The Bridge with Peter Mansbridge - Straight Talk About Where We Are On The Pandemic In Canada

Episode Date: November 12, 2020

Dr Isaac Bogoch is an infectious disease expert and he is frank about what we need to do if we are going to get this under control -- too many parts of the country right now aren't.

and hello there peter manspurge here with the latest episode of the bridge daily here we are on thursday of week 35 of our coverage of the covid story and uh what a story it's been, obviously. Today, a special guest going to try and give us some sense of what the heck is going on on the COVID story. Because if we thought we were in good shape during the summer, we know now that we certainly aren't at this point and things are difficult, to say the least, in many parts of the country. And we'll get to that in a minute. I got to update you on on two things. One, tomorrow we will do the regular Friday weekend special where we deal with your letters and comments and questions and probably mainly focused on the U.S. election.

We had a lot of them in over the last week. Bruce Anderson will join us from Ottawa, so we'll be able to handle that. Secondly, I've had a lot of emails from you, from people who have bought Extraordinary Canadians, my new book, and I really appreciate that. You've kind of slammed me with requests, though. I foolishly said the other day, you know, I can't get to sign your book,

but if you want, I can give you a book plate with a signature on it. So you've got to, you know, write to me an email with your address and I'll send it back to you. Many of you have. In fact, a lot of you. Now, first of all, you should know a book plate is not a plate. You know, it's not like a plate you use at dinner. It's a little sticker that goes in the front of the book, which I sign. They are small. So if you're sending in a request with, you know, all your aunts and uncles and kids and

everybody, I won't be able to cram them all into this little sticker, but I might be able to do one or two. So keep that in mind. But you're more than welcome to send them. Give me a couple of days before I get them in the mail to you, but you will get them and I will respond to everybody who sends in a request. I'm in Toronto today. I'll be back in Stratford tomorrow and I'll do it this weekend for those of you who send an email along to themansbridgepodcast at gmail.com, the Mansbridgepodcast at gmail.com. Okay, let's get to the business of the day. And we're very lucky because we do have a special guest today. And the reason that he's special is because you see him on so many different television networks and stations

because he's become one of the guests of choice trying to help us understand what's going on with COVID. It's Dr. Isaac Bogosh, who's an infectious diseases specialist at the University Health Network in Toronto. Among many other names and descriptions we could attribute to him, that's kind of the main one. So, Dr. Bogosh, great to have you with us on the Bridge Daily today. I'll try it now with your mic up. Sorry, that's my fault. Anyway, welcome. Great to have you with us.

Let me start with this, trying to understand kind of where we are on this. We, you know, this thing started 35 weeks ago, and at least it started in the minds of many Canadians. We know it started before that, but we started to see the real impact of it about 35 weeks ago. We went through a very difficult period in the spring. Things got better in the summer. We were warned a second wave could come. But either people didn't take it seriously, or we weren't prepared in any number of ways, because right now it looks like all hell's breaking loose in most of the country except atlanta canada now we know the numbers in the u.s are much higher but the numbers are bad enough here that we got to stop looking at the states and

saying we're doing better than they are and start wondering what the heck is going on here so why don't we start from that point? How did we get to this point where we're looking at numbers? I think the number today in Ontario was like over 1,500, another record. It seemed to be a new record every day of new cases. How do we get here? That's really unfortunate. And when I think about this, I sort of think about responsibility lying in three big realms. The first realm is, you know, in order to keep cases low, you really need a government and public health unit to have sound policy and really look at what are the drivers of disease, what are the drivers of infection,

and help create policy to prevent that from spiraling under control. You also need to really engage businesses and organizations. So that's the second major area. So if you have a roof, you're responsible for everyone under that roof. That could be a school, that could be a business. It doesn't matter. You're responsible for your students, for your employees, for your customers. And then the third major area is citizens. We have individual responsibilities as well. We can't expect the government and public health units or businesses to really look after every second of the day. And there certainly are decisions that we can make to help create a safer environment for ourselves, for our families and for our community. And I really think that, you know, this shared responsibility is key. And we've seen breakdowns in every one of those steps. We've seen, if we look across the country, certain governments

perhaps not having the most sound policy. We've seen public health units in certain parts of the country perhaps faster to adopt certain principles to get the virus under control. We've seen outbreaks associated in various businesses and organizations because they haven't taken appropriate measures to protect those under their roofs. And certainly, we've seen individuals let their guard down and continue to have parties or private gatherings in their homes, for example. And all of this will contribute to a rise in cases. And I think it really is, I hate the word, but it really is multifactorial.

