Front Burner - When will this seasonal ‘tridemic' end?

Episode Date: January 16, 2023

Seasonal viruses including influenza and respiratory syncytial virus (RSV) have come back with a vengeance, after sparing the public through most of the COVID-19 pandemic. Meanwhile, new COVID subvariants threaten to be the most transmissible seen yet, and appear to be on the rise. This triple-whammy 'tridemic' is straining the healthcare system and many families — especially those with young children who skipped a couple years of viral infection. Today we're joined by Dr. Allison McGeer, an infectious disease specialist and professor at the University of Toronto's Dalla Lana School of Public Health, to figure out when an especially tough sick season will ease up.

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. For weeks now, I have been under the weather. People in my family, friends, members of the FrontBurner team. It seems like so many people have been getting sick.

I keep hearing stories about people's holidays marred by COVID-19 or other illness. Kids, kids are just going from one thing to another. I feel this acutely. I have a toddler. I know health experts warned about this in the fall, the idea that the respiratory virus season was going to bring a triple whammy. COVID, of course, the flu, RSV. But what I really want to know here is how long we are all going to have to live like this for. To help answer that, I'm joined by Dr. Allison McGeer. She's an infectious disease specialist and a professor at the University of Toronto's Dalla Lana School of Public Health. Dr. McGeer, thank you so much for being here. A pleasure. Good morning.

Good. This is like kind of a selfish interview. So I'm very happy to have you here. I personally would like to know the answer to so many of these questions. So I know we got used to a couple of years with aside from COVID, almost no viruses going around because we were all kind of trapped in our homes, our bubbles, our kids weren't going to daycare or school. And that is clearly over now. But do we have a sense this year

of just how much sicker overall people are getting compared to pre-pandemic levels of sickness? So we don't, of course, track everybody in the community and every virus. The reason we're talking about a triple-demic is because COVID, flu, and RSV are the viruses that are most likely to make you sick and the most likely to get somebody into the hospital and severely ill. There's lots of other viruses.

and severely ill. There's lots of other viruses, but we do know very clearly that hospitalization, particularly in children, is substantially up over usual rates because so many kids haven't had viruses for so long. And there's every reason to believe that, you know, all of this other all of these other viruses are also causing much more disease than they usually do in an average winter. Yeah. So I know one of the reasons why these viruses have been ripping around the way they are, that people talk about is this idea of an immunity deficit. And this actually breaks down into two interpretations, as I understand it. So the first is this idea that because people weren't getting sick, their immune system somehow lost strength, making people more susceptible to catching things. So that explanation, I think, might sound right to a lot of people, right? Like if I stop running, I lose stamina. If I stop doing crunches, I don't know, my ab muscles, they're not so strong anymore. But it doesn't work like that. And can you explain why to me?

You know, so your immune system is just not like your muscle. Your immune system is a very finely balanced, very complex system that is intended to protect you from infections, but also not to overreact to things, right? So it very carefully runs balanced all of the time, and it deals with all sorts of things that are foreign to you, okay? In the food you eat, in the things you touch, in the air food you eat, in the things you touch, in the air you breathe in, in the water you drink, if you're pregnant, in the baby you're carrying, it's not just everything sends you, right? So your immune system, it's exposed to thousands of antigens every day. So a single viral respiratory infection here or there really doesn't make any difference at all. So that's

off the table. Okay, so the second version of this immunity deficit idea is that people just haven't caught these particular viruses yet. Maybe they would have during the pandemic, if not for public health measures in place. So they're catching them now, kind of all at once. Like basically, I'm describing a backlog here. And is that closer to the mark or am I oversimplifying it? No, that's very clearly what's happening on. And it explains nicely the difference between, you know, what we're seeing in children and their parents and what we're seeing in older adults. Because older adults actually aren't doing badly this year. And so if you think about it, if you have a three-year-old who was born right before the pandemic, that three-year-old in the first year

or two of their life, every year would have had about a 40% chance of getting influenza and a 30% chance of getting RSV and 100% chance of getting something each year. So all of those infections that they should have had in the first two years of life, not there. And now they're catching up. Okay. If you're 70, you've had, you know, 67 years of everything followed by three years of not very much. And so the impact of the backlog on older adults is pretty small. The impact of the backlog on kids is huge. is the question about COVID and unrelated viruses. So some people are suggesting that COVID has had some effect on the immune systems of people who have contracted the disease. Basically, that it's like damaged our immune system and it's damaged our ability to fend off other viruses, right? And that might explain too why people are getting more sick this year.

And does that theory hold up at all for you? So, yeah, I think it's a totally reasonable concern. We know when COVID causes more severe disease that a part of that, the damage that is caused is in the triggering of your immune system to actually add damage to what the COVID infection is doing by itself. system to actually add damage to what the COVID infection is doing by itself. And that's distinctive compared to other viruses and other bacteria that cause respiratory infections. So it's a totally reasonable thing to worry about. We also know that there are some changes in your immune system that happen when you get an infection with COVID that raise the concern that maybe it's doing something to your immune system. However, what we haven't had yet is any evidence at all clinically or epidemiologically that that's actually happening.

