Pandemic anniversary: COVID-19 lessons after year two

Two years after the World Health Organization first described COVID-19 as a global pandemic, leaders in Canada and many other parts of the world appear ready to move on, for better or worse, with the last of the Canadian public health measures set to lift over the coming weeks.

COVID-19’s enormous scope has resulted in an unprecedented torrent of knowledge. CTVNews.ca interviewed five medical experts who specialize in infectious diseases, immunology, and epidemiology for their insights into the lessons learned in the second year of the pandemic.

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'AN EXPLOSION OF DISCOVERY'

COVID-19 reached every corner of the world. More than 450 million cases have been officially counted, but actual figures are likely significantly higher, particularly after Omicron cases exploded and testing could no longer keep up. More than six million people died, and even that stark figure is widely believed to be undercounted as well. Those numbers will continue to climb.

The scale of the pandemic underscored the urgency with which scientists, health-care workers and global leaders had to act in order to contain the virus.

“There's some tremendous lessons that were learned. We've really seen an explosion of discovery,” Dr. Isaac Bogoch, an infectious disease specialist with the University Health Network and an associate professor at the University of Toronto, told CTVNews.ca in a phone interview.

“The pace of scientific discovery is moving at a speed that I don't think has really ever been seen, where we truly see science translated into policy extraordinarily quickly. We've seen this with vaccines and with drugs, and it really has transformed health care and the care of patients and also protecting populations as well. So it's pretty remarkable.”

The GISAID Initiative and Nextstrain.org, for example, allowed scientists around the world to share their data, submit genome sequences, and track the movement of the virus and its variants.

The shift in understanding how viruses spread, for example, changed how people, particularly in Western countries, responded to the pandemic. Airborne transmission was downplayed in the early days of the pandemic, when it was believed infection was primarily through contact with large droplets.

“We really underappreciated how important airborne transmission was going to be and that really made us slow off the mark to recommend masks and to recommend frankly, high quality surgical and N95 masks,” Dr. Christopher Labos, a cardiologist and associate with McGill University's Office for Science and Society, said in a phone interview.

“What we learned with COVID – and this very likely applies to most other illnesses too – is that these particles can linger in the air for a certain period of time, and we have to be much more mindful about the issue of air quality.”

This could change how schools and office buildings address air quality in the future, he added.

Experts point to the development of new therapies, a better understanding of the virus, and the development of vaccines as examples of what can be achieved when researchers have access to funding and when bureaucratic obstacles are removed.

“From identification and isolation of the virus to vaccine development in under a year was a major scientific achievement. Amazingly, many people saw that as a negative,” said Labos, who also has a degree in epidemiology.

“Basically, all the gaps, all the wasted time that happens during medical research was removed, and people could just focus on the science. And that's an amazing thing, because it's proven to us that if we want to solve a problem, we can solve it. Even if it's a very difficult problem.”

VACCINATION SUCCESS

What also stood out for experts was the vaccination campaign itself. Some governments experimented with different measures to incentivize the public into getting their shot – cash rebates, prize giveaways, lotteries, and so on – but none appeared more effective than vaccine mandates.

“[Incentives] didn’t really seem to have a major effect on people, whereas the vaccine passport system really did,” said Labos.

“It's going to be interesting to see when we look back, to try to discover what worked and what didn't so that we can use it for future diseases … and what we can actually do to encourage people to go and get vaccinated.”

Despite the differences in how provinces and territories rolled out their vaccination campaign – Nova Scotia had a centralized booking system while Ontario's campaign was often more patchwork, for example – many were still impressed at the number of Canadians who are fully vaccinated and even boosted. More than 85 per cent of eligible Canadians are fully vaccinated with their primary doses, according to data compiled by CTVNews.ca, and a majority of those have had their third booster shot.

“We figured out how to get vaccines to the vast majority of the country over and over – and over – in short order, which I think also speaks to our ability to learn and change and direct at a big level,” said Dr. Lisa Barrett, an assistant professor with the departments of microbiology and immunology and medicine at Dalhousie University, in a phone interview.

A protective mask is seen on the ground near St.Peter's Square, in Rome, Wednesday, Aug. 12, 2020. (AP Photo/Paolo Santalucia)

A protective mask is seen on the ground near St.Peter's Square, in Rome, Wednesday, Aug. 12, 2020. (AP Photo/Paolo Santalucia)

THE LIMITS OF HUMAN NATURE

The achievements made during the pandemic come at a great cost, however. COVID-19 has left a trail of destruction including burnt-out front-line health-care workers, families and friends who lost loved ones, and survivors who have been permanently changed. Pandemic fatigue set in long ago, even as many Canadians also believe it's not over yet. For doctors, this has been another lesson learned – or perhaps relearned.

A piece published over 100 years ago in Science Magazine by Major George Soper titled “Lessons of the Pandemic” could have been written today and shows that not much has changed in a century.

“The pandemic which has just swept round the earth has been without precedent,” the article, published on May 30, 1919, opens. But he later writes that one of the biggest challenges of the pandemic was “public indifference”.

“Essentially, the public just got tired of having to follow things, which interrupted aspects of their normal life … everybody just sort of gave up,” says Dr. Gerald Evans, an infectious disease specialist at Queen’s University, about the article.

“The interesting thing that people don’t remember is that during the [1920s], there were successive waves of more influenza that were seen after 1918, 1919. And that was really because nobody wanted to do anything more about it … So I think that we learned that not a lot has changed in 100 years. People still have a limit to how much they will do.”

