Five key things you need to know this fall about COVID-19

“At this stage of the pandemic, it’s about layering protections as much as possible.”

As Ontarians move into the colder months, we talked about all things pandemic with Dr. Fahad Razak, a general internist and epidemiologist at St. Michael’s Hospital. The former scientific director of Ontario’s COVID-19 Science Advisory Table tells us what to expect from COVID-19, why we should consider taking the latest vaccines, and how we can continue to protect the people who remain the most vulnerable to the virus.

By all accounts, we’re at the tail end of the seventh wave of COVID-19, and there’s already talk of an eighth surge due to the COVID-19 variant, BA.5. What should we anticipate from a new wave? And how equipped are hospitals to handle another one?

We really don’t know if an eighth wave of COVID-19 will occur or not. The data suggests that the seventh wave, driven by BA.5, is still active, and the wastewater signals and positive COVID-19 tests have plateaued at a high level. So we hope that as we head into the fall, we’ll see a clear pattern of COVID-19 receding. But that hasn’t happened yet. The real question is whether we’ll see a rise in this seventh wave. With more than 2 million children now back in school in Ontario and the onset of cold weather, there are factors that may accelerate the virus’ spread in the weeks ahead.

The traditionally busy fall and winter seasons could be very tough for our hospitals, which have already had to deal with three to four surges of COVID-19 each year. This has placed enormous pressure on the health system, leading to burnout and absences of nurses and other healthcare workers, as well as longer wait times. Even if there’s a modest COVID-19 wave and a recurrence of influenza, the aggregate effect of illness could be very bad on hospitals given their existing constraints. In medicine and public health, we have to worry about these things happening simultaneously.

To what extent should parents with school-aged children or those in daycare be concerned about COVID-19 transmission? What can they do to stem the spread?

This is close to my own heart. I have two children under the age of five: one is in kindergarten, and the other is in daycare. Earlier this year, both became infected with Omicron and brought it home. Then my wife and I got sick, too. My kids were very fortunate in that they didn’t end up in hospital, but both were as sick as we’ve ever seen them. My wife and I are triple vaccinated and otherwise healthy. But it was very disruptive to family and work life, for weeks.

So I worry about families with young ones. The good news is there are now vaccines available for all age groups – our own kids, in fact, got vaccinated, along with many other physicians’ children. I encourage parents to speak to their pediatricians or family doctors about what vaccine or booster is right for them. Other layers of protection available include masks, which we shouldn’t forget about. To me, every infection that is avoided is a good thing.

Ontario Chief Medical Officer of Health Dr. Kieran Moore has urged healthy Ontarians to receive the new bivalent vaccine – made specifically for the BA.1 Omicron subvariant – as their third or fourth dose. We’re also learning more about Novavax, the newer vaccine that uses the same technology as the flu vaccine and reportedly provides a high level of protection. What’s different about the bivalent booster and Novavax vaccine, and who should take them?

The bivalent vaccine is an excellent option – I recently received mine. At this stage of the pandemic, it’s about layering protections as much as possible. This booster is a better option for many people because it has a second component that targets Omicron, which has been the dominant version of the virus this past year. It will offer you protection against all existing, major Omicron variants, including BA.5, which is the most common version in Ontario right now. And the hope is the bivalent vaccine will give you some protection against the next variant in the Omicron family that emerges – along with an opportunity to increase your immunity – as we enter the higher-risk fall and winter seasons. Unless you’re newly vaccinated or have been infected with the virus in the last three months, getting this booster right now will be especially helpful for most people.

Novavax, on the other hand, is not heavily used in Canada. We have established a pattern of using the mRNA vaccines because they’ve been proven to be very effective. In fact, the majority of clinical evidence shows this. So I think that for the vast majority of the public, the mRNA vaccines are the way to go. But there are people out there who haven’t been vaccinated because of concerns about mRNA technology. To them, I say ‘please go out and get Novavax.’ It’s a good option for you, too, as it’s based on older, traditional vaccine technologies.

Despite the wider availability of vaccines and boosters, which vulnerable populations should we remain hyper-vigilant of?

We really have to worry about the most vulnerable in our communities, especially people who are older and immunocompromised because of a disease they have or a medication that they’re taking. We must also be concerned about the many school-aged children who are unvaccinated. The evidence suggests that when there are high degrees of spread, the virus finds a way of getting to vulnerable people.

To me, it’s about getting as close as possible to ‘normal life’ while reducing harm. There are important things we have to do, which I consider lowest burden steps, even if policymakers say that they’re no longer required. This doesn’t mean closing schools and businesses, or reducing capacity, but rather getting vaccinated; using rapid tests and staying home when we’re sick; wearing masks and keeping doors and windows open in crowded, indoor settings; improving air ventilation and filtration; and retrofitting buildings altogether. Although it may seem difficult, at times, this ‘vaccine-plus’ strategy helps to lower viral spread and protect vulnerable people, who may not get enough protection from vaccines, alone. Also, investments in improving air quality should give us long-term benefits – not only around COVID-19, but also for all other respiratory infections like influenza, which have caused us harm year after year.

We’ve heard a lot about the transition from the pandemic to an endemic. The WHO Director-General Tedros Adhanom Ghebreyesus recently suggested the end of COVID-19 – as a pandemic illness – is in sight. To what extent will COVID-19 remain a part of the infectious disease landscape?

COVID-19 will hang around as an illness – at least for the near future – probably indefinitely. It’s already in the animal reservoirs, so many different kinds of animals around the world have now caught the virus, and the virus is propagating in them. Even if we’re able to eradicate it within humans somehow, the virus would probably spread back from animal populations. But hopefully, COVID-19 will be like other respiratory viral illnesses: it won’t become something that dominates the health system in these relentless surges, as we have experienced. Hopefully, it will fall into a pattern of predictable, manageable surges on an annual basis.

Meanwhile, there are still billions of people across the world who have not been vaccinated. So we need to address huge imbalances, even within wealthy countries like Canada, in terms of the availability of vaccines and treatments. There is a lot of work to be done.

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