茄子直播

Better, but far from over: 茄子直播 experts share their COVID-19 outlooks for the year ahead

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The pandemic's end may finally be in sight as front-line staff receive vaccines, but 茄子直播 researchers who have been studying the virus and its impact say there remain many hurdles to clear in 2021 (photo by Rick Madonik/Toronto Star via Getty Images)

Allison McGeer is unequivocal when she is asked about the vaccines that are now being administered to fight the spread of COVID-19. 

鈥淚t鈥檚 a miracle that the vaccines have come so quickly,鈥 says McGeer, director of the Infectious Diseases Epidemiology Research Unit at Mount Sinai Hospital and a professor in the department laboratory medicine and pathobiology in the Temerty Faculty of Medicine. 鈥淲e鈥檝e been saying for many months that the only way out of this pandemic is the vaccine. If we had to continue without the vaccine, it would have been very difficult.鈥

But McGeer, who is cross-appointed to the department of medicine and 茄子直播鈥檚 Dalla Lana School of Public Health, and who has , adds that while the vaccine is helping to ease global society out of the pandemic, 鈥渋t鈥檚 a qualified miracle because it鈥檚 going to take months for us to deliver vaccines and because COVID is just not going to end fast 鈥 it鈥檚 not going away.鈥

Many questions have yet to be answered. Will people need to be re-vaccinated? How much is the virus going to mutate? How many people will roll up their sleeves?

鈥淚t鈥檚 a long list we need to answer to determine how we move from what I think of as acute COVID, which is what we have now, to chronic COVID, which is what we鈥檒l have at the end of this year.鈥

Allison McGeer is the director of infection control at Mount Sinai Hospital and a professor at 茄子直播鈥檚 Dalla Lana School of Public Health with cross-appointments in the Temerty Faculty of Medicine (photo courtesy of Allison McGeer)

McGeer鈥檚 questions about how Canada will fare in 2021 are echoed by a number of 茄子直播 scientists and scholars who have been focused on understanding the coronavirus and its effect on society since the outbreak took hold in North America early in 2020. 

Jeff Kwong, an associate professor at Dalla Lana and in the department of family and community medicine at the Temerty Faculty of Medicine, is the interim director of 茄子直播鈥檚 Centre for Vaccine Preventable Diseases. He welcomes the vaccine but agrees there is much more to consider. 

 

鈥淣ow, it鈥檚 all about the supply. How many doses can we get and how quickly and how fast can we get it into as many people鈥檚 arms as possible? That鈥檚 going to be the story for 2021.鈥

The first few months will be tough. 

鈥淥n the negative side, the first part of 2021, as we鈥檙e seeing now, is going to be hard,鈥 says Isaac Bogoch, associate professor of medicine in the Temerty Faculty of Medicine and an infectious diseases consultant at the University Health Network. 鈥淲e have record-high cases of COVID across Canada now and, unfortunately, those numbers will go higher because of social gatherings over the holiday season.鈥

 

Yet, despite the challenges, Bogoch, a member of the Ontario Ministers鈥 COVID-19 Vaccine Distribution Task Force who has become well-known to Canadians for his almost-daily appearances on TV and radio newscasts, says the vaccines are already beginning to make a positive difference. 

鈥淲e are now vaccinating some of the most vulnerable populations in Canada and will continue to do so throughout the first two to three months of 2021,鈥 he says. 鈥淭hat will do a lot of good. Long before we achieve herd immunity, vaccinating workers and residents of long-term care settings, seniors and Canadians with compromised immune systems will protect some of the most vulnerable populations in the country, alleviate death and suffering and take some pressure off of our health-care system.

鈥淚t won鈥檛 solve all of our problems, but it will certainly solve several of the issues we are facing.鈥

Bogoch adds that life in Canada should continue to normalize as we move further into 2021. 

鈥淎s 2021 rolls on and vaccine programs continue to expand across the country, I really think things are going to get better,鈥 he says. 鈥淲e鈥檒l probably start to see a lifting of several of the public health measures that we have, like larger gatherings permitted in indoor and outdoor settings, and we鈥檒l start to see mask mandates lifted, greater travel and transportation allowed and a softening of border measures. 

鈥淚 think that it鈥檚 going to be a period of rapid change 鈥 and change in the right direction.鈥

McGeer, Kwong and Bogoch are just three of the hundreds of 茄子直播 researchers and scholars who shifted their focus over the past year as part of a massive, university-wide effort to better understand the virus and its myriad impacts, work on new treatments and vaccines, and figure out ways to help the city, province and country engineer a strong and socially equitable recovery.

