PERTH COUNTY – With a motion opposing lockdowns on the agenda from Coun. Daryl Herlick, Perth County council invited Dr. Miriam Klassen, medical officer of health for Huron Perth, and Andrew Williams, chief executive officer of the Huron Perth Healthcare Alliance, to speak as a delegation at the May 6 council meeting.
“The facts about this pandemic, how the virus behaves, the significance of variants of concern, the benefits and risks of various vaccine formulations are complex and nuanced and will not be fully understood for many years to come,” said Klassen. “Equally the effects of public health measures including lockdown measures will take years to fully comprehend. There is no doubt that in addition to preventing COVID-19 illness and death there are unintended adverse impacts.”
She said the adverse impacts have been acknowledged and have been incorporated in decisions to find the most appropriate balance between mitigating against infection and protecting socio-economic health.
Klassen said that because COVID-19 is a novel pathogen and a COVID pandemic has not been experienced in known history decision-makers have been using what is known about pandemics, viruses and infections in general and adapting as they learn information specific to COVID-19 to inform decisions.
“All science is incomplete,” she said. “This is even more true in a rapidly-evolving situation such as this COVID-19 pandemic where it is necessary to make decisions with incomplete information and then as more information becomes available decisions are updated accordingly.”
While acknowledging the risk of severe illness and death is lower for children than adults, especially older adults, she said the risk is not zero.
“With the increase in variants of concern the risk has become higher,” said Klassen. “Additionally while children may not spread COVID as readily as older people, they do transmit COVID infections and can contribute to the propagation of the pandemic.”
Klassen pointed out that as of May 6 in Huron-Perth, there was almost the same number of cases in people aged zero to 19, 202, as in people 80 years and older, 212.
“As a sad reminder we have had over 8,000 deaths in Ontario, including 53 deaths in Huron-Perth even with all the Public Health measure implemented since the start of the pandemic,” said Klassen.
She said vaccines are widely considered to be the greatest public health achievement preventing untold numbers of disabilities, illnesses and deaths since the 1700s.
“The rollout of the COVID-19 vaccine has been unprecedented for several reasons, notably the level of global cooperation that facilitated the ability to bring a vaccine to market so quickly,” said Klassen. “This is not an easy task. We humans are not adept at understanding and evaluating risk. Emotions play a larger role than factual information.”
She said that ultimately the decisions regarding how to deal with the pandemic are about values.
“Ontario’s response has aimed to prevent as many hospitalizations as possible and to try to mitigate against social and economic adverse impacts in other ways where possible,” said Klassen.
Klassen emphasized that the situation in Ontario is very precarious with the hospital sector stretched to the limit.
“The variants of concern transmit very easily and we can’t erect a wall around Huron-Perth,” she said.
Klassen said if the pandemic is not brought under control then we’re not only at risk of COVID-19 infection, but also of not being able to access hospital care if needed for other illnesses.
“I’ve heard people ask why vaccines are being more focused in one area,” she said. “Why don’t we just do the lockdown measures in one area? I would say if the house is on fire and you are in the bedroom and the source of the fire is happening in the kitchen you direct your efforts at the kitchen, but it will ultimately save the bedroom.”
With vaccination rates increasing and provincial infection rates levelling off, Klassen said there is reason to believe conditions will soon exist for a successful and a hopeful final easing of public health restrictions. But, she emphasized that if it happens too soon cases could spiral out of control as has happened in other countries.
Williams said he has not spoken to anybody who is happy that the province is in a lockdown or is happy to deal with the restrictions, but he assured council that people working in the health care system right now feel it is fundamentally important to make what he is confident is the last push to get through this.
“In our Stratford site we have eight COVID patients today, seven of whom are in our ICU and six of those are from the GTA,” he said. “As you probably know the main driving force behind the big push to lockdown this time has been the increasing pressure on our intensive care units.”
As a result of the variants of concern, Williams said they have been seeing younger people in hospital and they were concerned the trajectory was going to overwhelm the system.
“We have 868 ICU admissions in the province today,” he said. “It wasn’t that long ago where we had half of that so it was key for us… to advocate.”
Williams sits on the Ontario Hospital Association board, and they wrote to the premier saying Ontario needed to lockdown.
“We need to target vaccinations and get ahead of the hot zones,” he said. “We need to do some societal things such as sick leave which is a policy issue.”
Williams said the current lockdown is “the absolute right call for us to make as a province.”
He believes the vaccines are going to be the major influencer for getting back on track.
“We’re seeing the numbers in ICU flatline this week,” said Williams. “They peaked at around 890 and they are now slightly dropping. That is positive but we’re not there yet… The worst thing we can do is go through the hell that we have, and I couldn’t agree with those (who) say that this has had a devastating impact because it has. It has on businesses. It has on lives and we know that but the worst thing we can do in memory of those impacted is to take our foot off the gas too soon… I can’t thank our community enough. I mean we stepped up in anyways possible, have done everything that has been asked of us and it has certainly helped us locally with the cases. We are part of the bigger system. We need to recognize that and do our part which we are happy to do.”
Coun. Daryl Herlick raised concerns about testing.
“My wife tested positive for COVID back in December,” he said. “Her symptoms were (an issue with her sense of) smell and a sore throat (which she had six weeks before her check-up), so they thought they should test her, she went in for a check-up and she tested positive.”
Herlick said his wife was told not to get another PCR test for months or a year.
“Daryl, I’m going to just stop you there,” said Warden Jim Aitcheson. “Your actual question is?”
“Just your thoughts on the PCR testing,” said Herlick.
Klassen said she thought he was asking about the limitations of the PCR test.
“What I will tell you is that every single test has false positives and false negatives and always needs to be interpreted with a clinical context,” she said. “A pet peeve of physicians often in non-COVID times is people who want to have testing for certain things just for reassurance or to rule things out. You will hear us say always that’s not a good idea.”
