Masks, boosters, self-isolation aren't behind us yet

These days fewer people are wearing masks and life is largely back to normal in Ottawa but the pandemic hasn't ended, said Ottawa's medical officer of health on Tuesday.  (Brian Morris/CBC - image credit)
These days fewer people are wearing masks and life is largely back to normal in Ottawa but the pandemic hasn't ended, said Ottawa's medical officer of health on Tuesday. (Brian Morris/CBC - image credit)

Take a ride on the O-Train or head to the mall and Ottawa feels much like it did before 2020 — entire faces are visible, coughs and sneezes are ignored, coffee shops no longer balk at reusable mugs.

Nearly four weeks after the World Health Organization declared the emergency phase of the pandemic over, and just over three years since the pandemic began, SARS-CoV-2 has faded from headlines and even from small talk.

But Dr. Vera Etches, Ottawa's medical officer of health — the woman who led the city's public health response since the first lockdown in 2020 — isn't ready to declare the pandemic over yet.

"COVID-19 has not disappeared. It is still with us," Etches said in an interview with the CBC's Omar Dabaghi-Pacheco Tuesday. "We're in a more stable situation where we're not seeing the same serious outcomes."

Etches referred to this phase as "a better place."

Ottawa's current wastewater signal is fairly flat, hospitalizations are down and the number of people who have died from COVID-19 this month is the lowest it's been since last June. Ten people have died in the city so far this month.

Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, thinks COVID-19 may be entering a "hyper endemic phase."

Better for most, but not all.

"It's more like the flood waters are always at our knees," Deonandan said Monday. "We're at a point where we expect a large number of cases pretty much all the time."

Dr. Fahad Razak, a professor of epidemiology at the University of Toronto and an internist at St. Michael's Hospital, calls this moment in the pandemic as the "adaptive phase" as opposed to the "responsive phase."

The flood waters are always at our knees. - Raywat Deonandan, Epidemiologist 

"I think we are certainly in a transition toward what could be an endemic virus," said Razak, who also served as the scientific director of the Ontario COVID-19 Science Advisory Table before it was disbanded in the fall of 2022.

Unlike other endemic illnesses like measles or tuberculosis, given the scale and spread of COVID-19, Razak thinks a better analogy might be heart disease. COVID-19 risks will have to be managed in the decades to come like high blood pressure.

There's no excuse for governments to be caught "flat footed," he said, in the fall or winter months next year by a surge of COVID, for example, when we know relatively brief periods of masking can blunt its spread.

"That kind of decision making I think would be the adaptive response that I'd like to see," Razak said.

To predict behaviour of future variants, Razak also thinks Ontario should resume COVID-19 modelling so public health agencies have time to prepare for a potential bad wave.

Focus on those at risk

Given the virus continues to swirl, Deonandan and Razak each said they want to see more of a focus from public health officials on protecting those who continue to become very ill.

"The immunocompromised, the disabled, the elderly, they are now encumbered with navigating this crisis on their own, which is unfortunate," said Deonandan.

"It's the opposite of what public health is meant to be, it's meant to be a community effort to keep everybody safe,"

Deonandan is calling for continued messages about staying home when sick and mask-wearing in crowded spaces. Razak wants to see public health officials emphasize the importance of boosters for high-risk people.

Trevor Pritchard/CBC
Trevor Pritchard/CBC

According to the latest available data from Public Health Ontario, fewer than half of those in the province between the ages of 60 and 69 have received their second booster (fourth dose), while 65 per cent of people in their 70s and 70 per cent of people over 80 have received their second booster.

"That's the kind of disconnect that's really important to realize," said Razak.

Ontario recommends high-risk people receive a booster shot if it's been six months since their last dose or last confirmed case of COVID-19. At-risk adults should also consider getting tested if they believe they have COVID-19 so they can access treatment.

Etches agrees the messaging from public health has shifted to an approach that focuses more on individual responsibility, but she said that reflects the need to give people a chance to resume normal life and the improved outcomes.

"Part of public health's role is to explain what the current context is to help people make informed decisions," she said.

Still, it might be a good idea to hold onto masks for a while longer.

While the summer looks like it should offer a few months of COVID-19 stability, Etches expects masks will be needed again during the next cold and flu season. She also said Ottawa Public Health has no plans to end its COVID-19 surveillance program.