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Quebec's COVID-19 Case Data Is Unreliable & Experts Worry About What Could Come Next

How bad will Omicron get in Quebec? It's basically anyone's guess.

Deputy Editor
Quebec's COVID-19 Case Data Is Unreliable & Experts Worry About What Could Come Next

The sudden arrival of the Omicron variant just weeks ago has hammered home a truth about the COVID-19 pandemic: Nobody is ever quite certain exactly what will happen next.

In Quebec, the uncertainty is especially true over this holiday weekend for a more problematic reason: In spite of days of record-setting case counts, Quebec isn't officially publishing updates on December 24, 25 or 26 (though their open data sites are getting updated), and regardless, even Quebec's own institutions say that data is no longer reliable because rapid tests results aren't factored in.

According to Prativa Baral, an epidemiologist and doctoral candidate at the Johns Hopkins Bloomberg School of Public Health, the numbers we do have "are an undercount — our testing capacity is maxed out, so we're not actually seeing what's happening with the case numbers."

With the lack of good data, "we are flying blind into a tunnel right now," Baral said.

"We need to develop a quick and easy method that allows people to record their positive case on a rapid antigen test: a website — or ideally — an app where people can record their positive case, and perhaps, record their daily symptoms too."

With that in mind, and with some surprised by the minimal new restrictions announced by Quebec Premier François Legault on December 22, the current situation is murky. Are we heading off a pandemic cliff or threading a needle?

Quebec's vaccination situation justifies a more lenient set of rules relative to last year, Dr. Anne Gatignol, a professor of immunology and microbiology at McGill University, told MTL Blog in an email.

"Also, considering all the efforts that most of the Quebecers have done for the last 22 months and the high level of vaccination, the government understood that a little bit of careful social gathering can occur," she wrote. "This is a reward to the vaccinated population, but it should not apply to the unvaccinated."

Dr. Mark Goldberg, an environmental epidemiologist and professor in the department of medicine at McGill University, agreed that the vaccination situation changes the stakes, but he called the lack of certainty around Quebec's data "shocking" said we are nonetheless "playing with fire."

"Case counts, which are grossly underestimated, are going through the roof and hospitalizations, which will lag by about a week or two, will as well," he said. "This will cause all sorts of grief for our amazing health care workers but, as importantly, many people who do not get hospitalized may suffer over the long term because of lingering symptoms and important pathologies from the infection ('long COVID')."

Goldberg was critical of federal and provincial responses to Omicron, which he said were far too slow. "In a pandemic, especially with the most infectious variant we have ever seen, every day counts and they diddled, again," he said.

"We should have boosted (at the least our most vulnerable) 7 days before the holidays, knowing people were going to gather," Baral said. "We failed to act in that window."

We can't even be certain about the impact of Quebec's restrictions because they were applied so recently, said Baral. "It usually takes a few weeks before the effects of restrictions are seen in cases," she noted. "But with Omicron, the sheer contagiousness of it and the widespread community transmission we have makes it unlikely that we will see a decline in growth soon, especially because it's winter and people will be mingling indoors for the holidays, increasing community transmission even more."

Gatignol was more forgiving of the lack of data reporting, saying that "we can understand that people at the front need to take some rest." She said the key factors to observe are the number of hospitalizations due to Omicron compared to Delta, the percentage of hospitalizations for Omicron compared to Delta, and the vaccination rate of those hospitalized with Omicron.

She said "several scenarios" should be considered. If the Omicron variant causes severe disease similar to the Delta variant, she said, "We will see massive hospitalizations within the next 2 weeks."

If Omicron is less pathogenic than Delta, "The increase in hospitalizations will be minimal and the health care system will not be affected as much."

Another possibility, she said, is that "only the unvaccinated will be severely affected and will end up in intensive care units."

In the end, Gatignol said, "The truth is probably a mixture of those."

We can gain some insight by looking at South Africa and Europe's experiences of Omicron, but Quebec's situation is not the same.

"South Africa has a younger population, and had a massive wave with an earlier variant which might have attributed some baseline immunity," Baral said. "In the UK, they have boosted a substantial proportion of their population compared to where we are (still >65+). So we will have to monitor case growth (and more importantly, hospitalization growth) over the next few weeks to start getting a better picture."

Goldberg said Europe's experience with Omicron is a good reference to "see how bad the situation will become."

"Luckily, we have higher vaccination rates than most other countries, and this will help," he said. "But boosters need to be available to everyone now."

This article's cover image was used for illustrative purposes only.

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