The Bridge with Peter Mansbridge - Omicron May Have Peaked But There's Still Weeks Maybe Months To Go

Episode Date: January 17, 2022

One of the members of The Bridge's unofficial "science table" joins for our regular Monday Covid Update.  Dr. Zain Chagla from McMaster University talks about where we are, how to interpret the numbers, where we are on boosters, therapeutics, and a lot more.  Then some remarkable stats on apps that are helping us through the pandemic.

And hello there, Peter Mansbridge here. You are just moments away from the latest episode of The Bridge. It's Monday and that means our regular Monday update on just where we are on COVID. That's coming right up. And good morning, good snowy morning from Stratford, Ontario. A fair amount of snow in central Canada dumped overnight and still going right now. I mean, it's not a lot of snow, but it's enough to make it look like winter for a change. So we welcome that, although, boy, it's been cold the last couple of days. Now, most governments, the Ontario government being one of them, have what they call a science table. A collection of experts who help them be aware of what the situation is and make

the decisions they need to make about how to deal with the pandemic situation. And some of those decisions have been, well, you've seen it. They've been controversial at times, and there's been blowback, and there's been debate and discussion over these last couple of years. Well, the bridge has its own science table too, if you will. We've been lucky enough for the last couple of years to have four of the country's top epidemiologists talking with us at different times about the situation. What I've tried to do is on a regular basis, Mondays, getting a kind of up-to-date,

where are we, what's happening, and what should we expect in the weeks, even months ahead. Well, today is no different than usual, and today we're lucky enough to be joined by Dr. Zane Chagla from Hamilton, Ontario. He's at the St. Joseph's Healthcare in Hamilton. He's also on the staff at McMaster University, where he is an associate professor of medicine. And he's a specialist in internal medicine, infectious diseases, infection control,

tropical medicine, you name it. If it's in any of those areas, Dr. Chagall has some thoughts on it, if it's in any of those areas, Dr. Chagla has some thoughts on it, which are certainly worthy of our consideration and our contemplation and our attempt to try to understand what's going on around us. So today Dr. Chagla is going to join, and there are a lot of questions that a lot of people have right now in trying to sort out just where we are. I don't need to tell you about all the conflicting information that's kind of out there in terms of what the current situation is. So let's get right at it then with Dr. Chagla and get his thoughts on where we are and where

we're going well dr chagla let's start with um a sense of the lay of the land if you will because once again this week i'm i'm a little confused by the things i hear on the one hand um i'm hearing you know some people suggesting that the Omicron numbers have peaked. We're kind of at a plateau and it's only kind of downhill for Omicron from here. On the other hand, I'm looking at staggeringly high hospitalization numbers, ICU numbers, and, you know, the death numbers aren't encouraging either. So where, given those two, you know, seemingly extreme opposites, where do you suggest we are? Yeah, it's interesting. This is, there's a lot of complexity here, right? There is cases where there are people that get infected which is kind of our was our leading

indicator before testing really fell apart with the sheer numbers here there's hospitalizations which usually again peak after cases because it takes some time for people to get sick to end up in the hospital and then icu's which peak a little bit after that because it takes long enough for someone to get sick enough to land in a hospital to then land in the ICU. The other complexity is the fact that this is probably spreading it or is in different parts of the epidemic curve in different parts of the country, right? So we see places like Ontario and Quebec, which probably got a head start in terms of its Omicron wave, whereas we see the West and the Atlantics that are starting to go through their omicron wave now and so there is likely some degree of stabilization in ontario and quebec based on the

numbers um even regionally within those areas there's still some areas that are still you know in in progress versus some that are at regress but the other point is is look we're even at the top of the epidemiologic curve you're still at a very high rate. And even if you go down a little bit from there, it's still a staggeringly high number. And so it's going to be a while before the numbers come down such that you see differences in case numbers, that you see differences in hospitalizations, you need to see differences in death. Because, yes, being at 50,000 versus 49,000 cases a day is a jump going downwards, but that doesn't necessarily mean there's not a burden from 49,000 cases and 48,000 cases and such and such. So, yes, we are dealing probably with a time when the maximums have been reached, but that doesn't mean that there's a lot of, you know, it's over.

