As Canadians close the door to 2022 and look ahead to the new year, many may be hopeful they can also look forward to good news when it comes to COVID-19.
But will 2023 be the year the emergency phase of the pandemic is declared over and that Canada recognizes the virus as endemic?
It turns out, declaring or deciding that a virus is endemic is not a straightforward or clearly-defined practice.
But if such a declaration is made in Canada in the coming year, some infectious diseases experts say they are concerned about how this could affect people’s attitudes and behaviours regarding the virus.
While the definition of COVID-19 endemicity may be unclear, SARS-CoV-2 has proven it is capable of presenting new surprises and challenges that can have significant impacts on the health of Canadians and the operation of health-care systems across the country, says Dr. Raywat Deonandan, epidemiologist and associate professor at the University of Ottawa.
“I think we’ve learned that there’s still a lot more to learn.”
How does a country determine if a virus is endemic?
An endemic virus refers to the “constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area,” according to the U.S. Centers for Disease Control (CDC).
But making the official designation of a virus as endemic is not necessarily a scientific endeavour, but rather is more “political” and can vary, says, an epidemiologist at the University of Ottawa.
“There is not a set of criteria that we can use to define endemicity,” she said.
“It is very different from defining a pandemic.”
Infectious diseases specialist Dr. Isaac Bogoch agreed, saying the official designation of a virus as endemic in a country is “not all scientific.”
“A lot of it is based on politics, on perception, and different places might come up with different definitions,” he said.
“I don’t know how globally we’re going to define this, but I do know that it’s important that we not bury our head in the sand and ignore that it’s there.”
The last year has proven the most deadly for the disease in Canada, with over 19,000 deaths recorded to date, according to federal data.
2022 also saw a massive increase in the number of Canadians infected with the virus after the Omicron variant emerged in late 2021 and tore through communities and countries across the globe.
More than 70 per cent of Canadians have likely been infected with COVID-19 since Omicron arrived, compared to less than five per cent of the population who had contracted COVID-19 before Omicron, according to blood test studies funded by the federal government through the national COVID-19 Immunity Task Force.
In addition, Dr. Theresa Tam, Canada’s chief public health officer, told Global News in a year-end interview new federal data also shows about 15 per cent of people in Canada who self-report contracting the virus can experience prolonged symptoms.
While the risks of contracting long COVID are still unknown, the high numbers of Canadians who have been infected with the virus coupled with the fact 83 per cent of Canadians have received at least two doses of the vaccine means many people have acquired so-called hybrid immunity, which some studies have shown provides enhanced protection, Tam said.
And while this is good news for Canada, the fact that COVID-19 immunity wanes over time means it’s still too early to declare the emergency over, Bogoch said.
“The virus continues to mutate as viruses do, and we aren’t entirely sure if another variant will emerge that might undo some of the good that we’ve seen happen through vaccination… and hybrid immunity,” he said.
“Is there going to be another variant that emerges that causes more widespread harm? The answer is maybe. And I think it’s unwise to be overconfident that the worst is behind us.”
What role does data play in determining if a virus is endemic?
Data and surveillance that provides information about how a virus is behaving and changing in a population is key to determining responses, including on decisions about whether it remains an emergency situation, Deonandan said.
But Canada is among many countries that have seen a significant reduction in testing for COVID-19, due to provinces and territories adopting testing policies that rely mainly on rapid tests to detect the virus, which are not tracked.
That means there is less data available to track and understand the impact of the virus, he said.
“It hobbles our ability to explain to the public the status of the disease.”
While some surveillance of the virus does remain, including wastewater testing and some official PCR testing, the only significant signal that a new wave of the virus is present is hospital admissions, Deonandan said.
“That reduces all of the arguments down to what we see in the hospital, which is unfortunate because the argument should be about what we see in the community, but we don’t have a sense of what’s happening in the community.”
