Better, but far from over: U of T experts share their COVID-19 outlooks for the year ahead

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

“It’s a miracle that the vaccines have come so quickly,” 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. “We’ve 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.”

But McGeer, who is cross-appointed to the department of medicine and U of T’s Dalla Lana School of Public Health, and who has several COVID-19 projects funded by the Canadian Institutes of Health Research, adds that while the vaccine is helping to ease global society out of the pandemic, “it’s a qualified miracle because it’s going to take months for us to deliver vaccines and because COVID is just not going to end fast – it’s not going away.”

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?

“It’s 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’ll have at the end of this year.”

Allison McGeer is the director of infection control at Mount Sinai Hospital and a professor at U of T’s Dalla Lana School of Public Health with cross-appointments in the Temerty Faculty of Medicine (photo courtesy of Allison McGeer)

McGeer’s questions about how Canada will fare in 2021 are echoed by a number of U of T 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 U of T’s Centre for Vaccine Preventable Diseases. He welcomes the vaccine but agrees there is much more to consider. 

“Now, it’s all about the supply. How many doses can we get and how quickly and how fast can we get it into as many people’s arms as possible? That’s going to be the story for 2021.”

The first few months will be tough. 

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

Yet, despite the challenges, Bogoch, a member of the Ontario Ministers’ 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. 

“We 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,” he says. “That 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.

“It won’t solve all of our problems, but it will certainly solve several of the issues we are facing.”

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

“As 2021 rolls on and vaccine programs continue to expand across the country, I really think things are going to get better,” he says. “We’ll 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’ll start to see mask mandates lifted, greater travel and transportation allowed and a softening of border measures. 

“I think that it’s going to be a period of rapid change – and change in the right direction.”

McGeer, Kwong and Bogoch are just three of the hundreds of U of T 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 U of T and its hospital network. U of T, meanwhile, has contributed more than $10 million through the Toronto COVID-19 Action Fund.

“Across 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,” said U of T President Meric Gertler in a recent report focused on U of T’s response to the pandemic. 

The report, titled “Demonstrating Resilience in a Pandemic: Scientists as First Responders,” chronicles the work of researchers from across of the university’s three campuses, as well as its nine partner hospitals and numerous industry partners.

It also recognizes the support of the federal government, which contributed $1.1 billion in funding to COVID-19-related research. 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 U of T’s Containment Level 3 facility and enable other urgent COVID-19 efforts. 

U of T 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 – days before the U.S. Centres for Disease Control and Prevention and World Health Organization issued their own alerts.

Kamran Khan’s 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, U of T 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’s 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 as part of a national collaboration with Université Laval.

Robert Kozak and Samira Mubareka, both in U of T’s 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’s Toronto COVID-19 Action Initiative as U of T’s associate vice-president and vice-provost, strategic initiatives, emphasizes that there is a huge amount of work still needed in the upcoming year.   

“Last year confirmed the power and impact of our scholars and interdisciplinary teams in tackling the world’s most important challenges,” she says. “In 2021, we will need to redouble our efforts, ensuring that the basic research and the applied and translational – and the links between them – are further strengthened as U of T’s research and scholarly community continue to contribute to social justice, economic progress and health security.”

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’s why she is focusing her efforts on the pandemic’s 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’s capital, Kampala – 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 – and to express their feelings and concerns. 

The challenges experienced by these young people and other refugees were severe in July – and Logie notes that the situation hasn’t improved much since.

“This 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,” she says. “I 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’t enough water and soap to enable them to do that. This is typical of what’s happening there.”

“While 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’t get a vaccine until 2022. We should all be concerned about that.”

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

“We know this is a very contagious virus and how it can rip through communities and spread around the world quickly,” he says. “So, we’re 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.”

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 “congregate settings” – operations such as hospitals, factories and grocery stores – where people must work in person and are often in close proximity to each other. 

“We really need to get these people vaccinated,” he says. “And I would extend that urgency to shelter populations. This is a vulnerable group and there’s already evidence in Canada that COVID can just tear through homeless shelters and refugee shelters. We have to protect people in those settings.

“This need is reflected in the provincial approaches to vaccine priorities this coming year and that is a good thing.”

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

“I 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),” 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’t be surprised at how hard COVID-19 hit the LTC sector. 

“Pandemics tend to lay bare where you are having trouble already,” McGeer says. “The 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’t changed in LTC. If I said to you ‘When you are in a hotel, would you share a room with three other people who you don’t know and share a bathroom with eight other people?’ You’d think I was crazy, right?  But we require people to do that in LTC all the time. That’s why the virus has spread the way it has in these facilities. And this crowding is just one problem.”

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

“The challenges are enormous and you can’t fix them during a pandemic,” she says. “But at some level, and maybe this is magical thinking, I’m 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’s going to be very hard.”

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

Eileen de Villa, Toronto’s 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. 

“This was early on in the pandemic in 2020,” says Sharpe, an associate professor at the Factor-Inwentash Faculty of Social Work. “The 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 – neighbourhoods that are disproportionately Black and Latino in the U.S. – were also experiencing the highest rates of COVID-19.”

She and her team then examined determinants that often lead to health issues in racialized populations – inadequate housing, education and low-paying jobs that don’t include paid leave. 

“When you consider these factors, you make this fundamental connection about the impact of structural inequities on some of our most vulnerable populations,” says Sharpe, who joined U of T in 2018 after 11 years at the University of Maryland in Baltimore and is the founder and director for The Centre for Research and Innovation for Black Survivors of Homicide Victims (The CRIB).

“In 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’t 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’s deadly impact (photo courtesy of Tanya Sharpe)

She adds that racialized Canadians “are 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.” 

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. 

“The 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.”

She welcomes the vaccine but is leery of the oft-used expression “getting back to normal.”

“I don’t think we should ever go back to normal,” she says. “The 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?”

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

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

“They need the information. Because in the absence of data, if you don’t count it, it doesn’t count.”

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

U of T’s Scott Schieman, a professor of sociology in the Faculty of Arts & Science who is known for his research on work – and the stress that often comes from work – 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 – 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 – especially when they are attending school virtually – 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. 

“Everyone 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,” he says. “But 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’ve seen before, you look at the job disruption for that group.” 

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

“The question now,” Schieman says, “is 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?” 

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. 

“The 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’ve looked at, loneliness is spiking again as we go back into lockdowns.”

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. 

“I’m 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,” 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.

“Winter and spring in Canada won’t be normal,” predicts Kwong. “And I don’t 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.

“That’s fantastic if that can happen, because that means by next year at this time we’ll have the majority of the population protected and we can, hopefully, have a normal December holiday season.”