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N.B. COVID-19 roundup: Impact of variants laid out by infectious disease specialist
The COVID-19 variants can infect people who have recovered from the coronavirus that has caused most New Brunswick infections, and younger people are more vulnerable to the newer strains, says infectious disease specialist and pandemic task force member Dr. Gordon Dow. Some vaccines are less effective against the variants and more New Brunswickers may need to be vaccinated to achieve herd immunity than previously thought, he said. There's "no firm evidence" that the variants are more lethal. But Dow is more concerned about their increased transmissibility. "Exponential spread means that mortality will go up exponentially," he said. The good news is there's no data to show the variants are more "virulent," or more likely to cause disease, said Dow. "So that means as long as people are following [Public Health guidelines] we can keep the variants under control ... I would expect … that we have a bright spring ahead of us. I would go so far as to say and an even brighter summer," he said during Thursday's COVID-19 briefing. New Brunswick has four confirmed cases of the variant first reported in the U.K. It is up to 70 per cent more contagious than the coronavirus that has caused most New Brunswick infections, Chief Medical Officer of Health Dr. Jennifer Russell has said. The most recent case, in the Moncton region, Zone 1, was confirmed on Tuesday. It's related to international travel and the person continues to self-isolate, Public Health has said. The Saint John region, Zone 2, has two cases of the variant, and the Miramichi region, Zone 7, has one. Two of these cases are related to international travel and one is related to travel in Canada. These individuals are also self-isolating, Public Health has said. The variants first reported in South Africa and Brazil have not yet been identified in New Brunswick. Dow provided a presentation on the variants at Thursday's briefing and fielded questions submitted in advance by members of the public. The province announced the opportunity on Twitter about two hours before the event began. The questions ranged from how confident officials are that the variants are "cause for concern" since much of the available information appears to be "hedged" to how the mutations affect children and how well the current vaccines will work. Variant expected to replace current strain within 3 months Dow said new information has come in phases throughout the pandemic, usually in a media release first, followed by a non-peer-reviewed publication and then a peer-reviewed one. But he believes the information officials are working with now about the variants is accurate because they have data going back to September. He said he expects the variants, which he described as "more fit," will replace the old strain within three months, based on the experience of multiple jurisdictions, including the U.K., Ireland, Scandinavian countries, South Africa and Brazil. Asked whether the variants are showing some more serious long-term issues for children, Dow said "there is some truth to that, but we need more information." He noted children were less prone than adults to getting infected with the old strain. Because the new strain is more infectious, children are more likely to get infected than they would have been with the old strain. "So as infection rates go up, we would expect to see complications go up in children," said Dow. What's not yet clear is whether the increased complications are due to the variants, or just due to the fact that children are more likely to get infected, he said. "Right now, most of the evidence suggests what we're seeing is due to the fact that children are more likely to get infected rather than the variant is somehow more problematic in children." Vaccine data 'encouraging' The data is "encouraging" for the effectiveness of the two COVID-19 vaccines in use in New Brunswick against variants, said Dow. Pfizer-BioNTech and Moderna are the two currently approved for use in Canada. Preliminary reports from those manufacturers indicate their vaccine is effective against the variant first reported in the U.K, he said. Some other vaccines under investigation have shown reduced effectiveness when they've been studied in South Africa, according to Dow. But that data has not been yet peer reviewed, he added. Given variants are more contagious, Dow thinks more than 70 per cent of the New Brunswickers will need to be vaccinated to achieve so-called herd immunity, where having a certain proportion of the population vaccinated protects others who aren't immunized. The percentage required varies for different viruses. For measles, for example, it's 90 to 95 per cent. "We don't know what it is for COVID. We've been guessing that it's around 70 per cent. … That is far from sure," he said. Dow pointed to the experience of Manaus, Brazil, which saw more than 75 per cent of its population contract COVID-19 last year. Now the variant has hit and caused a brand new epidemic, with some of the major hospitals running out of oxygen. "What that tells me is that 70 to 75 per cent is not enough for herd immunity because that city had a 75 per cent infection rate," he said. According to New Brunswick's COVID-19 dashboard, 18,643 doses of the vaccine have been administered, as of Monday. Of those, 5,347 people have received their second dose and are fully vaccinated. The province has received 25,850 doses of vaccine as of Monday, and is holding 7,207 of them in reserve for second doses and planned clinics, according to the website. Exponential spread About three or four weeks ago, the reproduction number of the coronavirus in some parts of the province was about 1.5, which means one person with COVID-19 infects more than one other person every four days, said Dow. Over a month, that would result in 675 infections and five deaths in New Brunswick. The variants are between 30 to 80 per cent more contagious, "depending on which study you look at," he said. If a variant is 50 per cent more contagious, the reproduction number would be 2.25 instead of 1.5. So that would mean 2,278 infections and 18 deaths. If New Brunswickers follow Public Health guidelines and vaccinations are factored in, the province's reproduction rate could remain at around 0.9, where it is now, said Dow. Applying that rate to what happened in the province a month ago, the number of infections could have been as few as 146 "or less," he said, and only one death. 