The Bridge with Peter Mansbridge - Just The Facts Please -- Where Are We In Canada On The Covid Story?

Episode Date: September 14, 2020

Time to talk to our expert. How Concerned should we be about the rising numbers in Canada?

And hello there, Peter Mansbridge here with the latest episode of The Bridge Daily. It's Monday of week 27. Week 27. Week 27. I still get a kick out of thinking of this, that when we started, we never would have thought we'd be going 27 weeks, at least with the Bridge Daily, looking at the COVID-19 story. But here we are, 27 weeks later. I don't know about you, but I had a difficult time today listening to the news with the latest kind of COVID case numbers.

You know, they're up again in Ontario and Quebec. They have been up in Alberta and BC, which report later in the day. No reason to believe they're going to be suddenly down. So we're looking at what everybody seems to call a spike, although not everybody agrees on what spike actually means, but the numbers are up. I mean, you look at Ontario. A couple of weeks ago,

Ontario numbers were double digits, you know, 50, 60, 70, around there. Then they went up into the 100s, then the 200s. Now they're in the 300s. This is not a good pattern. Quebec not quite at 300, but close for a couple of days in a row now. But as we've talked before, are those the numbers to look at? Well, the other, you know, we talked about positivity rate, and it's still not bad.

The other number we haven't talked about, but the epidemiologists talk about, is the R number, the reproduction rate. So in other words, an R number of one would be for a case of COVID that produces a second case, that would be a reproduction rate of one. That's the manageable number, one or below is where they want it to be. But a case of COVID that produces two other cases, that would be a reproduction rate of two, and that's really not good. Because think it through. Two then goes to four, four goes to eight, and you just get the pattern.

It grows exponentially. With one, you're kind of left at one and one. That can be handled. It doesn't put the hospitals in some threat of being overcrowded. Well, where are we now? We're at just over one, 1.1 or 1.2, somewhere in there. Just over one. Not a good place to be. And so we have been hearing these kind of warnings from acknowledged officials in the public health field that we've got to be careful here. We're running a risk of this thing getting out of hand. So as I promised, well, first a couple of weeks ago, and then last week,

and said, well, hold on a little bit. I don't want to hold on any longer. I wanted to talk to somebody, and the someone we talked to is the same person we've been talking to since back in April, and that's Dr. David Fissman. He's an epidemiologist. He's a professor at the Dalla Lana School of Public Health. And he's also a practicing physician of the University Health Network in Toronto. So this is a guy who knows what he's talking about when it comes to discussions about COVID. And what I wanted from him, basically, I didn't want to get lost in the technicalities of everything. But I did want to get a sense from him as to sort of where are we right now? How concerned is he? Where is this going? What should we be doing? That kind of stuff. So we had a great conversation a couple of hours ago,

and I'm going to play it all for you. It's about 20 minutes long. It's really good, and I think for the most part, we don't get lost in the weeds too much. A little bit here and there, but not really. But I think these are weeds you want to know about. So I hope you bear with it and listen to it. So once again, it's Dr. David Fissman. He's an epidemiologist. He's a professor at the Dalla Lana School of Public Health

and a practicing physician of the University Health Network in Toronto. So here's our conversation from just a couple of hours ago. Okay, David, we're seeing, you know, some of the public health officials in different parts of the country issuing, like, concern, kind of warnings that numbers are starting to spike a bit in different parts of the country. How concerned are you? I'm kind of, I have an intermediate level of concern right now. I think the numbers are going up.

We're seeing steady growth in several provinces, Ontario, Quebec, Alberta, BC, Manitoba, sort of on and off. Saskatchewan is a little bit more sporadic. And then the Atlantic is actually very quiet, as is the North. So it's a big country and the pandemic looks very different in different parts of the country. In the provinces that are active, which are most of the bigger provinces right now, we do have low-grade exponential growth. So the reproduction number is around 1.2. That means each old case is making 1.2 case before it gets better. And that you can think about that as like compound interest in a bank account, where what you have is every week, you've got 20% compounded growth in case numbers. And just it's really nice to have be really nice

to have 20% interest paid on your your investments compounded weekly. It's very much really nice to have 20% interest paid on your investments compounded weekly. It's very much not nice to have that situation with an epidemic. The flip of that is that the spread right now is very much concentrated in younger people aged 10 to 29. Certainly here in Ontario, I understand the same situations going on in British Columbia. And in as much as this is a disease that's much more severe for older people than younger people, not to say we haven't had deaths in younger people, but just the numbers just look much grimmer in older people. That's kept the hospitals and ICUs relatively empty. So it's not just the absolute number of cases. It's who's getting infected that's important.

