Front Burner - COVID-19 update: Explaining rapid tests and experimental treatments

Episode Date: October 13, 2020

Parts of Canada are back in lockdown as cases of COVID-19 spike across the country, particularly in Ontario and Quebec. And with the cold weather setting in, it’s tough to imagine how we may be able to return to normal. But there are some developments: Health Canada has now approved and bought over 20 million rapid tests. And Donald Trump’s COVID-19 treatment is raising a lot of questions about the use of experimental drugs. Today we’ll be talking about how the testing and treatment of coronavirus has evolved since the first wave with Dr. Isaac Bogoch, a physician and an infectious disease expert in Toronto.

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, Jamie. Hi, Daz. How are you doing? I'm good. I'm great. And I'm actually, you know, I'm ready to give you your show back now. Well, thank you so much for taking it. It was such a pleasure to listen to you these last couple of months. I spent a lot of time walking up and down the rail path in Toronto with Ollie.

And you were like one of my only adult companions during the day. So thank you for that. I appreciate that. And you can take back the host chair and deal with all the shenanigans. Well, it is so great that you're now part of our team. And I know like we'll be seeing and hearing more from you, hopefully as a host and as a guest. I know that you're always up to so many cool things. So Josh, thank you so, so much. And we'll talk soon. As cases of COVID-19 spike across the country, particularly in Ontario and Quebec, parts of Canada are back in lockdown. The Quebec government says the situation is critical. So three regions, including Montreal and Quebec City,

are heading to the highest level of alert. From Ottawa, Toronto and Peel, an end to indoor drinking and dining. Gyms are shuttered. So are casinos and movie theatres. And with the cold weather setting in, it's really tough to imagine how we may be able to return to normal, or at least more normal than this. But there are some developments. Health Canada has now approved

and bought over 20 million rapid tests, and Donald Trump's COVID treatment is raising all these questions about the use of experimental drugs. So today, we'll be talking about how the testing and treatment of coronavirus has evolved since the first wave, and whether pending a vaccine, these new advances are a way back to a more regular life. We're going to be helped today by Dr. Isaac Bogosh, a physician and infectious disease expert in Toronto, and of course, a big friend of the pod. I'm Jamie Poisson, this is FrontBurner, and it is great to be back. Hi, Isaac. How are you? I'm great. Thanks. Welcome back.

Thank you so much. I'm very, very happy that you're my first interview back, though I know that that also means that we're still in the middle of a pandemic. I think when I left five months ago, we were in a pretty strict lockdown, and here we are again, hey? Yeah, what's old is new. It's terrible, but you know what? Like anything else, we'll get through it. Yes, and I want to talk to you about that today, how we might get through the next several months, in particular, pending a vaccine. So of course, over the weekend, Ontario responded to a surge in cases by bringing back restrictions to Ottawa, Toronto, and the Peel region. All trends are going in the wrong direction. Left unchecked, we risk worst case scenarios, first seen in Italy and New York City. People will no longer be able

to go inside restaurants or bars or gyms, movie theaters, casinos. Last week Quebec announced similar shutdowns for hot spots like Montreal, Quebec City and nearly every community along the St. Lawrence River. The situation has become critical. If we don't want our hospitals to be submerged, we must act strongly right now. On some days, these provinces have reported about a thousand cases a day. And what do you think about the decision to lock down again? The first thing is that nobody wants a lockdown. They're terrible. They have tremendous health consequences, economic consequences, psychological consequences. Any of these lockdowns stink. And when cases are

low, when you have low rates of transmission in a community, you can have focused, targeted interventions to keep those cases low. But once the number of cases in a community starts to rise, those focused and laser beam interventions no longer work anymore. And you're just left with fewer and fewer options to get the number of cases under control so that we avoid overwhelming our health care system. We have to avoid that at all costs. So unfortunately, case numbers rose to such a degree in parts of Ontario and in parts of Quebec where the options to get these under control were limited. And sadly, lockdowns are a last resort. So was it the right choice?

