The Pandemic Will Only End With More Trust, Less Division and Better Solutions
The Pandemic Will Only End With More Trust, Less Division and Better Solutions
Only 436 (or 19%) of Ontario’s 2,279 COVID-related hospitalized patients are unvaccinated. The solution to the pandemic does not lie in blaming but in finding better solutions.
This piece is a longer version and extension of an opinion letter I wrote that was recently published at BayToday.ca. After hearing some of the terribly incorrect and dehumanizing comments made by many including our own Prime-Minister, I was motivated to dig deeper on this subject.
If you still believe that the pandemic is only being extended because of the unvaccinated; Or if you truly think these lockdowns, closures and delayed surgeries are because of the fringe minority of unvaccinated people; If you think the unvaccinated deserve any more hatred after being barred from all aspects of society, forbidden from working and from traveling and then to see the country still see the biggest surge in cases and hospitalizations primarily led by vaccinated people. Then please read this essay.
Introduction
Everyone is wondering when this pandemic will finally be over. Even though Ontario has one of the highest vaccination rates in the world (90% of the 12+ population has at least one dose), we are once again entering the harshest lockdown in North America (along with Quebec).
The major narrative or argument to explain why we are facing the exact same circumstances as one year ago when we had almost no vaccines is still based on our obsession with division.
Many believe the pandemic is only being extended because we still have unvaccinated individuals among us. This is a debatable argument, however it is increasingly being shown to be incorrect. In today’s essay, I’ll try to explain why this argument was originally the source of much hate for the unvaccinated and why it is no longer justified. Not only is it no longer a valid argument, but I believe the longer we ignore this, the longer we will avoid finding actual solutions and the more damage we risk doing to society. Ultimately, without better solutions and staying fixated on people’s health choices, we will extend this unsustainable cycle of repeated lockdowns. I’ll debate why our narrow focus on one simple issue (blame the unvaccinated) has resulted in the extension of the pandemic.
For months in early 2021, most politicians and experts advocated for vaccine choice. Most stated that “everyone who wants a vaccine will get one”. We even had the Premier of Ontario and the Prime Minister of Canada explicitly saying that they do not want to bring in vaccine passports due to the dangers of creating division in society. This seemed to all change in the second half of the year. The drastic change in attitudes on this did not appear to be entirely motivated by science but also by fear and by politics.
As a higher percentage of the population became vaccinated, and the pandemic seemed to be fading into it’s seasonal low of summer, the media did a very good job of creating a new narrative to keep us glued to the news. They divided us and created a very convenient scapegoat to rant about. The unvaccinated… The idea of targeting this shrinking demographic was also very convenient for politicians who needed a wedge issue during a pivotal election. Additionally, most authorities that had promised that “the pandemic would be over by now” needed something (or someone) else to blame for why nothing seemed to be approaching normalcy anytime soon. Lastly, the targeting of this demographic was like killing two birds with one stone as it also attempted to discredit many of the same people that had spoken out against other public health measures such as lockdowns.
The Original Argument for Vaccine Passports and Vaccine Segregation
First I’ll discuss the merits of this argument. I think it’s important to acknowledge that; although I think it was exaggerated for convenience by politicians and the media, it did have some logic if you ignored the unintended and ethical consequences.
In Ontario, as we surpassed the 50% vaccination rate, we started to see that overall cases counts were being found more disproportionately in the unvaccinated. This would lead to the belief that unvaccinated people were much more likely to spread the virus. I won’t argue that this is incorrect but the data was never conclusive enough to show that an unvaccinated individual was significantly more dangerous to the population. Nevertheless, it was clear based on the data we were given, that at least shortly after vaccination, a person was less likely to spread the virus.
This was the basis for the introduction of vaccine passports in every jurisdiction in Canada. When they were introduced by Doug Ford, he said “they would be used as a temporary measure” and “would not be used a single day longer than needed”.
We were told that in order to avoid another lockdown, we simply had to segregate the population and prevent the unvaccinated from entering public spaces, attending gatherings or participating in the workforce. Without considering the long-term consequences of such policies or without any real-world data showing that such policies would actually make a difference, we adopted them. The majority of the population quickly jumped on board. I believe the consensus of the population was carefully manufactured with misleading polls telling us that 80-90% of people agreed with the policies, which led many to simply want to be part of that majority.
