Front Burner - The puzzling unknowns of COVID-19

Episode Date: May 4, 2020

Until about 5 months ago, no one had heard of COVID-19. And, despite the overflow of information and research since then, there is much we still don’t know about the virus itself and the disease it causes. Today on Front Burner, we talk to special pathogens expert Dr. Syra Madad about some of the things we don’t know about COVID-19 and why this is such an unprecedented crisis.

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. Hello, I'm Jamie Poisson. SARS-CoV-2, the virus strain that leads to the COVID-19 disease, until about five months ago, it was an organism completely unknown. Today, medical researchers are hunting for clues. Scientists have published thousands of papers. But despite that overwhelming flow of information, this disease has turned out to be incredibly complex, with even the most experienced experts struggling to understand it.

We often talk about the things that we know to try and get a clearer and more complete picture. But today we want to talk about some of the stuff that we don to try and get a clearer and more complete picture. But today we want to talk about some of the stuff that we don't know about COVID-19, yet at least, and what they tell us about why this pandemic is such an unprecedented crisis. This is Frontburner. Joining me now is Dr. Saira Madad. She's a special pathogens expert and was featured in the recent Netflix documentary series, Pandemic, How to Prevent an Outbreak.

Dr. Madad is responsible for preparing New York City's municipal hospitals against infectious disease outbreaks effectively to contain the virus in that city. And she joins me now. Dr. Madad, thank you so much for making the time to speak with me today. Sure. No, my pleasure. Thank you for having me. I want to start off today by focusing on the virus itself. So I know that scientists are still trying to figure out how deadly it is exactly. And while the WHO estimates that the global mortality rate is around 3.4%, The rate across countries, it varies so

widely. Germany, for example, has a fatality rate of 3%. Italy's is 13%. And so could we start here? What explains this difference? We're only seeing the tip of the iceberg. A lot of factors go in when you talk about case fatality rate from one country to another. And one of the biggest factors is your access to health care. So the stronger your health care infrastructure is, the more chances of survival, if you will. I think what's probably a better indication in terms of what the true case fatality rate is for coronavirus disease is if you look at the cruise ship, the Diamond Princess cruise ship. It was starting off a really bad science experiment. You know, you've had hundreds of people confined to a ship. The Diamond Princess, which remains under quarantine in port in Yokohama, Japan.

An explosion of disease, going from one to more than 600 cases in two weeks. So many health authorities around the world calling it essentially a petri dish for the coronavirus. Because it was almost a controlled environment you had, I think over 700 individuals were actually positive. And what it showed in that particular controlled study is that the case fatality rate was actually around 1.1 percent, so much lower than the percent that's been estimated by the World Health Organization. And so, you know, there's a difference between what you're seeing in each of these countries and what is actually associated with the disease itself. Would it be fair to say that a lower mortality rate, you mentioned 1.1 on this cruise ship, it isn't necessarily good news, right? The idea that the lower the mortality rate, it could also mean that the virus could be more dangerous.

Compared to other viruses, and let's just take another example of severe respiratory disease, like SARS, you know, SARS and MERS. So MERS has a much higher case fatality rate of close to 30% and SARS close to 10%. With coronavirus disease 19, it being lower, at the same time, it is also highly transmissible. So there are many different factors that come into play. It's much more transmissible than its, you know, sister viruses. The other thing that we're seeing with COVID-19 is that people that are asymptomatic are still able to spread the disease. That's not the case with some of these other coronaviruses like SARS and MERS, where people actually start spreading the disease when they're symptomatic. So it's much harder to isolate these individuals or identify them.

I want to come back to the asymptomatic individuals in a moment with you. But first, I wanted to ask you about these excess deaths that we're seeing. So the Centers for Disease Control and Prevention says that in seven U.S. states between March 8th and April 11th, they saw 50 percent higher than normal deaths. So as of April 11, 9,000 more deaths happened that were not reported in official counts of deaths from the coronavirus. In New York City, it means an extra 1,700 fatalities. In Illinois, an extra 700. So why are we seeing these excess deaths as are being labeled? Well, you know, I think there's a couple of different reasons for that. And for some of these reasons include that first, people may not actually be seeking health care services, right? And so if they have coronavirus disease, they are reluctant to actually go to a hospital. And so unfortunately, they're dying in their homes, right? So a large majority of them may actually be dying of coronavirus disease.

