The Bridge with Peter Mansbridge - Back to the reality of the Pandemic.

Episode Date: September 27, 2021

You don't want to miss this.  A feature interview with Dr Isaac Bogoch of the University Health Network.  If you feel out of touch after weeks of politics with the pandemic this is what you need.  We cover a lot of ground here from kids, schools, teachers, boosters, attending major gatherings -- its all here with the authoritative, no-nonsense voice of Dr Bogoch.

And hello there, Peter Mansbridge here. You are just moments away from the latest episode of The Bridge. It's time to talk pandemic again. and carefully crafted with the highest quality ingredients, starting with quality animal ingredients, balanced with whole fruits and vegetables. Akana pet foods are rich in the protein and nutrients your dog or cat needs to feel and look their best. Available in grain-free, healthy grains, and singles for sensitive dogs. Akana, go beyond the first ingredient. And hello there, Peter Mansbridge here. And yes, after five weeks of politics every day,

we're going to try and remind ourselves of what we're in the middle of. We're still in the middle of a pandemic. And in some places in the country, it's been a very difficult time. It's been the fourth wave. So who better to catch up on this story with than one of your favorites? And that was proven in the last 18 months when a regular visitor to this podcast, to this program, to the bridge, was Dr. Isaac Bogoch from the University Health Network in Toronto,

but an advisor and a consultant to governments right across the country. And Dr. Bogoch has been great with us, and, you know, he gives us the real goods, and sometimes it's hard to listen to. And he's sometimes pretty frank about the challenges behind the scenes as well. So the idea here was to catch up on where we are, how we're doing, what some of the big challenges are right now, and you know them, and I get them, you know them almost daily from you in emails. I get them from parents.

I get them from kids. I get them from school teachers on the school question. I get a lot about boosters. Should I have a booster? When should I have a booster? We want to talk about that. We want to talk about the kind of opening up that has been going on on some levels

for vaccinated Canadians, double-vaxxed. And in the last week or so, and in the next week or so, you're going to be hearing a lot more of that as different provinces make decisions about how open they're going to be for, say, hockey venues or basketball for the Raptors or dance halls or you name it. So I want to talk to Dr. Bogoch about that and how comfortable he is suddenly seeing thousands of people congregating together.

I know they're double-vaxxed, but I still want to know how comfortable he is on that front. So all of that in a moment, but because we have not dealt with COVID and the pandemic for weeks, it's been all politics all the time here at the bridge. Let's just catch up on some basic facts. The big picture, first of all, the world. There have been 231 million cases since the outbreak began.

4.74 million people have died. The highest death rate in the world, that's deaths per million of population, is in Peru. 5,937 per one million. The U.S. is 20th, 2,109 per million. Canada is 88th in the world, 723 deaths per 1 million population. Canada's had 1.594 million cases, 1,594,000 cases.

27,581 people have died. That was, these numbers are as of last Friday. Vaccines, 2.5 billion people are fully vaccinated around the world. That's 32.5% of the population. A third of the world's population is fully vaccinated. Canada has 26.6 million fully vaccinated. That's about 71% of the population. That's among the very best in the world. The best in the world is the UAE, the United Arab Emirates. It's at the top, 83%. The USA, our neighbors to the south, 55% fully vaccinated.

There are a full 16 percentage points behind us. And as good as our numbers are, the pandemic is not over here. In the last seven days, we've seen 30,000 cases. That's about 4,300 a day. It's largely a pandemic of the unvaccinated. Of those who got COVID in Canada this week, or last week, 86.8% were not vaccinated. Just 2.6% were fully vaccinated. Of those in hospital with COVID, 84% were unvaccinated. 2.2% were fully

vaxxed. Of those who died, 81% were unvaccinated. 3% were fully vaccinated. In the last seven days, the case counts have gone wild in Saskatchewan and Alberta. Cases per million population, Saskatchewan, 2,808 cases per million. In Alberta, 2,555 cases per million. And by way of contrast, in British Columbia, there were 941 cases per million. In Quebec, 605 cases per million. In Ontario, the most populated province in the country, 314 cases per million. All right. I've, you know, blasted you with facts and figures, numbers.

You kind of need that for context as we go into this interview. So once again, Dr. Isaac Bogoch. Here he is on the bridge. Let's go. Well, I guess the last time we talked was June. It was kind of a different world then on a lot of fronts. But really, in many ways, what I want to try and achieve here in this next 20 minutes or so is to try and kind of bring us up to date, really.

