With COVID-19 on the rise in Alberta, what constitutes a fourth wave in a nation filled with vaccines?

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TORONTO — The R-value has climbed to peak COVID-19 levels in Alberta, even as daily case numbers remain fairly low, prompting the question: What constitutes a fourth wave of the pandemic in a country that has enough vaccines to inoculate everyone?

The R-value of COVID-19, or the “effective reproduction number,” is a way of measuring an infectious disease’s capacity to spread. It represents the number of people who will become infected by one infected person.

Alberta’s value was logged around 1.48 over the weekend according to provincial data, whereas at the peak of the third wave of the pandemic in the province when daily cases were around 1,500, the R-value fluctuated around 1.15.

“If your ‘R’ is greater than one, you're obviously growing. If the ‘R’ is less than one, you have a shrinking epidemic,” explained infectious disease expert Dr. Isaac Bogoch in a telephone interview with CTVNews.ca Wednesday. “A growing epidemic’s values are greater than one – a shrinking epidemic’s value are less than one.”

Alberta Health reported 194 new COVID-19 cases Wednesday, making the active case count stand at 1,334, the highest it has been in weeks. Eighty-four people are getting treated for COVID-19 in the hospital including 18 that were admitted to the ICU.

On Wednesday, in her first COVID-19 update in nearly a month, chief medical officer of health for Alberta Dr. Deena Hinshaw said “cases have risen recently, almost entirely in those who have not been fully vaccinated, as we expected would likely happen, as people come in close contact with each other again… I am pleased that overall hospitalizations continue to decline. And we will keep watching these closely.”

Hinshaw also reported that since July 1, people who were not fully immunized made up 95 per cent of all cases of COVID-19 in the province, 94 per cent of all those who have needed hospital care for COVID-19, and 95 per cent of all COVID-19 deaths.

Adjunct professor at the School of Public Health at the University of Alberta and former chief medical officer of health for the province Dr. James Talbot says the numbers are cause for concern.

“The numbers are going in the wrong direction,” Talbot said in an interview with CTV National News. “We were down to 30 to 50 cases a day…[it’s] a significant increase, and as predicted the Delta variant is now dominant.”

Talbot said the highly transmissible variant is “causing 90 per cent of the cases” and could cause an “exponential growth” of daily cases especially amongst those who are unvaccinated.

“It’s bad news for the province,” he said, adding that in light of Alberta lifting most public health restrictions on July 1, “the absence of any kind of control measures in place except immunisation, what you're left with is 25 per cent of people over the age of 12 who can serve as fuel for this fire - and then you have all the kids under 12 who, of course, haven't been immunised, who will also be transmitting the virus.”

In an emailed statement on Wednesday, the Alberta provincial government stated that “nearly 75.6 per cent of eligible Albertans have now received at least one dose of COVID-19 vaccine, and 64.3 per cent are fully immunized.”

“Vaccines dramatically reduce the risk of severe outcomes and the risk of infection. While COVID-19 cases may rise in the coming months, a surge of hospitalizations and other severe outcomes is much less likely thanks to vaccines,” the statement continues.

Canada now has enough COVID-19 vaccines to fully inoculate every eligible person over the age of 12, with more than 66 million doses received as of Tuesday, but despite the glut of vaccines and Alberta’s vaccination rate, Talbot said the province’s vaccine number announcement leave out a crucial piece of context.

“The key thing here is that 25 per cent are unimmunised; they have no protection,” he said, adding that that number has not budged in six weeks. “In the past, they were protected by the fact that there were people who were wearing masks, social distancing, et cetera, that they have no protection now.”

Alberta has the second-lowest vaccination rate in the country after Saskatchewan.

Talbot said with the Delta variant, unvaccinated Albertans and a rising R-value, the exponential growth of cases or “doubling time” could conservatively be between “a week to two weeks.”

“Take 10 days. So if we're at 100 [cases]… 10 days from now, 200, 10 days after that, 400, 10 days after that… by the end of the month, 800 cases per day,” he said.

“I mean, we were hoping to really get back to normal for schools and workplaces in September, and this is potentially going to put that in jeopardy,” Talbot said.

A FOURTH WAVE OR ‘AN EXPECTED RISE IN CASES’?

But where Talbot sees a potential fourth wave, Bogoch said it’s important to “change the narrative.”

“You know, I know everyone's trying to focus on Alberta, but I think the important point here is that it's not just Alberta, it’s Canada,” he said. “As you open up, which everybody is doing, to some extent, you're going to see a rise in cases -- we know that's going to happen.”

Bogoch said “it should come as no surprise” that if you give a virus like COVID-19 an “opportunity to be transmitted, it will be transmitted.”

B.C., which reported 185 new cases of COVID-19 Wednesday, has made masks mandatory again in indoor public places as parts of the interior see a spike in cases.

Ontario reported 158 new COVID-19 cases, as the seven-day rolling average of daily COVID-19 cases stands around at 160, up from 155 the previous week.

“It’s not just Alberta,” Bogoch said. “It's actually a bigger issue. And the question is to what extent will we be able to mitigate that rise in cases? To what extent will we be able to keep the pressure off of our health care system amongst amidst an expected rise in cases?”

“Cases are going to go up. We know that's going to happen. Alberta is just the first,” he said.

Bogoch also pointed out after well over a year of the COVID-19 pandemic, the country knows “how to keep this under control.”

“We can vaccinate, we can create safer indoor spaces like schools, places of work, restaurants, et cetera, so it's not like we don't know how,” he said, adding that “now, a lot of the decisions are really political decisions, not just medical and scientific and public health.”

Alberta announced Wednesday it will lift much of its remaining COVID-19 restrictions in the coming days, despite the rise in cases – for example, on Aug. 16, people who test positive for COVID-19 will not be mandated to quarantine anymore, but the province will recommend it.

“You know, the pandemic isn't over, we're doing really well and this is a great opportunity to strike while the iron is hot,” Bogoch said. “We've got enough vaccines to vaccinate every eligible Canadian, we've got health-care systems that are not overwhelmed at the moment, we've got a population that's quite willing to be vaccinated, and we've got very low rates of community transmission at the moment. So this is this is an opportune time to really get everything in order to prepare for an expected rise in cases that we're going to see later in the summer, probably in the fall.

“We can't ignore that we're way better off now than we were weeks and weeks and months ago.”

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With files from CTV National News' Heather Butts