The Bridge with Peter Mansbridge - Paging Dr. Barrett, Paging Dr. Barrett

Episode Date: November 22, 2021

A week ago we "paged" Toronto's Dr. Isaac Bogoch for his latest take on where we are on COVID 19.  Today a second opinion, this time from Halifax's Dr. Lisa Barrett.  This on the first day that 5-11 year olds begin to receive the Pfizer vaccine.

And hello there, Peter Ransbridge here. You are just moments away from the latest episode of The Bridge. Paging Dr. Barrett. Paging Dr. Barrett. That's what we're going to do right after this. Looking for a way to zhuzh up your dinner options? With 21 flavorful recipes every week, Chef's Plate ensures dinner time will never be boring. Our menu includes easy and quick 15-minute meals and favorite classics,

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boxes and hello again welcome to mondays with the bridge a week ago today, last Monday, The Bridge was headlined Paging Dr. Bogoch. Paging Dr. Bogoch. And thousands of you downloaded that podcast and listened on SiriusXM, Channel 167 Canada Talks.

Because we hadn't heard from Isaac Bogoch for a little while, a couple of months actually. And it was time to focus in on where we were on the COVID-19 story. So that was a podcast that a lot of people depended on and there's been a tremendous amount of reaction to it. And we appreciate that. But I thought, you know, these epidemiologists, they don't all agree on everything. They have a lot of respect for each other.

But sometimes it's good to get a second opinion. And second opinion is where we turn today with Lisa Barrett, an epidemiologist in Halifax. We've been listening to her for, you know, quite often over the last couple of years. She's been at the front lines of the battle against COVID-19. She also teaches at Dalhousie University. And she's been extremely kind with her time with us. So I want to get her take, and we'll do that in just a couple of moments. But I wanted to mention, you know,

a significant event that happened yesterday on the COVID story. And that was, you know, a plane that landed at Hamilton Airport last night, Sunday night. That plane was a UPS cargo jet. And why is it important? It's important because it was carrying thousands of vaccines for kids.

All right, Health Canada just approved the Pfizer vaccine for kids 5 to 11. And so we had to bring that special vaccine into Canada because it's not the same as the ones we've been taking. Okay, it's a slightly different dosage. It's administered in a smaller dose than the adult version and it has a slightly different formula. Now, this has been tested. It's been tested in different places all over the world, but in Canada, Health Canada has been testing it for the last month. And they have determined that its efficacy rate, it's been effective in 90.7% of cases in preventing COVID-19 in children. Now, 90.7 is not 100.

And it's important to remember that and constantly remind ourselves that no vaccine is 100% effective in preventing the illness right and vaccines they don't do that they're extremely effective but 100 no and we've been taking vaccines putting vaccines in our bodies for decades for various different illnesses, and very few of them have had an effective rate of over 90%. Most of them are kind of around 70%, 75% at best. So this is a big number, just as it was for the adult cases,

also big numbers, both over 90 percent both Moderna and Pfizer so that was the important moment last night right that plane arrives with the first they're going to be tens of thousands hundreds of thousands more vaccines arrive in Canada in the days ahead for kids but last night was the first one so it was a big deal. There was a lot of applause and clapping and cheering at the airport in Hamilton last night when that first batch of vaccines arrived. So that's just one element of what I want to talk to Lisa Barrett about, Dr. Barrett.

So let's do that. Sit back and let's listen to what she has to say about a variety of different topics on the COVID-19 front. We're going to take a quick break. When we come back, Dr. Lisa Barrett from Halifax, from Dalhousie University, and from the front lines of the fight against COVID-19. That's when we come back. Our Black Product Sponsor is The Economist.

