Front Burner - The final showdown? How to fight the 3rd wave

Episode Date: April 1, 2021

For epidemiologist Raywat Deonandan, the third wave of the pandemic is like the climactic battle scene of an action movie, when the foe is scariest and the hero is at their most tired. Here’s what he thinks it will take to win this last big fight against COVID-19.

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. You, like me, may be oscillating between hope and dread right now. Hope that the vaccines are actually here.

Maybe your parents or your grandparents have already gotten a shot. We heard yesterday that the Pfizer vaccine works in kids aged 12 to 15. This is really good stuff. But dread that in the meantime, things seem to be getting worse. Cases are skyrocketing in many parts of the country. ICU beds are filling up. Variants are running rampant. And a third wave isn't just some far-off scary possibility anymore. We are actually in the middle of it. Today, what the third wave in Canada actually looks like,

and how to deal with it at a time when people are already so burnt out. My guest is Professor Rawat Dianandan. He's a global health epidemiologist and an associate professor at the University of Ottawa. Hi, Ray Watt. Thank you for being here. Hi, thank you for having me. So I talked about my own mix of hope and dread at the top here, and I'm wondering how you're feeling right now. We know deaths from COVID are relatively low right now, but some of these case numbers and hospitalizations, they seem pretty concerning. And how worried are you about the COVID numbers that you're seeing?

I'm dreading the next couple of months. It's going to be a rough ride for the country and the world, frankly. If we look at the global statistics, we have a reproduction number. That's the average number of new cases produced by an old case. That's well over one. And in parts of the country, it's also well over one, which means we're seeing exponential growth, which means we're in this for several weeks, if not more. But I'm also optimistic because for the first time, we have an out. And that out, of course, is vaccination.

And we're getting them in vast quantities now. All we need to do is roll up our arms and receive them. So there is, again, light at the end of the tunnel to torture that old adage. And it will come sometime this year. But to get there, we have to go through some extreme discomfort and suffering for the next couple of months, possibly a bit longer. some extreme discomfort and suffering for the next couple of months, possibly a bit longer. Okay, and I want to talk to you more in a few minutes about that path out. But first, you know, maybe we can spend a little bit more time talking about where we are right now. So something that strikes me, looking at BC, this is a province that has generally opted to keep restrictions

very moderate. And just two weeks ago, Premier John Horgan said BC was on the right track. And then on Tuesday, the province went into the most severe restrictions they've seen since the first wave. And although I try to be hopeful every time I come to this microphone, I am here with a call to caution. We have lots to be hopeful about in the weeks and months ahead, but not if we don't follow the guidelines that Dr. Henry is going to lay out at this moment. And what does that tell you about how quickly the situation is changing, is evolving right now? It tells me a couple of things. First, that we're in a brand new pandemic in many ways. The new variants really are almost a brand new disease. And so the dynamics are different. The expectations are different. The extent to which

our mitigation tools work is different. And therefore the public behavior must be different as well. And the second thing it tells me is we didn't really learn enough about exponential growth this past year, something that science communicators have been harping on about for a while. Experiential growth tells us that the second you start seeing growth, it's time to enact some serious measures. Because if you don't, it'll be too late later on. You have to act early and hard. And any time you act, it has to feel like an overreaction. Otherwise, it's not enough. And that's what BC has discovered.

And I want to talk more with you about that as well, because I think that it's not going to be something that a lot of people are going to like to hear. with you about that as well, because I think that it's not going to be something that a lot of people are going to like to hear. But first, on this variant issue, and sticking with BC for a moment, what are we seeing in terms of variants that has doctors really concerned here? So BC is one of the top three provinces in terms of the actual number of B.1.1.7, which is the UK variant, so-called, because it was first seen in the UK. And that's the one that is running amok most of Canada. But BC is home to the most number of P.1. That's the variant first seen in Brazil, by a large stretch, in the case of hundreds of cases of P.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1 is concerning. It's possibly between 1.4 and 2.2 times more transmissible than B.1.1.7,

