People pass by a vaccine clinic during the COVID-19 pandemic in Mississauga, Ontario, on April 13. Nathan Denette / The Canadian Press
The decision by provincial and territorial governments to reduce the collection and reporting of COVID-19 data has left Canadians focused on what some experts call the most precarious wave of the pandemic to date.
Most jurisdictions have stopped testing extensively and are now limiting or consolidating data such as hospitalization rates. Many have also reduced the frequency of public reports from daily to weekly.
Governments that have done so – including British Columbia, Alberta, Saskatchewan and Manitoba – attribute the change to the fact that there is now more value in monitoring trends over time than in everyday fluctuations. But those who have worked to prepare Canadians for what lies ahead say they are now flying blindly as the last remaining public health measures are repealed and the Omicron BA.2 sub-option fuels a resurgence of cases.
“Absolutely the worst time to change your data flows is the rise of a new version, and that’s where we are,” said Sally Otto, a professor at the University of British Columbia and a member of the independent modeling group COVID-19 in British Columbia. . .
“I can’t make model predictions about how many hospitalizations are forthcoming, because I don’t really know how many people became infected in the first [Omicron] wool, when and how high their immunity is.
“I would say that we really have no idea whether we will see the same hospitalizations as our first wave or less. It can be significantly more and we enter into it without knowing it. “
Dr Otto said the reason there could be significantly more is that the most vulnerable populations were protected from recent accelerators during the first Omicron wave.
Over the past winter, the high-transmission variant of Omicron has pushed COVID-19 to unprecedented peaks, prompting most provinces to limit the use of polymerase chain reaction (PCR) laboratory testing to those at highest risk. This had implications that went beyond tracking how many COVID-19s there are in the community.
The Independent Modeling Group, of which Dr. Otto is a member, released its 20th report on April 6th. She called the BA.2-driven wave “the most uncertain point so far in the modeling pandemic” because of the scarce data on the total number of recent infections and the level of immunity targeted by the latest wave.
Without adequate testing, the group of experts in epidemiology, mathematics and data analysis said they could not study the effectiveness of the vaccine and booster against infection or hospitalization by age. They also do not have a good sense of susceptibility to re-infection, which relies on knowledge of past infection. In addition, BC hospital admissions data are updated irregularly by health authorities, leading to large fluctuations in daily admission estimates.
“We can’t handle and mitigate the risks we don’t know are coming,” Dr. Otto said.
Her group would like to see a random sample of the population tested for COVID-19, either as part of the workforce (as health workers), by random census (such as sending test packs) or by testing hospital admissions for reasons other than COVID.
Peter Juni, the retiring scientific director of the independent scientific advisory table on COVID-19 in Ontario, similarly said there should be a pragmatic approach to continuing disease surveillance tests.
“We need to replace widespread clinical testing with something that is accessible and gives us the information we need, and that’s a random sample of people,” he said.
Dr Juni said sewage monitoring was an important tool in helping Ontario navigate the Omicron waves. Analysis of wastewater signals from wastewater treatment plants showed that the province probably had between 110,000 and 140,000 infections a day during the first Omicron wave in the winter, he said. The current wave of BA.2 has reached between 100,000 and 120,000 infections per day, and preliminary estimates published this week suggest that the infections may have developed.
However, Dr Juni noted that there is still considerable uncertainty due to factors such as declining immunity to the vaccine, changes in the weather and how people have chosen to behave with regard to public health restrictions. He added that there is a growing immunity acquired from infection, but it is impossible to determine how much.
“To give you an idea, Ontario, with 14.7 million people, we can have somewhere between 4.5 and six million infections that have occurred since December 1,” said Dr. Juni. “That’s a big difference.”
The University of Calgary’s Center for Health Informatics maintains an Alberta sewage control panel, while BC’s sewage monitoring is limited to five treatment plants at Metro Vancouver. The University of Saskatchewan tracks wastewater from Saskatchewan, Prince Albert and North Battleford treatment plants.
Canada’s chief public health officer acknowledged the impact of reduced PCR testing.
“PCR remains important,” Theresa Tam said at a federal briefing on Tuesday. “Even with testing declining, and because it is more focused on the higher-risk population, we need to have more representative testing where possible. So I think that should continue to be encouraged. “
Michael Wolfson, a former assistant chief statistician at Statistics Canada and a current member of the Center for Health Law, Policy and Ethics at the University of Ottawa, said Canada’s data collection infrastructure was inadequate and raised “reporting issues up and down “.
He noted that while the provinces and territories administer and provide health care in Canada, the provision of statistics is a federal responsibility. He said Canada would benefit from COVID-19’s national integrated health information monitoring system with standardized data, and blamed “provincial persistence” and constitutional conflict over jurisdiction as barriers.
“Health data is not health care,” said Dr. Wolfson. “It is closely related and closely related to healthcare, but as far as you consider it a statistic, it is a federal jurisdiction. So the federal government, I think, should be ready to say to the provinces, “Excuse me, boys, do you want another $ 20 billion a year to increase the federal contribution? If you don’t raise, you know, don’t cooperate and don’t work together to get decent data, we won’t give you all that money. “
Kerry Bowman, a professor of bioethics and global health at the University of Toronto, said there were “certainly” concerns about the decline in COVID-19 data provided.
“Good ethics is based on good science, and good science is based on good data, and we have none of that,” said Dr. Bowman. “When you turn to people and say, ‘Now you have to take individual responsibility, not only for yourself, but for the vulnerable people in your life’, you can’t expect people to make good decisions without data.”
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