It's hard to tell. Here in the state of New York and in New York City, you have two brackets, confirmed COVID-19 deaths, and then probable. And probable depends on a number of different factors, you know, depends on when they died, you know, what it says on the death certificate and things like that. But the other reason, not just with COVID-19, is people that are also having, let's just say, non-COVID-19 issues like heart attacks, you know, respiratory issues not related to COVID-19, they're also reluctant to seek healthcare services because they think they're going to get COVID-19. There are warnings tonight that people are dying of heart attacks and strokes because they're avoiding going to hospital when they should.

I also wanted to ask you about the seasonal flu, which I know comparisons between the coronavirus, COVID-19 and the seasonal flu, they have outraged many. Some experts have even said it's like comparing apples and oranges. The WHO on why this coronavirus is something different. COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection. In the summer months, the flu tends to dissipate. What exactly is known right now about the seasonality of COVID-19? Is it possible that this thing could die down in the summer?

It's hard to speculate how it's going to behave in the future, but there are some indications in terms of what we can expect. And one of these indications is look at some of the countries that are battling coronavirus disease, but have warmer temperatures, right? So when you think about summer, you think about the temperature, the humidity, the environment. Some of these other countries, let's say, you know, Singapore, Iran, you know, they are already experiencing some of the higher temperature and humidity that we would potentially face here in the United States. And so the cases are not declining because of the seasonality.

And so the cases are not declining because of the seasonality. But you have some studies that show that perhaps there might be a reduction of almost 20% of coronavirus disease cases in the summer. But then it's going to, you know, pick back up in the fall months and the winter months. And I think some of those things, well, we'll see if that's true and time will tell. You know, a lot of people think that goes away in April with the heat. Typically, that will go away in April. Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away. I hope that's true. This is always going to be in the backdrop. It's not going to go away, right? There's no, this is not one of those things where summer comes around and COVID-19 just completely is gone. Right. And, you know, we know from like the 1918 Spanish flu

that there was a huge resurgence in the fall after the initial first wave. And, you know, we know from like the 1918 Spanish flu, that there was a huge resurgence in the in the fall after the initial first wave. And I know there are quite a bit of concerns about that, right? That's right. These studies are being done in controlled environments. If you look at the United States, it's an extremely large country. And so we have various different environmental factors, you know, so what we're going to see in the East Coast is going to be different than the West Coast, because we're so large, there's different climate and temperature changes, if you will, that fluctuates throughout the country. And so, as a whole, you know, maybe some states will see a decline because of the temperature, again, something that we'll have to

still investigate. But, you know, because of how large the country is, you're going to still see pockets of the outbreaks, you know, in full swing. If we could focus on the actual infection now, you know, I know that it's generally accepted that COVID-19 can last up to two weeks. But one study from Hong Kong published in The Lancet found the virus could be detected for 20 days or longer after the initial onset of symptoms and one third of patients tested. What makes this virus so unique that we don't seem to be able to yet identify how long the illness stays in the human body? And what does that tell us about the way that we've tried to contain it so far? When we talk about how long the virus can linger for in the human body, that can vary from person to person. And there's many different factors in play, you know, in terms of why some

people may be shedding the virus longer than others, right? It depends on our immune response, depends on our genetics, depends on, you know, just our overall physiology, if you will. And so you have some people that get the virus and they recover in two weeks. And then you have other people that it takes them maybe three or six weeks to recover. And during that time, they are still testing positive for coronavirus disease. Myself, as someone that actually got coronavirus disease, you know, just someone that actually got coronavirus disease, you know, just about a month or so ago, I tested positive even three weeks after recovering without even having signs and symptoms I was presumptive positive. So it really varies from person to