The World Health Organization (WHO) has been raising concern about a global drop in surveillance of COVID-19, and has warned this could open the door to a new variant of concern that could cause “significant mortality.”
For the last several months, WHO officials have been urging countries to beef up tracking, testing and sequencing of COVID-19, following a marked decline in surveillance measures as public health restrictions have been relaxed worldwide.
WHO has even added caveats to its weekly epidemiological reports on global COVID-19 circulation and case numbers, noting that any trends “should be interpreted with due consideration of the limitations of the COVID-19 surveillance systems.”
Bogoch says this drop in surveillance and data collection is “problematic” and a “major issue” in Canada and around the world.
“The less data we have, we’re wandering blindly into who knows what, and that can only harm us,” he said.
How declaring COVID endemic could affect responses to the virus
Given that virtually all former public health restrictions have been lifted across Canada, an official declaration of COVID-19 being endemic is unlikely to change much, Sulis said.
But she is concerned about the message such a declaration could send to the public.
“It is important to understand that saying that a disease is endemic doesn’t mean it is no longer a public health problem, because it is,” she said.
Diseases like tuberculosis and malaria are considered endemic in parts of the world where they continue to infect and kill millions of people.
When people talk about Canada moving into an endemic phase of COVID-19, it implies a level of success over the virus, Sulis said.
“But it is not, because endemic diseases still require policies, still require a structured response,” she said.
“It doesn’t mean we can stop bothering about those responses.”
If governments decide to change their messaging to say the virus is endemic, she believes the result could be “problematic.”
Deonandan echoed these concerns, saying he worries about the way the word endemic is used and the implications it can evoke.
“It seems to be an excuse by policymakers to do nothing just because something is endemic… hands up, we can’t do anything about this,” he said.
“High levels of endemicity are not good, and there are things we can still do to push those numbers down if we want to.”
How COVID-19 might impact Canada and the world in 2023
Health Canada says surveillance indicators, including clinical and wastewater testing, show that SARS-CoV-2 is still circulating across the country, and while Canada is past the peak of the last COVID-19 resurgence, “it is too soon to let our guard down.”
The federal agency also said variations in population-level of immunity and current global trends suggest that an uptick in COVID-19 could occur in the new year.
Genetic sequencing data that is available shows continuing increases in immune evasive variants, notably BQ.1 and BQ1.1, while the previously dominant BA.5 lineage variants are declining, said Anna Maddison, a spokesperson for Health Canada and the Public Health Agency of Canada, in a statement to Global News.
“With the increased prominence of these variants in Canada, at a minimum we could see a slower decline and higher plateaus in the number of infections as well as hospital admissions in Canada, as this respiratory virus season plays out.”
The situation in China could also play a major role in the evolution of the virus, as millions of people are now suddenly being exposed to the virus following the decision by the Chinese government to abandon its zero-COVID policy.
Dr. Monica Gandhi, an infectious disease doctor and professor of medicine at the University of California, San Francisco, says she is “very worried” about the situation in China, and how it could lead to new variants of concern that could pose a global threat.
“It’s true that variants do emerge when there’s rapid circulation among a lot of people, and as it is, it is very likely that there could be a new variant emerging from China,” she said.
Deonandan noted that the outbreak in China means about 10 per cent of the world’s population is about to become exposed to COVID-19 for the first time, due to low vaccination levels in that country.
This could have an impact on western countries like Canada that are now taking a “laissez-faire approach to COVID management,” he said.
“I think it’s likely that a new immune evasive variant will emerge, causing further waves,” he said.
“But the good news is that the vaccines continue to work against the worst outcomes. And if we continue to boost and we don’t see any bad effects from boosting, then the ability to curtail transmission should be maintained to some extent as well.”
Bogoch says the key message about the coming year when it comes to COVID-19 is that a lot of uncertainty remains, which means ongoing vigilance is necessary.