There are few people who have had more experience on this situation than you have in the country. So you've been involved since day one, really, on this situation than you have in the country. So you've been involved since day one, really, on this. We've learned a lot, obviously, about COVID since day one. But there are continuing series of surprises on this. For you, what's been the biggest surprise in this last 18 months? I think we know how to control this. It's pretty clear over the last year and a half, we obviously don't have all the answers, but we have a lot of the answers. And certainly, we know how to control this in indoor settings. We know where the virus is transmitted. We know

how it's transmitted. We know who gets it and where they get it and how they get it. We know how to control this in indoor settings. We know where the virus is transmitted. We know how it's transmitted. We know who gets it and where they get it and how they get it. We know how to create a safer place for people. So what astounds me is that we continue to make the same errors over and over again and get surprised when we do so. That's one. I think the other area that is, I don't know if it's surprising or not, but when you have a policy and you see that this try and say, you know what, we're going to, we're going to open up shop here. Like we could debate whether or not at the time that was reasonable or not. And, you know,

some people obviously raised concerns, but clearly it wasn't working. And clearly it wasn't working well before they reached the crisis that they're in right now. And the question is, if you knew it wasn't working, why not pivot quickly? Because you know how it's going to end, right? I think people are still surprised at exponential growth. And at this point in wave four, we shouldn't be surprised at exponential growth. We should know what exponential growth is. We've been there, done that three other times. So I just don't understand why people don't pivot when it's clear they're going down the wrong pathway. Well, I mean, should people be accountable for that? I mean, when you say like people don't pivot, I mean, those people are, are officials, right?

They're governments, they're public health officers. They're any number of different things. I mean, should there be some kind of accountability for that or is there accountability? I don't know. I mean, I think the story isn't written yet and we're still in the middle of this. I think we're probably at the tail end of it, but we're, we're not, it's not over yet. Maybe there will be accountability. Maybe there won't be. I don't know. There should be. You know, we certainly need to do part of the term a postmortem.

But we do. I mean, we need to look back and see what was working well, what was not working well. Why were certain policies taken? What was driving certain policies? What were the barriers to shifting gears when things weren't working in certain places? And, you know, obviously, I don't think it's going to be as simple as many people would like to believe, right? I appreciate that there's lots of moving parts and that, you know, turning on a dime is easier to say than it is to do. But having said that, I mean, these aren't normal times. And I wish we would appreciate that these aren't normal times. And many of the rules are out the window, and we should be much more nimble, at least at

this this phase. And, you know, not all of it, but some of it's even related to communication, right? People feel caught off guard, people feel the goalposts are changing. And they're right. The goalposts are changing as they should. If the virus changes, Delta variant, the goalposts change. You have to adapt to stay two steps ahead. And I don't think we've done that very well. We've probably done it better than many other parts of the world, but there's certainly room for improvement here. So we've got to be able to adapt much more quickly. We've got to stay two steps ahead of this thing, and we've got to communicate uncertainty and also the fact that pivots are likely to happen along the road for expected things and for unexpected turns. You know, you've been in the room when a lot of these things have been discussed and options have been tossed around.

Would we be surprised if we'd been inside that room? The short answer is yes and no. And obviously it depends on the room, but, you know, sometimes things are glaringly obvious and you're just, you, I'm sitting on my hands here because there's a lot of this. Sometimes these are obviously private and confidential conversations. And anytime I speak with a senior leader in health or in politics, the first thing I say is obviously we're just talking in confidence and feel free to chat because obviously if we want to make change, you have to feel comfortable around each other. People have to know they're not going to get blown out of the water publicly for just thinking of something or opining on some area. And obviously, I'm not shy. I'll let people know what my opinions

are. And sometimes people listen to them, sometimes people don't. But I think that, you know, sometimes this far in, sometimes you hear certain ideologies or understandings or lack thereof of basic scientific processes that I think are pretty well known in the general public right now. And that, you know, when you hear that around certain decision makers, you know, you you hear that around certain decision makers, you know, you sometimes can't get surprised at why we are seeing policies and heel digging in here and there. Having said that, I think there's also, you know, many people would might disagree with me on this, but behind the scenes, there's also some very good quality people and some very intelligent people and people that know how to navigate

back rooms. And I've been very, very impressed with some senior political leaders and some senior public health leaders. And a lot of this isn't really transparent and apparent to the general public, but you see some very skillful maneuvering. And obviously, there's more than meets the eye. It's been very impressive. And then it's not just with senior public health or political leaders. It's also with people that no one's ever heard of. You know, some anonymous bureaucrats who are just wonderful, smart, hardworking people that really know how to pull the strings behind the scenes to get things to happen. And it's really impressive to watch that. I'm not asking you to break any confidences and nor would you, I know.