Misleading Statistics
One of the major catalysts to start the hate campaign towards the unvaccinated was a statistic widely shared by most public health experts in August, 2021 which showed that 99% of cases in Ontario for 2021 were in unvaccinated individuals. This statistic and accompanying charts were plastered all over the news and widely shared on social media. This talking point was so misleading, that in any unbiased universe, Facebook and Twitter would have flagged it as misinformation. Consider the fact that in Ontario between January and August over 90% of the cases occurred in the first four months of the year (Jan-April) when we had our largest waves. During that time, 99% of the population was ineligible to be vaccinated. So of course 99% of cases in 2021 had occurred in the unvaccinated…
Side Note: Here is an equivalent example to explain why this statistic was very flawed and should not have been used to spark a desire for vaccine certificates. Over 99% of COVID cases among elementary students have been in unvaccinated children since we opened schools in September. You see the flaw in this statement? The vast majority of elementary students (all those under 12) would have been ineligible to be fully vaccinated up until now.
Unfortunately this was not the only time that our experts would mislead us. When the government of Ontario decided to start reporting daily case numbers based on vaccination status, they refused to provide a breakdown of test positivity levels based on that same status. This would have been a very important metric to keep track of early on to see the effectiveness of the vaccine, but for some reason, the ministry of Health refused to collect or disclose this information. Why would this have been important? In August and September, 2021 many health units instituted rules that required unvaccinated individuals to require more tests. For example;
A close contact to a COVID case that was vaccinated may not have been required to go get tested, but an unvaccinated person was.
Many workplaces and retirement homes were testing only unvaccinated individuals upon entry.
When schools started, an entire demographic of unvaccinated individuals (children) were subject to massive amounts of testing every time outbreaks occurred in schools.
All these policies likely meant that although the unvaccinated were more highly represented in the daily counts, it may have been because they were being disproportionately tested. If the per capita cases in the unvaccinated were twice as high as the per capita rate in the vaccinated, but the overall positivity rate (percentage of people who’s test comes back positive) between the two cohorts was the same, then there would have been no difference in risk.
This does not mean that the vaccine did not provide protection or didn’t reduce the spread, but I believe it means that we were making decisions based on purposely incomplete data.
Waning Immunity and Omicron
Even if the case for vaccine passports and vaccines based employment was solid in the Fall, arguing for these things today seems like trying to tell me the world is flat.
It’s becoming increasingly clear that the vaccines wane in immunity quite quickly and that new variants are vaccine resistant. This is supported by the fact that the Ontario Government has now recommended everyone receive a booster only three months after their second doses (previous recommendation was 6 months). It’s also why they have begun administering a fourth dose to nursing home residents three months after they received their booster shot in the Fall. The fact that Omicron is vaccine resistant is why Dr. Moore (Ontario’s CMO) advised that during Christmas, even triple-vaccinated people should avoid high-risk triple-vaccinated relatives or only see them outside.
Even Dr. Peter Juni (the Director of Ontario’s COVID-19 Science Advisory Table) stated on December 17 that: “the chance of someone who is six months out from their second dose getting infected could be as high as somebody who was never vaccinated.”
This does not mean they are a failure but it means that we need to view them from a different perspective. In the last 7 days before the government of Ontario stopped reporting the vaccination status of new cases, the vaccinated were disproportionately represented per capita (this means statistically on each of these days, a vaccinated person was more likely to test positive than an unvaccinated person, putting aside all other factors).
Even as cases were starting to appear more proportionally in the vaccinated due to the waning immunity by mid-December, hospital numbers seemed to indicate that the vaccines correlated with less severe outcomes. This is a great benefit and argument to vaccinate people and is the reason why I still recommend most high-risk people I know to continue getting booster shots whenever they are eligible.
January 2022
Up until now, I believe our arguments for vaccine based discrimination or hatred was wrong but it wasn’t completely outside the realm of a logical argument. But today it is and we haven’t noticed or acknowledged it yet.
When Doug Ford (the Premier of Ontario) announced yesterday that our province was going into another lockdown and once again deprived our children of an in-person education, he did not mention once that it was the fault of the unvaccinated. Along with the Minister of Health and the CMO of Ontario, they rightly encouraged Ontarians to get vaccinated or boosted but they did not blame anyone. This was an encouraging sign and I hope it means they will reverse some of the damaging policies currently in place, which openly promote hatred and division.
But there are still many that are arguing for more division and hatred. One of the strongest voices for this hatred is Dr. Katherine Smart, the President of the Canadian Medical Association. In her January 3rd tweet following the announcement by Ford, she said: “School again closing, surgeries again delayed- why? to protect a healthcare system overwhelmed yet again by unvaccinated patients.”
