As the potential for a fourth wave looms, we compare British Columbia to the outbreak areas around the world to analyze how things may be different here. We also get new modeling that shows the possible future for the province.
As the potential for a fourth wave looms, we compare British Columbia to the outbreak areas around the world to analyze how things may be different here. We also get new modeling that shows the possible future for the province.
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Disclaimer: This interview has been edited for clarity and length.
Jackie: Hi, my name is Jackie Lamport. Today is Thursday, July 29. Welcome to the Capital Daily Podcast. Today on the show, as the Delta variant sends cases upwards around the world. We focus on modelling for British Columbia to find out what we should expect and what possibly makes us different. As much as I hate starting off an episode like this. It has to be said that the pandemic isn't over yet. Vaccines have marked a major shift in cases and attitudes, but they cannot make the virus go away.
Right now, we're seeing trends around the world where the Delta variant is causing a fourth wave in the United Kingdom that seems to be coming out of a massive spike that rivalled their third wave. America is currently trending upwards, nearly matching numbers from the second wave. In British Columbia, we have had a summer that isn't too far off from what normal was on a few occasions, the new case numbers on the island for the day, or zero. But the past few days, the numbers have been ticking back up. So is it still possible to avoid what we are seeing elsewhere in the world? To find out, we welcome back modelling expert Dr. Dean Carlin for the fresh projections his group released on Tuesday. Before we get to him, though, here are a few stats to put things into context about what is different this time around.
Currently, the numbers in the province are heading upwards. Wednesday, the province announced 185 new cases in total, eight of those being on the island. That means we have 909 active cases across the province, with 41 of those being on the island as of Wednesday. However, there is still good news that came from Tuesday's announcement. Less than 5% of the recent cases are among fully vaccinated folks, which means that the vaccines are working. Dr. Bonnie Henry also stated that 78% of cases are in individuals who have not been vaccinated at all. And of the 176 that were hospitalized at the time of the announcement, 137 of those were completely unvaccinated. More proof that the vaccine, while not being a complete shield against contracting the virus, will protect you from having a more severe response to the virus. Numbers supporting this are not unique to Canada. On July 16, the director of the CDC in the United States said that 97% of hospitalizations were from unvaccinated individuals.
So what does this mean? Potentially it means containment strategies will look different. Yesterday Dr. Bonnie Henry updated us on the current outbreaks in certain areas of the province. The area of the Central Okanagan has her quite concerned 50% of the recent cases in the province have been in this area. Primarily this has been made up of younger folks who have yet to receive their second dose. But the response to this outbreak is perhaps a sign of what we will see going forward. The province has announced that they are reinstating mandatory masking indoors just for this area. This is effective as of 12 am this morning, so Thursday morning. The government also said they would be allowing people to receive their second dose within 28 days of their first in that area. Across the rest of the province, the time between doses is 49 days. They are also recommending no non-essential travel to or from the area unless folks are fully vaccinated. So as opposed to the province-wide restrictions, it appears possible that the outbreaks we see going forward will be dealt with with a regional strategy.
If it comes, which we will find out in a moment, this wave will be different no matter what. And I'll be optimistic on behalf of everyone and say; hopefully, that's a good thing. But as I said, we have the pleasure of welcoming back Dr. Dean Carlin, a COVID-19 modelling expert from the University of Victoria. His models have been used worldwide during the past year of this pandemic. And we're lucky to have him right here telling us what's going on in our own backyard. He'll take us through His group's brand new modelling that will show us if we should expect a fourth wave. What factors play into that, and how this wave may be different. Dean, welcome back to the show.
Dr. Carlin: I'd like to say it's great to be back, but this is bad news that I'm back speaking to you. But it's nice to see you again.
Jackie: Last time, I think I specifically said, "Oh, it's so nice to have a positive interview."
Dr. Carlin: Well, that lasted about six weeks.
Jackie: It was a good six weeks. Okay, so the Delta variant is on the rise here, and you just released modelling from your group. That was on Wednesday. What does the modelling show? Are you predicting a fourth wave?
