Front Burner - The next phase of COVID-19 in Ontario

Episode Date: November 12, 2021

In Ontario, COVID-19 cases are rising again — but unlike before, the Greater Toronto Area isn’t bearing the brunt of this wave. Dr. Sumon Chakrabarti explains why.

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. It's been a while since we've done an episode directly about COVID-19 on the show. But there's something interesting going on in Ontario, where since the beginning of September, the seven-day average of new cases had been on the steady decline,

which was good news. But then that decline stalled, and now it's reversed. Cases are climbing again. A combination of cooler weather and looser restrictions has seen a rebound of COVID-19 cases, perhaps enough to require a course correction. Ontario is hitting the pause button on the next step of its reopening plan. It comes after a spike in COVID-19 cases. Out of an abundance of caution, we are pausing the next step of the plan to reopen Ontario.

Today, why the change? And does this signal a new, more stubborn phase of the pandemic? Dr. Suman Chakrabarty is an infectious disease specialist in Mississauga, Ontario, which was hit exceptionally hard by this virus in earlier waves. Hi, Dr. Chakrabarty. Afternoon, how are you? I'm well, thanks, and thank you so much for joining us. I was hoping we could start by talking about sort of the top-line COVID numbers in Ontario, you know, before we get into what they mean.

So, first off, what have you been seeing Ontario's case numbers do over the last few months? Yeah, this has been a very interesting trend. Entering September, we know that around this time, a lot of increased contact happens, whether it's at school, at home, with friends, and a lot of this is indoor. So we expected the cases to rise quite a bit like we saw in other parts of the world. But what we saw in Ontario was there was certainly a rise, but it was more of a wavelet, if you will, something that was blunted. And this was a trend that we initially didn't believe, but it really has continued this way until recently. So I think that what we were seeing was a blunted wave compared to what we saw. And I think this is a

positive relief. And this past September looked very different from last September. Why do you think that was? Yeah, it certainly did. And I think that there probably are multiple reasons for this, but I think it's really important for us to consider that vaccine mediated immunity and also immunity from having just been exposed to COVID previously, that in kind of accumulation, when you look at it, probably did have a significant effect for making this wave be much more blunted than it otherwise could have been. What are the rates of vaccination in Ontario right now? So we're doing pretty well. If we look at the eligible individuals, so that essentially would be 12 and up,

we're at around 85% now fully vaccinated. That's huge. Now, it might not be the 90% that we have been talking about for Delta in order to reach a steady state, but this is still remarkable compared to any other vaccination campaign for this type of illness that we've had

in Canada. And where in Ontario are the case numbers going up now, today? Yeah, that's another really interesting thing is that in the past, it's been mainly GTA. If we look at the past, you know, year and a half. But right now, what we're seeing is that while there is some case growth here, we're seeing a lot of case growth that's happening outside of the greater Toronto area. I'll give you an example. Lambton County, where I was originally from, from Sarnia, Sudbury, we're seeing Haldiman, all these places that historically weren't hit as hard and as long by COVID. And this is where we are seeing it. And that's certainly a different pattern than what we've been seeing for the past year and a half.

Do you know why that is? Like what's to account for those discrepancies and why the numbers are higher in those rural areas? I think a lot of us have theories. And I think part of this has to do with, again, the is the great equalizer. It is extremely contagious, transmissible, sorry, compared to the previous variants of COVID. I think part of that, it has a really, really good ability to get into populations where there's susceptibility. And what we see is in areas, for example, like Peel, even though there is a chunk of people that haven't been vaccinated, because Peel was hit so hard in the first three waves of COVID and I guess the fourth wave as well. Toronto and Peel will be moved into lockdown. Gyms, casinos and salons are closed. Peel residents are asked to restrict contact to members of their own households even in their yards. We are very much on a knife's edge in the region of Peel.