There's a lot of room on the way down to have a lot of people that get infected that then lead to hospitalizations and lead to ICU stays. So when you use that phrase, it's going to be a while, what do you think it's going to be a while means? Yeah, I mean, it's interesting. I mean, South Africa did have a very sharp up and down curve.

And, you know, they are coming out of the worst of it now. You know, I think they've seen weeks over weeks of decreases in all indices, which is a good sign. But we're a little different here, partly because we're just on the top. Partly because, you know, certainly in places like Ontario and Quebec, they're still under a period of restriction, which means that, you know, as things slowly get released, there is probably going to be some more transmission associated with it. It's hard to say that this virus is just going to disappear, you know, once we decide to release restrictions. There'll be more contacts, there'll be more cases. And so, you know, I can see we likely will have that staggered fall. It won't go down necessarily over, you know, a couple of weeks.

I would probably say a couple of months to see that tail. And then recognizing as we get better, there's more controls that are lifted, which then means that, again, more contacts, more cases. And again, that cycle will likely continue, you know, for the foreseeable future. Everybody seems to agree that the best way to fight this is through the vaccine process. I've been surprised when I look at the, I mean, our vaccine numbers for first dose, second dose are pretty good. They're very good in some cases. But booster numbers are still lagging behind. What's the issue there? I think a few things. One, you know, the booster is a

controversial bit and we weren't totally clear on it prior to Omicron. After Omicron emerged, I think we were very certain that boosters would be needed for a segment of the population in that sense. People have questions and then unfortunately, you know, the health system is so overwhelmed that, you know, getting answers to those questions is not as easy as that first and second doses. But there was a, you know, all hands effort to get people vaccinated. And I think the third, and we've seen this as, you know in some places where um boosters went out indiscriminately to the population and it created a time where it was difficult for some people to

access a booster they had to stand in line they had to you know wait on social media to try to find a last minute appointment and those who were know, on the fence are kind of not necessarily putting it on top of the priority list, or, you know, had other concerns like jobs and families didn't necessarily get the chance to access it as aggressively as other individuals. And, you know, it is one of these things where if you don't necessarily keep the outreach, if you don't keep pathways so that the highest risk people have access uh ones that can't you know stand in line and come to a last minute appointment there are going to be consequences to this we saw this in the first and second dose campaigns particularly in urban areas like the gta um and so yeah i mean i think there is still a lot of

work to be done on the ground to make sure that people have equitable access now that people have easy access now and it fits their schedule to get the dose i think the last thing you know there are side effects people understand you know that even on my second and third dose it does not feel like great and so you know people put it off because they feel like uh you know taking a couple of days away from a very busy time they're already dealing with their kids and really deal with education at home and other things is going to be hard for them, right? So again, making it and framing it,

particularly for those highest risk people, those with medical conditions, those of the age of 50, this is something you need to do for the short-term future and making pathways for them to do it without a lot of barriers. Now, since scientists and researchers have come up with vaccines and since the push has been on to get millions of vaccines out there, there's also been a lot of work going on in the background on a new round of therapeutics.

Now, these are not vaccines. They're not going to prevent you from getting something, but they are going to make it a lot easier one assumes uh for you if in fact you do get something and you do get a serious round of of of omicron or covid generally where are we on the therapeutic front because there seem to be indications in the last few weeks, well, more than indications. I mean, they're being tested by their proper authorities to determine whether or not they can be released to the public. So where are we on those particular therapeutics?

Yeah, so there are a number of drugs, some of them that really just calm down the host response, that are repurposed drugs that are already here, right? So we do use drugs like inhaled steroids and old antidepressant called fluvoxamine may have some benefit in kind of tamping down inflammation. But then we have direct acting drugs against the virus, and really two categories, the antiviral pills, the one produced by Pfizer, Paxlovid, and the one produced by pfizer poxlovid and the one produced by merc molinipavir which has completed their trials they're undergoing authorization and we have monoclonal antibodies which are like the antibodies that all of us produce to a vaccine

or to naturally getting infected with the virus but in high quantities such that when given early to people uh you know it gives them that that shortcut to their immune system to kind of clear the virus much faster uh the antiviral similarly when given early to people give them a shortcut to dampen down that virus so that it doesn't lead to the inflammation that leads people to hospital and we know in good studies for all of these drugs to a certain degree, they limit hospitalizations. They limit death in people that are given those drugs. So in Canada, we've had access to monoclonal antibodies really since the summertime.

