Front Burner - Some good news on COVID-19 in Canada

Episode Date: March 9, 2022

As pandemic restrictions continue to lift across the country, we’re joined by Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton, for a look at where we are with COVID-19 in Canada, and how to weigh the risk factors for yourself. (And we promise — there’s plenty of good news!)

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 Jamie Poisson. Ontario Premier Doug Ford just announced his province is further easing measures for COVID-19. Vaccine passports are no longer required in Saskatchewan.

Quebec, gyms, spas and other venues are reopening at half capacity. Self-isolating when positive with COVID-19. On March 15th, it's only a recommendation in Manitoba. I think it's fair to say that Canada is entering what feels like a new phase of the pandemic. One less based on province-wide restrictions and much more based on what Canada's Chief Public Health Officer, Theresa Tam, calls individual risk assessments. Regaining in-person social and economic activities while the pandemic is still ongoing and the virus is not going away, it means we must use all that we have learned to do this safely and make it last.

Many provinces have already lifted measures like vaccine passports, capacity limits and masking mandates, and many others are planning to do the same in the coming weeks. And this time, there's reason to actually think the changes could be long-lasting. For many people, this moment feels like a massive relief. For others, it's scary and anxiety-inducing. So today, I'm speaking to Dr. Zane Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton, about how we should understand what the state of COVID actually is in the country and what kinds of risk factors people should be weighing as they go about their daily lives. Hi, Dr. Chagla. Thanks for coming back on. It's always so great to have you.

Oh, thanks for having me. So I firstly want to just get a sense from you of what's actually happening with COVID in Canada right now, because I have to confess to you, even when I'm looking at the case numbers and hospitalizations on the CBC's COVID tracker, sees COVID tracker, I'm not even really sure what to take away from them anymore, because Omicron has made those kinds of markers so much less clear, right? And so I wonder if you could take me through how we are doing on COVID right now as a country. So as you stated, Omicron, particularly for the fact that it just spread through the population so quickly made the way we track you know our disease activity in the community very different than uh prior waves where we could rely pretty much on people getting tested as as kind of our benchmark for what's

going on well again the sheer number of people infected, lack of testing, and really prioritizing testing to those who would benefit from it the most, really gives us a skewed sense of what's happening. So we have to take a look at surrogate indicators. Numbers are decreasing. And again, that really, over time, as long as the group that's being tested is consistent, does suggest a decrease in value. We know many of those groups being tested are those at higher risk, healthcare workers. And so as long as, again, they represent their community, that can be used as an indicator. We have sewage studies that are looking at the burden of COVID-19 in sewage and human stool. And again, studies, at least in Ontario, suggest that there has been a decline in a plateau amongst these values, suggesting that community activity is very different than it was at

the peak of our Omicron wave. And then finally, we have hospitalizations in ICU states, which have been our more objective indicator, particularly around kind of people who are hospitalized because of COVID-19 or in intensive care because of COVID-19. And again, we've seen declines really suggesting that, again, the community-based activity is much lower than it was two months ago at the peak of this crisis. So overall, some pretty good news. It's really nice to have you on to talk about some good news. Yes, yes, exactly. So given that, we are seeing restrictions removed right now. And we mentioned some of these in the intro, but many provinces have lifted or

are soon lifting vaccine passport rules, capacity limits in places like restaurants and movie theaters. I should say I went to my first movie in a very long time on Friday. I saw Batman. This is about a gig and brothers to match. I assumed it was a superhero movie. Yes. Of course it was. Yeah. From your perspective as an infectious diseases doctor, is this the right time to lift these restrictions? I think this really goes back to the primary reason for these restrictions. And, you know, at the beginning of 2020, when we were dealing with the original COVID, with no immunity in the population, with very little tools for control. Yes, you know,

population-based controls, testing, tracing, reducing capacity, limiting high-risk settings were the only tools we had. It's changed now. And we have to recognize that these interventions likely make smaller differences in the context of the larger situation. Omicron is here. It is infecting at a large rate. It probably has gotten 30% of the population and is expected to get 50% of the population by the end of March across the world. We are much different from an immunity standpoint than March of 2020 and recognizing that our biggest control for healthcare utilization and intensive care is not whether restaurants are open or closed, but the fact that people are vaccinated or unvaccinated.

