“Once the pandemic is over.”
That’s the caveat when making plans with friends, family and pretty much anyone else these days. We have two vaccines approved in Canada, and worldwide there are dozens of others in various trial stages.
But it might be a while before everyone in the country is vaccinated. And, in the meantime, cases are spiking and hospitals in some provinces are dealing with worrying capacity issues.
Where we go from here is complicated, experts say. There are still questions about how many people will take the vaccine, and how effective it will be at stopping the spread of the virus. All those future plans we want to make — from dinner parties with extended family to karaoke with friends — depend on these factors, though experts say it likely won’t be until the end of 2021 when life will feel more normal.
‘Back to normal’ may depend on health-care system capacity
For a disease to be eradicated, you need two things: a treatment and a vaccine that leads to herd immunity, Cynthia Carr, an epidemiologist based in Winnipeg, told HuffPost Canada.
Herd immunity occurs when enough people contract an illness or are vaccinated against it and become immune so it can no longer spread.
Carr does not believe in illness as part of a herd immunity strategy, so she said it’s important to continue with public health measures as vaccinations continue.
Based on those two criteria to eradicate a disease, Carr said it’s “highly unlikely” COVID-19 will completely go away — it will likely continue to circulate, possibly seasonally, like other viruses.
“So I think in terms of quote ‘back to normal,’ it’s going to depend on how well these vaccines assist the health-care system,” she said.
If a vaccine can alleviate some of the immediate impact on the system, it could be safer to gather in larger groups — but that likely wouldn’t be until “well into” 2021, Carr warned.
It may fall to local areas to make decisions about reopening as community-based spread and the rates of serious health impacts decrease, she said.
Carr also cautioned that the COVID-19 vaccine may not prevent the longer-term health outcomes that some people, sometimes called “long haulers,” have experienced.
“That will again inform how much risk we can really afford to take,” she said.
Eventual reopenings will likewise depend on how many people take the vaccine, said Dr. Susy Hota, the medical director of infection prevention and control at University Health Network in Toronto.
A December Angus Reid poll indicated 48 per cent of Canadians want to be vaccinated as soon as possible, up from 40 per cent a month ago.
‘Life will feel better’ as vaccine rolls out
Even as some Canadians get vaccinated, others will need to continue to follow public health guidelines.
“It’s kind of an all or none,” Hota said. “It’s the whole picture of who actually gets the vaccine that will determine when we’ve reached a point where we can start thinking about opening things up.”
Hota noted some people won’t be able to get the vaccine. Pregnant women were not included in clinical trials, and Health Canada has warned people who are allergic to vaccine ingredients to not be inoculated.
That means some may still take safety precautions, like continuing to wear masks or businesses limiting the number of people inside, Hota said.
WATCH: How a COVID-19 vaccine gets from lab to your arm. Story continues below.
“We do have to be cautious in terms of letting the guard down, so I would say it’s more like towards the end of 2021 that we would start to see the gradual reopening,” Hota said.
She added she doesn’t want people to be discouraged by the wait.
“It seems like such a long way from now, but I do think that life will feel better, and it won’t be so much negative news before that even, as we’re successful in getting this vaccine out and people are willing to take it,” she said.
She said decisions around what to reopen first will depend on what governments decide to prioritize, based on what’s valued most in society, noting the need to consider the economic impact of businesses being closed.
But she is hopeful part of the gradual reopening will mean giving Canadians the chance to safely have more social contact with family and friends.
“As long as it’s done carefully and slowly, I think that would be extremely important to me, and probably to a lot of people,” she said. “You know, you can hold off on going to that hockey game if you can see your friends and family at least.”
Vaccine’s impact on asymptomatic carrying unknown
Although some regions may have such high COVID-19 case counts that natural herd immunity is possible, for the most part Canada is relying on a vaccine to bring that about, Dr. Michael Libman told HuffPost.
While we know Pfizer and Moderna’s vaccines prevent illnesses, it’s unclear if they prevent people from being contagious, said Libman, a professor in McGill University’s infectious diseases division.
“It’s possible you might still get infected with the virus, but have no symptoms … but you’re still contagious,” he said.
That could be the worst-case scenario, Libman said, because people who can’t take the vaccine — or whose bodies don’t respond to it — would be vulnerable to contracting COVID-19. But high levels of vaccination could make it harder for the virus to circulate, he added.
He pointed to current estimates that suggest having 70 per cent of a population either vaccinated or infected with COVID-19 would bring herd immunity.
There are a handful of documented cases where someone has had COVID-19 twice, Libman said, but as long as that number stays low we’re heading in the right direction.
“It’s no big deal if the immunity fades, as long as the vaccine works and we can keep people going with vaccine boosters, for example — that’s pretty common in the vaccine world, that we have to get the vaccine … periodically,” he said.
Carr, the Winnipeg epidemiologist, said the efficacy of the current vaccines is still a major public health benefit since data from clinical trials shows they stop disease severity. But, like Libman, she said that isn’t enough to impact herd immunity, unless part of stopping the severity means people who are vaccinated have a lower viral load and are less contagious.
Hota said she suspects the vaccines will have some impact on stopping transmission and said more clarity will come with further data.
‘None of us are safe until all of us are’
Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, told HuffPost he predicts Canada will be able to start lifting restrictions around summer 2021 — assuming the vaccines prevent transmission, and enough people get inoculated.
He anticipates the pandemic will be officially declared over by 2022, but noted it will likely still exist in some countries. That means international travel won’t go “back to normal for several years,” he said, adding some airlines may require proof of vaccination.
But it also depends on what “normal” we’re talking about. We likely won’t ever go back to the way life was in 2019, Deonandan said, because some aspects, like Zoom meetings and distance learning, have become such accepted parts of day-to-day life during the pandemic.
So far, clinical trials have not validated the efficacy of vaccines in children, so there’s a chance schools could still offer distance learning in fall 2021. But it may be safer for children to socialize by then, Deonandan said, because older relatives would be less likely to get sick should they contract the virus if they’ve been vaccinated and are immune.
“It looks like [you] will be able to, you know, hug your grandparents by the end of next year with impunity.”
Still, even as some populations start to get vaccinated, it’ll only be completely safe to resume more normal activities when COVID-19 is controlled at the population level.
“Just because you’ve got a shot in the arm, the ordeal isn’t over for you. None of us are safe until all of us are,” Deonandan said.
Despite the unknowns, though, he said there are reasons to be hopeful.
“It looks like [you] will be able to, you know, hug your grandparents by the end of next year with impunity,” he said.
What will change forever?
The pandemic has drastically changed so many aspects of everyday life — including in ways detrimental to Canadians’ mental health and the country’s small businesses.
But other changes during this crisis may actually be positive ones, Carr said.
Now that Canadians have learned so much about how viruses spread, she predicted more people will stay home from work if they’re sick instead of feeling guilty and going in anyway.
Mask wearing may also become a “common tool in the toolkit,” especially during cold and flu season, she said, noting masks are already commonly worn in Asia.
Libman said there may also be more of an understanding of ways to keep people safe moving forward, like improving ventilation in restaurants.
Ultimately, he said, the goal right now isn’t to bring the risk of contracting COVID-19 to zero — it’s to make that risk “compatible with the risks we take in everyday life.”
“As part of life ... we all choose risks to accept,” he said. “If we bring coronavirus down to that level of risk, well, then that’s the risk of life.”
CLARIFICATION: This article has been updated to include the role of vaccinations in herd immunity, and to clarify Carr’s views on the best way to reach herd immunity.