Here's What An Endemic Might Look Like In Ontario & When COVID-19 Could Become One

Dr. Peter Jüni weighs in on what to expect next.

Toronto Associate Editor

Ontario is exceeding its vaccination targets for reopening and recording its lowest active caseload in 10 months, but what does the future of the pandemic have in store?

Ontario's Chief Medical Officer of Health Dr. Kieran Moore said recently that while COVID-19 isn't leaving the province anytime soon, Ontario will eventually move "from a pandemic to an endemic state where we can try to get back to normal" sometime in the fall. Moore and other experts predict that a rise in cases will take place in the fall.

Narcity spoke to the scientific director of the Ontario COVID-19 Science Advisory Table, Dr. Peter Jüni, about what an endemic state might look like in Ontario, and what the province could experience this fall and beyond.

What is an endemic state?

Jüni describes an endemic as ongoing transmission of a disease in a certain region, but at a low enough level that life can carry on as normal and sweeping public health restrictions are not needed. Smaller outbreaks will occur, but not the dramatic waves that have been seen so far.

"The extent of immunity gained either through vaccination or through natural infection is high enough that you don't end up in relevant waves that are indeed challenging to the health care system."

If COVID-19 were to evolve into an endemic, infections would occur at a relatively low level with the "potential for intermittent ripples or small waves, but to a considerably smaller extent than what we had during the last 16 months."

When might the endemic period be reached in Ontario?

Jüni said that the only way to move out of the pandemic and into an endemic is through extremely high vaccination coverage. However, this target becomes "higher and higher with the increased ability of the virus to adapt to its new host that's us, humans."

"The way to get ready for this transition is to get vaccinated, everybody absolutely fully vaccinated as many people as possible," said Jüni. "Ideally a target would be above 90% of the eligible population, meaning in all regions in the province across all age groups that can get vaccinated, and the smaller this residual percentage is of people who aren't vaccinated, the less we will be challenged."

He added that if the province were to consider measures to curb transmission in the future, vaccination certificates can be used to regulate access to public spaces like indoor dining, cinemas, casinos, and other settings. "Apart from that, there's, for quite some while, probably no way out of having to use indoor masks in addition to excellent ventilation," said Jüni.

Will Ontario experience another wave of infections in the future?

A fourth wave of COVID-19 is "no doubt" on the horizon, infection control epidemiologist Colin Furness told Narcity, which "will be almost entirely experienced by unvaccinated people."

Furness says he expects the rise in cases will consist of "sporadic, intense outbreaks, harder to anticipate or predict." He also said that it's likely that a third booster shot will be needed in the winter or early next year to combat emerging variants.

Furness, however, disagrees that the disease will evolve into an endemic like seasonal influenza. '[COVID-19] is WAY more contagious, which means it's most likely to burn bright and then burn out, the latter helped a great deal by vaccination. I can't think of a pandemic that ever became endemic, although the virus could evolve to do so," he said.

"[COVID-19] will persist for some time because it will circulate among billions of unvaccinated people, and held in check from spreading too rapidly (and burning out) by those who are vaccinated. We can expect outbreaks over the next year, perhaps longer – and if it goes on long enough, that will begin to look endemic."

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