Hamilton’s rising COVID cases, plummeting vaccination and looming fourth wave

One month has seen a staggering turn in the course of the pandemic as COVID cases and vaccination are both taking off in the wrong direction in Hamilton.

In July, COVID shots were hitting a peak of 9,000 a day and the weekly rate per 100,000 population had dropped to 11.

Now, shots have plummeted to 1,700 a day with the cases per capita shooting up to 36 as of Aug. 10.

It's a trend seen across the province that has the chief medical officer of health, Dr. Kieran Moore, telling the public not to panic, and stressing that Ontarians have the power to blunt the fourth wave with vaccination, masking and physical distancing.

But it seems to have hit Hamilton particularly hard with the city recording Ontario's highest COVID rate on Tuesday and Wednesday, according to analysis done by epidemiologist Ahmed Al-Jaishi. Windsor took over the top spot Thursday pushing Hamilton to a close second.

At the current pace, the Toronto Star estimates the doubling time of cases in Hamilton is less than two weeks.

It's probably an effect of reopening Stage 3," Dr. Dominik Mertz, associate professor in the division of infectious diseases at McMaster University, said about the dropping of some restrictions July 16. It's small numbers but it's certainly increasing."

At the same time, the Star used provincial data to show Hamilton has among the lowest vaccination coverage in the province. Haldimand and Norfolk had the worst rates.

I certainly hope that some people may come and get vaccinated once they realize the pandemic isn't done with us yet," said Mertz. We only have the benefit of vaccines if we actually use them."

Hamilton has lagged the province since the beginning of the rollout and could be one the regions that holds Ontario back from dropping almost all COVID restrictions.

Moore estimated Tuesday that the province was, at most, 10 days away from meeting its target of getting first doses to 80 per cent of those eligible and second shots to 75 per cent with no public health department below 70 per cent.

It remains to be seen if Ontario will move forward with the exit step" as some epidemiologists, including Al-Jaishi, say the fourth wave has already started.

We're going to see cases rise a lot more in September," he said. If anything, we should be thinking about reducing gatherings because that is where you see most of the spread."

Scarsin Forecasting for Hamilton predicts the fourth wave will be among the young and unvaccinated fuelled by the aggressive Delta variant.

Delta now makes up about 95 per cent of the cases while vaccination among those age 12 to 59 is particularly stalled.

Why are we lagging?" Coun. Maureen Wilson asked at a board of health meeting Wednesday.

The answer is far from clear. So far, public health has mostly blamed uneven vaccine distribution, with hot spots such as Toronto and Peel getting a greater share when supplies were scarce.

But that doesn't explain how Halton and Leeds, Grenville and Lanark have risen to the top with rates for first doses from 85 to 90 per cent.

At the beginning there was a greater distribution of vaccinations in some parts of Ontario because of some of the numbers but that is not the case now," said Wilson.

Without a doubt social determinants of health are at play. Hamilton's first dose coverage was 80.4 per cent in neighbourhoods with low poverty rates as of July 31, compared to 68.4 per cent in those with high poverty.

In addition, the most racialized neighbourhoods have lower vaccination coverage, although this gap has narrowed from 9.2 per cent as of May 29 to 4.8 per cent as of July 31.

Geography also appears to be a factor with the worst vaccine coverage in four areas: Lower central Hamilton, Flamborough, the area surrounding the Red Hill Valley and east end, and a pocket surrounding the Lincoln M. Alexander Parkway.

But infectious disease experts like Mertz have struggled to pinpoint how much of the issue is hesitancy and misinformation versus access.

I watch a lot of social media on this," said Coun. Jason Farr. It's fascinating and it's also extremely scary because these are very slick, well-produced messages that are completely against the science, that our government is conspiratorial."

On the flip side, Coun. Nrinder Nann went out to talk to residents in unvaccinated parts of the city and discovered barriers that are easy to fix.

Evening hours are essential," she said, pointing out some mobile clinics only ran from 10 a.m. to 3 p.m.

Proximity was the next one," she said. Many of the residents in L8L (postal code) don't have vehicles, they rely on transit,"

Lastly, another component was a misunderstanding about what to do with your children when you are going to a vaccine clinic," Nann said about the lack of awareness that parents can bring their kids.

Hamilton has created what it calls its last mile strategy," which focuses on bringing shots to high-traffic areas where it's needed most, along with teams specializing in community outreach and vaccine confidence. Family doctors are calling their patients. Community organizations can apply for funding to help with the rollout. Bus tickets and transportation are provided.

We plan on bringing vaccine to places people already are and partnering with community agencies who are familiar with our priority neighbourhoods," said Melissa Biksa, manager of the COVID-19 vaccine rollout.

To spur immunization, the province has changed how it reports data to show COVID is becoming a pandemic of the unvaccinated.

Hamilton's hospitals declined to reveal how many of their COVID patients have been fully vaccinated, but provincewide it was 10 of 61 on Thursday. When it comes to the intensive-care units, it was two of 51.

If you get the infection and you're double dosed your experience is going to be drastically different," said Dr. Ninh Tran, a Hamilton associate medical officer of health. A lot ... end up completely asymptomatic - they're feeling well - or they have very minor symptoms."

There is no information about how many of Hamilton's most recent cases are fully vaccinated, but provincewide it was about 17 per cent on Thursday.

Data from Public Health Ontario shows 0.5 per cent of Hamilton's cases have been among those who had two doses, but it goes back to Dec. 14 when the majority of the population was unvaccinated and Delta wasn't the dominant strain.

Moore calls Delta a formidable and humbling foe that has been a game changer," upping the vaccination rate needed for community immunity to 90 per cent.

It's a call to arms for every Ontarian," he said. That is the way we are going to reopen safely."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com