And those are largely available to the population. largely available to the population. And we have, you know, therapeutics for those who are not vaccinated, who don't make a great response to vaccines or are at higher risk to keep them out of healthcare. And so again, this is where the burden shifts. It doesn't necessarily have to be on society, on high risk environments to reduce, you know, community-based transmission, recognizing that the effects in terms of trying to save the healthcare system, there are a remarkable number of tools now as compared to 2020, where we can vaccinate the population,

we can treat the population, there's immunity in the population through what's happened with Omicron. And all of those make it a much more stable situation that doesn't necessarily need to invoke those population-based controls. I wonder if I could ask you this question, and I really don't want it to come out the wrong way because this wave has still been really horrific. But considering what you're saying about how many Canadians have some immunity from Omicron on top of the immunity most Canadians have from vaccination, say that Omicron ended up also being pretty instrumental in helping us get to where we are now,

where we can reopen more safely. I mean, I wish there were just no pandemic and no more waves. But, you know, it could have been much worse. Omicron hit at a time when the population had a significant amount of immunity, when we had much more experience in how to deal with COVID-19, our supplies of things like PPE were well balanced. We had access to therapeutics for high risk patients. It still caused health system stress. And some of that was hospitalizations, ICUs, surgeries need to be turned off. But if you look to examples like Hong Kong right now, where they're dealing with a naive population that really hasn't seen a lot of virus, where immunization rates amongst the highest risk were lower than the vast majority of the world who had access to vaccines, you're seeing a huge wave, but that's being followed with

hospitalizations and deaths at large levels. A rising number of the patients pass away in the emergency department, and that's why the hospital have to use up their own more trade capacity. So now we have to deal with it with more refrigerators contained in the hospital. You know, I think that really does say the contrast here in terms of how we got to this point in immunization and immunity, and what that's done for us during this wave, really mitigating the worst of those complications, despite a large number of our population being infected over the last three months. And places that had vaccinations and unfortunately had to derive immunity from a lack of vaccinations from prior waves, many of them are seeing stability after Omicron wave occurred.

And the epidemic curves in many countries looks entirely the same, an increasingly exponential number in infections, three to four weeks later, a peak, and then an exponential decline, which, you know, has been mimicked from Canada, the United States to Australia, to India, to South Africa, you know, again, this is the development of immunity that's led to then control over the epidemic wave. Right. So building on that Hong Kong example, where if I'm understanding correctly, experts are connecting those high death rates, both to the fact that most of the population hadn't really been exposed to COVID before Omicron, and also because they've got lower vaccination rates among some vulnerable groups. I've also seen

these really interesting comparisons between Hong Kong and New Zealand, which also had a similar COVID zero kind of policy and which also had a really serious Omicron wave, but they had way less deaths than Hong Kong. And so I'm wondering if you could talk a bit about that comparison and what you think we should be taking away from it. I mean, it's a great example, right? And again, these are two countries, they're probably two of the last countries, large countries on earth, or regions on earth that have had really immunologically naive populations that had not had a lot of natural infection, but saw this Omicron wave again. And so number one, you know, this concept of COVID zero, it was never a long term sustainable strategy. And you can see some of the places that pursued COVID zero,

they saw Omicron waves one way or another. But number two, the extent to which the damage is done is very different between Hong Kong and New Zealand, you are seeing significant death, significant hospitalization in Hong Kong, where the COVID zero strategy led to a little bit of fatigue around vaccination uptake rates and elderly being lower than other places in the world, whereas New Zealand had a very aggressive vaccine strategy, recognizing that that was probably going to be the long-term solution to COVID-19. They're seeing increasing number of cases. I think they're, you know, ranked in the top two in the world. This continued rise and also the number of hospitalizations we have means that we are now confirming our shift to phase three of our planned Omicron response. But the death is much lower in New Zealand.

