Three years later: What has COVID-19 taught us and are we ready for the next big threat?

Think back to the before times. Before March 2020.

You probably hadn't thought much about the possibility of a pandemic.

The idea of mandatory masking, isolating and shuttering schools and businesses might have seemed almost Orwellian. 

Then, a new and deadly virus snaked its way into our province. 

Those previously unfathomable measures became our collective reality, our leaders' way of protecting Albertans.

Many of us set our clocks to the daily news conferences.

We watched health officials rattle off COVID-19 case counts, hospitalizations, deaths. 

Hospitals were overwhelmed with sick Albertans. Intensive care units were forced to expand.

Exhausted health-care workers pleaded for help. 

Scientists developed life-saving vaccines at breakneck speed. 

We reacted to the threat. We learned how to protect ourselves.

Three years after the World Health Organization declared COVID-19 a pandemic, you might think we're better prepared for the next time a deadly pathogen hits.

But are we? 

What lessons have we learned? And will this help us navigate the next pandemic?

Ancient threat

It's not a question of if that happens, but when.

"Plague is an ancient threat," said Dr. Nicholas Christakis, a physician and sociologist at Yale University and author of the book, Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live.

"Respiratory pandemics come every 10 to 20 years.… But we only get a serious pandemic every 50 to 100 years," he said in an interview.

Think SARS, which killed 44 Canadians in 2003.

According to Christakis, there is evidence that respiratory pandemics are coming more frequently.

"We very well could have another one before too long."

He argues we are in the second of three pandemic phases, where enough people have immunity through vaccination and infection that the threat, while not entirely gone, has receded.

"But we have to cope with the aftershocks, with the political, social, psychological and economic aftershocks of the virus," said Christakis.

"The virus is like a tsunami. Initially, it's the water that causes all this devastation. Eventually, the water recedes. But now we've got to clean up the mess."

Science and Medicine

When you look at the pandemic through the lens of science and medicine, there have been some very clear wins.

"We went from really having no knowledge of the virus to having it sequenced, to having actually really good vaccines in an incredibly short period of time," said University of Alberta infectious diseases specialist Dr. Lynora Saxinger.

The province began its rollout of the COVID-19 vaccine in December 2020, nine months after Alberta confirmed its first cases.

"There's a huge number of lives saved by the vaccine."

And experts say the evidence shows public health interventions, such as masking, gathering limits and social distancing, helped rein in the virus.

"If you look at the jurisdictions that used public health measures, they had less COVID, less hospitalization, less deaths," said Timothy Caulfield, Canada Research Chair in health law and policy at the University of Alberta.

The timing and intensity of those measures can be debated, Saxinger added, but the fact they helped is indisputable.

As the pandemic unfolded, Alberta's medical system had no choice but to pivot. 

Hospitals redeployed staff, cancelled surgeries and cleared out wards to make room for COVID patients. 

A giant tent — a field hospital — went up in the parking lot at Calgary's Peter Lougheed hospital.

In the community, large testing facilities were opened, which, at their peak, conducted  more than 23,000 swabs a day.

"Those are all basically important tools that would be really relevant if we had a new avian flu or if we had a new coronavirus," said Saxinger.

Outside hospitals, the system also learned to adapt.

For instance, PCR test results weren't initially being shared with family doctors. But people from different parts of the health system worked to build a "data bridge" so physicians could care for their infected patients, said Myles Leslie, associate professor and policy research director at the University of Calgary.

"We figured out that it's possible to have primary care more closely integrated with the central [health-care] system — another big win, if you ask me."

These are all valuable scientific and health-system lessons.

The trouble is, people, by nature, make messes.

The 'mess'

Caulfield is worried revisionist history is taking hold.

"People are kind of reflecting on how the pandemic played out and painting a different picture than what really played out," he said. 

They suggest public health measures weren't necessary, vaccines didn't work and the public was lied to.

"But that kind of revisionist history, I worry, is going to create distrust with institutions," Caulfield said.

A key player? Misinformation.

"I was surprised at how powerful the misinformation was, how enduring it has been and the incredible harm that it has done," Caulfield said.

People watched the science unfold, in real time, as the virus embedded itself in our lives.

What many people didn't understand is that science evolves. 

"We wanted to be clear. We wanted to sound definitive," said Caulfield. 

"We wanted to sound certain in order to have people act on the recommendations. But then when the science shifted, it sounded like we were shifting, and that created distrust."

There's a need for better scientific communication and proactive debunking moving forward, he said. Another lesson learned.

But that is a grinding process. And Caulfield isn't convinced governments will have the political will to act if a new pathogen emerges.

"There's so much distrust now. There's just so much polarization. There's so much leveraging of uncertain science to really foster distrust in an unjustified manner that it leaves us in a very vulnerable position."

The question of trust

Remember Dr. Deena Hinshaw's rallying cry?

"We're all in this together," said Hinshaw, then the province's chief medical officer of health.

It eventually fizzled, lost its meaning.

Some sociologists argue the pandemic amplified socio-economic divisions that already existed in society. 

More advantaged people were willing to place more trust in Canadian institutions, said Alex Bierman, an associate professor of sociology at the University of Calgary.

"It was people who were already somewhat alienated who … became more suspicious and less trusting over the course of the pandemic," he said.

Bierman contends that a "substantial minority" no longer trust government leaders or even their fellow Canadians.

How does Bierman see this playing out if there is another pandemic? 

"We can create vaccines. We can create policies. Getting those vaccines into people, getting people to follow policies, I think, is going to be much, much more difficult."

He said the experience of the past three years has put a damper on the political appetite for future protective health measures.

"The result will be … much more death and suffering," Bierman said. "And I suspect that many people will not learn the lessons of this pandemic unless we see that level of death and suffering."

'We're not so broken'

But let's not forget: When it came time to roll up their sleeves, the vast majority of Albertans got their initial COVID-19 shots.

Provincial data shows 78 per cent of Albertans have had two doses.

"Most surveys still highlight again and again that most Canadians are accepting of the public health measures that were utilized … even here in Alberta. And I think that is cause for optimism," said Caulfield.

The naysayers, while loud, are still the minority.

"We're not so broken. We're no more broken than we were," said Leslie.

Through all the weeds, he sees hope.

"We've learned how to negotiate with one another and extend our relationships and be more equitable and be more empathetic," Leslie said.

"Change isn't as hard as we thought."

COVID is 'fiendish'

There is no question COVID-19 has had devastating consequences. And it continues to do so.

Our health-care system is still grappling with exhausted workers, surgical backlogs and patients who are sicker because their care has been delayed.

The virus has killed 5,622 Albertans. Dozens more die every month. And we've yet to grasp the health and economic impacts of long COVID.

But sadly — or perhaps terrifyingly — it could have been worse.

The "Spanish flu" of 1918 killed more than 50 million people worldwide — more than seven times as many deaths as COVID thus far, and at a time when the global population was far smaller.

"The thing about COVID that was so fiendish is that it was deadly enough to be serious, but not deadly enough so there was unanimity of opinion about what to do," said Christakis.

"If a new virus comes along and kills 10 per cent of the people that it infects, I don't think there's going to be a lot of disagreement about closing businesses.… A lot of it depends on how deadly the virus is. In other words, we had the luxury of having a political argument."

The next time we may not.

The reality is we are now saddled with this virus — and the mess that comes with it.

Can we do better next time? Let's hope so.