A Pandemic Punch in the Gut

Good morning, happy?Cyber Monday, and?Happy Hanukkah!?

Or if you prefer, you can recognize?Chocolates,?Lemon Cream Pie,?Square Dancing, or simply?Throwing Out Your Leftovers?– perhaps more appropriate if you held a big gathering for American Thanksgiving on Thursday. But somehow it seems more appropriate to note that Saturday was “Pins and Needles Day,” because that’s where we are now…

Just a week ago, I was starting to feel uncharacteristic optimism about the path of the pandemic, the advance of vaccination and the return to campus for January. Clearly we were all going to need booster shots soon, and likely annual vaccines, but life seemed to be getting back on its feet. January seemed a bit overly optimistic to me, but only by a few months. I was still emphasizing that CdnPSEs should have back-up plans for academic continuity –whether due to potential regional “fifth waves” of the pandemic, or simply to cope with extreme weather conditions.?

I was a little surprised to see how excitedly Colleges Ontario was promoting an “in-person”?Higher Education Summit?this week in Toronto, but admittedly last Tuesday I was starting to discuss (very tentatively) some possible in-person events for May or June 2022.

It was as though I had forgotten the relentless pessimism and excess caution that had served me so well in tracking the trajectory of this pandemic for the past 20 months. Since the Delta variant, I’ve tracked so many variants of interest and concern that ultimately proved false alarms, I was getting lulled into a false sense of security.

Then came Black Friday, in oh, SO many ways…??

Omicron

Since the Delta variant erupted on the scene 6 months ago, driving a fourth wave of the pandemic and a third round of vaccination shots, epidemiologists have assured us that we should expect ongoing mutations to produce endless new COVID19 variants, hitting the healthcare system, economic sectors, and society like minor aftershocks. Like Californians living near the San Andreas Fault, we knew “the Big One” could come any day, but as the WHO dismissed variant after variant as minimal threats, we started to anticipate a return to normal for Christmas and the new year.?

(Then again, I DID title my Pandemic Précis last week “the Calm Before the Storm.”)

South African Spike

I mentioned last week that?Africa has been miraculously spared?the worst of Delta infections, despite having just 6% of its population vaccinated against COVID19. But I?also?mentioned that?South Africa?has been hit hard, and that doctors in Zimbabwe were sounding the alarm last week about the risks of complacency. Later last week, the number of confirmed daily cases in SA spiked?exponentially,?from ~200 a day to 2,465 on Thursday,?2,828 on Friday, and?3,200 on Saturday?- and particularly infecting young people in their 20s and 30s (who are largely unvaxxed). Initially, it looked like a cluster infection among university students in Pretoria, but it quickly became thousands of cases across Pretoria and Johannesburg.??AP??

“Complacency is what is going to destroy us because we may be caught unaware.” -?Johannes Marisa,?president, Medical and Dental Private Practitioners of Zimbabwe Association

“The Worst Yet”

Just as Americans were sitting down to Thanksgiving turkey last Thursday, scientists in South Africa announced the detection of a new COVID19 variant responsible for about 90% of their new cases. (It was actually detected on Tuesday, in samples taken a week previous, and the earliest sample was from Nov 9.) B.1.1.529 is not descended from Beta or Delta, but is a new lineage of COVID19 with ~50 mutations, 32 of them on the spike protein, giving it a “really awful spike mutation profile,” in the words of one UK virologist. (That’s twice the number of spike protein mutations as the Delta variant. B.1.1.529?theoretically?appears to be both more transmissible?and?more capable of evading immunity, although it will take weeks for scientists to determine just?how?much more. It is also unclear whether it will outcompete the Delta variant in the wild.) South African physicians are reporting an “exponential rise” of cases, an alarming reproduction rate of 2.0, and a higher rate of breakthrough infections among the fully vaxxed. One uWarwick virologist said this is “the most heavily mutated version of the virus we have seen,” with potentially worrying changes never before seen in a single strain. Epidemiologist?Eric Feigl-Ding?says the new variant is “possibly ~500% more competitively infectious” and is rapidly displacing Delta in South Africa (see graphs above and below). One uOttawa virologist says “we know for a fact that this variant will be more difficult to neutralize.” The assumption is that some degree of “immune pressure” forced the virus to evolve in an immunocompromised patient with a chronic infection – and in South Africa, many people with untreated HIV could be in that pool.??Globe & Mail??|??Washington Post??|??AP??|??The Conversation??|??New Scientist??

