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When will we know the pandemic is over? Ontario doctors tackle that burning question

Dreams of a final, dramatic ending to the pandemic may have to be set aside in favour of a future where COVID-19 never really goes away.

Key benchmark is the use of health-care resources, Dr. Zain Chagla says

Though it's been hotly anticipated for 14 months, it's still not exactly clear how we'll know the pandemic is well and truly over. (Travis Dolynny/CBC)

"Not with a bang but a whimper."

Yes, it's that line again from a poem by T.S. Eliot. But infectious disease expert Dr. Allison McGeer says the end of the COVID-19 pandemic could come with both a bang and a whimper.

The "bang" part, she says, could last into this coming winter, with hospitals remaining busy and new issues brought about by a return to more global travel. 

"Then, the virus will get to the whimpering stage by next summer." 

Dr. Zain Chagla has his own way of describing things. 

The pandemic's end, he says, is not like a "light switch." 

"People need to be comfortable with the fact that COVID-19 is going to be around for the foreseeable future, and possibly the long-term future." 

McGeer and Chagla sat on a panel on Tuesday hosted by the Ontario Medical Association. The panel attempted to answer questions that have been front-of-mind for millions of people for more than a year now. 

Among them: what will the end of the pandemic look like? How will people behave? Will the virus mutate, and how will that affect our return to normalcy? 

Hospital resources as a bellwether 

In Ontario, the provincial government has laid out a three-stage path to reopening linked to the percentage of adults who have been vaccinated. 

But Chagla has long warned that we can't vaccinate COVID-19 out of existence.

He sees the end of the pandemic like this: an increasing number of fully vaccinated citizens, with their lower risk of complications and transmission, will "turn this into an outpatient disease." 

In other words, COVID-19 will circulate, but won't require hospitalization or other health resources. 

"The end of the pandemic in Canada … is going to be where health-care utilization is going to come down." 

He uses the words "in Canada" for a reason.

"This can't end until everyone has equitable access to vaccines," he said. Chagla points out that if the novel coronavirus continues to rampage in other parts of the world, it increases the chance that new and dangerous variants could arrive in Canada. 

WATCH| World Health Organization comments on need for worldwide COVID-19 vaccine equity:

WHO comments on need for global COVID-19 vaccine equity

5 months ago
2:04
People in wealthier countries are getting vaccinated at a much faster rate than those in poorer countries despite efforts by the World Health Organization and the international community to make COVID-19 vaccine accessibility equitable around the world. 2:04

The latest influenza?

Looking to the months and years ahead, McGeer sees two possible paths: either the virus that causes COVID-19 will stop mutating and settle, or it will continually evolve. 

She says if it keeps mutating, "then we may end up with a situation that's like influenza is now, which is that it's no longer nearly a serious disease, but it's not a trivial disease. And we're going to need ongoing vaccination programs." 

McGeer says she's "hoping for the first" scenario, in which the pathogen that causes COVID-19 stops evolving, but that "most epidemiologists and virologists are expecting the second." 

Given that, McGeer says, it's unlikely that COVID-19 will ever be truly eradicated. 

Eradicating a disease is difficult and expensive, she says. She adds that once enough people are immune, it likely "won't be worth the cost" to fully get rid of it. 

Behaviour will change slowly, expert says

For months, questions and concerns have also swirled about how people will actually feel when restrictions begin to lift. 

To tackle that question, Chagla and McGeer were joined by Dr. Thomas Unger, psychiatrist-in-chief at St. Michael's Hospital in Toronto.

He breaks down three post-pandemic reactions, which he says are in keeping with "most normal people's tolerance for risk and personality styles." 

Up to a third of people, says Unger, will immediately plunge back into activities they enjoyed pre-pandemic and "have a good time immediately." 

The larger group, as many as half of Canadians, will proceed with more caution, "dipping their toe in the shallow end" as they get comfortable. 

Patrons returned to the Art Gallery of Ontario in July of 2020. Dr. Thomas Unger says most Canadians will move slowly and cautiously through the reopening process, rather than plunging head first. (Evan Mitsui/CBC)

And a final group will need more support and are likely to remain "overly fearful and avoidant" long after most people have started doing things like visiting restaurants or taking the subway again. 

He also says some of our new behaviours, many born out of new knowledge around how viruses transfer, may linger — and that's nothing to worry about. 

"That's just the way humans adapt." 

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