Report

COSMO Wave 2.6

Prevalence of and experiences with long-COVID, and the use of public health measures while sick and barriers to staying home

Public Health Agency of Canada
Public Opinion Research Team, Privy Council Office

Impact Canada, Impact & Innovation Unit, Privy Council Office

table with medical supplies, such as stethoscope, syringe, pills and patient chart

Key Insights

Proximity to COVID-19 & Public Health Measures: 58% of respondents reported having been - or likely having been - infected with COVID-19 at some point in the pandemic (up from 31% in June, 49% in August and 54% in October) and 13% of those who have been infected reported having experienced symptoms of Post-COVID-19 Condition. A third of respondents reported having been sick with a fever, cough, sore throat or runny nose in the past month. Among those who were sick, half reported wearing a mask while sick and three quarters stayed home when sick.

Adult Vaccination: Among respondents with 2 doses of a COVID-19 vaccine, top reported reasons for not having gotten a 3rd dose so far were linked to: concern about side effects or not wanting to feel sick after getting the vaccine; the perception that vaccines are ineffective, that they are not curbing the spread of COVID-19 and that people are still contracting COVID after vaccination; and the perception that another dose is not needed.

Pediatric Vaccination: The top reasons provided by parents who had not yet vaccinated at least one of their children were: worries about side effects of the vaccine; the view that children are not at risk from COVID-19; the perception that vaccines were insufficiently tested; and the perception that vaccines are ineffective.

Sources of Information & Trust: Trust in information sources for COVID-19 has not shifted significantly since data collection began. 51% of respondents reported completely or moderately trusting the Canadian federal government, while 37% reported moderate or complete distrust. News consumption about COVID-19 decreased between April and June 2022 and remained low in subsequent months.

COVID-19 Knowledge & Misinformation: Large portions of the sample indicated uncertainty about the accuracy of true statements about COVID-19 – suggesting that there are knowledge gaps on COVID-19 information. A minority of respondents indicated that false statements about COVID-19 were ‘very accurate’ or ‘somewhat accurate’.

Mental Health & Wellbeing: Life satisfaction decreased slightly between August and October and remained stable in December. Younger respondents (18-34) reported lower life satisfaction and poorer mental health indicators than to older respondents.

Pandemic Outlook & Recovery: Over half of the sample (55%) indicated that the worst of the COVID-19 crisis is behind us. One third indicated that day-to-day life currently resembles pre-pandemic times, while one third indicated that life will never resemble pre-pandemic times. Over time, most of respondents’ health-related worries have declined, with the exception of worry about healthcare systems being overloaded, which has increased. Compared to worries about COVID-19, worries about inflation, increasing divisiveness in society and climate change are higher priority.

Background

From April 2020 to November 2021, Impact Canada led the implementation of the World Health Organization (WHO) Behavioural Insights (BI) Tool on COVID-19 in the Canadian context. This study - COVID-19 Snapshot Monitoring (COSMO Canada) - was conducted in collaboration with the Public Opinion Research Team at the Privy Council Office and the Public Health Agency of Canada. Insights from COSMO Phase One informed the federal response to COVID-19 and enabled whole-of-government decision making to meet the specific, changing needs of citizens throughout the pandemic.

In February 2022, Impact Canada launched the second phase and will continue to monitor the evolving pandemic response context with a new sample of Canadians and a new Advisory Committee.

Methodology

With a longitudinal design, the study follows 2,000 participants recruited from an online panel over eight waves of data collection. Respondents are a representative mix of Canadian adults aged 18 years and older and results are weighted using 2016 Statistics Canada census data to mirror the population distribution in Canada. For more information on the study methodology, please visit the COSMO Canada pre-registration page .

