For 64 days, the intensive care unit at Toronto's Michael Garron Hospital hadn't seen a single new patient with COVID-19.
That streak ended last week.
The patient: an otherwise healthy man in his 40s, unvaccinated by choice.
It was not a decision based on issues of access or availability, Dr. Michael Warner, the hospital's medical director of critical care, explained in a video posted online with the patient's permission. Instead it was influenced by "unscientific claims made by friends and colleagues."
"Delaying getting vaccinated is a decision this patient vehemently regrets now," Warner said grimly.
But as Ontario faces rising rates of the highly contagious delta variant, it's also experiencing falling rates of vaccination with the average number of daily new shots administered seemingly plateauing at around 43,000. That's while the delta variant now accounts for more than 90 per cent of COVID-19 cases detected in testing.
The decline in vaccinations wasn't something the province necessarily saw coming, said the province's Chief Medical Officer of Health Dr. Kieran Moore.
'A sudden drop off'
"We had a sudden drop off over the last several weeks and quite honestly, we have to re-bolster our efforts to immunize Ontarians," Moore told reporters Tuesday.
As it stands, Ontario has administered more than 20 million doses of COVID-19 vaccines, with nearly 82 per cent of Ontarians ages 12 and up having received one dose and 74 per cent having received both.
Yet some three million eligible Ontarians remain unvaccinated. Among the least protected are those aged 30 to 39 with only about 66 per cent fully vaccinated, 18 to 29 with roughly 60 per cent fully vaccinated and 12 to 17 with just 56 per cent fully vaccinated.
Even in older age ranges, gaps remain. According to Dr. Peter Juni of Ontario's Science Table, there are still 850,000 people aged 50 and up who aren't immunized.
"Imagine what this means, 850,000," Juni told CBC News. "That can easily still cause potentially up to 15,000 ICU admissions."
The facts are clear, he says: if you're vaccinated, your risk of being infected is eight times lower than someone who isn't vaccinated. The risk of being hospitalized is roughly 30 times lower. And the risk of ending up in an ICU is 50 times lower.
Trying to reach those 'on the edge'
So who are the holdouts?
There is and will likely remain a small percentage of the population that is adamantly against getting vaccinated and vaccinating their children, Juni says.
"We don't have to address those. They will learn it the hard way," he said. With much of the province reopening, the risk of infection over the next six to 12 months for those unvaccinated is 80 to 90 per cent.
But then there are those "at the edge," Juni says, who have been swayed by misinformation from friends or colleagues.
"A lot of people are out there who have had experiences in their lives that also make them reluctant and distrustful against the system, against the authorities and the government. And I can completely understand that," Juni said, adding many in this group are ethnically diverse or racialized.
"What pains me is to see basically that a lot of the misinformation out there is being spread by white privileged people and we need to be careful now that we counteract this … That's the challenge now, to get those people who are not clearly opposed to it but still have concerns."
The fact is, he says, no vaccine in history has been evaluated as well as the mRNA vaccines from Pfizer and Moderna.
Lack of access still a problem for many
Aside from the hesitant, there are also those who still lack access to the vaccine.
Juni says those are largely people who are precariously employed and need better support from their employers to get time off to be vaccinated as well as for possible side effects, should they experience them.
"This pandemic and the vaccine rollout are still primarily about the structural determinants of health. People who do not have the supports to take time away from work, or the transportation to get out to certain clinics are still facing such barriers," said Dr. Andrew Boozary, executive director of UHN Gattuso Centre for Social Medicine.
Boozary also believes vaccine efforts that put community ambassadors at the centre will also be key now.
"The vaccine rollout was always going to move at the speed of trust," he said.
Ministry of Health spokesperson Bill Campbell told CBC News, "Individuals who are still unvaccinated may be hesitant for different reasons and require a more targeted approach."
As the vaccine rollout continues, he says, high-volume sites like hospitals and community settings may begin to wind down their offerings, with mobile clinics and community-based pop-ups taking on a more key role.
The province is also working with public health units to offer dedicated clinic days for people with disabilities, holding townhall meetings in multiple languages, and providing services such as transportation, translation services, and drive-through clinics, he says.
Family physician Dr. Jennifer Kwan says she'd also like to see easy-to-understand visualizations to help spell out just how many of those getting sick are unvaccinated, and "help people make an informed choice to get vaccinated to protect themselves and their loved ones."
Risk of more deadly variant
For more proof the impact of being unvaccinated is real, just ask Dr. Kevin Smith, president of Toronto's University Health Network (UHN).
Since late June, Smith says UHN has admitted 45 people with COVID-19, all but nine of whom were not fully vaccinated. Thirteen patients ended up in intensive care — all unvaccinated — with nine becoming so sick they had to be put on ventilators.
One of the great worries now, he says, is every time someone passes on COVID-19, we run the risk of a further mutation.
"So the more quickly we can eradicate or reduce this to the base minimum ... the lower the risks of a more virulent and perhaps more deadly variant."
And to those still choosing not to be immunized, says Juni:
"The hard facts of life are, if you're not vaccinated, you will most likely get infected during the next six to 12 months. And getting infected with the virus causing COVID-19 is not a walk in the park."