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A man walks past a COVID-19 testing clinic, in Montreal, on Feb. 12, 2021.Ryan Remiorz/The Canadian Press

Canada’s chief public health officer says new COVID-19 cases are starting to tick back up after a month-long decline, giving urgency to the question of who should receive doses of the newly approved Oxford-AstraZeneca vaccine due to arrive in Canada Wednesday.

The “moderate increase” at the national level noted by Dr. Theresa Tam is in keeping with models forecasting a spike in cases over the next two months unless stricter public health measures are imposed to combat more contagious strains of the virus.

“The concern is that we will soon see an impact on hospitalization, critical care and mortality trends,” Tam said Tuesday.

Canada saw 2,933 new cases on average over the past week, a figure similar to last Friday’s numbers that revealed week-over-week increases of between eight and 14 per cent in Ontario, Alberta and British Columbia.

The uptick comes as provinces figure out how to allocate their various vaccines, especially as Canada receives 500,000 doses of the Oxford-AstraZeneca vaccine produced at the Serum Institute of India. About 445,000 doses of the Pfizer-BioNTech vaccine are also arriving this week, said Procurement Minister Anita Anand.

Which COVID-19 ‘variants of concern’ are in Canada? Alpha, Beta, Gamma, Delta and Lambda explained

COVID-19 is caused by a virus called SARS-CoV-2, and as it spread around the world, it mutated into new forms that are more quickly and easily transmitted through small water droplets in the air. Canadian health officials are most worried about variants that can slip past human immune systems because of a different shape in the spiky protein that latches onto our cells. The bigger fear is that future mutations could be vaccine-resistant, which would make it necessary to tweak existing drugs or develop a new “multivalent” vaccine that works against many types, which could take months or years.

Not all variants are considered equal threats: Only those proven to be more contagious or resistant to physical-distancing measures are considered by the World Health Organization to be “variants of concern.” Five of these been found in Canada so far. The WHO refers to them by a sequence of letters and numbers known as Pango nomenclature, but in May of 2021, it also assigned them Greek letters that experts felt would be easier to remember.

ALPHA (B.1.1.7)

  • Country of origin: Britain
  • Traits: Pfizer-BioNTech and Moderna vaccines are still mostly effective against it, studies suggest, but for full protection, the booster is essential: With only a first dose, the effectiveness is only about 66 per cent.
  • Spread in Canada: First detected in Ontario’s Durham Region in December. It is now Canada’s most common variant type. Every province has had at least one case; Ontario, Quebec and the western provinces have had thousands.

BETA (B.1.351)

  • Country of origin: South Africa
  • Traits: Some vaccines (including Pfizer’s and Oxford-AstraZeneca’s) appear to be less effective but researchers are still trying to learn more and make sure future versions of their drugs can be modified to fight it.
  • Spread in Canada: First case recorded in Mississauga in February. All but a few provinces have had at least one case, but nowhere near as many as B.1.1.7.

GAMMA (P.1)

  • Country of origin: Brazil
  • Traits: Potentially able to reinfect people who’ve recovered from COVID-19.
  • Spread in Canada: B.C. has had hundreds of cases, the largest known concentration of P.1 outside Brazil. More outbreaks have been detected in Ontario and the Prairies.

DELTA (B.1.617 AND B.1.617.2)

  • Country of origin: India
  • Traits: Spreads more easily. Single-dosed people are less protected against it than those with both vaccine doses.
  • Spread in Canada: All but a few provinces have recorded cases, but B.C.’s total has been the largest so far.

LAMBDA (C.37)

  • Country of origin: Peru
  • Traits: Spreads more easily. Health officials had been monitoring it since last August, but the WHO only designated it a variant of concern in June of 2021.
  • Spread in Canada: A handful of travel-related cases were first detected in early July.

If I’m sick, how do I know whether I have a variant?

Health officials need to genetically sequence test samples to see whether it’s the regular virus or a variant, and not everyone’s sample will get screened. It’s safe to assume that, whatever the official variant tallies are in your province, the real numbers are higher. But for your purposes, it doesn’t matter whether you contract a variant or not: Act as though you’re highly contagious, and that you have been since before your symptoms appeared (remember, COVID-19 can be spread asymptomatically). Self-isolate for two weeks. If you have the COVID Alert app, use it to report your test result so others who may have been exposed to you will know to take precautions.

Need more answers? Email audience@globeandmail.com

Guidance on the Oxford-AstraZeneca vaccine has caused some confusion. Health Canada authorized its use last week for all adults but the National Advisory Committee on Immunization recommends it not be administered to people 65 and over.