Considerations

Data Collected: November 22 to December 15, 2022
Sample Size: 1,886

When interpreting the COSMO results, it is useful to keep in mind the context of the data collection period, which may have influenced the responses of survey participants. Prior to and during the Wave 2.6 data collection period:

Most Canadians were vaccinated. As of December 4, 2022, approximately 90% of the Canadian population aged 18+ had received at least one dose of a COVID-19 vaccine, 89% had at least two doses, 60% had at least three doses, and 27% had four doses. As of January 1, 2023, 29% of adult Canadians completed their primary series or received a booster dose in the past 6 months.
Among children aged 12-17, 84% had at least one dose, 80% had at least two doses, and 18% had three doses. Among children aged 5-11, 53% had at least one dose, 41% had two doses, and 6% had three doses. 8% of children four and under had one dose and 4% had two doses.
On October 7, Health Canada authorized the Pfizer COVID-19 bivalent vaccine targeting the Omicron BA.4/BA.5 subvariants. The Moderna bivalent vaccine targeting the Omicron BA.1 subvariant was approved in early September.
During the data collection period, there was significant news coverage on the healthcare system being overwhelmed with cases of the flu, COVID-19, and RSV.

Proximity to COVID-19 & Public Health Measures

Over half report having been infected with COVID-19 at some point

In Wave 2.6, 58% of respondents reported having been - or likely having been - infected with COVID-19 at some point in the pandemic (up from 54% in Wave 2.5). The portion of the sample reporting not having been infected with COVID-19 decreased from 69% in February to 37% in December. Respondents aged 55+ were less likely (42%) to report likely having been infected compared to those aged 35-54 (65%) and 18-34 (73%).

Among those who have had COVID-19, ¼ may have experienced symptoms of post-COVID condition

Among those who have likely had COVID-19 (58% of the sample) 13% reported having experienced symptoms of post-COVID condition (i.e. physical or psychological symptoms lasting more than 12 weeks after getting COVID-19). An additional 13% reported being unsure whether they experienced post-COVID condition. A third of all respondents report that they personally know someone who has experienced symptoms of post-COVID condition.

The most reported symptoms of post-COVID condition are fatigue and cognitive/sleep issues

The most commonly reported symptoms of post-COVID condition were fatigue, cognitive issues (memory, concentration or sleep problems), shortness of breath or difficulty breathing and muscle aches. Most respondents experienced more than one symptom. On average, respondents reported having experienced 3 symptoms of post-COVID condition.

1/4 have been tested for COVID-19 in the past month

In Wave 2.6, 27% of respondents reported having been tested for COVID-19 in the past month, either using a rapid (25%) or PCR test (2%). 14% of respondents reported that they had administered a rapid test on someone else in the past month. Testing practices were quite stable between June and December.

Adherence to most public health measures is low

A third of respondents reported often or always practicing public health measures such as wearing a face mask when it is not mandatory (35%), taking steps to improve air quality (30%) and avoiding public places and events (32%). Respondents aged 55+ and women were more likely to report often or always practicing public health behaviours. Younger respondents, men, and residents of Alberta were less likely to report practicing these measures.

Frequent mask-wearing has decreased overtime, with a slight uptick in December

The portions of respondents who reported often or always wearing a mask when it was not mandatory has declined overtime (from 57% in April to 35% in December). However, here was a slight increase in frequent mask-wearing in non mandatory scenarios in the latest wave of data collection (from 31% in October to 35% in December).

Adherence to public health measures has declined over time

In general, the portions of respondents who report often or always practicing public health measures have decreased over time. Since the summer months, those who report often or always taking steps to improve air quality and choosing to meet others outdoors have steadily declined with the colder weather. Between October and December, there was a slight uptick in those reporting often or always avoiding public places and events (from 28% to 32%).

Respondents wear masks in a variety of scenarios

Respondents who reported sometimes, often or always wearing a mask in the past month were asked in which scenarios they typically wear a mask. The top scenarios were: attending health appointments (83%); shopping at a grocery store (70%) or retail store (65%); and visiting with people who are at higher risk from COVID-19 (63%).

Over 1/3 report having been sick in the past month

35% of respondents reported having been sick with a fever, cough, sore throat or runny nose in the past month. Respondents aged 18-34 were more likely to report having been sick (46%) compared to those aged 35-54 (36%) and those aged 55+ (26%). Parents with children at home were also more likely to report having been sick (49%) compared to those without children at home (31%).

