A reality check on Alberta's path to the devastating 4th wave of COVID

Premier Jason Kenney promised Albertans the "best summer ever."

The pandemic was ending, and the province was reopening "for good."

The Alberta premier's optimistic prediction was first voicedin the spring. But as the summerwound down, Kenney who faced harsh criticismfor vacationing as COVID-19 cases surged returned from holidays to plead with unvaccinated Albertans to get their jabs.

The United Conservative Party premier even dangled a $100 incentive for unvaccinated Albertans to get protected against the disease.

That was almost two weeks ago.

In the meantime, COVID-19 cases have soared, the province's ICUs have filled and public anger has swelled.

Questions continue to swirl around the UCP government's decision-making that made it so confident Alberta had "the upper hand" on the novel coronavirus, allowing Alberta to safely open.

Experts warned the reopening plan was riskyand premised on wishful optimism. However, other experts interviewed recently by CBC News say the government's actions in June were not unreasonable given what was known at the time.

In this CBC News reality check, we investigate whether Alberta could have prevented the fourth wave by making different decisions.

Was the UCP government overly optimistic about vaccinations?Were its COVID-19 models flawed? How much of the criticism is simply the benefit of hindsight and how much is valid, and will the province'snew incentive plan or recentlyannounced COVID-19 vaccination record make a difference?

Was the government right to lift restrictions in July?

In hindsight, the answer to the question seems obvious. Just over two weeks after lifting the restrictions, the fourth wave started its now-steep climb.

In fact, even Dr. Deena Hinshaw, Alberta's chief medical officer of health, now admits the reopening is to blame for setting out the disastrous fourth wave now consuming the province.

Currently, ICUs across the province are over capacity with the most COVID patients since the pandemic began, and hospitalizations, deaths and illness continue to climb. It's expected to get worse.

Weeks before Alberta announced on June 18 its plans to reopen,the premier was castigatingcritics, dismissingthe idea of a fourth wave and accusingjournalists who suggested otherwise of fear-mongering. Even before Kenney's comments, his executive director of issues management, Matt Wolf, went so far as to tweet: "The pandemic is ending. Accept it."

The move to reopen the province ahead of any other jurisdiction in Canada appears to have been made without proper consideration of the evidence, according to experts.

Modelling released by the province outlining the reasoning behind the Canada Day reopening and later moves to eliminate testing, contact tracing and mandatory isolation suggests it was relyingon data from the U.K. while ignoring conflicting data from south of the border.

In the United Kingdom, case counts had largely decoupled from increases in hospitalizations.

Kenney suggested the U.K.'s experience was evidence of Alberta's ability to reopen safely. He was confident vaccine coverage in Alberta was sufficient to ensure the same outcomes here. Kenney said Alberta wouldn't see a significant rise in COVID-19 cases until mid-October.

Speaking to CBC News last week, Dean Karlen, a physics professor and expert in modelling at the University of Victoria, who is a member of British Columbia's independent COVID-19 modelling group, said you don't choose just one jurisdiction, let alone one with the most optimistic outlook, in order to make your decisions.

Earlier this month, the B.C. modelling group predicted new COVID-19 cases in Alberta could climb to 6,000 per day by the beginning of October.

Dr. Lynora Saxinger, an infectious disease expert at the University of Alberta in Edmonton, says the reopening took place when case counts were low, and although there were some red flags in retrospect including the increase in delta variant cases at the time, the decision wasn't "obviously wrong."

"Based on the information at the time, you know, it's not outside the realm of reasonable public health practice," she said. "It might be at the edge of it, but it's not outside it."

For Saxinger, the bigger issue was not reacting to the situation quickly when some of the assumptions that girded the decision started to fall apart and hospitalizations started going up.

"To me, that's a more controversial piece," she said.

So, were the decisions based on faulty modelling?

Did Hinshaw's modelling get it wrong?

According to Saxinger, "all modelling is wrong."

There is a complex set of variables that go into a modelling projection and a lot of what comes out the other end is based on what's fed into it.

"The modelling itself was probably based on reasonable inputs. I think there could be a question as to how often the inputs are, you know, interrogated and how often they're cross-checked against what we're actually seeing," said Saxinger regarding the data that led to the lifting of restrictions on July 1.

Even as Kenney was removing those restrictions, however, experts were warning it was risky.

Saxinger thinks the U.K was a bad case study for Alberta, in part because of the geographical differences in vaccination rates in the Prairie province compared with the island country.

By July 29, the province announced it was going to end contact tracing and isolation requirements, which caused an outcry of concern.

Saxinger says there were a lot of other viruses, such as influenza and respiratory viruses,popping up in the population at that time and she thinks there was concern the testing system would be overwhelmed and there would be mass isolation once school started back up and those viruses spread.

"I think it was, in fact, a legitimate concern. But the whole concern there is relatively small compared with unrestricted COVID transmission," she said.

Given the rise of the delta variant and the government's reliance on vaccine coverage to prevent the current pressure on the health-care system, was it appropriate to reopen using 70 per cent of eligible Albertans with first doses as the threshold?

Was 70% an appropriate vaccine threshold to reopen?

Based on surging case counts, and the rapid growth in hospitalizations and ICU admissions, it would appear that threshold did not offer the level of protection the government hoped it would. Kenney had argued the vaccines gave Alberta "a superpower" to manage COVID.

