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Health

What you need to know as the Omicron BA.5 subvariant drives cases up

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Ontarians are being told to get up to date on their COVID shots as a summer wave fuelled by the Omicron BA.5 subvariant has likely begun.

It’s a particularly important message in Hamilton where booster uptake has been sluggish.

“The third vaccine dose is critical to protect against severe disease,” stated an advisory Wednesday by Ontario’s COVID-19 Science Advisory Table.

Its message to the public provides a guide of what Ontarians need to know about the seventh COVID wave.

Has a new wave started?

The science table declared a likely new wave on Wednesday. On the same day, Hamilton public health reported COVID transmission was increasing for the first time since April.

Both look to a number of measures, including rising wastewater samples with COVID-19 detected.

The number of tests coming back positive is above 10 per cent provincially for the first time since May. For Hamilton, it went up to an average of nearly nine per cent on June 30 from six per cent on June 16.

About 80 per cent of public health units are seeing exponential growth in cases. In Hamilton, average daily new cases were up to 62 on July 3 from 25 on June 6. Cases are a significant underestimate.

What is driving the wave?

Highly-contagious Omicron subvariants, particularly BA.5, are fuelling the summer wave.

“You can be reinfected by BA.5 even if you have recently been infected with an earlier strain,” stated the science table.

However, it doesn’t cause more serious illness.

“Current evidence does not suggest BA.5 is more severe or that it will lead to a rise in hospitalizations as large as previous waves,” stated the science table.

What if I get infected?

“Infections can leave you feeling unwell, and be disruptive to your family and work life,” stated the science table. “Each infection puts you at risk of long COVID.”

While the risk of severe illness isn’t higher with BA.5, it’s also not zero. The science table reported the first increase in COVID hospitalizations since May.

“If BA.5 spreads widely, we may see a rise in deaths among higher risk groups,” stated the science table.

What about the health-care system?

“Hospitals are already very strained,” warned the science table. “Any surge comes at a time when hospitals are already dealing with staff shortages and record wait times — this impacts all of us.”

Hamilton’s hospitals had 700 job openings they couldn’t fill as of May and 292 staff self-isolating as of Wednesday.

In addition, overcrowding on the wards and high numbers of patients coming to the emergency departments have resulted in ambulances waiting hours to off-load patients, causing a spike in “Code Zero” events in June. Code Zero is when one or no ambulances are available to respond to emergencies.

Hamilton’s hospitals also have pandemic backlogs they are trying to clear, including nearly 15,000 surgeries as of March.

At the same time, there are still COVID patients being admitted.

“Hospitalizations remain higher than at any time last summer,” stated the science table.

Do I need to wear a mask?

“Going back to wearing a mask again in crowded indoor public spaces is a good way to protect yourself until the wave is done,” stated the science table.

Hamilton public health also “strongly recommends wearing a well-fitting mask indoors, especially when it’s crowded.”

The science table suggested a high-quality surgical mask, KN95 or N95.

“Ventilate as much as possible by opening windows and doors,” stated the science table. “Choose lower risk alternatives — for example, enjoy the great weather by gathering with friends outdoors instead of indoors.”

You can still enjoy the summer while reducing your risk of getting COVID, urged the science table.

“Unfortunately, a recent infection may not protect you very well from reinfection with BA.5,” it stated. “So, as we’re entering a new wave, it’s worth re-engaging with multiple layers of protection to reduce risk.”

Does a booster make a difference?

“Ensure your vaccinations are up to date,” stated the science table. “It provides significant additional protection against serious illness.”

Hamilton data shows the staggering difference COVID shots make. The unvaccinated have a hospitalization rate of 434.1 per 100,000 population compared to 75.8 for those with three shots. The risk of being admitted to the intensive care unit is 12 times higher for the unvaccinated than the boosted.

But coverage remains low, with fewer than 50 per cent of Hamiltonians age 18 to 39 boosted. Coverage for kids is even worse, with only 17 per cent of those age 12 to 17 having three shots.

“New vaccines targeted to emerging variants could be available this fall, but as there’s a wave starting, it makes sense to get the vaccines you are eligible for now,” stated the science table. “If you are age 60 or over, or immunocompromised, and haven’t received your 4th dose, now is the time.”



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Health

Who’s getting sick? Report sheds new light on breakthrough cases and vaccine protection against hospitalization

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As Ontario tries to keep a resurgence of COVID-19 cases under control, new data from Public Health Ontario shows only nine fully vaccinated people under 60 have ended up in the ICU.

