The fall of 2020 was marked by a large and unexpected jump in COVID-19 cases, one that signalled that the pandemic was gaining a foothold. What followed was a sharp increase in hospitalizations and deaths.
With the fall of 2021 came a new twist, the far more contagious Omicron variant, and a dramatic surge in cases that saw almost two-thirds of the population infected or re-infected. Hospitals felt the strain again, but not with the same pressures on intensive care units. The proportion of people dying fell, but there were more COVID-19 deaths than ever because of the sheer number of cases.
So what can we expect from the wily coronavirus pandemic in the fall of 2022?
Early indications are that another wave is coming. (Canadian infection patterns have closely mimicked those in European countries like Britain, with a lag of a few weeks, and U.K. cases are up sharply.)
The good news though is that the immunity the population has built up over the past 30 months – a combination of vaccination and infection – is resulting in fewer severe cases.
The most important pandemic metric remains hospital capacity. Unfortunately, Canadian hospitals have little wiggle room. Well-known problems – overflowing ERs, bed shortages and staffing woes, and more – are chronic and it won’t take much of an increase in serious COVID-19 cases to push some to the brink.
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Still, with the lifting of restrictions and abandonment of protective measures, we are acting like the pandemic is over. That means, for all intents and purposes, it is – at least politically and socially.
There is little appetite anymore for collective actions. That means individuals have to manage their own risk, and that’s not easy in the shifting landscape.
The best protection against COVID-19 remains vaccination. The vaccines don’t provide great protection against infection but they still work remarkably well at preventing hospitalization and death.
The latest data from the Public Health Agency of Canada show that unvaccinated people are about seven times more likely to be hospitalized and eight times more likely to die than those who have had three shots.
Unfortunately, pandemic fatigue has also resulted in waning enthusiasm for vaccination. A really high number of eligible Canadians, almost 87 per cent, opted for the first two doses. But barely half has received a third dose and, fewer than 14 per cent of people have received a fourth dose (or, if you prefer, a second booster).
Confusing messaging about who should get bivalent vaccines, and when, hasn’t helped. The reality is that the timing of boosters now depends largely on personal circumstances, and requires some personal risk assessment.
But most people seem to be in a holding pattern. Only about 14,500 shots are now being administered daily countrywide.
Almost every COVID case in the world is now the Omicron variant, principally BA.5 and BA.4. But scientists are closely watching some concerning subvariants like BA.2.75., BQ.1.1 and XBB. (Yes, the names are getting ridiculous but a return to the Greek alphabet, and the emergence of Pi, would likely be even worse news.)
The subvariants, which still only make up a tiny percentage of cases, have mutated to evade immunity. Practically, that means vaccines will be less effective.
More concerning though is that the few treatments we have, like monoclonal antibodies, are not working against the subvariants. That leaves those who are at high risk of severe disease, like the immune compromised and frail elderly, at higher risk of death.
For the general population, however, infections (most of which will be re-infections) are likely to result in less severe disease. Symptoms are also changing: Sore throat is now the most common COVID-19 symptom, not cough or loss of smell.
However, there is growing evidence that re-infections result in more long-term problems, like a doubling of heart attack risk.
The parallel epidemic of long COVID also continues apace. It remains unclear if Omicron infections are more or less likely to cause long COVID.
As we enter the third fall and winter of the pandemic, it remains unclear if it is manageable yet.
Dr. Katelyn Jetelina, author of the Your Local Epidemiologist blog on Substack, describes the current state of things well: “We’re in a really weird spot of the pandemic where we’re getting this tug-of-war between the urgency of normal and a state of urgency.”
Editor’s note: Roughly 14,500 Canadians are currently receiving COVID-19 vaccines daily. The initial figure cited (4,500) was incorrect.