Do you tie those numbers in terms of younger people to, you know, return to school, return to college, return to university? Is that what it's tied to? Although, you know, that's kind of just happened. We may not see those numbers yet. Yeah, it's kind of just happened. We may not see those numbers yet. Yeah, it's interesting. I mean, we've done a number of things over the summer to probably not help ourselves out. There's this impulse to get back to normal as much as possible. But you have to realize that the data on restaurants, for example, it's a virus that likes indoor spaces. So the closed, close and crowded nature of restaurants, you can't have a mask on your face and eat.

That's generated a signal that showed up very early. they put out last spring looking at epidemic growth numbers by restaurant credit card spending in different states in the U.S. And the more people are dining in, the faster their epidemic is growing, which is interesting. And that's now been validated about a week ago. The CDC had an MMWR report that's shown exactly the same thing. The restaurant's a real hotspot. So, you know, we moved to indoor dining with phase three in Ontario, for example. It's unsurprising that we would see rising numbers as we increase contact rates for people in indoor spaces. Schools aren't going to help. Universities aren't going to help. We're going to see amplification of transmission there. So it's all sort of, it's effectively synergistic because the more cases we have from one setting, that means the more growth we can potentially see in another setting. And we're doing all of this as we move

more indoors because the weather's turned. And as this virus probably gets a seasonal boost from the changing weather, it does seem to like colder rather than warmer. So all of that is probably leading us into a second wave this fall. And of course, it's in younger people now, but it won't stay hermetically sealed in the younger component of the population because we all sort of cross-link. So I think folks can expect the months ahead to be fairly rough. Should we be assuming that officials, authorities may have to turn back the clock a little bit on some of the restrictions that they had lessened in the last month or so? Yeah, I think so. You know, I mean, it depends.

Do you want to make this easy on yourself or do you want to make this hard on yourself? We don't have, for example, a karaoke or strip club-based economy. There are a lot of other goods and services that we should be prioritizing over some of these settings where everyone, you know, we all would like to see businesses do well. But, you know, at this point, it's rather predictable in terms of where coronavirus spreads well. a broad brushstrokes approach to opening sectors of the economy, what that's going to precipitate is a catastrophe in mid-fall, and you're going to wind up shutting everything down because your hospitals are going to be overflowing. So the smart way to play this would be to really leverage the degree to which this pandemic has become rather predictable. Once we can predict how a disease process is going to act, we can actually control it. We can predict this, but we don't seem to be using that information in a meaningful way to prioritize what we open, what we close, how we use the tools at our disposal. You know, essential industry is something we probably have to keep open. Schools are something we'd very much like to keep open.

You know, we could be thinking about using engineering tools, improving ventilation in spaces, more aggressively targeting testing, even pooled testing in those locations to keep them safe. And, you know, once we're cutting down transmission in those special settings that are particularly vulnerable, that's going to have ripple effects on society as a whole and let us get further into this without more wholesale shutdowns. But there doesn't seem to be a particularly nuanced approach to this, particularly in Ontario, where the idea seems to be, oh, we're doing fine, we're going to keep stuff open. And I think that's probably going to send us over a cliff at some point in the coming months. And then you're going to have sort of a more extensive lockdown that's going to result in significant economic damage again.

You know, I tend to look at that particular area of the discussion rather cynically because it seems so obvious that there's an issue in terms of, you know, in-restaurant dining and bars and whatever along that line. And yet they opened up relatively early and they're still open in spite of some signals. And, you know, as a result, I tend to, you know, think about, gee, they must have a really powerful lobby group lobbying government to keep their operations open because, as you say, they're not, you know,

they're important and certainly to the tourist industry in some areas they're important but it's not like there's a flood of tourists coming into into the country and the you know the fact that they're still open uh is kind of begs the question why, are we actually in a second wave? What are we supposed to think in terms of this first wave, second wave, potential third wave stuff? Are we in a second wave right now? You know, I think when we're in the second wave, we won't have to ask that question. I've had a few people ask me that over the last week or so.

