Why new guidance for vaccinated Canadians leaves plenty of room for confusion

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Canada has finally released guidelines on what fully vaccinated Canadians can and can’t do safely together, but experts say while the long overdue guidance is welcome — it still leaves many unanswered questions. 

In an infographic posted to the Public Health Agency of Canada’s website late Friday afternoon, fully vaccinated Canadians were told they could now gather outdoors with the partially vaccinated or unvaccinated without masking or physically distancing.

That means a small family gathering, swimming, camping and even hugs are now permitted between those with one, two, or even no shots — but only “if everyone is comfortable with that,” the document states.

Canadians who are two weeks out from both doses of COVID-19 vaccines were even told they could gather in small groups indoors without masks or distancing for the first time.

WATCH | Tam outlines guidance for fully vaccinated people in social settings:

Canada’s Chief Public Health Officer Dr. Theresa Tam describes some of the new pandemic guidelines for people in social settings. She said Canadians should still check with local health authorities for the latest on pandemic measures and restrictions. 1:41

“Being fully vaccinated affords you a huge amount of protection,” Canada’s Chief Public Health Officer Dr. Theresa Tam said during a press conference Friday, “so you can go into some of these settings indoors with a much better sense that you’re protected.”

“If you have an underlying medical condition you may want to think about layering on more protection, but even unvaccinated people can go outdoors without a mask with vaccinated people.”

Yes, even those with just one or no doses can “consider removing your masks and being physically close to the fully vaccinated individuals” while indoors, but again, only if everyone is “comfortable” and no one is at risk of severe COVID-19, the document states.

For Canadians who have been waiting patiently for national guidance on how to navigate the pandemic six months after the first shipment of COVID-19 vaccines arrived — this is it.

But the release of the infographic followed a confusing, hour-long press conference where officials criticized similar rules from the U.S. Centers for Disease Control and Prevention that have been out for months, and pointed Canadians to a risk calculator from Ryerson University that directly contradicts some of the PHAC guidance.

“I’m a little unclear what the guidance is,” said Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto and a member of the National Advisory Committee on Immunization who does not speak on behalf of the group.

“Because there’s the information that was communicated in the press conference, there’s the information that was communicated on the website on life after vaccination, and then there’s the infographic — and to me, they all sort of conflict with one another.” 

Stall said that while he thinks the guidance in the infographic is “reasonable,” it’s also “vague and indirect” and came “millions of doses too late.”

“At the end of the day, this is guidance and it’s up to the provinces and territories for implementation,” he said. “My hope is now that we have national guidance in one form or another, local public health guidance will be updated in accordance with that.”

Thousands of people wait over six hours for their COVID-19 vaccine at a pop-up mass vaccination clinic at Jimmie Simpson Recreation Centre during the COVID-19 pandemic in Toronto on June 17. (Nathan Denette/The Canadian Press)

Concern over lack of guidance for kids

One notable omission in the guidance is how exactly Canadians are supposed to interact with one of the largest groups of unvaccinated people in the country — children. 

Stall said that unlike the CDC guidance, which includes guidelines for kids, the PHAC document provides “no accommodation” for gathering with children in small groups, which is especially challenging given the fact they could be unvaccinated for many months.

“A lot of things are still left unaddressed by this,” he said. “Even if it’s some small progress in the right direction.” 

Raavi Mahal, 5, watches her mom, Loveleen Mahal, receive the COVID-19 vaccine from Dr. Oliver Haw. (AHS)

Dr. David Naylor, who led the federal inquiry into Canada’s national response to the 2003 SARS epidemic and now co-chairs the federal government’s COVID-19 immunity task force, said given the fact clinical trial results for children under 12 aren’t expected until at least the fall, it would have been helpful to include some type of guidance for families.

“It’s really important to clarify given the rising proportion of cases in those aged 19 and under,” he said. “And the reality that many families include children or grandchildren who are 11 or under who will be unvaccinated for the entire summer if not longer.”

“Oh hell,” he added on Twitter. “I’ll just hug them anyway.”

Dr. Fahad Razak, an epidemiologist and internist with St. Michael’s Hospital in Toronto, said he hopes in the coming days the guidance will be consolidated around the infographic, which he said is a “really good start,” as opposed to the conflicting information on PHAC’s website and the Ryerson University risk calculator.

“Then consider extending it out to children,” he said. “That’s the next step.”

No explanation for lack of guidance until now

Canadians have put enormous faith in COVID-19 vaccines and public health officials throughout the pandemic, agreeing to mix and match shots and delay second doses for months in hopes of returning to a more normal life sooner. 

But as the fruits of our labour are finally paying off — with COVID-19 cases, hospitalizations and deaths dropping dramatically in recent weeks — little has changed in the guidance for what fully vaccinated Canadians can do safely until now.

Regardless of the shortcomings of the guidance, or why it took so long to get here, experts say that while it was never going to satisfy everyone, it will hopefully stop Canadians from making up their own rules in the interim. 

“The whole goal is not to think about every potential situation that every Canadian might get into, but just to have some high level advice for what’s reasonable to do and where we should still be cautious,” said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force. 

“The other thing too that might get lost here is that many people already knew this and already appreciated what vaccination afforded them and were already quietly doing this.”

For the many Canadians who have “collective PTSD” from the pandemic and have struggled to move ahead without some type of guidance to help navigate life post vaccination, this will hopefully provide some relief, Bogoch said.

“For the last 15 months, we’ve been isolating, we’ve been wearing masks, we’ve been careful about gatherings, we’ve been distancing — and everybody knows someone who has COVID, we also probably know someone who has been hospitalized or who has even died from COVID,” he said.

“This really hit a lot of us very, very close to home and some people just need this guidance and this green light from senior public health officials to say, ‘You know what? It is OK to start moving forward and it is OK to start getting together with others and it is OK to take off your mask in certain situations.’ So I think this is very, very helpful.” 


This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

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