person. But what is very important to note is that just because you test positive after a certain period of time does not mean that you're still infectious. Just because you are able to detect the genetic material of the virus does not mean that it's an infectious particle. Okay. I didn't realize that you had tested positive for COVID-19. I'm sorry to hear that. Are you feeling okay now? I am. Yeah. Thank you. I was very lucky. I had a mild version of the disease, but I also experienced a new symptom, if you will, from coronavirus disease. So you may know that the Centers for Disease Control and Prevention included additional signs and symptoms, and some of these include the new loss of taste or smell. And I experienced that

early on, and I actually did not have my sense of taste or smell for almost three weeks. So that also varies from person to person. Is there any precedent for this, you know, how diverse so many of these symptoms are? So, you know, I know now we're hearing doctors in New York reporting an increase in sudden strokes in young adults. Nearly triple the normal number, according to neurosurgeon Dr. Joanna Fifi. Half of the patients had COVID and were on average 12 years younger than typical stroke victims. Everybody on the team noticed it and said this there has to be a correlation. We're hearing about something called COVID toes, a skin discoloration in some

children's toes who are infected. Doctors in the U.S. and Canada were recently sent an alert. Look out for cases of kids with purple swollen toes. Sometimes they're hot and painful. Sometimes the children are otherwise well. You just talked about taste and smell. Why are the symptoms so diverse? Is there any scientific indication? Have we ever seen anything like this before?

So each virus is very different in how it can manifest in the human body. Based on the foundation of what we have, based on what we know about coronavirus disease, it's almost defying everything. And there is still no indication of why some people have more severe illness. Similar to Zika, right? So Zika was something that was on our radar just a few years ago, and you're seeing that children were born with microcephaly. Leandro's head and brain are smaller than they should be, brain damage linked to the Zika virus.

Babies with microcephaly tend to have a stiff musculature. That's made it difficult for Leandro to hold up his head and pick up objects. We're still following those children because we're trying to still figure out the full spectrum of illness, and we still don't know definitively this is what the outcome is going to be because these children, you know, they were born a few years ago and we're still following them. So similar with coronavirus disease, we're not going to actually get the full picture for at least another 50, 60, 80, 90 years to actually know, okay, this is what it actually causes throughout their lifetime. free on cbc gem brought to you in part by national angel capital organization empowering canada's

entrepreneurs through angel investment and industry connections you know i know one thing that has been puzzling to people is that it seems to be killing more men than women and do we know anything about why the virus seems to be targeting one gender this way so that's a great question and we certainly are seeing that actually play out specifically also here in New York, where you are seeing more men being infected than females. And this is something that's still being studied, but it's also looking at some of the underlying causes. And this may also include not just obviously the difference between the physiology of a man and a woman, but also some of the factors that may put people at higher risk.

Some of the behaviors that are associated with men versus women. In addition, you know, you're also seeing some of the health inequalities, not just between men and women, but also between different races and, you know, and ethnicities. But, you know, we're still investigating and seeing what the cause is. and ethnicities. But, you know, we're still investigating and seeing what the cause is. I want to come back to this idea of asymptomatic individuals that you brought up earlier, this idea that there can be silent carriers of this disease. And I know that we don't know yet what proportion of people are silent carriers, but experts do seem to say there's a significant number of them. And in Edmonton, Dr. Lenora Saxinger, an infectious disease expert.

You can find data from various sources that gives numbers anywhere from 5% to 80%. The more reliable data looks like it's probably 10% or less. And what do we know right now about how contagious these asymptomatic carriers are? I have to say, there seems to be so much conflicting information about this. What's happening is that you have people publishing reports and articles based on certain people's experiences that is not based on science, it's not based on evidence, it's not based on a cohort study, but then you're also having journals publish certain articles that may not be peer reviewed. And so that's adding to a lot of the confusion out there and it's very hard to filter through what is true and what is not but what we do know based on some of the peer-reviewed articles that have been

published based on some of the things that we are actually seeing boots on the ground is that asymptomatic transmission is real even pre-symptomatic youomatic transmission is real, even pre-symptomatic transmission is real. And what we mean by pre-symptomatic is that you actually are spreading the virus without even obviously having signs and symptoms. And then after a few days, the incubation period obviously varies from 1 to 14 days, but the median incubation period timeframe is usually about 5 days. That's when people tend to actually develop signs and symptoms. And so between that day one and day five, you are still able to spread the disease. And some of the recent studies actually are showing that people are the most infectious during the early days versus in the latter days. And so this

is when you don't even know that you have the disease and you may be going about and what we're seeing is that, you know, in the early days, that's when sometimes you're most infectious. I also want to ask you about the immunity question, just to get your perspective on this, because there also seems to be so much conflicting information around this. You know, in April, the World Health Organization said there was no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection. Some experts have said that there could be some level of immunity because they're looking at similar virus strains like SARS.