Once our hospital capacity starts getting challenged, that's a sign that we really need to take these measures seriously. You're seeing people that have already been exposed to COVID, even though it's not necessarily the same type of immunity as the vaccination is, it still is immunity nonetheless. The GTA, especially Peel, has a massive manufacturing sector. So you have a lot of factories where people are working in high density areas. And then people go home to what on average is a multi-generational family. So you can see this occupational to household transmission chain can continue even when the cases are overall low in the province, this conveyor belt can continue. And that leads to a lot of post-exposure immunity. Outside of these areas, you know, a lot of places

have been relatively untouched by COVID. So COVID did get there. Maybe there was a bit of a spike that was brief, for example, in Thunder Bay, but it wasn't the same sort of, you know, full level community exposure. So you have a lot of pockets that if there are people who haven't gotten vaccinated, if you haven't been vaccinated and you haven't been exposed, you know, you're susceptible to COVID. And again, Delta is very, very good at finding out these pockets and Delta is burning through those. And I mean, given what you've just said there, you know, you're going to have people listening who say, well, if exposure gives me immunity already and I have a low risk of hospitalization because I'm younger or I'm more healthy, then why bother being vaccinated? I mean, what would you say to those people?

Yeah, this is a thought that I get a lot in my clinic. And there's a number of things. First of all, I want to make it clear that immunity from being exposed to COVID, having COVID exists. We can't ignore that. This is an infectious disease phenomenon, but there's a lot of things that we have to be careful of. So first of all,

if you're, if you get COVID, you certainly have the risk of getting quite sick from it and transmitting it to others. So that's the first thing. And the second thing is that the immunity that comes from being exposed, it can be variable. And we don't it's not completely characterized yet.

It might not last for as long as being vaccinated or having a hybrid of being exposed to COVID and being vaccinated with a single dose or even two. So I think that it's just a bit of a gamble to take to do that. If you haven't been vaccinated yet, I still urge you to do so. It is the best defense. And again, Delta does seek out people who are susceptible. I mean, going back to those Ontario case numbers going up, I imagine that makes a lot of people nervous because we know that with this virus, growth can be exponential. And 400 cases one day can mean 800 soon after. Do you have a sense of that happening here?

So my overall sense is no. But as I've always said, number one, let's timestamp this conversation because things could change. And number two, I always want to have a level of humility when it comes to COVID because it can do things and it can really sometimes outperform our expectations, whether that is good or bad. My sense is with 85 percent vaccination on the ground, the networks of people who are still susceptible, they're spread out throughout the province. And the GTA is pretty, pretty immune when you look at the totality of things. So, you know, seeing areas, I do expect certain areas to have spikes in cases, but then for it to come down, I don't expect to see that same type of second and third wave that were actually on top of each other back

earlier this year. I want to dig a little bit deeper into what these numbers actually mean. We've been talking about case counts here, but let's go into those numbers a bit deeper. What has been happening in Ontario's ICUs? This is actually a positive note, is that what we saw is that over the course of the last several months, our hospitals have continued to decompress and our ICUs, which were very strained, especially in the third wave, have decompressed as well. Now, that doesn't mean that we want to get a whole bunch of new COVID cases. It just means that if we do see surges at some point, at least we can deal with it much better. I know that hospitalizations are a lagging marker.

So let's say if cases go up, hospitalizations are delayed from that. But overall, what we're seeing in the GTA is that where we were hit very hard before, the hospitals are seeing minimal amounts of COVID. Rather than previous, it was a tsunami. It's more of a slow drip that we're able to very easily deal with. Our first COVID case was March 26, 2020. And today we are COVID free. Marking a milestone in the pandemic fight, a Toronto hospital celebrates its medical surgical ICU being COVID free. Doesn't mean it can't change. I don't want to say that we're out of this yet. But the point is that we are in a much better position right now, hospital wise, than we were a year ago.