It's a tough choice. But given the circumstances on the ground, it was the right choice. And you know what, as we're talking today, there are early indications that it's already starting to work in Quebec. Right. As you mentioned, these are such blunt tools to try and control the pandemic at this stage. Do you think that there was a failure on the part of the Ontario government and the Quebec government to properly manage these cases? And that's what got us to this place? Yeah, I certainly think that if we had acted in a manner more suitable in the summer, where we could really target interventions on local outbreaks and boost lab capacity, boost contact tracing capacity, really hone in messaging and leadership, I think we probably could have avoided the scenario that

we're in right now. But in the same breath, It's never too late to turn around when you're going down the wrong path. And you just cannot have exponential growth of this infection in a community. We know what it leads to, and it's already starting to lead to a greater number of hospitalizations of people. So let's talk today then about new advancements and whether these new advancements might help us get out of some of this. Can we start with therapeutics first? And of course, Donald Trump has been talking about this a lot, talking about this to anyone who will listen. I think this was a blessing from God that I caught it.

This was a blessing in disguise. I caught it. I heard about this drug. I said, let me take it. It was my suggestion. I said, let me take it. And it was incredible the way it worked. Incredible. He's been talking about Regeneron in particular, which is an experimental drug that has not been approved by the u.s food and drug administration it has not been approved here in canada either but he's called it unbelievable these i view these and now they call them

therapeutic but to me it wasn't therapeutic it just made me better okay i call that a cure is regeneron something that canadians might actually be treated with one day? What do you think about this drug? Yeah, I honestly, I don't really know because we don't actually have any data for this drug. And, you know, in all fairness, sure, there's promise. Of course, there's promise. And basically what this drug does, it's not really a drug per se, but it's an antibody type therapy. body type therapy. So basically, when a virus gets into the body, your own immune cells create proteins that go and latch onto that virus and recognize it and target that virus for elimination by the other parts of the immune system. So what this therapy does is it basically infuses those proteins that should latch onto the virus and target them for elimination by your own

immune system. Smart idea. Similar drugs like that have been used in the past with some moderate success. So there's no reason that this couldn't theoretically be beneficial in helping people with COVID-19 infections. But at the end of the day, too, you know, this is science by press release. We don't really have a ton of data available. There haven't been large scale, transparent 19 infections. But at the end of the day, too, you know, this is science by press release. We don't really have a ton of data available. There haven't been large scale, transparent clinical trials with the results reported in peer reviewed medical literature. So a drug like this or a therapy like this, sure, it might have promise, but it still has to go through the same process that every other therapy has to go through, namely phase one, phase two, phase three human clinical trials, evaluation by the medical and scientific

community, evaluation by independent bodies to see if the benefits truly outweigh the risk before it has approval to be used in a population. So very much at the experimental end of the spectrum, and I would say probably pretty far from widespread use. Why is it trial by press release right now? In brief, we've seen a lot of this throughout the course of this pandemic and it's kind of obnoxious because many of us are seeing patients and sometimes we get a press release and you know you're truly caring for people and you need to make decisions in real time and let me give you an

example with dexamethasone. So dexamethasone is another drug we use to treat COVID-19. It's actually pretty effective in helping reduce the risk of death and people who are pretty sick with COVID-19 who are hospitalized that are on oxygen therapy, like they're sick enough that they're hospitalized and they need oxygen. So I remember... Right, and we're using dexamethasone here in Canada. Oh, yeah. Oh, we're giving it out like Halloween candy. So I was on the wards working when that data was released. And it was first released by press release. We saw all the news outlets say, hey, dexamethasone works by reducing death. Great. Thanks. Show me the data. How significant is this? How did you design your studies what were

the results the same thing goes with remdesivir so remdesivir has gone through those clinical trials it's published it's freely available anyone can look at the data and it's being used in many settings in the united states and in canada we're using it as well but we're really using it in the United States. And in Canada, we're using it as well, but we're really using it in the context of clinical trials. It's just that there's not a ton of this drug available globally. So we can use it. It's just a little harder to use. And we only really use it in the context of enrolling people into clinical trials at this point. And so dexamethasone, remdesivir, and Regeneron, these are all drugs that President Trump was given. And what you're saying is that dexamethasone and remdesivir have been used before. They're drugs that already existed.