You know, we were warned a month ago that things were going to get difficult. But did even the experts realize they were going to get this difficult? Well, yes and no. I mean, many of us in the summer were calling for additional measures for boosting testing capacity and for preparing for a spike in cases in the fall and winter. We knew that there was going to be a lot of drivers of infection in the fall and winter. Basically, summer's over, people are going back to work in person, kids are going back to school, it's cold, and people are

going back inside, and the economies were opening up. And it was just like the perfect storm that really was going to drive people into indoor settings. And we know now how this virus is transmitted. We know it's predominantly transmitted in indoor settings where people are not wearing masks, they're not physically distanced, there's not sufficient ventilation. And it doesn't matter if there's two people or 500 people. If you've got people in close proximity, So we knew that there was going to be a spike in cases. How big that spike in cases was going to be largely dependent on how prepared we were. Do we have the appropriate diagnostic testing capabilities? Do we have the appropriate contact tracing abilities? Are we set up to care for people in the outpatient and inpatient setting? Do we have the appropriate communication strategies and community engagement we're going to need to help drive positive behavior? I mean, it's hard to make a blanket statement over the country, but some parts were better prepared than others. And we're seeing that right now. And I actually like

what you pointed out a couple of minutes ago. Atlantic Canada, I mean, wow, they're doing fantastic. That's a tremendous success story. It's not perfect. They've had some small outbreaks, but they're really using their geographic and demographic advantage to the maximum level, right? Break that down for me. What are they doing right and how are they doing it? For starters, you know, they've got good leadership and sound policy. That's fantastic. But of course, they have a geographic and demographic advantage. I mean, the travel to and from that area pales in comparison to some of the more dense places like Toronto, Montreal, Vancouver, Calgary, Edmonton, et cetera. So the travel patterns to and from those areas, the density, their urban sprawl, I mean, it's just probably easier to control the infection in that setting. Having said that, there's lots of places that have a geographic and a demographic advantage that are doing very, very poorly around the world. And they still, I think it's extremely important to recognize smart leadership, smart policy

that is really keeping that Atlantic bubble safe. Well, when you look at the numbers that keep rising, whether it's Quebec, it's Ontario, whether it's Manitoba, which is one of those areas that's kind of like Atlanta, Canada, you'd think that they weren't going to have the kind of problems, but they are. They're having terrible problems. Alberta, BC. When you see these numbers keep going up, I mean, should we be scared? Should we be fearful of what's happening here right now? I think it's time to take a step back and fundamentally re-evaluate

every pillar of our pandemic response. And, you know, obviously things aren't going well. They're going less well in some places than others. And of course, each province is having some unique challenges associated with it. There's clearly some similarities across the provinces, but the epidemiology is going to be slightly different depending on where this infection is occurring. And at the provincial level, I think it's important to take a step back, look at your data, look at your response and reevaluate. You know, do we have good data to understand where transmission is occurring? Do we have sound policy to facilitate a block in this transmission. Do we need to reevaluate our general approach to this pandemic? Rather than being reactionary, you know, perhaps it's best to take a proactive approach here,

look at the direction you're heading in, predict where you're going to go, look at where transmission is occurring, and really stamp that out. And you need data to do it. But, you know, quite frankly, I was listening to a really good interview with some senior public health leaders in British Columbia, and they've taken a bit of a different approach than the rest of the country. You know, they, for example, still have restaurants open and they're still allowing in-person dining to a limited extent in restaurants. And they said, you know what, we have data that tells us that we're not seeing explosions and cases in restaurants and in those venues. We're seeing this associated with

households getting together. And basically, they said, you've got to stick within your household. You can go out, you can go to a restaurant, but you can go to a restaurant with people in your household and sit at that table. You don't have large gatherings at your houses. Basically, their policy is data-driven. And at the end of the day, I have no idea how this is going to work out, but they're using their local data to drive sound policy to keep their infection under control. Of course, they've had a rise in cases and many provinces have taken several different approaches. At the end of the day, we're going to have to see how this pans out. But ultimately, it may end up in a more significant lockdown based on how we're doing.

