Infectious disease physicians explain why it’s time to reopen and drop vaccine passports

The big question that looms over Ontario's move to the next stage of reopening is how much protection the province has against Omicron.

We don't really know very well how many people have had COVID over the last six weeks," said Dr. Dominik Mertz, medical director of infection control at Hamilton Health Sciences (HHS).

Estimates for Ontario range from 1.5 million infections to four million, Mertz told an HHS town hall.

The key, which will predict what's going to happen ... will be how many people do have immunity," said Mertz. If it's only two million, then we expect another increase in hospital admissions very soon."

With limited access to PCR testing, wastewater surveillance has become a key indicator of Omicron's spread. It's on a downward trend for all of the province except for the north, shows data released Tuesday by the Ontario COVID-19 Science Advisory Table.

The rest of the province is ready for the next step," said Dr. Peter Juni, scientific director of the table.

He estimates the peak of the fifth wave saw 100,000 new cases a day. Plus, over 6.7 million Ontarians have had a booster shot.

We have built up a wall of immunity," he said.

Will it be enough to protect the health-care system as Ontario loosens restrictions Thursday and drops vaccine passports March 1?

It's a particularly important question in Hamilton, where hospitals are still overcrowded and struggling to maintain essential services.

Ontario's nurses and the NDP say the province is moving too fast.

Juni and Mertz spoke to The Spectator on Tuesday about why they think the risk is worth taking and what could be ahead.

What are the changes?

As of Thursday, social gathering limits increase to 50 indoors and 100 outdoors. Capacity limits lift for all but the highest risk indoor settings. Sports events, concert venues and theatres can have 50 per cent of their usual seating. The cap is 25 per cent at nightclubs, bathhouses and sex clubs.

As of March 1, Ontario plans to lift proof-of-vaccination requirements and capacity limits for all indoor public settings.

Why get rid of vaccine passports?

Proof of vaccination is no longer feasible, explains Juni.

We are unable to implement something that makes sense," he said.

Two COVID shots protect against severe illness but not Omicron spread. As a result, the passport would need to be upped to three shots to slow transmission of the fast-spreading variant.

However, the province can't make that change because the National Advisory Committee on Immunization recommends waiting three months after a COVID infection before getting a booster.

It would be a lot of people who would not qualify at this point for a certificate," said Mertz. You'd be looking at roughly four million Ontarians who wouldn't really qualify for a booster for the next three months."

Will it be safe to go for a night out?

Dropping proof of vaccination doesn't significantly increase the risk of getting COVID for those who have had their shots, stressed Mertz.

It troubles me when I read people now being concerned about their own health," he said. I'm a little concerned this will result in more conflicts."

Firstly, it's important to remember that the unvaccinated are a small number. Juni says just 880,000 out of roughly 12 million Ontario adults haven't had any COVID shots. Many of them have now been infected with Omicron.

Secondly, vaccine passports are more about keeping the unvaccinated from getting infected.

I think the vaccinated need some level of reassurance," said Mertz. No, they are not being thrown under the bus ... They made the right choice. They did that to protect themselves and that's still valid."

Does this mean the pandemic is over?

A pandemic doesn't have light switches that we can magically use and then things are over," said Juni.

While there is increasing talk about learning to live with the virus, there is no way to predict what will come next.

Things are certainly moving in the right direction for now," said Mertz. Whether that means that things will still look the same way in a few weeks or few months, who knows?"

While the hope is that 2022 will be the year COVID becomes endemic, it's not something you can will into being.

You only know after the fact that you are in an endemic or that the pandemic is over," said Mertz.

It takes years of gradually increasing immunity in a population to get there, said Juni. He estimates a minimum of three exposures to the virus is required to have a mature immune response.

The easiest way to reach that is three COVID shots. But for some it will also include infections.

We need to think about it like a layer upon layer of immunity," said Juni. It will not be the case that there will not be any infections but the risk of serious outcomes at a population level will decrease."

The province has already come a long way.

I'm 54 (years old)," said Juni. My risk to die or end up in an ICU now compared to two years ago has decreased 50-fold. That is a dramatic decrease."

But there could still be quite challenging times ahead, especially if new variants arrive, or in future winter months when respiratory viruses tend to thrive.

Why lift restrictions now?

Omicron appeared to peak in Hamilton between Jan. 9 to 24 - it's slightly different in each part of the province.

Key metrics have significantly dropped, including outbreaks in high-risk settings, which were down to 15 in Hamilton on Tuesday from 101 on Jan. 14.

The number of COVID patients in Hamilton's hospitals were down to 111 from 309 at the peak. Of those, 14 were in the intensive care unit (ICU). Hospital staff self-isolating has dropped to 199 from 1,032 on Jan. 17.

I think it's the right decision at this point to move forward," said Mertz." I think the approach we are taking makes sense. We can see what happens over those two weeks before we go into the next step."

What is the risk?

Hamilton's hospitals are still severely overcrowded, with Juravinski at 112 per cent occupancy, Hamilton General at 107 per cent and St. Joseph's Healthcare at 104 per cent - optimal is 90 per cent at most.

HHS and St. Joseph's aren't yet resuming paused care despite getting the go-ahead from the province on Feb. 10.

Hamilton's hospitals continue to labour under the weight of the Omicron wave," said CEO Rob MacIsaac at the HHS town hall Feb 10. Our reality locally and across our region remains highly pressured and we continue to see an inordinately high demand for hospital care."

The Registered Nurses' Association of Ontario and NDP Leader Andrea Horwath have both said the province is going too far too fast.

While Omicron is milder overall, the sheer number of infections has led to a spike of deaths in Hamilton, with two more reported Tuesday. One of the fatalities was a senior age 80 or older and the other was a resident in their 50s. Hamilton has now had 508 pandemic deaths.

Joanna Frketich is a health reporter at The Spectator. jfrketich@thespec.com