5 Experts, 5 Answers

Your top COVID-19 questions answered by some of St. Michael’s and Providence Healthcare’s leading experts.

1. Dr. Peter Jüni, Epidemiologist and General Internist, St. Michael’s Hospital and Scientific Director of the Ontario COVID-19 Science Advisory Table 

Q. What is the data showing about how we’re doing with Omicron and what we can expect?

A. It’s important to think about what makes a pandemic a pandemic. Guess what? It’s us. It’s our lack of immunity that results not only in a high extent of transmission that works out rapidly in favour of the virus, but also in a health-care system that threatens to be overwhelmed.

Now, there are early signs that allow me to be optimistic that we’ll reach a plateau soon – it will still be challenging but it won’t get that much worse.

First, the vaccine has been a game changer. With the roll out of the third doses of the vaccine, we’re catching up on protection. If we didn’t have the vaccines available, every single one of the roughly 2,000 ICU beds in the province would already be filled with COVID-19 patients.

Second, there’s the behaviour of our population. Even before public measures restricting gatherings were instituted, Ontarians reduced their out-of-home mobility, meaning they reduced the number of contacts they had. That’s helped to keep things in check and keep our health system functioning.  In many places – for example, in New York – it’s a lot worse.

Now, I can’t guarantee that we will make it to an endemic state in spring, by which I mean there will be no threat to the health-care system anymore. However, as soon as we all reach some form of immunity – most of us luckily through vaccination, quite a number of us through a combination of vaccination and infection, and a small proportion just through infection – the face of the pandemic will change. It’s this wave that will change things quite considerably. Some form of immunity means a lower risk of hospital and ICU admissions after infection.

What could be the curve ball? It’s if we had a variant that results in even more transmissibility but also more severe disease or an even higher extent of evasion of the immune system. But there are several issues that are important when considering this.

First of all, we made it this far as a species because of a really fit immune system on average that is based not only on antibodies, but also on cellular immunity mediated by T cells, B cells and long-lasting plasma cells. These cells have learned what to do and they stay in our bodies, sleeping; if our antibody levels are low and we get infected, they immediately kick in, even if it’s a different variant. That should help us.

Second, the nice weather will help us. This disease is airborne, so once we move outside, we will be much better off. And next time we move back indoors, in the autumn, there will most likely be an updated vaccine. We’ll hopefully just queue up at the local pharmacy just like we do for the influenza vaccine.

Third, the new antivirals could be tremendously helpful in the future to avoid hospital admissions after infection, once we have received enough doses. This will still take some time.

If the situation weren’t so tragic, it would be fascinating to see how evolution plays out. This virus feels like an evil cousin: we know it very well, it will keep coming back, but we may be able to keep it under control.

2. Dr. Sloane Freeman is a St. Michael’s Pediatrician and Clinician Investigator at MAP Centre for Urban Health Solutions. She is also founder of REACH, a program bringing medical and mental health care to inner-city schools, and was a finalist in St. Michael’s Foundation’s Angels Den 2021. 

Q: As kids head back to school, what do parents need to know?

A: Many parents are concerned about Omicron, but it is important to remember that the vast majority of children who do get Omicron become mildly ill and do not require hospitalization. The single most important protective measure is immunization (2 doses for children and 3 for adults). Parents should ensure they and their loved ones, including children, are vaccinated. Moreover, parents should know that schools have excellent safety measures in place to reduce the risk of transmitting the virus –  masking, cohorting, social distancing, and improved ventilation.

On balance, the risks of attending school are lower than the risks of school closures. Research indicates that youth mental health disorders have increased during school closures, and children gained excess weight. Schools support social and emotional development. They offer access to physical activities and nutritious school-based meals. They provide speech and language support, physical and occupational therapy and special education supports that help children thrive. I am sending my own children – aged 5, 9, 14 and 16 – back to school, and they are all vaccinated.

For more on the science behind the return to schools, read the brief from the Ontario COVID-19 Science Advisory Table.

3. Dr. Stephen Hwang is Director of MAP Centre for Urban Health Solutions and Chair, Homelessness Housing and Health, at St. Michael’s Hospital. 

Q: What’s been the impact of Omicron on people experiencing homelessness, who bore a big brunt during earlier waves? Has anything that was put in place earlier (e.g. isolation hotels, vaccination programs in shelters) helped alleviate the burden on them? 

A: Omicron has swept through the homeless population in Toronto. Currently there are outbreaks or suspected outbreaks of COVID in more than 50 shelters.

The isolation hotel is at full capacity, and the very large number of new cases means that people experiencing homelessness who get COVID are “isolating in place” at their shelters rather than going to the isolation hotel.

Vaccination efforts are continuing, with good success, which is certainly reducing the health impact of the current wave. However, the turnover of people in shelters means that vaccination efforts have to continue to reach people who were not at the shelter during previous vaccination visits.

I have two major concerns right now. First, given the cold weather, we have to ensure that there is enough capacity at shelters to accommodate people and allow them to get out of the cold, despite ongoing outbreaks. Second, in the spring, many of the shelter hotels will likely close, and I’m concerned about where the people who are currently staying at these sites will go. We are urgently working to help some people make a transition to housing, rather than going back to shelters. 

4. Dr. Sharon Straus, Physician-in-Chief and Director of the Knowledge Translation Program, St. Michael’s Hospital 

Q: Long-term care facilities are experiencing another upsurge in cases that’s also impacting staff. What’s being done to manage the pandemic in these and other congregate living settings during this latest wave?

A: When the pandemic hit, St. Michael’s and Providence marshalled a team of over 70 long-term care and retirement homes, along with 40 other academic and community partners. We set out to identify risk factors among residents, staff, essential care partners and homes. We worked together to promote infection prevention and control, along with staff wellness, and improve vaccine confidence.

Those earlier efforts have informed the decisions to provide the third and now the fourth doses to individuals in long-term care homes. We’ve also implemented rapid testing for COVID and influenza in shelters, long-term care homes and retirement homes.

Our research team has been supporting the workers in those facilities, as well as in retirement homes and shelters. For example, we’re providing saliva testing for COVID-19, so they can return to work more quickly, once we know it’s safe for them to do so. We also have a number of resources, accessible on our Wellness Hub, to support their wellness if they are being quarantined. 

5. Dr. Kamran Khan is an Infectious Disease Physician based at our Li Ka Shing Knowledge Institute. He’s also founder and CEO of BlueDot, a social enterprise that leverages AI to spot current and future global epidemic threats.

Q: If Omicron is this transmissible and straining ICUs, what other COVID-19 variants of concern might be coming down the line? 

A: So long as SARS-CoV2 continues to infect large numbers of people around the world, new variants will inevitably arise. Some of those variants might be more intrinsically infectious than earlier ones, better at evading our immune responses from vaccines and/or prior infections, and potentially cause more severe illness – thereby placing further strain on our fatigued frontline healthcare providers. 

This is why it is so important for everyone to get vaccinated as soon as possible – not just here in Canada, but around the world. As we’ve seen with Omicron, it doesn’t take long for an emerging variant appearing anywhere to wind up everywhere. But by driving the number of COVID-19 infections down worldwide through vaccination, we can significantly reduce the probability that a dangerous new variant will emerge and cause the kind of disruption we are all living through right now. This underscores the fact that we are all in this together.   

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