I don't mean to blabber on and on and on. But when you start to get case numbers as high as they are, the options for getting this under control become fewer and fewer. Well, let's talk lockdown for a minute, because obviously governments, and as you say, different governments are operating differently on this. They're coming up with different decisions. And the BC example you just gave is a good one. But governments have got a kind of balancing two things here. They obviously have the health risk at the forefront of their mind but they also have the economy um not far behind and they're trying to figure out a way of keep people working while keep people keeping people safe and that's where the challenge is especially if you're talking

a real lockdown like manitoba just said they went into lockdown but when you really look at it they didn't really go into lockdown they locked locked down certain elements, many other elements not locked down, and still clearly open in most of the country are schools. And I don't know about you, I get a lot of mail from parents, some of whom really understand the reason why it's important their kids go to school, both for the kids and for the family. But at the same time, they're definitely afraid of what could happen. So where are we heading on this in terms of whether there's a real lockdown, which would be like back in the spring where everything was shut down

and you basically sat in your basement unless you were a frontline health care worker like yourself or a grocery store clerk or a farmer or whatever. Where do you think we're heading lockdown-wise? It's really hard to know. And I think the threshold, for example, for closing schools is going to be much, much, much higher than it was, for example, in March and April. We just know a lot more about this infection, who gets it and how it's transmitted.

And obviously, I'm not saying it's perfect. In fact, it's far from perfect. But we've seen the measures placed in schools and they can at least help prevent the transmission of COVID-19 in school settings. We know it's been introduced into schools. We've certainly seen some cases transmitted within schools, but, you know, it's a lot different now, I would say, than, for example, in March and April and May of this year. Having said that, I would imagine that the senior political leadership and senior public health leadership have several options that are, you know, on their buffet table. And, you know, a lockdown would probably be the very, very last option available. And I think the threshold to reach for that would be rather high. Having said that, if we're in a situation where our healthcare system

is over capacity and you're met with almost like a New York City style scenario like what they had, obviously no one wants to get there. But if you do get to a state like that, your options are limited. And unfortunately, a lockdown may be warranted. Are we going to get there? I honestly have no idea. I honestly have no idea. And I think a lot of that will depend on what unfolds over the next probably four to eight weeks. I think it's also important whenever we talk about lockdowns, however we define, however they're defined, whenever we talk about lockdowns,

as you point out, I think it's important to view these through different lenses. One lens, of course, the health lens, but there's many other lenses to view it through. The other is the economic lens. I think it's also important to look at it through an equity lens. We know that this infection in and of itself and the lockdown in and of itself disproportionately impact poor people, marginalized people, racialized neighborhoods, low income neighborhoods, small businesses, large businesses. Like there's tremendous negative ramifications of lockdown. And, you know, where that Venn diagram of an economic lens, a political lens, a health lens, an equity lens, where that Venn diagram overlaps is the sweet spot. It's just hard to find where that sweet spot really is. And of course,

that's going to change throughout the course of the pandemic as we have rising cases. So I don't envy our senior political leaders. I don't envy our senior public health leaders. They're in a very tough position right now because every decision they make is going to have some negative consequences associated with it. This ain't easy by any means. And I think, of course, we can learn from some collective lessons we've seen in Canada, and we can learn from our collective global experience. But it is quite concerning when you see these cases rise to the level they are and starting to see Canadian health care systems getting pinched. Edmonton's cancelling elective surgeries. Manitoba started to do that.

Peel region in Ontario is starting to ship patients to other parts of the greater Toronto area. That process is happening, and we need to solve this quickly. You're at the pointed end of this situation. Is there one thing you want to see done right now that's not being done? Yeah, there certainly is. I think what often gets lost in the mix is the communication component and the community engagement component. And we can talk about technical aspects of screening and diagnosis. We can talk about technical aspects of contact tracing and case management. And we can talk about all the fundamental pillars of an epidemic response.

