Front Burner - A pre-holiday Omicron update

Episode Date: December 22, 2021

Omicron is spreading rapidly in Canada. Barely two weeks after the first cases of the coronavirus variant were identified in Ontario, it became the dominant strain in the province, and experts say that will soon be the case across the country. Even as Canada is reporting some of the highest daily case counts seen throughout the whole pandemic, some doctors say the real numbers could be several times higher because of the difficulties many people face in accessing tests. Today, Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare in Hamilton, explains the latest research on Omicron from around the world — and how that research can help inform your choices around holiday gatherings.

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. So just last Thursday, we did an episode on the show about the Omicron variant of the coronavirus. But even just since then, the picture has really changed in Canada.

The decision to limit people's ability to gather, especially during holidays, is an extremely, extremely difficult one to make. This is unbelievable. And I'm warning you, I'm warning all Quebecers. This is, of course, not where we want to be. Barely two weeks after the first cases of Omicron were identified in Ontario, it became the dominant strain in the province. And experts say that's about to be the case across the entire country. Because it is so highly transmissible, it can creep up on you really fast. We do have something coming and we have to prepare for it. Right now, Canada is reporting some of the highest daily new case counts we've seen in the whole pandemic. Canada is reporting some of the highest daily new case counts we've seen in the whole pandemic.

The last couple days, we've logged more than 10,000 cases a day, including many who are fully vaccinated. And many doctors say the real numbers could be up to several times higher than that because it's so hard to even access tests right now. I was expecting a lineup, but not like this. Going to be chasing kits all over the place because they're hot. People want them. And of course, this is all happening at the height of the holiday season. And a lot of us are wondering how to see our loved ones while still protecting them from this new version of the virus. We can't make that decision for you, but we can tell you about what the latest research from around the world tells us about Omicron. And as you're thinking about your holiday plans,

how that info might help inform the choices that you make. Today, I'm unpacking some of that research with Dr. Zane Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton. Hi, Dr. Chagla. Thank you so much for making the time today. I know that you are very busy, so we really appreciate it. No problem. Thanks for having me. So firstly, you were on the show three weeks ago, just after the first cases of Omicron had been identified in Canada. And what has been most striking to you as you've watched the variants spread here since then? Yeah, I mean, the growth has been, you know, nothing we've ever seen before. Federal modeling predicted that if Omicron took hold, we could see an average of 7,000 new cases a day by

around New Year's Eve. Well, that turned out to be conservative. We are already at more than 8,100 a day, the curve pointing almost straight up. You know, when Alpha and Delta came into Canada, it took some time for it to become the dominant variant. They became and established themselves. But, you know, that process took weeks from, you know, a couple of months by the time we started seeing the first cases to when these established. This variant essentially just showed up and spread so rapidly that within days, you know, really two weeks, we saw this become the dominant variant. And now speaking, it's likely most cases in the province are Omicron until proven otherwise. And yeah, it's remarkable to see that happen, considering how recently we just talked about

this showing up in Canada and Ontario and how fast it spread into a region. What does the research from around the world, countries that I guess are further ahead on this than us. Tell us about why Omicron seems to spread so much more quickly than other variants. Yeah, there's a few basic science things and, you know, obviously population-based pieces. So from the basic science standpoint, you know, we are seeing cases with levels that are much higher in airways, in animal and cell models, than we saw in Delta. So the viral loads of people do still seem to be higher than Delta, which already had a high viral load in that sense.

The replication in bronchial tissue or the airway tissue is much higher than was seen with Delta. But number two is also the population basis. And again, the fact that this is now something that can spread in both vaccinated and unvaccinated populations and populations with prior infections, you essentially opened a new pool again, basically, of susceptible individuals. And the combination of the two, high viral loads, rapid spread with a reproductive rate of three or four, and a large pool for those folks to be infected, you know, really makes it become dominant very quickly. So it seems very clear that it's obviously spreading faster for all the reasons you just mentioned. There's like a bigger pool of people because it can break through vaccines that,