Alberta will fully reopen by Canada Day

3 years ago

Duration 3:00

The vast majority of those in hospital and in ICU are unvaccinated patients and there are a lot of them in Alberta. In addition, single doses seem to be less effective at warding off the delta variant, adding more people to the list.

At the end of June, Kenney was adamant that the 70 per cent threshold was appropriateand said about 15 per cent of the population had natural immunity from prior infection. In a recently unearthed video from the summer, Kenney predicted the province would have over 80 per cent of its population vaccinated no timeline attached.

But even in the spring, experts doubted the numbers were sufficient.

Dr. James Talbot, a former chief medical officer of health for the province,said even 70 per cent of eligible Albertans with two doses likely wasn't sufficient given the rise of the delta variant.

"Pushing for the 70 per cent of [one dose] is giving people a false sense that that's the end, that after that, everything is fine," he said in mid-June.

"If you get in the 70 to 80 per cent range with people who are protected [with two doses], you can protect even those who haven't gotten the vaccine. That's literally what herd immunity means."

Currently, Alberta is just barely past 70 per cent of eligible Albertans with two doses the lowest level in the country.

Saxinger says the 70 per cent threshold was a commonly held figure at the time of the decision but there werewarning signs of the delta variant already popping up.

"I think that there were some early flags probably present at that time, that it might be that that target has to be higher," she said. "But again, at the same time, a lot of stuff was evolving."

In early September, when Kenney announced the $100 incentive for getting vaccinated, the premier acknowledged the province was getting hit harder because of low vaccination rates, even though the province has now given at least one dose to 78.4 per cent of the eligible population.

"We are about five percentage points below the Canadian average, and that is why we're getting hit harder," he said, while hyping the government's plan to incentivize latecomers to get the jab in order to stem the rising COVID tide.

So, what about those incentives?

Do incentives work?

Yes and no. Maybe. A little bit.

There can certainly be an increase in vaccination rates in the wake of incentives, such as lotteries and small-sum payouts, but it's difficult to quantify the effects when there are so many other factors.

Often when there are increases, they are short-lived.

When he announced the $100 benefit, Kenney said vaccine"carrots" had worked in some U.S. states.

"I wish it didn't have to come to this," he told reporters, "but I'm much more concerned about protecting our hospitals."

Faced with plateauing vaccination numbers, the Alberta government launched an "Open for Summer" lottery in mid-July, offering three $1-million prizes for Albertans age18 and over who have had at least one dose. A few days later, it also added travel prizes as incentives.

Some researchers have concluded that suchlotteries have a negligible effect on vaccine uptakewhile things such as the $100 debit cards being offered by the province can result in small upticks.

An analysis of Alberta Health daily vaccine data suggests that after thevaccine lottery and travel prizes were announced in June, there was an increase in first-dose rates. But by mid-July, when outdoor prizes were added to the lottery, first-dose vaccination numbers had largely plateaued.

Writing in the New England Journal of Medicine with his colleagues, Dr. Kevin G. Volpp, a specialist in disease prevention, health promotion and behavioural change at the University of Pennsylvania in Philadelphia, says incentives can have a marginal impact, but they present risks such as setting heightened expectations of reward in the future for things such as booster shots.

The researcherssuggest three scenarios that are more successful and have a more lasting impact: mandated vaccines for health-care workers and beyond;vaccine passports; and increasing health and life insurance premiums for the intentionally unvaccinated.

A paper that is yet to be peer reviewed, co-authored by Volpp, found limited benefit to lotteries, using Pennsylvania as a test case. Other studies have found limitedbut fleeting success with incentives such as gift cards.

Muddying the waters a bit is the fact that past studies into other vaccines and incentives don't necessarily apply in the current context.

"WithCOVID, there's so many different complex reasons that people are not being vaccinated," said Saxinger.

"There's self-identity and misinformation, silos and politicization, and all of those things, I think, make it much harder to anticipate."

She, too, says requiring vaccines for participation in certain activities is more effective. For comparison, B.C. saw vaccine rates increase by 86 per cent after announcing vaccine passports while Alberta saw about asix per cent rise, week over week, after announcing $100 gift cards.

What's the difference between QR code and passport?

After months of resisting calls for a so-called vaccine passport,the province announced on Tuesdayit would offer a card-sized COVID-19 vaccination recordand a QR code for proof of vaccination through the province's MyHealth Records site or app, allowing Albertans to confirm their vaccine status at venues requiring proof.

But the notion of a provincial vaccine passport or a mandate requiring vaccinations to access non-essential events and services isoff the table.

The difference is essentially around who bears responsibility for checking one's status and the lack of uniformity across the province (or city or town or neighbourhood).

Myles Leslie, a research associate at the University of Calgary's School of Public Policy and patient engagement and health services researcher at the Cumming School of Medicine, says it comes down to an ideological debate about whether you prefer government or private interests making more of the decisions.

"That's part of the philosophy of this particular government ... [that] it should be done by other bodies," he said.

"If you do that, then you're saying that a public health choice is something that should be done along the lines of business interests, because that's who you're empowering to do the checking. And that's an interesting call."

Leslie says that decision will mean a fragmented system across the province, with some businesses requiring vaccine proof and others not. He says we're "deconstructing society" and putting the onus on business owners to determine what our community norms ought to be.

Instead of serving customers food, a restaurant owner will now be forced to be in one camp or another in what is becoming a charged political battle.