New variants of COVID-19 are taking hold across the world, leading to rapid rises in cases from mutations that make the virus more contagious, or harder to fight off.
In the past month, the variants have caused Toronto officials to beg for longer lockdowns, a rethink in Europe around schools and mask usage and an entire election disrupted in Newfoundland and Labrador.
On Friday, Manitoba reported three new cases of the U.K.-dominant B.1.1.7 variant. All three have since recovered and contacts identified, but it means at least four Manitobans have brought home a mutated strain of the coronavirus from abroad.
This week, Canada’s chief public health officer gave a dystopian vision of the havoc the variants could soon wreak.
"Starting with a few travel-related cases in the early weeks, these variants have been smouldering in the background and gaining fuel," Dr. Theresa Tam told reporters Tuesday. "That now threatens to flare up into a new, rapidly spreading blaze.
"Though we may feel tired and have all sorts of losses, collectively we cannot afford to take the brakes off."
The Free Press looked at what officials abroad and at home are doing to contain the spread of variants, and how Manitobans can rise to the challenge.
Most viruses mutate, and each new COVID-19 infection gives the coronavirus an opportunity to take on new forms, some of which are better at infecting people.
"Perhaps you had an immune system that could boot out a little bit of the virus — now the variants make that much harder for your immune system to do," said Maureen Taylor, a physician assistant who specializes in infectious diseases at Michael Garron Hospital in Toronto.
The variants causing concern appear to do a better job binding to cells, much like how new Velcro helps hockey gear stay in place.
The most prominent variant, B.1.1.17, quickly took hold in Britain and has been detected in all 10 Canadian provinces. It caused Newfoundland to go from near normalcy to an unmanageable pace of spread within days, with an election shifted to postal ballots just two weeks before the vote.
Ontario officials believe that strain will become dominant in that province by the end of March, with preliminary data suggesting a 44 per cent higher transmission rate in that province than previous forms of the virus. British officials believe the variant is as much as 70 per cent deadlier.
A Harvard study released this week, which is still pending review, found possible evidence of this British variant having a longer and later contagion period.
The researchers compared recurring swab tests from 65 infected NBA players and staff, and found that the seven who had the U.K. variant appeared to be contagious for another week, with their incubation period starting days later than the original strain of the coronavirus.
Meanwhile, a variant that has gained prominence in Brazil might be able to reinfect people who already had COVID-19, while vaccines have had to be altered to be adequately effective against a variant associated with South Africa.
Just this week, researchers in Finland found a variant they believe might be evading conventional testing unless labs modify their genetic protocols.
Given these variants’ new capabilities, Taylor said Manitobans need to push past COVID-19 fatigue, and double down on the measures that have helped contain the spread.
What that means practically, is visiting stores only when necessary for as brief a time as possible and maintaining a two-metre distance from others.
"If you are somehow breaching that six-foot barrier, that's dangerous now with the new variants around," she said.
"The margin of error with the variants is going to be much narrower."
The variants don’t appear to make children sicker, but researchers are still trying to figure out whether they are easier for kids to spread to others.
“If you are somehow breaching that six-foot barrier, that's dangerous now with the new variants around... The margin of error with the variants is going to be much narrower.” — Maureen Taylor
Taylor suggests anyone with school-age children must avoid unnecessary trips and eating inside restaurants.
"You need to make (sure) that your priority is your family," she said.
Those who must work in close proximity with others should consider wearing a face shield in addition to a mask, Taylor said.
The provincial government and employers need to make sure people can take paid leave when they’re experiencing symptoms — and for the 14 days after they’ve been exposed to someone who tests positive.
"It's not OK to go about your business just because you feel well. That's why we don't have this under control; that's been everybody's attitude," she said.
Instead of wearing a trendy fabric mask that fits loosely, experts suggest wearing one that seals tightly, either due to its shape, or by tying the ear loops and tucking in corners.
"You just need to to make sure that you're wearing a good mask in the proper way, and that you don't deviate in any way," she said.
