For a few fleeting weeks this spring, it seemed Canadians were eager to return to something like normal pre-pandemic life. The number of cases and hospitalizations had fallen after a second peak in Omicron variant infections in April. Canada was among the most vaccinated countries in the world. And lifting public health requirements has allowed people to travel without proof of vaccination and attend unlimited gatherings without masks. But then came BA.4 and BA.5, Omicron subvariants that can evade the immune system’s protection from vaccines and previous infections. Their arrival dashed hopes that the country was finally sufficiently vaccinated to bring COVID-19 under some control. “A year and a half ago, I thought, ‘Oh, as soon as we double-vaccinate everybody, we’ll be fine.’ But now, that doesn’t seem to be the case,” Jeff Kwong, a professor of family medicine and public health at the University of Toronto, said last month. “I don’t know what the end game is. I have no idea how this is going to end.” A tiny sample of SARS-CoV-2, the virus that causes COVID-19.NIAID-RML/The Associated Press This seventh and final wave of COVID-19, driven by BA.5, marks another new phase of the pandemic. And it demands a new fantasy of what the end game of the pandemic will be and how to get there. For much of 2020, public health efforts focused on keeping infection rates from rising, with measures like social distancing and stay-at-home orders. And for much of 2021, authorities worked to get as many Canadians vaccinated as possible, in hopes that vaccinations were, in the words of then-Ontario Health Minister Christine Elliott, “our ticket out of the pandemic”. Doctors and researchers continue to emphasize that vaccines provide strong protection against serious illness and death. But it has become clear that vaccination is not a ticket—at least, not by itself. Beating COVID-19, doctors say, will likely require many measures, including continued development of more effective vaccines, universal vaccine coverage, paid sick days, a concerted fight against misinformation and attention to indoor air quality . And however this pandemic ends, they warn, a full return to normal probably won’t come for a long time. “Most people would like to hear that we are closer to the end,” said Giorgia Sulis, a postdoctoral researcher in infectious disease epidemiology at McGill University. “The pandemic is not over. I want to be clear about this. And we’re a long way from that.” But first, the good news. Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, describes himself as optimistic By nature. And, when it comes to the pandemic, it remains so for a few reasons. “Society hasn’t stopped, has it? That’s the big one,” he said. The sense of apocalypse he felt in the spring of 2020, when he walked through empty streets, is gone. Other than that, he said, vaccines have worked surprisingly well in preventing hospitalizations and deaths. The more booster shots people get, he added, the better they are protected against these effects. “This means that this disease is no longer an existential threat.” Vaccinated people’s cellular immunity against COVID-19 – that is, their B and T cells – is quite resilient, he said, and continues to ward off the worst outcomes. But their humoral immunity, which includes the antibodies that prevent infection, weakens over time. (Think of it this way, Dr. Deonandan explained: your humoral immunity keeps invaders away from your shores, while cellular immunity occurs after the invaders arrive and is important in preventing them from taking over the capital. ) Even in the absence of new vaccine formulations, he said, it’s very likely that booster shots of existing vaccines will continue to prevent the worst outcomes. A syringe is filled with a COVID-19 vaccine at a clinic in Richmond, BCJonathan Hayward/The Canadian Press But Dr. Deonandan and others say, Canadians can’t afford to give up on efforts to avoid infection just yet. There is a common refrain among people who support an immediate return to normal that, because of vaccines, COVID-19 is like the common cold. It is not, Dr. Soulis said, and should not be perceived as such. There may be a time when the illness becomes like a cold, but it’s not yet certain that will happen, he added. For now, there are vulnerable people, including those with underlying health conditions, who still need protection. Long-term COVID – when symptoms persist for weeks or months after an initial infection – is still an unsolved problem. And high infection rates continue to wreak havoc on people’s lives, the workforce, and the health care system. A healthcare worker moves a patient in a Montreal hospital. Graham Hughes/The Canadian Press Most people who get COVID-19 do not end up in hospitals. But when there are many cases in a population, even a small percentage of severe cases can overwhelm healthcare facilities. According to the latest federal data, the number of people hospitalized with COVID-19 rose to 5,225 from 4,804 between July 18 and July 25, while the number of patients in intensive care units rose to 254 from 223 that week. Meanwhile, Canada recorded 253 deaths from COVID-19 in the week of July 17 to July 23. Although only about 18% of Canadians are unvaccinated, unvaccinated people account for the largest proportion of these deaths and hospitalizations. Overall, between Dec. 14 and July 3, nearly 52 percent of COVID-19 hospitalizations involved unvaccinated patients, compared with 20.5 percent among those who had received two doses, 18 percent among those who had received three doses and less than 1 percent among those who received four or more doses. Fifty-two percent of deaths from COVID-19 were among the unvaccinated, compared with 18 percent among those with two doses, 19.5 percent among those with three doses, and 1.5 percent among those with four or more doses. If Canadians stay on the current course, with few public health requirements and few people willing to receive additional doses of vaccine, Dr. Sulis believes that COVID-19 infections will continue to occur at rates that disrupt hospital operations and the situation we see today will be the future of our pandemic. The much-touted idea of wiping out local outbreaks when they occur is unrealistic, he said, because the high transmissibility of new variants leads to widespread transmission that is difficult to detect. “The scenario is simply that we will see waves of cases everywhere,” Dr. Soulis said. “If the virus is circulating at this rate, new variants are much more likely to emerge.” In the first year of the pandemic, Andrew Morris, an infectious disease physician at Toronto’s Sinai Health and University Health Network, was an advocate of a “COVID zero” strategy — meaning a society-wide push to reduce the number of COVID-19 cases as much as possible. possible. The goal was never to completely eradicate COVID-19, as that would likely be impossible, Dr. Morris said. He still thinks COVID zero was a good idea, but acknowledges it wouldn’t work now, with highly contagious variants circulating and more than 6 million new confirmed cases a week worldwide. Those who continue to cling to that goal — “I risk calling them COVID-zero zealots,” he said — now clash with those who wish to declare the pandemic over. What is missing from the current debate, and what has been missing from the start, he argued, is a strategy. The first thing needed in a pandemic strategy is a clear recognition that current mRNA vaccines against COVID-19 are not the panacea many had hoped for, Dr. Morris said. Initial efficacy studies for the Pfizer, Moderna and Oxford-AstraZeneca vaccines were much better than Dr. Morris and others had expected. “As has happened many times in the pandemic, we didn’t have the humility to say, ‘You know, we don’t really know what the future is going to be like,’” he said, noting that waning immunity from these vaccines has played into skeptics’ accusations that doctors and scientists lied about what they were shooting for could deliver. While he stressed the continued importance of people getting at least three doses, he said Canadians should rely in the future on new vaccines still in development, such as intranasal vaccines, which are applied by misting into recipients’ noses. These may be more protective than existing vaccines, more tolerable in people who are resistant to injections, and provide long-lasting immunity, he said. Children walk to class at a physical distance in Scarborough, Ont.Nathan Denette/The Canadian Press Other elements needed in a pandemic strategy include efforts to combat misinformation, according to Dr. Morris. He said this should start with children in schools. He also called for greater recognition that the transmission of COVID-19 is airborne, which he said means places where people work and congregate need better air circulation and filtration. For his part, Dr. Deonandan said it’s important to have an active COVID-19 surveillance system in place, which would include regular testing of random segments of the population to get a sense of who is infected, what percentage are highly symptomatic and how long they’ve had the disease. He also called for paid sick days to be made more widely available. This, he said, would give people less incentive to infect their colleagues. And he said it’s important to have more treatment options for…
