As COVID-19 case numbers and hospital admissions decline across most of the province, Ontario is moving into a new phase of its pandemic response. More Ontarians are getting vaccinated every day, but the highly transmissible Delta variant could threaten our progress.
Guiding the government’s response is the COVID-19 Science Advisory Table. TVO.org speaks with Peter Jüni, the table’s scientific director, about why Ontario shouldn’t rush to reopen, the risks fully vaccinated people face, and how to leave the pandemic behind for good.
Peter Jüni: I’m sorry I’m late — we were having a very interesting conversation with the science table about long COVID.
TVO.org: Well, then, we may as well start there.
Jüni: We need to be aware that we’re talking about a highly transmissible variant, Delta, that will eventually result in a high probability of infection in everybody who remains unvaccinated. What this means is that, based on everything we know, we probably have a 10 to 20 per cent probability in adults to experience long-term symptoms that go beyond three months. And we have — probably, we’re not quite sure — also about a 5 per cent probability in children to experience the same. Even though it’s a lower risk of death, since a lot of our most vulnerable population is vaccinated, it’s not no risk.
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I think it is important to acknowledge that in the discussions coming, especially now that we’re still having an issue with accessibility of vaccines. There are those who are clearly unwilling to receive the vaccine. These people need to be informed about what the alternative is: the alternative is infection, which is not a walk in the park. We also have those that are still struggling with accessibility.
In addition, we have the issue with long COVID, even in children, and the residual risk of a multisystem inflammatory syndrome, which affects multiple organs in children and adolescents, including the heart, for example. It is actually associated with high morbidity and high risk of admission to the ICU — probably one in 1,000 to one in 3,000 cases. Taken together, this means we can’t just flip and say, “Okay, once we have reached 80 per cent vaccination coverage in the eligible population, we basically just let it go.” It’s not an option, especially because we want to get our children back to school.
TVO.org: This seems like an argument for taking seriously the preparation of schools for the fall. Looking forward, how would you categorize the risk to children in schools?
Jüni: Based on what we know, the basic reproduction number has gone up from two to three during the first wave, to seven to eight now, with the Delta variant. Hopefully, we will be very efficient with the vaccine rollout and we really move fast, but we just need to be careful. We need to keep in mind that it will take at least four months from now before we can start vaccinating children.
And we need to know a lot more: this is still in the dose findings phase for vaccines in younger children. We would want to at least make it there relatively safely — that means we need to continue cohorting; we need to continue to face the music that our default will be masking in schools in autumn.
And then, of course, it depends on how things go. In Israel, for example, they’re starting to have Delta outbreaks in, among other things, schools. We need to stay alert.
TVO.org: I’ve seen some different estimates of Delta’s spread in Ontario right now. Is it hard to pin down exactly what’s happening?
Jüni: It’s not so hard. We have this fluctuating around 45 to 55 per cent of all cases being Delta now, where we are. We need to be aware of what’s happening, which is that the wild types [COVID-19 strains that contain no major mutations] have gone nearly extinct. So, if you go to our dashboard at the Science Advisory Table, what you see nowadays — there’s a graph there that just jumped above 50 per cent. That indicates that, indeed, probably 50 per cent of everything we’re seeing is now the Delta variant.
It’s staying relatively flat, which is great. So, the R-effective is lingering around one — a bit above, a bit below. But we don’t see the impact of Step 1 of the reopening yet. Step 1 will only be visible, at the earliest, on Saturday or Sunday. We typically need a little bit more time because of the characterization of the cases in terms of these mutations.
So I will only start to be confident that we’re keeping this thing under control by Sunday or Monday. Then we can pull it out to see what’s happening.
We also need to be aware of what’s happening right now in the province. During the pandemic, we have never been as mobile as a society in Ontario as right now. We have actually now overtaken the mobility that we had in August and September last year. Still, thanks to the vaccines, we keep seeing numbers go down. But what actually goes down is Alpha. Alpha will become extinct relatively soon — in the next few weeks. What will stay is Delta. The big question is: How will it stay? At what level? And can we avoid what we have seen in the United Kingdom?
TVO.org: At the same time, there are people talking about speeding up the reopening process because of the success of the vaccine rollout. What do you think when you hear that sort of suggestion?