So you already have been able to have some data, especially with dexamethasone, which sort of calms the immune system. And then with Regeneron, it's a new drug. So we don't know anything about it. But before we move on to testing, overall, taken together, the drugs that we're using in Canada, dexamethasone, remdesivir sometimes, how effective have they been at treating coronavirus? Like how well are we doing here on the treatment front? Most of the treatments are really geared toward people who are sick, sick enough to be in hospital, sick enough that they require supplemental oxygen, or sick enough that they're in the intensive care unit. That's where most of these drugs are beneficial, and it's namely dexamethasone and remdesivir. used to mitigate symptoms or decrease the severity of infection in people who are on the milder end of the spectrum have not really panned out. And similar, the drugs that have been used to prevent

infection in people who are exposed have not really panned out. So our current toolbox really is focused on treating people on the more severe end of the spectrum. And the drugs that we have, like dexamethasone, for example, can reduce the likelihood of death. That's pretty helpful. And remdesivir didn't significantly reduce the risk of death, but there was a real trend towards that in the studies. But it did significantly reduce the length of death, but there was a real trend towards that in the studies. But it did significantly reduce the length of hospital stay. So these are beneficial drugs. They're really helpful. Certainly, there's room for improvement. There's tons of room for innovation,

but we're still waiting for those. 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.

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This is only part of the solution, say officials. I think every tool that we add to the toolbox in terms of options for testing takes pressure off a testing system in general. And how did you react when you heard that news? I thought it was just a good step in the right direction. These are helpful tests. There's a couple of tests that have now been approved. Many of them are rapid tests so that you can get the results in about 15 or 20 minutes. They're not a silver bullet, right? They don't solve all of our problems. But what they do is they really lower barriers to diagnostic testing. They improve access to diagnostic testing. They can be placed in

regions, for example, that might not have the same degree of access. You can put them in higher risk communities or heavily impacted communities. You can put them in higher risk communities or heavily impacted communities. You can place them in rural or remote or underserviced locations. You can put them in areas where, for example, you need a rapid answer to this test. So perhaps there might be some sectors of the economy

like factories where we know outbreaks are common or in long-term care facilities. They have a ton of potential, but they still require a swab of the back of the nose. They still require a sample to be processed. You still need someone who's capable of getting that sample and processing that sample in the device, but you can get a rapid answer. And so, you know, some people have said, oh, there might not be that helpful, but they will be. It helps some of our issues, but not all. So I think it's a great step forward.

I'm really happy we have access to them. And the idea here is that they can be processed in places like pharmacies or walk-in clinics or doctor's offices, stuff like that. Yeah. What these aren't are do-it-yourself-at-home tests. This is not what this is. That would be amazing, but we don't are do-it-yourself-at-home tests. This is not what this is. You know, that would be amazing, but we don't have that yet. What about bringing these tests to areas that are slammed, like Toronto, for example, where people are waiting hours for a test? There's a lot of different places where you could put this.

I don't know if this is really going to shorten the lines that we're seeing. Obviously, when we're thinking about the tremendous need for diagnostic testing, a lot of the solutions that are going to be boosting laboratory capacity, which is already being done, and having better stewardship over who's getting the tests and the capacity to do those tests. Having said that, these rapid tests are going to be very, very helpful. I just think they'll bring diagnostic testing to areas that are in need that might not have access to current diagnostic testing sites or locations. So there's a lot of places where these tests will do good. Okay. I know that Health Canada and I suppose the government has been criticized for being slow on the uptake here with these rapid tests. MPs like Michelle Rempel have been

quite vocal about this. The reality is that somebody has to wait in line for hours for tests right now and then might have to isolate for days, taking time away from work and family members. So it's not that easy. Yet people around the world have access to at-home testing or rapid testing and nobody in Canada does. What do you make of that? This is something that was approved months ago in the U.S., for example. Yeah, in all fairness, I try to take politics out of the equation and just look at how we go about our business in Canada. And quite frankly, I'm pretty satisfied. I think Health Canada has done a good job. I think we also have to remember what this process is. And, you know, there's another pretty recent example that sort of sheds light on this.

So a few months ago, there were serology tests. Everyone was talking about serology tests in the United States. The FDA in the United States basically approved a ton of these serology tests. And, you know, their market was flooded with them. And then, of course, what happened was that most of those serology tests were junk and you couldn't really make sense of any of the results of what, you know, there were so many false positives, there was a lot of false negatives. Like it was just unclear what to do with these results. In fact, the CDC even came out with a statement saying, stop doing these serology tests. Don't make any meaningful decisions at an individual level based on your results. According to the CDC, less than half of those testing positive will truly

have antibodies. The CDC went on to say the tests are not accurate enough to make important policy decisions. And, you know, Health Canada, for example, with serology, took a much more cautious approach. They said, you know what, we are not going to approve every serologic test that comes through our front door. We're going to look at these and assess them, and we will take our time to ensure that Canadians have access to quality serologic tests. And we didn't get overrun with useless tests. I think the same is true for these rapid tests. There's a ton of products that are on the market or coming through the pipeline. And, you know, I think we're a little bit more conservative

in Canada. And when it comes to something like this, I appreciate that speed is important, but that still means it has to be good enough. And you don't want substandard garbage coming onto the market here in Canada. You know, you can't have political interference saying, approve this, we want this. Like, they have to do their job independently. So judging by what you just said, I think I might know your answer to this question. But you mentioned at-home tests before and how we don't have them here. They certainly do exist. And there are experts, experts at Harvard, for example, Michael Mina, who has been touting at-home tests, which work sort of like a pregnancy test.