“Of course, we all hope that the worst is behind us, and we know that the vaccines have stood the test of time in terms of protecting us against hospitalization and death throughout the entire pandemic, regardless of what variant we’re dealing with,” he said.
“But I think we still have to communicate uncertainty as to what lies ahead, because the virus does continue to mutate as expected. And there may be other variants that emerge that are unfortunately more harmful than normal right now.”
UPEI students offered $1,500 to leave residence during Canada Games – CBC.ca
Some UPEI students are earning extra money during the mid-semester break this year, simply by packing up and leaving campus.
The 2023 Canada Winter Games Host Society offered $1,500 each to students living in Andrew Hall if they give up their residence rooms to make space for arriving athletes.
The students have to leave a few days before the break starts, on Feb. 17, and can return March 7. They also had to give up their meal plan for the duration.
Many athletes are staying at UPEI’s new 260-bed residence, built to meet accommodation requirements for the Games’ temporary athlete village.
But Wayne Carew, chair of the Games, said there are 120 more athletes coming than originally planned.
“We ended up getting 44 rooms [in Andrew Hall] and that’s great,” said Carew.
He said the athletes staying at UPEI “are going to have a wild experience on the campus of the beautiful University of Prince Edward Island.”
Carew said the costs of doing this are a “lot cheaper” than arranging accommodations elsewhere. But he said the main reason is to provide all athletes the same, “once-in-a-lifetime” experience.
“Where they live, the food and the camaraderie and the experience of a lifetime: that’s what they’ll remember in 20 years’ time about P.E.I.,” he said.
‘Pretty good deal’
Some students were eager to take the organizers up on their offer.
“I’m going away to Florida during the two-week break anyways. So I was like, ‘May as well let them use my room then,'” said Hannah Somers.
“It’s $1,500. Pretty nice,” said Benji Dueck, who agreed to vacate the room with his roommate. “We’re moving out, living with a friend in the city. So, sounds like a pretty good deal to me.”
As part of the agreement, the students had to clear out their rooms. Canada Games organizers made arrangements so students could store their belongings.
But not all students thought it was a good deal.
“I’m not giving up my spot in Andrew Hall for $1,500,” said Maria de Torres. “It’s just too hard to pack up. It’s just too hectic. And since I’m an international student, I got a lot [of things] right now.”
Shelby Dyment is also staying in Andrew Hall. Dyment said she and her roommate are working as residence life assistants during the mid-semester break and she’s also doing directed study, so she has to stay on campus.
“There’s a lot of people doing it. It’s just for our situation it just wasn’t working for what we were doing,” she said.
In a statement, UPEI said that enough students had accepted the offer to host all the athletes.
It said the host society made all the arrangements with the students, including paying for their incentives and arranging for storage.
Organizers expect about 3,600 athletes, coaches and officials to participate in the Games. The event will run from Feb. 18 to March 5.
Germany won't be a 'party to the war' amid tanks exports to Ukraine: Ambassador – CTV News
The German ambassador to Canada says Germany will not become “a party to the conflict” in Ukraine, despite it and several other countries announcing they’ll answer President Volodymyr Zelenskyy’s pleas for tanks, possibly increasing the risk of Russian escalation.
Sabine Sparwasser said it’s a “real priority” for Germany to support Ukraine, but that it’s important to be in “lockstep” coordination with other allied countries.
“There is a clear line for Germany,” she told CTV’s Question Period host Vassy Kapelos, in an interview airing Sunday. “We do want not want to be a party to the conflict.”
“We want to support, we want to do everything we can, but we, and NATO, do not want to be a party to the war,” she also said. “That’s I think, the line we’re trying to follow.”
Defence Minister Anita Anand announced this week Canada will send four Leopard 2 battle tanks — with the possibility of more in the future — to Ukraine, along with Canadian Armed Forces members to train Ukrainian soldiers on how to use them.