“It’s an astonishing number of mutations.”?–?Jeffrey Joy,?genomics research scientist, UBC

“What we do know is there’s a significant number of mutations, perhaps double the number of mutations that we have seen in the Delta variant. And that would suggest that it may well be more transmissible and the current vaccines that we have may well be less effective.”?-?Sajid Javid,?UK health secretary

“At least from a speculative point of view we have some optimism that the vaccine should still work against a new variant for serious disease but really we need to wait several weeks to have that confirmed.”?–?Andrew Pollard,?director, Oxford Vaccine Group

Past Nu and Xi to Omicron

On Friday, just one day after the strain was identified, the WHO designated it as the 5th COVID19 variant of concern, christening it “Omicron.” (Skipping over Greek letters?“Nu” and “Xi”?to avoid confusion with “new” and offense to Chinese leader Xi Jinping – but what about poor?Omicron Networking?or?Omicron Development?) Considering how many variant strains the WHO has monitored for?months?without ever designating them VoCs, or even VoIs, this certainly appears to be a signal of potential risk. “We need to learn as much as soon as possible. We know precious little.”??Global???

“By the time you detect one variant, another is already circulating under the radar somewhere… We will be chasing variants endlessly.”?-?Kizzmekia Corbett,?viral immunologist, Chan School of Public Health, Harvard

Instant (Over)Reactions

Stock markets?immediately reacted to news of Omicron with panic: the Dow Jones industrial average plummeted more than 1,000 points, the S&P500 fell 107 points, and the Nasdaq 354 points – even on a holiday-shortened trading day. Not surprisingly, the price of oil fell by 13%, and United Airlines stock fell 9.6%. (“Investors are likely to shoot first and ask questions later.”) Even Bitcoin fell 8.4% – while shares in Zoom, Peloton and Pfizer rose by about 6%.?New York State?declared a state of emergency, sure that Omicron would be there soon. By noon Friday, countries around the world (including?Canada) were announcing?travel bans or quarantine requirements?on flights or passengers coming through southern Africa, and updating travel advisories against African countries. Israeli PM Naftali Bennett said “we are currently on the verge of a state of emergency. Our main principle is to act fast, strong, and now.” British health secretary Sajid Javid said “we must move quickly and at the?earliest possible moment.” The?World Trade Organization?postponed next week’s meeting of ministers in Geneva “indefinitely.” (One Calgary emergency room physician thinks we should clamp down on?inter-provincial travel?in Canada, too.) By Sunday,?Israel?was going a step further and barred entry by?all?foreigners – as did Morocco, at least by air. The US plans to ban travel from southern Africa beginning today.

In mere hours last week, global confidence in travel, tourism, hospitality and – yes – international student mobility took a beating. We won’t know for several weeks whether this was an under- or over-reaction, but clearly we’re still living in a time of pandemic turbulence and heightened global volatility.

Already Global

As NIAID director Anthony Fauci observed?in the journal Cell?more than a year ago, “we have entered a pandemic era” in which novel viruses will rapidly spread across the globe, thanks to habitat destruction, climate refugees and international travel. Even though Omicron was identified within just 14 days in South Africa, it likely had time to spread around the planet before we had even heard of it…?

Spreading Like Wildfire

Not only was?Omicron spreading quickly?across South Africa, but by Friday cases had been identified in Botswana, Belgium, and Israel. Hong Kong reported 2 cases – including a traveller?from Canada?who caught it while in a quarantine hotel there. Saturday morning,?Britain?confirmed its first 2 travel-related cases in Nottingham and Brentwood. 600 travellers from South Africa arrived in the Netherlands just minutes after the government banned flights, and 61 tested positive for COVID19.?By Sunday, the Netherlands had confirmed 13 as cases of Omicron, and?Australia?had identified 2, in fully-vaxxed travellers from southern Africa. (260?otherpeople aboard their flight have been ordered to quarantine as close contacts.) Italy had confirmed at least one case of Omicron, Germany 3,?Denmark?2,?France?8, and?Austria?one.?

(Sigh. I’ve revised the paragraph above so many times that it is unlikely to be up-to-date by the time you read it. This is a rapidly-evolving situation.)

