The holiday home stretch is upon us, but the only thing spreading faster than festive cheer is — you guessed it — Omicron. The new COVID variant has only been around for a few weeks (the first case was confirmed here on November 28), but already it has spread in a way that makes Delta look like dial-up. So what do rising case counts and concerns around vaccine efficacy mean for your holiday plans? Refinery29 Canada reached out to Sabina Vohra-Miller, a Toronto-based Doctor of Public Health and founder of the Unambiguous Science Insta feed, to find out whether it’s time to cancel your Secret Santa party and why rapid testing is — sigh — not a silver bullet solution.
I’m supposed to go to a Secret Santa party tonight. Ten people, all double vaxxed. I’m on the fence about whether or not I should cancel. What do you think?
I know how much people have been looking forward to the holidays, especially after missing a lot of favourite activities last year, but the fact is that things have changed extremely rapidly with the Omicron variant. Cases are increasing faster than they ever have before so the thing we need to do as we get close to the holidays is reserve all of our contacts for things that are our top priority. If you are hoping to be able to spend time with your family (or whoever you plan to gather with) in the next couple of weeks, you should reconsider a Secret Santa or any other type of indoor gathering, especially if people are going to be unmasked. The idea is that you want to bank your risk.
If you are hoping to be able to spend time with your family in the next couple of weeks, you should reconsider...any type of indoor gathering, especially if people are going to be unmasked. The idea is that you want to bank your risk.
Sabina Vohra-Miller, founder of Unambiguous Science
Okay, but compared to going to a concert or eating in a restaurant, isn’t getting together with ten people who I know a relatively low-risk activity?
I mean, it’s true that it is going to be less of a risk than some of the activities you mentioned, but that doesn’t mean it’s a good idea. The goal is reducing contacts and the thing with a Secret Santa party is that you have ten people coming from ten different households. Some might have kids at one school, or more than one school. Maybe they have gone to another party the night before. With multiple households, the number of possible exposures starts to climb very quickly. You don’t want to be in a situation where two days after the party, one of your friends tests positive and suddenly you’re having to quarantine over the holiday.
What if we all take rapid tests beforehand?
Rapid tests are a great tool to have in your toolbox. Even a couple of weeks ago, I would have said testing before an event was a good way to make small gatherings safe, but with Omicron, it is just spreading so much faster. We know that false negatives go up as community caseloads go up. And also that in order for a rapid test to be most effective, you really need to avoid any contact during the incubation period, which we believe to be shorter (about three days) for Omicron. Even then you can’t be sure. It's possible to be infected and test negative because it can take a while to build up a viral load after exposure. I'm hearing of cases where people gather after testing negative and then one person infects the entire group. The other thing is that you can look at the individual component, but there is also a community component. We need to bring down collective exposures as a community, otherwise we are very likely moving towards hospital capacity issues, school closures, cancelled cancer surgeries.
It sounds like you’re saying those things are more important than my ugly sweater party?
Yes, exactly. I know it’s disappointing, but the pandemic is not yet over and the last thing we want is to get to a place where we’re back in a full lockdown.
I have heard people saying that Omicron is less severe than previous variants.
That is simply not something we know for sure at this point. I think that information is something people are extrapolating based on what’s happening in South Africa where the Omicron variant was first identified. The problem is that with lag times we still can’t know for sure in terms of hospital and severe outcomes. And then also, the population in South Africa is 20 years younger than the population in Canada, which makes a big difference given that older people are more vulnerable. It’s possible that Omicron is less severe, but for now the only thing we know is that it is a lot more transmissible.
How much more?
We can look at the Rt (the rate of transmission), which is basically the number of new infections that arise from a single case at any given time. When it’s less than 1, that means an infection is not spreading exponentially, and when it’s more than one, it’s the opposite. The Ontario Science Table released new numbers this week where the Rt for Delta is less than 1 whereas for Omicron it’s 4.55. And then related, we have the doubling rate, i.e., the length of time it takes for case counts to double. The doubling rate of Delta was around 34 days, the doubling rate of Omicron is less than three days.
I’m picturing that scene from Outbreak where the red dots explode all over a map.
Yes. That’s what exponential growth looks like.
I’ve also heard people saying that everyone is going to get Omicron and it will be like the flu and we just have to “move on and live our lives.” What do you think?
I think that if you look at the percentage of vulnerable people who still don’t have the booster (only 20% of people over 70 have it in Ontario, for example) or children who are unvaccinated, then you have to remember that going out and living your life could have severe implications for others and of course for hospital capacity.
The vaccine is the single most important tool we have to get us out of this, but it can’t be the only tool.
SABINA VOHRA-MILLER, FOUNDER OF UNAMBIGUOUS SCIENCE
Weren’t vaccines supposed to save us?
Vaccines have and will continue to make a huge difference. Imagine if we had all of these cases and we didn’t have the advantage of the vaccine? On the plus side, we know that vaccines help to protect against severe illness, including with Omicron. The problem is that we are seeing evidence that vaccination is not as effective against the spread of Omicron. Especially right now when the majority of the population is still un-boostered.
It might be a very small percentage that has a severe case, but a small percentage of a big number is still cause for concern. The vaccine is the single most important tool we have to get us out of this, but it can’t be the only tool. At the moment having a vaccine doesn’t preclude other public health measures like masking, distancing, and of course reducing contacts.
This week, the Ontario government announced capacity limits for sporting and entertainment venues and B.C. is considering a similar move. Will that help?
I mean, that change is only for venues with a capacity over 1,000, which means that 999 people can still gather indoors. Or if an event had 20,000, it can still have 10,000. That totally blows my mind. Just one outbreak at that sort of event could put us over the edge. As for the 50% cap at sports games and larger venues, I mean, it’s better, but it’s really a too little, too late scenario.
There are a lot of different versions, but basically it means instituting policy to reduce contacts. So reducing capacity at restaurants and retail locations by 50% would be an example. The key is that the sooner we introduce a circuit breaker the shorter it can be.
I have to say I have a huge issue with this. We had a year to figure out what an equitable and accessible distribution system would look like and newsflash, it’s not at the LCBO. There was a huge outcry when this was announced earlier this week and already we are hearing about alternative locations like malls and transit hubs, so that’s good news, but it’s been very frustrating to see our government failing to be proactive — again. The same with the booster shots. We in the Ontario science community have been saying for weeks that we need to ramp up mass vaccine clinics again. Now they’re saying everyone 18+ qualifies as of Monday, but who is going to give the shots? Pharmacists and family doctors can’t handle this. It’s going to be chaos and it was so avoidable.
Okay, but just to be clear, people should get their boosters?
Yes. Absolutely. Getting your booster shot as soon as possible is the best thing you can do to protect yourself and others. I just worry that we are not equipped to make that happen.
Any tips for those of us trying to book appointments?
Correction: This story originally listed the wrong title for Sabina Vohra-Miller. Refinery29 Canada regrets the error.
This interview has been edited for length and clarity.
COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.