On the same day, Bruce Arthur, one of the most popular columnists at the Toronto Star tweeted “There still aren’t enough vaccine mandates”. Many other strong voices, still cling to the idea that we were still in a “pandemic of the unvaccinated ''.
On January 5th, even Justin Trudeau tried to shift the blame for being in a 4th lockdown in Canada from the government to “the unvaccinated”. He stated, dangerously: “People are seeing cancer treatments and elective surgeries put off because beds are filled with people who chose not to get vaccinated; they’re frustrated. When people see that we're in lockdowns, or serious public health restrictions right now because [of] the risk posed to all of us by unvaccinated people, people get angry,”
But let’s look at the numbers. Are the hospitals actually filling up with reckless, unvaccinated people?
On January 6th, Ontario reported that 2,279 people were in Ontario hospitals because of (or with) COVID. Of these, only 436 or 19% were unvaccinated. This is incredibly close to the proportion that the unvaccinated represent in the total population (all ages). Your choice of being vaccinated (especially if you are young and healthy) doesn’t seem to drastically correlate with a lesser chance of being hospitalized.
(source: Public Health Ontario’s daily epidemiological data)
Unfortunately, most news outlets have completely stopped reporting hospitalization percentages based on vaccination status now that there are no clear correlations. Again, I’ll state that vaccines are a great tool for many but we absolutely need to start being realistic about them. And we must demand that the media present accurate data regardless if it fits their narrative or not.
If we come to the conclusion that they do not stop spread or outbreaks (hence why we have 4x more daily cases then we did during the Third wave with almost no vaccine coverage) but only slightly reduce the severity of outcomes (for a period of time), then we must change our policies.
The NEW Argument for Vaccine Passports and Vaccine Segregation
As I stated earlier, many still think that the solution to the pandemic still lies in our myopic strategy of only targeting the unvaccinated. Here is the argument: If our goal is to protect our fragile healthcare system, and the unvaccinated still pose a slightly higher risk of being hospitalized (depending on age and risk factors); then we should impose rules on them to convince them to get vaccinated or remove their ability to take risks by continuing to prevent them from participating in society.
If you accept this argument, then let’s consider the following and tell me who has a higher risk of hospitalization in January and should probably have their rights curtailed a bit:
A 22-year old unvaccinated individual with no comorbidities who works in a school.
Vs.
A 62-year old vaccinated individual with one comorbidity who works in a hospital.
I think 99 out of 100 doctors would agree that the 62-year old has a much higher risk of occupying a hospital bed this month. The remaining doctor might be the current president of the Canadian Medical Association…
Or let’s consider the following two examples:
A 34-year old unvaccinated person with no comobities who works at Walmart.
Vs.
A 32-year old healthy vaccinated individual who practices high-risk downhill skiing every day.
Again, 99 out of 100 statisticians would tell you that, although both should consider a vaccine, the 32-year old is more likely to require hospitalization (related to a skiing injury) than the Walmart employee from COVID.
It’s been shown time and time again in the data that the biggest factors affecting severe outcomes of COVID are old-age and comorbidities. Alberta Health is the only provincial health authority disclosing complete comorbidity and age data on COVID and they present clear correlations on risk factors. I often refer to Alberta’s statistical database as it is the most complete one in Canada and provides great insight on all contributing factors to COVID. There is no reason to believe that with a similar demographic in Ontario, our numbers would not be similar if we decided to track and report them.
Since the pandemic began, less than 5% of the deaths from COVID in that province were in individuals without comorbidities. Only 142 out of Alberta’s 3,310 deaths so far have occurred in someone without comorbidity. It’s important to note that old-age is not considered a comorbidity. So, many of the 142 deaths were likely healthy seniors in the 70-90 range as they were at a high risk of COVID regardless of comorbidity. Even if just looking at hospitalizations in Alberta, 74% of COVID-related admission in the last twenty-one months were in individuals with comorbidities. The remaining 26% of hospitalizations were heavily weighted towards the over 70 age group. (Source: Alberta Health)
Even while knowing this, it would not make any sense and would be completely unethical to simply lock down everyone over the age of 60 or anyone who has a comorbidity.
But the unvaccinated made a choice… This is the last sliver of logic used in the argument for punishing this group if you can argue they are in fact a burden on the health system. Yes, the unvaccinated made a choice to put themselves at a slightly higher risk of COVID The key word is CHOICE. Old-age is not a choice. Comorbidity is also not often a choice someone made. But some risk-factors other than vaccine choice are. What about someone who CHOOSES to smoke or someone who CHOOSES to drink more than the recommended “casual amount” of 3-5 drinks per week? (smoking and binge drinking are listed as a comorbidities by Health Canada and makes someone much more likely to be hospitalized from COVID) What about any high-risk athletes such as a hockey player who CHOOSES to put their body at risk and potentially occupy a hospital bed every time they hit the ice? What about anyone who CHOOSES to take an unnecessary car ride and risks getting into an accident and using a much needed hospital bed.
