April 14, 2021 -- As millions more Americans receive COVID-19 vaccinations each day — including a record-breaking 4.6 million on April 10 — Canada is facing an increasingly dire situation.

Over the weekend, the per capita rate for new coronavirus infections in Canada surpassed the rate in the United States. Specifically, the rolling 7-day average of new cases rose to 207.27 per million Canadians, compared with 206.66 cases per million U.S. residents.

"We're certainly in a challenging position here in Canada. We've got our most populous provinces in the middle of a third wave," Isaac Bogoch, MD, an infectious diseases consultant and general internist at Toronto General Hospital, says.

"Hospital capacity is being stretched. Care is actually being rationed now — many scheduled surgeries here in Ontario are being canceled because of the influx of patients with COVID-19," Bogoch said.

"We're certainly in a very precarious place."

Public health officials point to the variants of concern circulating in Canada – particularly the B.1.1.7 variant first identified in the United Kingdom – and vaccination rates less than half those of the U.S..

For example, 15.2% of Canadians vs 35% of Americans have received at least one dose of a COVID-19 vaccine.

The proportion of the Canadian population fully vaccinated against COVID-19 is even lower, an estimated 1.88%, according to the Canadian government's coronavirus disease website.

"We are stretching the time for vaccination between dose one and dose two to up to 4 months so we can get a first dose in arms quicker," Bogoch said. "There has been pushback from certain groups, but I think based on the supply we have in Canada, in general that makes sense." Exceptions include immunocompromised and older people, added Bogoch, who is also a member of the Ontario Vaccine Distribution Task Force.

A Blunt CDC Warning

The Canadian border has been closed to most U.S. travelers since March 2020, with certain exceptions, such as compassionate visits to loved ones dying from COVID-19.

Even so, earlier this month the U.S. CDC issued a travel advisory for U.S. residents. Noting a Level 4, or "very high level," of COVID-19 in Canada, the agency cautions that "travelers should avoid all travel to Canada."

The advisory also notes that fully vaccinated travelers could be at risk for getting and spreading COVID-19 variants through travel to Canada.

With more than 6.6 million residents, Ontario is the most populous province in Canada. Ontario set a new daily record on April 11 with 4456 COVID-19 cases, a number higher than the peak of its second wave.

But for perspective, Canadian broadcaster CTV ranked U.S. states and Canadian provinces in one list. Michigan, New Jersey, and Minnesota top the list for 7-day rolling averages of new cases per million residents. The first province on the list, Alberta, comes in at #12, according to data updated today. The next province on the list is Ontario at #15, right after Illinois.

Stay-at-Home and Other Measures

The situation is so serious that Canadian officials have moved beyond mask mandates to enact more restrictive lockdown and stay-at-home orders.

On April 8, Ontario declared a state of emergency for the third time and began a 28-day stay-at-home order for residents, for example. The order closes in-person shopping at any non-essential retailer, prohibits indoor and outdoor dining at restaurants and bars, and shutters gyms, hair salons, and nail salons.

Outdoor exercise is permitted. People also can go to school or work, but only if remote options aren't available.

In addition to Ontario, British Columbia, Alberta, Saskatchewan, and Quebec are also experiencing a third wave of infections. As a result, Quebec has issued a curfew and British Columbia announced a lockdown.

Provincial governments are responding to the urgency of the situation by expanding pharmacy and primary care vaccination programs and setting up mass vaccination sites. Because of limited vaccine supplies, however, the mass vaccination clinics are restricted to people 60 and older in most cases, although some have dropped the minimum age to 50.

"Also, in hard hit areas and high-burden neighborhoods, there are very local vaccine programs, including mobile and pop-up sites," Bogoch said. Interestingly, there are no age cutoffs for adults in these outreach settings, with vaccinations open to anyone 18 or older.

"We're bringing the vaccine to the people instead of the people to the vaccine."