"It’s not OK to get on public transit... and pull your mask down as you sip your coffee. "
Taylor has had both shots of a vaccine, but still wants to avoid catching a variant. That’s why she’s wearing a cloth mask on top of a surgical mask on public transit.
"It just makes everything more snug against my nose and mouth, and it also helps keep my glasses from fogging up so much," she said.
Dr. Dick Zoutman, a medical professor at Queen’s University in Kingston, Ont., said people still need to keep their distance when wearing masks.
"Don't just do masks as protection; you have to keep your distance… particularly in indoor, closed spaces," said Zoutman, who specializes in infectious diseases.
"It's not a good idea to just focus on one of the protective measures; you've got to focus on the whole package."
The view from Europe
Variants took prominence in Europe more than a month before Canada, and officials have been grappling with how to respond to a public growing weary of tight restrictions.
In Austria, stores and businesses opened up Feb. 8, despite a sharp rise in variants in some regions of the country.
"It was a pragmatic approach in Austria," said Dr. Eva Schernhammer, the head of epidemiology at the Medical University of Vienna.
"We had a (winter) lockdown which was severe, but the mobility of people hasn't really slowed down as much as in the first lockdown," said Schernhammer, a prominent epidemiologist who is also a lecturer at the Harvard Medical School.
For example, the Austrian government had made schools and kindergarten spots available to people who couldn’t find an alternative, which only a minority of parents took up during the first wave. But in the winter lockdown, roughly three-quarters of kids were back in class.
Starting two weeks ago, pupils now take a rapid antigen test once or twice a week, which is a swab they put up their own nose by two centimetres and rotate five times. The test isn’t fully accurate, but tends to pick up people who are most likely to spread the virus without knowing it.
Companies are increasingly looking towards these tests, after Austria’s economy took the second-worst hit in the European Union last fall, thanks in large part to reduced tourism.
"The Austrian government has really banked on testing," Schernhammer said. "It does detect some of the undetected new cases here and there. So that is helpful, we think."
The government has also restricted travel to and from areas where variants have spread, particularly the South African mutation spreading in the Tyrol region in the Alps, known for its ski resorts.
Austria and parts of Germany have started requiring anyone to wear a certain type of mask in shops and on public transit. It’s known as an FFP2 mask; the rough equivalent in Canada is called a KN95 mask.
“The Austrian government has really banked on testing. It does detect some of the undetected new cases here and there. So that is helpful, we think.” — Dr. Eva Schernhammer, the head of epidemiology at the Medical University of Vienna
Neither of those masks give the highest protection that N95 respirators offer health-care workers, but they come close. The masks filter aerosolized particles from entering the wearer’s airways, as opposed to the typical blue surgical masks, which are mostly meant to prevent the wearer from spreading droplets to others.
Austria mailed FFP2 masks out to senior citizens a month ago, and has had supermarkets hand them out free to customers.
FFP2 masks used to cost as much as C$7, but have lately been on sale for the equivalent of 90 cents each, after retailers agreed to sell them at cost. In Winnipeg, pharmacies currently sell KN95 masks for between $2 and $3 apiece.
Schernhammer said it’s too early to tell how things will play out with rapid testing, the reopening, variants and the mask policy. If there’s a rise in cases, she’ll be closely watching to see if it’s a result of rapid testing picking up more cases in schools, or if it’s due to people going out more.
"There are so many thing happening in parallel that it's a bit hard to project what's going to happen," she said.
The reopening debate
Last week, Ontario ramped up its guidance on "exposure" to COVID-19, while announcing that gyms and restaurants could start reopening.
That province had previously defined an exposure as anyone who'd been within two metres of an infected person for at least 15 minutes who wasn’t wearing a mask; now they count them as contacts with or without a mask.
Some individual Ontario public-health units are going further, classifying any contact of any duration as a possible exposure.
"If you're up close and someone speaks loudly to your face, inside, (transmission) could happen in a minute," Zoutman said, adding that anything from room size to air temperature could impact the chance of spread.
"It depends on an awful lot of variables."