½ report wearing a mask while sick and ¾ stayed home when sick

Among those who reported having been sick in the past month, 48% reported often or always wearing a mask indoors when sharing space with others. 77% reported often or always staying home when sick. Women were more likely to often or always wear a mask while sick (52%) compared to men (33%). Similarly, women were more likely to often or always stay home when sick (83%) compared to men (72%).

Not being able to miss work or school was top reason for not staying home when sick

Among those who reported sometimes, rarely or never staying home when sick, the top reasons were not being able to miss work or school (58%), needing to pick up necessities (50%) and personal choice (37%).

Canadians’ view personal use of public health measures as effective at reducing the spread of COVID-19

Despite relatively low reported adherence to public health measures, the majority of respondents view their use of most public health measures as very or extremely effective at reducing the spread of COVID-19. For example, 57% viewed wearing a mask as a very or extremely effective measure, while only 35% reported often or always wearing a mask in non-mandatory scenarios. However, a quarter of respondents viewed wearing a mask (23%), improving indoor ventilation (24%) and isolating after having been in contact with a person with COVID-19 (25%) as slightly or not at all effective.

Most view the consistent use of public health measures by the majority of Canadians as effective

When asked how effective they view consistent use of public health measures by the majority of Canadians, most viewed the measures as very or extremely effective at reducing the spread of COVID-19.

Participation in gatherings, events and travel has been stable over the past 6 months

In general, participation in gatherings, events and travel increased wave-to-wave between February and June and remained relatively stable between June and December. Older respondents and women were less likely to report participating in the listed activities. For example, 73% of respondents aged 55+ reporting visiting with family and friends indoors compared to the average, 81%.

Over half continue to support the reintroduction of many public health measures, if necessary

The majority of COSMO respondents indicated that they would support the introduction or reintroduction of many public health measures should they be required. The most supported measures included mask requirements (58-63%), proof-of-vaccination requirements (51-53%) and gathering limits (49%). The most opposed measures were business closures (65% opposition), school/daycare closures (52% opposition) and stay-at-home orders (53% opposition). Respondents aged 55+ and women were much more likely to support the hypothetical reintroduction of measures.

Over time, support for reintroducing public health measures if needed has gradually declined

Over time, support for reintroducing public health measures if needed has gradually declined for most measures.

Over time, support for reintroducing proof-of-vaccination requirements has decreased but ½ continue to support them

Over time, support reintroducing proof-of-vaccination requirements has decreased. However, around half continue to indicate that they would support vaccine requirements if necessary to respond to a COVID-19 outbreak. Support for proof-of-vaccination requirements varies significantly by respondents' vaccination status, with those with fewer doses being less supportive of these measures.

½ say they are likely to wear a mask for reasons other than COVID-19

Half of respondents (53%) indicated that they are likely to wear a mask in public for reasons other than COVID-19, while 40% were unlikely to wear a mask. Respondents aged 55+ and women were more likely to say that they would wear a mask for reasons other than COVID-19.

2/3 thought their province was facing a healthcare crisis as a result of respiratory illnesses

68% of respondents agreed that their province was facing a healthcare crisis from respiratory illnesses such as the flu, RSV and COVID-19. Respondents from Quebec were more likely to agree that the healthcare system was in crisis (74%) and those from BC were less likely to agree (60%).

Adult Vaccination

Over time, intentions to get a 3rd dose have declined among those with 2 doses

In December, 16% of respondents with two doses of a COVID-19 vaccine indicated that they were likely to get a third dose. Over time, intentions to get a third dose of a COVID-19 vaccine have decreased, from 39% in February to 16% in December, while third dose uptake has not increased meaningfully.

Concern about side effects and perception that vaccines are ineffective are top reasons for avoiding a 3rd dose

In an open-ended question, respondents with two doses of a COVID-19 vaccine were asked to explain their reasons for not having received a booster dose so far. Top reported reasons were linked to: concern about side effects or not wanting to feel sick after getting the vaccine; the perception that vaccines are ineffective, that they are not curbing the spread of COVID-19 and that people are still contracting COVID after vaccination; and the perception that another dose is not needed and wondering how many doses will be enough.

