The Agenda with Steve Paikin (Audio) - Has Everyone Forgotten About COVID?

Episode Date: October 2, 2024

It was more than four years ago when the World Health Organization declared COVID-19 a pandemic and the world shut down. Now, things have largely returned to the way they were, but the virus still remains. How dangerous is COVID-19 today? And have people forgotten that the disease poses health risks and some are still feeling the effects of poor mental health? For insight, The Agenda welcomes: Isaac Bogoch, an infectious diseases specialist at the Toronto General Hospital; Dawn Bowdish, executive irector at the Firestone Institute for Respiratory Health and professor of medicine at McMaster University; and Kwame McKenzie CEO, Wellesley Institute and director of health equity at the Centre for Addiction and Mental Health (CAMH).See omnystudio.com/listener for privacy information.

It was more than four years ago when the World Health Organization declared COVID-19 a pandemic and the world shut down. Now, things have largely returned to the way they were, but the virus still remains. How dangerous is COVID-19 today? And have people forgotten that the disease still poses health risks, as some are still feeling the effects of poor mental health? Let's ask Dr. Isaac Bogoch, infectious diseases specialist at Toronto General Hospital.

Don Bowdish, executive director at the Firestone Institute for Respor... Boy, that's harder to say than I thought. Let me try that again. Don Bowdish, executive director at the Firestone Institute for Respiratory Health and professor of medicine at McMaster University. Anne-Quinn McKenzie, CEO of the Wellesley Institute

and director of health equity at ChemH, the Center for Addiction and Mental Health, and we are delighted to welcome you three here to TVO. I have to point this out off the top. You've been here before, but only on satellite, so welcome here for the first time. You've been here a million times, although never here. You've been on this show a lot.

Yeah. But this is your first time you've been here. It's lovely to be here. You've been on this show a lot. Yeah. But this is your first time you've been here. It's lovely to be here. Well, let's shake hands. This is the first time we've done it. Okay. And Quam, of course, was practically my co-host

during COVID. He was here so often. Anyways, let's start by looking at the latest numbers for COVID-19 in Ontario. This is from Public Health Ontario. The period examined August 25th to September 21st of this year. COVID-19 cases in Ontario.

Positivity, 18%. Outbreaks, 420. August 25th to September 21st of this year. COVID-19 cases in Ontario, positivity 18%, outbreaks 420, hospitalizations, yes, people are still being hospitalized for COVID, 764, and deaths 49. People are still dying of COVID. Isaac Bogos, start us off here. Should we be concerned about those numbers? Forgotten by many, but not gone.

COVID is transmitted year round. There's parts of the year where we see more COVID, for example, fall and winter, but it did not go away in the summer and it will not go away. People are still getting sick with this infection. We know what the risk factors are for severe infection, like hospitalization and death,

and the virus is continuing to do exactly what we would expect it to do. It is making older people and people at risk for severe infections, like those with underlying medical comorbidities, ill. They're still coming into hospital. Sadly, they're still succumbing to this illness. We do have tools to help reduce the risk of infection.

Perhaps we're not using those tools as well as we could be. Let me rephrase that. We are not using those tools as well as we could be. And we have a duty to do so to protect the population of Ontario, the population of Canada, and from an equity standpoint, of course, the population of the world. Dawn Bowdish, we are hearing that disproportionately older people are still suffering from COVID.

How are they getting it now? Same way any of us are getting it. Ironically, we think of older people as being the most likely to get hospitalized, but actually they're not the most likely to get infected. It's actually young working age people who are the most likely to get infected. So one of the reasons older adults get infected

is socializing with friends and family, just as we all do. And so I think that's an important point for families to remember. I always say vaccination is a family affair because you do it not just for your own personal health but you do it to protect the older adults and the vulnerable around you. And I think that's a message that families can take into the holiday season. What are vaccination rates looking like nowadays compared to when we were in the thick of it? Well finding a vaccine is pretty difficult actually. Though we've got COVID being an all year round disease,

we don't have access to vaccinations all year round. So we're still waiting for the latest version to come. So vaccination rates have decreased. People didn't get into the habit of having COVID vaccinations like they have others. And there's not the same push, say for instance, there is for seasonal flu. And so vaccination rates are low. I want to go off the page for a second here and just call an audible because when you three showed up today you had a mask on, you had a mask on, Quam, Isaac you did not, and I want to have a little bit of discussion here about why you

made those decisions. You want to start us off? No. I'd love to hear what they have to say first. Okay, fair enough. Dawn, why did you have a mask on? For me, there's sort of a mix about my duty to the people I study and care for. So I study vulnerable people and older adults in long-term care, and it behooves me as a young person to prevent the spread of infection to the vulnerable people around me. But I'm also concerned about my own health.

