Lifting public health measures will boost transmission and if Canadians don’t mask up, infections will increase significantly

Two years after the start of the COVID-19 pandemic, provincial and territorial governments in Canada have shifted their pandemic policies by lifting mask mandates, vaccine passport requirements, capacity limits and other public health measures. The provinces of Saskatchewan, Alberta and Manitoba removed most major restrictions first, with other provinces and territories relaxing protections in various ways and on different timelines shortly after.

The onus is now on the individual and on businesses: is it safe to recede all public health measures and de-mask, or should Canadians be choosing to maintain protective habits? The answer from CoVaRR-Net experts is the latter. Despite the fact Canadians are aching for a spring and summer that’s “back to normal,” the reality is COVID is still around, is surging in other parts of the world, and Canada could be poised for another wave.

The impact of the lifting of public health measures on transmission and infections

Computer modelling and data analysis done by CoVaRR-Net experts projects that COVID-19 infections among Canadians are likely to rise following the lifting of pandemic restrictions, due to the combined effects of relaxing protections and the growth advantage of the more transmissible BA.2 Omicron subvariant. If restrictions had not been removed in some provinces in February and across Canada in March, BA.2’s growth advantage would have likely overcome the decline in infections leading to relatively stable levels through to the summer.

“While there are a lot of unknowns, with the combined effects of BA.2’s rise and the relaxation of public health measures, the number of infections in Canada is projected to rise to between 230,000 and 300,000 new infections per day in May, based on a 15% or 30% increase in transmission. That is significantly higher than the level of infections (under 150,000 a day) there would have been if restrictions had not been removed. The number of infections is projected to be much higher than reported cases, since we are testing and reporting only a minority of infections,” says Dr. Caroline Colijn, CoVaRR-Net’s Computational Analysis, Modelling and Evolutionary Outcomes (CAMEO) Pillar Deputy, Professor at Simon Fraser University and Canada 150 Research Chair in Mathematics for Evolution and Public Health. “Public safety measures such as physical distancing and masking have proven to be effective over the course of the pandemic. Our models suggest clearly that removing precautions will allow an increase in the number of infections,” says Dr. Colijn.

Because the rates of transmission and infection are projected to rise significantly after lifting restrictions, the health risks will be higher for individuals and families in the community, schools, and the workplace, and especially for vulnerable populations.

Increasing the number of infections can mean an increase in the number of hospitalizations and deaths, as well, although high uptake of vaccinations and boosters provides a high level of protection against severe disease.

Reducing public health measures shifts risk assessment and management to individuals

One major consequence of lifting pandemic restrictions is that the responsibility for assessing and managing the risks of transmission, infection risk, severe illness, and death from COVID-19 shifts to individuals, families, employers, organizations, and businesses. Individuals must choose whether or not to wear masks indoors to protect themselves and others, get a vaccine booster, obtain a Rapid Antigen test or find and receive a PCR test when they have symptoms, and self-isolate for five days if they test positive for infection.

The danger is that many Canadians may assume or believe that because restrictions have been removed the risks have also been reduced or eliminated. They might then choose not to use preventive tools that are proven to work. “There is a mentality today that COVID is receding and the danger is over, but public officials need to tell people COVID hasn’t suddenly disappeared. It’s still putting people in hospital, causing long-term disability, and sometimes leading to death,” says Dr. Nazeem Muhajarine, CoVaRR-Net’s Public Health, Health Systems and Social Policy Impacts Co-Lead and Professor at the University of Saskatchewan.

“Individuals and families will need to do their own risk assessment, and it will be even more important for people to use the preventive tools we have available to manage their own risk and the risks to others,” he adds.

Social, economic, and mental health issues forced governments to relax measures

Two years of growing pandemic fatigue, economic disruption, mental health challenges and social frustrations that culminated with the trucker convoy protests have all put pressure on governments to remove pandemic measures. “So did the social trend towards framing and perceiving pandemic measures as restrictions on social and personal freedom rather than public and personal health protections,” says Dr. Cheryl Camillo, CoVaRR-Net’s Public Health, Health Systems and Social Impacts Pillar Deputy, and Assistant Professor, Johnson Shoyama Graduate School of Public Policy at University of Regina.

“In Alberta and Saskatchewan, the public messaging has concentrated on freedom and saying, ‘we want our freedom back.’ The timing was not coincidental but deliberate that when the trucker protestors were occupying Ottawa the Saskatchewan government announced it would relax the proof of vaccination policy,” suggests Dr. Muhajarine.