Protecting themselves against COVID-19 was top reason for deciding to get a 3rd dose

In an open-ended question, respondents with three doses of a COVID-19 vaccine were asked to explain their main reasons deciding to get a third dose. The top reported reason was to protect themselves against COVID-19 and/or new variants.

Some respondents with 2 doses may be more likely to get a 3rd dose in certain scenarios

The top scenarios that respondents with two doses of a COVID-19 vaccine indicated would make them more likely to get a third dose were: if a new more severe variant of COVID-19 began to spread (35%); if proof of a third dose were required for activities like travel (35%); and if a new vaccine were available that better prevented infection (30%). However, in most cases, a greater or similar number of respondents indicated that these hypothetical scenarios would make them less likely to get a third dose.

Over half of those with 3 doses of a COVID-19 vaccine intend to get a 4th

Over half (59%) of respondents with three doses of a COVID-19 vaccine indicate that it is likely that they will get a fourth dose. Intentions to get a fourth dose have decreased over time. However, this is likely explained by an increase in fourth dose uptake. Since the beginning of data collection in February, intentions to get a fourth dose (among those with three) have been much stronger than intentions to get a third dose (among those with two).

Protecting themselves against COVID-19 was top reason for deciding to get a 4th dose

In an open-ended question, respondents with four doses of a COVID-19 vaccine were asked to explain their main reasons deciding to get a fourth dose. The top reported reason was to protect themselves against COVID-19 and new variants.

New vaccines or the emergence of a more severe variant would motivate 4th dose uptake

The top scenarios that respondents with three doses of a COVID-19 vaccine indicated would make them more likely to get a fourth dose were: if a new vaccine were available that better prevented infection (73%) or targeted COVID-19 variants (66%); and if a new more severe variant of COVID-19 emerged (73%).

Just over 1/3 report getting a flu vaccine this year

Just over a third of respondents (37%) indicated that they already got flu vaccine in the 2022-2023 season and an additional 18% indicate they are likely to do so. 38% indicated that they are unlikely to get a flu shot this year. Flu vaccine uptake varied significantly by COVID-19 vaccination status. 0% of respondents who are unvaccinated for COVID-19 indicated that they got a flu shot, while 6% of those with two doses, 20% of those with three doses, 61% of those with four doses, and 81% of those with five doses indicated that they got a flu shot.

Pediatric vaccination

1/5 parents with children aged 12-17 with 2 doses intend to get their children another dose

30% of parents with children aged 12-18 indicated that their children have three doses of a COVID-19 vaccine. Among parents with children aged 12-17 with two doses of a COVID-19 vaccine, 21% intend to get their child a third dose ASAP or after some time. 50% do not intend to get their child a third dose of a COVID-19 vaccine. *Note: vaccine uptake in COSMO respondents was higher than real world uptake (among children aged 12-17, 84% had at least one dose, 80% had at least two doses, and 18% had three doses).

First dose vaccine uptake in children aged 5-11 has stalled, third dose uptake increasing

First dose vaccine uptake in the 5-11 age group has remained just under 60% since the beginning of data collection in February*. Second dose uptake remained consistent between June and October, at around 50%. There was a slight increase in third dose uptake – from 7% in October to 17% in December. *Note: vaccine uptake in COSMO respondents was higher than real world uptake (among children aged 5-11, 53% had at least one dose, 41% had two doses, and 6% had three doses).

Parents who have not yet vaccinated their children aged 5-11 do not intend to

The vast majority (92%) of parents who have not yet vaccinated their children aged 5-11 indicate that they do not intend to in the future.

Majority of parents with children aged 5-11 with 2 doses of vaccine intend to get their children 3rd dose

52% of parents who have already vaccinated their children aged 5-11 intend to get their child a third dose either as soon as possible or after some time. A third (31%) of parents in this group do not intend to get their child a third dose.