I am in the prime group for getting long COVID. That's 40 to 60 year old women. And as well, even if it wasn't long COVID, having a serious respiratory infection does contribute to long-term health issues. So I think of it as easy, it costs me nothing, it's an investment in my health. And lastly, I did not want to get sick and infect you

because you need to be doing the great work that you do. Oh, shucks. Thanks, Don. You can come back any time. Quam, why were you wearing a mask? Very similar reasons. Masks protect you, but they actually have a bigger protection for other people.

And I think it's important that when we have a public health emergency, like COVID, I mean, we're still talking about 50 people dying in a month or 600 a year. These are preventable. And if there's a small, easy thing I can do, which is put on a mask to help prevent the spread of the virus, that is something that I will do day in day out. I don't like wearing masks, right? But it's a simple thing to do in public. I came in,

you're wearing a mask, I put on a mask. I get on the subway, I put on a mask. I think it protects me but it's also my duty to others. This is not about mask shaming here, just so you know, but you were not wearing one, how come? No, I wear masks in certain situations, but certainly not all situations. We know what masks do, we also know what they don't do. And of course, they can reduce an individual's risk

of getting an infection, and that's important for a variety of reasons. We also know that it can protect other people if someone is infected and they're pre-symptomatic or even symptomatic and able to transmit this infection. I work in an acute care hospital. I put on a mask frequently in hospital settings, not just to protect myself, but of course to protect those around me.

But I don't wear a mask all day, every day, in every interaction. I know what the data is. I know what the strengths and weaknesses of the data are for risk of infection, risk of chronic complications, I know what the data is. I know what the strengths and weaknesses of the data are for risk of infection, risk of chronic complications of infections, risk of transmission. And I think at the end of the day,

I think what our duty is really to enable people to make smart decisions for themselves. And some people will choose to wear a mask. Some people will choose not to wear a mask. Some people will choose to wear a mask in various situations. But I think if we enable people to make good decisions for themselves based on their own risks, and and as you pointed out, you know, the risks might not just be to that

individual but to their household and family members, I think we're doing something right. Let me pick up on that because you had the mask on when you came in, you are obviously not wearing it right now. I say that for people listening on podcasts who can't see. Are you taking an inordinate risk by taking the mask off right now? We are sitting two feet away from each other. What do you think?

Well, I think we're in a big area room. There's not very many of us in this room, so I'm not really worried. On the subway, I will be masked because that's a really different situation. So I think it is about risk. I mean, we all have to make decisions about how much socializing we're comfortable with,

with mask on, mask off. You know, if you think of having a risk sort of budget for the day and the people you want to protect, I want to keep myself as protected as possible so I don't infect the people I care about so I can spend more time with them unmasked, especially the vulnerable people in my life. So it's a risk assessment.

Some people wouldn't be comfortable with this level of interaction, and I would encourage them to keep their mask on. I'm comfortable with this level of interaction, and I would encourage them to keep their mask on. I'm comfortable with this level. So that's my decision. I mean, very similarly, I thought about it and thought, should I have a mask on in this conversation about COVID to make the point about the need for masking?

But as you say, you have to balance the risk, but also can anybody understand you? It's interesting when you do things like the Emmys, the Oscars, those big occasions, they all have COVID protocols. And when they shut down the COVID protocols for the Olympics this summer, they started having problems. So it's interesting people are doing risk assessments and coming up with risks you know if you can't be shut down for six weeks because that will shut down a half billion dollar film. That's pretty serious. People decide they're going to take a different risk assessment. Can I add one thing to this? you know, obviously no shame whatsoever for whatever people choose to do and

Appreciating that everyone has different risk thresholds risk perceptions risk calculus That's important and appreciating that different people are going to do different things fine Part of that calculus is we have some tools to help reduce the risk of infection. They're not perfect, but they're good, right? Masks, we know improving the quality of air in indoor environments is helpful. Is it perfect? Of course not. We know vaccines are helpful,

but of course they're not perfect. But also factored into these equations are, this is never going away. This is for forever, and I think that needs to be acknowledged, right? And of course, we should take tools to help reduce the risk of infection. But this isn't something that's going

to be over in the next year or the next two years. Let me pick up on that. Do you think we, and when I say we, I mean not just the public, but governments, everybody responsible here, not you, but others, have become somewhat complacent about COVID now because we are not, you know, we haven't shut down schools, we're not shutting down cinemas, malls and all that.