1 week lag for test results New Brunswick is "exploring options" to be able to test for COVID-19 variants in the province, said the province's chief medical officer of health. Right now, the province sends samples to the National Microbiology Laboratory in Winnipeg to be screened for variants. It usually takes about a week to get the results, Russell said. Since Dec. 23, the province has sent 213 swabs to the national lab. Of those, 169 have come back negative, four have come back positive and 40 remain outstanding. "We're looking at being able to have that capacity," said Russell, and having "conversations regularly" with the laboratory at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton. In the meantime, because the variants "can be so concerning," medical officers will take extra precautions even before a sample is sent if they have high suspicions about a case, she said. "They're encouraging 21-day self-isolation instead of 14-day self-isolation. And they're trying to be very, very diligent and conscientious and probably a bit more aggressive with the contact tracing at this point in time." Dow said he doesn't believe the one-week turnaround is going to be "a significant problem." "That lag would be seen in most jurisdictions around North America, and our initial responses to clusters of COVID would be the same initially, whether it's a variant or the old strain," he said. Depending on the degree of an outbreak, the province then applies more stringent measures, "so no, I don't think that one week delay is going to impact our response in any way." Only 4% of rapid tests used New Brunswick has used only 4.15 per cent of the 284,064 rapid COVID-19 tests it received from the federal government. By comparison, Prince Edward Island is the province that has used the largest percentage of its supply — 25 per cent of its 37,000 tests, according to a survey by CBC News Network's Power & Politics. Alberta has used the smallest percentage — 0.89 per cent of its 1.9 million tests. Only Saskatchewan was unable to provide detailed numbers by the time of publication Wednesday. Russell said Thursday the rapid tests are useful for screening, but they're not diagnostic. "They are meant to be used for symptomatic people within five to seven days of the onset of their symptoms. They do have the risk of having a false positive, which is inconvenient, but it's not as dangerous as a false negative," she said. "A false negative is very dangerous because that means that somebody would have received a negative result and not know that they were actually positive and not know that they were actually transmitting COVID-19." Prime Minister Justin Trudeau has been urging the provinces to use the 20 million rapid tests sent out by Ottawa and discussed testing during his call with the premiers last week. "We know that rapid testing, even right now with the variants spreading, is really important to get us to a place where we're starting mass vaccinations with lower and lower case counts," Trudeau said during Wednesday's press conference. New Brunswick Health Minister Dorothy Shephard said the province could not be guaranteed a supply of the rapid tests from the federal government, so it kept them to be used strategically. 2 new cases, 1 more death There are two new cases of COVID-19 in New Brunswick and one more death, Russell announced on Thursday. The new cases include a person in their 20s in the Moncton region, Zone 1, and a person 19 or under in the Edmundston region, Zone 4. There are now 161 active cases in the province, she said. Six people are in hospital, two of whom are in intensive care. A resident in their 80s at Villa des Jardins, a long-term care home in Edmundston, died earlier today, she said. This is the province's 22nd COVID-related death. New Brunswick has had 1,377 cases of COVID-19 since the pandemic began in March. Since Wednesday, 15 more people have recovered. So far, there have been 1,193 recoveries. A total of 214,395 tests have been conducted, including 1,232 on Wednesday. Orange for at least 2 more weeks New Brunswick health zones at the orange COVID-19 alert level will stay that way for at least two more weeks to give the province time to "stabilize" the number of COVID-19 cases, the health minister announced on Thursday. "The situation is still precarious, and one wrong move could lead to an increase in cases," Shephard said. Provincial officials are working with Public Health to determine when a move to the less restrictive yellow level might be possible, said Shephard. The Edmundston region, Zone 4, is at the red COVID-19 alert level while the other six zones are at the orange phase. "We want to get all the areas of our province back to the yellow level as soon as possible," Shephard said. "And we also want to bring the Atlantic bubble back, but we must go about it the right way." Public Health is also reassessing whether any changes to the yellow guidelines are required to "best ensure the health and safety of the public." Indoor dining potentially problematic New Brunswick may need to reassess the rules around indoor dining now that the COVID-19 variant first reported in the U.K. is here, said Dow. "Does it make indoor dining more problematic? Potentially, it's more infectious, so it might," said the infectious disease specialist. On the other hand, Dow believes restaurants that have a good operational plan will provide "good protection." "Whether we need to enhance measures further remains to be seen." Shephard said the COVID-19 all-party committee and cabinet will follow direction from Public Health. "We know how frustrating it is that rules can change quickly one week to the next," she said, but new data and information become available every day and help form the recommendations of Public Health. The province's chief medical officer of health said if the majority of the population is vaccinated by September as planned, then she expects to be able to "relax" various Public Health measures. But given vaccines shortages, "this is an evolving situation and I think it's going to be a day-by-day, week-by-week thing," said Russell. What to do if you have a symptom People concerned they might have COVID-19 symptoms can take a self-assessment test online. Public Health says symptoms shown by people with COVID-19 have included: A fever above 38 C. A new cough or worsening chronic cough. Sore throat. Runny nose. Headache. New onset of fatigue, muscle pain, diarrhea, loss of sense of taste or smell. Difficulty breathing. In children, symptoms have also included purple markings on the fingers and toes. People with one of those symptoms should: Stay at home. Call Tele-Care 811 or their doctor. Describe symptoms and travel history. Follow instructions.
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