Omicron in Canada

Sure enough, just as I was hoping to put this issue “to bed” last night, Ontario reported it had confirmed Canada’s first 2 cases of Omicron in Ottawa, in 2 travellers recently returned from Nigeria. The PHO has them in isolation, and is tracing their contacts. (Start with everybody on their flight, please!)??CTV??|??CBC??|??Global

“The cat’s already out of the bag, so to speak.”?–?Nicole Errett,?public health prof, uWashington

Viruses Ignore Borders

The WHO continues to emphasize that travel bans are ineffective, provide only a false sense of security, and only serve to punish countries for transparency in reporting new variants. Sadly, the reality is that the Omicron variant is likely?already circulating worldwide, and imposing a travel ban on a few selected countries will?notprevent its spread. (“If we shut the door now, it’s going to be?probably too late,” in the words of one Hong Kong epidemiologist.) Canada’s chief PHO, Theresa Tam, said Friday she “wouldn’t be surprised” to see?cases?surface?in Canada?shortly. Vaccination, masking, ventilation and social distancing (but probably?not?Plexiglas?barriers) remain far more effective ways to prevent transmission of this or any airborne virus. (Even?British PM Boris Johnson?has reinstated some quarantine and mask requirements.)

Unfortunately, the fact that Omicron has surfaced just as?48M Americans?stirred the viral stew by travelling for Thanksgiving, and millions more crowded stores for Black Friday sales, means the impact could be significantly worse.?

“It’s akin to playing goalie and having 30 people shoot pucks on you at the same time. You’re just not going to keep this out.”?-?Sumon Chakrabarti,?infectious diseases physician, Trillium Health Partners

Failed Nationalism

The emergence of new variants in under-vaccinated countries, whether India, Brazil, or South Africa, only underscores the importance of a global vaccination strategy to combat vaccine “hoarding.” Getting a few wealthy countries to 90% vaxxed won’t stop COVID19 from evolving elsewhere. “Until we vaccinate enough people, we’re going to have this happen?over and over again.” The G20 have already monopolized 89% of all vaccines globally.?The WHO has been urging us to forgo booster shots in order to get first doses to vaccine deserts like Africa, and if we had only listened sooner, Omicron might have been postponed or even avoided entirely. As former UK PM Gordon Brown wrote this weekend, the world urgently needs “a?pandemic non-proliferation treaty.”??Washington Post

“Our failure to put vaccines into the arms of people in the developing world is now coming back to haunt us. We were forewarned – and yet here we are.”?–?Gordon Brown,?former prime minister of Britain

Retooling Vaccines

Now, we may need to retool our vaccine defences (although it will take several weeks to know for sure.)?AstraZeneca?said Friday it was testing Omicron’s “real-world” impact on its Vaxzevria vaccine and AZD7442 antibody cocktail in Botswana, and remained “hopeful.”?BioNTech?says it expects more data within 2 weeks to determine whether the Pfizer vaccine will need to be “reworked.” (If necessary, they could ship a new tailor-made mRNA vaccine in ~100 days – so likely around?March.)?Moderna?says it is working on a booster tailored to the new variant, while also testing a higher dose of its existing booster. (Versions of the Pfizer vaccine targeted to Alpha and Delta are?still?in clinical trials.)?

While the mRNA technology has vastly accelerated vaccine development cycles, the emergence of a truly immune-escape variant of COVID19 would set us back months in reopening.?

Pandemic Précis

So, aside from the rise of Omicron, what did the past week look like for the pandemic? Things were tense in Europe and parts of North America, kids were getting vaxxed, and Western reported its first residence outbreak this year…?

Europe Already Critical

Europe has been the pandemic’s epicentre for several weeks now, and the WHO warned the region could see another?700,000 deaths by spring, thanks to a combination of vaccine hesitancy and waning immunity. (Somewhat self-interestedly,?AstraZeneca CEO?Pascal Soriot says the UK’s advantage over Europe could be attributed to better uptake of his company’s vaccine, as opposed to the mRNA shots.) Although the?UK was hit hard?by the Delta variant back in the summer, European countries are experiencing it now, resulting in lockdowns or reimposed restrictions in?Austria, Germany, the Netherlands, and Belgium.?Switzerland, facing a?fivefold?increase in cases this month, held a referendum this weekend in which voters appeared to support vaccine passports.?Slovakia?imposed a 2-week lockdown on Thursday, as hospitals strained amid the world’s highest COVID19 incidence rate.?Czech Republic?president Milos Zeman was taken to hospital for COVID19 treatment, declared a 30-day state of emergency, and is considering making?vaccination mandatory?for at-risk groups. The country reported?27,717 new cases?on Thursday alone, and has infection rates 4x the rest of Europe.