I wonder if we could spend a bit of time now just sort of going through some of these big viruses that have been going around in the hopes of basically getting a better picture of how long we're all going to have to live like this. Let's do the flu first. Like, where is the flu right now? like this. Let's do the flu first. Where is the flu right now? Okay, so the flu is the good news piece of the current story. We had a season exactly like Australia's season in their last winter, which was it started early, went up really quickly, but it's coming down again. And it's not quite over yet, but it'll be over in two or three weeks. Things are getting much better. And that's really nice because the pressure on hospitals is worse when it's RSV and flu and everything else at the same time. Taking the flu away, things get substantially better. And there's no question that's happening. Well, that is very good news. Now, could we do RSV? This is the one

that's been especially troubling for kids. I know this firsthand in part because my own toddler had it and I had not seen him that sick. He was not hospitalized, but he was very sick. So where are we with that? So RSV, usually what happens with RSV in children, it goes up in October and it stays up and fairly stable through the fall winter and it goes back down again at the end of March. So if we were in a usual winter, we would expect RSV to continue at its usual rate until March. I think what's happening this year is that in October, November, December, we did a whole lot of catching up with RSV. Because we had this much larger cohort of kids

who had never been infected before, that meant that RSV was more easily transmitted from person to person, right? So if you think of a whole room full of kids and none of them have had RSV, you can imagine how quickly it can get from one person to the next. Now imagine a whole room full of kids in which two-thirds of them have had an infection before

and they're partially protected. Now it's much harder for RSV to get to everybody. And so it slows it down. So I think we can hope with our, I don't think we know what's going to happen with RSV because we haven't been here before, okay, but I think we can hope that the worst of the RSV in kids is over. It's probably going to continue at some level until about the end of March, but it shouldn't be as bad as it was in October and November. What's happening to adults is the same as it is in the usual year, which is that disease in adults is delayed behind disease in kids.

And adult disease usually peaks between the 15th of December and the 15th of January. And that looks like what's happening now. Really can't predict well, but it does look like we're going to continue to have adult RSVCs for some time. 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,

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XBB.1.5 has been detected in 29 countries so far. There may be more as sequencing becomes less and less available at a global level. It's difficult for us to track each of these sub-variants of Omicron. So it is part of Omicron. And as you've noted, it is the most transmissible sub-variant that has been detected yet. Many people are calling it the cracker. And what can you tell me about this variant where is where is that right now so you know it's an interesting question it is increasing around the world but at different speeds in different places so in the northeastern united states it's it's really taken

off and it's running now not as fast as people thought it was originally, but it's running now about 30% of infections. In Canada, in contrast, we're still seeing quite a lot more of some of the descendants of BQ.1.1 and that family. And so it's still not clear in Canada which one of those is going to win out, okay? Whether it's going to be the XBB.1.5 or whether the descendants of BQ1 are as transmissible and they're going to both continue on their way. And so on that point, can you help me kind of understand what my life is going to be like now vis-a-vis COVID? Am I kind of in this endless cycle of boosters? Is it, is it like how we treat the flu every fall? We're going to get a flu shot that has been, well, hopefully formulated to meet that, you know, variant of the flu, right? I know they don't always get it super spot on, but like, like what's it going to look like?

So, so let's do like short-term, mid-term, long-term. In the short term, like the next two or three months, it's a little bit hard to predict what's going to happen. We're already seeing COVID going up and that's a combination of the holidays when people traveled and they got together. You know what that does to COVID, right? So cases are going up. They're probably also going up because people's protection from vaccine is going down because many people's last dose was six, nine, 12 months ago. And we have these new variants, whether they're, you know, XBV1.5 or BQ1, they're new and they're more immune evasive. And that combination is going to increase disease in January and February.

And so I think, you know, the really important message is the way we keep it down, okay, the way we save people from being hospitalized and dying from COVID in the next few months is being up to date with our boosters, not going out when we're sick, wearing a mask in crowded indoor spaces. And if you're worried about yourself being immunocompromised or at risk or your family or friends, just thinking about keeping the contacts down, not locked down, but just staying out of more dangerous places for the next couple of months. Okay. Now, medium term, every dose of vaccine we give, every COVID infection that people get increases our immunity as a population. And we've clearly made, we've come a long way

from March, 2020. Things are infinitely better and they're going to keep getting better. I'm really hopeful that we're going to get through the winter with COVID. Things are going to settle down, and the summer will be okay, and that COVID is going to settle into the seasonal pattern we expect to see in respiratory viruses. So the really long term, so next year is still going to be, I think, more COVID than one would like. But each year is going to get better. Okay. Until we get to this balance, we have a lot of population immunity versus the virus. I think we're all hoping that two years from now, that balance is SARS-CoV-2 is just going to be another seasonal coronavirus.