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Go to chefsplate.com, click the sign-up button, and apply the code THEBRIDGE. That's one word, THEBRID to talk to you again. It's been a while. And why don't we start as a result with the big picture look at things, not just Halifax, not just Nova Scotia, not just Canada for that matter. We've been at this for almost a couple of years now where are we where how do you sort of assess the overall picture right now if I were to choose a couple of words I'd say hopeful, but not done. The WHO and its ability to recognize a pandemic was probably slow at the beginning, but they're certainly getting more savvy at reminding us that we've got a bit more work to do. So I think in terms of the world, we are in a coming along type of spot and

vaccines have been the, you know, the juggernaut of getting us there. But we're certainly nowhere near done. And I don't know that that's something that people want to hear as they've done all the hard work of being aware, being locked down, getting vaccines, being so aware of what they need to do for other people. It's been exhausting for folks who are used to living, especially in individualistic societies, and many of our cases, people are exhausted by having to worry about everyone all the time, I think. So hopeful, not done, still a lot of work to do. And in particular, it does worry me to watch the difficulties in rolling vaccines out in different countries. Well, you know, when you say there are those who are, you know,

kind of upset that it's not done yet. And, you know, we've seen that seen that take off in the last few days in a number of places in Europe, including some generally pretty easygoing places like the Netherlands, where there have been riots in the streets, ugly riots. But lockdowns coming in Austria and in in other places as well the german numbers have gone up now usually europe is kind of three four weeks ahead of us when there are waves um so when you look at europe now do you go oh you know it it's coming here. It's definitely coming here. So what we are struggling with, I think, a bit at the moment,

and public health has a fear of, and many groups have a fear of, is the recognition that vaccines can't be, in the first couple of years of a pandemic with a novel pathogen vaccines cannot be the only public health measure we take if we want to keep cases low and at a reasonable level to prevent death and hospitalization because it doesn't work. And Europe is demonstrating that. Now, I will say compared with Canada, they've had slightly different vaccine strategies and they've taken a slightly different approach to the brands, which means they may have a little less group or population immunity than we have in Canada with our predominance of mRNA, didn't rely on AstraZeneca, didn't rely on one-dose shots like Janssen.

But to be clear, vaccines don't work on their own, and they still won't until we're a couple of seasons into this, and we have everyone vaccinated, so large groups vaccinated, like under-12s, and we have a couple. So large groups vaccinated like under 12s. And we have a couple of seasons of exposure as vaccinated people to this virus. So until we get there, we're not going to be able to take away

the public health measures. And if we do like they did in Europe entirely, get rid of masks, et cetera, we're going to see the exact same thing, maybe on a slightly smaller scale because of masks etc we're gonna we're gonna see the exact same thing maybe on a slightly smaller scale because of the way we use vaccines but not significantly different how much can we rest on the laurels of the fact that our vaccination rate is you know it's not perfect obviously but it's it's pretty good and it's better than most places to help prevent us from getting hit hard again. Yeah, and I think it's great.

I think it's very good. It's higher than some of these other countries. And again, our vaccination strategy around the type of vaccines, the spacing, now recommendations around some third shots and some boosters is going to be useful. But again, if we just rely, if we take our toolbox, empty it all out, and the only thing we put back in our control, our COVID control toolbox, not only prevention, but control, the only thing we toss back into the toolbox are vaccines and leave all those other tools out, public health measures, some masks and testing, a fair bit of testing and border control, then we'll end up in exactly the same space as everyone

else. We are not special. Vaccines and our specific strategy will help, but it won't prevent. We do need a little bit more into the April to June part of next year. Are you concerned that there has been too much relaxation of certain regulations when it comes to those who are vaccinated? And I'm thinking of, you know, big sporting events, concerts, various kind of outdoor and some indoor events. Are you worried that there's been too much relaxation on that? So I watch this carefully because it does concern me, especially if, again, we're not using all the tools in the toolbox.

If you're going to have a big gathering, we could also be doing testing, right? To help people know when they shouldn't go to these events. And that's really all this is at this point. It's not about isolation so much. It's not about, you know, great big public health measures. It's just about people know what they should or shouldn't do if they have some virus hanging around in their body. But having said that, watching what doesn't happen after some larger events is useful to me. So I've watched bigger events, some Scotia Center, some different large events across the country, and noticing not a lot of cases after those is helpful. However, the places we do end up seeing cases transmission should be noted. And cold, damp, indoor events, even with vaccinated people, are great spaces and places for virus to spread.

