Front Burner - Mutated COVID-19 sparks closures, questions

Episode Date: December 22, 2020

A new strain of coronavirus in the United Kingdom has triggered border restrictions internationally and in Canada. It’s also sparked many questions. Dr. Isaac Bogoch is an infectious diseases physician and a member of the Ontario government’s vaccine task force. Today, he shares his thoughts on the mutation and explains its potential impact on treatment and transmission of the virus — and even vaccine efficacy.

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. So that is the sound of absolute chaos as Londoners desperately tried to board trains leaving town on Saturday. The scramble was in response to Prime Minister Boris Johnson announcing tighter public health restrictions in light of growing coronavirus infections and the emergence of a new variant of the virus in the United Kingdom. When the virus changes its method of attack, we must change our method of defense.

The announcement triggered travel restrictions internationally, including here in Canada, and sparked a lot of questions about this new strain, like whether it impacts treatment and transmission of the virus and even vaccine efficacy. Dr. Isaac Bogosh is an infectious diseases physician and a member of the Ontario government's vaccine task force. He's here with me now to explain what we know so far. I'm Jamie Poisson and this is Frontburner. Hi, Isaac. It's so nice to have you back on the podcast. Oh, my pleasure. Happy to chat.

Okay, so we've got this new, apparently more contagious strain of the coronavirus that's hit the UK. And we also have another similar mutation of the virus in South Africa that's now apparently rampant and has been detected in populations there since November. So, Isaac, is this the part of the movie where things are like just just looking up and then they take a real turn for the worst? Yeah, not not necessarily. necessarily. I mean, certainly, it is concerning when we are seeing different mutations in the virus, especially in parts of the virus that are, quite frankly, involved with how the virus gets into cells. But I really think there's still a lot of unknowns with this, you know, is it really more contagious? And if so, by how much? You know, does it cause perhaps a more severe illness? Doesn't look like it. But you know, obviously, we have to be open minded. I think one of the other huge questions is, is this going to impact the efficacy of vaccines that we have?

And again, we don't, it's hard to have definitive answers, but it doesn't look like it's likely. So yeah, there certainly are a lot of unknown questions here. And you know, in anything, these are, these are answerable questions. And obviously, it's best to be cautious while these are being sorted out. Okay, so I want to dig into all of those questions with you more today. But first, Isaac, why do viruses mutate? That's just what they do. Viruses mutate. Actually, bacteria mutate.

There is a constant change in the genetics over time. And of course, some mutate faster than others, some mutate in response to external pressure, but that's what they do. And in fact, most mutations are totally benign. You know, when we hear the word mutation, we often conjure up an image of something getting more aggressive, more serious, causing, you know, more significant illness. But actually, the vast majority of mutations do nothing. Now, of course, mutations can certainly change the properties of a virus or bacteria and make it perhaps more easily transmitted or create more serious illness. But more often than not, they don't. And when we think about a case like this, this could cause the virus to be transmitted more readily. But

I honestly don't think we have enough information right now to definitively answer that question. Okay. And why do you think that we don't have enough information right now to definitively answer that question? I am hearing statistics being tossed around 40 to 70% more transmissible. This is early data and it's subject to review, but it's the best that we have at the moment. And we have to act on information as we have it, because this is now spreading very fast. You know, some statistics coming out of the UK that as of the week of December 9th, 62% of people with confirmed coronavirus had this new strain versus 28 percent three weeks earlier. Does that give you pause? You know, it certainly raises an eyebrow. And I don't think it

would be fair to brush anything under the rug and to, you know, just say that this isn't an issue. It absolutely could be. But there are a lot of other reasons why this variant might be more common in a population. And we've seen this a couple of times before, for example, throughout the pandemic, there was another variant in China, there was another variant in the southern part of the United States. And even during those times, people were making, you know, they had some concern over it, as one should, if there are new variants that seem to be predominating in an area. But at the end of the day, I don't really think they amounted to anything significant in terms of how the pandemic played out. And also when you take a step back and look at the sort of big picture, does this change anything we do?

It doesn't. You're still going to put a mask when you go indoors. You're still going to wash your hands. You're still going to physically distance from others. You're still going to avoid crowded, close, confined settings, and life goes on. One thing I was wondering about, Isaac, is, you know, the idea that this is more contagious. How can you separate out how contagious a virus is from human behavior that could just be spreading this one variant of the virus? Like, is that possible? Yeah, it certainly is possible. And I think we can look at a couple of things.

