Canada still lacks national guidance for fully vaccinated Canadians as travel restrictions ease

Canada still hasn't provided clear guidance to fully vaccinated Canadians on what they can and can't do safely as the number of second doses of COVID-19 vaccines ramps up across the country and travel restrictions are set to ease.

More than 60 per cent of the population has at least one dose and more than eight per cent have two, but as our vaccine rollout strategy shifts toward getting more Canadians fully vaccinated national guidelines for what activities are safe to do still don't exist.

"We seem to be paralyzed in Canada," said Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto. "We don't differentiate between who's vaccinated and unvaccinated."

The federal government announced Wednesday that fully vaccinated Canadians and permanent residents crossing the border into Canada will soon not have to self-isolate for 14 days if they have a negative COVID-19 test, but there's no specific direction on what they can actually dosafely once they arrive here.

Without guidelines for the fully vaccinated, some experts say Canada is missing an opportunity to give Canadians a roadmap towardsomething resemblinganormal life, while others feel we need to proceed carefully to avoid risking the progress we've made.

Travel rules unclear

Manitoba Premier Brian Pallister announced Tuesday that fully vaccinated Manitobans will now be able to travel within Canada without having to self-isolate for two weeks after they return, with an immunization card used as proof.

Nationally, however, vaccine passports have not yet been rolled out and federal officials were unable to provide an exact time as to when quarantine rules will be lifted for fully vaccinated Canadians aside from saying on Wednesday they were aiming for early July.

Unlike Canada, the U.S. Centers for Disease Control and Prevention released guidelines on March 8 for fully vaccinated Americans that said they could safely interact indoors without masks or physically distancing themselves from others who had received both shots.

If you don't provide guidance, people are going to make it up on their own.- Dr. Isaac Bogoch

The CDC also said those who had two doses can travel both within the U.S. and internationally without testing, as well as skipping quarantine altogether upon return.

But three months later, Ottawa still hasn't provided similar guidelines for fully vaccinated Canadians despite saying over a month ago the guidance was coming "very shortly" and experts say that could be driving confusion across the country.

"I don't think we are thinking scientifically here," Stall said. "Are we going to wait for all Canadians to be fully vaccinated so that we can all move together?"

Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital and member of Ontario's COVID-19 vaccine task force, says guidelines are needed now because the number of fully vaccinated Canadians will rapidly accelerate throughout the summer.

"If you don't provide guidance, people are going to make it up on their own. Some people might obviously throw caution to the wind and others might still be, quite frankly, unnecessarily cooped up," he said.

"I think it's fair to say that if you're fully vaccinated and you're hanging out with other fully vaccinated individuals you can let your guard down. But I think we need some acknowledgement and some guidance from senior public health leadership."

Canada's Chief Public Health Officer Dr. Theresa Tam did provide some informal guidance for partially vaccinated Canadians on May 14, saying they could socialize with family and friends outdoors over the summer, but has not updated guidelines for the fully vaccinated.

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'Fragile' time to relax restrictions in Canada

But some experts say national guidelines for fully vaccinated Canadians could end up encouraging unvaccinated or partially vaccinated Canadians to stop following public health guidelines at a critical time, potentially risking outbreaks of COVID-19 in the weeks and months ahead.

"Giving advice to one group really is problematic because people are mixing," said Prof. Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa. "How can you tell in a crowd who's been vaccinated?"

Deonandan says he would prefer to see Canada release guidelines on what fully vaccinatedCanadians can do once a significant proportion of the population has two doses, rather than giving guidance on an individual level.

"It's still a narrative of 'me, me, me' rather than what does it mean for the population or the community or the country," he said. "Society doesn't work that way."

Dr. Allison McGeer, a medical microbiologist and infectious diseases specialist at Toronto's Mount Sinai Hospital, says now is not the right time to relax public health restrictions for fully vaccinated Canadians because hospitalizations and ICU admissions for COVID-19 remain high in parts of the country.

"Our current control of the pandemic is too fragile," she said."In terms of both control of the pandemic and of trying to be equitable about how we're all getting through this, people who've had two doses really need to just be in solidarity with the rest of us."

McGeer says one factor that could jeopardize our ability to control COVID-19 levels in Canada is the delta variant first identified in India, also known as B.1.617.2. Early research shows one dose of the vaccines are only about 30 per cent effective against it.

"The moment we're talking about delta, one dose is just not worth much anymore," she said. "Delta is writing its own rules."

New data from Public Health England is also discouraging and foundthat while two doses are more effective than one against delta, it also appears to be moretransmissible and can cause more significant illness as well.

Stall says while there may be uncertainty with delta and other variants in the future, there's no better time than now to offer clear guidance to vaccinated Canadians.

"We have six months of data from around the world that vaccines are highly effective at both protecting individuals and at stopping transmission," he said.

"It really defies logic. Fundamentally, it's a Canadian problem. It's like, we're all going to move as one because it's not fair that some people are going to get to go ahead of others."

Canadians need 'roadmap' for 'life back to normal'

Stall says national guidance could help combat vaccine hesitancy by further instilling trust in the shots and incentivize Canadians to get fully vaccinated by rewarding them with an opportunity to spend much needed quality time with loved ones.

"We need to show people what vaccinated life looks like. What is the carrot to getting vaccinated? Because currently there is not really a carrot everyone is being asked to follow the same public health measures," he said.

"I don't understand the hesitancy towards accepting the really amazing efficacy of the vaccines and we haven't provided people on an individual level the roadmap for what life back to normal looks like."

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Patty Hajdu, Canada's health minister, said the government is hoping to ease some restrictions in stages, starting in early July.

Bogoch said Canada should release practical national guidelines similar to the U.S. allowing for small gatherings indoors with other fully vaccinated individuals where the risk of COVID-19 is "negligible," and for grandparents to hug their unvaccinated grandchildren.

"If you think about the people who are fully vaccinated, a lot of them are older adults and some of them may have limited life expectancies," Stall said.

"These are precious moments that are fleeting. We've seen this in long-term care homes, but it also exists within the community as well. How many more Father's Days, Mother's Days and birthdays do people have when they're in their 90s or late 80s?"