Front Burner - COVID-19 on the rise: What you need to know

Episode Date: August 23, 2023

Over the last month, the percentage of COVID tests coming back positive started going up again, and wastewater COVID signals are also rising, suggesting a fall COVID-19 wave could be starting in Canada. Today on Front Burner, Dr. Allison McGeer, infectious disease specialist at Toronto’s Mount Sinai Hospital and professor at the University of Toronto’s Dalla Lana School of Public Health, discusses the state of COVID-19 in Canada and what you need to know. Looking for a transcript of the show? They’re available here daily: https://www.cbc.ca/radio/frontburner/transcripts

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 Tamara Kandaker. So I don't know about you, but in the last few weeks, I've been hearing something I'd happily gotten used to not hearing much in a little while. Friends telling me that they're homesick with COVID. Early signs indicate that COVID in Canada could be on the rise again. And earlier this month, the World Health Organization declared a recent

sub-variant of Omicron a variant of interest. So today I'm talking to Dr. Allison McGeer. She's an infectious disease specialist at Toronto's Mount Sinai Hospital and professor at the University of Toronto's Dalla Lana School of Public Health. She's going to tell us what's going on with COVID in Canada now and what it means as we head into the fall. Hi, Alison. Thanks so much for being here. Nice to talk to you. So first of all, could you give me a sense of what we're seeing with COVID cases in Canada right now? Because anecdotally, it feels like, at least here in Toronto, it's going around again. So is that actually the case?

Unfortunately, that is actually the case. You know, we cut a bit of a break this summer. It was nice, but it's over now. And there's no question that across the country, COVID cases are going up. Still pretty uncommon, but definitely increasing. And how do we actually know that? What kind of information is still being tracked by public health officials? actually know that? What kind of information is still being tracked by public health officials?

So the combination of things that people are watching are, first of all, wastewater surveillance, which gives you a good sense over time of whether things are going up or down. The percent of positive tests and people who are getting tested, we're not testing nearly as many people anymore. But as long as the indications for testing are the same, as long as that sort of the number and the type of people we're testing are the same, then as it goes up or down, it's a good measure of whether things are changing. And we're watching the number of cases, again, like percent positive, has limitations, but is still helpful, and the number of people hospitalized and the number of people who are dying. That's pretty much what we look at for other respiratory viral diseases like influenza

with the new addition of wastewater, which we didn't have before COVID, which is good for many things. But it's a system we're all used to for tracking what's going on. One of our producers on the team got sick last week and she was taking rapid tests for COVID that kept coming back negative. And she was saying that she was swabbing the back of her throat and then her nose and that she just wasn't sure if those tests were coming back accurate. And I'm just wondering, do you think at this point individuals are even getting an accurate sense of if they have COVID? Yeah, no, it's a real problem. Okay, so two things have changed in knowing whether you have COVID

and testing for it. The first is that when we were using a lot of public health restrictions, when we weren't going out, when there weren't concerts, when we weren't traveling, there wasn't much around except COVID because we pretty much stopped the transmission of other respiratory viruses. So if you got sick, the chances were much greater than usual that it was going to be COVID. But now we're back to normal, okay? And there's all sorts of other viruses out there. And as we go into August and September, enteroviruses start to become common. They're the viruses that give everybody colds when people go back to school and the wall. And so part of the effect of cases going up is that more people are getting sick, even though they don't have necessarily have COVID. as they used to be. And the reason for that is, I think, that now that people have had one or two or sometimes even three infections and lots of doses of vaccine, when you get COVID, you don't shed as much virus. And the rapid tests in particular are very sensitive to how much virus

you're shedding. So now they're not as good as they used to be. And there was one paper this summer that suggested that if you test positive, you're okay, you know you have COVID. But if you have tests negative, you have to do at least three tests on three days to know that you actually don't have COVID. And that means you've already stayed home for three days and you're feeling better, you know, at which point you can stop worrying about it. So it's really frustrating. It would be great if the rapid test for COVID still worked really well, but they just don't work as well as they used to anymore. Yeah. Okay. Okay. That makes a lot of sense. So is there any indication why COVID cases might be on the rise right now? So, you know, it's probably a mix

of things. And I think if you ask different people, you'll get slightly different versions of this. But it's highly likely that it's a combination of there are new variants emerging, right? And that's what we expect with coronaviruses. We're expecting that it's going to keep changing. It's like flu, you know, you track the changes over time, but it never stops. And as we get new variants, they are drifted away from the antibodies and the responses that we made to previous vaccines and previous infections. So you're more likely to get infected. In addition, it's been longer and longer since we all got booster doses of vaccine. So the minimum that most people are out is now seven or eight months. And those of us who are older or immunocompromised who got second bivalent boosters in the spring, most people are coming up on a year

