Alberta doctors got to ask Hinshaw their COVID-19 questions. Here’s what she said

EDMONTON — Alberta’s chief medical officer of health was grilled Wednesday night by colleagues on her recommendations to the province on easing COVID-19 restrictions, mandatory vaccinations and back-to-school.

The virtual Q-and-A saw about 600 health care professionals attend. Media were allowed to watch but not ask questions.

Over an hour-and-a-half, top doctor Deena Hinshaw addressed concerns from those on the front line about rising cases, a lack of modelling and data, and Alberta’s recent pandemic response changes.

The questions and her answers below have been edited for brevity.  

Why make a decision about keeping or easing public health measures by Sept. 27, rather than when COVID-19 numbers fall?

A minimum six-week delay of a decision to end most testing and isolating requirements until the end of September is to give her team more time to monitor Alberta’s pandemic numbers, Hinshaw said.

“That particular date is again the date by which we need to make a decision based on the evidence that accumulates from now until four to five weeks from now, and we’ll be able to decide if that is an appropriate time to make a change or not,” the chief medical officer of health explained Wednesday night.

“But again, I think the really hard part for all of us in terms of shifting to integrating our approach to COVID with all other respiratory viruses is to not look at cases alone but to look at the things we really need to prevent, which are the severe outcomes. And to be mindful and conscious of the unintended negative consequences of the public health measures we’ve needed to employ prior to vaccination being available. Now that we have that widespread availability, again, we just need to make sure — and I believe it’s my obligation as the public health physician responsible for the health of Albertans — to look not just at COVID outcomes but all health outcomes for all Albertans and to be weighing all of those things together.”

She added: “When it comes to imposing public health measures that come with health impacts of their own, that’s something that cases alone don’t justify, in my opinion, widespread public health measures. It’s the serious outcomes, the long COVID – those are the things that we need to be focused on.” 

When is more data and modelling coming?

One physician called it unacceptable that Alberta had not released the data with which it originally decided to stop mass testing and isolation requirements mid-August. At the time, Hinshaw said her team was compiling the information into an overview that would be more digestible to the public.

“I own the responsibility for not having that available at the time that we made the original announcement. I am sorry that was not done. That would have been the best way to go about doing it,” Hinshaw said.

“What I didn’t take into account was the actions that happened last week – which was the ongoing analysis, the identification that there was some issues we needed to flag in order to revisit the timeline of the implementation of the changes, and then be able to have the team really working on adjusting those timelines and all of the different policy implications for that.

“Again, that’s on me. I promised a timeline that ended up not being realistic based on the other work that was necessary for the team to do. I can assure you my team is working flat out and has been for a very long time and they’re doing their best to get these things packaged together.”

She acknowledged modelling by Alberta was of keen interest but said her team was still working on summarizing it all.

“This is not something I can do by myself and it’s also not something we can do without moving through all of the processes that are necessary in government… I am committed to having it released and make sure that all of you have an opportunity to look at it and the rationale and the evidence that went into making the recommendations that I’ve made.” 

Why not make COVID-19 vaccine mandatory?

“We are looking at legal implications, working with the labour ministry, around what kinds of considerations would need to be taken into account so that if there are employers who make vaccination mandatory, that we have a clear framework for that,” Hinshaw responded.

“That’s something that needs to be considered carefully. We know that other provinces have made vaccines mandatory in some settings, for example the ones that have been mentioned [health care and education]. And again, it’s just really important to be looking at all of the implications of that policy before a decisions made.”

The question came up more than once during the townhall. When asked why Alberta wasn’t supporting mandatory vaccination, Hinshaw reiterated she could only comment on her own recommendations.

“That’s something again that wouldn’t be a decision of mine, so that’s something that in order to consider whether or not this is something that would be possible here, we would have to look at our current legal environment and again, it’s not an easy path forward. So I really again wouldn’t be able to speak on behalf of decision makers on that topic,” she said.

“I believe that the most important thing that we can do to protect our population is to increase our immunization rates.”

