How Canada can avoid past mistakes as COVID-19 restrictions lift
Morale may be 'eroded' 2 years into pandemic, but rushing reopening could backfire
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Canada is entering a new phase of the pandemic as restrictions are set to ease across much of the country. But avoiding the mistakes of the past and keeping the public onside will be extremely challenging as Omicron continues to hammer our health-care system.
Ontario, Alberta and Manitoba pushed aggressively to reopen last February when the highly transmissible Alpha and Beta variants were taking off, setting the stage for a devastating third wave that led to months of reimposed restrictions in hard-hit regions.
A year later, many provinces are again forging ahead with reopening plans in the face of an even more devastating variant, while setting somewhat ambitious end dates at a time when record-high hospitalizations have just begun to show signs of peaking.
While our protection from vaccinations and prior infections may put us in a better position, infectious disease experts say Canada should take a cautious approach to reopening to avoid falling into the same traps of previous waves.
British Columbia and Ontario will begin easing limits on indoor gatherings, gyms, bars, restaurants and other venues on Monday, while Manitoba announced Friday it will extend its measures for at least another week and Quebec remains weeks away from reopening.
And while Alberta is waiting until hospitalization rates drop before beginning to lift its restrictions, Premier Jason Kenney joined Ontario Premier Doug Ford this week in boldly predicting the lifting of all COVID-19 public health measures by mid-March.
But if the last two years of the pandemic have taught us anything, it's that the virus doesn't work on our schedule. And while we may feel like we're done with COVID-19, it's not necessarily done with us.
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Pandemic 'chess game' continues with Omicron
A subvariant of Omicron known as BA.2 is showing early signs of spread in Canada, with more than 100 cases detected to date. Denmark's leading public health institute found it could be 1.5 times more infectious — highlighting the threat of the rapidly mutating virus.
"The greatest opportunity for mutations and variants to arise is when you get lots of transmission events and the virus has got opportunities to replicate itself more," said Dr. Susy Hota, an infectious disease specialist at the University Health Network in Toronto.
"So it's kind of this awful cycle that you get stuck in, where you have these massive surges of, say, Omicron this time around that hit so many people, and that allows for further mutations to happen and then from that may arise additional variants in the future."
Hota said that while BA.2 remains at low levels in Canada right now, it's important to keep an eye on its spread in other countries and ramp up our tracking efforts here, in order to make sure we detect the subvariant quickly and are prepared for further spread.
"This is a chess game — we make a move, and it makes a move, and then we make a move," said Dr. Lynora Saxinger, an infectious diseases physician and associate professor at the University of Alberta in Edmonton.
"The whole thing is — and always has been — a strategy game against a foe that has more tricks up its sleeve than we can even imagine."
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Saxinger said health officials should be communicating transparently with Canadians on what benchmarks need to be met for further reopening, as well as bringing the public onboard with what's informing decisions to get more buy-in if things take a turn for the worse.
"There could be another curveball. A lot of people are anticipating that after this Omicron surge is over, it will be a very different landscape and I think that that's very plausible — but I would not promise it," Saxinger said.
"It's just a flat-out mistake to make any promises right now. I mean, just promise transparency, promise being reactive, promise to weigh the right things — but don't promise what will actually happen."
Dr. David Naylor, who led the federal inquiry into Canada's national response to the 2003 SARS epidemic and now co-chairs the federal government's COVID-19 Immunity Task Force, said provinces need to "move carefully with reopening" to avoid reversing trends.
"We all are totally fed up with living in limbo," he said. "However, it's a potentially self-defeating strategy if the more severe measures become necessary because we didn't wait long enough for the latest wave to recede."
Given that PCR testing has completely dropped off a cliff in Canada, Naylor said officials must look at leading indicators, like wastewater surveillance, and lagging indicators, like hospitalizations, ICU admissions and deaths, to get a handle on when to lift restrictions.
Naylor said while public morale and patience has "eroded" and could lead to a "fatalistic sense" that we should just "give up and do the minimum," that mindset won't help control the virus.
"Those misperceptions and sentiments, if they become truly widespread, will make premature reopening more likely," he said.
"I'd be inclined to go steady and slow, looking forward to some seasonal relief, and relying on increases in background immunity from vaccines and mild infections to get us to better weather — literally and figuratively."
Can high population immunity fend off future waves?
As restrictions begin to lift across Canada in the coming days and weeks, time will tell if our current measures, coupled with the collective immunity levels from vaccines, boosters and infections, will protect us from another COVID-19 surge.
"We certainly have a greater degree of community-level immunity through first, second and third doses of vaccination and through recovery from infection," said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario's COVID-19 vaccine task force.
"And we can't ignore that community-level protection will have some benefits. The question really is now, is that enough to prevent a resurgence of COVID if an aggressive reopening plan is undertaken?"
It's difficult to predict what the coming weeks will bring as restrictions lift across much of the country, Naylor said. But one optimistic scenario could see smaller waves of highly infectious variants in the future that cause less severe disease due to our immunity levels.
That could mean reaching an endemic state with COVID-19, where the virus circulates at a manageable level, without repeated surges that threaten to overwhelm the health-care system. But that may yet be months or years away.
"There will still be a toll — particularly among vulnerable people with compromised immunity or multi-morbidity, and we have to be ready to respond," Naylor said.
"But if that succession of smaller waves becomes the trajectory, I think the level of any restrictions imposed could ease and some sense of normalcy will return."
Whatever the next few weeks may bring, it's important to remember we're not out of the woods yet — but the immunity from vaccinations and infections will hopefully put us in a better position to fend off another surge.
"We will have a very high degree of immunity against Omicron: How will that protect us against the next variant? That's the big question," said Dr. Irfan Dhalla, a University of Toronto medical professor and a vice-president at the Unity Health hospital network.
"Having seen the devastation of the first wave, the second wave, the third wave, the fourth wave and now the fifth wave, my own bias is toward being as prepared as we possibly can for future waves."