Dr. Chakrabarti, infectious disease specialist in Mississauga weighs in on vaccine passports and the 4th wave

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Published August 26, 2021 at 4:14 pm

Credit Valley Hospital in Mississauga

The excitement and relief that accompanied Canada’s successful vaccine rollout (and the enthusiastic response from eligible Ontarians) has dissipated almost entirely, replaced by fear and anxiety about yet another wave of cases that could challenge the province’s perpetually stressed health care system. 

But while cases (and yes, hospitalizations) are expected to climb during the fall and winter months, one expert says that the province’s impressive vaccine uptake will blunt the impact of the fourth wave and that some of the dire rhetoric people have been hearing isn’t particularly helpful. 

“First of all, it’s absolutely true that we’re seeing more disease activity and going into fall and winter, there will be areas where we’ll have significant hospitalizations and there are areas where hospitals will be stressed,” says Dr. Sumon Chakrabarti, an infectious disease specialist at Trillium Health Partners in Mississauga. 

“But we have 75 per cent of eligible people covered by the vaccine in Ontario and in people 60 and up, that percentage is even higher. In a population that is that vaccinated, it’s going to make some difference on how cases are able to transmit in the community.” 

On Aug. 25, Ontario Health Minister Christine Elliott tweeted that 20,566,473 vaccine doses have been administered so far, with 82.4 per cent of eligible residents vaccinated with one dose and 75.3 per cent with two.

As of now, children born after 2009 are not eligible to be vaccinated. 

But even though a huge percentage of the province’s population has gotten jabbed, vaccine uptake has slowed and Dr. Kieran Moore, Ontario’s Chief Medical Officer of Health, recently said that public health measures such as mandatory masking could be in place for another six to eight months. 

Moore also said that unvaccinated individuals are 29 times more likely to end up in hospital with COVID-19 than those who are fully vaccinated and that they are 48 times more likely to require intensive care unit treatment.

While Chakrabarti says we’re not out of the woods yet, he does expect the situation to look different this fall. 

“[Last year] when we were seeing a lot of cases in people in their 20s and early 30s, those spilled into older groups and we started seeing more hospitalizations. Even if fully vaccinated people get sick, they have protection against severe disease.”

Chakrabarti says that while caution is still needed, climbing case counts won’t necessarily lead to dire outcomes. 

“Case counts don’t tell the whole story. We have to be careful because things are going to get worse in the wintertime but I think that even with Delta, our situation is different because we don’t have the same level of unprotected population as before.” 

Chakrabarti says that going forward, Ontario might see more localized outbreaks rather than a province-wide “wildfire.”

“Unvaccinated people are more at risk of being hospitalised, but this will be more localized fires as opposed to that major stress we saw in the third wave when the entire province was on fire,” he says, adding that the province has learned from previous waves and is able to move severely ill patients to other hospitals when necessary. 

“There will be stress on hospitals, but I can’t see it being the same wave it was in the spring. I don’t have a crystal ball, but that’s my take.” 

As for whether or not there will be regional or widespread lockdowns in the fall and winter, Chakrabarti says he’s hopeful more targeted measures will be used to manage outbreaks, adding that Moore has gone on record saying that the province hopes to minimize significant disruptions to people’s lives in the post-vaccine era. 

“I am encouraged by hearing Dr. Moore say that he doesn’t want to disrupt people’s lives unnecessarily. Lockdowns work to bring numbers down but they are disruptive to multiple facets of life–health, mental health, businesses, etc. I do suspect that all efforts will be made to keep the interventions more focused,” he says.

As for whether or not vaccine passports–such as those that will be used in Quebec and British Columbia to temporarily restrict adults who are unvaccinated by choice from entering higher-risk venues such as restaurants, gyms and theatres–will work to stop lockdowns in Ontario, Chakrabarti says that a passport policy should be used fairly and carefully. 

“I think the temporary vaccine passport situation might be introduced,” he says.

