Front Burner - In Brief: Ontario’s reopening roadmap, herd immunity in Quebec

Episode Date: April 27, 2020

As Ontario lays out its plans to reopen, Quebec Premier François Legault pushes "herd immunity" as part of the strategy to reopen his province. But that strategy was tried elsewhere and led to rapidly climbing death rates. Tonight on Front Burner, we look into how this could play out in Quebec. Infectious disease specialist Dr. Isaac Bogoch returns to help us out.

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. Hello, I'm Jamie Poisson and this is FrontBurner's Evening Edition in Brief. Hello, I'm Jamie Poisson, and this is FrontBurner's Evening Edition in Brief. Today's big coronavirus headline. Ontario Premier Doug Ford laid out a roadmap for reopening the province.

The framework is about how we're reopening, not when we're reopening. It would be gradual, take place in three stages, and each stage will be monitored for between two and four weeks. Ford would not set any hard deadlines. Stage one, open some select workplaces that meet public health guidelines, allow some small gatherings, open some outdoor spaces like parks, continue physical distancing and other health measures. Hospitals could start to offer some non-urgent and scheduled surgeries. We're not in stage one yet. Stage two,

open more workplaces, which may include some service industries, office and retail workplaces. Then stage three, opening all workplaces responsibly. Further relax the restrictions on public gatherings, but no concerts and no sporting events. One important note, schools and daycares are not listed in any of the staged reopenings. So what are they basing these decisions on? First, a consistent two to four week decrease in the number of new daily COVID-19 cases. Ontario had 424 new cases today, down slightly from Sunday. Second, enough acute and critical care capacity and PPE. Third, 90% of people with new COVID cases

need to be reached by public health within one day so that contact tracing can begin. And speaking of contact tracing and ongoing testing, no numbers were provided about what this actually looks like. Meanwhile, in Quebec, Premier Francois Legault announced that some schools and daycares outside Montreal could start reopening on May 11th. Schools in Montreal won't reopen until May 19th. School will not be mandatory. Which brings us to today's topic. As part of his plan to start reopening Quebec from lockdown, Legault said last week it's time to start building herd immunity in the

province. It's an idea we've heard before coming out of the UK, Holland, and Sweden. Dr. Isaac Bogosh is back. He's an infectious disease specialist at the University of Toronto and the Toronto General Hospital Research Institute. And we're going to talk about whether he thinks there's any merit to this strategy. Hi, Isaac. Thank you so much for making the time. Not a problem. Thanks for having me back on.

So look, back in March, I know we heard a lot about this idea of herd immunity when countries like the UK, Holland, and Sweden implemented policies aimed at achieving it. So before we get rolling here, can we explain what the rationale is here? What is herd immunity? What's the idea behind it? So essentially, you know, herd immunity is basically when enough people in a population are immune to an infection. If that infection is introduced, it's just not going to spread throughout that population. So, you know, we often talk about it in terms of vaccination.

And, you know, one of the classic examples is measles. If you have vaccinated, you know, about 90% of your population to measles, if it's introduced to the country, you're just not going to have this explosive spread of the virus. Now, of course, we're talking about it in relation to COVID-19. We're in a pre-vaccine era. So when they're talking about herd immunity, they're really thinking about natural immunity, meaning enough people get this infection and recover. And presumably they have some immunity to this infection so that there's just less transmission in a community setting. So that's basically what they're talking about. So I know that the UK and Holland backed off from their herd immunity policies when it became clear that they were facing higher death rates than they were planning on.

But Sweden famously stuck with this policy. And the country is dealing with a very high death rate, higher than neighboring countries, which impose stricter lockdowns. neighboring countries, which impose stricter lockdowns. But for them, they say that this is like a long-term strategy, that they think it will allow them to open the country up while avoiding future spikes, second waves of the pandemic. And how much merit does that argument have? I think it's hard to know, but many in the medical and scientific community would think that that's But many in the medical and scientific community would think that that's, you know, going to be a challenging way to go about business. And one of the questions is how much immunity or how much herd immunity do you need before this is actually going to start to work in one's favor? And some of the models are suggesting about you need about 60-ish percent of the population to be infected and recovered before you start to see some of the benefits of having herd immunity. I'm not entirely sure if that's the right number, but those are some of the numbers that are being discussed seriously.