I guess what I'm getting at, there must be times when the medical people like you who've been inside the room with the patients are now inside the room with, you know, the bureaucrats or the politicians or whoever is you know very influential in the final decision making process that must be frustrating i mean it's part of the system and you need that kind of system to operate on any different number of different levels not just on the health care field but it must be frustrating when you've been up close with a patient and then suddenly you're in this other room trying to make decisions yeah sure it is at times and you know if you talk to any health care provider over the last year and a half it's no i don't think anyone's had an easy ride

anyone who's done hospital-based medicine and outpatient medicine has had some significant challenges right we've all had tons of patients die. We've had our, more than our fair share of, you know, awful Zoom deaths. And, you know, it's been tough. And then now that we're in the vaccine era, when you see people get really sick and land themselves in hospital, and you know that this was 100% preventable, it makes it even more challenging. And then you sort of sit down in the other rooms, as you point out, and use some of those experiences to help drive policy. Sometimes they get it right. Sometimes they're not quite there. And like anything else, you know, it's like pushing an elephant, right? It just takes time and pressure, but eventually it'll

move in the right direction. I want to get into some areas you'll feel more comfortable discussing, even though the topic is so difficult um did i have those questions well enough yeah no listen you're you're very honest about it and and that's what i and our my listeners have always appreciated about you um i i want to sort of delve into a couple of areas and the first one is is kids uh and where we are in this so you know a month or six weeks ago there was great fear heading into the new school year um across the country about how this would unfold for kids uh and teachers uh how has it turned out um so far I know we're really just into it, but is it better than you thought it was? Is it about what you thought it would be like, or is it worse?

It's two things. One, it's kind of as expected, which basically means it's a little bit soon to tell, but I think if you're watching the data closely, it's not necessarily headed in the right direction. And it's subtle, but it's there. If you look at transmission among school-aged children, certainly there are growing rates of COVID among school-aged children. The obvious arrow is to point to schools. But of course, we should also be looking at extracurricular activities as well. We know that there are lots of those, be it arts, sports, you know, whatever. And as community rates rise, we know the probability of bringing the infection into schools goes up as well. Depending on where you're in the country, you have varying get surprised when you have a very, very contagious Delta variant, plus millions and millions of kids who are not yet eligible for vaccination, all clustering together in an indoor space. Yeah, sure. There's some masks. Yeah, sure. There's maybe some feeble attempts at distancing. There's some better ventilation. There's cohorting. There's other mechanisms to keep this at bay. But there will be some transmission. I think short story long, it's early. It's only

the tail end of September. We've got a long fall and a long winter ahead of us. The wheels haven't fallen off the bus yet. That's good. But no one can pat themselves on the back and say, job well done, because it's not even close to being over yet. We really have to be vigilant to keep schools as safe as possible and keep those kids safe, especially until we have vaccines rolling out in that age cohort that's 112. Okay, I want to talk about exactly that in a moment. But of the kids today who are getting COVID as a result of the situation that you just outlined in terms of the numbers and the way they are congregating together, how are they dealing

with it in a general way? So, in general, I think we have to acknowledge that, of course, at a very basic level, kids can get this infection, kids can transmit this infection, kids can get really sick from this infection as well. Now, most kids don't get really sick. In fact, most kids do very, very well. In fact, depending on the data you read, anywhere from 30 to 45-ish percent of kids have no symptoms whatsoever. And when you compare younger cohorts to older ones, younger cohorts just don't get as sick. But of course, they still can get sick. They can still land in hospital. They can still have really bad outcomes. It's just much less common. But of course, it can still happen. So if you look at this in southern United States, like what happened down there?

Well, there were no mitigation efforts in place. And, you know, even though a small percentage of kids get really sick, a small percentage of a very, very large number of kids getting sick ends up being a lot of kids getting sick. And that's why we saw those pediatric hospitals overwhelmed and heard about some very tragic cases in children. You've got to protect everybody. And that of course includes kids. I think that rolling out vaccines will be very welcome in the five to 12 year old crowd. I think it'll help obviously at an individual level. It'll also help significantly at a population level. How far away do you think we are from that?

I don't think we're that far. I mean, you know, maybe Christmas ish plus or minus Halloween to new year's like we're sort of in that, that timeframe, like late 2021, maybe early 2022 at the latest. Um, no, the data's there. They're submitting it to the regulatory bodies. Um, the U S will probably be pretty bullish on this. We'll probably see it around Halloween in the U S I wouldn't be surprised maybe a bit, a bit later in Canada. Um, you know, we don't really, I haven't, I haven't even seen the data.

We've just seen press releases, but, uh, obviously health Canada will analyze this, uh, back and forth and make sure that it's okay. I think the key thing here is obviously we have to be really careful. And, you know, I know everyone's well, many people listening might say, I can't wait to get these vaccines rolled out. But still, like, let's pump the brakes. But let's also pause and recognize that, yes, vaccinating kids is extremely important. But, yes, adhering to safe and sound scientific, medical, and public health principles is also very important. I think we have to acknowledge that, yes, this will certainly reduce the risk of getting COVID, reduce the risk of transmitting COVID to others, reduce the risk of getting a severe infection,

which is already very low to begin with. But you can't ignore the potential side effects. I mean, obviously, everyone's watching this inflammation of the heart that's called myocarditis. You know, I think it's still debatable and under investigation as to what is the true incidence of myocarditis in younger cohorts like the 12 to 30-year-old crowd. We know it's more common in younger groups. We know it's more common in men. We know it's more common after the second dose.