20,000 foot view is you see these epidemic curves look exactly the same across multiple regions with higher restrictions, with lower restrictions, with more compliant populations, with less compliant populations. But it does really point out a little bit more of the lack of control we have with things like restrictions and some of those other measures and more how immunity really defines what comes out the other end of these pandemic waves in terms of the death and disability from them. I'm going to go. 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. 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, just search for Money for Couples. I just want to come back to the question of therapeutics, because you mentioned it earlier, you know, the drugs and

treatments that we have for people infected with COVID as we move away from public health restrictions. And, and, you know, as, as you've said, this sort of focus more on vaccination and therapeutics, what therapeutics are available in Canada right now, and how are they changing the equation here? So we have two therapeutic options. One is monoclonal antibodies, a drug called citrovimab, which is being used and has been available in Canada since about October of 2021. The other is Paxlovid, which is a compound produced by Pfizer. It's an oral therapy available since about six or so weeks ago. I think Canadians should be very happy today to hear that the oral antivirals are beginning to become available in Canada.

Both of these have the ability to reduce hospitalization risk further amongst high-risk individuals. So accessing these compounds early, in the first five to seven days of someone's illness, can reduce their risk of hospitalization by 70% to 80%. And so we know there are people, even with effective vaccines, that have immunosuppressive conditions where their vaccines may not offer as much protection

as a healthy individual. But currently, with the amount of drug that we have in the country, you know, there is the capacity right now to treat every high risk individual, even those who are vaccinated with high risk conditions, who need them. And so really, the paradigm is shifting. who need them. And so really, the paradigm is shifting. I think that a lot of people will be relieved to hear that what you just said about about therapeutics, especially treating people who are immunocompromised, people who might be worried, even if they're not as worried for themselves, but, you know, passing this along to somebody who is immunocompromised on a bus or at a Raptors game or at work.

As we moved into this individual risk assessment phase, at least that we're in right now, I want to just talk about with you some more of the factors that people may want to keep in mind as they make their own personal decisions. So firstly, masking. How should people be thinking about that as a protective measure? And when do you think they should be doing it, even if they're not like required to? Yeah, so, you know, we do know the virus transmits better in settings where there are more people, poor ventilation, and more mixing.

And so, you know, there's still a need to consider masking in those settings. Again, not necessarily forcing people to mask as these mandates end, but considering it as a recommended behavior. With that being said, you know, I think, again, the decision to mask really at this point becomes, especially when mandates end, becomes an individual risk behavior. If I, you know, if I live with someone that's vulnerable or I'm a vulnerable person myself, I want extra protection against COVID-19. And so, you know, wearing the most well-constructed mask, medical mask or higher, is an appropriate intervention for me.

But you know, when we talk about, you know, the ability to go to a restaurant and wearing a mask from the door to the table at the restaurant, you know, I think there's clearly some issue there in terms of what that's offering in terms of protection as you know, taking your mask off in the restaurant, then, you know, puts your risk back at the same level in that sense. So, you know, taking your mask off in the restaurant then, you know, puts your risk back at the same level in that sense. So, you know, people can consider it particularly in dense settings and poorly ventilated settings as, you know, a secondary control. And again, if they're going to use it as a personal protective measure, get, you know, a well-constructed mask that fits well in order to derive the most personal benefit from it.

