as the alpha strain and twice as likely to lead to hospitalization, he said, imploring officials to maintain a few more months of vigilance and caution before reopening too widely.
"We hope that the government will reconsider its current reopening plan and start to apply some science and start to recognize the facts that are becoming very apparent in other countries so that they can guide us through this better than we've been guided in the past," he said.
But Roberts doesn't expect they'll listen.
"Some of us warned last October that we were headed for a disaster in November and December. We were ignored then, but we weren't wrong," Roberts said. "In April and early May, we warned about the devastation that our health-care system was going to experience. We were ignored then, but we weren't wrong.
"It would be prudent for them to heed this advice. We don't have any illusions about whether they'll take it."
There were seven delta cases in Manitoba on June 4. As of Friday, there were 130 — a jump of 41 from the day prior — and the doctors expect it to be the dominant strain in the province by mid-summer.
Earlier this week, Manitoba announced its first death linked to the highly contagious variant.
The province said on Thursday the person died May 20 but the death wasn't originally reported as being linked to a variant of concern. It took several days before the sequencing process confirmed it.
"We're not in the business of hyperbole or spinning the facts," Roberts said. "Our health-care system is on its knees. The impact of a fourth wave would be catastrophic."
Manitobans have been encouraged, through the province's reopening plan released last week, to believe improved vaccination rates "will get us out of this mess," Roberts said.
Premier Brian Pallister and Chief Provincial Public Health Officer Dr. Brent Roussin announced last week that if at least 70 per cent of all Manitobans age 12 and older have received their first vaccine dose and 25 per cent have received their second dose by Canada Day, most businesses, services and facilities will be allowed to open at 25 per cent capacity or greater levels.
Further loosening of restrictions are tied to higher vaccination rates by the August long weekend and Labour Day long weekend. If those targets are reached sooner, things will reopen sooner.
"We need Manitobans to understand that short-term optimism is not based on current reality. Magical thinking will not get us through this," Roberts said.
"Over the past few months, that kind of thinking has left more than 1,000 dead, caused great financial hardships for many, gutted our health-care system and greatly affected marginalized communities."
Extreme caution needs to be exercised in reopening the province and it has to be based on a combination of low daily case counts, low test positivity rates and second-dose vaccine rates, the doctors' letter states.
First-dose vaccination rates should not be given as much weight.
Dr. Jazz Atwal, deputy chief provincial public health officer, said Friday that the delta strain is not part of the current modelling but that health and government officials "have taken the risk of the delta variant into play here.
"As more information comes out, we're going to continue to adjust our thoughts on the risk related to the delta variant and incorporate that risk into our reopen strategy as well."
Delta has become the dominant strain in Britain, where, despite 60 per cent of people being fully vaccinated, a fourth wave has begun, Roberts said. That country is now rolling back its reopening plans.
There are pockets of Ontario and elsewhere in Canada where numbers are on the rise, and experts in Alberta predict delta could become the dominant variant there by the end of this month.
Dr. Pamela Orr, an infectious diseases specialist, said recent information indicates that people can go from being exposed to delta one day to being infectious the next.
"So the incubation period is completely flattened, and you can remain infectious for longer than 21 days," she said.
Two vaccine doses remain highly effective against delta but at this point, just over 20 per cent of Manitobans are fully vaccinated, Roberts said.
The doctors are not looking for a lockdown but they are pleading for more caution before reopening and urging the government to "vaccinate as aggressively as possible," he said.
The province's acting health minister says the doctors' input will be considered alongside other feedback.
"We know there are a great variety of opinions on how to safely reopen, even within the medical community," Kelvin Goertzen said in a statement.
"These doctors represent important voices and those voices are welcome at the decision-making table, as are others. All of this input is heard by our public health leaders, who examine all the evidence very carefully before bringing forward recommendations to government."
Previous reopening recommendations were based on criteria from the World Health Organization, which were in turn based on the infection rates of the original COVID-19 strain, said Dr. Anand Kumar, a Winnipeg intensive care physician and infectious disease specialist.
"We're in a completely different situation with the delta variant," he said, suggesting the government should not consider loosening restrictions until test positivity rates are between 2.5 per cent and 3.5 per cent and there is a maximum of 50 new cases per day.
As of Friday, the current five-day test positivity rate was 8.3 per cent provincially and 8.3 per cent in Winnipeg.
Worry for children
The doctors said they are extremely concerned about students' return to school in fall, which is 80 days away.
Children younger than 12 are not yet eligible for any vaccines and if Manitoba is in a delta-driven fourth wave by then, the impact on schools will be great once again, they said.
There are more than 211,000 kids under age 12 in Manitoba that will not have a vaccine available to them and thousands more 12 and up who might only have one dose, the doctors' letter states.
"We failed our seniors in November when we allowed infection rates to overwhelm our ability to contain outbreaks," Roberts said. "We watched our health-care system crash in May because we weren't prepared for U.K. variant [B.1.1.7].
"The impact on our health-care system and on our children, if we make a mistake and we don't act prudently and cautiously [regarding the delta variant], is going to be indefensible."
Most people are unaware that at least a dozen children (if not more) have passed through the ICU with COVID during the third wave, Kumar said.
"So this is not something that spares children," he said.
"I know that people say that it's a mild disease in children, and in some cases it is, except … there are definitely cases where children are badly affected."
Orr said children with mild or moderate symptoms can develop long-haul syndrome — disability and illnesses that could last their entire life.
"This is a very significant health-care issue and one that's really been under-recognized in the United States. They're just beginning to come to terms with this," she said.
In their letter, the doctors "strongly recommend" government and public health officials do the following:
- Create and share new public health models that take into account the delta variant and vaccine efficacy.
- Enhance first- and second-dose vaccination campaigns with expanded hours, on-site workplace vaccination programs and continued community outreach.
- Enhance the effectiveness of contact tracing and increase contract tracing capacity before reopening schools.
- Implement mandatory paid sick leave.
- Improve classroom safety and ventilation.
- Continue masking and physical distancing requirements.
- Use stay-at-home orders quickly and proactively, when needed.
"If we take the right precautions now, that subsequent wave that will occur can be substantially blunted," Kumar said.
"If we do things wrong, it could be as bad as the last wave. If we do things right, it could be as mild as the first wave."
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With files from the Canadian Press