“Governments are changing their messaging, wanting to show the positive aspects of lifting restrictions,” says Dr. Camillo. “Lifting protections more gradually would have been better because without measures being reduced in a serious and thoughtful way, there will be negative consequences that could be with us for a long time. The main message used by some governments was ‘we have to learn to live with COVID.’ Unfortunately, that could also mean getting used to people becoming sick, missing work, having long-term health impacts, and dying of COVID, if precautions are not taken.”

Estimated new infections per day across Canada (November 2021-July 2022)

Legend:

Green line: With BA.2; no increase in transmission (public health measures remain in place)
Blue line: With BA.2; 15% increase in transmission (public health measures dropped)
Orange line: With BA.2; 30% increase in transmission (public health measures dropped)

Estimated new infections per day across Canada (zoom-in: March 2022-July 2022)

Legend:

Green line: With BA.2; no increase in transmission (public health measures remain in place)
Blue line: With BA.2; 15% increase in transmission (public health measures dropped)
Orange line: With BA.2; 30% increase in transmission (public health measures dropped) 

These graphs show projected daily new infections using three model scenarios: a) no increase in transmission, b) a 15% increase, and c) a 30% increase. The model uses a 40% transmission advantage for the Omicron subvariant BA.2 for all three scenarios. The “ribbons” (shaded areas in the appropriate colour) show there is a high uncertainty in projections. In addition, the model uses both a 15% and 30% increase in transmission to represent dropping mask mandates and other public health measures, as it is not certain what the impact on transmission will be. No increase in transmission represents keeping public health measures in place. Projects are a compilation of projections for Canadian provinces.

Experts’ advice: don’t ditch your masks and get a booster

So, what are Canadians supposed to do? As spring arrives and restrictions ease, people can live a more normal – but safer — life with COVID by choosing to adopt proven precautions to protect against the higher risk from increased exposure to other people and from BA.2 — or the next variant around the corner. “Masking indoors is one of the things people can do first. Masking is a very, very small inconvenience for a huge gain in prevention. We don’t want to ditch masks right away,” says Dr. Muhajarine.

Even though mask mandates are being lifted, government messaging should emphasize the benefits of wearing masks as a good practice, including substantially lowering long-term COVID prevalence, easing the inequitable burden of the pandemic, and protecting Canadians against the unknown rise and impact of new variants and waning boosters.

For people who haven’t yet received a vaccine booster, he advises that now is an even more important time to get boosted so they can enjoy greater freedom and live safely with COVID as restrictions ease. “Do travel, if you wish, but take these sensible precautions since you don’t know the vaccine status of the people you encounter. If you experience symptoms of COVID, get tested (or test yourself with a Rapid Antigen Test) and stay home. It’s the right thing to do as a responsible, caring person,” says Dr. Muhajarine. Ensuring good ventilation and socializing outdoors when possible are also ways to reduce transmission, and like masks, these have benefits beyond COVID in preventing other respiratory infections.

To support people in the workplace in making responsible decisions to self-isolate, Dr. Camillo emphasizes the importance of government measures such as mandatory paid sick leave and access to free PCR testing. “If those policies aren’t in place, many working people won’t be able to afford taking time off to self-isolate. Individuals in low-wage jobs lacking benefits such as private health insurance (to pay for testing) or on-site childcare are more vulnerable to becoming sick or losing earnings if, as modelling demonstrates is likely, the virus continues to spread while no public health or economic protections are in place. I also think the government removal of pandemic restrictions should be tied to increasing the vaccine booster rate,” she says.

Be prepared for future waves and new variants

With the lifting of restrictions, Canadians still need to be prepared for future waves of COVID-19 and the possibility of new variants in the fall, or perhaps sooner, as Europe and Asia are currently dealing with a surge in cases and with borders open, that case increase will spread to Canada. “Omicron happened very quickly and its spread was lightning fast. The next variant could be more contagious and/or more lethal,” says Dr. Muhajarine.

The choices that Canadians make in masking, vaccinating, testing, and isolating can make a huge difference in reducing the risks associated with lifting restrictions. “We have many more tools today to manage the pandemic. Governments, public health officials, employers, businesses communities and individual Canadians need to manage easing personal protections thoughtfully with the health of other people in mind,” concludes Dr. Camillo.

To arrange an interview with Cheryl A. Camillo, Caroline Colijn, or Nazeem Muhajarine, please contact:
media@covarrnet.ca