Front Burner - A fourth wave for whom?

Episode Date: August 26, 2021

As case counts rise across the country, health experts warn that the COVID-19 fourth wave is very much here. But who will bear the brunt of it?

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. Alright, so I know that this is absolutely not the topic that you would hope that we'd be talking about at this stage. I am feeling that very acutely right now too. Yet, here we are, suddenly looking at the fall at back-to-school season,

and the experts are saying we need to brace here. They're saying that a fourth wave could get real serious very quickly, despite the majority of the country being vaccinated. In response to rising cases and ICU admissions, British Columbia and Manitoba both brought back indoor mask mandates this week. BC will join Quebec in implementing a vaccine passport system, where you have to show proof of vaccination to, say, go to a restaurant or a concert. Meanwhile, in Ontario, a top epidemiologist recently quit an advisory panel of scientists. He said politics are getting in the way of Ontarians getting the information that they need. Information he says will show just how dire things could get.

Today, how bad could a fourth wave actually get? And who's likely to bear the brunt of it? Friend of the pod and epidemiologist at the University of Ottawa, Rawat Dianandan is here. Hi, Rawat. It's great to have you, as always. My pleasure, as always. So, look, we're hearing these alarm bells right now being raised by experts. I saw an infectious disease doctor in Toronto talk about up to 7,000 cases a day. In BC, possibly 12,000 cases a day if stricter health measures aren't taken. These are huge numbers. And I think I'm just trying to wrap my head around this. I don't really understand how that's possible at this stage in the game. Yeah, it's possible because we still have a large

susceptible population. Epidemics are all about susceptibility. And you become susceptible when you're not immune. Who's not immune? People who haven't been vaccinated and people who haven't got the disease and recovered already. So we have a large number of people in that category still. Plus, we have this new variant, Delta, which is raging through the unvaccinated population. It's almost like a new disease entirely. Hyper transmissible. Kind of like chickenpox, some people are saying. And if you don't know, chickenpox is really contagious. So that's why this seriousness right now, because a large number of people can still get infected and that those people are likely to get infected because of the hyper transmissibility of the virus. And I just want to be really clear here. Is this only affecting

the unvaccinated population? Like, are vaccinated people getting sick? Vaccinated people are always at risk of getting sick, but at a much lower rate. Vaccination is not a bulletproof vest, or as one colleague says, it is a bulletproof vest, but that doesn't help you if you're shot in the head, right? So the amount of virus circulating matters. If there's a lot of virus in the community, it will find holes in our defenses. So we should always expect a certain number of breakthrough infections. However, overwhelmingly, this is going to be a pandemic of the unvaccinated. They're going to be the ones who fill the hospital beds.

Those breakthrough infections, are those people actually getting really sick, though? Are they landing in the hospital? Well, some will, but to a much lesser extent. And who are they, really? They tend to be people who didn't mount a strong immune response in the first place, so they kind of resemble the unvaccinated to some extent. But some are going to be people who mounted a limited immune response, so they're going to get less sick.

Okay, and how would you know who those people are? I guess you just don't. You don't know, which is why it's important to keep the amount of virus in the community as low as possible, because you might be one of those people who didn't mount a response. Moving back to the unvaccinated population, which, you know, as you mentioned, is going to bear the brunt of this. I guess there is this huge group that doesn't have a choice right now whether or not they should get a vaccine. And that group is children. Yeah. And I wonder if you can help me understand how this variant is affecting children.

Are children getting sicker? That's a really good question. And there isn't a straightforward answer, unfortunately. Most of the data we have for the extent to which the Delta variant affects populations differently is on adult populations. So we have studies in Canada, Scotland, and Singapore that have shown, to some extent, that Delta might be more likely to lead to hospitalization and ICU admission and even death. But there is not firm evidence that disease is more severe, and all those studies were done in adults.

So what we do know, due to the fact that Delta is so contagious, it's affecting a lot more people. So more infected kids means more hospitalizations, even if the risk remains low. Right now, the U.S. is averaging more than 109,000 new cases each day. Nearly one in five of those infected is a child. In some places, ICUs are full, even pediatric COVID beds. So in the U.S., kids account for about 15% of all known cases of COVID. However, in the past week, that's gone up to about 22%. So it's affecting kids more, not because it's targeting kids, because they're the ones who are, as you noted, unvaccinated.

