Out of sight, out of mind? What the experts say we need to know about COVID-19 as we head indoors

Nearly five years after its arrival in Canada, it can be difficult to gauge how truly “beyond the pandemic” we really are.Outside of select circles, precautions around COVID seem to largely have been reduced to a vibe-check — if they are even thought about at all. A recent New York Times story highlights the growing laissez faire attitude, with many people deliberately avoiding testing for the virus despite showing symptoms.Masking in indoor public spaces is no longer mandatory; a quick glance around a hospital, on transit or in a grocery store reveals that, in most neighbourhoods, only a minority have kept up the practice.Some degree of relief seems warranted. Generally speaking, despite widespread infection, COVID cases are contributing to fewer hospitalizations on average than in previous years.The Centre for Disease Control and Prevention’s deputy director for science, Aron Hall, recently told NPR that he considers COVID-19 to be “endemic” throughout the world. Though the exact definition of the word is slippery, “endemicity” generally means a disease has become entrenched and appears with predictable patterns.Still, experts caution that “endemic” doesn’t mean harmless. William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, told NPR that “tuberculosis is endemic in some parts of the world. And malaria is endemic in some parts of the world. And neither of those are good things.”Some experts say that COVID-related deaths are significantly underreported, and despite reports of generally mild cold and flu-like symptoms, COVID infections are still 20 times more lethal than influenza.We also know that COVID causes immune deregulation, which some experts have pointed to as the reason behind the dramatic global upticks in infectious diseases. Reports are now showing that 400 million people world-wide are afflicted with Long COVID, a debilitating and potentially lifelong, multi-system syndrome that has only 7 per cent of patients reporting a full recovery after two years.This is to say nothing of the strain that COVID is still putting on our beleaguered healthcare system.While data availability around COVID is much more limited than in years prior—in July, Ontario shuttered its widely praised Wastewater Surveillance Initiative that has been used to track COVID-19, RSV, influenza, mpox and more—infection numbers are currently rivaling the highest peaks of the Omicron wave in 2022 and provinces have tossed out old COVID vaccines, with the latest formulations likely to remain unavailable until October.Most of us can agree that the time for closed borders and widespread lockdowns has passed. Some have claimed that though we are not “post-COVID,” we are “post-crisis.” But the question remains: “What should we be doing about COVID now?”Do we still need to be masking? If so, where? Marianne Levitsky, occupational hygienist with ECOH, adjunct lecturer at the Dalla Lana School of Public Health and board member of Workplace Health Without BordersCOVID-19 has not gone away, and trends in wastewater monitoring and hospitalizations show that infections are rising. While most of us are not willing to accept the constraints we lived through early in the pandemic, there are things we can do to limit the risk of infection. Good ventilation indoors is paramount but usually beyond individual control.Masking is a simple step that many of us can take, not only to protect ourselves but also to limit community infection and protect the vulnerable around us. The most effective masks are those with good filtration and a good seal to the face.Using masks to reduce risk doesn’t need to mean a major change in activities or lifestyle. Speaking personally, I have not yet had COVID nor had the usual rate of colds I experienced pre-pandemic. Of course, that is largely due to luck, which can run out at any time. But without giving up anything I want to do, I limit my risk by masking when it is feasible and risks are high, such as in crowded venues, especially indoors at performances and films. I mask in most stores, especially drug stores where there is a higher likelihood of sick customers.I’ll mask on transit and at the gym, and for healthcare appointments. Of course, I can’t wear a mask during dental treatment, but I brought some N95s for the dental hygienist—she appreciated it as she had only been supplied with a medical mask.If I go out to restaurants, I try to ensure that I’m eating in an area that isn’t very crowded.Masking not only reduces transmission but can also model mask-wearing for others who may be reluctant due to perceived social stigma. The more people wear them, the more acceptable it will be.There is good evidence supporting the effectiveness of masks in controlling disease transmission, but social resistance makes it difficult to return to mandatory masking in most situations. An exception may be healthcare, where there is a greater likelihood that vulnerable and/or infected people are present, and healthcare workers come into close contact with numerous individuals. As I said in a previous Healthy Debate article, it’s not just a matter of protecting ourselves—we need to protect others by controlling community transmission of COVID-19 