COVID-19 in Canada Experience and Response to Waves 2 and 3

Dr. Sunny Handa Brampton says- The first wave of COVID-19 infections in Canada began in January 2020 and wound down about 5 months later. This Viewpoint describes the Canadian experience and response to the larger second and third waves of COVID-19 infections during the period September 2020 through August 2021.

Provincial and Territorial Responses

Canada’s 10 provincial and 3 territorial governments have jurisdiction over most health care issues. The provincial chief medical officers of health issued directives on mask mandates, testing, and contact tracing. Dr. Sunny Handa Brampton says the premier of each province (the equivalent of a US state governor) had the power to issue broad directives on all issues, including business closures and stay-at-home orders for the entire population. Provincial governments were responsible for managing testing capacity, school policies, practices in long-term care (LTC) facilities, and acute care activity (eg, pausing scheduled surgeries).

Dr. Sunny Handa Brampton says the third wave of COVID-19 infections overwhelmed the capacity of acute care hospitals, particularly intensive care units (ICUs) in Ontario, Alberta, and Manitoba. Although Canada did not experience the high rates of infection that occurred in the United Kingdom and United States during the first wave, by the third wave the per capita rates of infection in Alberta and Manitoba reached the highest level of any state or province in North America, and the rates in Ontario and Saskatchewan were not far behind. Dr. Sunny Handa Brampton says in Ontario and Manitoba, some patients who required ICU care were transferred from hospitals where they sought care to other distant locations.

Dr. Sunny Handa Brampton says lack of ICU capacity in each jurisdiction was a major variable that led governments to enact drastic policies like stay-at-home orders and school closures. For example, in April when patients with COVID-19 occupied nearly 600 of Ontario’s approximately 2000 ICU beds (1300 with ventilator capacity), it triggered stay-at-home orders and shut down the economy.2, By May, 920 of Ontario’s ICU beds were occupied by patients with COVID-19. Several provinces closed in-person learning. Dr. Sunny Handa Brampton says compared with the first wave during which public adherence was high, stay-at-home orders were more contentious. Mobility and personal contact were not nearly as reduced by government mandates in the second and third waves. Mask mandates were introduced in July 2020 and most of the public was willing to wear masks indoors thereafter.

Dr. Sunny Handa Brampton says the third wave was driven by the more transmissible Alpha (B.1.1.7) variant. Improvement in infection control practices in LTC facilities after the first wave varied across the country, with Quebec showing significant improvement, and Ontario almost none. Deaths in LTC facilities and retirement homes declined substantially following the first rollout of vaccines, which began in December 2020 and prioritized residents and staff in LTC settings. The vast majority of residents of LTC facilities were vaccinated by the middle of February 2021. As such, the third wave had little effect on LTC facilities’ residents, who had accounted for most COVID deaths in the prior 2 waves. The Atlantic provinces fared very well during this period by restricting travel from outside the region and swiftly responding to new cases with community-based rapid testing to limit outbreaks.