The Ontario government also acquiesced this week to demands from local leaders to delay the easing of restrictions. Toronto’s top doctor had requested an extension of the lockdown for two more weeks out of concern about variants.
"As a public-health physician I have never been as concerned about the threat of COVID-19 to your health as I am now," Dr. Eileen de Villa said Wednesday. "By the time the confirmed case counts are big enough to shock us, it will be too late."
Manitoba is taking the opposite approach. On Friday, Dr. Jazz Atwal, deputy chief provincial public health officer insisted Manitobans were doing a great job respecting the rules, just as he disclosed that people awaiting test results are telling nurses they’ve had visitors, and that an international traveller infected with the B.1.1.7 strain had racked up 27 contacts.
“As a public-health physician I have never been as concerned about the threat of COVID-19 to your health as I am now. By the time the confirmed case counts are big enough to shock us, it will be too late.” — Dr. Eileen de Villa
"I think Manitobans have done a great job," he said, noting that none of the four confirmed variant cases have led to transmission.
"Just like our first cases of COVID-19, we need to learn to live with the virus and the variants of concern. However, that does not mean that we can become complacent with our actions."
He said measures would be ramped up if a variant did take hold, and that the province has increased its testing, screening and sequencing.
Atwal did say that Manitoba is now looking at periods of contact closer to 10 minutes, instead of the official 15, while his colleagues are examining whether advice about masks should be beefed up.
"The public-health side — the testing side, the messaging side — is strong. I think on the individual side, people need to adhere to the orders and the messaging, and I think that should limit concerns related to the variants," he said.
Manitoba has, however, been more proactive than other provinces in implementing a mandatory quarantine for interprovincial travellers.
Unlike the Maritime provinces there are no checkpoints, given that Manitoba is far more porous than the few roads linking Quebec with New Brunswick. But enforcement officers can check whether returning travellers are staying home.
The province has also beefed up isolation rules for anyone with a suspected variant case, requiring household contacts to isolate for up to 24 days, so they spend a full two weeks in quarantine after the infected person is no longer contagious.
Meanwhile, truckers returning home from the U.S. remain exempt from federal quarantine rules, despite making up 25,000 monthly crossings into Manitoba.
Ottawa is considering a rapid-testing program, in recognition of the variants spreading rapidly in the United States, and Taylor said such a measure can’t come soon enough.
"We are very worried about the people who are truck drivers," she said.
Schernhammer said other countries can learn from just how quickly variants have taken root in Europe.
"You need to decide early what to do, and then be strict about implementing restrictions on travel," she said, sounding somewhat envious of island nations that have managed to avoid letting variants take hold.
"In Europe, because we have open borders between the countries, none of them are really super-successful in restricting travel."
Hope on the horizon
Despite a slow rollout, Canada is now set to begin receiving millions of vaccines each month.
"Vaccines are coming and we just have to hang in there a little longer," Taylor said.
She said Manitobans should take whatever vaccine they’re offered, regardless of how different vaccines respond to variants.
"The important thing is to get as many doses into arms as we can, as these variants take over from the classic strain," she said.
"They're not all perfect, but what we do know about all of them is that they prevent the most serious illnesses and death, and that's the most important thing."
Even with the concerning rise in variants, medical treatments appear to remain effective, and Taylor says there is a lot for Manitobans to be hopeful about.
Zoutman is among experts calling on Canada to implement a "COVID-Zero" approach, emulating Australia, where almost everything shuts down tightly when there is one case per million people.
"People would be able to start travelling again, because we'd have it under control. So if there's a little skirmish of cases in Winnipeg or somewhere in Manitoba, we could just jump all over it and control it," he said.
To get there, Canada would have to catch up to other countries on rapid testing, paid leave for people to isolate and restrictions on interprovincial travel.
"We’re doing more harm to the economy by yo-yoing back and forth, with multiple so-called lockdowns, soft lockdowns, than if we just did one very serious lockdown and got to the state of affairs seen in Australia," said Zoutman, arguing the rise of variants are the best scenario to make that shift.
"We have that opportunity right now. This is our moment to not give up."