And I think we just have to label that. I know we love the hockey and the ringette and other curling. There are many events. Doesn't mean we shouldn't have them. But those are events that have been recognized now and types of activity that we know, virologically, immunologically, socially, that are risk factor places. And I think we should respond to that so instead of saying no big gatherings let's be smart look at what happens and then make a plan to use more of the tools and not just proof of vaccination in those settings to make them safer as opposed to locking people down which to your point earlier doesn't go well at this stage you know i've been to a couple of nhl games and you know i wear the the mask uh 100 of the time with the exception of you know if I'm taking a drink of water or whatever but the rest of the time 100% but I would say overall it's probably about a half a little more than half sometimes of those in the arena who are wearing masks and that bothers me I mean I know everybody's vaccinated or at least they've had proof of double vaccination or more.

But still, it doesn't feel right yet for me when I'm seeing a lot of people there who are not masked. I want to move to the... Did you want to say something on'm sorry no no go ahead go ahead you're backed up by science on that one right epidemiology and science cold damp air indoors even when transmission is reduced by vaccination doesn't prevent it and we've not just seen the theoretical but the actual that happens right you're backed up there and feel good about being backed up there we have to stop pretending that phenomenon doesn't

exist and labeling it and just adding more tools before i move to the 5 to 11 year olds let me just ask you because you i mean you you spend a lot of time in hospitals you spend a lot of time in hospitals. You spend a lot of time with COVID patients. How frustrating has it been when you see somebody in the hospital undergoing care who has or was double vaccinated, and yet they still got it? I mean, not only how frustrating is it for you, but how frustrating do you find it is for them? For me, it's not as much frustrating because I understand what vaccines are supposed to do. And I remind myself of that. They're never to prevent all disease and infection.

That's why we have public health. Right. That's why we're still working together as a community to keep cases low because it will happen. So for me, I feel sad and I'm so sympathetic to it, but I'm not frustrated by it. It's going to happen. For the patient themselves, it is incredibly frustrating. And it really is hard to explain to them what's going on and why this happened. And they're like, if only I had had a third dose, if only I'd had a booster. And some of them are triply vaccinated. And to explain to people that, again, the purpose of vaccines is not to prevent all disease, but for them, it's incredibly frustrating.

And I think we need to do a better job at explaining to humans. I think you can hold those two ideas in your head i think canadians can hold the two ideas in their head that vaccines are incredibly important but they don't prevent all transmission and disease so we need to make sure that we do other things i think if we don't start messaging that better for individual people so they're not as and and they feel blamed sometimes. They feel shame that they were in where they got exposed and getting them through that is a huge part of what we do right now. To just say, you know, we're not here. This is not a judgment situation, but also to explain

why this is happening to them and why it was still a great idea to get vaccines. So big bundle of things there that we're going to have to do better as we go forward. And it's nuanced and gray and nobody loves gray. But I think I think we can do it. All right. Let's let's deal with the with kids, the five to 11 year olds who it seems now are going to be getting their vaccines and very soon in some cases. You know, there are a lot of concern among some parents about the vaccines with kids.

And this goes beyond what we witnessed through the whole anti-vax movement. This is a different kind of issue for a lot of parents. It's just that the kids are young and these are new vaccines and there's they're worried about what's been proven etc and then you you see today there's a new study out in in britain where there's where they're they're raising they're not saying shouldn't do it but they're raising that concern again about some potential um heart issues on a very small number of those who had been tested. So given all of that, and given how protective we are of our kids, and how we worry about these things, I've talked to parents, and I'm sure you have uh many times already who are just you know they are

so they so want their kids protected but at the same time they're they're worried you know they're just it's a big decision they have to make and um you know and they're and they're constantly looking for advice and and studies and listening to people on this. So what is your take at this moment on, on, on the five to 11 year olds on vaccines? Yep. And the five to 11 year olds are pretty much what we can comment on at the moment from a science and data perspective.