The report paints the most detailed picture yet of breakthrough cases — and who is getting very sick despite being fully vaccinated — showing that the majority of those who need hospital care are adults over the age of 60, with the highest proportion in their 80s.

Experts say the findings underscore that vaccines are working well to prevent infections and hospitalizations. But they also support opening up third doses of the COVID vaccine to more older adults, and highlight why masking and other public health measures are still critical at this stage of the pandemic to protect the most vulnerable.

“It’s clear that vaccines are working phenomenally well,” said Dr. Isaac Bogoch, an infectious disease expert and a former member of Ontario’s now disbanded vaccine task force.

“But if you look at all the breakthrough cases, there is a greater probability that the older age cohorts will have more serious infections.” Based on this and data from other parts of the world, “it would make sense to expand third dose eligibility to the 50-year-old age cohort and up.”

Third doses have been opened up widely in the U.S. and Israel, but in Ontario only a few groups qualify, including health-care workers, individuals 70 and up, people who got two doses of AstraZeneca or one dose of Johnson & Johnson, and First Nations, Inuit and Métis adults. You have to be 168 days past your second dose to get a third one. Immunocompromised people, transplant recipients, patients with hematological cancers, and seniors living in congregate settings, such as long-term-care homes, retirement homes and First Nations elder care lodges, are also eligible.

The Public Health Ontario report, which includes COVID vaccination and case data up until Nov. 14, shows there were only 17,596 breakthrough cases out of the 11.1 million individuals who have completed two doses of the vaccine. As of Nov. 14, there were just 40 cases following a third dose, the data shows.

“The take-home message is that the COVID-19 vaccines … are highly effective at protecting against infection, and particularly effective at protecting against serious outcomes, including hospitalization and death, from COVID-19,” Dr. Sarah Wilson, a public health physician at Public Health Ontario, said in an email to the Star.

As of Nov. 14, unvaccinated individuals made up 91 per cent of COVID cases in Ontario, with breakthrough infections accounting for 3.8 per cent of cases. Public Health Ontario defines a breakthrough case as “individuals who have received two doses of a COVID-19 vaccine and were infected more than two weeks after receiving their second dose,” Wilson said.

The report notes a similar trend was observed for COVID hospitalizations and deaths “with unvaccinated cases accounting for 90.9 per cent of hospitalizations and 90.2 per cent of deaths while breakthrough cases accounted for 2.7 per cent of hospitalizations and 3.3 per cent of deaths.” As of Nov. 14, 178 fully vaccinated individuals had died of a COVID infection.

While the data shows older adults are more at risk of hospitalization from a breakthrough infection — particularly those over the age of 80 — the rate of “hospitalizations was higher among unvaccinated individuals compared to fully vaccinated individuals.”

Wilson said the data makes it clear the risk of COVID infection is higher for those who are unvaccinated. For those 60 and older, the risk of being hospitalized with the virus was about 16 times higher for unvaccinated individuals compared to those who had two doses.

Dr. Zain Chagla, an associate professor at McMaster University, said only nine intensive care unit admissions in people under 60 is “pretty remarkable,” but the “opposite side of the coin though is those over 60 probably do require booster doses.”

Especially since global vaccine supply is still strained and there are people in some countries who still don’t have access to first and second doses, “you want to make sure (third doses) are used in people where they’re going to derive the most benefit.”

Lucy Gerardi, who turns 68 soon, would be first in line if third doses were opened up for her age group.

“You just want to have that extra sense of security,” said the retired biology teacher and Oakville resident. As of Tuesday, it has been 168 days since her second shot and she’s been calling around to public health officials trying to get more information about when she can get a third, to no avail.

“You’re just kind of in limbo,” Gerardi said.

“But I guess we should be thankful we at least have two shots, when there are people in the world that have none.”

Nearly 420,000 third doses have been administered in Ontario, according to Ministry of Health spokesperson Bill Campbell, up from 290,000 last week. These numbers will start being reported publicly soon. “Ontario’s plan is to gradually expand eligibility for a booster dose to all Ontarians over time,” he said in an emailed statement. For now, in line with National Advisory Committee on Immunization (NACI) recommendations, they are being offered to vulnerable populations, Campbell added.

While the Ontario data shows COVID vaccines work very well, they still do not offer complete protection, said Dr. Abdu Sharkawy, an infectious diseases specialist at University Health Network.

