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Track the number of people in Canada who have received doses
Michael Lee CTVNews.ca Writer
As Canada enters a new year, and a new phase in the COVID-19 saga, some experts believe it’s time for the country to shift its thinking around the coronavirus — including moving to a point where it can be considered endemic.
The emergence of the new Omicron variant, while believed to be more transmissible and possibly evade some vaccine protection compared to the Delta variant, may be less likely to produce severe illness and hospitalization, causing some experts to revise their own predictions about managing the pandemic in the new year.
The World Health Organization (WHO) on Wednesday expressed hope that the worst of the COVID-19 pandemic could be over in 2022.
WHO Director-General Tedros Adhanom Ghebreyesus said he remains "optimistic that this can be the year we can not only end the acute stage of the pandemic, but we also chart a path to stronger health security."
CTVNews spoke to multiple experts about what the future of the pandemic may look like as we enter a new year.
Experts have commonly cited increasing immunity through vaccinations as one way to bring an end to the pandemic.
Dr. Dale Kalina, an infectious disease specialist at Joseph Brant Hospital in Burlington, Ont., told CTV News Channel on Wednesday that while people can still get the virus itself, even with vaccines and boosters, the disease is vastly mitigated once a person is fully vaccinated.
And while booster campaigns are well underway here in Canada, Kalina notes there are still millions of people around the world who have yet to receive their first dose.
"So I am on board with getting third doses. I think that third doses for people who can get them are very helpful, but at the same time, first and second doses around the world is a first step that we have yet to make, so that’s going to be very important for the worldwide pandemic to end, as well."
Deanna Santer, an assistant professor in immunology at the Max Rady College of Medicine at the University of Manitoba in Winnipeg and GSK research chair in immunobiology of infectious diseases, told CTVNews.ca in an email that the obvious data is that boosters will make a big difference with Omicron in preventing infection, "but that won’t solve the problem of those still unvaccinated and still months away from being triple vaxxed."
With many children ineligible to be vaccinated, Santer said she hopes schools and daycares will be prioritized to create safe spaces for staff and students, with proper ventilation and HEPA filters available, as well as providing N95 masks to staff and requiring them to be triple vaccinated, as examples.
"We just don’t know yet the long-term consequences if children are infected, so I wish we saw more investment here with keeping kids in school a priority, although with 30 per cent positivity rates it is not looking promising for January for many provinces," she said.
As opposed to a pandemic, where a pathogen hits multiple populations across geographic regions and at much higher than expected rates, a virus becomes endemic when it reaches a point where it may circulate annually but is fairly confined to a certain geographic area.
There also may be a fair amount of underlying immunity present in the population.
Dr. Martha Fulford, an infectious disease specialist at McMaster Children’s Hospital in Hamilton, Ont., and an associate professor of medicine at McMaster University, told CTVNews.ca in a telephone interview that pandemics do eventually become endemic, but a shift in mindset will be needed in order to make that transition when it comes to COVID-19.
The expectation, at least with a type of respiratory tract virus such as SARS-CoV-2, is that there will be enough underlying population immunity through vaccinations and recoveries, "that it will still be circulating, but the illness caused will not be particularly interesting anymore."
The idea that COVID-19 can be eliminated altogether is a "fantasy," Fulford added, with the virus unable to meet certain criteria that would allow it to be eradicated, including its current geographic spread and transmission among animals.
"So the very idea that somehow we’re going to eliminate a respiratory tract virus was a distraction and I think caused a lot of harm, because of instead of being allowed to sort of plan for co-existing, we went into this weird mindset of one case is too much," she said.
Part of that change in mindset, she said, is worrying less about general asymptomatic transmission and focusing more on high-risk individuals, such as those in long-term care facilities.
Fulford, however, says never in her entire time as an infectious disease specialist has she ever seen asymptomatic people be tested at the rate they are today, something she described as "unheard of" unless a person is sick or surveillance is being done at a certain site where a virus is known to be circulating.
Ontario, Alberta, and other provinces have recently adopted new guidelines where only those who are symptomatic, at high risk of severe illness or work in high-risk settings will be tested with a PCR test, considered the "gold standard" of testing in Canada. Some provinces also have moved to reduce the isolation time required for fully vaccinated individuals who recover from COVID-19.