2/3 of parents who have not yet vaccinated their children 4 and under do not plan to

Vaccines were approved for children aged 6 months to 4 years in July 2022. Since then, 21% of parents with children in this age group have vaccinated their children*. Of parents who haven’t vaccinated their children in this age group, 60% indicated that they do not plan to vaccinate their children and 29% of parents intend to vaccinate their children aged 6 months to 4 years, either as soon as possible or after some time. Between waves October and December, the portion of parents who do not intend to vaccinate their children increased (from 51% to 60%, perhaps explained by uptake). The portion who intend to vaccinate their children as soon as possible or after some time decreased (from 40% to 29%). *Note: Vaccine uptake in COSMO respondents was higher than real world uptake (8% of those aged 6 months to 4 years were vaccinated with at least 1 dose by Dec 4, 2022).

Concern about side effects is top reason parents have not yet vaccinated their children

In an open-ended question, parents who had not yet vaccinated at least one of their children were asked to explain the reasons that their children had not yet been vaccinated. The top reason provided by parents were: worries about side effects of the vaccine (35%); the view that children are not at risk from COVID-19 (19%); the perception that vaccines were insufficiently tested (16%); the perception that vaccines are ineffective (14%).

Worries about children being infected with COVID-19 remain low

Worries about children being infected with COVID-19 have remained low since the summer months. In December, only 9% of parents indicated that they were very or extremely worried about their children contracting COVID-19, compared to 25% in February. 19% of parents were somewhat worried and 71% reported being not at all or slightly worried about their children getting COVID-19.

3/4 parents report their children have had COVID-19

73% of parents reported that their children have or likely have been infected with COVID-19 at some point in the pandemic. Relatedly, 77% of parents reported that they have or likely have been infected themselves, compared to 53% of respondents without children at home.

Under 1/5 report that their children got a flu shot this year

In December, 16% of parents reported that their children had already received a flu shot this year and an additional 19% indicated that their children were likely to get one. Over half (56%) reported that their children are unlikely to get a flu shot this year.

¼ parents reported that in recent months their children have had illnesses other than COVID-19 more than before the pandemic

26% of parents thought, in recent months, their children have been sick with illnesses other than COVID-19 more often than prior to the pandemic, while 15% thought their children have been sick less frequently than before the pandemic.

Sources of Information & Trust

The most trusted sources of information on COVID-19 are healthcare workers and scientists

The majority of respondents trust (4-5 out of a scale of 5) healthcare workers (81%), scientists (78%) and international health authorities (64%) for information on COVID-19. Trust in the federal (63%) and provincial (57%) public health leaders and federal (60%) and provincial (55%) government briefings is also relatively high. Less than half of respondents reported trust in newspapers and other journalism and television news for information on COVID-19. There were no significant changes in trust in information sources between February and December 2022.

¼ report not following the news on COVID-19 at all

Only 8% of COSMO respondents reported following the news about COVID-19 very closely and 24% reported following it pretty closely. More than one quarter of respondents (26%) reported not following the news about COVID-19 at all. Older respondents were more likely to report following the news about COVID-19.

COVID-19 news consumption has been steady since June

News consumption about COVID-19 decreased between April and June 2022 and remained stable the following months.

Social media use varies by platform

Respondents were more likely to report using Facebook (48%) and Youtube (38%) either ‘multiple times a day’ or ‘once a day’ compared to other social media platforms. Use of social media platforms varied by respondent age, with younger respondents being less likely to use Facebook and more likely to use Reddit and TikTok, compared to older respondents.

Half of respondents reported trusting the Government of Canada

51% of respondents reported completely or moderately trusting the Canadian federal government, while 37% reported moderate or complete distrust. Women reported higher trust (57%) than men (46%). University educated respondents reported higher levels of trust (65%) than those with college (47%) or high school education (46%). Respondents from Alberta (43%) and Manitoba and Saskatchewan (45%) reported lower trust relative to other provinces.

COVID-19 Knowledge & Misinformation

Large portions are unsure whether factual statements about COVID-19 are accurate

The majority of respondents accurately rated most true statements about COVID-19 as somewhat/mostly/completely accurate. However, large portions (3%-45%) indicated that they were unsure whether the statements were true or false. Some respondents rated true statements as inaccurate. For example, 11% of respondents rated the statement “none of the COVID-19 vaccines authorized for use in Canada contain the live SARS-CoV-2 virus” as somewhat/mostly/completely inaccurate.

