The Bridge with Peter Mansbridge - The Omicron Challenge -- Another four to eight weeks?

Episode Date: January 10, 2022

This week's feature interview on the Covid story is with Dr. Lisa Barrett, the Nova Scotia epidemiologist at Dalhousie University who is tracking the virus not just there but around the country and around the world.  Her thoughts about where we are, what we are doing right and wrong, and where we are heading.  

And hello there, Peter Mansbridge here. You are just moments away from the latest episode of The Bridge. It's Monday, and Mondays usually mean where are we on the COVID story? Well, that's our topic for today. And welcome to Monday. You know, here in southern Ontario, I'm in Toronto today. Here in southern Ontario, winter has finally started to hit. In the sense that it's getting cold. It's been cold the last couple of days.

After really a balmy November and December. Now I know that is not very interesting especially if you live in western Canada and if you've been hit by the snows in maritime Canada. The west has really been hit hard with cold temperatures, especially in the last month. But it's finally starting to come to southern Ontario. Now, cold here is not cold in the west. Cold in the west is cold. Cold here in central Canada is, you know, minus five, minus eight, sometimes a little lower than that.

But still, it's something the system needs to take a few minutes anyway to get used to. But after all, it is what January is supposed to be all about. Now, for a lot of people, they're staying inside because of COVID. And so what it's like outside really doesn't make that much difference. But a lot of people need to go outside, people especially who are at the front lines of this thing. Well, if you've been following the bridge for the last couple of years,

you know that Mondays we've tried to use as a vehicle to understand where we are, what we're dealing with, and what the latest trends and ups and downs on the battle against COVID have been. And it's been particularly, I think, challenging to do that in the last month as a result of the Omicron virus. Trying to understand exactly where we are and where we're heading. And there's a lot of different discussion about that.

And I know that amongst my circle of friends over the weekend, there was some, you know, good discussions and good debates and arguments, really, about are we near the end of this? Are we really not near the end of this? How long is all this going to go on? Where's the end? What is the end? You know the discussions because I'm sure you're having some of them as well. So what we've managed to do on Mondays in the last couple of years is seek the advice and counsel of some great epidemiologists. You know, we never realized in this country we had so many epidemiologists.

There are a few, quite a few. And they're all good. Some of them are really good. And obviously I'm partial to the four who have been kind of a mainstay for the bridge over these last couple of years. Eleonora Saxinger in Alberta, the University of Alberta. Isaac Bogoch in Toronto, the University Health Network. Zane Chagla in Hamilton, and Lisa Barrett.

All doctors, all epidemiologists, Dr. Lisa Barrett in Halifax at Dalhousie University. And Dr. Barrett's been at the front line, as all of these have been, at many of the discussions that take place in their particular regions. But they stay connected either to each other or to other epidemiologists in the country, and they have a sense of country when having these discussions. And so that's what I wanted to get at today by connecting with Dr. Barrett this week and getting her sense of how things are, the challenges that we're still facing and what the future short-term and long-term, actually looks like. So I connected with Dr. Barrett, and we're now going to listen to that conversation.

Here we go. So we seem to have reached that point in the story where everybody knows somebody who's got COVID, or they know a number of people who've got COVID or they themselves have COVID what does that say about where we are in this? Natural history of a pandemic you run into a variant that has exquisite transmittability between people at a time when people are tired, and they're together a fair bit. And yeah, there's a lot of COVID around. So we are at the point, I think, where COVID is really and truly coming into the community as a present partner,

if you will. The trick now is for us to just get the rate of spread right so that we can still provide the kind of healthcare that people, I think, in Canada expect and want. What numbers do you look at? Because if we saw these numbers on the base of it a year ago, we would have totally freaked out. Now, I know some people are still freaking out, but it seems that we're seeing such huge numbers, but in some ways people are just sort of saying, well, you know, that's what it's got to be. And I guess that's true.

We have always said that we do not want our vulnerable people in our communities and towns to be the only people who get sick or are disadvantaged. And we've always said we want to be able to have a health system that works. And so we aren't quite there in terms of vaccines, boosters, and treatments, early treatments. We're not quite there enough to let things go quickly yet. There's not enough natural and acquired immunity in the community to do that. So the numbers I look at aren't just the case numbers, because quite frankly, we all know that those are only a teeny tiny number compared to what's actually out there. So the things I look at that help me understand whether

the vulnerable are being disproportionately disadvantaged, and if our hospital system is safe, are the case number, I still look, but the percent positivity of the number of tests that are positive is still important. If that's increasing, you know, you're not at the peak of your infections and that things are going to get more challenging from a healthcare setting perspective. I look at the doubling time of the numbers, given, hopefully, that the testing strategy in a province doesn't change in that length of time, and you're comparing apples to apples. And you look at the hospitalization numbers. And I don't just look at the hospital numbers of COVID specific admissions, I look at the number of people with COVID positive tests who are in