Side Note: According to Statistic Canada auto accidents kill between 1000 and 2000 thirty to thirty-nine year olds (my age group) each year. In the first twelve months of the pandemic, COVID claimed 137 lives in this age group (almost inclusively in those with comorbidities). So if you are in this age group, consider that you may have a 10x higher chance of dying and likely occupying a hospital bed by driving than you do from COVID in 2022. Regardless of your vaccine status.
Even if we look past all the rational flaws in this new argument for vaccine segregation, based on what is and what is not a choice in life, we must not underestimate the long-term issues that such a precedent will set. Especially if we don’t end it now.
Lastly, if you still think that the solution to ending the pandemic still lies in more rules for the unvaccinated, think it through to the end. We have one of the smallest percentages of remaining unvaccinated individuals of any state or province in the world. Will any further policy shrink this percentage any further? What is realistic? If we go from a 90% vaccination rate on the first two doses in the 12+ population to a 92% vaccination rate in the next three months (due to more mandates) but then lag on the booster shot or children’s vaccine uptake, will we be any further ahead? If we are told that we need 100% coverage of a vaccine for it to be effective at ending the pandemic, then we must abandon that strategy right away. Most educated experts know that you will never get 100% compliance on a population level regardless of how safe or effective something is. If the solution in the pandemic required every Canadian to take one long collective breath of fresh air today, you would still have holdouts. Just by virtue of requiring it some will oppose it. That’s sort of one of the strengths of a liberal democracy. So if the vaccine solution rests on getting the final 10-15% of the population to make the same choice as you, it’s an unwinnable battle.
You cannot be a politician currently saying that this lockdown only happened because a small minority of people still aren’t vaccinated. As a citizen you cannot accept this rationale either. Because then you are simply accepting perpetual lockdowns in the future as no country has figured out how to get to 100% compliance. Most countries haven’t even come close to Canada's already high vaccination rate. Not even in authoritarian countries such as Russia (46% vax rate) or China (47% rate). Or in any of the democracies that have threatened forced vaccinations by law like Austria (73% vax rate).
Solutions
The point of an essay, especially a long-form one like this is to tackle a problem. Up to this point I simply tried to present the problem we have but now I’ll propose some solutions.
Be Realistic
If we truly believe that the best solution to end the pandemic is to increase vaccine uptake then we are fighting an uphill battle until the experts win back some trust. Many people have lost trust in the experts as they are not realistic or honest. Many times, they may have over-promised but never corrected their assessments later on. We were all told that the pandemic would be over once we vaccinated 60%, then 70%, then 80% of the population. That obviously wasn’t the case. It doesn’t mean that experts lied to us or acted in bad faith but we need to start acknowledging that we were over-promised on the benefits of the vaccines.
The lack of acknowledgements or the lack of realistic messaging regarding the benefits of the vaccine (they will not end the pandemic and will likely not contain spread but will help prevent severe outcomes) has led many to distrust the authorities.
This will be felt even more strongly in 2022 when the children’s vaccine or booster shot uptake naturally lags behind the first shots, as many countries have experienced. Israel’s third shot uptake has been 10% lower than the original two-dose course, now six months into the rollout of the booster. Additionally, this early world leader in vaccinations has only been able to convince 10% of parents to vaccinate their children one month into their approval of the vaccine. The uptake will likely suffer further with that country’s 4th shot recommendations announced this week. Many blame the disconnect between the authorities and the general population for the drops in vaccine uptake. A problem we may soon experience in Ontario.
We should not give up on the vaccines, we just need to be realistic about them. Someone who is not vaccinated that may benefit from a vaccine is much more likely to accept a recommendation from a realistic and trustworthy expert as opposed to one who clearly over-promises its utility and threatens them by withholding normalcy.