There are more than 110 federally funded COVID-19 research initiatives at 茄子直播 and its hospital network. 茄子直播, meanwhile, has contributed more than $10 million through the Toronto COVID-19 Action Fund.

鈥淎cross so many fields and in so many different ways, the University of Toronto community is applying its expertise and experience to help Canada and the world resolve this unprecedented global crisis,鈥 said 茄子直播 President Meric Gertler in a recent report focused on 茄子直播鈥檚 response to the pandemic. 

The report, titled ,鈥 chronicles the work of researchers from across of the university鈥檚 three campuses, as well as its nine partner hospitals and numerous industry partners.

It also recognizes the support of the federal government, which . Also of note was the historic donation of $250 million from James and Louise Temerty and the Temerty Foundation to the Temerty Faculty of Medicine. The foundation advanced $10 million of that donation to expand 茄子直播鈥檚 Containment Level 3 facility and enable other urgent COVID-19 efforts. 

茄子直播 scientists were among the first in the world to begin investigating the virus. Kamran Khan, a faculty member at the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health, started BlueDot in the wake of the 2003 SARS crisis in a bid to develop an early warning system for virulent diseases. In early January, the company pushed out an alert to its users about an unusual cluster of pneumonia cases arising from a market in Wuhan, China 鈥 days before the U.S. Centres for Disease Control and Prevention and World Health Organization issued their own alerts.

Kamran Khan鈥檚 BlueDot was among the first organizations to flag an unusual cluster of pneumonia cases arising from a market in Wuhan, China (photo by Jorge Uzon/AFP via Getty Images)

By March, 茄子直播 researchers and Sunnybrook Health Sciences Centre microbiologists Samira Mubareka and Robert Kozak, in collaboration with McMaster virologist Arinjay Banerjee, were among the first to isolate the virus, using specimens collected at Sunnybrook from Canada鈥檚 first infected patient. Their work gave researchers across Canada a ready supply of virus on which to test treatments. Kozak is now developing a vaccine .

Robert Kozak and Samira Mubareka, both in 茄子直播鈥檚 Temerty Faculty of Medicine and at Sunnybrook Health Sciences Centre, were among the first to isolate the coronavirus (photo by Nick Iwanyshyn)

As vital as that work was in 2020, Christine Allen, who helped steer the university鈥檚 Toronto COVID-19 Action Initiative as 茄子直播鈥檚 associate vice-president and vice-provost, strategic initiatives, emphasizes that there is a huge amount of work still needed in the upcoming year.   

 

鈥淟ast year confirmed the power and impact of our scholars and interdisciplinary teams in tackling the world鈥檚 most important challenges,鈥 she says. 鈥淚n 2021, we will need to redouble our efforts, ensuring that the basic research and the applied and translational 鈥 and the links between them 鈥 are further strengthened as 茄子直播鈥檚 research and scholarly community continue to contribute to social justice, economic progress and health security.鈥

Carmen Logie, an associate professor at the Factor-Inwentash Faculty of Social Work, says the vaccines are lifesavers but notes that getting them to developing countries and then into the arms of people is much more challenging than in Canada. That鈥檚 why she is focusing her efforts on the pandemic鈥檚 outsized impact on people in low-income countries. In particular, she is studying how COVID-19 is affecting adolescents and young people who are refugees in Uganda鈥檚 capital, Kampala 鈥 many of whom fled violence in the Democratic Republic of the Congo. She and her research colleagues have been using a mobile phone app to help these young people receive information about preventing COVID-19 鈥 and to express their feelings and concerns. 

 

The challenges experienced by these young people and other refugees were severe in July 鈥 and Logie notes that the situation hasn鈥檛 improved much since.

鈥淭his is a low-income country and the pandemic is striking Uganda and the refugees in an extremely hard way that is much different than in Canada,鈥 she says. 鈥淚 read a report in mid-December that said in one refugee camp a lack of face masks, water and soap is pushing COVID-19 infection rates higher. The refugees are being given one mask and they are supposed to wash it daily and reuse it, but there isn鈥檛 enough water and soap to enable them to do that. This is typical of what鈥檚 happening there.鈥

鈥淲hile we do need to take care of one another in Canada, and we need to address the inequalities within Canada, we also need to keep an eye on larger global inequalities. The fact is that there are low-income people in the world won鈥檛 get a vaccine until 2022. We should all be concerned about that.鈥

Bogoch, too, is concerned about the international picture. His background as an infectious disease specialist includes many years on the ground in Africa 鈥 mostly in Ghana and Cote d鈥橧voire 鈥 treating people with parasitic infections. 