Why not keep a provincial mask mandate, given aggression on the front line over masks? ​

Dr. Hinshaw reminded doctors that Alberta is keeping face coverings mandatory in high-risk and enclosed, public settings, like acute care and transit, but called it challenging to have a broader mandate in place for a prolonged period of time.

“It’s something of course that we continue to look closely at the data and to determine what might be required, but I’d just point out in that respect we’re quite similar to our neighbouring provinces on either side,” she continued.

“I believe we need to look at risk and benefit, weighing all of the considerations… Unfortunately even with a provincial mask mandate there is still aggression against people who are telling that person in front of them they need to wear a mask in stores or wherever else, so a provincial mask mandate doesn’t actually remove that challenge.”

​She said efforts were best directed at improving Alberta’s vaccination rate and strengthening the ability of local authorities to deal with an influx of transmission.

She said if a majority of the primary care network wanted to see masks mandated in community clinics, that conversation could be revisited.  

At what point will Alberta consider bringing back public health measures like a mask mandate?

“We know that in the U.K. where they saw a Delta surge that happened earlier this summer, they did not see an escalation of their acute care in patient capacity and in fact they moved to open the restrictions they did have, despite the fact they had a higher baseline than we did when we opened,” Hinshaw said.

“Now, that doesn’t mean that will be our experience. As we’ve mentioned before, they have a higher double vaccinated population than we do. We have a lot of opportunity to improve that, and if we need to bring in restrictions to protect the health care system, of course that would be something that we’re looking at, but again, I believe that it’s important to focus on the most effective intervention that we have, which is vaccine, to be able to work at a local level where we’re seeing surges of cases to mitigate transmission, and to be able to consider if there are needs for additional restrictions in order to protect hospital capacity.”  

Why don’t parents get to know about COVID-19 cases and exposures in school?

Alberta will neither report COVID-19 cases to school authorities when they return to class in the fall, nor require families to do so.

“Before we had, again, from a community level, the opportunity to utilize vaccine as a protective intervention, we needed to use that kind of quarantine intervention. But at this point going forward, I believe that the downsides of quarantine — the negative impacts, the mental health and isolation that that causes, especially for those that went through repeated rounds of quarantine — needs to be taken into account,” Hinshaw told physicians.

“And if we’re not requiring quarantine, then an individual’s health information shouldn’t be shared with others, again, when there’s no legal requirement to have any kind of follow up.”

She reminded her audience Alberta was still tracking COVID-19 data, including from waste water monitoring, which is publicly available.

Alberta Health will work with schools when a cluster of illness is identified.  

Why not protect youth in schools who can’t get vaccinated with masks and physical distancing?

The top doctor agreed so-called “long COVID” is a concern, but said she “absolutely support[s]” the ability of local authorities to make decisions best for them.

Alberta has left the decision — along with others — to require masks up to school boards, but given guidance on operating and outbreak procedures.

“I think it’s really important that we don’t focus on COVID as a primary risk to the exclusion of risk of all others and to make sure that we’re thinking about that broad spectrum of risks when decisions are made,” Hinshaw responded.

“I think reasonable people can disagree. I’m not suggesting that this approach is the only one. I’m just providing my rationale and again that weighing of risks and benefits and moving forward and doing the best that I can to consider all of the risks that we face together and not COVID as a standalone risk.”

Later on in the Q-and-A, she’d comment, “My concern if we’re not going to have vaccine for kids less than 12 until sometime in 2022 is there are significant impacts, significant health impacts of maintaining an aggressive COVID suppression protocol in place until that time.”  

Will Alberta provide third doses of COVID-19 vaccine?

Hinshaw said Alberta was waiting for the National Advisory Committee on Immunization’s advice on third doses, but examining the short and long-term impacts of booster shots for immunocompromised people or those who received shots at a less-than-ideal interval.

“No decisions have been made because it really does need to go back to the evidence with respect to who needs that dose at what time interval is it most optimal, and how does that impact the longer term protection that vaccines provide,” she said.

“Stay tuned for more on this. It’s definitely being looked at very closely and we are eagerly awaiting the national advisory committee’s recommendation on this topic.” 

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