you know, research shows that it's replicating faster in our bodies. But let's talk about vaccines for a minute here, because there is this kind of wild case study out of Oslo, Norway, where like 111 people who went to a Christmas party at a restaurant and then 80 of them ended up testing positive, probably with Omicron. And the vast majority of them were double vaxxed with an mRNA vaccine. What is the research showing us at this point about how well two vaccine doses protects against symptomatic Omicron cases? Yeah, so, you know, that was one of the first indication that, you know, this can spread really fast, really quickly. And at Oslo Gathering, there are a few people that had returned from travel. And again, that probably just set off the storm of all those people getting

infected at once. We are seeing a couple of data sets, one from the United Kingdom, where they've looked at their cases and kind of modeled out efficacy based on that in unvaccinated populations. And, you know, again, two mRNA vaccines are probably in the range of 30 to 40% protection from symptomatic COVID-19, not necessarily hospitalizations for your cases, but just getting COVID-19. And similarly, a big private insurance in South Africa at the epicenter, you know, similar 30 to 40% protection from symptomatic disease from two doses of mRNA vaccine. So it's not nothing. There definitely is a protection there.

But certainly there isn't as robust as we saw with the 90, 95% when these vaccines were first released. What about three doses? Yeah, the UK does have a little bit of data around three doses. And three doses including one mRNA after two doses of AstraZeneca or one dose of mRNA after two doses of mRNA vaccine, where within a month of that, you know, the efficacy goes back to about 75%. So, you know, there is some data here to suggest boosters would reduce symptomatic COVID-19 amongst people that get them. And that really is in parallel to a number of neutralization studies,

so lab studies, looking at antibody levels after a booster. And again, similar to kind of that two-dose series initially against Delta that we're seeing as a three-dose series against Omicron. Okay, okay. So I guess pretty good message uh, get yourself a booster shot if you can get your hands on one right now. Yeah, absolutely. I mean, I think that's, that's probably the biggest intervention here. Toronto Mayor John Tory says city vaccine clinics have tripled their capacity in a month and are pledging to continue ramping up. All governments are working together to help people get through this and to help make sure that that capacity gets expanded. Still, the booster rollout isn't exactly going at the speed promised by Premier Doug Ford last week. The best defense is a lightning fast offense.

All right, so let's talk about severity now, because I think this is a pretty important question that a lot of people have. And so we've been hearing lots that Omicron seems to be milder than other variants. But when I look at these studies coming out of these different countries, the picture does seem quite confusing to me. So generally, what does the research say so far about the disease severity from Omicron? Yeah, you know, the confusing nature is, as we talked about, is from a number of different things. Looking at the South African data set from the Discovery Network, which was the one that

looked at this, they saw a 70% reduction in hospitalization amongst people who got two doses of an mRNA vaccine. Now, it's not perfectly distributed, right? We know that 70 and 80-year-olds are the ones that make lower immune responses and are at the ones at the highest risk of hospitalization. And so there is that little bit of imbalance. The other issue with the South African data set is the comparator group, the unvaccinated, we know in places like South Africa are also naturally immune because a lot of people got COVID-19 in the first two waves. And so, you know, again, if your comparator has some protection against hospitalization, it falsely makes your vaccine look less effective in that sense. So they're a little bit unclear in that sense. We're looking at Danish data. And you know,

the today's report, which is still early suggests about a 1.4% hospitalization rate amongst people who had Delta versus a 0.5% hospitalization rate amongst those who got Omicron. So, you know, these are early signs. They may not be perfect to kind of declare that it's mild altogether, but there is starting to emerge a number of data sets in both South Africa and in Europe that might suggest that this is, you know, maybe milder. And again, not necessarily the disease has gotten milder, but the hosts are much more attuned and are ready to deal with COVID-19 if it comes into their systems, meaning less hospitalizations at best. I'm going to go. Canada's entrepreneurs through angel investment and industry connections. 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.

