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COVID-19 cases and deaths are declining, but the pandemic's toll on health systems and vulnerable populations continues.

End of the pandemic is in sight, says WHO. What does that mean for Canada?

The world has never been in a better position to end the COVID-19 pandemic, said World Health Organization Director-General Tedros Adhanom Ghebreyesus in his most optimistic assessment of the global crisis to date.

“We are not there yet, but the end is in sight,” he said in a news briefing in Geneva.

Countries have reported more than 611 million cases of COVID-19 and more than 6.5 million related deaths since the beginning of the pandemic in 2020.

According to WHO’s latest update, there were 3.1 million new infections reported globally between September 5 and 11, down 28% from the previous week, and continuing a declining trend across all regions.

Meanwhile, weekly reported deaths from COVID-19 dropped 22% to just over 11,000 – “the lowest since March 2020,” Tedros said.

“Now is the time to run harder…”

“We can see the finish line, we are in a winning position, but now is the worst time to stop running. Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work.”

The WHO expects more waves of infections driven by new variants and warned that declines in testing and surveillance mean many cases are going uncounted.

Tedros urged countries to “take a hard look at their policies and strengthen them for COVID-19 and future pathogens with pandemic potential.”

To that end, the WHO released six policy briefs outlining actions governments should prioritize to improve testing, vaccination, infection control, and clinical management of COVID-19, as well as to build community trust and combat misinformation.

“If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption and more uncertainty,” Tedros said.

Omicron boosted hybrid immunity

The downward trend in COVID-19 cases and deaths is a testament to the impact of global vaccination efforts, said Isaac Bogoch, an infectious disease specialist and associate professor at University Health Network in Toronto.

“We’ve had massive global outreach and uptake,” Bogoch told CMAJ. And despite the “major omission of low-income countries that were largely left out of this, which is awful,” Bogoch said, billions of vaccine doses have been administered worldwide.

Combined with boosted immunity from the rapid spread of less deadly Omicron variants, “that’s why our deaths are so low at this point in time,” he explained.

According to preprint research from British Columbia, by August 2022, more than 60% of the population had antibodies from a previous SARS-CoV-2 infection, “resulting in more robust hybrid immunity.”

However, the authors noted that older people at the greatest risk of severe outcomes “remain largely dependent on vaccine-induced protection alone and should be prioritized for additional doses.”

The long goodbye

For vulnerable populations, especially, the pandemic is far from over, Bogoch said.

His hospital is seeing fewer COVID-19 patients with pneumonia requiring high-flow oxygen or intubation now. But they’re seeing more cases in which COVID-19 impacts a patient’s long-term outlook, contributing to hospitalizations and deaths that may not be counted in the pandemic’s official toll.

“What we are seeing is people who get COVID, and it exacerbates one of their underlying medical conditions, such as COPD or atrial fibrillation, and it’s become a life-altering condition,” he explained.

According to Allison McGeer, an infectious disease physician at Sinai Health System in Toronto, the upcoming flu season could pose additional challenges to struggling health systems. “The combination of the state our healthcare system is in, the fact that we’re going to continue to have COVID, the fact that we want to be catching up on all of the surgeries and other things that we got behind on, and the busy flu season, is going to make it really hard,” McGeer told CBC News.

The impact of long COVID is only beginning to be felt. Even mild SARS-CoV-2 infections can leave people with a constellation of lingering symptoms, including brain fog, impaired memory and concentration, extreme fatigue, headaches, breathing difficulties, and a loss of smell and taste.

In July, the American Academy of Neurology declared that long COVID is now the United States’ third leading neurological disorder.

It’s unclear how many Canadians are affected by the condition, but the Public Health Agency of Canada estimates a prevalence of 30% to 40% among people who were not hospitalized for their initial SARS-CoV-2 infection, and possibly higher among those who were hospitalized.

Targeted vaccination campaigns for vulnerable people “would go a long way in terms of saving people from hospitalization and protecting people from death,” Bogoch said. As of mid-August, just over one in 10 Canadians, and half those over age 70, were fully up to date with COVID-19 boosters.

“This is still going to be something we’re going to be contending with for years and years to come, unfortunately,” Bogoch said.

Photo credit: Yaraslau Saulevich/iStock via Getty Images 

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