Matt Strauss: As vaccination gains pace, the argument for continued lockdowns weakens
We appear to be turning a corner on COVID-19. This is good news
By: Matt Strauss
Third wave! Lockdowns! Variants!
It might not seem like it, but there is actually a good news story about our current predicament, beneath the scary headlines. The COVID-19 case rate and death rate have diverged in a way never before seen in Canada. We need to celebrate this fact, and account for it in designing our responses to the third wave.
Back in May 2020, the peak of the first wave, on our worst day, Canada saw 222 deaths, several weeks after cases per day peaked at approximately 2,700 per day. In very big picture terms (more on that in a minute), we can say that we were suffering (very roughly) one death for every 10 cases. Jump to the second wave: in December of 2020, we saw 250 deaths and a far higher daily case count of 11,000 on our worst day. This worked out, again using big-picture math, to one death for every 50 cases.
As a critical-care physician, I would love to say that this drop in crude mortality rate reflected improvements in our ability to treat COVID-19. Alas, it probably reflects a massive increase in our testing capabilities. This is why all my numbers above should be considered approximate, and for illustrative purposes only: you may remember that in the spring of 2020, Canadians were told that if they experienced symptoms of COVID-19, they should stay home and self-isolate. There were not enough tests to go around, so we reserved tests for severe cases requiring hospitalization. We were performing five times more tests in December 2020 than in May 2020, picking up those mild cases unlikely to cause death. Not surprising, then, that the death rate was five times lower.
Now that we’re in the third wave, with greatly improved testing, we can confidently point to what is genuinely great news: the death rate is clearly dropping again — by a lot. For the first time, the chart below shows the case rate (red line) and the death rate (blue line) moving in opposite directions. It doesn’t appear to be because of a difference in the testing rate; that has remained stable since December. What gives?
The vaccines are having their effect. It is true that Canada’s rollout has been lacklustre; we’ve had roughly three times fewer shots in arms than Americans or Britons. But even so, having employed a focused protection strategy in the vaccine rollout, we can expect to see an incredible number of lives saved with just the seven million doses we have given.
COVID-19 is not an equal opportunity killer. In my home province of Ontario, a majority (51 per cent) of COVID deaths occurred in nursing home residents, even though only one per cent of Ontarians live in nursing homes. A mere 300,000 doses of vaccine can be expected to cut the death rate in half.
It gets better. While only four per cent of Canadians are over 80, they account for more than two-thirds of COVID-19 deaths. Different jurisdictions in Canada have had different one- or two-dose vaccine policies at different times, but we may expect that three million doses will prevent two-thirds of the deaths in the present wave.
This is a stunning achievement. Never in the history of humanity has the death rate from a disease been cut by two-thirds within 14 months of its discovery. And it should only get better from here. There are still five million doses I haven’t accounted for; many have gone to the 500,000 physicians and nurses nationwide. Many more are heading to the still vulnerable 70-79 age bracket, at a rate of hundreds of thousands per day.
COVID-19 has become significantly less deadly. Whatever your position on the more draconian policies aimed at limiting its spread, they are becoming less justifiable. Clearly, they are not without their harms. Depriving children of education, adults of their livelihood, and elders of social contact has real health consequences. Suppose that those downsides were outweighed by their benefits last year. Can the same be said about a disease now three times less deadly?
It is true that rapidly spreading variants of concern are around 60 per cent more dangerous. This bears watching. But all studies in humans so far seem to show that the most common vaccines remain effective against the most common variants. It perhaps would have been marginally better for a healthy young person to have been infected by original COVID last summer than by B1.1.7 today — but only marginally. A 35-year-old in the U.S. who gets COVID-19 today is three times more likely to die in a car accident over the next 12 months than of their COVID-19. A 60-year-old Canadian who gets COVID-19 is about as likely to die of something else in the next 12 months as of their COVID-19. A 60-per-cent increase in very small chance of death is still a very small chance of death.
Of course, that is not to say that COVID-19 is not still a serious problem. It’s prudent to take reasonable precautions to avoid catching and spreading it; and the sooner we can roll out vaccines, the better. However, as the vaccines makes their impact, the virus is rapidly joining the ranks of one of many risks that we have to navigate in our everyday lives.
You’ll have heard the argument that lockdowns are still justified to protect hospital capacity. Indeed, while two-thirds of deaths have occurred in Canadians over 90, two-thirds of hospitalizations have occurred in Canadians under 70. Hospital occupancy must be watched closely, and strong measures may be called for in certain areas to buy time for our vaccine campaign to continue. But there is a danger here in letting our governments off lightly for their deeper failures before COVID-19. At baseline, Canada has half as many ICU beds per capita as the United States, and a third as many as Germany.
Since I was a child, there have been stories in Canadian press of seasonal influenza overwhelming hospitals; in 2017, it caused half of Ontario hospitals to be at 100-130 per cent of capacity. Overcrowding in Canadian hospitals is a literal SNAFU.
Further, for all the fairly placed concern about ICU capacity, in the course of the past year, our ICUs have not yet been overwhelmed. Ontario stands at about 80 per cent ICU capacity today — and that doesn't include the increased capacity we ought to be able to create in the event of a crisis. Of the approximately 1,800 ICU beds currently in use in Ontario, roughly 540 people are there because of COVID-19: this is no doubt difficult for the individuals involved, but hundreds of additional ICU patients shouldn’t be enough to tip an entire province of 14 million people into lockdown.
Lockdowns were originally sold to us as a way to buy time to increase hospital capacities. Some have done just that; I know of a few hospital systems in Ontario that have made plans to increase their ICU capabilities by three times in a pinch. None have had to do that so far. Let’s hope that remains true.
In the meantime, the era of COVID-19 vaccines is here, and more are being delivered into willing arms every day. The era of lockdowns will soon be behind us — they simply won’t be justifiable anymore.
Matt Strauss is a critical care and internal medicine specialist who practices in Ontario.
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My question for Dr.Strauss is how much consideration he’s given to potential long term effects of COVID infections. A German study last year had noted permanent heart damage in 75% of people who’d had COVID, even mild cases. There was reporting of increased incidence of blood clots in younger people who’d had COVID. “Long COVID” appears to hit about 10% of cases. Anecdotally, my wife and her colleagues have noticed more cases of normally rare pediatric illnesses like septic hip over the past year. A lot of focus is put on reducing death rates in the short term, and managing ICU capacity. However, it seems like there’s a strong case to be made for use of measures like lockdowns to limit infections until we’ve deployed enough vaccines to approach herd immunity. The risk is that we have a generation of people afflicted by the COVID analogue of post-polio syndrome in a couple of decades.
With 80% of the population NOT vaccinated, it would still grow exponentially. The USA at second-wave peak hit 300,000/day. We could easily hit 30,000.
Even if few were dying, pandemics enforce lockdowns, just because too few people can get in to work to keep things running; everybody's either home sick, or nursing a sick wife, child, or parent. We got that lecture about O1N1 when "dying" wasn't even being discussed.
The original Wuhan death rates were 1.9% for 60-70, 0.6% for 50-60, 0.16% for 40-60. All those should reportedly be doubled.
I really think you're still looking at an overall death rate close to 1%, once P1 and B117 are all there is, in three more weeks.
Also, the deaths would be far more pathetic and sympathy-raising. We're already getting news about one under-50 dying in Ontario ICU every 2.8 days. Were all of Canada to be at double Ontario's current infection rate, it would be ten forty-somethings dying every week, and a couple of 30-somethings.