A minority of respondents indicated that false statements about COVID-19 were accurate.

A minority of respondents indicated that false statements about COVID-19 were somewhat/mostly/completely accurate. These portions ranged between 3% and 9%, depending on the statement. For example, 7% of respondents rated the following statement as at least somewhat accurate: “the COVID-19 vaccine enters your cells and changes your DNA.” Large portions of the sample were unsure about the accuracy of some of the statements. For example, 32% were unsure whether the following statement was true or false: “the COVID-19 vaccine interferes with the development of the placenta during pregnancy.”

Mental Health & Wellbeing

Life satisfaction has been relatively stable

In December, 71% of respondents reported that they were satisfied with their lives as a whole. 8% were neither satisfied nor dissatisfied and 21% were dissatisfied. Younger respondents (18-34) reported slightly lower life satisfaction (67%) compared to those aged 35-54 (70%) and those aged 55+ (76%).

More than 2/3 respondents report good mental and physical health

70% of respondents reported that their mental health is excellent, very good or good. Younger respondents were less likely to report good mental health compared to older respondents. 69% of respondents reported that their physical health is excellent, very good or good. The portions of respondents reporting good or better mental and physical health were consistent between October and December.

Many Canadians experienced negative wellbeing at least some of the time in the past two weeks

23% of respondents reported feeling stressed most or all of the time in the past two weeks. An additional 20% reported feeling burnt out most or all of the time. Younger respondents and women were more likely to report experiencing these negative indicators most or all of the time in the past two weeks.

Most, but not all, Canadians have someone to turn to

When a series of three questions serving as a measure of social capital, the majority of respondents agreed that they have someone to turn to when they are lonely, need an emergency loan or need advice. However, 10%-15% of respondents disagreed with these statements. Female respondents were more likely than male respondents to agree that they have people to talk to when they are lonely and that they have someone to turn to for advice. Both genders were equally likely to have someone to turn to for an emergency loan. University educated respondents were more likely to agree with the statements than those with college or high school education.

Pandemic Outlook & Recovery

More than half of respondents believe the worst of COVID-19 crisis has passed

In December, just over half of respondents indicated that the worst of the crisis is behind us (55%) compared to 59% in October. A quarter of respondents were unsure whether the worst of the crisis has passed or is yet to come. Consistent with previous waves of data collection, 11% of respondents indicate that they do not consider COVID-19 to be a crisis. Men (14%) were more likely than women (8%) to say that COVID-19 is not a crisis. Residents of Alberta (15%) were also more likely than residents of other provinces to think that COVID-19 is not a crisis.

One third of respondents think life currently resembles pre-pandemic times

Overall, respondents were quite split on when they think life will resemble pre-pandemic times. 32% think that life will never resemble pre-pandemic times, 32% think that life already resembles pre-pandemic times, 20% think that it will be longer than six months, and 4% think it will be one to six months. Over time, there has been a significant increase in those who think life already resembles pre-pandemic times (from 3% in February to 32% in December).

Cost-of-living and societal divisiveness are top-of-mind concerns, COVID impact on economy less so

Two thirds of COSMO respondents (66%) indicated that they were worried about inflation or cost-of living increases. Respondents aged 55+ and residents of BC and QC were less likely to be worried about inflation. 61% indicated that they were worried about increasing divisiveness and/or conflict in society. Respondents aged 18-34 and residents of AB and ON were more likely to be worried about increasing divisiveness in society. Concern over the impact the COVID-19 on the economy continues to trend downwards, from 63% of respondents in February to 34% in December.

Respondents remain concerned about the healthcare system being overloaded

59% of respondents report being very or extremely worried about the healthcare system being overloaded. Older respondents (64%) and women (65%) were more likely to be worried about the health system being overloaded. 37% of respondents were worried about the pandemic’s impact on the mental health of Canadians. Older respondents (27%) and men (32%) were less worried about mental health impacts.

Most COVID-related worries, aside from health system overload, have declined over time

Over time, most health-related worries have declined. The only exception is the portion of respondents worried about the healthcare system being overloaded, which increased in August and remained steady at 59% between August and October.