But what's it going to be like in the five to 12-year-old crowd? These are important questions. And the clinical studies that were done don't entirely address that question. They only enrolled about 2,500 kids in some of these studies. And if this is something that happens at a rate of one in six to one in 10,000, you're not going to see it in those early studies. You only see it after it rolls out. So yes, everyone wants these vaccines, or most people want these vaccines, but we still have to be very careful and watch this closely. You know, just the way you've answered that question, a lot of the things you've just said in the last, you know, two minutes are going to have an impact on parents.

Parents who are not anti-vaxxers, they're hesitant when it comes to their kids. And they're going to be hesitant, one assumes a proportion of the parent group are going to be hesitant when and if vaccines are approved for kids in the 5 to 12 zone. And, you know, even if they've had vaccines themselves, they've had both vaccines, they're fully vaccinated, the parents, and yet they're going to be nervous and hesitant about their kids for some of the reasons you mentioned, even if they're approved. How are you going to deal with that? I mean, quite frankly, the same way we deal with it in older cohorts. You take it seriously. I don't like the shaming and blaming.

I don't think ostracizing people helps. I don't think it just polarizes conversations and makes things more challenging. Like anything else, I think we've got to do a lot of listening. We've got to listen to what people's concerns are. We have to treat this and approach this with empathy. Because if there are people who are on the fence, you know, pointing fingers and, you know, painting them with the same brush as you're painting, you know, people who are completely anti-science, it's not going to do anything. It's just going to further push people to the fringes. And at the end of the day, what's the goal here? Like, we have to remember

what our goal here is. Our goal is, let's get out of this pandemic and let's do it in the safest manner as possible. And the way out really is by having as many people as vaccinated as possible. And to do that, you actually have to sit down and listen to what people's concerns are. You have to address them head on. Listen, I think it's pretty clear when that five to 12 year old cohort gets the thumbs up, there's going to be some people stampeding toward getting their kids vaccinated. It's pretty clear that there's going to be some, I don't know what percentage, but there's going to be some people in that.

There's going to be some people that no matter what, no matter what, they will not get their kids vaccinated. It doesn't matter the reason, logic, science, data that's presented. They're just not going to do it. There's going to be a ton of people who are sitting on the fence and I don't know exactly what they're going to be waiting for. Maybe time, maybe more data. Maybe they just don't feel comfortable yet. Maybe they need a conversation with their family doc or something like that, or to chat with neighbors to see how it went. But whoever those people are who are sitting on the fence, obviously, I think it's going to be a heterogeneous group of people. There's going to be a lot of people that have different reasons for not being vaccinated, ranging from questions to barriers to, you know,

you name it. And we have to treat them, you know, in an empathetic manner. You mentioned family doctors, and I'm just wondering, have family doctors been utilized enough on this? We got a lot of family doctors sitting there who normally give vaccines to their patients, young and old, on a variety of different reasons, but not on this. Yeah, early on, no, early on, at least in Ontario and many other provinces, they weren't utilized to their full extent. And it was very challenging. I'm not patting myself on the back by any means here, but, you know, day, I don't know,

three or something after they named the people on the Ontario Vaccine Distribution Task Force, I reached out to senior leadership in various parts of the province, various sectors. One of them was primary care, which includes family medicine and nurse practitioners, and tried very, very hard from the earliest parts of the vaccine rollout to integrate and listen and get them included. And I don't think we did a very good job for the first part of the vaccine rollout to integrate and listen and get them included. And I don't think we did a very good job for the first part of the vaccine rollout, at least here in Ontario. Now, there's certainly much more involved. They can vaccinate in their clinics, and many are vaccinating in their clinics. But I think that came a little bit too late. Having said that,

here we are. They play a very, very important role because they know their patients well. They have longitudinal relationships with their patients. They know their context to which their patients live. They know their life circumstances, and they know vaccines well. So these are the individuals who will sit down, take the time, have a conversation, address concerns, overcome barriers, circumvent issues, and really do a lot of the heavy lifting, especially with the people who need vaccines now. There's a lot of people who, like we said earlier, a lot of people were stampeding towards vaccine centers to get it. But this is the harder bit now. We're working on the last 15-ish percent of eligible people

who are not yet vaccinated. And the family physicians and nurse practitioners and public health leaders are really doing a lot of heavy lifting, reaching out to these under-vaccinated communities to promote vaccinations, to address hesitancy, and to circumvent barriers. And they're doing a good job. It takes time. It takes a lot of time, but they circumvent barriers, then they're doing a good job. It takes time.

Like, it takes a lot of time, but they're doing it, and they're doing a good job. Boosters. A lot of talk about boosters now. I hate boosters. Okay, well, tell me that. Oh, God. Thanks, America, for ruining everything yet again.