There's this really interesting study out of a lab in Hong Kong that found something that seemed to possibly suggest one reason why Omicron symptoms may be less severe. And I wonder if you could tell me about that experiment and what they found. So, you know, one study in Hong Kong that actually was the first study that talked about Delta being such a high viral load, looked at kind of their Delta data and compared it to Omicron data, and saw, you know, replication in the upper airways, the bronchi being very high and 70 times higher than Delta, but replication in the lower airways, the lungs where we see pneumonia and those complications from from hospitalization and ICU stays being much less than Delta. And so,

you know, again, that picture of maybe this is more of an upper respiratory tract infection as compared to a lower respiratory tract infection. Right, right. So the fact that it replicates so much faster explains, as we talked before, why it's spreading faster, but the fact that it doesn't, you know, get into, well, it looks like it doesn't get into your lungs as much as the other one. The other iterations of COVID could explain why it's not as severe. Exactly. I guess either way, though, because this is spreading so much quicker, if a ton of people are getting sick, even if the majority are milder, our odds are that there will still be more pressure on hospitals, right? Is this sort of part of the concern here, basically, that the small proportion of a very

large number is still a large number? Yeah, there's obviously mechanistics, you know, that suggests maybe it's milder. But again, as you said, a small number of a large number is still a relatively large number, it may not be as catastrophic as, you know, Delta or Alpha when it came to our population that was relatively naive from an immunologic standpoint. But, you know, enough to put pressures on a system that's already pressured. The other thing I would say is, you know, there are still a lot of vulnerable people who have very compromised immune systems. And we know those people, even with mild infections, can often have

prolonged and difficult and hard to treat presentations. And so, you know, there is enough of them that just became unlocked here with Omicron that, you know, that could also Is there any research on how this is affecting children? Is it more severe in children? Yeah, so not a lot that has come out. You know, there is a theoretical risk if we have more upper respiratory symptoms. Those tend to actually affect children more disproportionately than adults because the respiratory tracts are less developed. There was a lot of children initially admitted in South Africa relative, but it wasn't clear necessarily if that was just the tip of the iceberg because there was just so much transmission in South Africa that they saw that. As things have gone on, there are actually relatively less children being admitted as many of the adults are being admitted in that context. So we're waiting

for places like Denmark and the United Kingdom who have good surveillance networks to kind of give us the better sense of what this means for our children moving forward. Right. Okay. I want to talk about testing Omicron now. I've read that the incubation period that like the period between when you're exposed and when you get symptoms might be shorter for omicron and i've seen some speculation that that could make it trickier to detect through testing and so what kind of research is there around that yeah so you know absolutely they the the issue i think comes to the fact that you have to diagnose people early for things like case and contact management to be involved. But there's a lot of issues here. You know, first of all, people have to test very early into their symptom complex.

And again, within that two to three days, we know people are transmissible even before their symptoms develop. symptoms develop, you know, the die may have been cast for one or two generations already, even if someone gets tested right on time to prevent them from having infection. And, you know, the Oslo example, for example, they did rapid tests the day prior to that gathering, not perfect, but, you know, at least had proven the night before that everyone didn't have active COVID-19, which is, you know, again, remarkable considering nearly all of them got it at that gap. So, you know, again, the timing of testing may not be enough to identify the appropriate cases and slow down transmission in that sense. And then number two, look, from a practical standpoint, if this rips through a population,

if the numbers are so high with a limited access to testing and limited resources in testing you're going to overwhelm the system with the amount of people coming forward to need to get tested which means that there's delays which means there's even more transmission by the time that people are able to access the test and all of a sudden yeah you have three or four generations by the time you figure out someone had COVID. For people, and I realize I'm saying this, we're kind of in a real Hunger Games mentality right now to get them. But for people who do have access to rapid tests, when should they be taking them to get the most helpful results? Yeah. So first of all, if you have zero access to PCR tests in your community, and you have

symptoms, doing a rapid test may not be perfect, but if you get a positive result, it probably means that you have COVID and can consider yourself infectious to others at that point. Number two, if you're going to use a rapid test as preventing transmission during a gathering or seeing a vulnerable person and using it as an extra barrier, do it as close as you can to the event, literally minutes before, because you're going to get as much sensitivity as you can out of them. I want to keep talking a little bit about sort of the practical things that people should do here and what they could take from all of this. So obviously we are a few days out from Christmas here. A lot of people, whether they celebrate Christmas or not, probably have a lot of holiday plans over the next couple of weeks.

