EMS prepare the ambulance at the U of A Hospital in Edmonton on May 7.JASON FRANSON/The Globe and Mail
The Alberta government’s recent approach to COVID-19, ending virtually all public-health measures over the summer and refusing to change course as infections soared, was based on an optimistic theory: that vaccines had so dramatically changed the pandemic that the province could weather a significant spike in new cases without worrying about hospitals becoming overwhelmed.
Premier Jason Kenney and his Chief Medical Officer of Health, Deena Hinshaw, pointed to data out of Britain as proof that infections had become “decoupled” from severe outcomes; in other words, a spike in COVID-19 cases would no longer result in a similar increase in hospital admissions. But Mr. Kenney was forced last week to admit those predictions did not come to pass in Alberta – a miscalculation that now threatens to push hospital admissions past the peak of any previous wave and bring the health care system closer to a breaking point.
The experience in Alberta, where the government has prided itself on imposing fewer pandemic restrictions than other provinces and recently urged the public to stop viewing COVID-19 as an emergency, could serve as a warning to other governments thinking of abandoning public-health measures altogether. Experts say there are still too few people vaccinated – not just in Alberta, which has the lowest immunization rates in the country, but elsewhere in Canada – to abandon public-health measures and act as if the pandemic is over.
In Alberta, that realization prompted the government to act on Friday, announcing the return of a provincewide mask mandate and a curfew on liquor sales at bars and restaurants. The government is also paying anyone who has yet to get their first or second dose of a vaccine $100 to finally get a shot. The government previously delayed plans to end widespread testing, contact tracing and mandatory isolation.
The situation in the province’s hospitals has been rapidly deteriorating. Hospital and intensive-care admissions more than doubled in the past two weeks and newly released modelling shows those numbers could surpass their previous peaks within weeks. On Friday, the province’s ICU beds were 95-per-cent full. Alberta has among the highest per capita COVID-19 infection and hospital admission rates in the country.
Mr. Kenney had repeatedly pointed to Britain to defend Alberta’s approach. When infections in the UK surged over the summer, hospital admissions did not increase by the same degree. Hospital admissions increased in July and August, but government data show they have so far stayed far below any of the previous peaks.
“Unfortunately, this has not been Alberta’s experience,” Mr. Kenney said on Friday.
“Vaccines do decouple individuals from severe outcomes dramatically on an individual level, but because of the large group of people who have no vaccine protection, we have seen the Delta variant spread widely and cause severe outcomes at much greater rates in unvaccinated adults.”
Dean Karlen, a professor at the University of Victoria who is part of the B.C. COVID-19 Modelling Group, said hospital admissions in Alberta have been increasing slightly faster than they have in previous waves. The modelling group, which has also been releasing projections for Alberta, had been warning this would happen.
“There wasn’t really much of a basis to assume this decoupling would happen,” Prof. Karlen said.
He said it has been clear for some time that Britain was an outlier. Increases in infections in other jurisdictions in Europe and the United States have been followed by significant – and predictable – pressure on their health care systems, he said.
Prof. Karlen also pointed out that most new infections are among unvaccinated people, so there was no reason to assume they wouldn’t end up in hospital at the same rates as they have before.
“The situation really hasn’t changed dramatically in any respect to suggest that hospitalization demands won’t be as high as they were before per case,” he said.
Jim Kellner, an infectious-disease expert and pediatrician at Alberta Children’s Hospital in Calgary, said it was a mistake to assume the British experience would be replicated in Alberta. Britain has higher vaccination rates for both first and second doses than Alberta and a higher proportion of people in that country have had COVID-19, leaving them with a level of immunity even if they aren’t vaccinated, he said.
Dr. Kellner also noted that vaccination rates in Britain are more consistent across different regions, unlike in Alberta and places in the southern United States, where there are large pockets with very low coverage.
“It was just too early [for the Alberta government] to back away,” he said.
Cynthia Carr, an epidemiologist based in Winnipeg, said vaccines are expected to “decouple” infections from hospital admissions eventually, but it was a mistake to assume that had already happened.
“Certainly, the goal of a vaccination is to drive that decoupling between infections, hospitalization and death – that would be a true sign of success,” she said. “However, in Alberta and other provinces, we still have too much of a gap in the target groups who are not vaccinated.”
Ms. Carr said that given the current hospital admission numbers, Alberta should abandon plans to end widespread testing and contact tracing at the end of the month. Dr. Hinshaw said Friday the government is looking at whether the province will end its testing program on Sept. 27 as planned, though she still downplayed the effectiveness of contact tracing.
Ms. Carr said it would be dangerous to proceed with that plan.
“I really can’t think of many ideas that would be less advisable right now,” she said. “Any move to remove accessibility, whether to vaccination or testing or information, which you would get from contact tracing, is not a good idea.”
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James Keller