Right. So it's like, it's still a small percentage of kids are going to be hospitalized, but a small percent of a very large number is a large number. Right, right. I know that percent in the U.S., the latest figure, it's hovering around 2%. And look, maybe it's worth bringing up here, you and I both have very young children. So children who do not qualify for a vaccine right now, who are not able to get vaccinated. So could I ask you personally, how worried are you right now? Oh, I'm quite worried. And that's because I'm a new parent and I'm worried about everything. That is true. I can feel that. I feel that. Yeah. You can control some things in your kid's life. You control what school they go to. You control what they eat. You can't control their exposure to a disease that we barely understand. So it's the inability

to control his safety that concerns me. And it would be nice if vaccination was available to him, and I would jump at that personally because I think the benefits far outweigh the risk. But absent that opportunity, I want society to take care of them. So it's important that all of us do our bit to keep COVID out of the community so that our children do not become exposed to it. I want to talk about how you think we should do that in just one second. But first, do we know or do we have a sense right now when the vaccines may be made available for younger children, for children, I believe it's under 12 right now. Right. So clinical trials are underway. Data is expected from Pfizer, at least, and possibly from Moderna by sometime this fall,

in which case governments can make a decision relatively quickly. What the data shows, I don't know, but I anticipate the data will show high safety and high effectiveness, as it showed for kids between 12 and 18. So when that happens, hopefully the government pulls the trigger relatively quickly. If I were a betting man, and I am, I would say maybe by November. Okay, so not too far off. And do you think that it will go sort of all the way down to infants, or are we looking at maybe five up? I know that it's being trawled on kids as young as six months, but I would not be surprised if we are careful and only allow it for those five years at first. And so now let's talk about how we protect children in absence of the vaccines right now

and other unvaccinated people in this country. And I guess maybe we could talk about getting vaccinated ourselves, right? Because for many, many months, we heard from experts like you, that this is how we protect other people to get to herd immunity. And so here we are at 75% of people over 12 in this country fully vaccinated, which I remember at one time seemed like a pretty good target. And so why does this no longer seem sufficient? It's no longer sufficient because Delta has changed the rules. So about a year ago, when we first started talking about herd immunity, some rough calculations suggested that maybe 70-75% of the total population had to be immune before the virus could take hold of the population again. And that's based-75% of the total population had to be immune before the virus could take hold

of the population again. And that's based on the effectiveness of the vaccine and the degree to which the virus is contagious. Delta is at least twice as contagious as COVID classic and has diminished the vaccine effectiveness by a little bit, not a lot, but a little bit. And that changes the threshold for herd immunity significantly, moves it from 70 to 75% to over 85%, probably 90%, if not higher, of the population. That means we don't get there unless kids get vaccinated, likely. So we really have to maximize the number of eligible people who get vaccinated. It should be 100% without exception. Are vaccinated people spreading this variant? Because it seems like there's a lot of information floating around out there, and I find it very difficult to wade through.

So first of all, vaccinated people can spread it, but they have to get infected first. And the probability of a vaccinated person getting infected is quite low compared to an unvaccinated person. Then it looks like once you are infected, a vaccinated person has a similar viral load to an unvaccinated person, which suggests that they can pass it on just as easily. However, a vaccinated person carries that viral load for a shorter amount of time, which means that over the duration of their infection, they can infect fewer people. Bottom line is, vaccinated people infect far, far, far fewer people than unvaccinated people. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization.

Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income?

That's not a typo, 50%. That's because money is confusing. 50% of them do not know their own household income. That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. I know when it comes to vaccines, you were on this show a little while back and you talked about how important you think it is to work and educate the vaccine hesitant and push people, even with things like vaccine passports, because it makes their non-vaccinated lives more onerous. And I assume you're going to be a huge proponent of the vaccine passports in Quebec and B.C.

It means a B.C BC vaccine card will soon be required for nearly everything deemed non-essential. This is our way of getting through this next phase of the pandemic that we've been dealt and to make sure that we can go through the fall with safely reopening schools. But just back to kids for a moment, they are going back to school soon.

But I guess my question for you is, should they be? That's a tough one. If you'd asked me a few months ago, I would have said, yeah, they absolutely should be. Now I'm not so sure anymore. Only because we can use a few extra weeks to upgrade ventilation systems. And ventilation systems aren't a panacea. They won't solve this problem, but they will help. We have to upgrade ventilation systems. And ventilation systems aren't a panacea. They won't solve this problem, but they will help. We have to layer on protection. So we have to ventilate. We have to make sure there's masks wearing indoors, high quality

masks, preferably N95 style masks. And we have to make sure that everyone that these children come into contact with are vaccinated. If we can achieve those things, then I think the schools should be open. And we should have surveillance systems in place so that we can pull the plug quickly if need be. Right, but are you seeing any evidence that we are achieving those things? I guess would be the obvious question. Heterogeneously, possibly, but not universally. Heterogeneously, I mean that some places are doing better than others. Some schools are so old that some places are doing better than others.

