Restaurants are open. Festivals are back. Masks, for the most part, are optional. And starting Monday, June 20, proof of vaccination will no longer be required of Canadian air and train passengers.

It may be tempting to put the pandemic in the past, now that governments have eased public-health restrictions and wastewater testing suggests rates of infection have declined since early spring. But the struggle against COVID-19 isn’t over, says Dr. Gerald Evans, a member of the Ontario COVID-19 Science Advisory Table.

COVID hasn’t gone away. It’s still there,” he says.

Case counts in Canada are actually higher than they were in June, 2021, he says. And based on the past two years, Dr. Evans says he anticipates two surges after this summer, one in the late fall or early winter and another in the late winter or early spring.

Here, he and other health experts share the top five issues that need to be addressed now.

Health care system capacity

One of the most pressing issues is to ensure the health care system can provide timely and adequate care for patients, says Dr. Karen Born, assistant scientific director of the Ontario COVID-19 Science Advisory Table. That doesn’t just mean having enough hospital beds, she says, but enough health care workers.

During the pandemic, front-line health workers have experienced high rates of burnout and many have left their jobs or retired early, says Dr. Born, who is an assistant professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation.

This challenges the health care system’s ability to handle not only potential surges in COVID-19 cases, but a backlog of surgeries and procedures that were postponed during previous waves, she says. Patients who deferred hospital and clinic visits earlier in the pandemic are now seeking care, contributing to lengthy wait times, she adds.

Boosting health care capacity involves training new health care workers, building new physical spaces and improving infrastructure – all of which are not quick solutions, says Dr. Susy Hota, medical director of infection prevention and control at Toronto’s University Health Network.

But taking these steps is necessary to end the pandemic, where we reach a state of stability to cope with COVID-19 for years down the road, she says.

Third doses and boosters

Dr. Nazeem Muhajarine, professor of community health and epidemiology at the University of Saskatchewan, says he’s concerned the push to get people vaccinated and boosted seems to have died down lately, and public-health messaging has gone quiet.

“It seems like where did everybody go?” he says. “Did the volume get turned down or turned off?”

As of late May, 81.7 per cent of the total population in Canada was considered fully vaccinated, according to federal data – that is, they received both doses of a two-dose vaccine or one dose of a vaccine that requires a single dose. But among those ages 12 and older, only 55.5 per cent had received at least one additional dose, which many health experts now say is necessary for optimal protection against COVID-19.

Over the summer, those who have had only two doses should be encouraged to get a third, says Dr. Evans, chair of the division of infectious diseases at Queen’s University. (He says two-dose vaccines should now be considered three-dose vaccines to complete the course.) And those who are particularly vulnerable should be encouraged to get a fourth dose as a booster. But for individuals who aren’t yet eligible for a fourth dose, he says it may be reasonable to wait until a new vaccine is available.

Dr. Evans says newer vaccines, which include an additional component that targets the Omicron variant, could be introduced this fall. Both Pfizer and Moderna are working on such vaccines. Last week, Moderna announced its new booster candidate led to a stronger antibody response to the Omicron variant compared with its current vaccine.

In an e-mail, Moderna Canada’s country medical director Shehzad Iqbal said the company’s goal is to have the updated vaccine available by early fall, though its timelines are dependent on a number of factors, including Health Canada’s approval process.

Indoor air quality

Public-health restrictions, such as school and business closures, have contributed to people’s sense of pandemic fatigue, says Dr. Born.

“But there’s also a lot of other things that can be done that shouldn’t really be seen as restrictions, but are more permanent investments that will improve our ability to respond to pandemics,” she says.

Among them is improving indoor air ventilation and filtration in congregate settings, she says. While schools in various parts of the country have begun adopting such measures, she notes large outbreaks occurred earlier in the pandemic at food processing plants, warehouses and other facilities where essential workers were working in close proximity in poorly ventilated spaces.

Upgrades and maintenance of air ventilation and filtration systems in these kinds of settings will not only improve the population’s resiliency against COVID-19, it will also help prevent the spread of other infectious diseases, such as influenza and respiratory syncytial virus, Dr. Born says.

Long COVID and other lasting effects

Canada is falling behind Britain, the U.S. and other parts of the world when it comes to understanding and addressing long COVID, says Dr. Muhajarine, a member of the Coronavirus Variants Rapid Response Network (CoVaRR-Net) of researchers across the country.

While there are efforts among the Western provinces to collaborate and create a long COVID registry, “we really are not doing enough and we are late to the game,” he says. “We don’t even have a guestimate of the prevalence of long COVID in Canada.”

Dr. Sonia Anand, professor of epidemiology and medicine at McMaster University, says she hopes to see standardized definitions of long COVID and more research on the condition, which is associated with a wide range of symptoms from brain fog to high blood pressure and low heart rate.

She says she also wants to see accessible and equitable care and resources for those with long COVID and other lingering health consequences of the pandemic. Dr. Anand says she is particularly concerned about members of communities that have borne the brunt of the pandemic, such as the South Asian communities in Ontario’s Peel Region. They’ve experienced high rates of COVID-19 infection and many are struggling with long-term side effects and the loss of loved ones, but are not aware of long COVID clinics and supports, she says. Essential workers may not have time off to access them, she adds.

Meanwhile, social isolation and loneliness have also had a negative effect on people’s physical and mental health, from young children who have not gone to school to older adults, she says.

“I’m concerned across the life course that there will be a long-term sequelae,” she says.

Surveillance

While tackling these longer-term issues, the short-term goal for Canadians should be to continue to lower the rates of COVID-19, says Dr. Nitin Mohan, assistant professor in the department of microbiology and immunology at Western University. That involves ensuring surveillance systems are working at their highest capacity to monitor levels of infection and to detect new variants, he says.

Data from wastewater testing are providing a picture, but it’s not definitive, Dr. Mohan says. He says he would like to see rapid antigen tests remain free and widely available to the public. And while the need for PCR testing for individuals may not be as robust as it was earlier in the pandemic, it should be made more accessible to keep an account of cases, he says.

“From a data perspective, it’s important to know how many cases of COVID we’re getting, what populations are getting them, and what the outcomes are,” he says.