It may be tempting to leave the pandemic in the past, now that governments have eased restrictions on public health and sewage tests suggest infection rates have dropped since early spring. But the fight against COVID-19 is not over, says Dr. Gerald Evans, a member of the Ontario COVID-19 Scientific Advisory Board. “COVID has not disappeared. “It’s still there,” he says. The number of cases in Canada is actually higher than in June 2021, he says. And based on the previous two years, Dr. Evans says he expects two outbreaks after this summer, one in late fall or early winter and another in late winter or early spring. Here, he and other health experts share the top five issues that need to be addressed now. Possibility of a health care system One of the most pressing issues is to ensure that the healthcare system can provide timely and adequate care to patients, says Dr. Karen Bourne, Assistant Scientific Director of the Scientific Advisory Board for COVID-19 in Ontario. That means not just enough hospital beds, he says, but enough health care workers. During the pandemic, front-line health workers experienced high rates of burnout and many quit their jobs or retired early, says Dr. Bourne, who is an assistant professor at the University of Toronto Institute for Health Policy, Management and Evaluation. That calls into question the health care system’s ability to handle not only potential increases in COVID-19 cases, but a host of surgeries and procedures that have been postponed during previous waves, he says. Patients who postponed visits to hospitals and clinics earlier in the pandemic are now seeking care, contributing to longer waiting times, he added. Strengthening healthcare capacity includes training new healthcare workers, creating new physical spaces and improving infrastructure – all of which are not quick fixes, says Dr. Susy Hota, Medical Director of Infection Prevention and Control at the University of Toronto Health Network. But taking these steps is necessary to end the pandemic, where we reach a state of stability to tackle COVID-19 for years to come, he says. Third installments and enhancers Dr Nazeem Muhajarine, a professor of community health and epidemiology at the University of Saskatchewan, says he is concerned that the push to vaccinate and empower people seems to have waned recently and that public health messages have stopped. “It seems that where did everyone go?” He says. “Has the volume been reduced or turned off?” As of the end of May, 81.7 percent of the total population in Canada was considered fully vaccinated, according to federal data – that is, they received both doses of a two-dose vaccine or a single-dose, single-dose vaccine. But among those ages 12 and over, only 55.5 percent had received at least one extra dose, which many health experts now say is necessary for optimal protection against COVID-19. During the summer, those who have taken just two doses should be encouraged to take a third, says Dr. Evans, president of the Department of Infectious Diseases at Queen’s University. (He says two-dose vaccines should now be considered three-dose vaccines to complete the course.) And those who are particularly vulnerable should be encouraged to take a fourth dose as a booster. But for those who are not yet eligible for a fourth dose, he says, it may make sense to wait until a new vaccine is available. Dr Evans says newer vaccines, which include an additive targeting the Omicron variant, could be introduced this fall. Both Pfizer and Moderna are working on such vaccines. Last week, Moderna announced its new candidate booster that resulted in a stronger antibody response to the Omicron variant compared to its current vaccine. In an e-mail, Moderna Canada’s medical director Shehzad Iqbal said the company aims to have the updated vaccine available by early autumn, although its schedules depend on a number of factors, including the Health Canada approval process. Indoor air quality Restrictions on public health, such as the closure of schools and businesses, have contributed to people’s sense of pandemic fatigue, says Dr. Bourne. “But there are also many other things that can be done that should not be considered restrictions, but are more permanent investments that will improve our ability to respond to pandemics,” he said. Among them is the improvement of ventilation and filtration of indoor air in gathering places, he says. While schools in various parts of the country have begun to adopt such measures, there have been major cases earlier in the pandemic of food processing plants, warehouses and other facilities, where key workers worked nearby in poorly ventilated areas. Upgrades and maintenance of ventilation and air filtration systems in such settings will not only improve the population’s resistance to COVID-19, but will also help prevent the spread of other infectious diseases, such as influenza and respiratory distress. says Dr. Born. Long-term COVID and other lasting effects Canada lags behind Britain, the US and other parts of the world in understanding and dealing with long-term Covid-19, says Dr. Muhajarine, a member of the Coronavirus Variants Rapid Reaction Network (CoVaRR-Net) of researchers across the country. While efforts are being made between the western provinces to work together to create a long COVID register, “we really are not doing enough and we are late in the game,” he says. “We do not even have a guess about the prevalence of long-term COVID in Canada.” Dr Sonia Anand, a professor of epidemiology and medicine at McMaster University, says she hopes to see standard definitions of long-term COVID and more research into the condition, which is associated with a wide range of symptoms from brain fog to high blood pressure and low heart rate. . He says he also wants to see accessible and equitable care and resources for those with long-term COVID and other prolonged health effects of the pandemic. Dr Anand says she is particularly concerned about members of communities that have been hit hardest by the pandemic, such as South Asian communities in Peel, Ontario. They have experienced high rates of COVID-19 infection and many struggle with long-term side effects and the loss of loved ones, but are unaware of the long-term clinics and support for COVID-19, he says. Key employees may not have free time to access them, he adds. Meanwhile, social isolation and loneliness also have a negative impact on people’s physical and mental health, from young children who have not gone to school to older adults, he says. “I’m worried all my life that there will be long-term consequences,” he says. Surveillance In addressing these longer-term issues, the short-term goal for Canadians should be to continue to reduce COVID-19 rates, says Dr. Nitin Mohan, Assistant Professor in Microbiology and Immunology at Western University. That means ensuring that surveillance systems work to the best of their ability to monitor infection levels and detect new variants, he says. The data from the sewage tests provide an image, but it is not definitive, says Dr. Mohan. He says he would like to see rapid antigen tests remain free and widely available to the public. And while the need for PCR testing for individuals may not be as strong as it used to be in the pandemic, it should be made more accessible to keep track of cases, he says. “From a data point of view, it is important to know how many COVID cases we receive, which populations are affected and what the results are,” he says. Photos Murat Yukilir