Some schools are so old that the windows are painted shut, and you can't open windows in the middle of winter. And the classrooms are so overpacked that even if you could open the windows, there probably isn't sufficient ventilation to offer sufficient dilution of viral particles. It would need more time and more money to do that well. As well, getting sufficient, high-quality masks into schools takes time as well. I think it's advisable that schoolboys look into procuring high-quality N95-style respirator masks fitted for children, sufficient so that parents don't have to buy it for their kids. Yeah, it is a bit of an expense, but it's probably worth it at this point. And additionally, hopefully they're spending

time looking at small class sizes and a rolling kind of symptom check that can be applied across the board. Those are administrative challenges, and again it takes time to organize that well. So I don't know if there is sufficient time to do all of that as well as it could be done. What would you say right now to a parent who is weighing whether or not to send their kids back to school, including perhaps maybe some questions that they should be asking of their school before they make that ultimate decision? Exactly. I would ask the schools, how many of your staff are vaccinated? They may not have that information. It might be illegal for them to ask, but if they do have it, they should probably offer it up. Ask the schools, what are your masking policies?

What are your policies around detection and symptom checks? If you haven't got a clear answer, I'd be concerned. If there's a solid answer, if there's a plan in place, then I'd be a little more confident. And also look at your community. What are the transmission rates in your community? What are the vaccination uptake rates in your community? If it's not in the community surrounding the school, it's unlikely to get into the school.

So that's our first step is looking at what can we adults do around the school to make it safer. And if your neighborhood, your community, is not looking as if it's on board with preventing COVID transmission, I'd be a little more concerned. Okay. I think the obvious question for a lot of people here is, in addition to schools, what will our immediate future look like here? Because I think, myself included, a lot of people were thinking, we're heading back to work this fall.

Are we? Are we headed into more lockdowns? Are there going to be more orders to like, like stay within your household? Yeah, I don't think that's going to happen. I think we're going to have an open society with some controls in place. For a number of reasons. I don't think the tolerance for lockdown is there anymore. And nor should it be because we have tools to prevent it. We have vaccination, we have mask wearing, we have symptom checks and surveillance. And as we see in other parts of the world, it might be possible that our vaccination rates and our nudging upward of community immunity might be sufficient to blunt the size of this wave. All this might be, you know, unneeded panic. It's always a possibility, but it's better to prepare for the worst than to be caught off guard. So I think if

we are responsible and we keep our wits about us and we do not do things untowards like having raves, throwing the borders wide open, not having masking policies in our places of work, then I think we have a really good chance of weathering this while we wait for vaccination penetration to get most of our butts out of the fire. And I guess just one last question for you, like. Like meantime, you know, you're an epidemiologist. You're a father to a young child, as we've talked about. And I just wonder, like, how are you navigating your daily life right now? Like, are you going to the gym?

Are you going to restaurants? Are you eating inside? Are you seeing friends indoors? Are you making different decisions around those things because you have a young child? Yes, absolutely. So I only associate indoors with vaccinated people, almost exclusively family members. I don't go to the gym. I don't go to restaurants. I never leave my house except to visit close family members who I trust and who are vaccinated and who have done symptom checks and sometimes rapid tests as well. Maybe I'm over the top that way, but I think I could not handle it emotionally if I brought

COVID back to my child. So I err on the side of safety and conservatism. I think most parents would probably understand that. Yeah, absolutely. And I should say, I keep using this example of the gym. It really wasn't something that I was doing very well before COVID. So I don't know why I keep bringing it up. But anyways, fair, fair. Okay. Thank you so much for this. We appreciate it, as always.

Bye-bye. Bye-bye. before we go today i wanted to give you an update on mariam and ahmed the couple stuck in afghanistan that we told you about yesterday mariam the canadian citizen was able to make contact with global affairs yesterday so she's in their system, and she's eligible for a rescue flight out of the country. And as her immediate family, her husband Ahmed is eligible to go with her. But when we last heard from them, they were still waiting on more instructions from Global Affairs. And Kabul is so dangerous right now that it's unclear when and if they might be able to get out at all. According to a government source who spoke to the CBC on Wednesday,

Canada could have just 24 to 48 hours to get planes in and out of Kabul as part of the Afghanistan evacuation effort. That's because of the looming August 31st deadline for U.S. combat troops to withdraw from the country. That is all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner, and we'll talk to you tomorrow.