So there is a bit of a signal and, and I hate putting numbers on things because they're, I don't think they're super helpful to parents and be we're still learning. One very rare but present that some people, some children will get some heart inflammation around the time of vaccine, but it is incredibly rare. And it is less a factor than the complications that can come with COVID-19 even in children although most kids are great there is that post-inflammatory or multi-system inflammatory syndrome that has put kids into hospital around the world in the thousands and that has hard inflammation with it too and the difference is that syndrome is far harder to treat when kids have COVID-19 than it is to treat and recognize the actual complications of COVID-19, we think. And number two,

it is far more reversible and identifiable and treatable when you get the vaccine and get some heart inflammation than it is after you've endured an actual infection with COVID-19. So for parents out there who are worried that this exists, it does exist, but it's very rare. It is identifiable. It is treatable. And in the vast, vast, vast, vast, vast majority of cases, it is reversible. And that is not as much a certainty if your child gets COVID-19 and some of the inflammatory conditions associated with it afterwards. So for me, I don't have children, so I'll be very transparent about that. But many of my colleagues and friends, not just infectious disease doctors who are sometimes seen as pushing the agenda, but many of my doctor colleagues,

many and pretty much all of my immunology colleagues are just waiting for this to roll out so they can get their kids vaccinated and i think that's another good surrogate marker of safety at an expert level you know i doctors don't wear contacts you know that the that they can go poorly i you know so um i follow what they do. I still wear contacts though. When physicians and experts are just waiting at the door to get their kids vaccinated, I think people should take note of that as well. When you and other people of your professional training and background and concerns right now gather together together whether you're in a

you know at the hospital in a you know lunch room or or whatever or at the university um just kind of shooting the breeze on this topic what do you talk about what's front of what's front of mind for your group these days? When we're hanging out talking about 5 to 11 vaccination, it's always how are we going to make sure that we recognize that there can be side effects or what we call adverse events, but we want to make sure we get the message out that we're not moving forward any further, not just as a population, but for protection of kids

until we get people vaccinated and how do we help support people in terms of being confident and comfortable with this vaccine so that is the most common thing we talk about uh all masks still at the moment for indoors ps um but that that's that's what we talk about is how are we going to move the needle for folks and make them feel comfortable? The big recognition that that's going to take individual conversations in some cases, and that's okay. And hopefully we can provide people with more and more data as we go. But there's a lot of data out there that says that this is an okay thing to do. So this rhetoric, I think it's more rhetoric that this is, nobody's been treated with this before.

Same vaccine, smaller dose, smaller people. They're not exactly, you know, kids aren't just mini adults, but from a vaccine perspective, they often are. And we'll keep an eye on this this issue with heart inflammation and other side effects but our big conversations these days are a little bit around that is there any more information coming out on side effects because we all want to keep on top of that and we all have no problem saying if something shows up that we're worried about or is becoming more of a feature that will tell

people no you shouldn't get vaccinated and that data just isn't there and there's a lot of data coming that's the stuff we talk about one how do we help people and support people and two hey are there any new or different side effects we all try and keep up on that and we do keep up on that and three people should know that all of us will have no trouble pulling the plug and saying hold the bus if there are safety issues none of us are so indoctrinated into getting people vaccinated that we would ever ignore a safety signal i'm getting my booster my my third shot on uh this week uh what should i be thinking about that? I mean, I'm getting it right on, you know, it used to be six months, but it's now actually 168 days or something.

In Ontario, they did. I'm not sure that's everywhere, but whatever. The day that I'm allowed to do it is the day I'm going to get it on Tuesday. So what should I be thinking about that? From a health perspective or from a worldview perspective? Well, no, from a health perspective. Given what you told us earlier, that, listen, vaccines are vaccines. They're not, you know, 100% cures for you.

They are what they are. But this is the third one I've had in a year or less than a year. Right. So the only reason boosters are approved for certain groups is because they have a high risk of running into virus, for example, healthcare workers, or because we know that certain groups have a than expected weaning antibody level.