It's been a process to try to get them out into the population. And these are intravenous drugs, meaning you have to bring someone to your center or find a way to meet them. You need a skilled nurse that can start an IV. You need an infusion. You need monitoring afterwards for reactions. So there's a limited amount of output you can get from that. In the U.S., they've been really, really aggressive in trying to get them into many centers. Here, there haven't been a lot.

Our own institution, through a lot of work, started one. And even getting 200 doses out to people been a lot. Our own institution, there were a lot of work started. One, even getting 200 doses out to people took a lot of time. We've done it over three months, but it took a lot of time and a lot of community partnerships to really get that working. And then when we talk about these antiviral pills, we're a bit behind on having them. We have the United States, the United Kingdom, the EMA that's about to approve them.

We still have not approved any of these treatments, but they offer a huge solution. Look, we know there are people that are going to get COVID that even with a vaccine, they're going to be vulnerable. People have compromised immune system, the extreme elderly, people with multiple medical conditions, and unfortunately, people that haven't gotten their vaccines. And so, you know, having another option to say, you know, healthcare capacity can be maintained is so important. And unfortunately, you know, Health Canada has not approved them yet, meaning that we haven't had the ability to actually give them or scale up to have them available for the population.

If they are approved, are they a game changer? Yeah, absolutely. Look, there are always going to be people that's in the cracks. And again, being able to identify them early, get them tested early, offer them these treatments. And we're seeing 70 to 90 percent reductions in hospitalizations amongst people who get these drugs. You know, even in that worst case context of the people that really break through vaccines or again the people that don't get vaccinated but are willing to engage with getting tested and taking a treatment it's enough to save the health care system if the numbers are good we can build the systems to do it and people are engaged it's not perfect there will always be

people that slip through the cracks that don't do any of that um but again it gives another layer of protection to keep our health care system safe, which is exactly what we've been aiming for, for all of us. Now, one of the phrases you've used throughout this discussion on the therapeutics is getting it to the patient early. So I want to break that down a little bit, recognizing that it's not available yet. But what is happening right now is a lot of people are getting covet right we all know friends and in some cases many friends who are getting covet usually um for the most part relatively mild you know whatever i hate that word because it doesn't sound mild to me what some people are going through.

But nevertheless, the, you know, five to eight day kind of cycle. Would those people, if this pill was available now, would those people use this pill? Yeah, I think so. You have to build it though, right? And so you need that first off education right off the bat to the highest risk groups, people are in cancer chemotherapy people have organ transplants people on certain

medications people of a certain age even people that are unvaccinated who choose not to be vaccinated that are high risk you know if a provider can reach out to them and say fine we've tried but please get tested if you have symptoms because we can at least make the disease a whole lot better for you when you get it. You know, if you can provide that upfront education to people to say within a day or two of you getting symptoms, please don't get tested.

If we can build public health systems so that those people do have priority access to testing, recognizing if you get it right for them, you may save a hospitalization or an ICU. And then you have providers that are able to take that information from testing and reach out to those populations to make sure they have access to therapeutics you know it does take a lot of steps but the benefit is there it's cost effective you know a cost of a hospitalization for a covid patient is 23 000 in canada and so

building these systems as long as you're preventing, you know, one hospitalization a month, you know, you can spend $23,000 and still be cost neutral there. And if you scale it up, if you build expertise, if you get trust, you'll likely save dozens in hospitalizations, likely going to be cost effective over time to operate this. So there is an impetus, even from an economic sense to get all of those steps in action.

And again, make sure people have extra protection and limit their hospitalization. Is that $23,000 figure for the length of a stay dealing with COVID or a daily? It's the average patient, like healthcare costs for a single patient by Pi High, which is the Centers for Health Informatics for Canada. And so, yeah, $23,000. Those are $52,000 if people make it to the ICU for an entire stay, basically. One assumes there's going to be a tremendous demand for these pills once they come on market, if in fact they do. Are we in the position to be able to deal with that demand?

