WHO to decide if COVID remains an emergency. What will this mean for Canada?

As a World Health Organization committee mulls whether COVID-19 remains an international emergency, some health experts say regardless of what is decided, the virus is still a public health threat and measures to combat and contain it in Canada should continue.

The WHO Emergency Committee has met 14 times over the last three years since the UN agency first declared COVID-19 a public health emergency of international concern in January 2020 to determine whether the designation — its highest level of alert — should remain.

WHO Director-General Tedros Adhanom Ghebreyesus said Friday that while the global situation has improved, a recent increase in the number of deaths and large-scale outbreaks in China are concerning.

“As we enter the fourth year of the pandemic, we are certainly in a much better position now than we were a year ago, when the Omicron wave was at its peak and more than 70,000 deaths were being reported to WHO each week,” he said in his opening remarks to the Emergency Committee meeting in Geneva Friday.

“However, since the beginning of December, the number of weekly reported deaths globally has been rising… last week, almost 40,000 deaths were reported to WHO, more than half of them from China.

In total, more than 170,000 deaths have been reported in the last eight weeks, a number that, in reality, is “certainly much higher,” Tedros said, pointing to a massive global drop in testing, surveillance and reporting of the virus.

But whether this reversal of progress means the WHO will continue to keep its highest alert in place for SARS‑CoV‑2 remains unknown, in part because there is no official WHO criteria or process to determine when a public health emergency of international concern ends.

This differs from when an emergency is declared, as there are criteria under international health regulations that must be met, including the need for an internationally-coordinated response to a public health threat that is “sudden” and in need of redress, says Maxwell Smith, assistant professor in the faculty of health sciences at Western University.

“Certainly now that we’re getting into the fourth year of this pandemic, it’s not so sudden anymore,” he said.

“Perhaps it doesn’t make as much sense on that side of things to still call this a public health emergency of international concern.”

He said he is concerned keeping the emergency designation in place could diminish the global response to future viral outbreaks, given the progress that has been made in tackling the virus and lack of immediate crisis.

“If we keep the designation in place, then people might not really think that it means much anymore,” he said.

“Then the next time that we declare something, a public health emergency of international concern, perhaps people think, ‘Well, we shouldn’t take that too seriously because they’ve kept this around for three years with COVID, and that’s not changing. So it’s nothing to really worry about.’”

Nonetheless, if the WHO decides to declare the emergency over, it will be important to ensure the public understands that doesn’t mean COVID is “over,” he added.

“We have to be very clear that that doesn’t mean that the disease doesn’t exist, that we still ought not to have measures in place or that we ought not to take it seriously.”

Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre, agreed.

“As long as the label isn’t ‘COVID is gone,’” he said.

“It doesn’t change how we should approach the fact that COVID is still around us, and the measures that we will have to take will not be modified in any meaningful way.”

However, changing the definition could have implications for some countries, Conway said, as it may have been the tool that unlocked allocation of resources and compelled measures to protect the public from COVID.

As such, lifting the designation could alternately be used as a way to justify withdrawing resources away from COVID measures, he added.

“I think we still face issues of vaccine inequity and whatever the World Health Organization says, that will be part of their message — that we really need to continue to vaccinate the world to prevent the emergence of the next variants. That may be a game changer.”

Regardless of what the WHO decides, Canadians should be aware that there is no “off-ramp” for COVID yet, as the virus continues to circulate, mutate and infect people in Canada — and will for some time, Conway said.

Last week, there were 222 new deaths and close to 14,000 reported cases of the virus in Canada, according to federal COVID-19 data.

“COVID will be with us for the measurable future,” Conway said.

“I think that hopefully that will be part of the message — that we’re out of the pandemic phase and we’re into a long-term endemic phase.”

Canada’s Chief Public Health Officer, Dr. Theresa Tam, did not want to comment ahead of the WHO’s decision, but during a briefing Jan. 20, she said she believes Canada is doing what it needs to do to monitor and respond to the virus.

“In the upcoming year, we need to continue to monitor the evolution of the virus, the Omicron variant, because it’s still spreading quite a bit all over the world (and) is going to undergo its mutations. I think we are seeing that in real time,” she said.

The virus will likely increase its immune evasion properties as it continues to change, she added, which means Canada may have to adjust its responses, including vaccine formulations.

“Whatever the decision is made by the director-general of WHO, I think we just need to keep going with what we’re doing now.”