Experts in BC and across Canada are sounding the alarm about an oncoming wave of COVID-19 infections this summer, even as new research shows those who’ve been infected multiple times have a higher risk of long COVID, hospitalization, and death. 

In Victoria, hospitals are bracing for the impact of yet another pandemic wave on an already crippled healthcare system. 

“All of us are having to work even more unsustainably now,” wrote Saanich Peninsula Hospital emergency physician Dr. Jeff Unger in a text message.

Sarah Otto, a UBC professor, infectious disease modelling expert and member of the independent BC COVID-19 modelling group, has been keeping a close eye on two new Omicron subvariants that have been circulating in other parts of the world: BA.4 and BA.5. 

At the moment, she says all available information—wastewater data, testing of blood samples, and genome sequencing—shows that cases are currently low in BC. 

“But if you zero in on what's happening to this BA.4 and BA.5 wave, it's rising,” Otto said. “Over the next week or two, we should see the case numbers flip around,” as the new wave takes over.

In a statement to Capital Daily, a spokesperson for the BC health ministry confirmed there have been 141 BA.4 and 290 BA.5 cases detected in the province as of June 22. There is already starting to be a “steady increase” in BA.5 cases in particular over the past month. 

Not much is yet known about the severity of illness these variants cause, but a new peer-reviewed study in the New England Journal of Medicine makes one thing clear: BA.4 and BA.5 are able to get past antibodies carried by people who have been vaccinated or already infected, making the new subvariants highly transmissible. 

The fact that COVID-19 cases across Canada are starting to rise again appears to prove this. “By now in Canada, almost 100% of the population has had COVID or has been vaccinated, and yet we’re still seeing the spread of BA.4 and BA.5,” Otto said.

New genomic data that the province is required to share with the federal public database shows that the two subvariants started spreading in BC in early June, with BA.4 spreading 11.6% faster and BA.5 14% faster per day than other Omicron subvariants. 

Throughout the pandemic, looking to other countries already feeling the effects of a new variant has been one way to predict what will happen here. This time it’s a bit more difficult: in parts of the world where BA.4 and BA.5 have already become dominant, its impact on hospitalization rates has varied from low—like in South Africa, where this wave has already peaked—to high and still rising, like in France. 

However, as explained by Financial Times columnist John Burn-Murdoch, it’s too early to tell the true impact of BA.4 and BA.5 on hospitalizations in many countries, as its rise coincides with (and is masked by) a drop in the number of people hospitalized during the previous BA.2 wave.  

‘An incredibly challenging summer and fall’

Meanwhile, hospitals across Greater Victoria continue to operate understaffed and over capacity, as they have been for months. Dr. Unger says all three major hospitals in the region have been operating at 100% capacity these days, with his hospital recently hitting 140%.

“Last night at one point there were 18 admitted patients in the 15 bed ED [emergency department],” Dr. Unger told Capital Daily in a text message on Tuesday. “As a result, to make space for new ED patients, a few admitted patients had to be placed in chairs in the waiting room.”

Some steps have been taken to mitigate the dangerous situation. At Saanich Peninsula Hospital, emergency physician staffing hours have been increased by 3.5 hours per day, and the COVID surge funding that provided six extra physician hours since August 2021 has been extended to the end of this year.

“This will help, however, we have no more physicians available to work,” wrote Dr. Unger, adding that the hospital has posted jobs, but almost every emergency department on the Island is also looking to hire at the same time. So in the meantime, the doctors who are there have increased the lengths of their shifts by an hour or two.

A new wave of COVID-19 patients this summer would exacerbate the already precarious staffing situation. Dr. Unger predicts that every contingency plan—including cancelling elective surgeries and redeploying staff—would have to be used. “It will be an incredibly challenging summer and fall.” 

In preparation, staff and leadership at Saanich Peninsula Hospital submitted a proposal to Island Health last week asking for planned closures of the Emergency Department overnight, during their quietest hours. Dr. Unger says between 1am and 7am are their quietest hours, and shutting down would let them redirect staff to the other 18 hours of the day, when 90% of patients seek ER care.

This proposal was denied by Island Health—an unfortunate outcome, according to Dr. Unger.

“A proactive plan seemed most logical and safest for patients,” Dr. Unger said. “We are likely to be left with reactive, unplanned closures over the summer instead when there aren’t enough staff to safely care for all the patients.”

Island Health confirmed in a statement to Capital Daily that there are no planned closures or diversions for the Emergency Department at Saanich Peninsula Hospital. “In general, diversion or temporary closure is a last resort and would only occur after every possible mitigation strategy is explored and exhausted,” they said. 

The health authority said they’re working on initiatives to mitigate the staffing crisis, like “securing additional physician coverage” at Saanich Peninsula’s emergency room—the extra hours Dr. Unger described—recruiting new employees, and moving to remote registration systems to reduce workloads for emergency department staff. 

The real risk behind reinfections

BC, like most jurisdictions, currently has none of the public health measures that were aimed at reducing infection transmission during past waves of the pandemic, like mandatory masks indoors, reduced indoor capacity, and physical distancing requirements. 

With the new variants’ ability to get past vaccinations, prior infections, and even a combination of the two, more people across BC can expect to get reinfected this summer. 