Midwest US is Slammed

In the past week,?US cases of COVID19?have surged 18%, hospitalizations 6%, and deaths 9%. The country is averaging some?100,000 new cases?every day. Hospitals in?Michigan?are being overwhelmed by an “almost unmanageable” flood of unvaxxed cases as the state reached all-time highs and requested?military assistance. (The only reason Spectrum Health was reluctant to declare “code red” status is that they anticipate even?worseto come, and “don’t have a darker colour.”) To make things worse,?uMichigan?has been grappling with an outbreak of 500+ flu cases – and nonetheless (sigh), students are?rallying in protest?of vaccine mandates. COVID19 cases are also up significantly in New Mexico and North Dakota – and even in?highly-vaxxed stateslike Minnesota, New Hampshire and Maine. “When you have a virus as transmissible as Delta, in the context of waning immunity, that dynamic is going to negatively impact even the vaccinated people.”

Rising Numbers in Canada

As winter sets in, restrictions are lifting and immunity starts to wane, many regions of Canada are starting to experience rising case counts of COVID19.?Quebec’s?case counts have been steadily rising this week, and its state of emergency will remain in place until 2022.?Ontario?has been logging more cases, and the CMOH forecasts that case counts will continue to rise until spring: “We never declared the fourth wave over. This is simply a continuance.” (I don’t know – it sure?looks?like a fifth wave in the graph above.)

“We never declared the fourth wave over. This is simply a continuance.”?–?Keiran Moore,?Ontario Chief Medical Office of Health

Saskatchewan Holds Tight

On Thursday, Saskatchewan premier Scott Moe announced he was extending current pandemic health restrictions (including mandatory masks indoors and in schools, and proof of vaccination requirements) at least 2 more months, until Jan 31, to help avoid a potential post-holiday fifth wave. (And Moe indicated they were likely to be extended again at that time. CMOH Saquib Shahab has suggested the mandates should continue until spring.) Pressure on SK hospitals has plateaued, but many epidemiologists worry about the impact of waning immunity in the winter months. Business groups and opposition politicians gave the move cautious support.??CTV??|??Globe & Mail??|??Saskatoon Star-Phoenix

Changes for Canada?

As Parliament resumed in Ottawa last week, and?Conservative politicians?challenged the vax mandate on the House of Commons, Ottawa confirmed a?hybrid sitting format?until at least June, and introduced new legislation to make it a?criminal offence?to intimidate patients or healthcare workers. The next challenge for Health Canada and NACI will be to balance?third dose boosters?for the general population with vaccine equity for other countries, in the face of rising anxiety about the Delta and Omicron variants: “at 8 months, is a vaccine effectiveness of 70-something per cent good enough? Or is that going to open the door to disaster?”

Rolling Up Little Sleeves

Many parents felt a sense of relief last week as pediatric COVID19 vaccinations rolled out for children aged 5-11 across Canada, at immunization clinics in?Alberta,?Saskatchewan,?Manitoba,?Ontario,?Quebec,?New Brunswickand?PEI, at pharmacies in?Nova Scotia, and in schools across?Newfoundland & Labrador?(and eventually also?Ontario, Quebec, Manitoba and Saskatchewan). Parents in?British Columbia?have been booking appointments for their children to start this week. Shots for children will begin in the?NWT?shortly, and in the?Yukon?Dec 6. An?SFU mathematician?calculates that, if 87% of 5-11-year-olds get vaxxed, Canada’s overall vaccination rate will reach almost 85%. (Although many epidemiologists say we need to achieve 90-95% for effective herd immunity against the Delta variant.) Pfizer is already running clinical trials for infants from?6 months to 5 years of age, and Moderna is recruiting children for a similar study. A baby/toddler shot could be approved by Health Canada early in 2022.?

New Outbreak at Western?