So, okay, like, this shouldn't be complicated, but of course we have to make it complicated. For starters, everyone's watching what the United States does and will ask, why are we doing this or why are we not doing this no matter what they do? I mean, we have to obviously timestamp every conversation we have. As of September 2021, if you're in Canada and you're immunocompromised, and that definition is beautifully laid out on the provincial health websites and on NACI's website, you can get a third dose of a vaccine. Great. Pretty straightforward. If you're living in a congregate care setting,

like a nursing home or a long-term care setting, you can get a third dose of a vaccine. Great. And that's happening in many provinces right now. It's rolling out quietly in Ontario, for example. That's where we're at right now. And that's data-driven. That's smart. And we'll probably and that's data driven. That's smart. Okay. And we'll probably see this umbrella gradually expand. Maybe it'll include community dwelling seniors. Maybe we'll fight for a little while about what the age cutoff is and make that a big issue. But like, really, we can do this. And, you know, at some point in time, I don't know when, but at some point in time, we're all probably going to need a third dose of this vaccine. We just don't all need it yet. Right now, it's immunocompromised, it's people in congregate care settings, and maybe some community dwelling seniors. That's

pretty much it. The United States had this huge thing, I don't want to get into it, but they had the FDA, then they had their equivalent of Nassau Pine on it. Then they had Dr. Walensky who runs the CDC talk about it. Basically, I think what's going to happen is it's just going to be a giant free-for-all and everyone's going to run out and get a booster and say, oh, I'm a smoker. Oh, my body mass index is high. Oh, I've worked in a grocery store once. I just think that the way they framed it, they tried to pretend to curtail it a little bit, but they didn't. And I just think it's going to be a free-for-all. And the problem is

that has ripple effects because everyone's watching them. And now it's not even... Of course, we're starting to get questions, tons of questions saying, well, I worked in a grocery store once. I might've smoked a cigarette 20 years ago. I had high blood pressure measured once three years ago. I need a booster too. And the answer is, yeah, you might need one soon, but you don't need one now. And remember, we've got the vaccines. There's no shortage here in Canada.

We've got them. We can and are giving boosters. But let's do this in a smart, data-driven manner. This is not Halloween candy. It's a vaccine. You've got's do this in a smart data driven manner. Like this is not Halloween candy. It's a vaccine. Like you've got to do this in a responsible way. It's a medical and public health intervention. You've got to do this right. And in a data driven manner, like I would not be giving a third dose of a vaccine to an otherwise healthy 12 to I'm just making up a number 30 year old person right now. Like if they've had two doses of a vaccine,

what's their risk of having a severe outcome from COVID-19? It's about 0%. Like it's not zero, but it's getting pretty close. If you've had two doses of a vaccine, you're probably not going to land in hospital. Like that risk is exceedingly small for certain age cohorts. You don't need to give boosters to those people. And I think we're going to see some of that in the United States. And a lot of it might not even be documented. I think people are just going to walk into their local CVS pharmacy and say, I'm at a criteria, I want a

shot and get it. But is there not evidence that the effectiveness of the second dose and the first dose, I guess, is beginning to wear out? That there is a timeframe here at which you should be, no matter what age you are, no matter whether you have underlying conditions or not, that you should be thinking about this. So we absolutely should be thinking about it and we should be timing it correctly. But like, is there waning immunity? Maybe, depending on the data you look at, maybe there's waning immunity. And if there is, it probably isn't at this point in time, very significant. Now, the other thing I think we should be talking

about is slightly different from waning immunity, it's not mounting the same degree of an immune response as others. So for example, if you take immunocompromised people, if you look at people over the age of 65, for example, if you look at those who live in congregate care settings, it's not that there's necessarily waning immunity, it's that they're not going to mount the same robust immune response as a younger population has. And we should be thinking of this as they've received two doses of a three dose vaccine series. I mean, listen, we've known this long before COVID-19. There's a reason people over the age of 65 get a high dose flu shot and not the regular dose flu shot because they need an extra kick for

their immune system. There's a reason we give immunocompromised people a double dose of the hepatitis vaccine and not a single dose because they need that to mount an immune response. And the same is very likely true. Well, it's definitely true for COVID-19 vaccines. There's some people that don't mount the same degree of an immune response. They're susceptible. And yes, there probably is some element of waning immunity, but I think the heavy lifting, at least at this point in time, is just not mounting the same degree of an immune response. And that's why there's some people that need that third dose. Semantics are kind of important, and you'll hear more and more people talk about this as a third dose rather a booster, but the semantics behind it are somewhat important, at least in professional circles, because if it is a third dose, it's really the third dose of a three-dose vaccine series rather than you finished your vaccine series, you've had waning immunity,

and now you need a booster shot. Any reason to be concerned if you, because the third dose appears to be, it's Pfizer, right? That's what we're stocked up on, Pfizer. Does it concern you at all if you've had two doses of other vaccines? No, not at all. If you end up with Pfizer? No? No, no. I mean, I think the data is pretty good. You can pretty much flip a coin Pfizer or Moderna if you're going to get a third dose.