And it's one of these things where- I guess what I was getting at was, are we in a second wave or are we really still in the first wave? Are we just sort of in the middle or the end of the first wave and things are picking up again because of our actions. Yeah, I think the answer to the last question is yes, we're giving this an assist by it has a predictable seasonal assist, this pandemic, because it's getting colder, because we're moving indoors. And we're also helping it by increasing contact numbers, which is the reproduction number of an infectious disease,

that's the number of new cases from an old case, is proportionate to contact numbers. So it's just plain math. If you increase contact numbers by, you know, opening restaurants and bars, by getting people back to school in indoor settings, you know, school opening is massively cross-linking the population and massively increasing effective contact numbers in the population. So it would be astounding if we didn't have increased transmission once we opened schools, once we had students on university campuses, once we have people dining in and bars and restaurants. It just wouldn't make any sense for that not to happen. Then you look at the seasonal impact. You know, you look at a place like Melbourne in Australia that really seemed to have this beat and along came their flu season and they had an epidemic this year. There's clearly, you know, during our summer, it's their winter. And it really does look like there's a seasonal boost that this pathogen gets.

It makes it harder to control in winter than summer. And then you look at history. You look at the 2009 pandemic, which took off in September, peaked by early November. You look at the 19 pandemic, which had a summertime wave, an early out of season wave, much as this thing's had, took off in September and peaked in November. So the history would suggest that's where we're going. The numbers suggest that's where we're going. Common sense suggests that's where we're going to go based on how limited our approach to control is right now. So, you know, I mean, could something incredibly surprising happen?

Grumble back along at a reproduction number one and it stays endemic through the fall? I mean, I guess. I don't have a crystal ball or, you know, pointy hat with moons and stars on it. I don't know the future, but I know how pandemics have behaved in the past. I can look at the numbers today and say, oh yeah, it looks like we're starting to be on the up. And I can also look at what we're doing in terms of contact numbers and say, well, that's inevitably going to lead to more transmission. So from a variety of different angles, you look at this thing, and it seems pretty clear that we're going to head into a wave. And the whole wave thing is, you know, you look at historical data

and you see these things that look like waves in the sea where they're sort of shaped like a bell curve. They go up, they have a peak, and they come down. That's what we're talking about. We haven't had one of those since March and April. We had a classic epidemic wave that had that sort of contour to it. And those shapes, those wave shapes are a hallmark of exponential growth that goes up until we sort of react to it, probably react to what we see around us, react to what's happening with disease, cut our contact patterns back enough, possibly even lock

things down. Then we get that reproduction number down to one, that's when it peaks. And then of course, you have to go down the other side. There's this sort of misconception that once we're at herd immunity, once 50 or 60% of people have had this infection, it suddenly stops and drops, and that's not how it works. And unfortunately, it still has to go down the other side of that wave. So you're only halfway there by the time you achieve herd immunity through infection. But that's what a wave looks like, you know.

Okay, let me – I know you want to stay away from putting that pointy hat on, but let me talk just a little bit, one last question on in terms of the future, because I find a couple of things interesting in the last week or so. While you've got Donald Trump, you know, whenever he can, pushing the idea that we're just like days or hours away from a vaccine uh you have other more responsible people staying away from that discussion but you've also had in the last week you've had um dr fauci in in the states and dr tam here in canada both suggesting that we are probably within you you know, going to have to learn to live with COVID-19't been putting kind of a time frame on it really uh in the past

so i'm wondering what is that what does that say to you that they're just trying to caution people on on what a president who's you know at best being questionable in his actions, or they know something we don't know? Yeah, I'm not a vaccine insider. Both of those people are, and undoubtedly know things that I don't know. I can tell you what little I know. I actually think the progress on vaccines has been remarkable. But we're talking about something that typically takes years and years to develop. And we're already, you know, we're already getting into phase three trials now. We've known about this pathogen for eight months. So that's, that's lightning speed. That said, you know, we had an episode over the past two weeks where AstraZeneca actually suspended its trial because of an unexpected medical condition

developing in someone who'd received the vaccine. You know, they need time to investigate that and see whether it's vaccine related. The trial is now back on, so they must have decided that that wasn't vaccine related. But that's the sort of thing you see with a new vaccine. And that's why the trials are so important, is because you can have something that, you know, you give it to a monkey and the monkey gets antibodies, that doesn't mean you're done. And we don't do what they do in, I believe, in both China and Russia at this point, which is we take people who have no autonomy and no choice and force the vaccine on them. I think both of those countries are giving untested vaccine to their military.