No. The production lines, particularly for the Pfizer pill, are pretty slim. I think we'll probably get 10,000, 20,000 doses off the bat, which will be distributed to the provinces, which then will be distributed to local people like myself who can prescribe them. And so there probably does need to be guidelines in terms of who needs to get this. We do know who's at highest risk. And so really saying you have to fit into bucket A, B, or C, or you're immunocompromised, you're very elderly, you have medical conditions, you're unvaccinated and at high risk.

Those people are probably the ones that need to have access to this over the general population who has two or three doses of vaccines, which will likely do as much as these pills can offer. But yeah, there will likely have to be some ration and decision-making. And the production process takes a little bit of time to ramp up to, I think Canada has ordered a million or a couple of million doses. making and the production process takes a little bit of time to ramp up to i think canada has ordered a million or a couple of million doses so we probably won't see all of that for months if not years um but we'll have some of it in the next few weeks if this is approved and at least

targeting those high-risk populations dealing with this wave we'll likely have those benefits even for a few thousand doses i was gonna say 10 to 20 000 doses doesn't sound like much yeah it's i mean again there's it's enough though right i mean you know again if you're talking about a population where the risk of hospitalization is about 10 percent give or take you know 10 000 doses means a thousand people have heard it from hospital that's a lot like you know and some of those will end up in the ic. That's still a lot. It's not perfect, but you know, again, there's, there's still the ability to target the high risk populations and give them

another layer of protection. Okay. The last area I want to do discuss with you is one that I know you are concerned about. And as most epidemiologists are, that this virus is circling the globe it's not just circling canada and the only way you're eventually going to defeat it or at least manage it is to be able to say that you've got the world covered in terms of vaccines uh we're nowhere near that at the moment. Although this weekend there was some good news that the COVAX group, the group of countries that are supplying vaccines

to underdeveloped countries and poor countries around the world, they added a billion doses. But that's still a long way from dealing with this. What are your thoughts this weekend on that process and that program and how close we are to getting anywhere near the kind of number that you would need to do to have the world, to safely say that the world is engaging this virus in a proper way. Yeah, I mean, I wish COVAX was the solution. You know, they've done a great job in trying to stand up vaccinations, but it's by no means the final answer.

And there's been problems. You know, that billion doses, there's been some that have had to be destroyed for the sake of the fact that they're near expiry date. And you can imagine, you know, in Canada, we have to destroy vaccines near its expiry date. We're a well-resourced country with, you know, militaristic supply chains and we can't get vaccines out by the expiry date. You can imagine countries that don't have those resources. Of course, they're going to have issues in getting it out by expiry.

So, you know, I have hope that countries are finally living up and Omicron has really taught the world that if you don't deal with this virus in other segments of the world, you're probably going to get burned very quickly by it as it comes back into the population as a new variant. COVAX will help.

There is still a big need for local manufacturing. And I think that is the one thing that has been lost in all of this. Look, countries have made their decisions to prioritize their citizens first and put COVAX second. So countries that are completely reliant on COVAX

have a pecking order that is very different than the rest of the world who has access to first-line doses through private contracts. Creating local manufacturing capacity, which is releasing patents plus supporting intellectual development of local manufacturing, makes it more sustainable so that places in sub-Saharan Africa can generate their own vaccine for their own population to be able to deliver it. I think a great example here is India, right? India is a middle-income country.

The world was not going to supply the billions and billions of doses that India would need to vaccinate its population. So what did it do? It took the unpatented vaccine in AstraZeneca, and it created its own vaccine in Covaxin and made an incredible, probably the largest vaccine effort globally uh you know and compared to other countries to make sure citizens had access through local capacity recognizing india had to take care of india at that point and so you know

i think that is it is that that ability to you know transfer technology transfer patents is probably going to be a longer term solution in this pandemic than vaccine donations from COVAX. COVAX is probably the first line that we can do temporarily. But again, globally, we really do need to push towards sustainable solutions here as again, you know, donation based effort is not necessarily going to fit the prerogatives of many places in the world. And, you know, in some places in the world, it's not just getting the vaccine, it's getting the ability to transport it around their particular country because, you know, they need deep freeze for a lot of these vaccines and, you know, moving stuff across, you know, sub-Saharan Africa is probably not an easy thing under those conditions. What's the kind of number that you're looking for

