Front Burner - Omicron: New variant, new tactics?

Episode Date: December 2, 2021

Canada and a growing list of more than 20 countries have confirmed cases of omicron, the latest version of the COVID-19 virus to be labelled a "variant of concern" by the World Health Organization. Despite omicron's global reach, dozens of nations are enforcing travel bans on mainly southern Africa, where the variant was originally detected. Some countries have celebrated South Africa's identification of the variant mere moments before announcing restrictions. Meanwhile, vaccine stockpiling by outside nations has contributed to spotty supply and high hesitancy on the continent. Africa faces a looming wave of omicron, with a full vaccination rate in the single digits. Today on Front Burner, infectious diseases physician Dr. Zain Chagla explains how measures by countries like Canada have put Africa into this precarious position with omicron, and why vaccines are more important in regions that are currently seeing far fewer doses.

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 Angela Starrett. Omicron's very emergence is another reminder that although many of us might think we're done with COVID-19, it's not done with us.

As the World Health Organization Director General addressed the new, highly mutated variant on Monday, it was hard not to think, here we go again. We're living through a cycle of panic and neglect. Hard-won gains could vanish in an instant. Scientists first detected Omicron in South Africa and Botswana just over a week ago. It took until Friday for the WHO to give the virus its most serious label, variant of concern.

And now, the world seems to be continuing our same variant cycle. Cases of Omicron are confirmed around the globe, including at least seven in Canada. But dozens of Omicron are confirmed around the globe, including at least seven in Canada. But dozens of countries are putting travel restrictions on mainly southern Africa. And we've taken the action immediately to stop those direct flights. All air travel to these countries should be suspended. I took immediate steps to restrict travel from countries in southern Africa.

We don't know if Omicron originated in Southern Africa. But while just 7% of the continent is fully vaccinated, wealthy countries elsewhere are ramping up their booster programs. So today, I'm joined by Dr. Zane Chagla, an infectious disease physician at St. Joseph's Healthcare. He's going to tell us what to make of the very limited data we have about Omicron so far and what the world should actually be doing to contain these variants. Hi, Dr. Chagla.

Hi, how are you? I'm well. Thank you so much for joining us for this conversation today. And I want to start with why we're worried about Omicron. What are the physical differences that are, I guess, putting the concern in this variant of concern? So, you know, the major thing here is the number of mutations that have been seen in this variant. And, you know, to take us back, you know, alpha, beta, gamma, delta, the four prior variants of concern had five to 10 mutations, a couple of them maybe with transmissibility, a couple of them with immune escape.

But this is 30 mutations. And, you know, some of these have not been seen in other variants in the past. You know, that's the one concern is it kind of has the genetic or skeleton to be something that is very different than prior variants of COVID-19. What the other major concern is, is what's happening in South Africa, particularly in the Gauteng region around Johannesburg and Pretoria, where they have seen growth that is really outpaced any other wave that's occurred in South Africa. So, you know, really suggesting that, you know, that transmissibility element is probably starting to play out in real time. And I mean, looking at that skeleton of the virus,

what does it tell us about how Omicron might have mutated? it tell us about how Omicron might have mutated? It's interesting. So when you, again, look at Alpha and Delta, there was a few mutations that led to a few mutations that led to a few mutations that then it kind of took off after that. You see this kind of gradual shift. Omicron is very different in the sense that, you know, when you try to map the lineage back to the original SARS-CoV-2 virus that was described in Wuhan, it is actually pretty close to that lineage. And in fact, when you kind of try to draw the branches out, it's like a single branch that comes off the tree pretty early. And so it is very suspicious that there may have been an individual that was chronically infected that may have been infected back in 2020 again this is all speculation but you know in their inability to clear the virus

the virus gets more and more mutations over time and eventually it hit the right formula to then spread back into the population you were just talking earlier just, you know, about the questions with variants that seem to be how easily they are spread and how serious the symptoms are. What do we know about whether this variant makes people sicker? The severity piece is still really, really early. And again, you're hearing little anecdotal snippets from different settings. There's physicians in South Africa that are saying that their patients are predominantly mild, that they're feeling mainly muscle symptoms, that a very small number are getting hospitalized.

But again, is that just the young, healthy patient that you're seeing? And is that just the manifestation that would typically be there in the young healthy patient that started in the apparently college and university students in that region, there are an increase in hospitalizations in that region. But again, is that because the disease is more severe or because it's spread so much deeply into the population that a small number will have to come to hospital. And that number is growing right now.