Canada first needed permission from Berlin to re-export any of its 82 German-made Leopard 2 tanks to Ukraine. After a meeting of 50 defence leaders in Germany earlier this month, it was unclear whether Germany would give the green light.
But following what German Chancellor Olaf Scholz called “intensive consultations,” Germany announced on Jan. 25 it would send tanks to Ukraine, and the following day, Canada followed suit. It is now joining several other countries, including the United States, the United Kingdom, and Poland, which are sending several dozen tanks to Ukraine.
NATO Secretary General Jens Stoltenberg said this week the tanks would allow Ukraine to “significantly strengthen their combat capabilities.”
“It demonstrates also the unit and the resolve of NATO allies in partners in providing support to Ukraine,” he said.
Meanwhile Sparwasser said Germany is “walking that fine line” of avoiding steps that could prompt escalation from Russia, while supporting Ukraine, and staying out of the war themselves.
“I think it’s very important to see that Germany is very determined and has a real priority in supporting Ukraine in its struggle for freedom and sovereignty,” Sparwasser said. “But we also put a high priority on going it together with our friends and allies.”
Sparwasser said despite warnings from Russia that sending tanks to Ukraine will cause an escalation, Germany is within international law — specifically Article 51 of the United Nations Charter — to provide support to Ukraine.
“Ukraine is under attack has the right to self defence, and other nations can come in and provide Ukraine with the means to defend itself,” Sparwasser said. “So in international law terms, this is a very clear cut case.”
She added that considering “Russia doesn’t respect international law,” it’s a more impactful deterrent to Russia, ahead of an expected spring offensive, to see several countries come together in support of Ukraine.
With files from the Associated Press
COVID: Canada retaining Evusheld – CTV News
While Health Canada says it is “aware” of the U.S. decision to withdraw the emergency use of Evusheld, a drug by AstraZeneca used to help prevent COVID-19 infection— the agency is maintaining its approval, citing the differences in variant circulation between Canada and the U.S.
The U.S. Food and Drug Administration (FDA) announced on Jan. 26 that its emergency use authorization of the drug was pulled due to its inefficacy in treating “certain” COVID-19 variants.
The FDA stated in a release on its website that as the XBB.1.5. variant, nicknamed “Kraken”, is making up the majority of cases in the country, the use of Evusheld is “not expected to provide protection” and therefore not worth exposing the public to possible side effects of the drug, like allergic reactions.
In an email to CTVNews.ca, Health Canada said the U.S. Food and Drug Administration pulled the drug as the main variant of concern in the U.S. is XBB.1.5.
“Dominant variants in the [U.S.] may be different from those circulating in Canada,” the federal agency said in an email. “The most recent epidemiological data in Canada (as of January 1, 2023) indicate that BA.5 (Omicron) subvariants continue to account for more than 89 per cent of reported cases.”
On Jan. 6 the FDA said in press release that certain variants are not neutralized by Evusheld and cautioned people who are exposed to XBB.1.5. On Jan. 26, the FDA then updated its website by saying it would be limiting the use of Evusheld.
“Evusheld is not currently authorized for use in the U.S. until further notice by the Agency,” the FDA website states.
On Jan. 17, Health Canada issued a “risk communication” on Evusheld, explaining how it may not be effective against certain Omicron subvariants when used as a preventative measure or treatment for COVID-19.
“Decisions regarding the use of EVUSHELD should take into consideration what is known about the characteristics of the circulating COVID-19 variants, including geographical prevalence and individual exposure,” Health Canada said in an email.
Health Canada says Evusheld does neutralize against Omicron subvariant BA.2, which according to the agency, is the dominant variant in many communities in Canada.
The drug was introduced for prevention measures specifically for people who have weaker immune systems and are unlikely to be protected by a COVID-19 vaccine. It can only be given to people 12 years and older.
“EVUSHELD is not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended,” the agency’s website reads.
Health Canada says no drug, including Evusheld, is a substitute for vaccination.
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