One area to look at is certainly what happens at a molecular and cellular level. And we know that some of these mutations are on what's called the spike protein of the virus. The spike protein, people might have heard that word a bunch so far, because the spike protein is really important. That's the part of the virus that really helps it get inside our cells. It's also the part of the virus that the vaccine really targets. So you can look to see, you know, with these changes, does it more readily get into the cells of our body? And that certainly can answer some of the questions. But I think the other important thing to look at is how does this actually play out in real time? You know, it's not sufficient just to say that we're seeing more of this variant in a population, therefore

it's more readily transmitted. I think we have to look at rates of transmission and really use all the best epidemiology and modeling capabilities we have to see how it's transmitting through a population and what other factors are happening at the same time that might be fueling transmission of a virus, regardless of what variant of the virus is present, to really determine if it is more transmissible. So this will likely be a combination of epidemiology, modeling, and how this behaves in a laboratory setting, looking at how infective it is to different cells. You mentioned the vaccine and that some of the mutations here are on the spiky protein that the vaccine also targets. And is it possible that this mutation could affect

the efficacy of the vaccine? I know you mentioned earlier that you don't think so. Why? Yeah, so, you know, I got to be totally transparent. Some of this is definitely above my pay grade, but I've been speaking with some very good friends and colleagues who are virologists and vaccinologists and have been discussing this in detail over the last couple of days. And it just seems that the consensus is that it's unlikely. Again, I got to be careful with my words here because nothing is certain and these still are unanswered questions, but it is unlikely that this will have any meaningful impact on vaccine efficacy. And the reason is because the mutation in the spike protein is just a mutation in the spike protein. And when we look at how the vaccine

works and how you mount an immune response to the spike protein, it's in a more robust manner. It's not just to one tiny little element of the spike protein, it's to lots of elements of the spike protein. So it's certainly more of a robust immune response to it. And one small change in the spike protein is unlikely to have any significant impact. I want to bring in Dr. Bruce Alward now. He's senior advisor to the director general at the WHO. So far, we have not seen any evidence that the evolution of the change of the mutations in the virus have changed the fundamentals that allow the vaccines and immunity to work against it, because the part of the virus that these vaccines are targeting is relatively stable. But again, I don't think anyone can look you in the eye and tell you with 100% certainty that

this isn't going to impact vaccine efficacy. I think it's just much less likely to impact it. When might we know the answer to that question? Like we're rolling out vaccines around the world right now? Yeah, I think we'll know probably on the sooner end of the spectrum. So a couple of things are happening right now. In the UK, you've got virologists who are studying this intently. You also have vaccine programs that are rolling out pretty aggressively in many parts of the UK. So there's various ways you can study this in the laboratory and also in real world settings to determine if this is going to impact vaccine efficacy. In addition to this, it sounds like the scientists

at the Walter Reed Institute in the United States have their hands on some of these samples and are looking at this as well. So you've got a lot of different teams that are working on this. And I think this is something we'll probably have a good answer to probably in the week or weeks ahead. Could the virus mutate even more, you know, than these tiny changes that you're talking about? And would that affect the vaccine? It certainly could. And that's certainly a possibility. And this sort of raises the question, okay, we're all hopefully going to get vaccinated to this and hopefully the nearer side of the future, not the distant future. But, you know, will we need a booster vaccine? Will we need some frequency of vaccination to sort of stay up to date with a changing virus similar to what we have with influenza? And the answer is, yeah, we probably will at some point. We probably will need a booster vaccine at some point. But I don't really know when that would be. You know, is that going to

be an annual thing? Is this going to be sometime every three years or sometime every five years? Like, I honestly don't know. But I don't think it's implausible to think that we will need one. We probably will. It's just not entirely clear when. Hi, it's Ramit Sethi here. Brought to you in part by National Angel Capital Organization 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 also want to dig down into the ferociousness, I guess, of this new variant. Like, is it more dangerous? Do we know anything about how hard it's hitting people?

And is it hitting people harder? Yeah, that's a good point. And here's a neat word. Virulence is sometimes the word that's used to describe it. And it just doesn't appear that that's the case. And certainly speaking with colleagues that are seeing lots of patients in in London and other parts of the United Kingdom where this virus is seems to be predominating. It doesn't sound like that's the case, but that's really anecdotal. anecdotal. And I think this will be studied in detail. But I think many people following this closely would really side with this likely not causing any more severe illness compared to other

variants of COVID-19. I think many people as well would side with this perhaps being a little bit more contagious than and certainly being open minded to that. But quite frankly, it's not quite sure if it is and if so by how much. And I think most people following this at this point in time, even though it's still early, would believe that this is likely not going to impact vaccination efficacy. But of course, like anything else, we've got to be careful and open minded to new data as it emerges. And you can still be skeptical at the same time, as long as we're open minded to the data that emerges and are careful along the way. Right. But you know, the UK is saying that they have more hospitalizations, that hospitalizations

are up. And so, you know, what could explain that if it's not this variant? You know, some people might say, well, it's because of this new variant. But I think we also have to be critical and skeptical with some of the data, but of course, open-minded as well, that, you know, a lot of this might be related to more and more people getting the infection, resulting in a greater number of hospitalizations and sadly, a greater number of deaths, just largely related to the volume of people getting infected. We certainly have seen a spike. So perhaps, again, in the situation where perhaps, I'm guessing here, but if it is more easily transmitted, that could result in a greater number of hospitalizations and deaths just because there's more people infected, not because it's more lethal.