in terms of a percentage of the world that should be vaccinated if we're seriously going to be able to say we're tackling this head on and we're making real gains? Yeah, I mean, the World Health Organization has set 70% first doses as the response for 2022. It's a good number. We recognize that many countries likely have their populations unfortunately have to deal with the pandemic through waves of natural

infection adding vaccines to that will kind of you know make that immunity in those populations more robust and so yeah i think you know we're 10% of the low income world now. And so there is still, you know, 60% of that world that needs access to their first doses. But I think if you do get to 70% is kind of where we started seeing stability at the end of our pandemic, kind of in April, May, June of 2020, 2021, you know, you likely are going to start seeing daylight and a lot of that population having solid protection that will help with not only the generation of variants, but, you know, the health systems that are fragile there that are suffering just as much as our health systems here. Dr. Chagla, I always feel better informed after having an opportunity to talk with you. I know you're a busy guy, just like the others in your profession are these days. In a battle, it never seems like it's ever going to win, but let's hopefully predict that it will, in some fashion, be over by

within the next few months. Let's hope so. Anyway, we'll keep our fingers crossed. I think we'll be on a better side in a few months, for sure. Thanks again. No worries. All the best. Yep. Dr. Zane Chagla in Hamilton, Ontario. And let me just make a couple of quick points on Dr. Chagla and his colleagues.

Mondays have been moments that I have found really informative on the bridge over these past months and years, because we're affording the epidemiologists the time to actually talk about some of these issues. I know they're under a lot of pressure time-wise, so are the media organizations that have been extremely grateful for their opportunity to talk to them during this couple of years. But few have the opportunity to talk at length like we do. And so getting 20, 25 minutes of the time of some of these doctors, when the pressure is really on for them in terms of their time, both in hospital, in classes, in research, in study, on science tables, advising governments. Their time is precious. And we've been extremely fortunate to

manage to have some of that time for you here on the bridge. Okay, we're going to take a quick break, and then I've got some interesting statistics for you about how you're using your time through the pandemic. I think you'll find, well, I'm pretty sure you'll find these fascinating when we come back. And welcome back. You're listening to The Bridge right here on Sirius XM, Channel 167, Canada Talks. Or on your favorite podcast platform.

It's always available, the bridge on the podcast platform of your choice. So wherever you're listening from, we're glad you're with us. Okay. I promised some interesting statistics before we leave for this day and get our week launched. And I found these pretty incredible, really uh almost unbelievable in some cases but let's see let's see what you think um this is a report from the bbc our good friends across the pond um and what they've done is they've dealt with a particular firm in the UK that monitors people's, not only their attitudes, but how they're spending their time. headline on this story from the BBC's technology reporter Jane Wakefield is people devote a third of their waking time to mobile apps now that's that's the big number that I find a little hard to believe but you know then again when you look out and see other people walking around, no matter where they are, or in some cases driving around, which is really wrong,

you see a phone in their hand, or that they're connected in some fashion to a phone. Well, according to the UK regulator Ofcom, who do these studies for the BBC and with the BBC people are spending an average of 4.8 hours a day on their mobile phones and both BBC and Ofcom use a app monitoring firm called App Annie to come up with these numbers. Now, there's a full breakdown on what these numbers mean, and I'm not going to go through it all, but I am going to read some of it because what it does, it talks to you about how you're spending that time,

what you're doing on apps, and how it's affecting your life. Here's some of the trends spotted in the research, because they reflect wider changes, especially in how the pandemic has altered the way we all live. All right, once again, this is from the BBC, from their technology reporter, Jane Wakefield. So if you want to break it down, get more info, I'm sure it's easy to find online. But here are some of the trends. For instance, people were spending a lot of time in shopping apps.

I can understand that. I've spent a bit of time on shopping apps myself. But 100 billion hours globally, with Singapore, Indonesia, and Brazil growing the fastest in terms of using their shopping apps. There's also a huge growth, this won't surprise you, in food and drink apps, such as Uber Eats and Grubhub. The number of sessions on such apps grew to 194 billion.