We're kind of, kind of sort of back to normal otherwise. I think complacency is a huge problem. I think one of the things that I wish we'd done differently during the pandemic is we reported so much about deaths and hospitalizations. I work a lot with older adults. And for older adults, sometimes dying is not the scariest thing. It's losing independence and the ability to live a good life. When I see those hospitalization stats,

every number there to me is a family who's going to struggle to help their loved one get back to the level they were. When you're middle-aged and older and you're in the hospital with a serious infection, COVID or any other infection, the chance of going back to the life you once had is small and we don't have the resources to do that. It's estimated that only 2% of Ontarians get rehabilitation care, which is evidence-based practice for recovering from a serious hospitalization. Our family practices are completely overwhelmed because one of the things that happens post-hospitalization

is what's called increased medical complexity. You might have a heart attack next. You might need some help getting mobile again. So the complacency here upsets me because it's straining so many of the other systems and we're not putting two and two together and attributing the stress in our family practices, the stress in our hospitalization, our healthcare worker burnout, to the fact that we have a lot of hospitalizations still for COVID because there's a lot of COVID going around.

Who do you blame for the complacency? I think I will put some blame on government policies. You know, it's hard for people to know how serious it is. And we discussed earlier how hard it is to get a vaccine. As I always say as an immunologist, actually any COVID vaccine provides some protection. So when somebody's starting chemotherapy, maybe they're going to the hospital for a major surgery.

There are lots of good reasons why you should get vaccinated right now if you have something like that coming up and you can't. And as well, we don't have access to testing. COVID's an unusual infection because we actually have a treatment that helps keep people out of hospital, which is Paxlovin, but it only works in the first day or two that you have COVID.

So without the testing, without the public knowledge about that, without any of us being able to say how much COVID is there around, it's difficult for people to make that risk calculation. Feels Isaac like the provincial government, and I, okay, I'm gonna be careful how I say this, but they're reading the room. They're pretty good at public opinion.

And public opinion is, we're done with this. So do you blame them for not leading the way? I wanna politely push back on a few items. Sure. Think about the levers we have to pull, okay? Said another way, what are you going to do different? We're well past the era of mandates for vaccines and for masks. Like that should not even enter the equation. Okay. We know this virus is never going away. We know that we can improve

the indoor air quality and that's a, there's a big push to do that, and that's a good thing. We know that many people can choose to wear masks. But again, like I said, we're well past the era of mandates. We know that vaccines do not block infection and transmission nearly to what they did earlier on in the pandemic. They still have some capacity to do that to a lesser extent and for a shorter duration, but the heavy lifting

of the vaccine is to significantly reduce the risk of severe manifestations like hospitalization and death. We know that the therapeutics, Paxlovid, based on the most recent data, probably, keyword probably, helps those only at greatest risk for severe infection and doesn't really have much utility in a vaccinated or infected and recovered population that's younger with fewer risk factors.

So like this virus is here and this virus is gonna continue to circulate. And we of course can take steps to protect ourselves and protect those around us. I just have to, I think we have to be realistic about what tools we have and the utility of those tools, which is kum si kum sa. And to one other point that's semi-related, thinking that an infectious disease specialist,

an immunologist, an ethics experts are going to navigate this. Yeah, we're helpful, but like we really need behavioral scientists and the integration of behavioral scientists into communication, epidemic management, pandemic management is extremely important because to your point, you know, how do you read the room? How do you reflect doing the best you can to protect individual and population health with what is the will of the people you're working with because that's going to be different in different populations. Well let me ask you about what was... Behaviour sides because I'm a psychiatrist. I was actually going to ask you about long-term care homes

because that was ground zero for many people when COVID was at its worst. Have we learned enough? Are we employing what we have learned to ensure that long-term care homes are safer today? So I'll come to that in just one second, but just want to pick up on something that Isaac said. One of the things we know about COVID at the moment is it's not the same as most infections. It increases the risk of a number of physical illnesses and there's a risk of long

COVID. And the more often you get COVID, the more likely you are to get long COVID. So if this virus isn't going away, then part of the calculation we have to do on risk, and also the calculation we have to do on public policy is around what happens over a period of time where more and more people have been rein have been infected more times and therefore we have an escalating number of people with long Covid. If you do the math that way you start thinking that some of the public health measures that are in our arsenal are things that we should be employing more now to prevent the long-term problem.

People think COVID is just like having a cold. It's not. And that is our public policy problem at the moment. Is the calculation around acute infectious disease is one thing, but the calculation around what you do about a much bigger long-term risk is another thing. And that's where the behavioral science and the psychology comes in.

Because as you said said people are done with this they want to forget they want to believe that they've woken up from a nightmare and it it's not a problem but it's just not true. Okay how about long-term care homes? I'm gonna get... Well long-term care homes are interesting to me because obviously just before the pandemic we decreased the amount of inspections we were doing. That was one problem. We didn't have good infectious disease protocols in long-term care. That was the other problem that we had.

