Alberta's COVID rate is highest in Canada. How did it get so bad?

Experts say a premature easing of restrictions, an underestimation of variant spread and inequitable vaccine rollout all played a role

Calgary Herald 8 minute read May 10, 2021

Storm clouds move in over walkers in Edworthy Park and the downtown Calgary skyline on Tuesday, May 4, 2021. Gavin Young/Postmedia

Over the past several months, political and public health leaders repeatedly characterized the third wave of COVID-19 as a race between variants and the vaccine.

In Alberta, where per-capita rates of infection are higher than anywhere else in North America, the outcome has been clear for weeks: the more-contagious variants were victorious — and the race was never even particularly close.

As of Sunday, Alberta has 570 active cases of COVID-19 per 100,000 residents, more than twice the Canadian average and well ahead of Manitoba, the province that currently has the second-worst outbreak. It’s the highest rate recorded anywhere in Canada at any point during the pandemic.

The province is now mired in its third major round of restrictions since the pandemic began last March, after the surge forced the reintroduction of strict, sweeping public health measures last week, closing all schools provincewide and temporarily shuttering many non-essential businesses.

What factors led to the sharp third wave, and how might it have been averted?

Experts and commentators say a premature easing of restrictions, an underestimation of variant spread, an inequitable vaccine rollout and non-compliance with public health measures all played a part.

Even as Alberta moved to relax restrictions imposed to stop the second wave, its third wave was already beginning, they say.

On Jan. 29, when Premier Jason Kenney announced plans to begin lifting some measures, 37 cases of variants had been found in Alberta. Just over two months later, the B.1.1.7 strain, first found in the United Kingdom, would become dominant in the province, driving a wave of infections that grew faster and more fiercely than the ones that preceded it.

In the early days of variant spread, both the federal and provincial governments misjudged how quickly variants could take hold, said Calgary urgent care physician Dr. Raj Bhardwaj. Some cases slipped through the federal test and quarantine program for international travellers, he said, and low case counts in Alberta were allowed to fester.

“We underestimated the speed with which the variants are able to multiply and spread under our noses, and I think that partly speaks to underestimating an exponential curve,” Bhardwaj said.

CAL072020-gyc-8 copy

“When B.1.1.7 was first identified in Alberta, just sort of meandering around, we were always hearing, ‘Oh, it’s OK. It’s not doing here what’s it’s done around the world.’ But why is Alberta different? We were just not necessarily seeing it or catching it or interpreting it properly.”

Case counts of the B.1.1.7 variant grew rapidly through February and March, threatening to take over as the most prominent strain in Alberta.

That shouldn’t have come as a surprise, said Dean Eurich, a clinical epidemiologist at the University of Alberta, who said the province had a “crystal ball” on how variants would behave once introduced but didn’t act soon enough.

“From an Alberta perspective, we should easily have been able to see how the variants played out in our province, because we had foresight from Europe, Quebec and Ontario, because that’s the way it was rolling across,” Eurich said.

“And the fact that it took so long to really put policies in place to try to control it is 100 per cent the reason we’re in the boat we’re in right now. We were just way too late in the way we were approaching the variants.”

When Alberta started relaxing public health restrictions as the second wave died down, the province continued to report 300 to 400 cases of COVID-19 each day, rates higher than those seen even at the peak of the first wave in April 2020.

It meant the third wave began at an elevated level of community spread, further heightening risk of transmission when variants were added to the equation.

By the time strict restrictions were brought in, case rates had already rocketed to record highs, a sluggishness Bhardwaj said cost the province.

“We could have acted weeks ago when cases were 1,000 per day, at the end of March, beginning of April, instead of waiting until cases topped 2,000 a day before really acting in a decisive way,” he said.

Bhardwaj said that unlike Ontario, where the third wave surge overwhelmed hospitals, Alberta’s hospital utilization somewhat recovered between the second and third waves, helping to prevent a disastrous scenario. Nonetheless, Alberta Health Services released a document late last monthdictating how doctors should prioritize care for patients if demand on the health-care system exceeds resources.

Alberta’s mortality rate also dropped significantly in the third wave, with early immunizations of seniors and those living in continuing-care facilities protecting the province’s most vulnerable from dying from COVID-19.