There’s evidence that reinfection can be more dangerous for patients’ health. A new, non peer-reviewed study involving 38,926 people who have had COVID-19 twice or more found that the more times a person is infected, the higher their risk of at least one post-COVID complication, hospitalization, and death. These heightened risks showed up in both vaccinated and unvaccinated people while they were sick as well as afterwards. 

The authors of the paper call on health authorities to reduce people’s chances of catching COVID-19 again: “Given the likelihood that SARS-CoV-2 will remain a threat for years if not decades, we urgently need to develop public health measures that would be embraced by the public and could be sustainably implemented in the long-term to protect people from re-infection.”

In the absence of other public health measures, Otto says the key for people hoping to avoid getting reinfected is to get a booster shot right before the next wave begins, since immunity from booster shots is proven to start waning four months after it’s administered. In BC, that means the time to get a fourth dose is right now.

“If you have a choice and boosters available to you, then taking that booster does three things: it reduces the chance that you get COVID; it reduces the chance that you have these long COVID risks that we don't even document very well; and it's one [fewer infected] person so that reduces the transmission [risk] from person to person,” Otto said. 

“The disadvantages are that it takes some time to go and bother to get a booster.”

The other disadvantage is that booster doses are nearly impossible to get for most British Columbians. So far, fourth doses of vaccine are only available to British Columbians aged 70 and older, Indigenous people over 55, and people in long term care, six months after their last booster. They are not available to anyone who wants one, even though 200,000 doses of vaccine are on the brink of expiry, as reported by CBC. 

Otto expects that once cases start to rise more clearly, the province will start expanding the booster program.

In their statement to Capital Daily, a spokesperson said the ministry is reviewing guidance issued by the National Advisory Committee on Immunization on Wednesday which recommends a booster dose be offered to everyone aged 12+ this fall. 

NACI’s third recommendation, labelled as “discretionary,” says booster doses “may be offered at an interval of 6 months since a previous COVID-19 vaccine dose or SARS-CoV-2 infection. A shorter interval of at least 3 months may be warranted in the context of heightened epidemiologic risk, as well as operational considerations for the efficient deployment of vaccine programs.”

Long COVID clinic stretched thin

To date, there are still 1.2 million adults in BC who have yet to get their third vaccine, despite it being available to them. 

“We've got very high uptake in boosters among the elderly and not very high uptake among younger people,” Otto said. “And that could well be because they are not aware of the long COVID risks.”

When asked whether they plan to issue information warning people about the heightened risk of long COVID and other health risks that come with getting infected more than once, the health ministry reiterated that vaccines “continue to be the primary tool in our toolbox for managing COVID-19 in the long term.” 

“Measures like staying home when you’re not feeling well, washing your hands and wearing a mask when appropriate are also important,” reads their statement. None of these steps required a public health order to go into effect.

In BC, there are five post-COVID recovery clinics—including one at the Royal Jubilee Hospital in Victoria—whose purpose is to support people who develop long COVID, refer them to medical and mental health specialists, and conduct research to find causes and treatments. 

Across BC, 6,361 people have been referred to these clinics and about 40% of them have had at least one clinic visit. In the Island Health region, 250 people have been referred to the Jubilee clinic since it opened in April 2022. Neither the province nor the health authority keeps track of how many people have been hospitalized due to post COVID complications.

Precious little has been said about long COVID by public health leaders in BC. In January, provincial health officer Dr. Bonnie Henry claimed that in the Delta wave, two doses of vaccine cut the risk of contracting long COVID in half. To date, the ministry has been unable to back up that claim.

“It is too early to know whether there is a lowered risk of people experiencing persistent post-COVID symptoms in BC after vaccination,” the health ministry spokesperson said Thursday. 

In February, the ministry said they hope to make the long COVID research being conducted at post-COVID recovery clinics public in early 2022. The studies are ongoing, and details about some of them are available on the Post-COVID Research website, but there are no results to share yet. 

According to Dr. Unger, the long COVID clinic in Victoria is just as strained for human resources as the rest of the healthcare system, and only employs two physicians. He estimates that the emergency department at Saanich Peninsula Hospital refers about five long COVID patients to the clinic per week, while the Victoria General and Royal Jubilee emergency departments each send them 10 people per week. At this point, Dr. Unger says the wait time for intake is up to six months.

Dr. Unger said some patients—particularly those who do not have a family doctor and could not access a walk-in clinic on time—end up coming back to the emergency department while they’re waiting for treatment at the long COVID clinic. “We trial and error interim care for them as best we can, recognizing this is far less than ideal,” he said. 

Dr. Unger and his colleagues are dreading what is to come this July and August, and that the majority of the 18 members in his group said in an anonymous poll that they’re already feeling “moderately to severely” burnt out.

“We are trying to balance the immense need for providing more and more care, with the need for self care for long term resiliency,” he said.

“We are all incredibly worried that there will be more morbidity and mortality.”

To date, 3,722 people have died of COVID-19 across BC. New data obtained from the BCCDC through a freedom of information request by Fraser Valley Current editor Tyler Olsen shows how many people the virus killed in each city between January 2020 and April 2022.

In that time, 254 people in the Island Health region died of COVID-19, 101 of whom lived in Victoria. As of June 23, the BCCDC dashboard says 380 people in the region died after contracting the virus. This means 126 people died between April 12 and June 23.