Dr. Carlin: Well, unfortunately, it does appear that BC is following the pattern that we've seen elsewhere, we've seen this in Europe, and in the United States, all states are presently undergoing a rapid rise, driven by Delta. And so we've seen in the last two or three weeks in new NBC data, the first signs of this, that is a departure from that decline that we saw in cases, that fall following exactly that decline that we are hoping to see. And that lasted for, you know, about six weeks or so. But now, in the last couple of weeks, the cases are rising compared to that expected continuing decline. And unfortunately, the rise in cases is following the pattern that we have seen in other jurisdictions quite, quite concerningly, the decline in the alpha variant was significant, eight or 9% a day. Now we're seeing growth that's consistent with eight or 9% a day growth. So that's a swing of like, almost 18 or 20% a day. That's the same kind of swing that we've seen elsewhere. So we think it's important to be watching this carefully. It's in the early stages, but we've seen that rapid growth continues for weeks and weeks in other countries. Some European countries have been able to turn it over, but not in the United States. All the states in the US are undergoing this rapid growth right now.
Jackie: It does seem that the UK is heading back down. Is that the major peak that we can look at? That peak actually mirrored their third wave.
Dr. Carlin: It is remarkable. In the UK, they had this well; they were probably one of the first European nations to get significant growth in Delta as that was a lot of travellers introducing Delta into their population. From India, that growth lasted for many months, as I recall. So it brought cases in the UK. Originally, they had gotten things under control before Delta came in; they had maybe 2000 cases a day, but after five or six weeks, that rapid rise of Delta brought them back to like 50,000 cases a day from 2000. So you're right. They have turned that around in the past week and a half. I have no idea why that big turnaround occurred because I thought they were recently celebrating their freedom to remove all restrictions. But possibly some social behaviour as a result of that rapid rise. It's individuals saying, "No, we got to be more careful." Is that enough to turn it around? A lot of this is uncertain, of course. They didn't just have the Euro Cup finish, so that was a mechanism to transmit Delta very efficiently.
Jackie: Yeah, it didn't seem to translate. Are there any areas in British Columbia specifically showing similar science to the UK and United States numbers?
Dr. Carlin: Yeah, so, of course, it's the interior that's showing the largest departure from that decline. And the cases are growing exponentially as expected; it does not look like just simply some short-term outbreak. It follows that pattern of, of one declining strain, and another one coming up in between and, and this whole pattern, how it declines and then slowly transitions to growth is that pattern that we see elsewhere. The magnitude of that shift from a decline to growth is the same. So I would say that pattern is most firmly established for the interior, but in Fraser and Coastal, we see that same pattern, but not yet to the same extent of certainty. And here again, looking at the data in a week, if it continues to show sustained growth, it's time to provide more advisories to reduce social behaviour. Perhaps introducing masking requirements are recommendations similar to what the US CDC did just yesterday.
Jackie: They are now recommending masks for fully vaccinated people, which is something they had stopped recommending not too long ago.
Dr. Carlin: And that's based on some interesting recent findings in which there were cases with people fully vaccinated having Delta variant infection, their lungs, etc., who had had a low viral load, so they didn't have the symptoms. They were well vaccinated there. They were fully vaccinated, but their nasopharynx, or their nasal cavities where the virus load there was similar to a viral load of an unvaccinated individual. So those vaccinated cases that can transmit could be another source to help grow that virus but asking vaccinated people to mask up in indoor settings would help reduce that form of transmission.
Jackie: I wanted to see the island's numbers specifically right now because it looks like the island isn't necessarily at that point you said the interior is, but the cases aren't going down anymore. Is it difficult to see the island's patterns because the case numbers are so low?
Dr. Carlin: So it is hard to say anything quantitatively given the low numbers on the island. But it's certainly not, but ruled out that that same transition to higher growth is underway. But given such low numbers, we would have to wait a few more weeks to see how that data transpires. So we should consider this to be something that could be happening in all regions and in British Columbia.
Jackie: I think one of the interesting things that people have noted, anecdotally and backed up by numbers, is that there is minimal spread among fully vaccinated people compared to unvaccinated individuals or people who have just received one dose. Does this play into your modelling at all?
