Ontario doctors give a glimpse of life after the COVID pandemic

We will soon be able to hug again.

As the province comes down the other side of the third wave of COVID, the Ontario Medical Association gave a glimpse Wednesday of what life will look like after the reopening.

Hugs will be on the table" as early as the next couple of months as more people are fully vaccinated with two doses, says Dr. Zain Chagla, co-medical director of infection control at St. Joseph's Healthcare.

On the flip side, masks are here to stay for a while longer.

With variants circulating, we want to be careful about ripping off masks very quickly," said Chagla who was among four doctors discussing how the pandemic will end.

Is the pandemic over?

Not yet, says Dr. Allison McGeer, infectious disease specialist at Toronto's Sinai Health System.

It's going to be a hard winter," she warns. Although, she stresses it will be better than what Ontario has been through already.

The virus will get to the whimpering stage next summer," she said. This is not (out) with a bang, but with a whimper. It's just a question of when the whimper is coming."

Will COVID disappear?

Many of us have this vision in our heads of the pandemic ending with a light switch - cases essentially come down to zero and life goes back to normal," said Chagla. I think people have to become comfortable with the fact that COVID-19 is going to be around for the foreseeable future and probably into the long-term future ... It has fundamental characteristics of a disease that isn't about to be eliminated."

Will COVID always be a threat?

We have vaccines which have essentially turned this disease into something that can be managed much more as an outpatient where a fully vaccinated individual faces a much lower risk of significant complications," said Chagla.

The hope is COVID will become a mild illness but there's also the possibility it could be similar to flu.

We may end up with a situation that is like influenza," said McGeer. It's no longer nearly as serious a disease but it's not a trivial disease and we are going to need ongoing vaccination programs."

She said it will be at least nine months and possibly years before the future danger of COVID is known.

The Phase 1 trials of combined influenza and SARS-CoV-2 vaccines are already running, said McGeer. People are working really hard to make sure that if we do need them, we have the right set up and we'll get them in time."

What happens when Canada has herd immunity?

The end of the pandemic in Canada ... isn't necessarily the end of this pandemic," said Chagla. We need to think about the global exit plan ... recognizing this doesn't end until everyone has equitable access to vaccines. ... The development of variants of concern is going to be directly linked into that epidemic outbreak spread in areas with incredible vulnerability based on their population. We as Canadians could lose progress in terms of what we've achieved in the last six months if a variant of concern emerges ... that breaks through vaccines. That changes the game altogether."

Will life go back to normal?

We'll probably see a small portion ... they are just going to go wild," said Dr. Thomas Unger, psychiatrist-in-chief at Toronto's St. Michael's Hospital.

They're just going to be out there partying like nothing happened, over the top, ignoring any continued risks or cautions from us - we might already be seeing some of that.

He says the majority will be cautiously dipping their toe in the shallow end."

They'll gradually slide back into most of our normal life routines but with some possible changes," he said. It won't be a sudden thing."

A minority will remain fearful and avoidant."

We will see a small segment ... who will have some difficulty getting back," said Unger. They might need a little bit of support and encouragement but most of them will come around."

Unger said for the most part people are more resilient than we often give them credit for."

When can we travel?

To travel unabated to other parts of the world is going to be still tricky," said Chagla. I can see the United States probably being our first partner and then elsewhere after that. It's not going to be as simple as you can fly to anywhere at any point in time."

He said travel will likely be dependent on a country's vaccination, transmission and circulating variants.

What about vaccine passports?

There are a litany of ethical, legal and privacy issues that go along with the need for a vaccine passport," said Chagla. How do you enforce? What types of exclusions are allowed? ... Do I think we're probably going to tie vaccines to things like travel - absolutely. ... Do I see it being tied to a place, like going to a concert or going to a movie, then you create a litany of other issues that are really difficult to wrangle with."

Will there be lasting mental health effects?

Unger calls it the coming mental health wave." It's health care workers who held the hands of the dying, families who couldn't have a funeral or financial devastation when government support stops.

Our concern is with an already stressed health system often operating at around 100 per cent most of the time anyway, where is the flex capacity to absorb that increased requirement for care," said Unger. Mental health and substance use disorders has been ... systemically under resourced and funded ... Will it be addressed in time for it to catch up with the coming mental health wave? ... That's what we're really worried about."

What about Ontario's reopening plan?

I think our plan is reasonable," said Chagla. The opening plan in Ontario prioritizes the outdoors more, tries to integrate low risk activity and then push into higher risk stuff and tie it to vaccinations ... It leaves a lot of wiggle room both to speed things up but also to slow things down."

What will signal the end of the pandemic?

When it stops being the thing that is worrying everyone more than everything else that will tell us that we've moved on," said Dr. Samantha Hill, president of the Ontario Medical Association. When COVID stops being the automatic fill in ... on your Google search."

For Chagla, it's when ICUs empty out and the health care system gets back to normal.

That's probably going to be the sign that this has changed fundamentally into an outpatient disease," he said. We're not there yet but I think that is what our future holds in the foreseeable few months."

McGeer measures it in immunization saying, I think the sign of it coming to an end is when we're up to around 40 or 50 per cent of the world's population vaccinated."

For Unger it will be getting back to my life ... without impairing my life."

Going to see some live music or maybe having company for dinner because I feel comfortable doing that," he said. That will be my moment."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com