The tolerance of the public for pandemic measures may have reached a finite limit, experts say, even though the virus is still changing rapidly and uncertainty remains over what the future will bring.

"Science in real time can be really, really challenging,” Evans said. “How do we inform the public accurately and not have the backlash?”

A FAILURE IN COMMUNICATION

Experts say one of the biggest lessons learned was the failure to include input from behavioural scientists on how public health officials communicated developments and information during the pandemic.

“We’ve learned that it is much more complex than just having health-care experts…we have to be really, really careful and deliberate about public health messaging in ways that we hadn't been before,” says Dr. Matthew Miller, an associate professor with McMaster University’s Immunology Research Centre, in a phone interview.

“Simplicity and nuance are often at odds with one another, but it's especially important in situations where oversimplification subsequently leads to the perception that the message was inaccurate. People don’t like feeling like they’ve been lied to.”

Behavioural scientists understand how and why humans behave the way they do, and can bring insight into best practices on dealing with conflict, polarization, and disinformation, experts say, and they need to be incorporated into the planning process.

Communicating uncertainty is important so that the public is aware that things may change, particularly during a pandemic, where events can shift quickly and dramatically. What is true today, may not be true tomorrow.

“It's critical to be transparent about where science is evolving,” said Miller. The public will understand if health officials take an overly precautionary approach to protecting citizens early in the pandemic, because so little is known about the virus, he said, pointing to masks as an example.

It is a benign intervention that doesn’t hurt anyone and there is no scientific evidence of adverse problems, Miller said. But experts say the flip-flopping on masks was an example of how a different approach may have led to less confusion and resistance.

“It's kind of like, ‘oh, public health officials and government don't have their cards in a row on something as seemingly simple and straightforward as masking. How can we expect them to provide trustworthy guidance and other more complex issues?’” Miller said.

The intention is not to deceive, but the public’s perception of why messages change can at times make it seem that way, which has a downstream impact on compliance when public health measures are put in place, he added.

Some provinces, cities, and groups have been more effective in their public health campaigns than others, demonstrating how it can be done, experts point out.

Vaccines are another example where oversimplification led many to believe it would result in herd immunity and the end of the pandemic. Nuances like how immunity may not last, how variants could impact its effectiveness were lost.

“The communications piece is extraordinarily important. And you need to involve behavioral scientists, you absolutely need to. At the end of the day, what are we trying to do here? This is the business of behavioral change. We want people to wear masks. We want people to take the vaccine. We want people to adhere to public health measures,” says Bogoch.

The disinformation campaign that led to people not getting vaccinated and people becoming sick and dying has been absolutely awful, he added.

“I was naive at the beginning, thinking that this was going to be us against the virus, when a lot of this was us against ourselves.”

Barrett said it was a “fight” to get a behavioural psychologist included in some of their response groups in Nova Scotia, but they ultimately succeeded. Even so, there was “uncertainty fatigue,” she said.

Everything has an expiry date in this world, says Barrett: “And everyone wants the pandemic to expire. Unfortunately, biological processes don’t work like that.”

“But you know, we’ve coached people in bigger and longer, situations like the Depression, where there was no food for five years. We’ve done this better before.”

Multiple funeral pyres of victims of COVID-19 burn in an area that has been converted for mass cremation in New Delhi, India, Saturday, April 24, 2021. (AP Photo/Altaf Qadri)

Multiple funeral pyres of victims of COVID-19 burn in an area that has been converted for mass cremation in New Delhi, India, Saturday, April 24, 2021. (AP Photo/Altaf Qadri)

GLOBAL DISPARITIES REVEALED

The second year of the pandemic also highlighted the vast differences in vaccine access for low-income countries, and the way every country – and even regions within a country – managed the pandemic and vaccinations.

Depending on where you lived, “lockdown” meant very different things and a “surge” in cases could mean tens of thousands of new daily cases or 100. Some countries focused on minimizing hospitalizations and deaths, while other countries followed a zero-COVID policy. The pandemic showed how well-funded some public health systems were, while exposing the cracks and lack of funding in others.

Even within Canada, some experts noted that death rates have been grossly different in different provinces and territories, as have the risks of getting infected or becoming seriously ill.

“We learned that there's a lot more disparities between different parts of the world even though it's all still one pandemic. And the way it was dealt with in different places became increasingly disparate,” said Barrett, adding that it is one reason why ongoing challenges remain.

When vaccines became available at the end of 2020, the WHO stressed the importance of ensuring vaccine equity and access. COVAX, the global vaccine sharing program, failed to deliver on its promise, regardless of its best intentions. The logistical problems in other parts of the world stretched beyond equity, some experts said. It showed the limitations of our ability to help and what we can learn from that for the future.

“Vaccinating an entire planet of seven billion people is pretty darn challenging,” says Evans, who was involved in pandemic planning 20 years ago.

“It wasn't just getting vaccines to other parts of the world … It was getting vaccinations done. If the infrastructure is not there, if you don't have all the other things that you need to vaccinate people with – you don't have needles, you don't have people, you don't have clinic setup – it can actually be hard, even if you have the vaccines sitting in a warehouse and available.”

As the world enters the third year of the pandemic, experts generally agree there will be new variants and more waves ahead. But scientists, globa leaders, and the public are armed with much more information.

“We’ve come an incredible distance forward. All that knowledge that we’ve put together – it’s so powerful,” said Barrett, adding that we need to recognize that uncertainty remains and to move forward with caution.

“Realism is a wonderful thing when it's based in knowledge, and we have a ton more of that now.”