After 3 years of COVID-19, here’s how Canada’s ‘endemic’ future may look

On March 11, 2020, the world came to a screeching halt when the World Health Organization declared the COVID–19 outbreak a global pandemic.

Schools across the world shut down, workplaces turned remote and the fast-spreading virus revealed the fragility of many countries’ health-care systems. Since then, the virus has claimed close to seven million lives, of which more than 51,000 were Canadians.

Fast-forward three years and COVID-19 hospitalizations and deaths are declining, more than 70 per cent of Canadians have contracted the virus at least once and effective vaccines and treatments paired with previous infection have allowed many to live somewhat normal lives again.

Some experts now say the pandemic is slowly transitioning to an endemic state — when a disease, like COVID-19, is consistently present, often within a particular area or region. Examples of this include the flu, malaria, ebola and hepatitis B.

“I think we are seeing that point,” explained Dr. Zain Chagla, infectious disease physician and associate professor at McMaster University in Hamilton.

“We are seeing death rates lower since the beginning of the pandemic, we’re seeing health care utilization slowing, we are seeing the population having immunity to this,” he said.

Dr. Theresa Tam, Canada’s chief public health officer, echoed this sentiment.

Speaking at a media conference Friday, she said Canadians should not expect a surge of COVID-19 in the upcoming months.

“We are now at a point in Canada where COVID-19 activity has reached a relatively steady state. In recent months there have been no distinct variant-driven waves,” she said. “Over the past six to eight months COVID-19 hospitalizations have been relatively stable despite the ongoing spread of Omicron subvariants.”

In light of the good news, Chagla warned COVID-19 will be around for “quite some time as it’s reached every corner of the Earth,” meaning there will be future challenges with infection and hospitalization – especially for older and immune-compromised Canadians – just like there is with influenza every year.

But if the virus is here to stay, at least in the near future, will society ever be able to recover when a persistent threat of a new variant remains just over the horizon?

New variants are likely to circulate, Chagla warned, but the impact may not be as profound as it was in 2020 or 2021.

“Many have been infected with Omicron or had a vaccine and because most of the population has seen the virus as well as a vaccine, it makes a higher barrier for health destabilization to happen,” he explained.

Danielle Rice, assistant professor at McMaster University in the Department of Psychiatry & Behavioural Neurosciences, said if there are more variants on the horizon, it may cause anxiety for some, but many people may have become accustomed to the consistent threat of a new variant of concern.

Rice, who is also a clinical and health psychologist in supervised practice at St. Joseph’s Healthcare, said people’s mental health has been “resilient” during COVID-19 and likely will continue.

“There have been challenges, such as folks that may feel distressed with the reality that we may be living with COVID-19, but on the other end are folks adapting to this new reality,” she explained.

“In general that’s how anxiety works, the more we are exposed to something, the less anxiety we face.”

New variants may emerge in the future, but testing for COVID-19 may not be as prevalent, Chagla said.

Instead, the message from health officials may be simply to stay at home if you are sick, he added.

“I think the guidance of staying home while sick is more effective from a long-term standpoint,” he explained. “Rather than saying, with one disease you isolate and another disease, you don’t isolate.”

At the end of January, Health Canada announced it was ending shipments of rapid antigen tests to provinces and territories.

Supply is not an issue as Ottawa and provincial health authorities have millions of rapid tests in their stockpile. However, demand appears to be waning, according to officials.

“It’s not surprising, just given the fact that we are starting to see this gradual transition out of the pandemic into a little bit more of normal life,” said Dr. Gerald Evans, infectious disease specialist at Queen’s University in Kingston, Ont.

“So it may be that a year from now or so, the rapid test may not be necessarily useful,” he told Global News.

As the virus has mutated over time, the emergence of new variants has also reduced the sensitivity of the antigen tests, said Evans.

But, Evans argued that cutting back on supply might make it difficult for people who want to continue testing themselves, and many may have to start paying for it.

If people end up having to buy them, Evans suspects most won’t be keen on spending out of their pocket.

Last week, Canada’s national vaccination advisory body advised high-risk individuals to get another COVID-19 booster shot, starting this spring.

The National Advisory Committee on Immunization’s (NACI) recommendations said an additional vaccine shot may be offered for people at a higher risk of severe illness, such as the elderly, those living in long-term care homes, and Canadians who are immunocompromised.

Chagla explained that focusing on boosting the high-risk population is likely the approach Canadian health officials will keep using in the future.

“We are starting to see a switch (of booster campaigns) to really focusing on highest risk and focusing less on lower risk populations,” Chagla said.

Although vaccine rates are dropping among the lowest-risk population, he noted it’s still too early to say if Canada will soon recommend an annual COVID-19 booster.

In January, the U.S. Food and Drug Administration (FDA) asked its scientific advisors to consider simplifying COVID-19 vaccination to encourage most adults and children to get a once-a-year shot to protect against the virus.

Under this proposal, Americans would no longer have to track how many shots they’ve received or how many months it’s been since their last booster.

Canadian health officials have not indicated whether they are considering a similar proposal, but in a statement to Global News, Health Canada said NACI “continues to monitor evolving evidence, including evidence on the potential need or benefit of booster shots, and will update recommendations as required.”

As Canadians start heading into a new COVID-19 chapter, one where federal health officials are moving towards treating the virus like a “regularly occurring disease,” experts warn not to forget about the vulnerable population.

“Going into this pandemic phase … for most people that means going back to normal. But it’s important that resources for the highest-risk populations are maintained,” Chagla said.

“If we’re going to cut back on testing, we really do need to make sure testing is still there for the high-risk population. And if we’re going to cut back on vaccinations, vaccinations need to be easily accessible to those people that need to get them.”

Rice agreed.

She explained that pre-pandemic, society made sure to focus on protecting infants, the elderly and the immunocompromised from getting infected during the cold and flu season.

It will be the same battle moving forward with COVID-19.

“These are some transferable skills that are actually now able to take to the COVID-19 pandemic, potentially going to this endemic situation,” she said.

— with files from Teresa Wright and Global News’ Saba Aziz