But the other fundamental pillars are community engagement and communication. And from a community, and ultimately, the goals of that is to drive positive behavioral change. You can't legislate or regulate your way through this. You really need to have buy in from the community. and churches and synagogues and sports leaders and local heroes involved in setting a good example and helping with community buy-in and having a network to reach out to different religious groups and cultural groups in an age, language, and culturally appropriate manner. The other thing, too, is the community engagement piece is intimately related to the communication piece. And communication isn't just saying, put on a mask, you know, stay two meters apart. Communication is really about driving behavioral change. It's driving behavioral change. And that's hard to do. And while the communications teams I know are working full out and everyone's doing the best they can, you know, it might be go on the holidays we go on, if we remember what a holiday was, and really driving positive behavioral change.

You know, we should not be getting together for private gatherings in other people's houses. You know, we know that's a driver of infection. You can make a policy saying, hey, stay under your roof, but how are you actually going to positively drive that behavioral change? Well, it's probably a different message to different ages and different cultural groups. So you really need an age-appropriate, language-appropriate, culturally appropriate message delivered on the right medium, radio, Instagram, TV, to hear the right, to land on the right eyes and ears and to drive the right behavioral change. So I really think the two areas that we should be focusing on,

in addition to everything else we are, are community engagement and communications, because that will ultimately help drive the right behavioral change that we need to see, especially for the next six months to a year. You seem to be talking about the best possible kind of marketing and salespeople who governments and health authorities should be engaging to come up with a plan that can convince people. Because, I mean, there's so many things that they need convincing on right now. You know, we can't convince them to take a COVID alert app, right?

Yeah. And the fear is that, you know, when that day comes, and hopefully it's not too far away, that there's a vaccine, how many actually want to take it? And will believe that it can work. And the latest stats you see are not good on that front. And unless there's some way you can convince people that they're part of the solution here, it's not going to happen.

I agree. I mean, talking with a 20-year-old is probably a lot different than speaking with a 45-year-old in northern Saskatchewan. It's different than speaking with a member of the Jewish community or the Punjabi community or the Chinese community. You've got to have the right message, right? The age, language and culturally appropriate message to drive positive behavior. And I'm not saying that's easy to do, but I do know that it's not going to come from a boring 42 year old doctor wagging his finger on TV or on the radio, right? It's going to come from a boring 42-year-old doctor wagging his finger on TV or on the radio, right? It's going to come from people who are experts in communication and driving positive behavioral change. And it's a big process. And I think it's an extremely

important process. It's kind of maybe a little bit peripheral to this discussion, but for example, the healthcare teams learned this the hard way in the early Ebola virus outbreaks in the Democratic Republic of Congo. You know, they choppered in all the right equipment and all the right people and had the hospitals and the tents set up. And in many of these earlier on, you know, people weren't going to the hospital. They're running away from the hospital. And, you know, they weren't sure where these outbreaks were occurring. The citizens thought, well, you go to that hospital and you don't come out. And what really was needed was better community engagement, getting the senior leaders of the communities involved, getting buy-in from senior leaders of the community, communicating to the community what's happening, working with the community to get them actively involved in the care. Like, you know, it sounds a little bit wishy-washy, but it is. I mean, it's a fundamental

pillar of epidemic management. And certainly it's being done to some extent here, but I think there certainly is room for improvement. Okay, last question, because I know you've got to get going. But in terms of the basic advice to the ordinary family, we've been saying for months now, wash your hands, keep your distance, avoid big crowds, wear a mask. And now we're telling them, wear a mask not just for those you see, but for yourself as well, which to me has always been, that's kind of obvious from the get-go, but they didn't want us to say that for the longest time. They finally got around to saying it.

But aside from those kind of basic principles that we've been saying for 35 weeks now, one way or another. What else do you say? What else do you say to that young mother, young father who's raising a couple of kids and trying to live through this? What do you say? In terms of practical advice, there's nothing new. Nothing has changed, right? We're still supposed to avoid gatherings. We're still supposed to put a mask on when we go indoors. We're still supposed to wash our hands. We're still supposed to keep within our our household unit, not have people over. Like, absolutely nothing has changed. We have no new miraculous development that's going to do anything until a vaccine comes out.