Start Fixing the Healthcare System YESTERDAY and accept more risk
Since March, 2020 all our lockdowns and restrictions were based on the fact that our healthcare system would collapse if we saw a surge in hospitalizations. This week’s lockdown was announced while the province had less than 1 COVID-related ICU admission PER hospital (Ontario has 371 hospitals and currently has 319 COVID-related ICU patients as of Jan 6). Our total number of COVID-related hospitalizations is 2,279 (an average of 6 per hospital). According to the Ontario Hospital Association, the province currently has 33,300 beds. So patients admitted with or from COVID should occupy approximately 6% of our hospital beds. We must take into consideration that Omicron is so widespread that some experts believe it’s already infected 5-10% of the general population as our case numbers are estimated to be 80% underreported due to testing capacities. Hospitals routinely test all admitted patients even if they are asymptomatic so theoretically we could have at least 3,000 people in Ontario Hospitals that are actively testing positive for COVID just based on how prevalent the virus is currently spreading. If we estimate that Onicorm will impact 20% of the population by next week then we shouldn’t be surprised if COVID-related hospitalization goes up to 6,000 next week. We also shouldn’t be alarmed if the majority of these are in the hospital for other reasons.
Our hospitals have always operated at capacity. In 2019, CBC reported on the hallway medicine crisis in Ontario before the pandemic started in January 2020. In their analysis they found that:
-Some of Ontario's biggest hospitals were filled beyond 100 per cent occupancy nearly every day in the first half of 2019.
-Five hospitals in the Greater Toronto Area, as well as the main hospital in Hamilton, Sudbury, Peterborough and Niagara Falls all spent more than 160 days over their funded capacity during the 181-day period from January through June 2019.
-Over half of the acute care hospitals in the province spent at least 30 days of 2019 at above 100% capacity.
Read their entire analysis here: https://www.google.com/amp/s/www.cbc.ca/amp/1.5420434
This is not new. If we don’t drastically overhaul this entire system we will have the exact same problem in January 2023 regardless of COVID or not. If COVID is conquered, the roaring return of the seasonal flu next Winter will bring our hospital admissions to 100% capacity very quickly (it does every single Winter). Are we ready to lock ourselves into our homes and delay important surgeries every Winter when a seasonal virus affects just 6% of our hospitals? Again a proportion of these might be there for something else but just happened to test positive for COVID.
One idea to start tackling hospital capacity issues would be to hire back the 10,000 qualified health care workers who lost their jobs in Canada in the last few months and now statistically don’t pose a higher risk to the patients than every other double-vaccinated employee working (as per Ontario’s Science Table Director). This would obviously just be a small step in fixing a very broken system.
End all COVID related restrictions. NOW
All of them… Many have argued that this virus is not controllable by government intervention. Many states in the US have shown that lower restrictions don’t lead to more cases or hospitalizations (just compare New York & California versus Florida & Texas). If this virus is going to spread regardless of rules, then they need to stop now. We’ve had 20 months to “flatten the curve”. I think it’s as flat as it’s going to get.
Stop restricting businesses' ability to make money. Trust individuals to make their own decisions in their private lives without restrictions on their gatherings or how much risk they take. Let nursing home residents have visitors (if they choose to) in the last remaining months of their lives. Let humans decide if they or their child should wear a mask all day. Let kids be kids again…
Conclusion
I will end on a positive note. I think we need to forget about the imposed division we suffered through the Fall of 2021. We should chalk it up to a misguided mistake and a bad experiment that failed to end the pandemic. We need better solutions. We need to stop constantly trying to find a “bad guy” to blame. We need to work together to find a long-term solution as we cannot afford to keep closing our schools and our economy. We need to accept more risk and strain on our current healthcare system. There is no way that 2,279 COVID hospitalizations should cripple a province of 14.5 million people with 371 hospitals and 33,300 hospital beds.
Side note: Florida hasn’t had a lockdown in 18 months and has had up to 17,000 COVID-related hospitalizations in some waves with zero fear of a collapsed health-care system (per capita that would be equivalent to 11,000 hospitalizations in Ontario). Even as of today they have 5,299 COVID-related hospitalization (would be the equivalent of 3,550 in Ontario).
All elective surgeries are going ahead this week in Florida and schools are not closing… Floridians have also never been told how many people they can have in their homes and can attend a football game unmasked and unvaccinated with 40,000 people.
Agree or disagree with their strategies, but it’s mind-boggling to see the difference in what their health care systems can handle versus ours. Who ever said Canadian based health care was so great…
The damage we have already inflicted on the next generations is already enormous and will likely go down as one of the biggest mistakes of public health in the 21st century. But we can start fixing these problems now.
So my message is simple:
Open schools
Start fixing the healthcare system
Accept more risk
Hire back unvaccinated workers, especially in areas of shortages
And above all else: Trust individuals to make their own f&*ing (good or bad) lifestyle and health choices from now on and leave them alone!