which is also significantly more transmissible than COVID classic, as I call it. And P1 may be able to reinfect people between 25% and 60% of the time, which means that people who were previously infected by COVID classic, who think they're immune now, are now being reinfected by P1. So it's causing havoc. And P1 will give public health people nightmares if it's allowed to spread throughout the rest of the country. Right. And speaking of that havoc, Whistler Blackcomb shut down this week because of so many cases in town of the P1 variant. And there are reports that there are more cases of P1 confirmed in a Vancouver lab than the entire US, which is really shocking, actually. It is shocking. Now, part of that could be a detection bias. Now, they're able to look for it more vigorously and more energized to do so. But part of it is actually true. So the thing about this third wave

that makes it interesting in the worst possible way to define interesting is that it is driven by the new variants and that it's probably caused by travel because the new variants got here because of travel. It didn't just emerge here, right? And so the extent to which BC is a travel hub, it's probably causing a lot of the crisis seen there. People are going to BC for its wonders and its beautiful things to see and touch and feel. And that's what's bringing the variants. Right. But on that note, I want to ask you about Regina. Saskatchewan Premier Scott Moe said recently that they've got a higher concentration of variants, mainly the UK variant, the B.1.1.7 variant, than anywhere else

in Canada. The vast majority of the cases that are occurring in Regina and the more effective transmission of the variant in Regina is proving to, well, it's leading the nation, unfortunately. I'm wondering how that is happening, because not to throw shade at Regina here, but it's not a major travel destination like Whistler. So what's going on there? Yeah, I don't have a clear answer for you there, except to say there is stochasticity built into the system, meaning there is some randomness. But that's a cop out. And a more complete answer is something like concentration is not the same thing as raw numbers. There are more raw numbers of B.1.1.7 in places like Ontario. The concentration is relevant because possibly a traveler infected a community that was not well protected and it ran rampant through that community. These things happen because of these

random situations. There's nothing particularly problematic about Regina, I'm quick to say. You just got some bad luck. Yes, Yes. Not to offend Regina. Good point. On the question of the variants, can we just be very clear here about how dangerous they are? Of course, we know that they're more contagious, but are they more deadly? Do they make you more sick? I find the discourse around this a little bit confusing. Yeah, they're definitely more transmissible. No question there. But it also appears to be more deadly. So B117 appears to be 30% to twice as deadly as COVID classic. And P1 might be resistant to neutralizing antibodies and to convalescent plasma. So our ability to treat it is compromised as well. So yes, the morgue might be

more representative of new variants, unfortunately. Okay. But like I mentioned at the top of this conversation, deaths are down right now. So COVID killed 206 people in Canada on January 22nd, for example. This past Tuesday, it killed 26. So what's going on? What's happening? We have competing ratios here. So on the one hand, we've vaccinated a very large proportion of our extreme elderly, those who are profoundly most likely to die of any version of COVID, COVID classic or any variant. So they have been hardened against this disease. And our long-term care centers now are still pretty much in lockdown to a large extent. So they're now less likely to die.

As a result, the virus has shifted its target to a younger demographic. So our ICUs are filling up with more young people simply because they are more likely to be infected. In addition to that, the new variants means more people are getting infected. And so the proportion that is represented by young people is higher and a larger number of young people are in there as well. Now, young people in general are less likely to die, but now they're slightly more likely to die because of the greater lethality of the new variants. But they're not that much more likely to die that it really affects the overall death toll numbers. So it's a mathematical soup. People are going to die more than we need them to, right? More than we need

them to. But my hope, let me knock on wood here, is that they will not be as great of a death toll as would have otherwise been seen had we not inoculated our elderly. You know, in terms of these variants spreading, I want to ask you about a very hot button issue here, a very controversial subject, which is schools. So in Ontario, there are currently more than 1,100 schools with a reported case. That's a quarter of all schools in the province. And officials in Alberta are saying that school-aged children now make up 20% of their total cases. And how big a role do you think that schools are playing in accelerating this third wave? As you noted, this is a deeply controversial topic. And no matter what I say, I'm going to

get some pushback from people. So here's the controversy. Do schools need to be open? Probably. Should kids be in school? Are they better served by being in classes? Absolutely. But are schools pandemic accelerators? Those who support school openings either say kids can't get it or transmit, which is false, or they say they can get it and transmit. They are not pandemic accelerators. I think it's clear now that regardless of how we thought about COVID classic, the new variants appear to show that schools are indeed accelerators. So places like UK, Denmark, Portugal, Austria, enormous numbers of school closures resulting from B.1.1.7 running rampant through those environments.