They're going to be great. In fact, I know for whatever reason in Canada, we've loved Pfizer. Remember people were saying no to Moderna and going to get Pfizer. But like, if you look at the longitudinal data, you know, Moderna probably has a bit of an edge over Pfizer in terms of mounting an immune response. And, you know, does it matter? Not really. I mean, it's like, you know, I gave another example somewhere else, but it's like Laphroaig versus Ligavulin, like they're both amazing. Like it's not a big deal, whatever you get. But, you know, maybe,

maybe later on, this will impact the timing of a third dose if we see that there is waning immunity with one faster than the other. But for now i don't think it that knowledge is going to drive any meaningful policy shift at least today maybe in the future it will but not not today all right i'm going to get you into a an area which i know you're comfortable with and that's that's hockey aha we're going to take a quick pause though first of all before we get to hockey. And this you will find interesting as well. So, stand by. We'll be back in a moment. This is The Bridge with Peter Mansbridge. and peter mansbridge back again you're listening to the bridge

on this monday as we kick off a new week end of politics we're talking pandemic our guest is dr isaac bogoch we're covering a lot of ground here. You're listening either on Sirius XM, Channel 167, Canada Talks, or wherever you've downloaded your favorite podcast from, you're getting the bridge on this day. Enjoying is not the right word for this, but I hope you're feeling a little more informed on some of the key issues around COVID-19 that are still with us here. this but i hope you're feeling a little more informed on some of the key issues um around covid19 that are still with us here all these months year and a half more later than when we

started all this um but we really appreciate the time dr bogoch has been spending with us and let's pick up our conversation because we're talking hockey. Oh, yeah. So all the NHL cities in the country are trying to come to grips with this now in terms of what kind of a crowd they're going to allow in the arenas. They're not all the same on this question, but let's take Toronto, for example, seeing as it's closest to you, and at the moment, they're looking at 50% occupancy in the arena. Now, you're a hockey fan. I don't know whether you're a Leaf fan.

You're probably an Oilers fan. Oh, are you kidding me? Don't you have an Alberta background? Well, remember, there's two cities. Oh, Flames. I'm sorry. Flames, whatever it is, you're probably not. You can tell.

Remember when Edmonton went to the finals a hundred years ago and everyone says, oh, let's rally behind them. That's Canada's team. Yeah. Not in Calgary. Everybody except if you're south of Red Deer, it wasn't. Everyone just cheered for them except Red Deer South. Okay. Well, let's say the Flames are playing the Leafs in Toronto. Are you comfortable going into the arena with the 50% occupancy? So short answer, maybe.

That's a hard maybe. Here's the deal. Everyone inside is vaccinated, or at least theoretically should be, depending on how robust this system actually is. Everybody's wearing masks. You've got 50% capacity, and apparently we've got better ventilation systems in these arenas. So let's look at this in terms of layers of protection. If everyone who's eligible for vaccination is vaccinated, that's 12 and up, great. How many under 12s go to these games? Not zero, but it's not going to be flooded with six-year-olds. Everyone's wearing masks, unless you're sipping a beer or having some nachos. You've got half the crowd there. Instead of 20,000, you've got half the crowd there instead of 20 000 you got about 10 and you've got good ventilation so there are some significant layers of protection having said that you know there's a lot of screaming people and like listen we know in indoor settings with lots

of people in crowded conditions that's where this virus is transmitted vaccinated people are less likely to get this infection but it's's not impossible. If you are vaccinated, you still can transmit it. You're just less likely to and will transmit it to fewer people. So, you know, then you put it into context. How are we doing now in Toronto and elsewhere in Ontario? Not bad. It's not amazing, but it's not bad. So when you look at the safety protocols and you look at the context of the community around, I actually

don't think that's a terrible idea. Having said that, I wish they would communicate uncertainty. I wish they would communicate risk. And I wish they would communicate that if things don't appear to be working well, they would pivot very much like what we talked about earlier on. Like you can't continue to do this. If you've got sky high rates of COVID-19 it's just not acceptable doesn't mean you have to cancel hockey it just means you have to rethink how many people you're going to let in the building okay you can do this and you can do this safely but you know this is not a one-way street forward you might actually have to take a few steps back and I wish they would communicate that better because I think people say yeah first we're going to do

this and then we're going to be you know packing the nosebleeds with 20,000 people. And maybe that'll happen, but maybe it won't. Then you take a glance left and look at Alberta. There's no wiggle room in the healthcare system in Alberta right now. They're talking about flying patients thousands of kilometers away to ICUs because their neighbors can't even accommodate the ICU patients. They're in deep trouble and will be in trouble for weeks to come. Even when cases start to decline, it takes a long time to decompress ICUs across schools. So they're in trouble for a long time. That's a very different context. Even if everyone's vaccinated, even if everyone's wearing masks, you can't afford even a little bit of transmission in a setting like that. So I think places like that have to really rethink it. It's not necessarily the same if you're in Toronto

right now versus if you're in Edmonton or Calgary right now. Context is extremely important. Pivoting is extremely important if things aren't working out. Communicating, this is extremely important so people don't feel the rug is pulled out from underneath them. So if it was you and your kids, it's a maybe. It's a maybe. I mean, I'm not trying to punt. Like, you know, listen, I've done like here's another example. You know, people say, well, are you going to go to the gym?

