Towards an endemic north of Toronto

Peel Region, northwest of Toronto, was one of the areas of the country most decimated by COVID-19 in the first three waves, but its medical officer of health and Ontario infectious diseases now say the region is approaching of the endemic phase. The region’s experience could recur elsewhere in the country in the first quarter of 2022, according to infectious disease specialist Sumon Chakrabarti.

“I think there are a lot of reasons to be optimistic,” said the region’s medical officer of health, Dr.r Lawrence Loh, in the journal Caledon Company, December 26. If infections from the Omicron variant are less severe, he says, the fifth wave could represent the end of the pandemic as we know it. According to one recent analysis from Public Health Ontario, the risk of death or hospitalization associated with the Omicron variant would be 54% lower than that of the Delta variant.

“The Omicron wave could accelerate the transition to the endemic phase since the variant is extremely contagious, which means that the majority of the population who have not had COVID will be infected,” explains Dr Fahad Razak, internist and epidemiologist at St. Michael’s Hospital, Toronto. But this is already partly done in the region of Peel, where nearly 10% of the population has been infected, not to mention that 88.7% of people over the age of 12 have received two doses. At the height of the third wave – between March 28 and May 8, 2021 – the postcode L6P positivity rate, northwest of Brampton, averaged around 22.3%, according to the Institute of Clinical Evaluative Sciences, one of the highest rates in the country.

For example, few people are hospitalized at the two regional hospitals – Trillium Health Hospital in Mississauga and Civic Hospital in Brampton – even though Peel Region reported 1,468 new cases on December 30. Civic Hospital was treating more COVID patients than any other hospital in Ontario during the third wave, in April 2021. By contrast, only two patients were in intensive care on December 29.

Catching up with regions

We are currently witnessing a stabilization of cases in the province, according to Dr Sumon Chakrabarti. Downtown Toronto – relatively free from the concentration of cases since March 2020 – is now theepicenter of this fifth wave. Rather, this was the case with suburbs or surrounding cities like Brampton, where less affluent populations reside, in the past.

The so far little afflicted Kingston area faced an explosion in cases in early December, despite a high vaccination rate, as a small percentage of the population had been exposed to the virus, according to the Dr Gerald Evans, Infectious Disease Specialist at Kingston Hospital.

“All those places that have been rented in the past [en raison de leur faible nombre de cas], like the Atlantic provinces, are being decimated since unvaccinated people have not been exposed to the virus, ”says Dr.r Chakrabarti.

A situation soon comparable to that of influenza?

There is still a risk for these people in the short term, even though the Omicron variant is less virulent. The hospitalization rate per million population in Ontario is 311 for those unvaccinated, compared to 44.7 for those who obtained at least two doses, according to the weekly report of the scientific table of the province. Although they represent only 23% of the population, unvaccinated people occupy 65% ​​of intensive care beds in Ontario.

But within two years, the death toll from COVID could be on par with influenza – which claims around 1,365 Ontarians every year, according to Dr Gerald Evans. The Dr Sumon Chakrabarti shares his opinion. “You will see peaks during the winter, but that will not overwhelm the health system,” he says.

Possibility of another variant?

The Dr Fahad Razak explains that the population of developing countries will have to be vaccinated so that we can prevent the spread of a new variant that would thwart our immune system, as Omicron has done. Globally, only 8.4% of the population of these countries received at least one dose. “Research on the origin of the Omicron variant points to populations that have few people vaccinated”, continues the doctor.

“The big challenge is to convince people [dans ces pays] that it is worth to be vaccinated, as well as the possibility of having the infrastructure and the personnel to vaccinate ”, underlines the Dre Valérie Sales, infectious disease specialist at the Markham-Stouffville hospital. “We hope that by achieving vaccine equity, we can end the critical phase of the pandemic,” said Michael Ryan, emergency operations manager for the World Health Organization, on December 29.

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