It’s hard to say something new about the pandemic the same way it’s hard to say something new about the weather: you can talk about changing conditions, how it’s affecting your day, but for most people, it’s part of life on the planet right now. Some people appreciate umbrellas or sunscreen. Some don’t and don’t care if they or others get sunburned or wet.
And as Ontario’s sixth wave peaks — hopefully, as sewage signals continue to jump after the holiday weekend, even as hospitalizations have leveled off — it’s both a revealing and uncertain moment. It’s telling in that a lot of people have decided that the pandemic is something that happens to other people, and in a way, a lot of people are right; the atomization of collective responsibility, this backtracking to ignore vulnerable parts of society, is basically life returning to a pre-pandemic normal.
This moment is uncertain because the pandemic is not over, as everyone wishes. This wave is still not over and hospital systems are quietly degrading due to loss of personnel and volume. Hospitals will be the last place it will be over. And there’s still so much we don’t know.
Start with the variants. They still take place on the Omicron branch of the tree, with BA.2 (here and elsewhere) and BA.4 and 5 (South Africa and elsewhere, and which seems to be very good evade Omicron post-infection immunity in unvaccinated.) South Africa is at the start of a new wave that could portend a version of the future: recurring and punitive waves every six months or so, each with a new version of COVID as immunity wanes.
And more variations are coming. We just have no real idea what exactly they will do.
“I think we’re quite certain that other variants are emerging,” says Dr. Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Saskatoon. “I think we have absolutely no idea how important they will be in terms of public health.”
The variants of concern outshine other strains: Omicron variants are as transmissible as anything we’ve ever seen in measles. Rasmussen explains that when viruses replicate so quickly, they don’t care if you get sick: by the time they’ve infected a new host, what happens to the host is no longer the problem of the virus at all. .
“There’s been this persistent myth that viruses have always evolved to be less pathogenic, but that’s just not true,” Rasmussen says. She points out that in a highly vaccinated population like Canada’s, selection pressures on the virus may include vaccine avoidance or post-infection immunity, or even T-cell immunity, which could also result in gravity changes. She points to work led by Dr. Vineet Menachery of the University of Texas Medical Branch at Galveston on the virus’s nucleocapsid protein, which in animal models is a control of gravity.
“There could therefore be mutations occurring outside the peak (protein, where the majority of mutations occur) of which we have no idea of the functional consequences,” explains Rasmussen. “This could make the virus potentially more transmissible, more infectious or more pathogenic. And it’s really scary to think about.
After Omicron’s incredible luck – which was initially thought to be only about a quarter less serious than Delta, and found itself closer to 50-70% less likely to send people to the hospital – we might get lucky again. We might not.
This brings me to the other questions. We don’t yet know how long it takes for three-dose vaccine protection against severe outcomes to wane, or how Ontario and Canada will push for better three-dose coverage everywhere. The University of Toronto model earlier this week that showed the unvaccinated are dangerous to the vaccinated was observed anecdotally by healthcare workers: an older relative with waning protection after just two doses and a young unvaccinated family member, for example. This vulnerability is also seen in the United States: as the Washington Post wrote, in California and Mississippi, “three-quarters of vaccinated elderly people who died in January and February had not received booster doses.”
“It’s a three-dose vaccine,” says Dr. Peter Jüni, outgoing scientific director of the Ontario Independent Volunteer Science Table. “The fourth dose is the first real booster, but the question now is how long will it be before the effectiveness of the third dose against hospitalization really starts to decline to any relevant degree.”
Beyond that, there are implications that we are only beginning to grasp. We don’t know how long COVID is prevalent, especially after Omicron, or how much one, two or three doses help. I have a ridiculously healthy and fit friend who took Omicron in January, just before his third dose: he has been suffering from headaches, brain fog and low energy for four months. In an age of almost deliberate mass infection, it’s a lottery.
“We estimate that about 45-55% of the population of Ontario has been infected with Omicron,” says Juni, “so if the risk of developing long COVID only increases or decreases by a percentage or two , this is extremely relevant because the numbers are so big.
Then there are habits. As the precious Ed Yong recently wrote for The Atlantic, climate change is pushing animals to different habitats, increasing the risk of the virus spreading between unknown species. We live in the pandemic – an era where pandemics will become more common. This is where the measures we should be implementing – normalizing masking in places where high-risk people need to go, improving ventilation, more incentives for vaccinations and adapting to life with the viruses – should come into play.
So right now, Ontario’s sixth wave may be peaking, and the weather is improving, and while it still entails a huge burden of suffering, much of society seems to have accepted it. Maybe Ontario can ignore the weather for a while, even if COVID isn’t over: as Rasmussen said, with a half-laugh, “I just want to get back to working on Ebola. I miss Ebola. She can’t get over it yet.
Bruce Arthur is a Toronto-based columnist for The Star. Follow him on Twitter: @bruce_arthur