and other airborne diseases.What should the government be doing about COVID from a public health perspective?Andrew Longhurst, health policy researcher and PhD candidate at Simon Fraser UniversityIt seems like the more that we learn from the biomedical literature about the long-term effects of COVID-19 on the body, the less politicians and policymakers seem to care.There are some very straightforward things that we could be doing to prevent transmission. First and foremost, we need to move toward indoor air-quality standards. We need legislated standards for common spaces where people share air, whether that’s businesses, long-term care, hospitals, schools, workplaces, you name it.It’s also astonishing to me that we don’t have masking in healthcare settings where there are lots of sick people. Meanwhile we can’t adequately staff emergency departments because of illness. The impact on our healthcare workforce really can’t be overstated. It’s going to be increasingly challenging moving forward if we can’t, at a minimum, limit transmission in healthcare settings.A strong argument can also be made for standardizing a 10-day paid sick leave for any healthy public policy approach to manage COVID-19 and other infectious diseases like mpox. We also need to encourage the use of at-home testing. We had all of these tools. It’s not a great burden to place on people. Yet, we’re being told by public health officials that we don’t need to do any of these things.The future is not lockdowns or vaccine mandates. It’s not having restrictions on people’s activities. But it does mean being honest about the increasing morbidity and mortality that we continue to see.Right now, we’re in a wave that rivals the 2022 Omicron wave. This summer has proven to be quite deadly, much more so than last summer. This is probably due to a number of factors, including that a lot of people aren’t keeping up to date with vaccinations or using mitigating measures like masking.But the fact is that Long COVID is not abating. At this point, it’s a numbers game. Every time you get infected with COVID, it’s like playing Russian roulette. The literature shows that at some point, you’ll get unlucky and experience these longer-term effects and disability. I don’t think that’s being effectively communicated to people.What’s the deal with boosters? Do we still need to get the COVID vaccine?Horacio Bach, PhD and clinical assistant professor, University of British Columbia’s Division of Infectious DiseasesIn the last few weeks, we’ve seen an increase in infections of COVID-19 in the U.S. and Canada. About six months ago, the Food and Drug Administration asked Pfizer and Moderna to produce an updated mRNA vaccine as the virus has continued to evolve to new variants, such as JN.1, KP.2 and KP.3.Another vaccine that may become available in the coming weeks is Novavax, but it’s not an mRNA vaccine but a protein-based vaccine. If it becomes available in Canada, it would only be formulated against the JN.1 variant.JN.1 has been one of the most contagious COVID variants so far. It’s not producing massive death in the way that the variant from 2019 to 2020 did. For most people, the acute infection causes flu-like symptoms for a few weeks, except for those who are immunocompromised or with specific underlying health conditions.The other variants are now KP.2 and KP.3. The new vaccines that are updated by Pfizer and Moderna will protect against these latest strains. We don’t know yet if the JN.1 vaccine will also cover KP.2 and KP.3 variants but it would have to offer some degree of protection to be approved.When it comes to the COVID-19 vaccines from last year, the studies that have been done show that the antibodies we generated with the previous vaccines are not as efficient at neutralizing the JN.1, KP.2 and KP.3 variants. In Canada, these newer vaccines are under revision and should potentially be available in October.People who need to be vaccinated should wait until the new vaccine formulated against the latest variant because otherwise, they will need to wait six months to be vaccinated again with the new formulation.People who are immunocompromised should be prioritized but I still think that everyone should plan to be vaccinated. If you have children who are returning to school, I recommend that they be vaccinated as soon as it’s available. But it is also worth emphasizing that masking in general is a very effective way to reduce transmission. They are very efficient and now that we have new diseases on the radar, for example, mpox, it’s a very efficient method to protect yourself.How much time should we take off when we’re sick with COVID? What should regulations around this be?Mara Waters, infectious diseases physician and member of the Decent Work and Health NetworkThe suggested isolation time for COVID-19 has varied over the last four years. The current strains of COVID-19 may be more contagious, but with milder symptoms and shorter incubation periods than previous variants. Ideally, you should stay home until you are symptom free, but at a minimum you should isolate until you no longer have a fever for 24 hours.Unfortunately, without employer-paid sick days we are seeing that many workers, especially those in high-risk jobs, still tend to go to work when they are sick