And therefore the protection probably does wean a bit over time. And for people who are at high risk of bad things, you know, as you get older or you have other health problems, then that's why that third dose or boost, sorry, the booster doses are being recommended. And so should people feel good about getting it? Yes. It is exactly the same formulation. It is not a reimagined Delta variant specific type of vaccine. It does work very well still against the Delta variant. So you should feel good that you're going to boost up antibodies and probably some of your T cell responses, which are that other arm of the immune system that's helpful.

So you're probably going to boost those up. We know we've seen data that that's true. We're seeing emerging data that boosters are helpful at a population level, mostly from Europe. So feel good about getting a booster shot, but does it change the fact, at least right now, that you should have a little bit of extra public health measure when you're in bigger groups and or riskier settings? No, I really want to remind people that this third dose booster is to get us there.

We're not quite there yet. If you're going to run into virus, take it or you're in riskier situations, indoor, large group. For the next little, I would consider that people do things, but keep a little bit of public health measure in the back of their head, like a little bit of masking in riskier situations. So feel good,

but don't take away the idea that COVID pandemic is still present. We've got about another six or eight months, I think, before it's a wise idea to forget about that. It seems in Canada, the two, that it's either Pfizer or Moderna that they're offering up as the booster. Does it make any difference which one you take of those two? The data that we have suggests that there's not an appreciable difference, to be honest. And right now, given the world supply and what we have in Canada, I would definitely tell people there is no appreciable difference at a person level that for people to say, no, I can't possibly get this one versus another one. So I'd feel pretty good about getting either of those. There are some

data and studies that are actually formally looking at that. Early data says probably not a huge difference. And certainly not during the early, you know, I still think of this as the early part of the pandemic. I got yelled at the other day for saying that. They're like, are you kidding me? We're two years in. But these things take five years. I mean, these pandemic things. So right now, I don't think there is enough of a difference in the data to suggest that as an individual human, your immunity will be appreciably different, whether it's Moderna or Pfizer. Last question, and it picks up on on your point that you just expressed with that you have with your colleagues and others about the length that we've been dealing with this. Are we still learning new things every day, every week, every month about COVID-19? 100%. I hope so. Because if we're doing something wrong, as I just said, you know, there may be data in a year that says Moderna versus Pfizer may be slightly different or slightly better as your next dose.

We learn something new about therapeutics and treatments for COVID-19 every day. Our clinical group that we have a Nova Scotia clinical group, we meet twice a week because things change so much in big and small ways for the care of our inpatients who are really sick. We have new knowledge coming out all the time on how COVID-19 moves and spreads. So if we don't learn something every week, and not in a negative way, just a, you know, bite-sized piece of information way at a public level, we're going to fall behind. So folks should still expect that data is going to change, that that's a good thing, not a bad thing.

And if things haven't changed in your world around a few key core things you might want to take a look back as a member of the general public and once a month check in to see what's the big change because things should change uh just as a final final last point um your good friend and uh and colleague uh isaac bogach who don't you who you don't always agree with as as we know the two of you um yeah but uh he was suggesting last week when i talked to him that uh you know i'd say it's not clear yet but the possibility exists that this booster could be in fact the last one know, there's been much talk about, you know, it could be annual annual shots on COVID. But that in fact, this one could be the last one.

And I heard Dr. Fauci talk this weekend in a somewhat similar vein, you know, not saying absolutely, but saying it was possible that this could be the last one. Yeah. And I think, so I guess, first of all, of course it could be. Sure. An RNA virus, we're watching it evolve. If it evolves quicker than we think into something that's quite mild, and then the vaccine protection plus the exposure protection over time becomes durable and good enough to keep people in large numbers from getting sick then that could be the case

and there are some some preliminary signs that that might be true not all just are on that same page. And I would say immunologically, I think we would have, it's a little early to make that call. And then that brings me to the next point, which is why would we want to make a comment on that at this stage? Is it because people are tired? Is it because we want to give people hope that the next booster is the way we're going to motivate people to get a third dose. I'm not sure why we want to make a judgment on that. I think the data is too early to say me. The answer to that question is not super important yet.