Dr. Carlin: That's the model that I used to describe DC and Europe and US, assumes that vaccinated people gain immunity. And to the extent that we've seen measured over 30 or 40 days, they finally achieve maximum immunity, which isn't 100% but 90% or 95%. And so when the model, none of those people who are immunized, do not get the disease. And so it's in the models; it's only the unvaccinated that are producing cases and are being hospitalized or dying, just as we see in the data. With this possibility, the fact that CDC is reporting the possibility of vaccinated individuals transmitting is not in the model at all. So with further information, we might be able to incorporate something like that into the model. But right now, it's incorporated, and the fact that we're seeing rapid growth. It’s incorporated by having an increased transmission rate. So that transmission can occur in many different ways. If there are more ways to transmit, you'll have a higher transmission rate. So that's how it's being dealt with right now, specifically, for that case.
Jackie: Our projections, assuming that we continue to become fully vaccinated at the same rate that we're currently doing so.
Dr. Carlin: What has been done is to use the vaccination schedule and pass vaccination rates on a weekly basis or daily basis, incorporated in the model and then projecting forward that same rate. Now the important rate to be followed is the first dose. As we expect, those people who have the first dose will get the second dose. We're seeing a significant slowdown in the first dose. And so that is in, in the model. And in fact, one has to assume some ultimate dosage. What fraction of the population are willing to get vaccinated? We're getting close to what our original assumptions are about. Perhaps 80% of eligible will be getting vaccines. We hope that number goes up, and we will adjust the model accordingly.
Jackie: This is anecdotal and also an assumption, but I feel like once people start to see and understand the numbers of COVID-19 among vaccinated versus unvaccinated, maybe we will see those numbers tick up.
Dr. Carlin: Yeah, that data is so compelling. Essentially 90-95% of those who are seriously affected by COVID are those who are unvaccinated. You don't want to be part of that club. You want to get vaccinated.
Jackie: We're seeing these numbers in the United States, and it feels at this point like it's a little bit of an inevitable future. Are there factors that separate us from the United States In the United Kingdom that we need to keep in mind?
Dr. Carlin: Yeah, well, the big factors, of course, are the vaccination rates. I think we've done much better than the US now. We have a slower start, but a greater portion of our population is fully vaccinated and first doses as well. That's important now, the social behaviours at the same level of vaccination. If we look back in our history, Canada and the provinces have had a lower growth rate for the same level of vaccination as saying that we've had less transmission. So we've been adhering to masking recommendations, etc.; generally better than in the United States, while in the United States, they've relaxed most of their issues. So those that play a big role in how much transmission there will be. So both of those factors will influence our collective futures. But right now, we're not sure what that future is for BC, but we're suggesting that we take special care to pay attention in the coming weeks for that.
Jackie: Yeah, maybe this could also play as a warning sign for us to turn it around before we end up that way.
Dr. Carlin: The faster one reacts to these, the better our position is if we wait until we are back to 1000 cases a day, which we were not many months ago. Then it takes us that much longer to go back down, and there are many more people who are seriously affected by hospitalization and death.
Jackie: One of the things that we talked about last time was that when the United Kingdom decided to start opening and same with the United States, their vaccination rates were lower than ours, when we, you know, administered the exact same loosening restrictions. Is that something that could play into our favour at this point? Or are we all even on the playing field now?
Dr. Carlin: Well, it plays into our favour because generally, we have lower rates right now then than those other nations do refer to when they opened up. When you're starting from a lower number of cases per person, or per 100,000, then you have that ability to, for example, deal with a slight rise; you're doing good contact tracing because you have the resources to manage all of those who are testing positive. So yeah, definitely it is. We're in a better position if we're willing to take action and not wait too long if we see rapid growth being sustained.
Jackie: There's also something that separates us from the United Kingdom. And that's the type of vaccine that was the dominant vaccine used. And in the United Kingdom, it was AstraZeneca, and Pfizer and Moderna, have different efficacy rights. Would that also be something that your modelling would take into account?