So it's hard to know what to say, because I feel like we just keep saying the same thing. And really what the troubling aspect is, I firmly believe that COVID fatigue is a real thing. A lot of people are sick and tired of this. A lot of people have felt the pinch financially, psychologically. Some people have been the pinch financially, psychologically. Some people have been affected health-wise, either directly or through a love life. So people know what's up. They're smart. We know what to do.

It's the motivation to continue doing this for the foreseeable future. But as you pointed out earlier, there really is a light at the end of the tunnel, part of the platitudes. But it's true, like vaccines are coming out. We are going to have a vaccine. And, you know, whether or not it's that Pfizer one that we heard about recently this week or another one, vaccines are coming out and they're coming out in 2021 in Canada. So, you know, there really will be an end to this. We really will slide slowly towards normalcy. 2021 is going to start on a pretty sour note.

I think it's pretty fair that we can say that looking at where we are now. But as it progresses, I think it's going to get better and better and better. And if we can just keep doing what we're doing until then, we'll be okay. But I can't pretend for a second that that's going to be easy because it clearly isn't. But really, truly, 2021 is going to be our year. We're going to, as these vaccine programs roll out, as more and more people get access to them, we're going to gradually have some of the lifting of our public health restrictions. And it's very conceivable that mid-2021 and late-2021 are going to look very, very different than early-2021. So you wouldn't be surprised if we were talking this time next year,

that we're talking about what happened in the past as opposed to what's happening in the present yeah i really think that's a a very high probability um look we've got what 11 vaccines that are in phase three clinical trials right now there's 50 vaccines that are in human clinical trials total. There's 150 in the pipeline. A lot of them aren't going to work out. Most of them aren't going to make it to market, but a lot of them will. And quite frankly, Canada's done a pretty good job. We've got access to at least seven of them. Yeah, you know, there's going to be logistical issues. There's going to be access issues. There's going to be a staged and slow rollout. There's going to be logistical issues. There's going to be access issues. There's going to be a staged and slow rollout.

There's going to be, you know, predictable hiccups and bumps on the road. But we're going to get them and they're going to roll out. And, you know, that will significantly enable us to return toward what we remember before COVID-19. Yeah, we're going to have to put on masks for a while. We're going to have to physically distance for a while. We're still going to have to do it during vaccine rollout. But I think, like, at some point through 2021, there's going to be a day where we say, you know what?

You can have larger gatherings now. You know what? We're going to loosen the restrictions on that border with the United States. You know what? Enough people are vaccinated. You can start to take off your mask. You know what? We're going to have a giant concert. you know what? Enough people are vaccinated. You can start to take off your mask. You know what? We're going to have a giant concert.

Or you know what? You can go to a hockey game and see a growing number of people in the stands there. That's going to happen. It is on the horizon. And it's not even the distant horizon. It's going to start on the near horizon. The problem is we still have to be vigilant until then. And that's hard to do.

So you're saying that we likely will be there for when the Leafs hoist the cup, finally. Yes, we will. Dr. Isaac Bogoch, listen, thank you so much for talking with us today. This has been a real treat, and I know you're a very busy guy, but I think you've helped us understand it understand the difficulty of the situation we're in right now and some of the ideas that you have in terms of how we can try to condition ourselves to make

things better. So thanks so much. My pleasure. Happy to chat. Yep. Alright well listen folks that kind of wraps it up for this day, this Thursday of week 35. Once again, a reminder, tomorrow will be the weekend special. We'll have your mail.

Bruce Anderson will be alongside, and there are quite a few questions about the U.S. situation. So we will deal with those tomorrow. In the meantime, go get your copy of the book, Extraordinary Canadians. It's available, And I'll sign book plates if you send me the address to do that. I'm Peter Mansbridge. This has been The Bridge Daily for Thursday, week 35. Thanks for listening. And we'll talk to you again in 24 hours.