But Dr. Gabriel Fabreau, an assistant professor at the University of Calgary and an internist on the COVID-19 ward at the Peter Lougheed Centre, argued Alberta’s COVID-19 immunization campaign is among the most inequitable in Canada and has failed to prioritize those at greatest risk from the virus.

Vaccine campaigns must target areas where barriers exist to health-care access, Fabreau said.

“(Alberta’s approach) almost guarantees worsening inequities and prolonging the pandemic,” said Fabreau, who, alongside Dr. Annalee Coakley, helped spearhead vaccine clinics at meat-processing plants such as Cargill in High River. The pair are now among doctors looking to expand pop-up sites into hot spots, including Calgary’s northeast.

“The same barriers that increase risk of transmission and infection and death and hospitalization are the barriers that reduce the likelihood of getting vaccinated.”

Alberta’s vaccine rollout was broken into numerous phases, mainly differentiated by age. Some front-line health-care workers were given access to vaccine early, as were those who had some chronic, underlying health conditions.

It wasn’t until mid-April, however, that other health-care staff and front-line workers in high-risk, congregate environments such as prisons, meat-packing plants and homeless shelters had a chance to get a shot. And teachers and other school staff wouldn’t be offered vaccines until early May, only days before availability opened to the general public.

CAL042121-gya-10 copy

“Many school boards came out calling for teachers to be added to a prioritizing list for vaccinations, and the government just seemed to ignore that,” said Medeana Moussa, executive director of the Support Our Students advocacy group. “It really speaks to a lack of organization and forethought on the government’s part to just be making this a free-for-all instead of recognizing there was a need to go where outbreaks had been occurring.”

Moussa pointed out schools were a late priority for the province when it came to introducing more restrictions to protect Albertans from viral spread.

“Schools were never prioritized. They closed down at the same time as patios,” she said.

Cases in schools rose in mid-March, coinciding with the takeover of variant cases, though Alberta provided little information about to what extent school cases involved variants.

On April 14, the day before Calgary public and Catholic junior and senior high schools moved to online learning, there had been active COVID-19 alerts or outbreaks in 453 schools, about one in every five schools in the province, with more than 2,600 cases linked to schools since the start of the semester.

By May 6, the final day before all schools provincewide went online, the number of those affected grew to 728, more than 30 per cent of Alberta’s schools.

“We have had a lot of children infected in the province,” Eurich said. “There was basically outbreaks in every major region of the province in terms of schools. Kids seem to be fairly resilient to it, though we’ve seen more admissions to hospital with children with the variants than in the first and second wave.”

As case rates rose, so too did concerns over non-compliance with public health rules, and what some characterized as a lack of enforcement against flagrant rule-breakers.

The GraceLife Church, outside of Edmonton, held weekly services above capacity restrictions and became a flashpoint for opponents of the province’s public health measures. AHS eventually shuttered the church in early April, but similar enforcement against other scofflaws, such as the Calgary Street Church, wouldn’t come until a month later.

The situation became even more politically volatile for Kenney when a quarter of his caucus signed a letter opposing restrictions, said Mount Royal University political scientist Duane Bratt.

“You had this outright, high-level defiance. And probably the last straw, at least for Kenney, was the Bowden rodeo,” said Bratt, referencing an illegal Central Alberta rodeo at the beginning of May where hundreds congregated without masks or physical distancing.

Other non-compliance was less visible, with individuals losing resolve and bending on some rules, said Eurich.

The U of A epidemiologist said based on current trends, case rates will remain high for several weeks, with hospitalization rates likely not peaking until late in May. He said he’d be surprised if the latest round of restrictions can even be lifted in three weeks.

It’s a forecast that suggests a difficult spring, and a summer spent in recovery — a far cry from the “best summer in Alberta’s history,” promised by Kenney in early April.

But, with about 35 per cent of all Albertans immunized with at least one dose of COVID-19 vaccine and inoculations accelerating still, Bhardwaj said brighter days are in sight.

“We’re gonna get there, and I think people need to know that. It’s probably not going to be the best summer ever, but it’s certainly going to be a lot better than our winter, our Christmas, our Thanksgiving, our spring.

“There’s hope in the air.”




Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our community guidelines for more information and details on how to adjust your email settings.