Almost two years ago, community measures including lockdowns to suppress Covid transmission had widespread support, with a movement (“Covid Zero”) that promoted more draconian measures, hoping to eliminate Covid altogether. Schools, institutions of higher learning and businesses were shuttered. Even playgrounds and outdoor washrooms were closed, and youths simply enjoying outdoor summer parties were vilified. Most of these measures were ineffective, many were harmful. Has anything been learned from these mistakes or will they be repeated the next time case counts go up? We have some thoughts for the future.

It is time to accept that Covid-19 cannot be stopped and will continue to evolve. Full faith was first placed in the vaccine, and then in boosters as “our way out of the pandemic.” However, the vaccines don’t stop infections of transmission as much as originally hoped — nor do boosters. The Covid Zero movement is dead, and many early proponents have recanted. It is impossible to stop a virus that spreads before symptoms appear, and with super-spreader events that can infect most people in a room.

The other challenge is that Covid reinvents itself quickly. As one strain transmits through the community, population immunity emerges and the next strain is selected to keep itself going — this is viral evolution.

It’s like the iPhone: when the market gets saturated with the latest version, a new one is released to fill the void. Right now, the variant with the longest run has been Omicron, with its relatives (BA.4/5) now in circulation.

How long the Omicron run will last is anyone’s guess: more Omicron variants, or a completely new variant could take over soon. How long before the newly released bivalent vaccine, targeting the original Covid and Omicron strains, is also out of date?

Additional vaccine doses should be tailored to the specific circumstances of the person, not a “one-size-fits-all” solution. One thing has remained constant since the pandemic began: the young and healthy under age 50 seldom have severe outcomes from Covid-19, so guidance on vaccination should be tailored to age, immunity and risk factors.

While a very small number of people remain vulnerable, either prior infection, or vaccines received many months ago still prevent serious outcomes for almost everyone — that’s what matters most to protect the health-care system.

Even our higher risk elderly are seeing disease that is less severe than what we see with other common viruses, including other coronaviruses. The mortality rate for those in elder care homes was eight per cent with other (non-Covid) coronaviruses, similar to what we see with Covid now.

Likewise, it is folly to believe that more vaccination uptake (adult rates in Canada are at 91 per cent for two doses), or that more booster doses of the latest bivalent vaccine will stop transmission or the emergence of new variants.

This is because vaccine protection for infection falls off (wanes) within a few months following a dose. Consider the latest NACI guidance regarding boosters being needed every three or six months: Dosing this frequently is unlikely to further lower hospitalizations and will be very hard to accomplish — coverage rates of third and fourth doses for those under age 40 are well below 50 per cent and five per cent respectively.

As discussed in a recent New England Journal of Medicine article, it is also impractical to give boosters more than once a year. While it is tempting to blame new variants on low vaccine uptake, this causal link is far from clear. Evolutionary dynamics, especially with fast-mutating coronaviruses, make the emergence of new variants inevitable, regardless of vaccination rates.

There’s a bigger picture issue here: in 2020, Covid had a more significant health-care system surge impact than other respiratory viruses. By 2022, with significant population natural immunity, vaccine immunity, or both this is no longer the case.