And if you look at some of the places that were hardest hit, like places that had their health care systems overwhelmed, New York City, Iran, Italy, or Wuhan, China, of course, these are places where now when they're doing some of the deeper dives, you're only seeing about 15 to 20 percent of the population infected. So, you know, 60 percent is a long way away. And that's from healthcare systems that were overwhelmed over a pretty short period of time. I think it's also important to know that this is not static. This does change with time. And, you know, if you slowly, slowly have infections in a community setting, you might build up to those numbers where you're going to get herd immunity. But in order to do that rapidly, and really it sounds like some of the strategies of countries that were, you know, talking about herd immunity as, you know, a mechanism of approaching this were, you know, talking about herd immunity as, you know, a mechanism of approaching this pandemic, you know, they're really talking about doing it over

a more rapid period of time. And to no one's surprise, when that path is taken, you see, you know, a larger number of deaths than what many would consider to be acceptable. So you mentioned this idea of getting to herd immunity very slowly. And so Quebec Premier Francois Legault, he now says he wants to increase Quebec's immunity rate. He says they're less than 10%. I'm not sure how you feel about that number. But to boost that number, the province would very gradually, in a very controlled manner, start letting more people return to work and start letting kids go back to school. And what do you make of his argument? Well, I think the devil's in the details, like anything else. And, you know, I could argue that the plan that we're using elsewhere in Canada is doing the exact same thing, right?

We appreciate that there is underlying infection. For example, let's just talk about Ontario, which has a slightly different policy. So we're having, you know, a significant community transmission of this infection in Ontario. We're doing everything we can to stop it. So we have these impressive physical distancing measures and these public health policies that we're living under. But of course, people are still getting infected. And the goal here is to really drive that down to as little as possible and then reopen. And of course, rapidly identify after things reopen. Of course, this is a slow reopening. This is a gradual reopening. But of course, as people mingle,

as there is this slow, gradual reopening, there's going to be a predictable second wave. There for sure will be. And the whole goal is to blunt that as much as possible by, you know, rapidly identifying people and their close contacts and ensuring that those people go for a 14-day period of isolation. But during that reopening, you know, even with all the stopgaps in place to significantly curb community transmission, there still is going to be community transmission, just hopefully at a much lower level. So with transmission, you're still on that slow, slow path toward herd immunity. You're just doing it a lot slower and in a much more controlled manner. And, you know, what I took out of this, these discussions that we heard from Quebec was that it was, you know, more of a rapid opening up of the economy, especially given the

context of where they are right now in an epidemic. And they're seeing, you know, a lot of cases, even Montreal is certainly a hotbed. So I think they've got to be very, very careful about reopening now in the context of having such a high degree of community transmission. Because, you know, they're quite frankly, if they do this and they see a surge in cases, you know, they're at risk of overwhelming their hospital system there and their health care system there. And that's a problem. Like we know what happens in that situation. It's completely avoidable. And quite frankly, I don't think it's a safe approach. information out there about whether or not you can actually get it. The prime minister in his news conference today was pushing back against the idea of herd immunity. Our chief public health officer, Teresa Tam, is also saying the same thing. They're saying there's just no evidence

or not enough evidence that you can't get this twice, that you can't get COVID-19 twice. And then over the weekend, the WHO, they released information about this. They initially said there was no evidence people are protected from a second infection, but then they like walked that back. And they said that we expect that most people who are infected with COVID-19 will develop an antibody response that will provide some level of protection. So like, what is it? What does the science tell us? Yeah, I mean, there's a lot going on over the course of the last few days on this subject. So basically, exactly what you said, they said, you know, there's no evidence that having this infection makes one immune to this. And you know what, that's not wrong. But,