Data from Europe shows that schools ended up closing in November, December, and January because of these new variants. It seems unlikely that we're going to be any different. Now, in Paris, schools were kept open at all costs for political and ethical and social reasons. That's fine. But guess what? In some cases, schools are open without teachers present. And that, because they're sick, right? And that certainly doesn't serve any educational outcome. So what's the right thing to do here? Yeah, okay. Yeah. So what's the right thing to do here? I think the right thing to do is to start closing schools, unfortunately, because the sooner we can get a grip on the spread of the pandemic,

the faster we can put this to an end and the faster we can put kids back in schools. Okay, so you're advocating for a closure of schools. What else would you like to see happen tomorrow? I think it goes without saying, in these provinces with really, really high case counts. Right. I mean, obviously, I think some economic restrictions are indicated here. Nothing else seems to be able to quell the spread quickly enough. We can't vaccinate our way out of this quickly. Obviously not. We have to slow down spread so that we have time to vaccinate and harden the population. So absent, you know, lockdowns or whatever you want to call them, we should be doing things like investing in better ventilation. I can't say this enough. COVID is airborne. Let's accept that and move on, right? And because it's airborne,

we have to make the appropriate capital investments in ventilation and air purification I can't say this enough. COVID is airborne. Let's accept that and move on. And because it's airborne, we have to make the appropriate capital investments in ventilation and air purification, keeping windows open when we can, and moving activities outdoors when we can, maybe even getting better quality masks. Now, there's no specific data or research that suggests that mask improvement is needed, but it kind of makes sense. And Dr. Fauci himself said, you know, let's double mask to protect ourselves. We should be using rapid tests. I don't know why we haven't been doing this over the past few months. Other countries use rapid tests to high capacity and high effect. We should be using paid sick days to encourage people not to come to work when they're sick. And we should

support those who cannot distance. I mean, right now it's fashionable to criticize younger people because they are the ones who are getting sick more and to say they're being irresponsible. British Columbians aged 20 to 39 reeling after these comments directed at that demographic were made on Monday. The cohort are not paying as much attention to these broadcasts and quite frankly are putting the rest of us in a challenging situation. But my appeal to you is do not blow this for the rest of us.

And some are, but many of them are frontline workers or grocery store clerks and baristas, and they live in group settings and they can't socially distance. So we should support them and empower them to protect themselves and others. Right. And so, look, we've been talking about these things for a long time, right? We're a year into this. It's not a new idea to talk about good ventilation in places like schools, to talk about paid sick days, to talk about deploying the rapid test that we actually have but haven't been using.

So how confident are you that any of this is going to happen now? I have zero confidence that this is going to happen, zero. And here's why. I think we've gotten used to mass suffering. We've gotten used to overcrowded hospitals. And we have the sense that the end is near, that our only way out is vaccination. That's not true. Vaccination is not our only way out. We have other tools that allow us to have a more pleasurable exit. And I don't think the stomach for the capital investments I talked about or the stomach for lengthy lockdowns is there, unfortunately. Having said that, I think the inevitable circuit breaker lockdowns that are coming will probably get us to a point where we can survive without totally overwhelming our ICU capacity and get sufficient vaccines into arms so that we have light at the

end of the tunnel and the sun coming up at the end of the spring that will stay up for a long time. With the caveat that I hope new variants don't emerge that really compromise that scenario. Right. Please don't tell me. Please don't. Please just don't bring those up. Do you think that people are even going to tolerate circuit breaker lockdowns at this point, having lived through this? And in a lot of places in this country, people have been living under some sort of lockdown,

even if it's like a half lockdown, for a long time now. And I think, you know, it's taken a real toll here. Mental health is suffering. Reports of suicidal thoughts are up. Calls to crisis hotlines are way up. I think people will tolerate it. And here's why. I think deep down we understand what needs to be done.