You know, I have to ask, Isaac, you don't seem extremely concerned here. Why then do you think that governments have reacted so quickly here? You know, the Canadian government is shutting down all flights from the UK. Many European countries are doing the same thing. So why are we seeing this kind of action from governments? Yeah, I think it's reasonable. I certainly think it's okay to be careful, but we don't need to panic. We just need to be careful, but we don't need to panic. We just need

to be careful about it. And all these issues that have arisen with this variant of the virus are answerable questions. And I guess the reason I'm not too concerned is that these are questions that are being addressed right now. In addition to that, travel to Canada is very different than travel from the UK to, for example, mainland Europe. We have very little travel. It's not zero, but very little travel compared to pre-COVID-19 times from everywhere in the world, including the United Kingdom. And on top of that, we also have the Quarantine Act. So everyone that comes into Canada has to quarantine for a period of 14 days. Now, of course, we know it's not 100% perfect,

but it's still really, really good. So there's a three-day stoppage of flights coming into Canada from the United Kingdom. On top of that, everyone who does come in has to quarantine for a period of 14 days. And we've heard that there's going to be some advanced testing and advanced procedures for those who are coming in from the United Kingdom, really to ensure that they are adhering to their quarantine and perhaps even integrating diagnostic testing there. So I think these will be very helpful, very helpful mechanisms to keep us safe in Canada. One question I had for you is testing. Will current COVID-19 tests detect the new variant? Yeah, they certainly will. So it doesn't matter which variant somebody has with COVID-19. The tests that we have in Canada, if someone's positive, regardless of the variant, those tests

will still be positive. That will certainly be conserved. So we wouldn't have an issue with that. Okay. And what about the treatment of COVID? Like if you have this new variant, like what current treatments we have, like I'm thinking about monoclonal antibodies, for example, still work? Yeah, yeah, absolutely. Nothing changes. Nothing changes at all. I think we would prevent it the same way. We would manage a case the same way. We would treat it the same way. We would protect others from an infected individual the same way. Like at the end of the day, when you think about how is this going to change anything we do, it doesn't. It certainly doesn't. You know, at a federal policy level, there's some changes in terms of travel restrictions and perhaps having enhanced surveillance for people coming in from the United Kingdom and really ensuring people

adhere to the Quarantine Act and really adhere to that 14-day period of quarantine. But quite frankly, at the end of the day, in terms of how you and I would go about our day or how we would care for people in the hospital or making diagnoses and treating people, nothing changes at all. So Isaac, I know you're saying that there's a lot of unknowns here, but what are you looking for, you know, in the coming days and weeks that would give you pause, that would be very concerning for you when you're looking at these new mutations? Yeah, so certainly if there was any evidence that the vaccine, for whatever reason, is not as effective as it should be with any particular variant, that would be quite concerning. I don't think that's going to be the case with this based on my conversations with virologists and vaccinologists.

But of course, if we do see mutations like this, or perhaps other ones that did confer worse outcomes because people wouldn't be able to mount an appropriate immune response with the current vaccine, that would be problematic. But luckily, I don't think that's the case here. Okay. And just, I know you're saying that this is highly unlikely, but when you say problematic, like what are we talking about here if this was problematic? Well, that would involve going back to the drawing board and obviously having a good understanding of what these mutations are, and then creating vaccines that would be perhaps more successful in mounting an appropriate immune response. Again, I think it's a low probability event based on what most

virologists and vaccinologists are saying, based on how people mount an immune response to the vaccine. But, you know, there might be a time where there are mutations or a certain number of mutations in certain parts of the virus where perhaps the current vaccines aren't going to provide enough protection and we might need an updated vaccine or a booster vaccine. And again, it's not quite clear if or when that's going to happen, but it certainly might happen. And, you know, luckily, there is now a lot of highway miles in understanding how to create these vaccines for COVID-19 and how to mass produce them and distribute them. So, you know, it would be certainly a roadblock, but not nothing that we wouldn't be able to do.

Okay, Isaac, thank you so much, as always, for coming by. We're really appreciative. Oh, my pleasure. All right, so some news before we go today. On Monday, as COVID-19 cases continued to spike in Ontario with 2,123 new infections, Premier Doug Ford announced the province would begin a lockdown on Boxing Day. This difficult action is without a doubt necessary to save lives and prevent our hospitals from being overwhelmed in the coming weeks. Make no mistake, thousands of lives are at stake right now. The shutdown will continue until January 23rd in southern Ontario

and will remain in place in the north where there are fewer cases until at least January 9th. No indoor public events or social gatherings will be allowed except members of the same household and only essential businesses will be open. When pressed on why he didn't call for a lockdown earlier, Ford said the worst hit areas like Peel and Toronto were already under lockdown and he wanted to give businesses time to prepare. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and we'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.