I just said, like, 194 billion in 2021, according to the research. That's up 50% on the previous year. Okay, all that food and all that time. How about our health? Well, funny you ask. The number of sessions on such apps of health and fitness also saw growth, as the pandemic meant people couldn't always attend gyms or conduct group exercise classes. And reflecting greater emphasis on mental well-being, meditation apps such as Headspace and Calm, we mentioned Calm last week, right, the sleep app, prove popular, especially with young people, with the top five most downloaded seeing a 27% growth last year. spending on dating apps. Okay, this one surprised me. Dating apps during a pandemic?

Dating apps? Really? Spending on dating apps surged past $4 billion. That's a 95% increase since 2018. And countries with apps to help handle the COVID-19 crisis, whether vaccine passports or just information tracking, also saw a huge take-up. The NHS app in England, that's the National Health Service app,

where it acts as a record of vaccinations, was downloaded by 71% of the fully vaccinated population. While Malaysia's app, similar app, called MySegetera, saw 80% of this same demographic adding it to their phones. Now, I know I just threw a lot of numbers at you, but they're all pretty impressive. If they're, you know, I still have, I have trouble with the big number.

I don't have trouble with some of the smaller numbers because I see myself doing the same thing. You know, I certainly use shopping apps way more than I ever used them before the pandemic, which speaks to, you know, the fact that for the most part,

many of us are kept indoors and yet there's still some things we need and an awful lot of things we don't need that we end up buying right i mean you look out i mean i i'm looking out right now at the snow-covered streets and beautiful snow-covered streets and gardens of uh the houses along my street here in Stratford. And one of the most common things you see on your street these days is delivery vehicles that are dropping parcels off,

packages off at houses. They don't even knock at the doors anymore. They just drop them at the front door. Never saw that in these kind of numbers a couple of years ago. So, you know, things have changed because of the pandemic. We've changed because of the pandemic. Some of it is by necessity. Some of it is by a little bit laziness. But it's different.

And you wonder when this is going to all be over, and let's hope that our conversation with Dr. Chagall points in the direction of when things are going to be over. We may have, you know, the headline to me out of our conversation with Dr. Chagla points in the direction of when things are going to be over. We may have, you know, the headline to me out of our conversation with Dr. Chagla was we may have peaked. We may have plateaued in Omicron numbers, not in all parts of the country, but certainly in some. But that doesn't mean we're anywhere close to this being over.

We're still weeks, more likely months away from a point where we can say, you know what, we've passed through that phase. You know, I'm convinced that we're going to have a much better summer than we've had in the last two. That doesn't mean it's over, but it means we're going to have a much better summer. And I'm going to hold true to that I'm going to believe that

And I'm going to figure You know If we're going to have a better summer And we can be outdoors And we can be near a lake Or we can be swimming or golfing Or whatever it is we like to do in the summer We're not going to be on our phones ordering things we don't need

from different places around the world. I'll say one thing. I concede that I've shopped more than I should have online in the last two years. But I will also say that everything arrived. Sometimes it took a little while, but everything arrived. And basically, as billed in the ads, you know, on some of these, you take a bit of a risk. But so far, so good.

All right. We're done for Monday. Exciting week ahead, as usual, highlighted by Wednesday's Smoke Mirrors and the Truth with Bruce Anderson, Friday's Good Talk with Chantelle Hebert and Bruce. Tomorrow? Hey, let's see. Thursday, I love having some of your letters. I've scaled back on the letter programs,

not because I haven't been getting them, but I like to try and get a new influence each week from new listeners, although I always read everything that comes my way. So don't be shy. Send your thoughts on any particular subject that you may have to themansbridgepodcast

at gmail.com themansbridgepodcast at gmail.com and Thursday is the day that we kind of open the mail bag on air. All right then. This has been The Bridge for Mondayay the beginning of yet another week remember a couple years ago when we used to do the week by week number that's it for a week

such and such we stopped doing that i don't know around the one year mark and we've never gone back so i don't know what the number is now. But whatever it is, thanks for sticking with The Bridge. We always enjoy trying to be as informative as possible and also have a little fun at the same time. All right, that's it for The Bridge for this Monday. Thanks so much for listening. I'm Peter Mansbridge.

We will be back again in 24 hours.