Fully vaccinated people can now meet indoors in small groups without masking or distancing, the Public Health Agency of Canada said on Friday.

The agency released the new guidance through an infographic on its website at the tail end of a press conference on Friday. At the virtual event, officials struggled to explain the new guidance and Chief Public Health Officer Theresa Tam told reporters she hadn’t yet seen it. The agency later clarified that Dr. Tam had seen previous drafts, but not the final version.

The guidance lays out advice for what fully vaccinated, partially vaccinated and non-vaccinated people can do. But it cautions that individuals still need to follow local health advice, in particular for communal spaces such as work and public transit.

“Outside is always better,” Dr. Tam said Friday. “Inside, the three Cs – just remember that still applies.”

The three Cs are what health officials say should be avoided: close contacts, confined spaces and crowded places.

Vaccines add significant protection, Dr. Tam said. “If you’re fully vaccinated, there’s a lot that you can do now with a lowered risk.”

The new rules were welcomed by epidemiologists and infectious-disease experts who had been calling for updated advice for weeks. But they noted that advice for families with children who are not yet eligible for a vaccine was missing from the updated PHAC guidance. Critics also noted the apparent confusion and mixed messages at the press conference risked having the public tune out.

The guidance says if you are fully vaccinated and gathering indoors with a small group of fully vaccinated people, it is safe to do so with no masking or distancing. It also notes that if you are only partially vaccinated or not vaccinated at all but spending time inside with fully vaccinated people, you can forgo the usual COVID-19 measures such as masking and distancing “if everyone is comfortable with that, AND nobody is at risk of more severe disease or outcomes.”

If you are outdoors with a group of people with mixed vaccination status, the advice says a fully vaccinated person can ditch the mask and distancing. However, with that same group indoors, the guidance is that if you are at risk of severe illness from COVID-19, you should mask up and keep your distance.

Despite the new guidance on individual activities, Dr. Tam and deputy chief public health officer Howard Njoo appeared to put more emphasis on using an online risk-assessment quiz that gives users more tailored advice.

Dr. Njoo said American guidance for fully vaccinated people released in March “makes it seem straightforward,” allowing people to think they can do whatever they want.

“We’re saying, ‘No, it’s much more nuanced than that,’” Dr. Njoo said. “You can see by the tools that there’s also a level of what we call your personal risk assessment and risk tolerance.

“It’s not as simple as what your status is with respect to your vaccination,” he said, adding that community spread of the virus also needs to be factored into decision-making.

Dr. Njoo urged people to take the quiz for answers to common questions they might have – such as whether it might be safe to hug their grandparents – because the online tool also takes into account other factors such as underlying health conditions.

At the press conference, PHAC released modelling showing a dramatic drop in COVID-19 cases, hospitalizations and deaths. However, citing the more transmissible Delta variant, Dr. Tam and Dr. Njoo urged caution and stressed the need to get fully vaccinated.

The models showed that Canada will avoid hospitals becoming overwhelmed with a fourth wave if personal protective measures are only eased when 83 per cent of people aged 12 and over are fully vaccinated.

Andrew Morris, an infectious-diseases physician at Sinai Health and a professor at the University of Toronto, said PHAC’s guidance infographic makes sense, but still leaves families with kids without specific advice. He said it’s likely health officials are treading cautiously because of disease resurgence in countries with high vaccination rates, such as Britain and Israel.

“They’re trying to navigate all of these multiple things and what’s ended up happening is quite poor communication,” Dr. Morris said, adding the risk is that the public may start making their own decisions as a result without clear health advice.

The opposition criticized the rollout of the new guidance, with Conservative MP Michelle Rempel Garner calling it “confusing and delayed pandemic advice” that should not have taken so long to release.

“What should be helpful and clear is instead confusing and unhelpful,” NDP MP Don Davies said.

The Globe and Mail, June 26, 2021