They actually are very accurate. They can achieve sensitivities in the high 90 percentile. The convenience of testing is a very important part of public health. If we have enough people who are frequently testing, then we have a very good shot at finding a lot of people who turn positive, say, in the first day that they're potentially transmitting virus. Why do you think we don't have those here? I think we may at some point have them here. And I think those tests have tremendous potential, right? If we're really thinking about a rapid point of care test that cheap, you know, cost a buck or two that will give you an answer in a couple of minutes, I think this is tremendous. And we can think about how these could be integrated into our daily routine. Of course, those tests may not be

perfect, but again, do they really need to be perfect or they just need to be good enough? The goal with those tests is to answer the question, you know, am I contagious? Not, do I have tiny shreds of virus genetic material in the back of my nose that I'm not at risk of transmitting to anyone? It's am I contagious? Yes or no. So like those will answer the question, should I go into the office today? Yes or no. Should my kid go to school today? Yes or no. And, you know, people say, well, it's not exactly like a pregnancy test. Yeah, I get it. It's not exactly like a pregnancy test, but the pregnancy test is also not the definitive answer as well. Right. If someone like a pregnancy test, but the pregnancy test is also not the definitive answer as well.

Right. If someone does a pregnancy test and the question is, should I go out and have three Appletinis tonight and the pregnancy test is positive, then the answer is no, I shouldn't go out and have three Appletinis tonight. I should probably speak with my primary care provider in the next couple of days to get a definitive pregnancy test. And then, and same with these rapid, you know, rapid COVID-19 tests. If the test is positive, we could think now and do the heavy lifting now to think about what protocols are necessary. How are we going to integrate these to make Canadians safer? So for example, do you have them at school? Do you have them at work? And you know, you do one before you go into work, or do you have them at home? How would you deal with a positive test? How would people be counseled? Where would people go for a confirmatory test? You know, I think we can do the heavy

lifting now to recognize how we might want to integrate those into real world Canadian settings, because they probably are coming through the pipeline. And it's a good idea to be proactive and figure out how we're going to use them. Okay, well, it sounds to me and just to end our conversation today, it sounds to me like the therapeutics, the drugs that we're using to treat Coronavirus, and also the new testing advancements, rapid antigen tests, which are sooner than maybe at home tests, but these sort of rapid tests, you think that there are tools that can help us manage this, but really you're waiting for a vaccine. That's what you think will be the ticket to get us out of this tire fire. It feels like just a nightmare. Tire fire, dumpster fire. We could think of a lot of different fires, but yes,

totally. I totally think so. And I think we have to remember that there's probably very few silver bullets here, right? All of these innovations, the rapid tests, the testing capacity, the therapeutics, we're watching science move quickly. But remember, it moves incrementally, right? There's very few home runs or slam dunks, right? This just moves us ahead bit by bit by bit. just moves us ahead bit by bit by bit. We're going to see incremental benefit, incremental safety, incremental help from these innovations and therapeutics and diagnostics. But I really do think that the vaccine, that truly would be extraordinarily helpful in returning back to the time we remember before COVID-19. Isaac Bogosh, thank you so much. You have left me with a little bit of optimism. I also really enjoyed your many sports metaphors.

And I think now I know that your drink of choice is an appletini, it sounds like. Maybe not mine, but perhaps that was an example that hit close to home with someone very close to me. Okay, good to know. Okay, Isaac, thank you so much. We'll talk to you soon, I'm sure. Have a great day. All right, that's all for today. And while at-home rapid testing is still something on the horizon,

according to the federal government, 2.5 million molecular rapid tests will arrive in Canada by New Year's Eve, and 8.5 million of the first approved rapid antigen tests are also expected by the end of this year. I'm J.'m Jamie Poisson, back in the host chair. Thanks so much for listening to FrontBurner and talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.