A pedestrian wearing a mask walks through an empty downtown Calgary, Alta., on Dec. 9, 2020.Jeff McIntosh/The Canadian Press
A month ago, Alberta was Canada’s COVID-19 hotspot, breaking daily records for infections as intensive-care units were pushed beyond capacity and health experts warned of a coming catastrophe.
While the situation in the province is still precarious, daily infections have since been cut in half. Hospitalizations have levelled off and are beginning to ease. An expected surge from holiday gatherings doesn’t appear to have materialized. There is cautious optimism among health officials, doctors and epidemiologists that strict measures in mid-December are working to bend the curve down.
At the same time, the United Conservative Party government is facing increasing pressure to loosen those measures, which include restrictions on all social gatherings and widespread business closures. The province pulled back slightly this week, announcing that small outdoor gatherings would now be permitted and personal service businesses such as hair salons will be able to open, but the government says it is still too early to reopen more widely.
Experts say things appear to be moving in the right direction, but the true impact of the recent restrictions is still difficult to measure, as the lower infection numbers were also accompanied by testing rates that plunged over the holidays and have yet to fully bounce back. And they argue there are still significant risks for the province, such as more contagious COVID-19 variants discovered in the U.K. and South Africa that demand more caution, not less.
“I don’t think we’re out of the woods yet,” said Stephanie Smith, director of hospital infection control at the University of Alberta Hospital and a professor at the university.
“I think all of us are worried that next week the government’s going to say, ‘Okay, we’re gonna open things up again.’ I am worried that would be too soon.”
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Infections in most provinces started picking up in the fall after a relatively calm summer in which COVID-19 cases slowed to a trickle. Manitoba was the first province to see a significant surge, followed by a spike in Alberta that was faster and more severe than any other province during the second wave.
Alberta recorded more than 1,800 infections per day in mid-December, more than three times the rate of Ontario, and soon led the country in hospitalizations and intensive-care admissions. More than 20 people a day are dying of COVID-19, with about 800 deaths since the beginning of December.
The provincial government boasted last year that it had among the least stringent approaches to the pandemic in the country, opening up wider and staying open longer than most places in Canada. Premier Jason Kenney said his government preferred to rely on voluntary measures while appealing to Albertans’ sense of “personal responsibility.”
That approach became untenable as the province’s ICUs were filled past capacity and the province scrambled to add more beds. In late November, the government banned indoor gatherings and cancelled in-person classes for older students. When that didn’t work, outdoor gatherings were banned and a range of businesses (including restaurants, gyms and salons) were ordered closed.
Since then, cases have fallen. Infections have been averaging about 900 cases per day and the province now ranks fourth in terms of new infections as cases increase in Quebec, Ontario and Saskatchewan – though none of those provinces are anywhere close to where Alberta was a month ago.
There were 806 people in hospital as of Wednesday, down from a peak of 949 just two weeks ago.
Dr. Smith said the hospitalization numbers in particular are a sign that the decrease in infections is not simply because of lower testing. She also noted that the percentage of tests that come back positive has also been decreasing. A high positivity rate would suggest not enough people are being tested.
“As time has gone on and we’ve gotten further and further from Christmas and New Year’s and these trends continue, then I do think it’s real,” she said.
The latest round of federal modelling, released on Friday, projected infections to continue falling in Alberta and Manitoba until at least March, but increasing significantly in Quebec, Ontario and B.C.
Recent opinion polling has suggested Albertans followed public-health orders over the holidays at higher rates than other provinces. Surveys from Innovative Research Group and Leger both found respondents from Alberta were more likely to say they avoided contact outside their household than those from other provinces.
Lynora Saxinger, an infectious-diseases expert at the University of Alberta in Edmonton, agreed that the progress made in recent weeks could be lost if the province lets its guard down and reopens too soon. That could lead to a yo-yo scenario where the province has to bring back restrictions, which would wear on public patience and make it even more difficult to convince people to comply.,
“If you let up too soon, or don’t have a graded return, that can be problematic,” Dr. Saxinger said. “We will lose the benefits of the efforts so far.”
She also cautioned that the situation in hospitals remains dire. Some COVID-19 patients spend weeks in the ICU, meaning pressure on that part of the system will be slower to ease.
The start of vaccinations has added to the optimism about the situation in Alberta, but that is unlikely to have a significant impact on hospitalizations for some time. The average patient receiving critical care treatment is 59 years old, while the average age of hospitalized COVID-19 patients is 63. Alberta is still months away from vaccinating people in that age group.
“If things just turn right back around, there will be no break in the hospital setting. It will just continue straining at the seams,” Dr. Saxinger said.
Adam Vyse, a doctor in High River, was among the health-care workers pushing for a “circuit breaker” shutdown in November, when case numbers were far lower than they are now. Kids returned to school just last week, so the province cannot yet fully grasp how that will affect community transmission.
“We’re so close to getting out of this,” Dr. Vyse said.
Alberta, he said, would be wise to tough it out a bit longer – until people over 50 get vaccinated and a large percentage of the people who are at risk of hospitalization is protected.
Dr. Vyse also counsels against regional rules, even if some communities with few cases feel they are being unnecessarily forced to operate under rules written to stem the crisis in hospitals in Edmonton and Calgary. The Premier has suggested his government is considering having different rules for regions like the province’s south, where infection rates are comparably low.
“You need the big picture,” Dr. Vyse said. “On a local level, it might not seem like much, but each case from a small town feeds into the city ... and the cumulative effect is these massive numbers.”
Patients with severe cases of COVID-19 often end up being treated in Calgary or Edmonton, regardless of where they live. In turn, smaller hospitals absorb patients without COVID-19 from the larger cities. In High River, for example, officials opened up a unit to take care of patients from Calgary who are waiting for spots in assisted living facilities. High River’s hospital has 16 such patients right now, Dr. Vyse said. This opens up hospital space in Calgary, which is about 65 kilometres north of High River, and keeps vulnerable patients away from facilities struggling to stamp out COVID-19 outbreaks.
There have also been COVID-19 outbreaks in many of the province’s hospitals, adding to that pressure. That is true not just in Calgary and Edmonton, but also in smaller communities and rural areas.
Wetaskiwin Hospital and Care Centre (70 km south of Edmonton), for example, has cancelled all non-urgent and elective inpatient operations and day surgical procedures, as a result of outbreaks. Patients needing urgent surgeries and procedures are being taken elsewhere.
Alberta’s health minister said at a news conference earlier in the week that the province wants to avoid lifting restrictions only to be forced to clamp down again if cases increase.
The province’s Chief Medical Officer of Health, Deena Hinshaw, said the recent decline in infections is not enough for her to be comfortable lifting restrictions. Dr. Hinshaw said she would need to see the rates of hospitalizations, new cases and test positivity continue to decline, though she didn’t offer any specific targets.
“The changes need to be done in a very slow manner so we can monitor them,” she said during a briefing on Thursday. “How it impacts our overall case numbers is up to all of us. If we continue to follow those basic public health measures in all of our activities ... we can continue to have a downward trend at the same time as enjoying a few more activities in a safe way.”
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James Keller
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