You know, Dr. Tagler, we have been in this for a couple of years now, and I just wonder what you might say to people, whether they're immunocompromised or not, who just may be feeling a lot of years now. And I just wonder what you might say to people, whether they're immunocompromised or not, who just may be feeling a lot of anxiety as all these restrictions are suddenly lifted. Like for me, for example, I've had Omicron, I'm triple vax. I actually don't have a ton of anxiety about this, but I still found myself in this movie on Friday night in this movie theater thinking like, whoa, I haven't been around this movie on Friday night in this movie theater, thinking like, whoa, I haven't been around this many people in a long time. And I did feel sort of like a pang of nervousness. I don't even know how to explain it, right? Yeah, I mean, it's a very different time. And again, we've been excluding ourselves from others and really

keep our gathering small for two years. So obviously going into these settings is going to provoke a little bit of, oh, that's a bit strange. So, you know, first and foremost, people don't necessarily have to do everything that's provided to them. And, you know, if people want to continue to wear their mask aggressively and want to do things outdoors and sit on an outdoor patio rather than being at a packed indoor restaurant and not go to the Raptors game, they are free and eligible to. In fact, should not be pushed or discouraged or heckled for doing such a thing. This is personal risk and people judging their personal risk behavior and how they interact with the world.

We deal with this with other infectious diseases in that some people are higher risk and people judging their personal risk behavior and how they interact with the world. We deal with this with other infectious diseases in that, you know, some people are higher risk and some people are lower risk and they judge their risks accordingly. You know, I think, you know, from the standpoint of things like employers, you know, there are going to be people that are going to be afraid to go back into the workplace. And again, you know, if jobs can be done remotely, if people can be given the support to be able to engage slowly, then they should be provided with that in order to, again, deal with that re-engagement. And certainly people that have medical issues where acquiring COVID-19 may not be as mild as other people. Certainly, you know, there does need to be a prioritization

to make sure that those individuals have protections as well as, you know, if they can work remotely, can continue to work remotely. But I think, you know, it's just everyone is going to have their barometer. We know how this virus transmits. We know where this virus transmits. And people do need to just judge that risk based on their own health status, their vaccine status, and their ability to tolerate risk in terms of where they want to engage and where they shouldn't. And we just have to be encouraging to each other that we don't necessarily cause more resentment towards each other based on our risk decisions. All right.

And so before we go, I just, I would like to end this conversation by talking about the future for a minute here and what could possibly be on the horizon. So we know, for example, there's a new sub-variant of Omicron called BA2. That has started to gain traction in a number of countries, including Canada. And signs point to it possibly being more transmissible to BA1, what we had simply referred to as Omicron. And what do we know about it? And how much of a risk could it be as we continue to open up, especially as immunity wanes? You know, maybe people have had their third shots a couple of

months ago. In places like South Africa, for example, who were the first to deal with Omicron and are probably the first to deal with BA2, it is essentially replaced their BA1. But we have data from neutralization studies suggesting that people with three doses of vaccines are largely at the same level of protection for BA1 than BA2. And people that have acquired BA1 probably have significant cross protection for BA2. There are a few reinfections noted in Denmark, but they're not huge. It's less than 0.001% of the samples in that pool. So, you know, I think this is probably going to cause some disruption for immunologically naive populations. This may be an issue because it might be a little bit more severe for them than Omicron, the original. And so it is still important for us, even in a period

of calm, to really reach people with immunizations with their first, second, and third dose when appropriate, and making sure that they have that protection. But the future does still look bright. There will be variants, and this virus is evolving. It's infected a huge number of people. And it will continue to infect people where it evolves and goes to further individuals. But we have a brand new set of vaccines that are going through phase one and phase two trials that look at pan-coronavirus elements, that look at intranasal strategies. So not necessarily not only protection against severe disease, but protection against more transmission at the level of where we

transmit and where we require infection the most. We have new therapeutics that are coming down the pipeline. And so all of this really gives us a better sense that as the years go on, we're going to get better and better and better in terms of how to prevent this disease and how to treat this disease as the future holds. Yes. Thank you so much for this, Dr. Chagla. It is very nice to have a conversation with you. So much good news in it. So thank you. No problem. So thank you. No problem. All right.

That is all for today. If you are a fan of this show, we would love it. If you would take the time to review and rate us, it really, really helps people find us. Talk to you tomorrow.