“The message that is distilled from this report should not be one of nihilism, that vaccines just don’t work well enough,” he said. “The vaccines work very well, but they have their limitations.”

That’s why maintaining public health measures, particularly masking and minimizing risks that come with crowded, poorly ventilated indoor spaces, is still critical, even with a highly immunized population, Sharkawy said.

“We have to maintain a sense of vigilance around those things that can prevent at-risk people from becoming sick. And that means preventing the possibility of breakthrough infection by not simply relying on the vaccines alone.”

Wilson said Public Health Ontario will be publishing further reports on breakthrough infections “that could be used to inform third dose rollout” and that researchers are looking at data on different age groups and the timing of infection after a second dose.



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Health

Two new Delta offshoots have emerged in Western Canada. It’s a warning, say disease experts

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The emergence of two sublineages of the COVID-19 Delta variant in Western Canada holds important lessons for the rest of the country on the consequences of allowing a virus to spread unchecked, infectious disease experts say.

But it’s yet to be known if the sublineages, called AY.25 and AY.27, are more effective at replicating or a greater threat to Canadians.

Dr. Jessica Minion, a medical microbiologist with the Saskatchewan Health authority, highlighted her concerns with the Delta variant sublineages in a town hall last Thursday.

The Delta variant is the dominant variant in Saskatchewan, making up nearly 100 per cent of cases. Minion said the AY lineage cases are “exploding” in number, from only 12 on Oct. 9 to nearly 125 as of Nov. 5.

“It is very difficult from an epidemiologic perspective to sort out whether those expansions of the AY lineages are due to advantageous mutations that are making them more transmissible … (or) maybe this particular lineage got into a population that was largely unvaccinated, got into a super-spreader event and is expanding exponentially due to pure chance,” she said.

Alberta and Saskatchewan have grappled with the highest rates of infection and the lowest rates of vaccination among the provinces in the fourth wave. Dr. Ilan Schwartz, an infectious diseases expert and assistant professor at the University of Alberta, said the more opportunities a virus has to replicate the more likely genetic mutations will occur.

“It’s unsurprising in a climate where the virus has basically been given free reign over the summer and fall months specifically in Alberta and Saskatchewan,” Schwartz said.

“The question is to what extent these random mutations are going to confer a fitness or survival advantage that is going to allow the one particular mutant or variant to be able to out-compete other random mutants or variants?”

That still remains to be seen. The earliest detection of the AY.25 and AY.27 sublineages were in Western Canada, specifically Alberta and B.C., but that doesn’t mean they originated here, said Dr. Jeffrey Joy, an assistant professor at the University of British Columbia’s faculty of medicine and an expert in genomic epidemiology.

“I was able to see that there’s actually an identical sequence detected in India at around the same time. So I think the jury is still out a little bit on whether it actually evolved here or whether it came here,” Joy said, noting there is a lot of interchange between Canada and India.

“We were doing a lot more surveillance here than they were doing in India at that time,” he added.

What it does show is that the virus will continue to mutate and evolve, something that is expected, but especially in areas where there are large populations of people unvaccinated.

“It highlights for everybody that evolution is happening right here in Canada, potentially, and every new infection is an opportunity for the virus to evolve,” Joy said.

Caroline Colijn, an epidemiologist, mathematician and professor at Simon Fraser University, said AY.25 was circulating in other parts of the world whereas AY.27 is an almost exclusively a Western Canadian phenomenon.

“That doesn’t mean it’s only here, because of course people in the world are not sequencing all of the cases,” she said.

What does it mean for Canadians? The sublineages are already on the move and could become the dominant strain in Canada. Thus far, there is some indication the new sublineages are slightly more effective at spreading.

But they don’t seem to pose a much greater threat than the baseline Delta variant.

“It looks like they are expanding and have a slight transmission advantage. (But) it’s not to Delta the way Delta was to Alpha or the way Alpha was to the original COVID,” Colijn said.

While experts are cautious to ring alarm bells over the discovery, Schwartz said they offer a cautionary tale to the rest of the country.

“It doesn’t really change what we do clinically, but it does sort of reinforce what scientists have been saying for many months, which is it’s bad idea to allow unhindered replication of this,” he said.

“This is something we’re paying for now in terms of increased cases, but then we may ultimately see consequences down the road in terms of giving this virus the opportunity to generate new variants that may potentially create some difficulty for us.”

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