or 18 months or even two years since they last got a dose of vaccine. And we know that vaccine efficacy wanes over time. So that combination is probably what's doing most of it. But if you think about it, summers are really busy time for travel, right? And travel really amplifies the transmission of COVID. And so all of the traveling that we've all been doing this summer, which was lovely for many reasons, okay, is likely amplifying COVID. And there's, I think, some theories that some people that say that because it's been really hot and people have been more forced indoors because of the temperature, so there may be more transmission because we're indoors. But most of it is probably just length of time since vaccines and new variants coming. It's the same problem we see with flu every year. At this point, generally, just how sick are people getting from COVID?

are people getting from COVID? So gradually people are getting less and less sick. Okay, so how sick you get from COVID depends on how many doses of vaccine you had, when you had your last dose of vaccine, whether you've been infected before, and if so, how many times. And obviously, there's also person to person variability. So in the older you are, the more likely you are to get more severely ill, that's a general truth about infections, the more your immune system is compromised, the more likely you are to get ill. But we're slowly moving from, you know, a situation where even younger people had a significant risk of having significant lung disease and maybe needing to be hospitalized to a situation where most people under the age of 40 really don't need

to worry about getting severe COVID any longer. The people who are really at risk are people who are older and people who are immunocompromised. Doesn't mean that if you're younger, you don't want to get the vaccine because there's still the risk of feeling truly miserable and of getting long COVID. But it does mean that we just keep slowly shifting to less and less severe disease, something much closer to the severity of influenza now than COVID was when it first started. Yeah, you mentioned long COVID, and I was wondering about the prevalence of that. Do we know how many people are contracting long COVID at this point and what kind of impact it has? You know, the evidence we have is that the further we get into the pandemic, and this is also

history with previous pandemics, the further we get into the pandemic, and this is also history with previous pandemics, the further we get into it, the better protected you are when you get COVID, the less likely you are to get long COVID. But people are still getting long COVID. And certainly we have an accumulation of, you know, a large number of people who are suffering from long COVID. Most of those people do get gradually better. So that by the time you're a year or two years out, things are improving, but it can be a very long time. And there are some people who will really be compromised in their function for a long time. It's a, one of the things that we really need to hold on to as we try to put COVID behind us is the knowledge that we need to be there to be helping people who have long COVID and looking for, you know, more effective treatments and trying to make sure that this group of people gets supported in what they need.

So we've talked about people getting severely ill and long COVID, but do we have a sense of how many people are still dying from COVID in Canada or whose deaths could be related to a COVID infection? So the further we get into COVID, the harder it is to actually count deaths from COVID. Certainly, we are still counting them in Canada. I can't tell you off the top of my head for Canada. And in Ontario, we're down at, I think, four or five deaths a week. So that's not nothing, okay? But it's a much smaller number than we've been used to. The challenge is that the further we get into it, the less severe things get, the more likely it is that very frail, already compromised people are the people who are going to get COVID. And then sometimes it's difficult to decide whether the reason for their hospitalization was because they were already very frail, or because they were on chemotherapy for their cancer, or whether it was the COVID

infection, because often it's a combination of both that is causing the problem. So there's two things to learn from that. The first thing is that in general, in those situations, COVID may just be tipping you over, the COVID may not be severe, but you still don't want to be in the hospital, right? So that's a very good reason why we need to be making sure that people who are frail and whose immune systems are compromised are getting their boosters on time and are well protected because it takes less additional illness to tip those people into needing help in the hospital. But it's also true that it's going to get harder to try to judge just how bad COVID is and what we count as a COVID death or not COVID death.

We heard a lot about overloaded hospitals during the height of the pandemic. And how big of a concern is that as we approach a potential new wave? So, you know, at the moment, it's not a problem. There are definitely patients with COVID in the hospitals, but know, at the moment, it's not a problem. There are definitely patients with COVID in the hospitals, but it's something the system can cope with. I think the concern is what's going to happen this winter. It's important to remember that our hospitals are already stressed. They're even more stressed after COVID just because of the last three years of challenge. And pre-COVID, in a severe influenza season at peak, it was not uncommon for surgery to have to be canceled, for people to be

staying in hallways, for people to be admitted in the emergency department. So this is not a new problem. And if we have a bad COVID winter and a bad flu winter together or another winter of more active RSV, which we're expecting, then we may get into trouble again. It's not going to be trouble we can't cope with in some senses in the system, but it may well be enough that it's going to compromise our ability to provide the highest quality of care for patients. to provide the highest quality of care for patients. And that's another reason why going into this fall, it's so important for people to get their booster vaccination and their flu vaccine and their RSV vaccine if it's available to them. In the Dragon's Den, a simple pitch can lead to a life-changing connection.