"I do realize that people have been monitoring the total daily test positive count rigorously, but we have to pivot," Ontario’s chief medical officer of health, Dr. Kieran Moore, said during a press conference on Thursday.
"We know there’s ongoing community activity across Ontario, we know we’ll have very high transmission risk and that data element now has to be targeted and focused to best protect Ontario — to screen those that need treatment, to screen those that are working in our highest-risk settings, to best protect Ontarians."
Also "unprecedented," Fulford said, is including people who get COVID-19, but have no symptoms, as cases.
"Quite frankly it’s wrong and it’s a complete misinterpretation of diagnostics and test interpretation," she said.
A positive lab-based polymerase chain reaction, or PCR, test alone only means a person has the virus. Other important factors that must be considered, Fulford says, are clinical signs and symptoms, so an otherwise healthy individual with no illness isn’t considered a case in the same way a truly sick person is.
Ontario’s COVID-19 dashboard currently does not distinguish between symptomatic and asymptomatic cases or hospital admissions. Some have suggested the data be updated to reflect hospital and intensive care unit patients who have been admitted for COVID-19 with those who are admitted for other reasons but test positive after being screened.
When considering additional public health measures to control the spread of COVID-19, Fulford said health not only involves the absence of disease, but a person’s physical, mental, social and emotional well-being.
This includes not just the prevention of COVID-19, but also reducing the risk of cardiovascular disease, encouraging physical fitness, mental health, education and also the increases in substance abuse and addiction that have been observed during the pandemic.
"In other words, health is a hell of a lot more than just COVID," she said.
Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization (VIDO) at the University of Saskatchewan and head of the host-pathogen interactions pillar of the Coronavirus Variants Rapid Response Network (CoVaRR-Net), also says that, in general, when looking at other respiratory virus pandemics such as the infamous 1918 flu pandemic, they all end.
But pandemics don’t really end with a "bang," she says. Instead, they tend to "go out with a whimper."
Rasmussen also described the idea of eliminating SARS-CoV-2, or a "zero COVID" strategy, as unrealistic and a "waste of time frankly," not only because a significant number of people in Canada and around the world are unvaccinated and have no prior immunity, but also because the virus is incredibly "generalist" and can infect animals.
"We’re not looking at a future where SARS-coronavirus-2 is gone forever," she said.
"I hate to use the term, ‘We have to live with it,’ but we probably do in that it’s going to continue causing outbreaks."
But that doesn’t mean Canada or the world will be living in a "forever state" of pandemic crisis, particularly as more people acquire immunity, whether through vaccinations, boosters or infections, which will help mitigate the severity of the disease.
"So we really do, in this final stretch for Canada, need to focus on making sure that people are getting vaccinated, that people have access to vaccines and they’re getting boosted, both here in Canada and also, as Canada steps up to be a leader on the stage of global health, we need to be doing everything we can that everyone around the world has access to vaccines."
With Omicron, she says, from an individual and community perspective, it makes sense to treat it as if it could still be a public health threat.
Even though a relatively smaller proportion of Omicron cases may require hospitalization compared to Delta, a large wave of infections could still increase the absolute number of people in hospital and add pressure to the health-care system.
"But the real question for me is how do you get people who are vehemently opposed to masks for political or ideological reasons, who are vehemently opposed to vaccines, who are opposed or are at least skeptical of boosters, or skeptical of the vaccines in general," she said. "I think it’s going to be a lot harder to persuade those people, because they’re not a monolithic group."
This issue of lost trust in government and public health, Rasmussen says, is a perspective she understands and something that will take time to rebuild.
Others, she added, may just be simply sick of the pandemic, possibly because they had COVID-19 already and didn’t experience a severe outcome.
But beyond access to vaccines, particularly in underserved communities, issues such as general access to health care, child care and transportation need to be addressed.
Even with the emergence of therapeutic drugs to treat COVID-19, Rasmussen says if supplies are low or the disease isn’t detected fast enough, because of a lack of robust testing capacity for example, those treatments won’t be of use.
"Until that is really addressed meaningfully, I think that these systemic issues are going to continue to plague us with regard to our ability to truly respond as effectively as we could and mitigate the negative impact of more SARS-coronavirus-2 outbreaks once we’ve entered the endemic phase."
People wait in line for a walk in PCR COVID-19 test site in Toronto on Wednesday December 22, 2021. (THE CANADIAN PRESS/Chris Young)
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