All the anecdotal reports are really that. They're tiny little snippets of what the entire image are. Right. And I mean, I guess a lot of Canadians have got two vaccine shots now, even over three quarters. Can we still expect those vaccines to protect us from Omicron? So when we talk about vaccine efficacy, I think there's two pieces or two volume switches we deal with. One is the volume switch for, you know, being infected or not being infected. And that's kind of that 95% efficacy we heard with Pfizer and Moderna at the beginning. That part is really due to antibodies. So the antibodies you make and how they bind to the virus spike protein, which has been fundamentally changed in Omicron. And so, you know, yes, there is a theoretical reduction in the way that these antibodies bind. When we talk about the other

part, which is not just infection, but severity, so people getting sick with COVID-19, the immune system is much more complex at that point. And so we have not only the antibodies binding, we have other immune cells like T cells, we have antibodies binding to different parts of the virus. And so, you know, that piece is a whole lot harder to overwhelm or reduce. It might reduce a little bit, but, you know, knowing that these virus, these vaccines have held up against every single variant, including some with some significant immune escape, like the beta variant in the past, there is a lot of hope and optimism from the scientific community

that protection against severe disease is likely going to be somewhat preserved. It may not be perfect, but we're 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. talk to millions of people, and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know 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, You and your partner create a financial vision together. To listen to this podcast, just search for Money for Cops. I want to talk about, I guess, the presence of this variant in other parts of the world. You know, as you said, we're seeing the world celebrating how quickly scientists in South Africa detected this virus. U.S. President Joe Biden, for one.

this virus, U.S. President Joe Biden, for one. This kind of transparency is to be encouraged and applauded because it increases our ability to respond quickly to any new threats. And that's exactly what we did. But at the same time, a list of countries is putting travel restrictions on South African nations, including the U.S., EU, U.K., and even Canada. And South African President Cyril Ramaphosa called this not informed by science. Now, these restrictions are completely unjustified and unfairly discriminate against our country and our Southern African sister countries. The only thing the prohibition on travel will do is to further damage the economies of the affected countries and undermine their ability to respond to

and also to recover from the pandemic. How much can travel bans even help at this point? You know, when we look back to 2020 and when the virus first emerged in Canada, all of us were focused on Southeast Asia, you know, China and the surrounding regions having cases. And now the government of Canada has issued a warning to people to essentially avoid non-essential travel to China. Air Canada taking a big hit. It is suspending its service to China until April, we know now, scaling back flights to Hong Kong. We also know it's allowing passengers wanting to

go to northern Italy to perhaps rebook, giving them the flexibility. But when you look back genomically at what happened in North America, it was repeated introductions from Europe that actually brought the virus to Canada, that seeded the United States, where Canada was subsequently seeded by Canadians going to the United States. And so the country that is not looking may be the one that is importing cases as fast as possible. We're hearing about a traveler from Israel that was in London that had the Omicron variant, which means that clearly it's in a significant degree in London that had the Omicron variant, which means that, you know, clearly it's in a significant degree in London. And again, this was only identified because it showed up in a region where people had that genomic surveillance. South Africa, unfortunately, has been a bit demonized by

the fact that they had this, where they were only the people, the messenger, they were the people that identified there was a problem and told the world there was a problem. And again, they became the plague bearer of the world, which is not helpful for the scientists that are trying to work and deal with this, to try to get reagents, to try to be able to do this epidemiologic where it's not good for global health partnerships with that region. It's not good for economics and tourism in that region. Many of the other regions in sub-Saharan Africa, Southern Africa that are on the travel list similarly, you know, did nothing wrong. In fact, the world kind of turned their backs on those places in terms of vaccinations. And now they're being shunned because they may

have the presence of this variant. We are banning the entry of foreign nationals into Canada that have traveled through Southern Africa in the last 14 days. That ban includes seven different African countries, stretching from Mozambique to Namibia. And officials say that list could expand. Lastly, again, we are starting to hear about cases showing up before South Africa detected that there was something going on. The Netherlands has found Omicron in two

cases nearly a week before South Africa first reported it. This person had contact with the person who had just returned from South Africa. It could also be that we cannot find the source anymore. People that were positive for this Omicron well before last week. And, you know, if we got the news that the United Kingdom, for example, had identified this variant Omicron first, you know, would we have done the same thing? Would we have closed the border to the United Kingdom and the rest of the EU like a snap like that? I don't think so. So scientists have been warning about new variants possibly arising in Africa because of low vaccination numbers. South African epidemiologist Salim Abdul-Karim said this just last month. And this vaccine inequity that has seen African vaccine coverage still below 5% when globally vaccine coverage is around 50% is creating an opportunity for the virus to spread and yet more mutations to occur.

