Both Sides Now

Mounting evidence that the Delta variant is even more dangerous than previously imagined has sent us into a new pandemic phase, one where those wanting to guard against infection must also protect themselves from the unvaccinated among us.

A fourth wave is clearly underway, sooner than most, including me, expected. Ontario reported 650 new cases today – up dramatically from a few weeks ago. Of these, 136 were in Toronto. Compare that to 114 daily new cases at this time last year. And that was months before anybody had been vaccinated!

Could the coming fall and winter bring a new round of business shutdowns and school closings as Delta returns with a vengeance? What if winter brings with it some even more deadly variant?

The fear of such devastating outcomes has recently prompted employers, both public and private, to require workers to be fully vaccinated. The City of Toronto announced the most stringent of those policies yesterday, requiring all employees to have at least one dose by September 13 and to be fully vaccinated by the end of October.

The number of large companies adopting similar policies is growing daily. Sports and entertainment companies such as MLSE, owner of the Toronto Maple Leafs, will not be allowing anyone without proof of vaccination to attend an event or restaurant on its property. Many countries and airlines are welcoming only the fully vaccinated.

In short, the unvaccinated will soon be unable to work in many offices, to travel, or go to a sports event. As other jurisdictions adopt vaccine passports so that businesses can easily identify which customers are not vaccinated, many business groups are calling on Ontario to do likewise.

In March, I began advocating for mandatory vaccination for all City staff dealing with vulnerable populations, such as those in long-term care homes. Even that was considered extreme at the time. Now it's clear that COVID will continue to run amok through the unvaccinated, and that this spread can endanger even the fully-vaccinated they come into contact with.

Because Ontario's third wave was triggered by the Delta variant months before it caused the current surge in the U.S., perhaps we should not have been surprised by its resilience. But our vaccination rates are so good – 82% of those 12 and up with one dose and 74% fully vaccinated - it seemed that this alone might reduce new infections to a trickle. For a short time it did.

But that was by yesterday's standards. Herd immunity, the level of vaccination at which the virus starts to die out because there aren't enough new hosts to move to, is now thought to be upwards of 90% against Delta, which spreads far more easily than either the common cold or seasonal flu.

Equally concerning are recent studies showing that vaccine protection can wane over time and that, against Delta, "breakthrough" infections among the vaccinated are more common than previously thought.

It appears that we need to reframe our expectations about what vaccine success looks like. Against the original form of the virus, MRNA vaccines such as Pfizer were thought to be about 95% effective in preventing any COVID infection and close to completely effective at preventing hospitalization and death. Against Delta, many health experts now express these percentages as a range.

Clearly, vaccines are not entirely effective at preventing infection, nor do they prevent the vaccinated who get infected from spreading it to others. But it is also still true that the vaccinated are considerably less likely to catch COVID and therefore much less likely to spread it. And that those who get COVID, if vaccinated, are still very much less likely to get very sick or die from it.

But, as gatherings move indoors with the coming of colder weather, it is important to understand all the risk factors and to take every precaution you can while still trying to resume all safe aspects of everyday life.

The Premier of Ontario has said he opposes vaccine passports because he does not want a society split between the vaccinated and unvaccinated. Perhaps that split society has already created itself, and vaccine passports are one of the important tools for navigating safely through it.

The song of the week is about not knowing what we don't know..