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said that the new monovalent vaccines should be available within a matter of months. So what should people consider when they're deciding whether to get boosted again right now or to wait for that updated vaccine in the fall? Yeah, it's a challenging decision. You know, the current recommendation from NACI and in Ontario from the province, and I think most other provinces, is that people should wait for the new boosters for the moment. And that's very sensible just at the moment for almost everybody, because even though cases are increasing, they're still uncommon. It's still not a lot of disease, and it still makes sense to wait for the boosters to come. I'm sure it's putting pressure on the people who are making the boosters and testing the boosters to move it as quickly as possible, because it does raise the concern that we might want them earlier than we had originally been talking about. But just at the moment,

there's not enough disease around to really make you want to go out and get your booster this week or next week. Something we need to be watching carefully. And I think there are some circumstances where people might choose to get a current booster. So if you're living in a long term care home where an outbreak of COVID-19 has just started, well, that's a really good reason to get your booster, right? If you have for some reason, if you're immunocompromised, and you have to do a lot of traveling internationally in the next two or three months, that's a good reason to get your booster, you know. So there are some very specific reasons why people might consider getting, you know,

what booster is available now and not waiting. For most of us, however, it makes sense to wait till the boosters come or at least wait to see what happens with this increase. You know, just the fact that this increase does not mean that it's going to go up exponentially, and we're going to be in much more trouble a month from now, we don't know how fast it's going to increase. So for most of us, the sensible thing at the moment is just to wait and watch. Bit irritating, but still the most sensible thing to do. Yeah, I have heard from some people who are like, how many more of these boosters and vaccines do we need to get? And there's going to be people who have had COVID once or maybe more than once

who haven't been hit particularly hard and who maybe feel like they don't need to get another booster. What would you say to those people? So, you know, when people say to me, I think I've had enough COVID vaccines, what always comes to mind is that because I'm a healthcare worker and I'm getting old, I've had my flu shot every year since 1991 and it hasn't done me any harm and it's protected me from a lot of influenza. So, you know, COVID vaccines are like that because the virus changes and evolves, you need repeated doses to protect yourself well. And, you know, that's just a general fact of life. You know, it's true that you only need,

you know, three or four tetanus doses to protect you for most of your life. But for respiratory viruses that change, you need repeated vaccination to be well protected. It's also true that, you know, younger adults who've been infected and had, you know, three or four doses of vaccine are very well protected against severe disease. But still, there's a non-trivial risk of feeling miserable. There's a non-trivial risk of getting long COVID. There is still a risk of getting sick enough to be hospitalized and potentially to die. That's now a very small risk, but there's no question that the risk of getting vaccinated is even smaller. So the reason that NASA is recommending that you get your vaccine is because it's still very clearly a benefit, even if you're young and healthy. The additional

benefit, of course, of getting your vaccine if you're young and healthy is that you protect other people. Beating respiratory viruses is a team sport. And the better we do at teams this fall with everybody getting their vaccine, the fewer people will be ill and the fewer people will die and the better off our healthcare system will be. So there's a really good reason why Nancy said, not just for older people and people who are ill, it's all of us who should be getting our booster this fall. Yeah. So then to wrap up here, Alison, beyond boosters, what other precautionary measures would you recommend people take to avoid getting COVID themselves and spreading it to their community? Yeah. So I think you still want to think based

on your own situation, whether it's how at-risk complications you are because of your age or underlying conditions, and who you know and live with and want to spend time with, and what your risk of transmitting COVID is to them. Because still, you know, the basics that we always knew apply, all right, which is that if you stay home when you're sick, you won't transmit to other people nearly as often. If you clean your hands regularly, that will protect you from COVID. Not perfectly, but still something you still may wish to think about what you're doing in large, crowded indoor spaces. You know how much time you want to spend in airports, in concerts or in other crowded indoor spaces, you know, how much time you want to spend in airports, in concerts, or in other crowded indoor spaces, not because you shouldn't do that, but because you can control your risk of COVID by avoiding those things, if you choose to, or selecting which ones make the

most difference to, you know, international travel for all sorts of reasons is a risk. So I think there are lots of people who are going to get their biolay on booster and say, now I can do what I like, and they're right. But many of us are still going to be thinking about making sure that we clean our hands regularly, making sure that we stay home when we're sick, and thinking carefully about just how much, you know, doing all the things we want to do, but not putting ourselves at unnecessary risk through this fall and winter. All right, Allison, this was really helpful. Thank you so much. It was great to talk to you. Pleasure to talk to you. Take care.

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