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Mustafa Hirji is the acting medical officer of health for the Niagara Region.

Several headlines over the past two weeks have declared that we are in a sixth wave of COVID-19. Chief Public Health Officer Theresa Tam has advised Canadians to expect subsequent surges in the fall and the winter. While hopeful these could be avoided, Dr. Tam warned of the potential for new variants to require reintroduction of social restrictions.

Canadians are understandably weary of pandemic life. Provinces are shedding COVID measures and promising normalcy. But the current wave reaffirms that the pandemic is not over. “Living with COVID” means repeated waves, more hospital admissions, more deaths, more Canadians living with disabilities from long COVID, higher health care costs and the threat of new variants disrupting everything again.

There is a better way. And it doesn’t involve lockdowns.

Many infections that historically afflicted us heavily in Canada are uncommon today. Several, such as the plague, malaria and diarrheal infections, never had vaccines. Yet they are now rare. These infections were defeated by adapting our society.

Diarrheal disease, for example, was the third-leading cause of death in Canada in 1900. As we learned how contaminated water drove those infections, we applied that knowledge to adapt. We separated our homes from open sewers and cesspools. We invested in infrastructure to treat the water we consumed as well as wastewater. We regulated agriculture and food production to require use of clean water. And we created a social norm of handwashing before handling food.

Today, deaths from diarrheal infections are almost unheard of in Canada.

We can similarly adapt to become more resistant to COVID. The virus spreads through the air and likely, we now realize, so do other respiratory infections such as influenza and colds. We can suppress infections by sanitizing our air, just as we stopped diarrheal infections by sanitizing our water. Increased ventilation can remove air and any airborne virus that an infected person may have exhaled. Where ventilation can’t be improved, high-efficiency filters can remove viruses as air recirculates, and ultraviolet devices can inactivate viruses.

In part, thanks to the natural ventilation of the outdoors, we’ve experienced two summers of reprieve from pandemic restrictions. Let’s double down on this proven success and continue to facilitate outdoor patios and walkable streets.

The December holidays, a time of indoor gatherings, pose a perfect opportunity for infection to spread among family and friends, and then to co-workers and colleagues when everyone returns to work and school right after. It is no surprise that January is the usual peak of flu season. Similarly, we saw COVID peak each of the past two Januaries.

Perhaps we can adapt our winter calendar to allow a “washout” period between holiday celebrations and a return to work/school. Or a couple of weeks of working from home so infection can be contained.

For two years, we’ve stayed home from work or school when sick, protecting others from infection. We should entrench this social norm; including legislating paid sick days so no worker ever has to choose between paying the bills and protecting vulnerable colleagues, co-workers or families.

The risk experienced by such workers reminds us that neighbourhoods with lower income or more racial minorities suffered disproportionately from COVID. We need to accelerate making our society more equitable to reduce the burden COVID has on high-risk persons, and in turn on all of us.

By making these kinds of adaptations, not only can we lessen the continuing burden of COVID, we can also decrease other respiratory infections including the average 12,000 hospital admissions and 3,500 deaths from influenza each year. And any future variant or new respiratory viral pandemic would also be less able to infect us.

There are local efforts under way to begin these adaptations. In Ontario, Peterborough Public Health is lending carbon-dioxide monitors that allow assessing the effectiveness of ventilation. At Niagara Region Public Health, we’ve incorporated ventilation assessment and carbon-dioxide monitoring into health inspections. Toronto Public Health is exploring how municipal property standards could promote improved ventilation.

However, to truly adapt our society, we need provincial and federal leadership.

Through two difficult years, Canada has had fewer than half as many per capita deaths as the United Kingdom, and 65 per cent fewer than the United States.

Our sacrifices have saved tens of thousands of lives. Our task now must be to begin adapting for the long term, so we can continue protecting health while moving past the disruption of this pandemic.

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