So I know there are no simple answers here, but equipped with the information we've just been talking about, what do you think people should be keeping in mind as they make their decisions? Yeah, number one, you know, the odds of someone walking into your gathering, especially as it gets larger and larger, is higher and higher that someone has COVID at the time and could be infectious to others. And so, you know, keeping numbers small is important because it mitigates some of that effect. Number two, you know, doing a rapid test. If you have a limited number, use them in the people that have the highest contacts to society. So kids in school, children in daycare, people who work in hospitals, etc.,

where people are essential workers, where they're probably the highest risk if you have a limited amount. around where people are essential workers, where they're probably the highest risk if you have a limited amount. Thirdly, you know, again, make sure the people at that don't come with minor symptoms and be very clear, you know, be flexible, let you know, reschedule, do things. You don't want a chance that if people have a headache and a sore throat, but say they're fine, you don't want to be going back and say, actually, that person had COVID and everyone else has COVID at that point. I think the people that are vulnerable, particularly those who are compromised, elderly, make sure that they have access to a booster. And again, if you can't achieve these, you're feeling nervous, there's issues, then don't necessarily say that you have to have the traditional family dinner. Open the windows, go outside.

I heard about someone whose very elderly parents still want to meet. So they're having pizza in their garage with the doors open, basically. You know, I think there are ways to say, okay, this may not be perfect. Maybe we add more mitigations in place so that we can gather in a small number, but use things like ventilation or masking to really aggressively reduce the risk further. I wonder what you might say to somebody who's planning on attending or is having a gathering where there aren't people thought of as vulnerable there. Like there isn't anybody over 70 there and everybody is vaccinated. And some people might even have boosters and so maybe they're just thinking to themselves well everyone will be fine even if a bunch of us get get on omicron anyways look you know there are

two sides of the coin to this you know there is the vulnerable people and those people probably should be concerned about if they eventually have to interact with vulnerable people to make sure, again, that they're they're symptomatically well, that they're testing appropriately. But number two, you know, the other side of the coin here is that, you know, that a fully vaccinated 20 year old may not face the same risk from this as a fully vaccinated 80 year old and that Omicron is here to stay. vaccinated 80 year old and that omicron is here to stay and and so you know i think people are in a mentality if we lock down or if we close down harder you know this is going to go away it's not this virus has made itself the fittest virus on our soil and so yes maybe it's not christmas that you get exposed but it's new year's or a week later or a week after that especially as the community activity ramps up. And so, you know, it does get to be a little bit difficult to start saying you need to restrict this for this

particular day. But then the next day and the next day after that, you know, you're going to be at risk in that sense. So I think, you know, the long term here is people need to make these risk assessments. So basically, would your overall takeaway here be something like be safe, try to reduce risk for yourself and those around you, but we eventually have to learn to live with this thing. We can't be hermits for the rest of our lives. So get your booster as soon as possible. mitigate spread. But unfortunately, this one is getting out of our hands in terms of how much we can control it. And again, people have to be prepared that they may acquire COVID-19 in the next few weeks. Okay, Dr. Chagla, thank you so much for this. Thank you. No worries. All the best. All right, so a few Omicron-themed updates before we go today. Yesterday, the City of Montreal declared a new state of emergency in an effort to curb the spread of the variant. The same day, Quebec's Provincial Health Authority announced that Omicron now accounts for 80% of COVID cases in the province. Meanwhile, BC announced new restrictions, including shutting down bars, nightclubs, and gyms,

and banning gatherings like weddings. Officials also said the province will be canceling scheduled non-emergency surgeries as of January 4th to manage hospital capacity. And the NHL has reportedly decided not to send its players to Beijing to compete in the Winter Olympics because of COVID concerns. That's all for today. If you've got a moment to rate and review our podcast, we'd really appreciate it. I'm J.B. Poisson. Thanks so much for listening to FrontBurner and stay safe out there.