Jüni: Right now, we’re in a blind flight. We don’t know what will be happening with Step 1 of the reopening — we will only know that on Sunday. So everybody who suggests opening now doesn’t understand the epidemiology of this disease, period. Very simple.
We also have, of course, some Twitter scientists out there who are suggesting that we don’t understand what’s going on. That’s a challenge. So right now, what we see is that the R-effective for Delta is lingering around one. That’s now. What we see today, yesterday, tomorrow, is reflecting the situation before we started to go to Step 1. So how will this play out? We will see.
The challenge is, we are more or less in the same situation that the U.K. was in around mid-May in terms of gaps in vaccine coverage. In fact, the U.K. was relatively well-protected, comparable to how well we are protected now. And then they opened up one step more, and two weeks later, they were in trouble. You started to see clear evidence of exponential growth for Delta.
Therefore, it’s important now, with our more effective vaccine and more thorough vaccination of the younger age groups, that we first try to understand how the balance of power goes between reopening and Delta on the one end and the vaccine rollout on the other.
TVO.org: As case counts decline, one benefit is that we’re able to use the tools we talked about at the beginning of the pandemic — test, trace, isolate. If done properly, how important will they be in this phase of the pandemic?
Jüni: Oh, this will be very important. We will have three different tools in our toolbox. One is to vaccinate as much as we can and to make sure that vaccine coverage in all the regions of the province, in all the age groups that are eligible for vaccination, will be above 85 per cent with two doses.
The second one is because we will have the 15 per cent, and the virus is highly transmissible now with the Delta variants — it will find its way in this pocket. That’s guaranteed. It’s testing and tracing that can keep this part under control as much as we can.
And the third one is making indoor space as safe as possible. What does this mean? One thing is, in discretionary indoor spaces, like a cinema and restaurant, we need to think very carefully, depending on how bad the situation is: Who is eligible to be in the space? Is it just fully vaccinated people and people with a negative test? Or can we be more liberal? This will depend on the epidemiological situation.
The other part to make these places safe is not hygiene and cleaning protocols: it’s ventilation. We need to get into a different mindset. We need to optimize ventilation relative to the occupancy and complement it in certain situations with filtration.
TVO.org: The science table’s latest modelling indicates that we should expect to see cases decline for about 10 days. That was almost two weeks ago: What are you seeing?
Jüni: What we see is that the overall numbers are still continuing to go down. Delta is currently lingering at around 100 to 150 cases per day. The challenge now is, can we keep it that way or even bring that down? One of the issues is that 30 to 50 per cent of the Delta cases are coming from Waterloo right now. The reason for that is not completely clear. Perhaps it was introduced relatively early by neighbouring regions, such as Peel or Toronto, or is related to the Nunavut mine that had a Delta outbreak. It just shows you this can go very quickly with Delta. And when we get Waterloo under control, then I’m relatively optimistic that we can get these numbers down even more. We need to keep being alert. If we now just open up without being able to assess the data, because the data are not available yet, then we simply don’t know what our situation is.
But the good news is, for those of us who are partially vaccinated, we are already relatively well-protected against severe COVID. And those of us fully vaccinated are also well-protected against infection. This means those of us who will be fully vaccinated can start to have more liberties.
TVO.org: As someone who got his second dose yesterday, I’ve been wondering: In two weeks, can I freely see other fully vaccinated people?
Jüni: You have three different risk modifiers that you need to factor in. One is, what is the baseline risk in the area that you live to bump into somebody who is an active case? So, basically, take the daily case count, multiplied by roughly 10, and find out what this is as a percentage of the population. That’s basically your baseline risk. You should multiply that by roughly three, because only every third case winds up in the case count; the other two remain undiagnosed.
And then what you have, if two people then are fully vaccinated, this baseline risk is being reduced by a factor of 10 for each of the two people. That’s the beauty of it. This is a powerful risk modifier. So that what happens then is if two people are fully vaccinated, they are tremendously safer and they benefit mutually from the vaccination stages if they’re more than 10 days beyond the second vaccine dose.
Basically, when you think about it, the baseline risk will be reduced by a factor of 100 through the fact that both of you are vaccinated.
