Is the last major COVID wave behind us and what comes next?

The last significant wave of the pandemic could be behind us, say Ontario's doctors.

Hope" and optimism" were the words the Ontario Medical Association used Wednesday to describe the summer.

But with the aggressive Delta strain, holding off a fourth wave depends on the race toward a crucial two-dose summer" and residents following the rules of Step 2 after the province opened up further Wednesday.

With vaccination significantly lessening COVID's threat to the health-care system, attention is turning to the staggering backlog left in the pandemic's wake.

At Hamilton hospitals alone, it adds up to 11,300 surgeries.

What will it take to get to Step 3?

The vaccine target has already been met - it was 70 to 80 per cent of adults with a first shot and 25 per cent with two doses. Hamilton is at nearly 75 per cent with one dose and 35 per cent fully vaccinated.

However, Ontario's chief medical officer of health, Dr. Kieran Moore, says it takes at least 14 days after the shot to build immunity so a cushion is required.

There are also other factors at play such as hospitalizations, how fast the virus is spreading and trends around the world.

Moore said Tuesday that he wouldn't support moving into Step 3 before July 21.

We need that 21 days to be able to understand the impact of opening on our communities," he said.

Why is Ontario so cautious?

The Delta variant could cause a fourth wave. It's already behind spikes in parts of Ontario, including Waterloo. Moore says it has the potential for rapid explosive outbreaks."

It is a difficult adversary," he said. It's aggressive, it wants to spread rapidly."

If not kept under control, he says Delta jumps from one person to six to 36 to 216 in a three- to five-day cycle.

If it gets a foothold in a community, Delta spreads fast, particularly among the one in four who have not been vaccinated.

To keep Delta at bay, Moore urges Ontarians to go for testing when sick and get immunized as soon as possible.

Can the fully vaccinated get back to normal?

Ontario doesn't have separate rules for those who have had two shots - all must follow what is set out in Step 2.

The Public Health Agency of Canada put out guidelines June 25 but they don't apply yet.

For now, public health measures such as physical distancing and masks are still required.

Are hospitals back on track?

The worst is likely behind us," Ontario Hospital Association CEO Anthony Dale tweeted Wednesday.

Vaccines protect against severe illness to the point that Ontario's former chief medical officer of health, Dr. David Williams, called COVID hospitalizations and deaths now mostly preventable.

At Hamilton's hospitals, surgeries have been restored to just over 80 per cent of regular volumes. For procedures, it's between 65 and 74 per cent.

However, the backlogs created by the pandemic are immense. Hamilton Health Sciences has a wait list of 5,600 surgeries, while at St. Joseph's Healthcare it is 5,700.

Do vaccines mean COVID has been defeated?

Vaccine distribution hasn't been equitable around the world. Moore pointed out in June that 90 per cent of the globe is not immunized.

That is where the virus continues to circulate, where mutations will develop and any returning traveller could bring the virus back into Canada at any given time," he said.

Surveillance for new variants, fast contact tracing and good quarantine strategies will need to continue for the foreseeable future, said Moore.

Obviously we're looking for any strains that would escape from the vaccine so the vaccine wouldn't be as effective," he said. That would be a very serious situation for us. We will maintain capacity over the next year to ensure we can identify them, have aggressive case and contact management to prevent the spread within any community and have a very robust testing strategy, including whole genome sequencing."

Will the pandemic end?

The pandemic is expected to turn into an endemic - Moore says it could be as early as fall.

An endemic is when an infection is circulating perpetually in a geographic area and is much more predictable like seasonal flu.

What happens after Step 3?

Soon Ontarians will have to decide their own risk tolerance.

People want the answer - do this, don't do this," said Paul Johnson, director of Hamilton's Emergency Operations Centre. What we are going to see with life with COVID-19, it's going to be nearly impossible ... to do this as absolutes. It will be about thinking about those risks, thinking about your own health and your own comfort level with things and then making the appropriate decisions. The good news is that all the advice you need in terms of how to do most things in a safe manner is available."

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