So what do you think is going on here? Like, do you think that you can get this virus twice? Or do you think that people develop some level of immunity if they get it once? So based on just basic virology, what we know about viruses, not just COVID-19, when you get infected, you should develop some type or form of immunity. How long that immunity may last for varies. And so with SARS, what we've seen is that people that get infected can have immunity for up to two years. With coronavirus disease 19, some of these antibodies are protective, but it remains to be definitively established, right? So we still don't exactly know whether all infected patients actually mount a protective immune response,

and then how long any protective effect will actually last. But I think based on some preliminary results of what we're seeing is that you should have some form of immunity. You know, you're probably seeing some articles again in the news talking about people getting reinfected. A study being done by a team of investigators with South Korea's CDC has found the virus may have reactivated after lying dormant within the patient's body. But some experts say there is no evidence to support that. And some of these actually articles were just debunked. The individuals that thought they were reinfected actually were not. If you're going to get retested right after, let's just say, four or five, six, seven weeks,

either you may have a false positive or a false negative, right? So it depends on the factor of the test. One of the other things we don't know is how much of the virus actually causes the infection. And to give you an example, if you, you know, touch a surface that, you know, somebody sneezed on, and then you touch your mucous membrane, you may have only picked up a very small amount of the virus. And that might not actually be enough for you to have an infection. Okay. The last thing that I wanted to ask you about to wrap up this conversation is a possible endgame here. So many scientists say that only a vaccine can bring this pandemic to a halt. As Dr. Tam explained, there will likely be smaller outbreaks for a number of months after

the summer. This will be the new normal until a vaccine is developed. And given your work in preparing for epidemics and pandemics, I'm wondering if you think that this pandemic will be contained or even stopped? And, you know, if you'd even be willing to wager a timeline here? So, you know, it's very hard to predict the future. And it's very hard to put numbers or accurate timeframes when it comes to infectious disease outbreaks because they behave so erratically. What we know for certain right now is that coronavirus disease is not going away any time soon. And the reason for that is because

we obviously don't have a vaccine and we don't have a therapeutic for it. We need to make sure that while we want to open up states and, you know, get our economy back up and running, which is extremely important, we need to also just prepare ourselves that we need to continue to take a number of different public health measures in our day to day life, we're not going to go back to what was normal, you know, before COVID-19 started, we're going to have a new normal. And what this means is that we're going to need to continue to wear face masks out in public, we need to continue to keep a distance from other people. We need to continue to do these everyday measures, like if we're sick, staying home until we're actually able to get to that

vaccine that can build that herd immunity. But in order for us to establish herd immunity, naturally, you need to have at least 60% of the population infected. And right now, that's nowhere near where we need to be for herd immunity. And so we're in this for the long run. And as you mentioned earlier, we still have some question marks around how long or how much immunity a person can build in and of itself. Dr. Medad, thank you so much for making the time to speak with me today. We're really appreciative. My pleasure. Thank you for having me. Okay, so before we sign off today, you might remember a few weeks back, we told you about this really promising rapid coronavirus test made right here in Canada by Ottawa-based company Spartan Bioscience. People were calling it a game changer because it's supposed to deliver on-the-scene results within an hour.

Well, it's hit a bit of a roadblock. On Sunday, Health Canada announced they're restricting the use of the product. It can only be used in research right now. Apparently, there have been problems with the tests that make it unreliable. Spartan is recalling about 5,500 tests. It has already shipped nationally. And the company says they're working on the issues with the swabs in the testing unit. They say that the swabs are the problem and not the machine itself.

Canada has ordered 40,000 tests a month from Spartan. Provinces have also put in orders 200,000 total from Quebec, 900,000 total from Ontario. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and talk to you soon.