But what do we really know about where Omicron originated? Yeah, so I mean, I think I would suggest that probably South Africa was not the place where it originated. And, you know, the reason being, it just seems so convenient that it is in the Johannesburg area. For that region, for most of Southern Africa, many of the flights go through Johannesburg. That's the hub. Many truck drivers go through Johannesburg. That's the hub. And so, you know, to see that community seeded is often a sign that it had come from someone else or somewhere else, whether it be within the continent of Africa or, you know, outside of Africa. And again, that was just the place where it was convenient that it was picked up by a big genomic surveillance network. So I would be, you know, say it would be really unlikely that South Africa was actually the origin of this.

It's just the first place identified that is being kind of demonized amongst this. I want to talk a little bit about vaccine equality. I want to talk a little bit about vaccine equality. More than 80% of the world's vaccines have gone to G20 countries. Low-income countries, most of them in Africa, have received just 0.6% of all vaccines. We've got global initiatives like this, like COVAX, that are supposed to help share vaccines around the world. So rich countries don't monopolize them. We've all heard rich countries making pledges to donate doses, you know, Canada included. So why haven't more vaccines been getting across in Africa?

Yeah, I mean, it is multifactorial. And the first piece is supply. is multifactorial and the first piece of supply. As much of the world fixated on vaccines, particularly as certain countries bought more than their individual citizens and actually started stockpiling vaccines. And unfortunately, in Canada, we're completely in line with this, with over 14 million doses that were stockpiled over the last few months, which is doses that were not being used, it makes it harder to fill contracts. Botswana, for example, had a contract with Moderna where the doses of vaccine were actually higher priced than the doses of the Moderna vaccine we bought in Canada. But because the demand in Canada was so high, those contracts are filled here

before they're filled there. And so even in that context, even in a country trying to negotiate a contract, they're still not able to fill and not able to bring it because again, they're considered smaller in the realm of these private companies. As COVAX has been our vaccine sharing, I mean, we've taken doses away from COVAX because of the crisis in India. The AstraZeneca vaccine going to COVAX has been slowed, and India is now putting vaccines back in because no one else is. All of these things added up to less vaccines on the ground. Even then, Canada gave 800,000 doses of AstraZeneca for Nigeria. They arrived within two months of their expiry date.

for Nigeria, they arrived within two months of their expiry date. And so you can imagine the distrust in the system and the stress in the system to import vaccine, verify them, quality control them, distribute them to the community in a matter of two months. Clearly, you're not able to do that, even if we're not able to do that appropriately, this not only creates, you know, a supply chain issue, but it creates distrust, right? You know, when we were done with AstraZeneca and Johnson and Johnson, because of our risk of clotting, and we gave them to the developing world that had huge news reports saying, you know, people are dying, take this vaccine, clearly, there's going to be some hesitancy introduced into that population. That distrust of the Western world, particularly with their hoarding, particularly with their boosting, you know, is manifested into vaccine hesitancy,

even if vaccines are there. There's a lot of medical distrust for these Western vaccines that are now second grade, right? So it is a multifactorial issue. There are many countries there. And it's not as simple as saying, you has to turn down some vaccine shipments, which they did. It's hard to even build that infrastructure to deal with vaccine hesitancy when you don't know what your supplies are like. And I will say this. Three of the four vaccines we used in Canada, Pfizer, AstraZeneca, and Johnson & Johnson, all involved clinical trials that were partially done in South Africa. And, you know, they received their first doses of these vaccines to large scale vaccinate their population in May of 2021. And that's a tragedy. We actually took their research experience.

We took their patients to develop a vaccine for us in order to protect our society, but gave them the last access to it, despite them, again, putting forward their own population to make sure these vaccines were safe. And so, again, there is a significant amount of distrust there, considering what's happened with vaccines to this point. We don't know whether the variant came from Africa, as you said. What we do know is that many nations have to deal with Omicron with little protection from vaccines. Are health care systems across Africa equipped to deal with this variant? No, I mean, there are public and private healthcare systems in many of these nations. And you know, in some senses, some of the private healthcare facilities are actually pretty

equivalent to Western healthcare, but the public healthcare, particularly in some of these areas, is really lacking. You know, there was a report at the beginning of the pandemic that said there were less than 25 ventilators between Namibia and Zimbabwe. I mean, I work in a hospital that has 30 ventilators. So, you know, more than two nations, right? There's been some scale up and then again, the private system is able to offer some help there too. But when we're talking about people with respiratory disease, we're talking about the infection control complications, the PPE, the need for ventilators, the need for long stays, the need for rehabilitation, the need for surgical management, some of the drugs, which have also been hoarded by, you know, some of the world. It's not there. I mean, you know, they can manage patients. But again, if healthcare systems get overwhelmed, it's going to be devastating for patients. And we know mortality goes up in that setting. And these are precious health care facilities that provide all care for patients. So cancer care, heart care, tuberculosis and HIV care, malaria care. You know, there are so many other plate diseases where if you overwhelm the health care system, if you take out health care workers, you know, you're going to be dealing with complications not only from COVID-19,