But while a lot of people and organizations are clamouring for the passports, Chakrabarti says they need to be used to protect the unvaccinated from infection and protect the economy from closures–not punish those unwilling to get a shot. 

“A lot of people are sold on the idea but the devil is in the details. Will it be an effective intervention? Some vaccinated people can pass on COVID, but less so than someone who is unvaccinated. We’re not trying to stop every transmission but keep it low enough and keep the number of vulnerable people from getting sick. A vaccine passport could potentially help in that situation. If there’s a scientific reason for using it and it’ll work, then we should do it, especially at high transmission times. When it no longer makes sense to keep it in place, we should lift it.”

Chakrabarti says it’s important that any passport be used as a protective rather than a punitive measure and that its use should be temporary.

“You can’t keep people out of a public space because you don’t like them, so if transmission is low and hospitals are decompressed, you can’t just exclude people from public spaces.” 

Chakrabarti also says that society will need to adjust to the idea of COVID becoming endemic–meaning that it will likely always be with us in some capacity.

“What will be difficult is that as society goes into the post-pandemic phase, we have to understand that people will get COVID and some could get sick but be fine. You can’t hide from the virus forever. The vaccine makes it so you don’t get sick to the point of being hospitalized.” 

As for whether or not Canada should be following in the footsteps of Israel and the U.S. and rolling out booster shots for almost everyone, Chakrabarti says that the focus should be on getting first and second doses to people in developing nations and reserving domestic booster shots for those who truly need it, such as those with severely compromised immune systems.  

“We hear stories [in the media] and we think the virus will completely evade the vaccine or immunity will wane. We haven’t seen the raw data, but Israel saw waning immunity and gave a booster and said ‘oh, the immunity is back up!’ Even though more people are symptomatic, the protection against hospitalization and severe disease is maintained,” he says. 

“Boosters make sense for some people, such as immunosuppressed people, people with blood cancers and people on drugs that deplete their b-cells. They should get an extra dose, but we want to be benevolent and give vaccine doses to the rest of the world where the pandemic is burning bright. If it rages in other parts of the world, it could affect the world economy and create new variants.” 

Chakrabarti is also concerned that stories about transmission amongst vaccinated people could be fueling some vaccine hesitancy because the data is not always well-understood by people outside of the medical field. 

“If I find the virus in the nose of a vaccinated person, the vaccinated person’s viral level drops off very quickly. Your chance of transmitting is significantly reduced.” 

Ultimately, Chakrabarti says it does more harm than good when medical experts talk about how much trouble the province will be in going into the fall. Such rhetoric, he argues, drives despair and gives the impression that the vaccination campaign hasn’t helped and won’t make a difference. 

When I hear rhetoric like ‘we are in big trouble,’ I ask if it’s really needed. We have to be aware of what happens with respiratory viruses in the winter and we’re not out of the woods yet, but does this help? The population is so fearful and when people are fearful and stressed, they often make poor choices,” he says, adding that some of his unvaccinated patients have told him that they’ve refused the jab because they don’t believe the vaccines work. 

“Some people are afraid of side effects and if they don’t think the vaccine works, they won’t take it.” 

Chakrabarti says people need to understand that getting down to zero cases won’t be possible. 

“We’re still in the mindset that any transmission is bad and this obsession is difficult to undo but we must undo it because this virus is going to be endemic. There will be transmission. When it comes to a respiratory disease, you can’t defeat it.” 

Chakrabarti says that although fall and winter could very well prove challenging (especially with burnout amongst medical workers and nurses in particular) and that caution is needed heading into the cooler months, we should still be celebrating the positive impact the vaccines are having–and will continue to have–on the pandemic. 

“In many ways, we’re prepared and we know what we’re doing and PPE is no longer an issue. Health care workers are mostly vaccinated, but we have to be careful about staff burnout, especially with nurses. You can have the bed, but you need the expert nurse. But these vaccines are very good and we’ve significantly reduced the risk.”  

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