And then we had to make a decision and we made a decision during COVID that we were going to prioritise hospitals and acute care and ICU beds and we were not going to prioritise long-term care. Which in some ways that was a decision that we made but we can see from different decisions that were made in BC or decisions that were made in places like Germany is if you actually put more PPE and protocols and time and policy into long-term care you decrease the deaths. So we had a disproportionate number of deaths in long-term care homes partly because we made the decision not to focus on them. So that is something that we should have learned

during the pandemic and something that we haven't learned now. Because one of the interesting things from Ontario was your chance of death in the long-term care home, I understand from the figures, were greater if you were in a private long-term care home than if you're in a private long-term care home than if you're in a public long-term care home. So there are things we could learn, prioritise the people at greatest risk, think about inspection

and protocols in long-term care homes, but also think about what happens when you have for-profit compared to not-for-profit and where the values and the value stream happens in those settings. So if you want to expand long-term care and the virus is going to be around forever, do you want to expand it in the for-profit or the not-for-profit sector? How do you want to deal with that? And I don't think we've learned from that, as we should. Let's ask Dawn whether four and a half years into this thing we now have a good enough understanding of what the lasting effects of COVID are on people. You know it surprises people to hear that any

serious respiratory infection has long-term health consequences. So for example being middle-aged or older and being hospitalized for pneumonia, influenza, et cetera, accelerates risks of dementia, cardiovascular complications. And COVID seems to be worse in many cases than that. So again, one of the things that we need to think about in this calculus is not just the cost of the acute care,

but all the care people need afterwards. Do we have long COVID sorted out? No, we don't. But even if you took that away, even just the cost of acute care, but all the care people need afterwards. Do we have long COVID sorted out? No, we don't. But even if you took that away, even if you took long COVID out of the calculation, you'd still see that people's COPD is being exacerbated by COVID infections like others, and that's the number one cause of hospitalizations in Ontario. You'd see that people are still having cardiovascular events that are attributed to COVID, just

like any other respiratory infection. And that increased medical complexity puts a strain on long-term care, because sometimes people can't leave their hospital to go to their home. They need respite care, which we do not have enough of in this province. They need long-term care beds. That increased medical complexity

is not budgeted for in family practice. So our family practice is based on the health we had 30 years ago, not the age and the demographics of the people we have now. So all of that has to go into the calculus of how we treat COVID and frankly, other serious respiratory infections as well. Isaac, down our last few minutes here,

and I wonder if you could help us understand what the consequences of us forgetting what the last four years have been like as we look at the future, and in particular, winter. Okay, you don't need a crystal ball to predict the future. We're gonna see a lot of COVID in the late fall and winter. We are, we know that, everybody knows that. We certainly know what we can do about it.

We have vaccines, unfortunately not this minute, but hopefully rolling out soon. We know those are going to be especially important for people at greatest risk for severe infection. And we need to lower barriers to vaccination, really. Continue to bring vaccine to the people rather than people to the vaccine. We can improve the quality of our indoor air

to help reduce the risk of distant transmission. We can enable mask wearing in indoor settings, especially for people who are more vulnerable to this infection. That's pretty straightforward. But a 30,000 foot view is we also have a crystal ball in that this isn't the last pandemic, right? We know we're going to have another pandemic.

Of course we're going to have another pandemic. There's a short-ish list of pathogens that would be considered higher probability. But there are significant lessons learned from COVID that should be applied to creating not just a safer Canada, but a safer planet, because no country is an island of obviously these pathogens, pardon me, these pathogens do not respect political

boundaries and we can be doing a lot more as a planet to help prevent, detect, respond, quell future pandemics. There's significant, a significant number of emerging pathogens out there and I think my biggest concern is there are many lessons we can learn from COVID, but not a lot of them are actually being applied to create a safer world. How big a problem do you see amnesia being right now? Amnesia, I think, obviously, people want to forget COVID. Obviously, there are governments who,

from an economic perspective, who want to get COVID. Obviously there are governments who from an economic perspective who want to get business as usual and on top of that there are people who are using COVID and certainly the lockdowns and others as wedge issues and so there are people who are being mischievous around COVID. So I think there are lots of reasons why people are pushing the amnesia. But I would like to now we're talking about the brain. Just remember that COVID, in the three months after COVID, you have a significant increase risk of having a mental health problem, depression, anxiety, various other things,

cognitive deficits that go with long COVID. So there's this big mental health burden which has come through COVID. And during the lockdowns, we had increased rates of intimate partner violence plus substance use, which also have a long-term impact. So one of the things I think when we're thinking about the next pandemic and the things we've learned from this pandemic is don't forget mental health. It's high on the list of important subjects that you need to be thinking about and you need to plan for for this pandemic and the next. We are underfunded in Ontario with regards to our mental health services, way underfunded.

And we need to boost that if we are going to properly deal with pandemics. Some good advice from three people who know. Dr. Baudish, Dr. Bogosh, Dr. McKenzie. Good to have you three with us here at TVO tonight. Many thanks. And yeah, let's go put our masks on after this. Probably a good idea. Thank you all.

Thank you. Thank you.