We don't roll like that here. So the ethical approach is that we have to get through trials and then we also have to scale up vaccine production. The AstraZeneca vaccine, for example, I believe they're already manufacturing in anticipation of a positive trial result to try to telescope down the time to manufacture vaccines. But, you know, I have a friend who worked in the vaccine industry for years who says, that pneumococcal vaccine that goes into your arm, it took a year to make those components. These are complicated things, and it's a very precise enterprise because purity is important. So it takes a long time to do this right. We have vaccines, the RNA-based vaccines, are vaccines of a type that have never been made at scale before.

So people are actually going to have to build bricks and mortar manufacturing facilities that can make those vaccines. We have issues with those vaccines of cold chain. They need to be kept very, very cold so that they don't lose effect. And that obviously has importance not just in North America, but even more so in countries that have less functional power grids. So there's a lot of moving parts to this. to remember, you know, in 1918, 1919, they were still 15 years or so away from knowing that viruses cause influenza. Okay. So, you know, there's some aspects of this where the historical parallels are meaningful and some aspects where we live in a different world. And one of the ways in which we live in a different world is we have viral diagnostics and we actually know what's causing this. They thought it was a bacterium. And so what happened in 1918, in the absence of any meaningful vaccine, what happened is they had

multiple waves that you can almost overlay so far, our waves on those waves. As I say, it looks like we're heading into a rough fall. But what happened to those waves over time is the big one was the second wave in the fall in the northern hemisphere, fall of 1918. And then you had smaller waves, two subsequent smaller waves, and you had declining case fatality over time. Because the virus, you know, just as the virus is new to us, we are also new to the virus. And in as much as, you know, science fiction movies tend to have the mutant virus be the bad virus, in nature, it actually goes in the opposite direction. You know, you don't want to anthropomorphize the virus, but to the degree that any sort of selective pressure is going to be at work here, the selective pressure is going to push less virulent strains of this virus towards success, towards out-competing the more virulent

strains. And that's what they saw in 1918. After a couple of years, it wasn't the terror that it was when it first emerged. And that's called a pathogen coming to a balanced pathogenicity. And indeed, that viral strain, that terrible strain from 1918-19, circulated as seasonal flu until 1957, right? And came back in 2009 as this this not that big a deal pandemic? So the virus is going to learn to live with us as we learn to live with the virus. And the likely effect over a couple of years is that it's going to attenuate. But, you know, Anthony Fauci and Theresa Tam are two of the smartest people in my field who also have a lot of information that I don't have access to. So I would take their word on this.

I think we will. But listen, you know, David, as we have, as we've checked in with you a number of times during the past six months, this has been a fascinating conversation. It's almost, you know, for some of us, it's kind of like, I guess, epidemiology 101, one of your classes at the U of T. And, you know, and we need that because, you know, information is knowledge. Information is, you know, is power in a sense. And giving us this rundown of where we kind of really are in this situation, as best we can gauge at the moment, has been really helpful. So I do appreciate it.

Thanks. I know your time's precious to you, and we appreciate having some of it. I'm glad it's helpful. Happy to talk anytime. And there you have it, Dr. David Fissman, epidemiologist, University of Toronto doctor. I hope that helps kind of put some context as to where we are right now and what we should be thinking about here on week 27. And wondering very much now what weeks 28 and 29 and 30 and so on are going to be like.

Because it looks like we're in for a challenge here. And how we handle it, and how governments handle it, and what decisions they make in this next little while may well be critical in terms of how things are going to play out. All right, as I've often said, we don't want to be consumed by negative news. We want to try and add, you know, some nice moments as well in every podcast. So I got a little story to tell you about.

And I think we've all been kind of thinking about this. Ourselves over the last six months. The drastic way in which our life has changed and the way we have changed living our lives may also produce some good aspects. You know, I've talked about, you know, just my garden. How much greener it got, how much quicker it got green, how fresh the air smells, and all of that stuff.