Causes colds. Yeah, occasionally it causes more severe illness, but really it's just another common cold virus. So that's the good scenario. The not quite so good scenario is maybe it's going to be more like influenza. And we're going to have to deal with SARS-CoV-2 the way we deal with influenza. And the additional good news is that people are already working on combined flu and COVID vaccines. So, you know, in that scenario, what will happen is it gets your flu and COVID shot from a flu. It can still really suck, right? Like I'm just trying to picture a winter where I get a really bad flu and then I get COVID and I get knocked out for five days, too. Like that's a rough six week stretch.

But if you get your flu and COVID vaccine, that's not going to happen to you. Right. Or I wouldn't get it as severely, right? You wouldn't get it nearly as severely. And I think the other thing that's kind of interesting that's going on is, you know, it's always a shock to our systems when we have kids and we find out you know what as soon as your kid goes to daycare or as soon as your kid is kind of out and about in play groups you're going to spend a winter where you're just infected all the time okay um and the first infection your child gets is always really scary. So that's a uniform experience that parents have been spared for the last two years. Having said that, there's also other good news on the horizon,

right? There are now RSV vaccines. And it's really too bad that we didn't quite have them this year, And it's really too bad that we didn't quite have them this year. But by next year, or maybe the year after, we'll have RSV vaccines for pregnant women. And the reason that's for pregnant women is because you give the vaccine to a pregnant mom. She transfers the antibodies across the placenta to her kid. And when her kid is born, her kid is protected for the first three to six months of life, which is when RSV is most dangerous. So we're going to have vaccines for kids and pregnant women and older adults for RSV. And that will really help because then it'll take RSV kind of off the table.

And instead of having to deal with flu, RSV and COVID, we'll have to deal with flu modified by vaccines, COVID modified by vaccines and practically no RSV. If I was trying to picture my life in the medium and long term, right, you know, how much better could I expect? We haven't even talked about like the common colds and everything else that's running around. Like, at what point is it going to feel like we're not sick all the time? I might not be the best example. I have a toddler and I don't think I've shared this on the show yet, but I'm also pregnant. So I'm in a bad category. But I do feel like this is something that a lot of people are talking about, right? It's not just parents of small children and families. Like everybody feels like everybody's sick all the time. So I think two things.

I think we get through this winter, then it's going to have gone away. We're going to be more or less caught back up. So you think of your children as small people, right? But I'm a microbiologist and I know what your children are. They're culture plants for viruses. Yes, that's what they do. Okay. The most dangerous people in your life from a viral infection kind of you are not strangers okay there's your own small children okay i feel like that's fair so for for people with small kids just your disease-ridden kids need to need to grow up but but for everybody else you grow up it's really When they grow up, they don't get viral infections. Yeah. And for everybody else, we're heading into a much better year next year, if that's a fair

summary. Yeah. Okay. Final question before we go, Dr. McGuire. Like, do you think that we're doing enough to mitigate some of this winter? Like, should we be doing more masking? Should that be more mandatory? Do you think that we're kind of hitting those mitigation measures and we're hitting the right balance? So, you know, from my perspective, our challenge now is that we still have much more severe illness and death due to COVID than we need to have now most of that as death is is in older adults but I'm in the older category I care about my friends and my family you know and we could reduce that amount of illness and death really successfully, probably by, you know, at least 30 or 40%. The big effect would be from people getting their booster vaccines.

You know, if you're going to do one thing, okay, if you still want to keep going to concerts and parties and have your life, just get your vaccine, Okay. But I also think that getting COVID is not safe if you're over 60 or 70, even if you've had all of your vaccines, particularly if your last vaccine was more than six months ago. People have so had it with the pandemic that I don't think public health people are going to mandate masks. Of course, I work in a healthcare institution, so we do have mandated masks. We wear masks all the time. It's fine. And I'm very happy. I still wear my mask in indoor spaces.

I still wear my mask in the TTC. To me, it's a small thing that I can do that helps to protect people around me, and it's not a big deal. but i understand there's a whole range of opinions about how bad wearing a mask is in 2022 we had more people die of covid than in 2021 yeah and and 2023 we're probably still going to have two or three times as many people die of covid as flu that means like six times as many people dying of COVID as people who die in car accidents. So that's a, to me, that's an uncomfortable number that we should be working on. Right. I think that's a really nice PSA for us to end this conversation on. So get your boosters. I got mine a couple of days ago. It took like three minutes at my local grocery store.

And thank you so much for this, Dr. McGeer. Also for providing a little bit of light at the end of the tunnel. It's, I think, very appreciated by many people listening. So thank you. Yeah, it's been a really miserable fall for many, many people. Yes, yeah.

Okay, thank you so much for coming on. Take care. Bye-bye. All right. That's all for today. I'm Jamie Poisson. Thanks so much for listening. Talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.