Longtime readers will recall that Western U experienced outbreaks in at least 8 of its campus residences during the 2020-21 academic year, with more than 377 cases logged in its community (by my count - not to mention 170 in adjacent University Hospital). That experience doubtless contributed to Western’s somewhat controversial decision to mandate full vaccination in its residences?back in May, long before it was the CdnPSE trend. And yet, nonetheless, just as the Fall 2021 term draws to a close, Western announced Saturday another residence hall outbreak, with 5 students in Saugeen-Maitland Hall testing positive for COVID19 (so far… SMH holds 1,250 beds). There is “no evidence of classroom transmission,” and the students are self-isolating. The local PHO says these students?were?vaccinated.??Western News??|??CBC??|??London Free Press??|??Global??|??CTV

Implications?

Thanks to the emergence of Omicron, it’s suddenly too early to forecast what the pandemic will look like in the next few weeks, or by January – but that in itself is a MAJOR change from the relative certainty we all had a week ago!

This Could Blow Over…

Until we have more certainty about Omicron’s R0 rate and its impact on the effectiveness of existing vaccines, any public health reactions are just “out of an abundance of caution.” In the words of one?infectious disease specialist, “I don’t want to discount this, but I don’t want to sensationalize it, either.” The Omicron variant could all blow over by Christmas and be entirely forgotten by New Year’s, much like the Beta and Gamma variants did…

Or Change Everything

But as we sit here on pins and needles, we?also?have to consider the very real possibility that we may have just witnessed the start of a major new wave of the pandemic – in which case, plans for in-person conferences, convocations, or the return to campus in January could at?best?be frustrated and complicated by border closures and new PHO restrictions, and at?worst?could have to be completed reversed. Over the next few weeks, scientists will measure Omicron’s transmissibility, infectiousness, virulence and capacity for immune escape. By Christmas (or at least Epiphany), the wise men may bring us some answers on this new variant from the East.

Optics and Politics

Some of the key decisions that PHOs will make in the coming days – whether to close borders, reimpose quarantine requirements, close schools, or enforce physical distancing or capacity limits again – will hinge on that science, but as always much will be determined by politics. And campus leaders will need to be conscious of the impact of their?own?decisions on the confidence of staff and faculty, and perceptions of their institution from the surrounding community. The optics won’t be good if our campuses incubate outbreaks of the Omicron variant in January. (As it is, this week’s crisis first appeared to be the result of student parties at?Tshwane U of Technology?in Pretoria.)??

Stay Tuned!

So, just as I was thinking I could drop my weekly “Pandemic Précis,” and enter hibernation until January, we find ourselves in a rapidly-changing, urgent phase of the pandemic once again. (As the?Washington Posteditorial board put it Friday: “the pandemic is the unwelcome guest who won’t leave.”)?As always, I’ll do my best to keep you informed. The next few weeks may be crucial in shaping Winter term 2022 for CdnPSE.?(More on that next time!)??

#ICYMI

Although entirely unintentional, a slick new campaign from Royal Roads U echoes the theme of today’s issue, in a sense…?

Are You Ready?

Royal Roads U?is in field with its latest “Boldly Different” campaign, running in digital, social, print and outdoor through March 2022. A series of :15-sec videos feature bold, punchy graphics and diverse students?leaping into new careers, opening?doors to their future, confronting their?future selves in a mirror, andamplifying their ambition. Instead of asking prospective students to apply, RRU challenges them with a series of bold questions: “Are you ready to meet your future? …to reinvent yourself? …to elevate your education?” Instagram polls ask viewers whether they want to “change my career” or “change the world.” Explains RRU, “this year’s campaign carries the rallying tone of the previous campaign and pairs it with compelling visual twists on transformation and empowerment.”??YouTube??|??Stimulant Online??|??RRU Campaign Page

Phew! As always, thanks for reading this far – and my sincere apologies for starting off your week with an in-depth look at what could be pretty bleak news!?

Clearly, we all need to stay vigilant and flexible, as pandemic uncertainty continues. Tomorrow, I’ll take another look at CdnPSE announcements for the Winter term, and consider how the evolving Omicron story might impact those plans.?

Meanwhile, as always, stay safe and be well!?

Ken

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Ken Steele?is Canada's leading higher ed futurist and strategic consultant, through his company?Eduvation. He delivers virtual presentations and facilitates virtual retreats or workshops centred on emerging trends, enrolment management, pedagogical innovation, and strategic planning.?

Ken has developed?9 new topics?specifically to help institutions cope with the?post-COVID19?“new normal.”

For more information, please reach out to?[email protected]