Dr. Laura Hawryluck says she felt something more was coming.
In November 2021, the Toronto-based critical care doctor had just experienced the toll COVID-19’s Delta variant could have on the human body. However, something told her that health-care workers weren’t done with the pandemic yet.
“By the time Omicron attained that level of general consciousness, it had seemed that with the waves of previous variants that we had seen that we were due for another one,” she told Global News.
“The most important thought that went through my mind … was, ‘I hope it’s not going to be as bad as the Delta wave that we had just lived through.’ The concern of having to go through that again and see so many people struggle to breathe, so many people not survive – the thought of that was just heartbreaking.”
One year ago on Nov. 24, a group of scientists in South Africa alerted the World Health Organization (WHO) to a concerning new COVID-19 variant that featured a large number of mutations. Two days later, on Nov. 26, 2021, the WHO declared it a variant of concern, and name it Omicron.
Omicron “altered the course of the pandemic” by infecting millions of Canadians, resulting in the further strain of the health-care system, said Chief Public Health Officer Dr. Theresa Tam in her 2022 review of the pandemic.
Omicron has remained the dominant COVID-19 strain ever since its emergence one year ago, so what does that mean for the future of the COVID-19 pandemic?
“From an evolutionary standpoint, no other variant has yet to evolve to outcompete Omicron. It doesn’t mean it won’t happen, and that’s why many of us watching this are always walking on eggshells because the virus continues to circulate in someone’s lungs somewhere on the planet,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University Health Network in Toronto.
“These viruses are undergoing millions of mutations. You only have to get unlucky once for a mutation to roll around that might outcompete Omicron and replace it, and cause more illness around the world.”
Omicron ‘most noteworthy’ variant of pandemic: Tam
Omicron’s arrival last year marked “perhaps the most noteworthy and rapid changes in the epidemiology of COVID-19 and the public health response,” Tam said in her State of Public Health in Canada 2022 report.
Compared to the Delta variant, Omicron was more transmissible and better able to evade both vaccine and infection-acquired immunity. Waning immunity and an increase in indoor gatherings over the winter exacerbated its spread, Tam said.
Despite being linked with less severe illness when compared to Delta, Tam said, Omicron resulted in an increase in hospitalizations and deaths with more infections reported.
It took four weeks for Omicron to become dominant, and by January, it drove daily confirmed case counts to more than five times the largest number previously reported. Furthermore, COVID-19-related hospitalizations were twice as high as the largest earlier peak, Tam said.
Omicron’s quick spread overwhelmed testing infrastructure, which resulted in many provinces changing eligibility around PCR testing and promoting the use of at-home rapid antigen testing.
During the initial Omicron wave, public health measures like capacity limits were re-introduced in some regions to protect the health-care system. As Canadians rushed to get vaccinated and boosted, hospitalization rates began declining in February, and many of the public health measures began to ease, Tam said.
In Hawryluck’s intensive care unit, she said Omicron didn’t have the same impact as the Delta variant, which drained health-care workers energy further as staffing shortages continued to plague the system.
However, with the WHO currently monitoring more than 300 Omicron sub-variants, the anxiety of a new variant-driven surge remains.
“Every time a new variant arises, whether it’s a sub-variant of Omicron or a new variant, we feel this sense of trepidation that maybe it’s going to be more aggressive and maybe it’s going to be more virulent,” Hawryluck said.
“It’s going to take some time before that anxiety relaxes.”
Where could the pandemic go from here?
This past summer, Omicron BA.5 emerged and became the dominant strain in Canada, driving an increase in infections and severe outcomes. The number of hospitalizations and deaths during the first seven months of 2022 surpassed those reported in the previous year.
Omicron has shot out a number of sub-variants that are still fighting for supremacy, and Omicron will continue to serve as the base of new mutations in the future, said Dr. Craig Jenne, an infectious diseases specialist at the University of Calgary.
“Now, although it was getting breakthrough infections in vaccinated people, what was quite remarkable was vaccines still provided fantastic protection against severe disease,” he told Global News.
“Though somebody could become infected, the vaccines worked very well to limit that infection … and as a result, people had milder symptoms and less risk of hospitalization or ICU admissions with not only the original Omicron, but most of these sub-variants as well.”
In recent weeks Canadian officials have been pleading with the public to stay up-to-date on their vaccinations and wear masks indoors as less restrictive environments have resulted in a resurgence of influenza and RSV, on top of COVID-19.
Flu shots are now available, and Health Canada has approved a slew of COVID-19 vaccines re-tooled for Omicron’s contagious sub-variants.
As the holidays near, and with winter settling in, those measures will be important for Canadians to take to stay protected, Bogoch said. However, there’s still uncertainty in terms of where COVID-19 will go from here.
“There’s going to be another variant and what degree of protection are we afforded with by our vaccinations and our hybrid immunity? There’s still a lot of uncertainty in the road that lies ahead,” he said.
“I get a little uncomfortable hearing some people say, ‘It’s over. There’s nothing to worry about. Let’s move along.’ I think we have to still watch this very closely.”
Hawryluck hopes more Canadians will choose to mask indoors over the next few months.
“It’s a small thing to do. I don’t think anyone is saying that we’re going to have to mask forever, and if we mask right now … and it helps just that little bit or makes a difference for one person, why wouldn’t you?” she said.
“One of the most important lessons from Omicron, from Delta, from this entire pandemic, is that we have to think about ‘we’, and not just ourselves and what’s comfortable for us or how we assess risk, which may not completely reflect the reality.”