I'm clearly in the placebo arm of the steroid trial here. But yes, I do try to work out and stay in shape from time to time, even throughout the pandemic. And we know some gyms, people are a little nervous about masking and transmission in the gyms. I went. I went. I went with my mask, and I went ready to turn around and walk out if I didn't feel that

I was comfortable there. And I looked around, and there were very few people there and it was spaced out and it was well ventilated and everyone was wearing masks. My perception was, you know what, this is pretty reasonable. This is okay. I'm going to stick around. I felt like, listen, if it starts to get crowded or I just wasn't comfortable, I'd leave. I think we're all slowly tiptoeing our way around and seeing what we're comfortable with and what we're not comfortable with and you know i do the same with with with hockey okay although that's a pretty expensive uh ticket to tiptoe away out of that rink if you're not comfortable that sure is um okay last question uh one of your first answers in our chat today offered some glimmer of hope that we may be finally kind of near the end of this.

Can you expound on that a little bit? Why do you think? I know that's not the first time you've said that. We thought at the beginning of the summer we might be near the end of it um why are you feeling a little bit more positive at this moment even though as you point out you know we're in deep trouble in some places some parts of the country uh but you're you're offering us some hope here there is hope i mean, these vaccines have really stood up the test of time. They're incredible. They work really, really well. And I mean, all the data we've seen, if the metric is, does this prevent you from getting really sick, landing in the hospital and dying?

They're extraordinarily successful. They're so successful at that. And it's holding up even in places that have rolled them out earlier than others. So vaccines work. Vaccines are here. Vaccines. We're so lucky to live in Canada. Vaccines are plentiful. There is no shortage. We have widely available free vaccines that are safe and extremely effective at keeping people alive and out of hospital. You got the tools to end this in Canada, or at least make sure this doesn't disrupt society. And you know what, we're slowly getting there. Yes, Delta variant is a pain in the butt. And even though there still are millions of unvaccinated Canadians, and they're, you know, grossly overrepresented in hospital. But I think we will wiggle our way through the fall and the

winter. And we'll probably have some ugly times in the fall and the winter in various provinces at various times, we probably will. But like, if we look at the midterm, maybe not the near term, but the midterm future, perhaps the spring of 2022, we might be able to wiggle our way through this. And we might be, you know, in the third period of this, of this pandemic, at least here in Canada, globally globally we've got a longer way to go i mean vaccine equity is such a major issue and of course we've got to really take incredible strides to get these vaccines especially into low-income countries where they're sorely lacking but here in canada we are we are doing very very well can you separate from the vaccine front right uh can we separate the two though i mean if we seem if we appear to be getting through it by the early part of next year, and yet it's still on fire in different parts of the world, especially third world countries, does that not mean that we're not safe? Yeah. I mean, it does to some extent because the concern is, will there be a variant that emerges there that chips away at the effectiveness of the vaccines? That's always

a possibility, right? We had the alpha variant earlier and now we've got the delta variant. We'd be foolish to think that something else can come along and might be transmissible or evade immunity to some extent. I don't think anything's going to come along and might be transmissible or evade immunity to some extent. I don't think anything's going to come along and just pull the rug out from underneath us by completely evading immunity we get from these vaccines. That's probably not going to happen. But the concern is it'll slowly chip away at the effectiveness of the vaccines. And then we've got ourselves an arm race of building bigger and better vaccines versus variants that are emerging overseas. But having said that, looking like these vaccines still will very likely prevent people from getting sick and dying.

And quite frankly, if you're vaccinated and you get infected, you know, sometimes we think that's a failure, that's a breakthrough infection. But like if these are vulnerable individuals that would otherwise be in the hospital or be in the ICU or die and they're not going to hospital, that's amazing. And they're working. And that's exactly what we're seeing. We're seeing some people get infected and they even feel crummy. They feel crummy for a day or two or a week,

but they're not sick enough to land in hospital. And if they weren't vaccinated, they would be. I mean, think about where we'd be right now if we didn't have the vaccines and we had the Delta variant here in Canada. We would be so screwed. It would have been awful, awful. And like, look at places that have had big Delta outbreaks, like India or Nepal, they ran out of oxygen. Like it was just horrific. And I think we would have just, it would have been so bad. Here we are in Canada where we have, I don't know,

about 75% of our total population with at least the first dose, about 85% of the eligible population with at least the first dose. Like, yeah, there's some tough spots, and there are going to be some tough times ahead, but we're doing much better than we could be had we not had the vaccines. Doctor, I've missed talking to you. I know this is a difficult subject for all of us and you see it firsthand in so many different ways, but we're better informed because of people

like yourself. I really appreciate the opportunity to talk to you again. And let's not make it three months before the next one. Sounds good. All right. Have a good one. Yes, you too. Take care.

