Road to the end of COVID-19 will be long
Vaccines may end pandemic, but it will take most of year to do it
The data can seem overwhelmingly bleak, with rising numbers of COVID-19 cases, hospitalizations and deaths. The darkness seems even deeper when you realize the pandemic does not yet include an expected spike in cases arising from holiday gatherings.
And while Niagara’s top public health official said all signs appear that things will get worse before they get better, he is urging Niagara residents not to lose hope.
Despite the profound challenge, the community is not helpless, said Dr. Mustafa Hirji. It can act to get Niagara into better shape to prevent as much serious illness and death as possible.
“This is the time for us to really buckle down, follow those protocols and get this infection rate back under control,” Hirji said. “We have done this before during the first wave. The task before it is more difficult because there is so much more spread of the virus, but if we can act with a shared sense of sacrifice, it can be done.”
From Hirji’s point of view, 2021 can be a better year than 2020. But given that a fully public vaccination program is still the better part of a year away, the aim now is to reduce the human and economic damage of COVID-19 so that when shots do start going into arms, Niagara will be in a better position to recover.
Combined community action and the vaccines will mean, this time next year, life will be drastically different.
“I think we can absolutely be in a position this time next year to be able to celebrate the holidays in something that looks more normal,” Hirji said. “We just have to get there.”
Advances in vaccines, stalemate on treatments
Nearly a year has passed and human ingenuity has laid out the path to escape the pandemic in the form of vaccines. Two vaccines using new MRNA technology from Pfizer and Moderna are approved for use in Canada. A third, more traditional vaccine that uses inert virus to create an immune response, from Astrazeneca is anticipated to be under review by Health Canada for approval soon.
While vaccines were produced with historic speed, they were not conjured out of thin air, said Dr. Karim Ali, head of infectious diseases at Niagara Health.
The MRNA technology — it teaches the immune system to recognize and attack protein spikes on the novel coronavirus — had been in development for years before the pandemic. And early in the crisis, the genome of the virus was decoded, Ali said, giving scientists a historically unprecedented head start in creating a vaccine.
While the vaccines are a medical marvel, the advances in treatments have not progressed nearly as fast.
Several drugs were offered as possible silver bullets, from the malaria drug hydroxychloroquine once touted by now outgoing U.S. President Donald Trump to convalescent plasma therapies that use the blood of recovered patients to treat the infected.
None of them have really panned out, Ali said.
Others, like the anti-viral drug Remdesivir, have shown only limited success in reducing the severity of COVID-19 in some cases.
One drug that has shown more promise, Ali said, is the corticosteroid steroid dexamethasone, which can help reduce inflammation in the lungs. Apatient with COVID-19 experiences severe respiratory issues and the powerful steroid, used to treat other lung ailments, can help.
However, Ali said dexamethasone is no silver bullet. It is only recommended for use in the most severe COVID-19 cases. It is a tool for doctors, he said, but it is not a cure.
“So much of the time, it is about helping a patient manage their symptoms while their own immune system fights the virus,” he said.
Ashot in the arm
It was not clear, as of Sunday, when Niagara will start receiving supplies of either Pfizer or Moderna vaccines. While the federal government purchases the drugs, each province is responsible for distribution. At the moment, Ontario public health units with decades of immunization program experience are not part of the decision-making process at Queen’s Park.
Hirji said he has been given no indication when vaccines will start locally, but a joint public health and hospital system task force is laying the groundwork to launch as soon as doses are available.
The most vulnerable people and front-line health-care workers will be vaccinated first, with the rest of the population to follow as supplies increase.
The federal government has said it expects to have all Canadians who want a vaccine to get one by September — a goal Hirji said is “somewhat aspirational,” that leans on assumptions of more vaccines being approved and supply lines and rollouts working flawlessly.
The end of 2021 seems more likely to Hirji at present and he said even as the vaccines become more widely available, some public health measures such as masks and distancing will remain in place for a time.
How long they remain in place depends greatly on two factors: the long-term effectiveness of the vaccines and how many Canadians get the shots.
While the approved vaccines have proven safe and effective in studies, how long the immunity lasts and whether booster shots will be required can only be determined by real-world experience, he said. And if enough Canadians refuse to get the vaccine, the virus will have enough wiggle room to continue to spread.