The next phase of the pandemic will be different. So we’ll need to read the data differently

OPINION: We’re heading into a new stage that will be less scary — but more complicated
By John Michael McGrath - Published on Jul 29, 2021
Ontario COVID-19 vaccinations by age as of 8 p.m., July 28. (Data from the Province of Ontario; visualization by John Michael McGrath)

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It’s not unusual to take time off in July or August, and yet I feel weird going on vacation next week. There’ll be 10 or so days between this column and my next one for TVO.org, and in that time Ontario is going to move into the next phase of the pandemic. It’s almost certainly going to be less overtly scary and lethal than prior waves, but it’s also going to be more complicated — and we’ll all need to re-weigh some of the indicators we’ve been following for more than a year now.

Minister of Health Christine Elliott announced Thursday that Ontario has hit the first benchmark for moving out of Step 3 and into something substantially closer to “normal life”: 80 per cent of eligible Ontarians have received their first shots. The remaining enumerated benchmarks: 75 per cent need their second shots, and none of Ontario’s public-health units can have less than 70 per cent of the population with both shots. 

Since 67.89 per cent of the 12-and-up population already have their second shots, it won’t take long for us to hit 75 per cent, even at the lower rates of daily shots we’ve been posting in recent weeks. That leaves making sure that no public-health unit is lagging too badly behind the provincial average, but here, too, the good news is that, in even the lowest-scoring PHUs, more than 70 per cent of residents have received their first shots. Those people are also likely to show up for their second, so it’s a matter of when, not if, we enter whatever comes after Step 3 — which Premier Doug Ford says will involve lifting the large majority of public-health measures.

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The other qualification to enter the post-Step 3 world is that Ontario is supposed to wait no less than 21 days; this was also true of the previous steps, and Ontario didn’t adhere to that rule, so I honestly have no idea how seriously to take it. In any case, we’ll hit the 21-day mark on August 6. I expect we’ll have hit all the other benchmarks by then or will hit them not long after; entering Step 4 by mid-month seems plausible — certainly before Labour Day, barring some dramatic reversal in the hospital system.

When we do, in fact, reach Step 4 (or whatever the government chooses to call it), we’ll be in a novel place: with the removal of most public-health measures, COVID-19 will certainly spread more freely than it does now, and most of the government’s health experts — from the chief medical officer, Kieran Moore, to the technical experts who spoke to reporters Wednesday about the surgical backlog  — acknowledge that we’re likely to see a fourth wave in the fall. Beyond that, it’s a fool’s errand to try to describe the future in too much detail. There are too many open questions, including, most critically, when children five to 12 will be approved for vaccinations, to make solid predictions.

We can say at least this much: some things really will be different, this time. A new wave of cases, even one as large as the second or third waves, won’t generate the same number of new hospitalizations and deaths. Some cases will be among the vaccinated, and thus mild or even asymptomatic; the vast majority of the unvaccinated are in the younger, and thus lower-risk, populations. The United Kingdom may be exiting a pandemic wave nearly as severe as previous ones in terms of overall cases, but it’s still quite small if measured by hospitalizations.

As much as I agree with people saying that we shouldn’t necessarily let large case numbers in the fall panic us, I can’t sign on to the argument that case counts simply no longer matter

There are two reasons for that: First, case counts are still the most basic input from which future hospitalizations and deaths are made — trying to understand what’s going on in the pandemic without at least keeping an eye on what the case counts are, where in the province they are, and where they’re going is a bad plan, even if the large majority of infections never result in serious cases.

Second: Case counts are, crucially, a leading indicator, while hospitalizations and deaths are a lagging one. Ignoring case counts entirely is a recipe for getting a nasty surprise when people start showing up in the ICU again. These are basic facts about the pandemic that vaccinations haven’t really changed. The multipliers have changed — it will take many more new cases of COVID-19 to create new hospitalizations and deaths — but the basic relationship between the variables hasn’t: if cases go up, especially if they go up in large numbers for a sustained time, hospitalizations and deaths will follow.

The discussion about how vaccinations have and have not changed the pandemic also tends to ignore the fact that hundreds of thousands of people over the age of 50 — more than 600,000 people in the age cohort that has seen 98 per cent of all fatalities and still generates the majority of hospitalizations — are still unvaccinated. If the Delta variant is allowed to spread in an uncontrolled way, these people will arguably be even more vulnerable to severe outcomes than they were last year.

So while I’ll definitely be reacting less to the daily case counts as Ontario heads into the fall, I won’t be ignoring them entirely. I’ll be placing more weight on the change in hospitalizations, especially the intensive-care-unit counts. The daily vaccination numbers are going to fade to insignificance until children are approved (or the government changes its mind on vaccine passports, whichever comes first). And if the province resumes the reporting of COVID-19 cases in schools, I’ll be keeping a close eye on that, not necessarily because I’m terrified of the outcomes directly for kids (though, as a parent, I’m anxious) but because hundreds of thousands of parents and grandparents are still unvaccinated in Ontario, and the virus can spread quickly in schools.

One of the few areas of the pandemic in which Ontario’s performance has been almost unreservedly great is data: it’s provided detailed information and done so regularly. As we head into the fall, we’ll have to be more careful and nuanced about how we read the data, but it’s still one of the most valuable tools we have to figure out where this is all going.

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