AstraZeneca, Moderna or Pfizer? Take whichever COVID-19 vaccine you’re offered, experts say

The advisory committee cites concern over limited data from clinical trials for older patients. Health Canada also acknowledges that issue. But the advisory panel, which recommends how vaccines should be used, says the limitation means seniors should take priority for the two green-lighted mRNA vaccines – Pfizer-BioNTech and Moderna – where dearth of data is not an issue.

Alberta’s health minister said Monday the province will not give Oxford-AstraZeneca’s vaccine to anyone over 65. British Columbia, Saskatchewan, Ontario and Prince Edward Island are on similar courses, though details on who will get those jabs is not always clear.

“With clinical testing of AstraZeneca limited to those under 65, we will need to adjust our plan to look at a parallel track for some of these more flexible vaccines in order to cast the widest net possible,” the B.C. health ministry said in an e-mail.

Provincial health officer Dr. Bonnie Henry said B.C. will use the Oxford-AstraZeneca vaccine to target younger people who have more social interactions and who would have to wait much longer for the other vaccines.

Ontario Health Minister Christine Elliott characterized Oxford-AstraZeneca as “very versatile " because it lacks the same cold-storage requirements as the two other vaccines in use in Canada. It won’t go to seniors, but she said shots might be administered in correctional facilities for that reason.

P.E.I. will target AstraZeneca at “healthy younger individuals who are working in certain front-line, essential services,” said Dr. Heather Morrison, the province’s chief medical officer of health.

Health officials in Quebec and New Brunswick say they await further advice from health authorities and are taking time to examine how to deploy the latest vaccine.

Nova Scotia’s chief medical health officer Dr. Robert Strang said the province has yet to give an answer to Ottawa “about whether we actually want to take the vaccine.” All provinces must provide a response by midday Thursday, he said.

COVID-19 news: Updates and essential resources about the pandemic

Two experts say essential workers who are more likely to contract and transmit COVID-19 should be prioritized for immunization with the Oxford-AstraZeneca doses.

Caroline Colijn, a COVID-19 modeller and mathematician at Simon Fraser University, and Horacio Bach, an adjunct professor in the division of infectious diseases at the University of British Columbia, also say the Oxford-AstraZeneca vaccine could be better promoted by provincial health officials as a strong alternative to the Pfizer-BioNTech and Moderna vaccines.

Oxford-AstraZeneca reported their vaccine is about 62 per cent effective at preventing COVID-19 while Pifzer-BioNTech and Moderna have said the efficacy of their vaccines is about 95 per cent.

But Colijn and Bach say the fact there have been no hospitalizations from severe illness and no deaths among those receiving the Oxford-AstraZeneca vaccine needs to be underscored because people awaiting immunization seem to be fixated on the higher efficacy data for the first two vaccines approved in Canada.

“If the AstraZeneca vaccine will prevent you from getting really sick that’s still a win for you,” Colijn said.

“I see this huge, huge benefit of vaccinating young people, particularly people with high contact, essential workers, sooner.”

No province has been spared from the increase in new variants circulating across the country, though several continue to ease anti-pandemic restrictions.

Modelling from the Public Health Agency of Canada projected a steep surge in new cases starting late last month – and reaching 20,000 new cases a day before May – if public health measures weren’t tightened. Since that Feb. 19 forecast, restrictions in many regions have loosened as Canadians return to restaurants, cinemas and hair salons.

But Tam said Canada is gaining ground on “the vaccine-versus-variants leg of this marathon” every day.

“Canada is prepared, and Canada remains on track,” she said.

Provinces have now reported 1,257 cases of the B.1.1.7 mutation that was first identified in the United Kingdom, 99 cases of the B. 1.3.5.1 strain first identified in South Africa, and three of the P. 1 variant first identified in Brazil.

There have been 870,033 cases of COVID-19 in Canada and 22,017 deaths as of Monday night.

There were 30,430 active cases across Canada, with an average of 42 deaths reported daily over the past week.

Provinces are also figuring out whether to stick to the original injection schedules or extend the interval between doses beyond three or four weeks. The national advisory committee is expected to update its recommendations this week.

Ontario is waiting for that guidance, while B.C. is pushing ahead with its plan to prolong the interval to four months.

Dr. Bonnie Henry, B.C.’s provincial health officer, said Monday the decision was based on local and international evidence that shows the first dose of the Pfizer-BioNTech and Moderna vaccines provides “miraculous” 90 per cent protection from the virus.

Prime Minister Justin Trudeau says more Canadians will get vaccinated sooner now that a third vaccine has been approved in Canada and more doses of it have been secured. Health Canada's chief medical adviser Dr. Supriya Sharma says the AstraZeneca vaccine and all the others Health Canada has approved are safe and effective against COVID-19.

The Canadian Press

With files from Camille Bains, Kevin Bissett, Laura Dhillon Kane and Holly McKenzie-Sutter

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