Alberta's Chief Medical Officer of Health Dr. Deena Hinshaw says, 'It’s important to recognize that, because we can’t eliminate COVID, the question isn’t whether or not we change our approach. The question is when.'JASON FRANSON/The Canadian Press
Alberta is preparing to shift away from the strategy that has defined the response to COVID-19 since the pandemic began early last year: test, trace and isolate.
The province will no longer require people who have COVID-19 symptoms or test positive for the novel coronavirus to isolate as of Aug. 16, though it will still be recommended. Alberta will also stop routine testing, instead limiting tests to people with severe illness for whom a positive result could affect medical care, and will only conduct contact tracing for “high-risk” settings such as long-term care or medical facilities.
The new policies have been criticized by medical experts, Alberta’s Opposition New Democrats, the Canadian Paediatric Society and Federal Health Minister Patty Hajdu, who consider the loosened restrictions particularly worrying because of Alberta’s low rate of vaccination compared with the rest of Canada. But provincial health officials insist they are implementing an evidence-based plan that will allow the province to prepare for life with COVID-19 over the long term.
The Globe and Mail asked the province’s Chief Medical Officer of Health, Deena Hinshaw, why she believes it’s the right time to scale back the response to COVID-19, and about some of the criticism that has been levelled against Alberta’s plan.
What data, evidence or studies from other jurisdictions are there that support this approach to ending routine testing, contact tracing and isolation?
The Delta variant is now the dominant strain in Alberta, and so one of the things that’s important as we’re looking around at other examples is looking at what other countries have experienced with the Delta variant.
The U.K. Is a an obvious example, where they saw a significant surge in transmission of Delta with a high spike in cases, and their severe outcome spike was much, much lower – orders of magnitude lower – than previous rounds, where they had seen much higher hospitalization and death rates. So it really demonstrates the power of vaccines to decouple cases from severe outcomes.
The other thing that’s important is that, when [the U.K.’s] cases started to spike, they really hadn’t started their younger-age vaccines yet. Those under 30 were just barely starting to be able to access the vaccine, whereas we’ve been able to offer vaccine to those 12 and older since late May.
When we look at our own data, we have to take into account a few things. When we compare our PCR diagnosis data with our serology data, we can see that, even with our very aggressive testing approach, we’ve captured about a quarter of the overall cases. Even though that testing and tracing has been an absolutely critical part of our response prior to widespread vaccine availability, in partnership with the public-health measures, it has never been able to capture all cases.
This fall, we’re going to see not just COVID cases, but there is a whole host of different respiratory viruses that we will see coming back again. So as we were planning for the fall, we were looking at all of those things together – looking at the fact that if we were to continue with the status quo, the volume of testing was likely to exceed even what we saw at the peaks of our previous waves, because we’d be testing anyone with mild symptoms. As people are out and about and doing more activities, the ability to accurately contact trace and actually determine where they acquired disease and who they might have exposed becomes much more challenging.
We would actually need more people and more resources to continue with the current policy – for, in some ways, diminishing returns, because the vaccine coverage has really shifted that ratio of cases to severe outcome.
When we look at the evidence, it’s not just COVID evidence. It’s also looking forward and seeing, what context are we are managing COVID in? I think it’s clear to everyone we’re never going to eliminate COVID. And so we’re trying to figure out, how do we live with it in a sustainable way?
No other jurisdiction has ended testing, tracing and isolation. What do you say to criticism that Alberta is going off in its own direction?
Alberta is definitely moving down that road earlier than others. But I think it’s important to recognize that, because we can’t eliminate COVID, the question isn’t whether or not we change our approach. The question is when.
When I’ve had conversations with my counterparts, there is actually pretty broad agreement that eventually we do need to shift to more of a geographic-based approach targeting high-risk areas.
In public health, we typically use the aggressive case identification, contact tracing approach with isolation and quarantine for diseases like measles, where we can eradicate them. But for COVID, we can neither eliminate it nor offer any kind of post-exposure prophylaxis [such as with a virus like measles].
Instead, I think it’s important that we think about what are the kinds of habits that we’ve built through COVID that we need to maintain. That’s where wastewater surveillance comes in handy, because it tells us very accurately what that geographic experience is and gives people that information so they can make the best decisions with their daily activities, knowing what that transmission risk is at the moment.
If the argument is that this is an issue of timing, why are you confident that now is the time for Alberta, given that we have some of the lowest vaccination rates in the country – far below jurisdictions that are continuing aggressive testing and tracing?
The vaccination issue is a critical one and we will continue – and need to continue – doing everything we can to ensure that people have easy access to the vaccine, that they have accurate information about the vaccine. That is the number-one best course of action people can take to protect themselves and their communities.
If we were to try to make a change in the middle of our respiratory virus season, at some point in the next several months, it’s very difficult to make a shift when we’re in the middle of not just seeing increased COVID cases but we’re going to be seeing all sorts of other things.
It’s critical that people take the opportunity to be vaccinated, but in public health I see my job as continually assessing the overall risk in context of what other risks we need to face.
We, tragically, have babies dying of congenital syphilis. There are opioid deaths happening. We have childhood vaccination rates dropping, cancer screening rates that need to be bolstered. There are all sorts of things that also impact Albertans every day that we simply haven’t had the ability to be on top of, because we’ve been focused on COVID as the number-one risk – which we had to do. But I believe that I have an obligation to continue to assess those risks and then make recommendations based on the balancing of all of those things.
For children, particularly those under 12 who can’t get vaccinated, what is the risk of long-term COVID symptoms if we’re letting COVID spread more than we have been in the past year?
What I’m asking people is difficult. This is a big shift to make in a short period of time. This is not easy. I know that. But with respect to kids and long COVID, I have two kids under 12 myself, so there’s both personal and professional considerations as I think about that particular demographic.
There is a study that just came out looking at kids in the U.K., comparing the kids who have long COVID with kids who had respiratory symptoms and tested negative for COVID and then went on to have long-term symptoms.
It does seem to be something that affects older kids more than younger kids, and it’s also important to note that while it was more frequently observed in those who tested positive for COVID, there is that proportion who have symptoms past eight weeks and tested negative for COVID. There’s nothing that we choose for our kids that is without risk. We can’t completely remove the risk of COVID from kids, and every choice we make brings with it risks of a different kind.
The interventions that we had to use last year, particularly in schools, were disruptive for many kids and had their own negative outcomes. It’s a question of balancing and working with parents and trying to provide the best possible information about how to balance all these risks and make the best choice for individuals and their families.
With no legal isolation requirements and no widespread testing, what do you say to the criticism that people in front-line jobs will once again be forced to choose between their paycheques and going to work sick?
There remains an occupational health and safety obligation on employers to create a safe working environment, so we have been working with the Labour Ministry to remind employers that having someone come to work sick isn’t just a risk for that person, but for their whole workplace.
The best thing that all of us can do is to do whatever we can, within our own sphere of influence and control, to create environments that are supportive for people to be able to stay home when sick. We had that problem even with the mandatory requirement [to isolate] and certainly we will continue to work with Labour to see if there’s anything from the public-health side that needs to be done to support that.
To have the legal order in place for isolation for anyone who has mild illness really requires a significant infrastructure to continue to contact each one of those people who have tested positive, make sure that they understand the obligations.
Taking it away isn’t meant to indicate that it’s not important. It’s meant to shift into a more sustainable way of living with COVID.
This interview has been edited and condensed.
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