because they can’t afford to take time off. This creates a cycle of transmission.Low-wage workers in particular tend to face retaliation for missing work, which disproportionately impacts racialized workers, women and other more vulnerable populations. When it comes to implementing 10 employer-paid sick days—like the Decent Work and Health Network and other labour groups have been advocating for since the beginning of the pandemic—we still have a lot more work to do—58 per cent of Canadians currently do not have paid sick days, which shows we cannot rely on the kindness of employers. We have met with the ministry of labour, but (Ontario’s) Ford government has not prioritized our concerns around employer-paid sick days. We know that jurisdictions that have paid sick days have lower mortality rates. It really is a public health issue.A common critique of implementing paid sick days is cost. But in New York City, for example, they found that they were able to implement paid sick days without having any negative impact on profitability; further, 98 per cent of employers in New York reported that no one was abusing these policies.We currently have a pertussis outbreak in Ontario; mpox cases are rising; we are seeing a huge number of COVID cases in hospitals. There are many contagious and largely vaccine-preventable infections circulating right now, and we will continue to have outbreaks if we do not take a preventative approach.What about indoor air quality? Nazeem Muhajarine, PhD, FCAHS, professor and epidemiologist, Community Health and Epidemiology, College of Medicine, University of SaskatchewanThe COVID-19 pandemic should not be a global catastrophe pushed out of memory. There were enormous lessons to be learned; a core lesson is that prevention is better than cure.A core prevention strategy now and for the future is to retrofit buildings so we breathe clean, uncontaminated air. This is true for everyone—we spend 90 per cent of our time indoors—but especially so for children who inhale more air per kilogram of body weight. Children are also more vulnerable to the health effects of poor indoor air quality because their bodies, brains and respiratory systems are still developing. School buildings, where children spend enormous amounts of time, unless they are newly built, are lagging in benefitting from new and improved HVAC technology.Certain provincial governments appear to have put the lessons of COVID-19 out of their minds in preference to preparing for the next election cycle and playing to their political base. In schools this past year, keeping students protected and healthy hasn’t been the priority, as is necessary, through legislative means and funding support.The virus that causes COVID is continuing to mutate, at a much faster rate than any other air-borne respiratory pathogen we know. COVID is still maintaining considerable potency to harm people, including children, for a long time. Governments and public health authorities have to resolve not to let the moment pass by—to create healthy and safe school environments for all children, staff and families.Where are we in terms of global vaccine equity? Sabina Vohra-Miller, founder of Unambiguous Science and Doctor of Public Health Student at Dalla Lana School of Public HealthGlobal disparities for the COVID-19 vaccines are not as acute, partially because global production and distribution has vastly improved but also unfortunately due to reduced overall demand. As of earlier in 2024, more than 70 per cent of the world’s population has received at least one dose of a COVID-19 vaccine. However, global vaccine inequity in general continues to be both persistent and pervasive, as lessons that we should have learnt from COVID-19 have been discarded with haste in our quest to put the pandemic behind us.For example, in 2022 outbreaks of mpox outside of Africa resulted in our first mpox-related PHEIC (public health emergency of international concern). This was effectively handled in North America and Europe with swift vaccination campaigns. Yet, vaccine access was not extended toward African countries, and even those with active outbreaks were conveniently left bereft. Two years later, we are now grappling with newer strains of mpox and uncontrolled outbreaks resulting in a renewed PHEIC. We had two years to prevent this from occurring, yet it took until this month for Africa to finally receive the first 200,000 doses of the mpox vaccine—even though it requires more than 10 million doses to effectively combat the disease. Questions on what is being done to bridge the gap that remains are left unanswered, while richer countries continue to fill up their stockpile.Once again, I find myself asking the question—when are we going to learn that global access to vaccines, and with urgency, is not just the right thing to do, but in fact the only way we can get ahead of pandemics? Borders have never kept out viruses and that’s not going to change any time soon.This article is republished from Healthy Debate under a Creative Commons licence.Maddi Dellplain is a national award-nominated journalist specializing in health reporting.

Out of sight, out of mind? What the experts say we need to know about COVID-19 as we head indoors

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