And what do we know about who is getting admitted to hospital with COVID-19 right now? What we're seeing a lot is people who are unvaccinated. Now, if you look at the overall case count in Ontario, there are a lot of people who are unvaccinated. Now, if you look at the overall case count in Ontario, there are a lot of people who are vaccinated fully getting COVID. But based on what we're seeing in the hospital, those must be very mild cases because the majority of people who are sick enough to get hospitalized, especially in the ICU, the vast majority of those, upwards of in the high 90s in terms of percent are individuals who have not yet been vaccinated. People who have been vaccinated fully, we've seen the occasional person, but by

and large, these are individuals who are elderly or have significant immune suppression, such as being on chemotherapy for a blood cancer. And when we're thinking about those who are immunocompromised or elderly, I mean, we also know that there are new treatments for people who get COVID to hopefully prevent hospital stays or deaths. Are those promising at all? Definitely. Now, they're still in their infancy. So one of the biggest things we're using right now my colleague Dr. Zane Chagla in Hamilton has been spearheading it here in Ontario is monoclonal antibodies I know we don't talk about Trump very often but it's actually what Trump was given when he was exposed back in whenever it was but I spent four days there and I went in I wasn't feeling so hot and within a very short period of time they gave gave me Regeneron. It's called Regeneron. And it was like unbelievable.

This is an antibody that's given to people who are at risk of severe disease. So for example, a person over the age of 65, a person with diabetes, etc. And these can be given soon after exposure or when you first develop symptoms., let's say, the first couple of days. And there's an infusion clinic that's running that can help to prevent that person from going on to severe disease. So that's a promising. We do have some oral antivirals that are coming down the pipe. They were just, I believe, in England. We're the UK, the first country in the world to approve Merck's antiviral pill. It's a drug called

monupiravir, monupiravir, and it is the first oral antiviral treatment. So the first pill for the illness to get the green light anywhere. But these certainly allow an oral option for early treatment of people who are not yet all that sick, but are in the community and are at risk of getting sick. And I want to talk a little bit about case counts. I mean, I know in BC here, just like other provinces across Canada, it felt like for so long, you know, daily provincial case numbers were what we all kept our eyes on. It's what we use to frame our understanding about where things were at and to a degree how, you know, we use those numbers to sort of predict how we should behave. But do you think that should still be the case or should we be thinking of these case counts differently now? I think we should be. And I agree. I'm one of those people myself that every day at around 10 o'clock,

you look for what the case count is. But as time has gone on, this case count, while it still has its use, it is becoming less illustrative. I think before people were using that as almost a surrogate risk of how much at risk am I of COVID. And maybe that was the case in, let's say, first and second wave, but it certainly isn't the case now. Just because case counts are going up does not necessarily mean that we're headed right back for lockdown. I personally think that the information needs to be available, but the kind of publishing of this in a, you know, a news format every single day is not as helpful as kind of looking at the overall picture of what's happening. Look at the vaccination level, acknowledging the fact that we are having significant impact, positive impact seen by

the vaccines. While we might need restrictions at some point, it's not the go-to anymore. I think that what people are seeing is when the case counts go up, you start to see those discussions, those arguments of why are we open too soon, et cetera, et cetera. And I think by taking that out of the picture and looking at a world where we live with COVID and we're mitigating the risks, it is going to be a bit more productive for the population. 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. Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. 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 want to talk about the possibility of COVID-19 maybe transitioning from pandemic to endemic. But first of all, can you just define these terms for us, pandemic and endemic?

Absolutely. There is an epidemiologic definition of both, but to put it into plain language, a pandemic is when you have like a raging wildfire type infection that is in multiple large regions, generally multiple countries. But in this case, it's the whole world. So you have an outbreak, an epidemic that is growing in multiple countries. So that's a pandemic. Endemic is kind of the other end of the spectrum where you basically have a slow burning, stable transmission that you can occasionally have spikes. But in general, it's a background, it's background noise that you live with, you have a certain number of illnesses at a time, it might be worse in the wintertime, for example, like influenza. But for the most part,

you're not seeing this massive explosion of cases all the time. And endemic happens when you have kind of a balance between infection and population immunity. It's not a static thing. It changes with time, but it's still overall a low type of transmission as opposed to this high that we're seeing around the world with COVID, especially in the first year of it. Do you see signs of COVID becoming endemic in the Toronto area? I do think so. Now, again, I don't want to upset my epidemiologic colleagues. I want to say that I think there are some early signs that we might be into that phase. Oftentimes, this is something that you have to look at the trend over time, and you're often doing it