TVO.org: I think, in the peak of the third wave, you, along with many health-care leaders, were frustrated and nervous and anxious. I’m wondering whether now, given that the situation is a little more positive, you have been able to reflect on the darker days? And how are you doing now?
Jüni: Did I reflect on that? What we experienced there was just … hmm. I’m just thinking. I’m trying to just get to grips with that. What we experienced there was just pointing toward a complete misunderstanding of this pandemic. It’s a bit like when I now see some people suggesting, “Okay, we can just open.” They again miss the plot with Delta. In February and March, three things were really misunderstood. One was that this is a real deal with Alpha. What seems so trivial now thanks to the vaccine was a real threat there. The second aspect was the distinction between indoor and outdoor space. That was misunderstood. The third one was that it was predominantly essential workers and their families and people in precarious living situations who were affected.
The measures first not taken, and then the wrong measures taken, pointed toward a complete disconnect between the characteristics of the pandemic and the decision-making. It was really, I don’t know, challenging for me personally, just to look at that. I had this strong feeling of personal failure there that led me to reconsider — perhaps somebody else would do this job better? If I failed so miserably at communicating what is important now, am I still the right person to do this job? This was basically what went through my mind at that time.
And what I then felt was that, just being honest also about this part, the reactions of people — in my personal environment and much more also people I didn’t even know — all the emails I got made it very clear. And that’s also what we said at the table is, we’re not only doing it for elected decision-makers; we’re trying to help you as much as we can, the people of this province.
As we all saw how this was evolving with the third wave, something that made me tremendously, tremendously optimistic was this shift going through people to solidarity, to perseverance, and to resilience. This was remarkable, to be honest. We just really felt privileged to be able to help, even though it was challenging and difficult. It made me tremendously optimistic. That’s the truth, and it was because of the people, the way people reacted.
TVO.org: As we hopefully move away from the worst parts of the pandemic, it feels like a good time to consider the lessons we need to learn from it. I’m wondering whether you can think of one big-picture lesson and one small one that we should take from the past year?
Jüni: So, first of all, what we see is evolution in real time. And this means we have an opponent that we will need to continue to take seriously despite our vaccinations. Meaning right now, as I said before, carefully calibrate the reopening against the growth curve of the Delta variant. Already mentally get ready for what’s coming when we start to move inside again in October. That’s the bigger-picture lesson — not expect that everything is over. We will have smaller fires as we see right now in Yukon, when you move inside again with a much more formidable opponent than before.
We are doing absolutely the right thing, and we can be optimistic, but we can’t just let everything go.
That was the bigger one. There’s the other part: on the global picture, what we need to be aware of is that, as long as we don’t have this pandemic under control globally, it will continue to bounce back. So it’s all bigger pictures; there’s no smaller right now. We do not know yet whether the virus has maxed out on its evolution. After a while, this virus found its way into a new host, and the new host is us. And what you see now is that is optimizing the virus-host relationship with us. And now it’s relatively well underway, with a reproductive number that is six to eight. Does it stay there? Perhaps you’re lucky, and it does. Or does it evolve more? It has ample opportunity to evolve, theoretically, because of the pandemic absolutely being out of control in many places in the world.
For us, as Canada and as the Western world, it will be absolutely important not only from an ethical and moral perspective to support all remaining countries, but it will also be the only way to get back to a normal that is not dominated by travel restrictions and continued challenges over years. So we really need to do our homework as a society, speed up the vaccine rollout, and provide all countries in the world with sufficient vaccines and with sufficient information. We’re in this together, globally. This is one strange rock we’re on. We’re so connected. There’s no way that we’ll be able to resolve that if we just do that on a national level.
TVO.org: Is there anything else that you think we should talk about?
Jüni: I don’t know — I spoke too much already. There is this experience, to be part of this scientific community and this community of senior health-system leaders. I spoke about the dark moments in February and March. In contrast, it was the most satisfactory professional experience, to be part of this group of perhaps 120 to 150 people who really work tirelessly in the background and in the foreground and try just to get things done, irrespective of what time of the day it is, what kind of resistance was out there — they just got it done. It was an extraordinary experience.
This interview has been condensed and edited for length and clarity.
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