you know, you saw rapidly after the, you know, there's millions of people watching these WHO messages. And rapidly, right after that, you see these headlines all over the place saying, you know, no immunity to COVID-19 and, you know, huge problems ahead. intended messages by health and science reporters who are just going by what they're given. And then the WHO, in real time, which this is what I liked about the WHO, in real time, they realized that this wasn't necessarily, while technically accurate, wasn't necessarily the most helpful message, and it could have been conveyed in a much better way. And they sort of said, oops, let's try this again. Our first message wasn't ideal. Here's what we really mean. And I like that second message a lot better. And really, when we take a step back and look at, you know, just about every respiratory virus and not every infection, but most respiratory viral infections, once you have this infection, you know, you're going to mount an immune response to it. And that involves creating antibodies. And for the most part,

you're likely to have some immunity against that virus for at least some period of time. Of course, what are the unknowns? Yeah, we've only known COVID-19 has been around for five months. So, you know, we'd be foolish to think we have all the answers. But, you know, most people in medical, in the medical and scientific community believe that if you have recovered from this infection, you are probably somewhat immune for some period of time. The real questions are, what, what is the, you know, what are the, what, what degree of immunity do people have? And what is the duration of immunity in those who recover? Those are sort of the key questions. And I think the way the WHO phrased it in their second message was just a lot more accurate

and really reflective of what we know about other respiratory viruses and what's likely the case with COVID-19. Right. This idea that they expect that most people will develop some sort of antibody response. So, you know, the last thing I wanted to ask you about today is, you know, in light of this, this idea that people will develop some sort of antibody, regardless of how long it is. There's been a lot of talk globally about these immunity passports. Chile has floated this idea that they're going to basically give people immunity passports.

The prime minister said today it's just way too early to even speculate about Canadians having to share their medical information. And so let's say we did go down this road of immunity passports, which would essentially be like a piece of paper or something that, you know, maybe I can go back to work if I've already had this, right? What challenges do you see here? So I think we have to think about two different things here. One is you need to, you know, one of the questions is, does that test, this is called a serology test that measures antibodies, does that test accurately represent a person making antibodies? So if your antibody test is positive, do you actually have antibodies? That's question number one. And, you

know, the answer, unfortunately, is no, that's not entirely the case. As of right this second, the tests that we have available are of varying quality. The United States really relaxed some of their measures. The FDA relaxed some of their measures. And just quite frankly, a lot of dubious tests flooded the market there. Many of these, you don't know what to make of the results. In fact, New York City or New York State Public Health issued a statement saying, don't rely on these test results yet, they're not good enough. And so other public health agencies have done the same. So in the coming weeks, a strong horse or strong horses will emerge and we will know which tests are more

trustworthy than others. So that's question one. You know, if you have a positive test for antibodies, can you trust the positive, can you trust the results? And then, of course, there's question two, which we kind of alluded to before. So if you have antibodies that are detectable, how much protection do you have against COVID-19 and what's the duration? And, you know, fortunately, the federal government allocated a billion dollars to look into this. So they, this was about three or four days ago, they said that they're going to allocate a tremendous amount of money to really study the immunology behind this, the degree to which people become immune to the virus,

vaccine research. And, you know, this is a great way to answer some of those questions. But, you know, today, if someone was to say, look, I did a serologic test. I have positive antibodies. I am safe from this infection and can go back to work. You can't trust that. Those are not fair statements to say. And those are, quite frankly, not safe statements to say based on the data that we have today. There's a tremendous amount of work going into this. I hope our conversation continues in the weeks and months ahead, because we may have very different answers to those questions that are being asked right now. But as of today, I would say no,

the immunity passports are certainly not the correct approach, but this will very likely change with time. Okay. Dr. Isaac Bogosh, thank you so much for this. Anytime. Have a great day. 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. All right, that's all for tonight. Thanks so much for listening to FrontBurner and we'll talk to you again tomorrow morning. For more CBC podcasts, go to cbc.ca slash podcasts.