Dr. Carlin: Currently, I don't have the different distribution of vaccine types in the model. These are relatively small differences. And there are many other factors regarding how fast that efficacy ramps up. So if 111 tried to have a perfect model like that, which included all such factors, then you would try to segment the vaccines into different categories. But their efficacy, when fully vaccinated, is not significantly different. So currently, that's not in the model. Now, perhaps the more important question you're having is whether or not the UK might be at a slight disadvantage because of the efficacy of AstraZeneca being possibly lower for fully vaccinated against Delta. I think it's still not a large difference between those and the bigger factor is how large a fraction of your population can you get fully vaccinated.
Jackie: There's also new research that shows that at least for Pfizer, delaying the second dose did increase protection and Canada as a country that prioritizes waiting for longer intervals between doses, which is something that some people saw as a risk early on, but it seems to have paid off. Could that also have an impact in preventing a fourth wave?
Dr. Carlin: Yeah, that's a very good point. And that's all to do with what's called waning of immunity. And that's something that the modellers in the US CDC group are now starting to investigate. I've incorporated this waning loss of effectiveness with time into my model, but I've only assumed a rather long period before that weight waning occurred. So we'll start looking into that issue. As more data comes in about how the immune system response is decaying with time, we'll be in a better position to understand whether or not boosters are something that will be necessary for a fixed period of time. I think, of course, in terms of allocating additional doses right now, it's really important to get the world vaccinated rather than topping up our immunity. But in the longer term, that's an interesting point that needs to be investigated.
Jackie: Do your numbers show hospitalizations and deaths at all, or any projections for that?
Dr. Carlin: We do take some effort to model the hospitalizations as that is one of the priorities for us. It is interesting to see that in the United States, in the last four weeks or so, if you look at the ratio of hospitalizations to cases, that ratio is going up. We wouldn't normally think that that ratio should be going down as the age distribution of those being infected is going down. But in fact, it is going up. So if we're talking about hospitalizations per case, that ratio could be going up because the case says they're not all being reported as much as that fractional in cases people are not. Perhaps the testing is not as easily available, or younger people aren't as vigilant to get tested. Or it could also be partly in effect that the Delta variant could generate more severe responses. And so, there is a higher chance of having to get hospitalized with Delta. There is a study from Scotland showing just that. So yeah, tracking hospitalizations and deaths are important.
For BC, in the most recent analysis and in our report, we show that the cases and hospitalizations have more or less followed each other in the past. Although in recent weeks, there are more hospitalizations per case than we had seen in months prior. So I don't know if that's related to what we're seeing in the US. But the other reason to be looking at that is to see, okay, what is the effect of this rapid growth? If this gets sustained? How does that affect hospitalizations going forward? We haven't seen it yet. If this growth is sustained, we'll start to see increasing numbers in the hospitals in the next week. And, of course, that's a primary concern for the government.
Jackie: I think this is just me hypothesizing a bit, too, but many of the cases are among people who aren't vaccinated. And if Delta is stronger than those people are going to see more severe responses as opposed to people who were vaccinated. So could that also be playing into the numbers?
Dr. Carlin: Like I was saying, if Delta is stronger than Alpha, that will cause hospitalizations to increase. You're right that primarily the infections are in the unvaccinated in the vaccinated; generally, the body is responding. Even if there isn't an infection, you're not getting those severe responses or virus growth in the body that causes some individuals to require hospitalization.
Jackie: Do you think it's time to reinstate some of the restrictions that we had seen earlier?
Dr. Carlin: Given this past year of following these trends on a weekly basis, I think it is quite clear that BCG is entering this phase, but I can understand that one has to be extremely certain. So another week of data will make this even more apparent. Now what it takes to react to that, I think the kinds of measured responses that are our help authorities have done in the past where one could start with a limited response to understand if that will be sufficient to turn this around will be something I think they should be considered in the near term within a week or two so that we don't have many weeks of rapid growth. But of course, those decisions are made by people who have to consider all sorts of factors, not just growth and cases.
Jackie: Dr. Carlin, thank you so much, and I hope to talk to you again on a more positive note.
Dr. Carlin: Absolutely.