Klassen said that’s why there is good clinical testing guidance about how to interpret results. “It’s extremely sensitive and in symptomatic people, it’s very helpful,” she said. “When you look again at how a novel pathogen was found less than 18 months ago and was sequenced and we were able to do a test and develop vaccine… There is very solid science behind it.”
Coun. Rhonda Ehgoetz said she has been asked by constituents why people with COVID have been moved out of Toronto.
“I realize it was because they were swamped but if you use the farming analogy, if I had three barns of animals and one of them is sick I don’t move my sick animals to the two barns that are healthy,” she said. “Why didn’t they find a bigger facility to try to keep them in Toronto or Kitchener or wherever the hot spots were?”
According to Williams, there is a finite number of ICU beds with ventilation capacity in hospitals across the province and a finite number of staff to support those beds so the only way they could have prevented moving patients out of the GTA would have been to take all the ventilated beds and the staff from across the province and moved them to the GTA.
“We felt that would have been far more disruptive so when you look at the ICU at our Stratford site before the pandemic we had six beds that we could vent patients on,” he said. “We have now increased that to 13. We’ve done that by reducing surgery and we have reallocated our staff to the ICU.”
Williams said it’s a capacity issue.
“It’s very disruptive as you can imagine for everybody,” he said. “I mean the families… and their loved ones are travelling hundreds of kilometres away, it’s tough on them. It’s tough on the teams in hospitals that have been redeployed. We’ve taken OR nurses and they are now supporting intensive care patients so it’s hard on everybody but it’s the right decision in the context of where we are right now.”
Klassen added that in the terms of infection prevention control the first choice would be to not move people but it was similar to the situations where people needed to be decanted from long-term care facilities in Huron-Perth during outbreaks.
“It was not our preferred choice,” she said. “We tried to keep people where they were onsite as long as we possibly could but ultimately when that started to impact the ability to provide the correct level of care then we had to consider moving (patients).”
Without citing a source, Herlick said he read an article on vaccine rollout which stated Canada just now hit three per cent of its population vaccinated.
“I’m just curious where they think the sweetheart number is going to be,” he said. “People are hesitant. It’s frustrating at times you know… I’m not anti-vax. I vaccinated and have been involved with vaccines as much as anybody. It’s tough.”
Aitcheson stopped Herlick and asked Klassen to reply.
She said that if the article was referring to people who have had both vaccines it might be three per cent, but the number of Canadians who have had at least one vaccine is about 40 per cent.
“Certainly in Ontario, it’s over 40 per cent and what we know is that already does create very good immunity,” said Klassen. “We want to get caught up and get everyone their second dose eventually but getting that first dose out raises the level of immunity.”
She used the long-term care home sector as an example because recent outbreaks have not been as devastating and once residents got two doses in it was even better.
“I think you were getting at what level would we reach what is called herd immunity or when will the level of vaccination permit a loosening of public health restrictions,” said Klassen. “I think that will be a bit of a gradual thing… we’re hoping that in the summer you are going to see a lot more activities permitted in the outdoor setting.”
Vaccine hesitancy is something she said is always a challenge, but in Huron-Perth the response has been tremendous.
“I just looked at our data,” said Klassen. “Our 80 pluses are at 94.6 per cent. 75 to 79, 91.9 per cent, 70 to 74, 92.2 per cent, 65 to 69, 80.5 per cent for one vaccine and odds are that the vast majority of those people are going to come back for their second.”
Aitcheson raised the question of whether people will be able to mix and match vaccines depending on availability when they need to get their second dose.
“Almost certainly, I mean there is likely no harm coming from it, the question is more will you get the preferred immune response,” said Klassen. “What we know is there is also the possibility you will have an even better immune response by using two vaccines that approach the problem from slightly different ways… I’m sure we’re going to continue to learn more about how the vaccines work together or impact the immune system and additional recommendations will be coming out.”
She said that in all likelihood this is going to have a lasting impact, so people are going to need boosters.
“This is probably going to become a routine childhood kind of vaccine so this is going to become part of Ontario’s publicly-funded immunization schedule if you ask me,” said Klassen. “There is the Immunization of School Pupils Act which is upheld by local public health units. Will that antigen be added to the current act? I expect it will… but don’t hold me to it… in case the province goes a different direction in terms of how they roll that out but I certainly think that is one possibility.”
Herlick raised his hand to ask another question. Aitcheson asked him to be brief.
“I’ll be quick,” he said. “The mutation and the new strains and variants, that’s a concern depending which week it seems. We know there has been the new strains and the variants.”
Klassen cut him off.
“That’s how viruses behave,” she said.
“That’s another issue,” said Herlick. “The fact that coronaviruses mutate all the time. We know this and (they) change their makeup. I just want some thoughts on that.”
“All viruses behave that way, we expect that,” said Klassen. “The influenza virus changes every year as well. The thing is, the higher the rates of transmission, the more mutations, the newer variants you are going to see so one strategy is to drive down rates of transmission and then another strategy would be to continually update vaccines as we do with influenza to deal with any major shifts… but the No. 1-used strategy is to drive down the rates of transmission in the first place.”
“I would also like to add one further comment,” said Aitcheson. “I would like to thank the Perth County EMS for everything they have done through the pandemic… they have done a lot of the decanting, they have done the transportation of a lot of the people from Toronto – in and out, they’ve done swabbing, they’ve done vaccinating, they’ve pretty well run the gamut and they’ve done a great job while doing it so I also want to pass on the praise to them as well.”
“Agreed,” said Klassen. “And our hospital partners – fantastic primary care.”
Colin Burrowes, Local Journalism Initiative Reporter, Listowel Banner