And I'm totally convinced it's because there are less cars on the road, there's less air pollution as a result, there are less planes in the sky. Here in Stratford, we're right on one of the routes that has the big overseas jets coming from Europe heading into the U.S. They fly, you know, on some of their routes. They fly right over Stratford. And the same, obviously, with a lot of planes that come in to Toronto, to Pearson International, from different places, from the States, from Western Canada, you name it. I'm going to be on one of those planes next week. Still go back and forth about that.

I've got to fly out to Calgary to give a speech. It should be interesting. Maybe I'll do the Bridge Daily from the plane. You never know. Anyway, here's the story I want to tell you about. Now, for those of you who've ever been to Hong Kong, which I think I told you last week was one of my favorite cities in the world. If you've been to Hong Kong, then you know what the Star Ferry is.

It's the ferry that shuttles back and forth between Kowloon and the main island of Hong Kong. And it's an experience all its own. It's still running. It's still operating because it's obviously a busy area, but the ferries that aren't operating are the much more modern ferries, super fast, that run to Macau from Hong Kong. They're on a much reduced schedule. And I saw this little story in Reuters that I thought was pretty neat.

The headline is, Rare Dolphins Return to Hong Kong as Coronavirus Halts Ferry Traffic. So the Reuters story is, the number of Indo-Pacific humpback dolphins seen around Hong Kong has jumped as the pause in high-speed ferry traffic due to the coronavirus allows the threatened species to make something of a comeback, scientists say. Marine scientist Lindsay Porter of the University of St. Andrews said the mammals, also known as Chinese white dolphins and pink dolphins, were moving back into parts of the Pearl River Delta that they typically avoided due to the ferries that connect Hong Kong and Macau.

Dolphin numbers in the area had jumped by up to 30% since March when the ferry traffic was suspended, allowing scientists a rare opportunity to study how underwater noise affected their behavior. So those ferries make a lot of noise apparently underwater as well, and so the scientists have been dropping microphones in to the water trying to get a sense of the difference between the sound when a ferry does pass and when not, and then timing out the days to see how much better time they have.

Scientists think there are about 2,000 dolphins in the entire Pearl River estuary. A Hong Kong government survey from 2019 found only about 52 dolphins entered the waters around the Asian financial hub, but Porter believes the real number may be slightly higher. So I like that story. I like anything that gives us a glimpse of what lies are like or would be like if there was the less of the hustle bustle that we have created around us.

Needed, understandably so. That's life in the 21st century. But right now we're getting a glimpse of life without the 20th century hustle and bustle. And there are going to be obviously some good things towards it and as a result of it. So I talk about my garden. I wonder about, you know, animal life regularly. I know that at my cabin

in the Gatineau that, you know, every year is kind of different. Some year there's, there are frogs and you hear them. Other years there are more snakes than you think from the year before or less things change there's a pattern to nature that changes but how drastic are some of the changes that we witnessed this year as a result of less man-made issues, whether they be noise in Hong Kong Harbor or air pollution in southwestern Ontario or what have you. So tell me, if you've been witnessing anything in your neck of the woods that's different and you think it's different because

of the way we are and have been living for these last few months, that could be interesting. Obviously, it's had some impact on greenhouse gas emissions. It should have some impact on the issues that concern those who worry, for good reason, about climate change, but whether they're lasting or not, well, that'll depend on the length of the pandemic. Anyway, if you've seen things, let me know.

Love to hear about it. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. Now, quick glimpse through into the week. Wednesday is the race next door. Bruce Anderson will be joining us. We haven't decided yet what we're going to talk about, but we'll probably take some guidance from the many letters

that keep pouring in to the Bridge Daily from you. And you can keep sending them in if you wish at the Mansbridge Podcast at gmail.com. And the week, well, I may be going, I may go up to the cabin again because I've got to start closing some things up as they get ready for the winter.

Don't even mention that word. Plus the colors may start to be happening in the Gatineau. We're getting near the end of September. They don't usually really get going until Thanksgiving, but we'll have a look. So that's kind of the week ahead. There will be a podcast, we hope, every day of this week

and ending on Friday with the weekend special. Your thoughts and comments and questions. All right. I'm Peter Mansbridge. This has been the bridge daily. Thanks so much for listening. We'll see you again. Talk to you again in 24 hours. Thank you.