How to prevent a third wave

St. Michael’s Dr. Peter Jüni, Scientific Director of the Ontario COVID-19 Science Advisory Table, fills us in on the new COVID-19 variants and why they’re more infectious.

Dr. Peter Jüni is an epidemiologist and director of the Applied Health Research Centre of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital. He is Scientific Director of the Ontario COVID-19 Science Advisory Table, a group of scientific experts and health system leaders who evaluate emerging evidence to inform Ontario’s pandemic response.  

We hear a lot about the different COVID-19 variants showing up in Canada. What are the real risks here?

The main risk is currently coming from B.1.1.7, the variant first detected in the U.K., which is starting to gain a foothold in Canada. It is about 40 per cent more contagious, which means more people will get infected. But we can’t take our eye off the variants first detected in South Africa and Brazil, which are also more transmissible. 

Why is the B.1.1.7 variant more contagious?

It’s more transmissible because it attaches itself more easily to the host cell receptor than the traditional variants do, and entry into the host cells is the first step in viral infections. And it could have a shorter generation time, meaning it could become infectious earlier.

Is there a risk of a Canadian variant?

We can never exclude the possibility of a Canadian variant, as the virus is continuously mutating. But because Canada has a relatively small population and a lower incidence in comparison to other countries, the risk is relatively low. We have done pretty well in Ontario since the beginning of the pandemic; our case numbers have not been much higher than those of Iceland, Norway and Finland, which are either islands or have been fairly isolated during the pandemic.

Are we looking at a third wave in Ontario?

If B.1.1.7 takes hold and we’re not careful, a third wave is inevitable. The percentage of cases caused by the new variant currently doubles every seven to 10 days. So if in one week it is 2.5 per cent, then the next week it will be five per cent, one week later 10 per cent, and so on. It won’t take long to go up like a hockey stick.

How can we avert a third wave?

By sacrificing short-term satisfaction for long-term gain. We need to be very careful when we start to reopen. We need to shut down immediately if we see that the variants are about to become dominant and there’s the slightest indication that cases are starting to rise. If we leave it too long, the cases will be too elevated and they won’t come down again, even with a lockdown, because the new variants are more transmissible. Any ground lost will stay lost unless we lock down harder than we just did. If we manage the impact early and aggressively, and spring kicks in and people get outside, and the vaccines arrive and we vaccinate early and smart, then yes, there’s light at the end of the tunnel.

What does “vaccinate smart” mean?

The best predictor of the future is past experience. In addition to people in long-term care facilities, the highest burden of disease has been on members of racialized communities, and the socioeconomically disadvantaged. So we need to address these factors and take a community approach as to who gets vaccines first. The Science Advisory Table is currently working on a vaccine rollout strategy that takes both age and neighbourhood into account.

What’s it been like working on the Science Advisory Table?

There are around 100 people working tirelessly and seamlessly nearly 24/7. We’re all pulling together and we’ve developed a shared sense of where to go to keep Ontarians as safe as possible. It’s been a remarkable experience.