鈥淲e know this is a very contagious virus and how it can rip through communities and spread around the world quickly,鈥 he says. 鈥淪o, we鈥檙e in a global situation where no one is safe anywhere unless everyone is safe. This is especially true for countries that are not as well-resourced as countries like Canada.鈥

Helping in that effort, he says, is COVAX, an initiative launched by the World Health Organization, the European Commission and France to provide equitable access to the COVID-19 vaccine for low- and middle-income countries. Canada is a participant. 

Even in developed countries, the spread of COVID-19 among vulnerable populations continues to be a major problem. Bogoch is particularly concerned with 鈥渃ongregate settings鈥 鈥 operations such as hospitals, factories and grocery stores 鈥 where people must work in person and are often in close proximity to each other. 

鈥淲e really need to get these people vaccinated,鈥 he says. 鈥淎nd I would extend that urgency to shelter populations. This is a vulnerable group and there鈥檚 already evidence in Canada that COVID can just tear through homeless shelters and refugee shelters. We have to protect people in those settings.

鈥淭his need is reflected in the provincial approaches to vaccine priorities this coming year and that is a good thing.鈥

And then there is the deadly situation in long-term care homes, which has become one of the most troubling aspects of Canada鈥檚 COVID-19 response. 

鈥淚 spent a long time in January of 2020 looking at respiratory infections in a variety of health-care institutions and it was clear to me that we were going to have a disaster in long-term care (LTC),鈥 says McGeer.  

While she is thankful the vaccine is beginning to be injected into the arms of LTC workers and residents, she also notes that we shouldn鈥檛 be surprised at how hard COVID-19 hit the LTC sector. 

鈥淧andemics tend to lay bare where you are having trouble already,鈥 McGeer says. 鈥淭he issues in LTC existed pre-pandemic. For example, we got out of having four patients in a room in most hospitals in this country years ago. But that hasn鈥檛 changed in LTC. If I said to you 鈥榃hen you are in a hotel, would you share a room with three other people who you don鈥檛 know and share a bathroom with eight other people?鈥 You鈥檇 think I was crazy, right?  But we require people to do that in LTC all the time. That鈥檚 why the virus has spread the way it has in these facilities. And this crowding is just one problem.鈥

Nevertheless, McGeer hopes the LTC experience over the past year has been a wakeup call. 

鈥淭he challenges are enormous and you can鈥檛 fix them during a pandemic,鈥 she says. 鈥淏ut at some level, and maybe this is magical thinking, I鈥檓 hoping we will as a society be able to look at the impact of inequities and do something longer term to reduce them in Canada. But it鈥檚 going to be very hard.鈥

The pandemic has also had a notable disproportionate impact on racialized populations in Canada.

Eileen de Villa, Toronto鈥檚 chief medical officer of health, revealed data in a July CBC article showing that Black people accounted for 21 per cent of reported cases of COVID in the city even though they made up only nine per cent of the overall population. The disparity was similar for people of Arab, Middle Eastern and West Asian descent, de Villa noted.

Tanya Sharpe encountered the same phenomenon last year as she was conducting research on the sociocultural factors that influence coping strategies of Black family members and friends of homicide victims. 

鈥淭his was early on in the pandemic in 2020,鈥 says Sharpe, an associate professor at the Factor-Inwentash Faculty of Social Work. 鈥淭he U.S. began to capture data by race, which is a standard practice in the U.S., but not so much in Canada. They began to show that many of the same neighbourhoods that experienced the highest rates of homicide violence and victimization 鈥 neighbourhoods that are disproportionately Black and Latino in the U.S. 鈥 were also experiencing the highest rates of COVID-19.鈥

She and her team then examined determinants that often lead to health issues in racialized populations 鈥 inadequate housing, education and low-paying jobs that don鈥檛 include paid leave. 

鈥淲hen you consider these factors, you make this fundamental connection about the impact of structural inequities on some of our most vulnerable populations,鈥 says Sharpe, who joined 茄子直播 in 2018 after 11 years at the University of Maryland in Baltimore and is the founder and director for (The CRIB).

鈥淚n Canada, vulnerable populations impacted by structural inequities are disproportionately Black and Indigenous people who often do not have the luxury of social distancing from family members when there are five or six people in one household, or don鈥檛 have access to clean drinking water to wash their hands to protect themselves from the virus.

Tanya Sharpe, an associate professor at the Factor-Inwentash Faculty of Social Work, says the pandemic forced society to see what it had previously chosen to ignore: structural inequity, which resulted in Black and other racialized communities bearing the brunt of COVID-19鈥檚 deadly impact (photo courtesy of Tanya Sharpe)

She adds that racialized Canadians 鈥渁re so often the front-line workers, the nurses and personal support workers in nursing homes and the cashiers in the grocery store who are taking care of everyone else and exposing themselves day-to-day, putting themselves at risk to simply survive.鈥 

Sharpe emphasizes that the disproportionate number of COVID-19 cases among racialized communities is simply the latest chapter in a long history of systemic racism. 

