The lack of restrictions in schools and universities don’t jive with Health Canada’s sensibly cautious recommendations around COVID 19.
UNLESS THINGS CHANGE DRAMATICALLY over the next few weeks, British Columbia will launch a massive experiment in pandemic management strategy involving about a million children, teenagers, young adults and their families and teachers.
It begins when students, at least a quarter of a million of them completely unvaccinated, return to crowded classrooms—some university classes number 300 students or more—with (so far) few requirements for masks or social distancing. With a month to go before schools reopen, about 85 percent of kids under 17 were still unvaccinated. About 40 percent of those aged 18 to 29 still had not been fully vaccinated as of August 9.
BC’s allowance of crowded lecture halls with no requirement for masks or vaccinations is contrary to Health Canada’s recommendations around COVID 19.
Some students, parents and teachers want masks and a more conservative approach to classroom safety protocols. Some even advocate that high schools and university students require proof of vaccination before admission to classrooms and university events. One recent poll found that 77 percent of British Columbians want mandatory vaccination as a prerequisite for university attendance and even more—about 80 percent—think the same should apply to attending sports events or to flying anywhere in the province or, for that matter, to the rest of Canada.
But so far the province is standing by its announced position that these additional safety measures are not necessary and that a continued gradual easing of restrictions is the proper response. It says it’s finding a balance between public safety and opening up the economy.
Anticipated rules might change, though, after an announcement August 16 that the province had recorded 1,434 new cases in the previous three days—about 50 percent higher than was reported a week previous. The number of hospital cases had increased by over 50 percent, with those admitted to intensive care doubling over the past week.
The present calculation is that high vaccination rates in BC’s adult population—the government certainly deserves its praise for that—and rising vaccination rates among the population aged 12 to 29 (which currently has the lowest vaccination rate but is also least susceptible to serious illness) will nevertheless blunt both the rate of transmission and the lethality of the virus for those who do get infected. The best case is that transmission of COVID 19 stalls and, while we don’t exactly return to normal, at least we get back to a semblance of normal.
That is the plan. But as every wise general knows, few are the plans that survive engagement with the enemy.
The threat to the reopening plan is what looks suspiciously like a troubling fourth wave. New infections have been increasing on an exponential growth curve, doubling every 7.5 days. Most of the new infections are among the unvaccinated.
The unvaccinated provide a fertile field for the virus, particularly the aggressive delta variant which now comprises most infections and is about ten times as transmissible as the first. Even the vaccinated who are exposed to the delta variant but develop no symptoms can carry heavy viral loads which can then be transmitted to others, including those who are vaccinated but for some reason have less robust immunity.
FACED WITH THE PROSPECT of a return to business as usual in classrooms where few are vaccinated, masks are optional and classrooms are expected to be used at maximum levels, parents and teachers and university faculty associations are protesting the moves and urging stronger precautions.
At Simon Fraser University, the biology department simply defied the administration. The chair of biological sciences at SFU ruled that masks would be required in all biology classrooms and lecture theatres and that staff would have the right to refuse unvaccinated individuals entry to biology offices and labs.
The student society at SFU told media it’s detecting a lot of anxiety among students, not because they fear disruption but because making masks optional, eliminating social distancing requirements and failing to limit capacity in most classes, lecture halls and at campus events puts them and their teachers at greater risk.
At the University of Victoria, the faculty association asked for mandatory vaccinations for faculty, staff and students. The graduate students there moved unilaterally to require masks for entry to their society’s buildings and offices and the UVic Students’ Society says it supports the faculty association’s request. Unions at the university representing teaching assistants, sessional instructors and other staff at UVic want a mask mandate and urge that vaccination be required for residents and workers in student housing. (I should disclose here that I’ve taught—and still sometimes teach—the occasional university course in journalism, creative non-fiction, research methods and so on.)
As with many policy decisions based on big picture statistics, the devil is often in the details.
For example, while most teachers and faculty are vaccinated and therefore assumed to be safe, many younger university students still are not, most teenaged secondary students are not, few junior secondary students are vaccinated and no students under Grade Seven are. So they are at primary risk for infection which makes them a greater threat to their older teachers and their own generally older contacts from partners to frail elderly parents.
There’s growing evidence in the research literature that the older one is, the greater the risk of lower immunity, even if vaccinated, simply because immune systems degrade over time.
So, older teachers have a higher risk. How much higher? Well, we don’t really know because we haven’t had sufficient time for the baseline research. We do know from emerging research, though, that five out of every 100 people in the general population could still get infected even after two doses of either of the leading mRNA vaccines now in widest use in BC.
And we know from research that these “breakthrough” infections are most likely in persons over 65 and among those who have underlying medical conditions that put them a greater risk of serious complications—whether actual disorders or therapies which compromise the immune system. Diabetes, high blood pressure, asthma, congestive obstructive pulmonary disorder, being overweight and so on are all indicators of greater risk.
Okay, how many teachers are in these higher-risk age and health brackets? Well, according to an age profile of the teaching profession tabulated by the BC Teachers’ Federation, there are about 5,500 teachers in the province’s schools who are over 50. And one compiled by the Canadian Association of University Teachers for 2018 on a discipline-by-discipline basis found that more than 10 percent are over 65. Of these, statistical averages suggest about 20 percent of teachers aged 50 to 64 will have high blood pressure and for those over 65 it jumps to about 40 per cent. On average, about 23 percent of those over 50 will have diabetes. So one in five teachers in a school or university classroom is at elevated risk of a serious outcome should they contract COVID 19, even if fully vaccinated. That’s a minority, but it is a significant minority.