Eventually. I think that's a great question to ask in the spring. And I think we'd have much more information to be much more informed about it right now. It's a little bit too crystal ball for me. And I, I'm, I'm 50, 50 on the fact of whether or not we might need another dose. So stay tuned. This is another, another one. Uh, and I, I think it's great to talk about it, but be careful because once you start

down that road, then everyone's like you told us this is the last shot um so i'm i'm mindful of that as well it's been good to talk to you i've missed talking to you which is probably a good thing because not talking to you has probably been a suggestion at least that we were you know we were moving along that things were looking better but uh there's every indication that you know there are going to be some difficulties ahead in the months ahead so uh having your guidance uh along with the others is really helpful to us so you know as always dr barry you know getting your time as a very busy person is something all of us appreciate. So thanks much.

Oh, it's always great to chat with you. Dr. Lisa Barrett in Halifax. And as I said, always good to hear her view on and her take on things. And after the last week with Dr. Bogoch, a combination of those two is a pretty powerful combination. We're lucky in this country to have the kind of people that we do in the field of medicine and especially

in the field of dealing with COVID-19. There are others as well, of course, and as you know, they've been on this program. But those two are pretty special and we really appreciate their time. Okay, we're going to wrap it up here in a moment for this Monday. I did want to mention one other thing, because when I look at the calendar,

this date is always important to me. I remember being 15 years old and actually writing a history exam on this day at Glebe Collegiate Institute in Ottawa. I can't remember what grade I was in. 10 or 11, I guess. And it was a history exam and they came in over the PA system. On that day, it was a Friday, November 22nd, 1963. And they came in over the PA system and they said, there's been an event in Dallas, Texas. Shots have been fired at the President

of the United States, John Kennedy, and it appears that he has been assassinated. So it was something along that vein. Those were the headlines of the announcement. And I wrote that down on my paper, and it was actually because there was a history exam. The teacher gave me certain credit for writing that but the impact of that day went far beyond the exam i mean i you know went home everybody was in some degree of shock uh that this had just happened uh i got home my mother was there she was like kind of in tears watching television,

and she was watching Walter Cronkite on CBS, and the CBS feed had been put on the CBC at that time. And so we watched Cronkite and his colleagues tell that story through that day and through the day that followed, and then into Sunday when the assassin, Lee Harvey Oswald, was himself assassinated in the basement of the Dallas police station. And then on Monday, there was the funeral in Washington for President Kennedy.

So it was four days where I sat pretty frozen to the television in our living room, all black and white, watching that story unfold. Not realizing that it was having an enormous impact on me, not just the story, but watching the coverage. Because, you know, within a few years, I was in the business of journalism. And a few years after that, I was in television. And a few years after that, I was doing live coverage of big events. Just like that.

So November 22nd is always marked on my calendar. I always remember it. I always remember it. I always remember that day and the impact it had on me, on my family, and on my friends. It was huge. All right, that's going to wrap it up for this day. We'll be back tomorrow, of course, on the bridge. Wednesday is Smoke Marys and the Truth with Bruce. Thursday, we'll see.

There may be another round of your turn. So get your emails in at themansbridgepodcast at gmail.com, themansbridgepodcast at gmail.com, themansbridgepodcast at gmail.com. And also, as I mentioned last week, if you go out and buy a new copy of my book off the record, because I can't do a book tour, I've agreed to sign some more book plates, at least for the next week or two.

I won't be able to do it after that. So if you want a book plate for your copy of the book, send proof of purchase to the Mansbridge podcast at gmail.com, the Mansbridge podcast at gmail.com, and I'll get that out by regular mail to you. Lots of you wrote over the weekend. Lots of you wrote over the weekend. Anyway,

happy to do that for you. But once again, I've only got a couple of weeks to do it because I'm going to be out of the country and that won't be happening again. So if you're getting copies of the book for Christmas to give as gifts or just for yourself, draw me a note and I will get your book played. All right. I'm Peter Mansbridge. This has been The Bridge. Thanks so much for listening. We'll talk to you again in 24 hours.