鈥淭he pandemic has forced all of society to see what I think people purposely choose not to see: structural inequity that is in fact inherently violent and can no longer be ignored.鈥

She welcomes the vaccine but is leery of the oft-used expression 鈥済etting back to normal.鈥

鈥淚 don鈥檛 think we should ever go back to normal,鈥 she says. 鈥淭he unearthing of the structural inequities suggests that, yes, we need to make sure everyone is vaccinated, but what are we going to do about the systemic racism of inequities that continue to plague Black and Indigenous communities?鈥

Sharpe says it鈥檚 essential to address the lack and accessibility of race-based data collected by Canadian governments. 

Ultimately, it鈥檚 data, she says, that enables policy-makers to make change that can help to address structural inequities.

鈥淭hey need the information. Because in the absence of data, if you don鈥檛 count it, it doesn鈥檛 count.鈥

For all Canadians, how work and employees will recover from the pandemic remains an open question.

茄子直播鈥檚 Scott Schieman, a professor of sociology in the Faculty of Arts & Science who is known for his research on work 鈥 and the stress that often comes from work 鈥 launched a study in September 2019 to document the experiences of 3,000 Canadians. His original plan was to replicate the study annually to track changes over the next decade. But COVID-19 caused Schieman to pivot so the study could map the short- and longer-term impacts of the pandemic, including job disruptions, financial strains, and the shift (for some) towards remote work 鈥 all of which are expected to have consequences for physical and mental health. 

Eight months later, Schieman and his team are seeing those COVID-19 stressors come alive. 

He notes that those who have been able to keep their jobs and work from home have fared relatively well. This is especially true if those workers have not had to take care of children while on the job at home. But add children to the mix 鈥 especially when they are attending school virtually 鈥 and Schieman says the stress on parents has become much greater.  The patterns are particularly strong for those with younger children at home. 

One of his main concerns is workers who have lost their jobs, either temporarily or permanently, because a business has been forced to close. 

鈥淓veryone is experiencing significant and often very different impacts on quality of life, and their sense of optimism, loss of control over their lives and feelings of uncertainty about the future,鈥 he says. 鈥淏ut certain job sectors or industries are more compromised. Accommodation and food services, for example, got slammed, especially during the early months of the pandemic. If you want to see a line on a graph that looks like nothing you鈥檝e seen before, you look at the job disruption for that group.鈥 

His research shows workers experienced a simultaneous spike in the sense of powerlessness and distress 鈥 mostly because of a sharp rise in financial strain. 

鈥淭he question now,鈥 Schieman says, 鈥渋s whether that sector will come back and how it will rebound. Once the vaccine is administered, will the rebound be smooth or uneven? And what will it mean for their well-being?鈥 

Scott Schieman, a professor of sociology in the Faculty of Arts & Science, is mapping the short- and longer-term impacts of the pandemic, including job disruptions, financial strains, and the shift to remote work (photo by Brian Summers)

Schieman has also noted increases and dips in the loneliness and social isolation pandemic that lockdowns and job losses have caused. 

鈥淭he loneliness spiked early in the pandemic, but then summer came, the lockdowns eased, many businesses re-opened and people could socialize in person more. But in the latest data from our study that we鈥檝e looked at, loneliness is spiking again as we go back into lockdowns.鈥

Social isolation, he adds, can have a profound effect on mental health, resulting in severe psychological distress. He says recent data shows older study participants are feeling that loneliness the most sharply. 

鈥淚鈥檓 speculating at this point, but I have to wonder if that is partly because younger people more easily engage in social media technology and that helps them stay connected to their friends,鈥 he says.

So, when will we be free of COVID-19 for good?

Kwong, at the Centre for Vaccine Preventable Diseases, says the holy grail is herd immunity, when enough people have been vaccinated or developed natural immunity that the virus no longer spreads like crazy.

鈥淲inter and spring in Canada won鈥檛 be normal,鈥 predicts Kwong. 鈥淎nd I don鈥檛 think people should be making huge travel plans for the summer. But I heard the prime minister say that every Canadian who wants the vaccine will be able to get it by September.

鈥淭hat鈥檚 fantastic if that can happen, because that means by next year at this time we鈥檒l have the majority of the population protected and we can, hopefully, have a normal December holiday season.鈥


 

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