but other things. So it sounds like, I mean, they need this vaccine more than ever. So, I mean, does it make sense that countries like Canada should be ramping up, you know, their booster shot campaigns or getting like kids under 12 vaccinated? I mean, all of these things are, you know, need to be evidence based, right? You know, was there a reason for us to give our first two shots? Yeah, I mean, again, even then, could we have slowed down the campaign to be able to support other nations? Probably. But yeah, when we're getting to the point where we're talking about putting booster shots in 20 year

olds, you know, at that point, when we know the risk of severe disease in that population is low and has been incredibly lowered by vaccine, at some point, you know, we're getting to a point where we're just using vaccines for the sake of using vaccines. And again, we're not asking the question of why we have 14 million vaccines in the stockpile. There's a lot of people saying, well, we should use them because we have them, which is great, but there are so many issues with the fact that many of much of the world would love to have 14 million doses of vaccine at their disposal, but don't have access to it. As we talked about the health vulnerabilities of sub-Saharan Africa, it's so much more important to vaccinate that setting than us, right? You know, we've been,

and it's been tough, but we've been able to use public health measures, physical distancing, you know, even at the worst of times, lockdowns and other restrictions, being able to provide economic supports for businesses that have gone out of business, that type of thing. You know, those are not great scenarios, but we've been able to do it. Well, when lockdown means, you know, when 50% of your population essentially lives in informal townships, which are, you know, improvised housing, you can't necessarily impose those types of restrictions on people without having mortal danger to those individuals. And so this is where vaccines are even more profound. And this is where the tragedy is, is, you know, a place like Canada could have slowed down their

vaccine campaign and been able to deal with it with public health measures. They're not great, but we would have lived. Whereas a place like Sub-Saharan Africa, there's going to be a lot of population that can't do public health measures because of the fact that it will lead to malnutrition, it will lead to poverty, and it will lead to adverse outcomes. The value of vaccination in that setting is even more important than in Canada. It's been 11 months, almost 12 months to the next couple of weeks since we started vaccinating people. And we're still looking at less than 10% of that world having access to a first dose, which is incredible considering the progress we've made over the last year. And we know that this variant is in Canada. And now we've got at least seven cases

confirmed as of Wednesday afternoon. Obviously, we're watching watching very very closely the situation with Omicron. We know that even though Canada has very strong border measures now we need vaccinations to come to Canada. We need pre-departure tests. We do testing on arrival. There may be more we need to do and we'll be looking at it very carefully. Are we going to ban more flights? Are we going to ban more flights? What kind of public health measures should Canada be putting in place to restrict Omicron right now? I think adding testing at the border is probably a reasonable step while we're learning about the virus. You know, people have to do a pre-72 hour test and now have to do a test on return. You know, that probably captures 90 to 95 percent of positive travelers. It may not capture all of them. But again, we're never going to capture all travelers as, you know, if this is

truly as very as transmissible as we think, it's going to escape from quarantine one way or another as alpha, beta, delta have across the world. You know, I think, again, going into the winter, there's still a need to just be careful about capacity measures, be careful about masking, obviously, and consider using mask mandates to make sure that we're protecting as many settings as possible. And again, doubling down on vaccines. Look, we have reasonable suspicion that the vaccines are going to work against severe diseases. They've worked against every variant in the past. We also have COVID Delta rates in Canada that are starting to creep up and that virus we know is completely susceptible to these vaccines. And so, you know, I think, you know, doubling down on that, you know,

is going to be a reasonable for the state we live in right now with Delta circulating and, you know, only probably getting worse in terms of transmission when Omicron gets here. Thank you so much for this, Dr. Chegla. No, no, I appreciate it. All the best. Before we go today, a major update on Chinese tennis star Peng Shuai. We talked about her case on the show last week. The Women's Tennis Association now says it's suspending all tournaments in China until further

notice. It's also calling for a fully transparent and uncensored investigation into her sexual assault accusation against a former high-ranking government official. Her public disappearance after making that allegation led to global concern for her safety. She's since told Olympic officials in a video call that she's safe, but questions remain. And that's all for today. I'm Angela Stair in for Jamie Poisson. If you liked this episode,

please give us a review or rating on your preferred podcast app. I'll talk to you tomorrow.