TORONTO, May 26, 2021 — As the COVID-19 pandemic’s third deadly wave fizzles out and vaccination rates climb, people in Ontario are naturally asking themselves, is this it? Are these the signs we’ve been waiting for that the pandemic is finally over?
“In the past, the viruses that cause pandemics didn’t go away, exactly, but they became less deadly,” Dr. Samantha Hill, a cardiac surgeon in Toronto, said as host of a recent Ontario Medical Association media briefing in her then-role as president.
“The human body is amazing, and our immune systems adapt and learn different ways to fend off the deadliest versions of infection. Instead of causing widespread deaths, over time, the viruses caused small surges of illness like a seasonal flu that were much milder.”
But what will the end of the COVID-19 pandemic look like? Experts say even they can’t be completely certain what lies ahead for the virus.
“Many of us have this vision in our heads of the pandemic ending with a light switch, cases essentially come down to zero and life goes back to normal,” Dr. Zain Chagla, co-medical director of infection control at St. Joseph’s Healthcare Hamilton, said at the briefing. “People have to be comfortable with the fact that COVID-19 is going to be around for the foreseeable future and probably into the long-term future.”
COVID-19 is a disease that has a significant pre-symptomatic phase where testing doesn’t recognize all cases. While vaccines are working well, they aren’t enough to eliminate every case, he said.
“The pandemic ends in Canada with our health-care utilization from those significant and serious complications from COVID-19 being put aside and people now turning this from an in-patient disease to an out-patient disease,” Dr. Chagla said.
Even as the burden on health-care resources returns to more manageable levels in Ontario, not every country is containing the virus and its variants at the same pace, he added.
“As we think about our exit plan, we need to think about the global exit plan as part of this, recognizing that this doesn’t end until everyone has equitable access to vaccines,” he said.
Dr. Allison McGeer, an infectious disease specialist Mount Sinai Hospital in Toronto, said while the world has eradicated smallpox and is close to eradicating polio, wiping out disease entirely is difficult and expensive, even with good vaccines.
She said that once people are vaccinated and have immunity, COVID-19 will likely be mild enough that the cost and effort to eradicate wouldn’t be worth it.
“If we can get through next winter, then the virus will get to the whimpering stage next summer,” she said. “The more difficult scenario would be if this virus decides to continue to evolve… It’s going to turn into something like influenza that can change over time and escape from immunity… Then we may end up with a situation like influenza is now. It’s no longer nearly as serious a disease, but it’s not a trivial disease and we are going to need ongoing vaccination programs.”
Most epidemiologists and biologists expect that we’re going to have to live with COVID-19 and its vaccines in the long term, Dr. McGeer added.
Still, Ontario is phasing in its reopening plans, which raises questions around how we will respond as life returns to “normal,” or some version of normal.
The answer depends on a person’s tolerance for risk and personality type, Dr. Thomas Ungar, psychiatrist-in-chief at St. Michael’s Hospital, said at the briefing.
“We will probably see a small portion — 10 per cent maybe up to a third of the public — going to be out there partying like nothing happened. Not advisable, but we’ll see that,” he said. “But we’ll probably see the big bulk of the middle of society — at least a third to a half — gradually, cautiously dipping their toe in the shallow end. If they’re comfortable and it goes well one time they will try again and…gradually slide back into most of our normal life routines.”
Dr. Ungar said a small number of people will remain overly fearful and avoidant. Those with psychiatric conditions such as clinical depression or anxiety disorders may need extra support and possibly treatment to resume life after such prolonged isolation.
Dr. Ungar said some societal behaviours may change as the world reopens. For example, people may use transit differently, others may push the elevator button with a pen and workplaces may require employees with colds to wear a mask.
“Checking in with people is a good thing, reaching out and asking people how they’re doing, encouraging them if they’re not doing well, and to see if it’s a regular concern and sadness, which we all have at this strange time,” he said. “If it’s more than that, encouraging them to seek out help, reach out to their health-care provider, family physician or telephone crisis line, because help is available.”