Remember, less than half BC’s population aged 18-29 and less than a quarter of those aged 12-17 had been vaccinated. As of July 30, almost half the new cases in Canada, virtually all involving the delta variant, were in people under the age of 29.
A reopening of campuses with no mask or social distancing requirements in classrooms means that the least vaccinated age cohorts—in which symptoms are expected mostly to either not present or to be mostly mild—will be unavoidably mixing with several age cohorts which are at considerably higher risk for serious adverse effects from an infection even if they are fully vaccinated.
Federal safety guidelines affirm this concern, which may alarm the groups affected but doesn’t appear to worry the provincial government.
Here’s what Health Canada was saying the last time I checked its website. The caveat “last time I checked” is required because, as the federal public health office observes, circumstances are fluid and “the risk of getting COVID-19 is evolving daily and varies between and within communities. Overall, the risk to most people in Canada remains high.”
“Deciding what personal preventive practices, like masking or physical distancing, you can safely ease up on and when and in what settings depends on several things,” Health Canada advises. “The decision isn’t just based on whether you’re fully vaccinated.”
It says other factors are age and personal health status and warns that the potential for severe illness following infection increases with age, underlying conditions (like high blood pressure or diabetes) and the age and health status of those immediately around the exposed person.
“The impact of you being infected is greater when you’re with older people and/or people with certain medical conditions,” Health Canada says. “This is because they’re at higher risk of severe illness.”
Thus we have one group that’s not largely vaccinated or is only partially vaccinated and is therefore more exposed to infection, even if the outcomes are mostly mild or asymptomatic, and another population which is mostly vaccinated and therefore has greater protection but which also has components that are at higher risk if infected, not only in themselves but to others in their immediate circle who likely have elevated risk due to age and medical status—very old parents, say. The 95-year-old parent of a 65-year-old teacher, for example, is about 600 times more likely to die from contracting COVID 19 than is a 22-year-old student.
Not surprising, then, that teachers, university professors, students and parents are all expressing anxiety at what seem to be contradictory messages from the BC government and from Health Canada.
Canada’s top public health agency is saying that we shouldn’t be engaging in what it calls “least safe activities” on the basis of age, personal health, medical conditions and the age and health status of those around us. It defines “least safe activities” as large indoor gatherings, especially where masking and physical distancing are not undertaken and/or being physically close to an unvaccinated or partially-vaccinated person when the virus continues to circulate in the community.
A first-year lecture with 300 students jammed into a lecture hall with no requirement for masks doesn’t seem to meet Health Canada’s “keep your distance” benchmark. Nor does exposing a 60-year-old public school teacher with diabetes or asthma or high blood pressure to a classroom of unvaccinated kids who aren’t required to wear masks.
And it gets more complicated. A just-published study of 50,000 vaccinated patients by the famed Mayo Clinic found that the effectiveness of the Pfizer/BioNTech vaccine with comprised the first dose for most of BC’s higher risk population had declined to 42 percent effectiveness against the newly emerged delta variant which now represents 95 percent of the new cases in here. And in Oregon, 20 percent of July’s documented COVID 19 infections were among already vaccinated individuals.
The upside to that gloomy news is that the number of breakthrough infections that are serious is small—for now. Yet another variant could change that. The present strain of COVID 19 rampaging through vast numbers of unvaccinated people in our neighbour to the south provides an ideal natural laboratory for developing new vaccine-resistant strains which, as we well know, pay no attention to borders.
All of which helps explain, perhaps, why Health Canada is warning that notwithstanding vaccination, if you are older and/or have pre-existing medical conditions, you are at greater risk of severe illness if you are infected and you may not get as much protection from vaccination compared to a younger person.
For this reason, the agency says, you should “keep wearing a mask and avoid getting close to others in public even if you are fully vaccinated.”
But BC’s plan for all teachers to return to small, enclosed classrooms with students who may not be vaccinated and for whom not wearing a mask is an option for personal choice, seems to ignore such advice.
A recent report in the New York Times quotes epidemiologists warning that seniors and people with immune systems compromised by advanced age and/or underlying medical conditions “could be particularly vulnerable in a surge, even if they were fully vaccinated, because their bodies might not produce a strong immune response from the vaccine.”
None of this is to suggest that vaccines aren’t the most important and valuable weapon for suppressing that exponential growth curve and minimizing detrimental health effects from infection. But it’s a bit more complicated than simply basing policy on the assumption that a vaccination is the silver bullet in this campaign.
Sending potentially vulnerable teachers back into classrooms with students who are not fully vaccinated and for whom wearing a mask is a personal choice is to ask those teachers to risk become potential transmission points to others who might be at even greater risk of severe illness or even death.
Setting up mass vaccination clinics for returning university students who already say they want mandatory vaccinations and telling them to wear masks in classroom settings doesn’t seem particularly onerous. After all, students and faculty can’t drive to campus without proof that they have a driver’s licence; they can’t park on campus without a permit; use the towels in the athletic facilities without paying a fee; take books out of the library without first obtaining a card; or attend classes without putting on their pants. Asking them to get vaccinated and wear a mask doesn’t seem unreasonable.
Stephen Hume has spent half a century as a journalist writing about Western Canada, the Far North, BC and the Island. He has been vaccinated.