And I've been fond of talking about this point of the pandemic as the third act of an action movie. So if you think about action movies in three acts, the first act is when the crisis emerges. The second act is when the first big battle is fought. And the third act is when the final big boss, the final evil villain is taken down. And sometimes that final foe isn't the biggest, baddest foe. Sometimes it's just the worst fight because the heroes are tired. And we're the heroes are tired. We're the heroes in this analogy. So we're about to fight the final battle of this action movie.

And I think everyone kind of understands that. And part of the battle involves sacrificing one last time, enduring one last lockdown, so that we can have the tools, the weapons needed to enable us to vaccinate at scale and to get this beast finally under control. And I really hope there isn't a direct-to-DVD sequel. Me too. But so essentially what you're telling me here is that, you know, we have been maybe in Avengers Infinity War when Thanos came with all those stones and things got real

bad. You should have gone for the head. and things got real bad. You should have gone for the head. But we are entering into, like, Avengers Endgame, where things really turn around eventually. In a sense. And remember in Endgame, there was a price to be paid.

People did die, you know? And that's what's going to happen here, too. Yes, that is a very good point. 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. 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. Okay, I just want to push back a little bit on this idea that we can't vaccinate our way out of this problem too, Because haven't we seen that happen in the United States and Israel, for example, these are both countries that did not have the epidemic under control at all.

And now cases are really falling off a cliff in both of them. So, you know, I suppose I asked this question because I feel like there's a lot of conversation around what we can do, that we can stay home, that restaurants and gyms and hair salons can stay home, that we can augment our individual behavior. And that's all fine. But, you know, I also wonder if the other side of this is that, you know, the government needs to get its act together and start administering vaccines at a faster rate. For example, 650,000 vaccines in Ontario are just sitting in freezers right now, and a large vaccination site in Toronto closes at 8pm. There's a lot of blame to go around here. And I'm more than happy to dole out blame to the government at all levels for an ineffectual vaccine rollout and for getting insufficient numbers of vaccines into play fast enough. But Israel did really well. They got

enough vaccines early and got into arms early on. So their deployment was far faster than us, and they avoided the third wave because of it. The USA is doing very well, but guess what? They're starting to see the signs of a new wave. So they didn't get there in time either. I don't think we have enough supply, and I don't think we have the infrastructure or indeed the public desire for a vaccine sufficient to get ahead of this particular crisis. So a colleague had tweeted earlier this week a pithy and sobering thought, and I think he's right about this, and I've been amplifying it wherever I can. The third wave was characterized as a race between vaccination and variants. The variants won, and then it became a race between vaccination and ICU bed capacity. And the vaccines are going to lose that one too, unless we, the heroes of this story,

do what it takes to slow down the path of the virus so that vaccines can win that battle. So this is where the heroism comes in. We have to tolerate additional restrictions to give time for vaccination to prevent the overwhelming of the healthcare system. And when that happens, things slowly get back to tolerable. We roll out vaccines at a greater pace, and then normal comes back. And when that light, when that sun rises over the horizon, it's going to remain high in the sky for a very long time. That day is coming. It's coming very, very soon.

We have to endure two or three months of suffering, of hell possibly. And longer if we do nothing, shorter if we act hard and act now. Okay. I feel like that's probably a really excellent place to end this. Ray Watt, thank you so much for this conversation today. Thank you so much for having me. I had a wonderful time. A couple developments that happened after our conversation that are worth noting here.

First, late Thursday night, CBC confirmed via sources that Ontario will announce today that the entire province will go under a gray zone lockdown for the next 28 days, although schools will remain open. In Quebec, Premier Francois Legault announced new lockdowns in Quebec City, Lévis and Gatineau to curb the spread of variants. And in France, actually, the country announced it will be closing schools for the next three weeks as part of a nationwide lockdown. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner. We'll talk to you tomorrow.