Six things governments should be doing about COVID, now

by Raywat Deonandan

July 6, 2022

This article was originally published in The Ottawa Citizen on July 6, 2022.

Ontario wastewater signals suggest that the province is knee-deep in yet another wave of COVID-19. The BA.5 subvariant of Omicron is now dominant and threatens to increase the likelihood of both reinfection and vaccine-breakthrough infection.

Meanwhile, a concerning new study — albeit still awaiting peer review — suggests that COVID reinfections heighten the risk of all-cause mortality, hospitalization, and other adverse health outcomes. And while more investigation is needed, smaller studies are seeing a relationship between infection and long-term brain impairment. It is too early to assign a level of certainty to these suspicions, but they are nonetheless concerning.

This is all against a backdrop of loosening restrictions and a seeming retreat of public health officials from the front-line battle against the disease. Residents could be forgiven for incorrectly assuming that the pandemic is over, as this is the message passively conveyed by our leaders.

A more nihilistic view is that those tasked with battling the pandemic have largely surrendered to the virus, accepting that large numbers of people will experience repeated reinfections. It seems that our leaders are relying solely on the power of vaccines to prevent the worst outcomes.But the current crop of vaccines do not work perfectly. The ability of two and three doses to curtail infection and transmission has been greatly reduced by Omicron. And some breakthrough infections still result in hospitalization and death, although that risk is profoundly greater among the unvaccinated.

Despite Ontario’s impressive rate of vaccination (more than 81 per cent with at least two doses), the high rate of breakthrough infections and worker burnout results in regularly understaffed hospitals, businesses and other service providers. Our institutions remain fragile and in need of protection. None of this is sustainable.

However, there are things that all levels of government can do to blunt these effects without having to institute lockdowns or economic restrictions. These include, first, making N95 respirator masks freely available to all residents. These masks can be unaffordable for many who need them, differentially punishing lower-income people with higher infection risk. By removing an economic barrier to self-protection, we can at least take a step toward democratizing infection control.Second, we must follow the lead of other jurisdictions and offer second vaccine boosters to all adults who want them. There is no real scientific reason for restricting them to older or immunocompromised people. Data from Israel and the United States show that a second boost not only greatly improves protection against serious outcomes like death, but also increases protection from becoming infected at all, at least for some months.

Hence, there is additional need to plan on making boosters available every few months to account for waning, until a new generation of vaccines is available.

Which brings us to the third thing that many governments must do: incentivize the development of new vaccines. Work is already underway on intranasal and pan-coronavirus vaccines, which offer durable defence against infection as well as wide-spectrum protection against many, if not all, variants. What is needed is the financial underwriting of clinical trials, much like what was done for “Project Warp Speed,” to accelerate several product candidates to market.

Fourth, two million Canadians under the age of five are still ineligible for a COVID vaccine. This needs to be remedied immediately. The U.S. has OK’d doses for that age group while Canadians still await the green light. Getting some immunity into that demographic soon would make the Fall wave less dangerous and more tolerable for many kids and their stressed parents.

Fifth, mandating paid sick days for all workers would remove the financial incentive for visibly contagious people to infect their co-workers. Several studies have shown that this simple policy change measurably reduces the incidence of COVID-positive people in the workplace.

And sixth, the messaging around the state of the pandemic should be fixed. The public needs to be told that: the disease is still here and has not gone away; infection should be avoided, not embraced; vaccines work and are overwhelmingly safe, but need updating and boosting; masks work and should be encouraged and de-stigmatized; and that we can continue to live our lives in the midst of impending waves if we just remain diligent and respectful of the virus and of each other.

The time to consider these and other measures is now, before the cooler months bring school openings and more indoor activities. We have the tools to minimize and manage COVID. We should be using them.

Raywat Deonandan is an epidemiologist and associate professor with the Faculty of Health Sciences, University of Ottawa.