retrospectively. So what we saw in the fourth wave, where you saw this kind of cases rise and then it blunted, I do think that is potential evidence that, yeah, we have a significant amount of immunity in this area that's allowing this to, you know, to blunt the spike. Based on our analysis of other jurisdictions around the world with similar rates of vaccination, we believed that we could prudently move away from addressing COVID as a pandemic and towards an endemic. It is now clear that we were wrong. And for that, time will tell. But I do think that moving into 2022, we are going to see more and more places have this pattern as immunity accrues. Ironically, with Delta, yes, it spreads a lot more effectively than the other variants did. It, in a way, immunizes, quote unquote, people who are not, that are still susceptible. And that can also help to accumulate immunity in the community. But not all viruses settle into this kind of forever zone, right? Like the SARS virus from 2003 is considered extinct.

Is there hope that this could happen here? You know, I doubt it. I would think that for SARS-CoV-2, the virus that causes COVID-19, I think that would be highly unlikely. So SARS-CoV-1 or SARS-1, it had characteristics that made it so that it wasn't able to propagate for a long time. And one of the biggest things was is that you were the most infectious with SARS-1 at the time, around seven or eight days when you were very, very sick. So it was easy to identify those patients and isolate them and break the transmission chains. With SARS-CoV-2, especially if you're unvaccinated,

you're contagious a couple of days before you even have symptoms. So there's really no way to reliably stop it in that sense. So this is something that I think is going to be with us forever. That does not mean it's going to be like this. It is going to be something in the respiratory virus milieu that we'll have to identify. And hopefully with vaccination, it'll be in good control and with therapeutics that are on the horizon. And a time when we heard about this idea of COVID-19 becoming endemic was, you know, not so long ago. While COVID-19 cases may rise in the coming weeks and months, a surge of hospitalizations and other severe outcomes is much less likely thanks to vaccines.

severe outcomes is much less likely thanks to vaccines. That was when Dr. Dina Hinshaw in Alberta said it was time for the province to learn how to live normally with the virus and she stripped the province of a number of public health measures including financial support for isolation and not too long after her announcement we started to see these huge spikes in cases, hospital visits and ICU stays. Are you concerned about the consequences of calling something endemic too soon? Yeah. So to be fair, Dr. Hinshaw, Dr. Hinshaw, I think was placed in a bit of a position herself. And she really, really, you know, I read that article that she wrote, and she really, really had some good thought to a what we call wicked problem. But that was because there was a significant desire for the province to move forward. The answer to that question is absolutely

yes, we certainly don't want to declare something endemic, and then completely drop everything and see what happened in Alberta. That said, again, I can speak the best for Ontario, the situation is different here. But you know, what we're seeing in the GTA with more blunted spread is certainly not the case in other places in Ontario, as we're seeing at press time with Sudbury, Haldimand, Lambton County and many other places. So I do still think that it's going to be some time before we're in that kind of stable endemic place across the province and across Canada. But I will say we are getting close to there as Delta is really good at seeking out people who are susceptible and infecting them and in the process giving them immunity. Dr. Chakrabarty, thank you so much for your time today. It was a pleasure to be here. Thanks for having me. to be here. Thanks for having me. Before we let you go today, Stalo poet, author, and professor Lee Maracle has died. Maracle lit a path for Indigenous artists with books like Ravensong

and I Am Woman. She was fearless and courageous in her push to see Indigenous people of all walks of life humanized at times when racism was at its height. She schooled many of us, including me, to be more compassionate in the world. And that's all for this week. Front Burner is brought to you by CBC News and CBC Podcasts. The show was produced this week by Simi Bassi, Imogen Burchard, Allie Janes, Joytha Simgupta, Katie Toth, and Derek Vanderwyk. Our intern is Akanksha Dhingra. Our sound design

was by Brittany Amadeo, Mackenzie Cameron, and Julia Whitman. Our music is by Joseph Schabison of Boombox Sound. The executive producer of Frontburner is Nick McKay-Blocas. I'm Angela Starrett, in for Jamie Poisson. I'll be back with you again next week.

Thanks for listening. For more CBC Podcasts, go to cbc.ca slash podcasts.