Yep. Dr. Isaac Bogoch. And yes, we do thank him again. And yes, you know, when he says, what would this situation have been like right now if we didn't have those vaccines? Seems like a long time ago, right? This all started and was a long time ago, you know, more than 18 months ago. And I can remember in the, because we started the podcast right away.

We went daily right away thinking, you know, hopefully this won't last more than a month or two. That was coming on two years ago. But I remember often we used to talk about when will those vaccines come? And at that time, there was a lot of discussion that vaccines could take years because that's what they'd taken before. And as the good doctor says, imagine what it would have been like right now if we didn't have vaccines. We would be almost certainly one of those countries that is having a difficult, awful, deadly time dealing with COVID-19.

I mean, it's difficult enough as it is right now in certain parts of the country. Alberta, Saskatchewan for sure. Parts of BC. New Brunswick's having its issues. But it would have just been absolutely horrible. Now, we're not out of it yet. And sadly, some other parts of the world are truly not out of it yet.

And you heard what Dr. Bogoch said about those other countries and the impact they can have on us. Let me give you a sense. Remember that we're at 71% fully vaccinated in Canada, one of the best rates in the world. 71%. Keep that number in mind. Here's some countries at the other end of the scale.

Philippines. A lot of Filipino Canadians, right? In the Philippines, their vaccination rate, fully vaxxed, is 18%. 18%. Vietnam. A lot of Canadians with roots in Vietnam. 7%. Nicaragua.

Not that far away. Central America. 4%. 4%. We're at 71. The Central African Republic, 0.2%. Not even 1%. 0.2%. The Congo. The Congo.

The Congo. Less than 0.1%. Those numbers are, they're not just startling, they're scary. And this is why there's such a push. I think it was just last week, Biden announced half a million, or not half a million, 500 million vaccines going out to different countries that are facing the kind of awful numbers

that I just ran through on that list. And that's just some of them. And Canada has been moving vaccines as well. I think we're moving a lot of our AstraZeneca vaccines. You never hear about people talking about AstraZeneca anymore, right? It's either Pfizer or Moderna. And the stockpile that we have for boosters, I think, is primarily Pfizer, if not exclusively Pfizer.

We've bought a lot of Pfizer. So that's important to remember. Now, there was something else that Dr. Bogoch mentioned that I want to pick up on for a sec before we sign off. He was talking about entry into major events, sporting events or big social events, social gatherings, concerts, what have you, where it's clear the rules are you have to be double vaccinated to get in.

And he had a line in there when he was describing that saying, of course, that'll be dependent on how robust the checking is. That's right. How robust will it be? I went to a Blue Jay game two weeks ago, one week ago. And that's when there were just 15,000 allowed. And you had to be double vaccinated. And you had to prove you were double vaccinated at that point you know you you either took the receipts you got from your

your vaccination at the drugstore wherever you got your vaccination you took the receipts with you to prove it now what i did did was I took my receipts to like one of those office supply stores, and I had them reduced in size and what's the word, plasticized? Basically, so a little card that could fit in my wallet. And so I produced that. Now, this is not like a government-issued card. It was a government-issued document, but the card itself was something I had made, and the size of the documentation was obviously not government-issued. It had been reduced by this little store,

and the guy was a guy who checked my ticket and asked for proof of vaccination. He couldn't have looked at that more than a second. Just fine onward, and, you know, there was a lineup. On you go. And I was thinking, did he really look at that? Is he trained to look at that? Perhaps he is.

I don't know. But I think that gets at what Dr. Bogoch is talking about in terms of how robust will the checking procedure be to ensure that people, in fact, who are going into these events are double vaccinated, which is obviously an important part of the process. Now, in Ontario, in some other provinces, Manitoba I've often referred to, have vaccine passports with a QR code on it.

And just like with your tickets at some of these sporting events in particular, when you go in, there's a scanner on the QR code. Now, I assume it's also on the vaccine passport that is issued in some provinces. Ontario just started theirs last week, and I got mine over the weekend. And I got to say, for a government operation, it was very easy. Like the whole process took less than a minute. And bingo, there you have it on your smartphone with a QR code. I assume that'll make things a lot easier and a lot more reliable.

I don't know that. I'm just assuming that. But I'm looking at it right now on my smartphone, and it's pretty impressive. Didn't have to have my date of birth there. Time to look at that. I really feel old. Okay, we're going to wrap it up.

This has been a special edition of The Bridge today, and we thank Dr. Bogoch once again. I know some of you will have questions. Fire them in, themansbridgepodcasts at gmail.com, themansbridgepodcasts at gmail.com. We'll keep them around for our Your Turn edition later this week. Tomorrow, I'm not sure what we're going to do tomorrow. I have some ideas.

Wednesday will be Smoke, Mirrors, and the Truth with Bruce. Excuse me. Friday, of course, is Good Talk with Chantelle Hebert and Bruce Anderson. Thanks for listening today. We'll talk to you again in 24 hours.