hospital, even if that's for a heart problem, or a a kidney problem or a diabetes problem, because we know that COVID affects other systems. So I keep a closer eye, not just on COVID admissions, but on total admissions related to COVID to understand what's going on and how many empty beds we have. And if we have zero empty beds, we've got a problem if we haven't yet peaked in terms of our doubling time and percent positivity. Okay, you gave me a lot there. So I want to back you up just a little bit on, first of all, on the case numbers issue. When you talk about it being a teeny tiny number compared with the actual number of cases that are likely out there, is that because people just

aren't getting tested anymore? A good chunk of this is because most provinces have switched their testing strategy to use PCR for only those who are highest risk for bad disease. And so therefore, that's a culling of the test numbers right there. And then other people are using augmenting that PCR test with rapid antigens. And not many of those are being registered, they're being done by people at home. And in some places, Nova Scotia, we ask people to report them, but we know that a lot of people don't report them. And so combine that with the fact that people are in many cases not having bad symptoms and may not know they're infected, but still are transmitting to other folks potentially, then we know that there's a heck of a lot more virus out there than what we're seeing

in the actual case number. Well, it must make it awfully hard to come up with the multiplying number that you talk about. I mean, initially, when we first started talking about Omicron, you know, it was only a few weeks ago. But when we first started talking about it, we were talking about it, how it was, you know, case numbers were doubling within, you know, a day or two. Do we have any idea what they're doing now? It's tough to know, to be honest. And that reproductive number that we used to estimate, the R, most folks have said we can't do that right now reliably. And in fact, it would be dangerous to guess because we don't have enough information to be able to do that. And most public health

groups in the country are so overwhelmed that they can't even take a small proportion of the outbreaks or cases and contact trace them to get that kind of information. How many secondary cases are there for every person that gets infected? They can't even do that. So we really are at a point where that is not known well. It's going to have to be retrospective that we guess at some of those things as we go forward. But I don't know if it's the most important thing for us to spend all our time talking about or trying to get a good answer on, given that we are starting to head into that pre-world of having to figure out how we manage this as something that's going to be around for a while. And when you say that, what do you mean?

The going forward, being around for a while? Yeah. It's likely that this version or some version of COVID is going to be around for a number of years, if not always. We don't know the answer to that quite yet. And I think to guess is a little bit premature, but there's going to be some version around for quite some time. What I mean is, at some point, we will shift from testing and testing and testing to saying, if you have respiratory symptoms, stay home. And for the first five days after you feel better, wear a mask when you're outside to protect others in case you're still infectious, regardless of what respiratory virus you have. But we're not quite there yet. I think in terms of everyone is into this, oh, we just have to live with this. Let's just all get it and we'll be fine. I do not

mean we are at that point. We might be there from a testing strategy point and concentrate our tests on people with no symptoms to slow spread. But I do not think we have enough healthcare capacity to look after that 0.3% of people who will still need to be looked after in our health system if we all get sick at the same time. We just won't. Actually, I'm going to take that back. We do not. It's not a matter of me thinking. There is not the capacity to look after people if we get rid of the public health restrictions that are in place right now too early over the next 48 weeks. Where are you on the M word, the mild word? You know, I keep going back and forth on this because some of the people I've talked to who say,

oh, no, I've just got it mild. And then they start describing what they're going through. And I go, gee, that doesn't sound very mild to me. I mean, where are you on that? Yeah, so I am not a person who likes to overhaul medical conditions. And if you knew me from general life and the way I doctor and present things to people, I'm not a minimalist, but I expect that not every day will you feel perfect. And so if somebody gets a cold, I certainly was one of those people who would wash my hands, wear a mask and go to work.

So, I like the word mild when it's appropriate. Right now, what I think people hear is that all of the time when you get sick with COVID and this variant, that you're not going to feel terrible. To your point, lots of people feel quite terrible, in fact. Number two, people who are vulnerable and have other medical problems or are older are still vulnerable to bad disease with COVID. And that's prevented a lot by vaccines, but not entirely. Again, it is not the magic cloak of invisibility to COVID. You can still get sick. So the word mild to me is really hard to use

at a time when people are tired and looking for something to hang on to. It oversimplifies the disease and underestimates the impact of what's going to happen if we all just get Omicron at the same time. What should you expect? If you're going to get it and you're going to be one of these people in the sort of five to eight day range and then it passes, what should you expect those five or eight days to be like? Obviously, there's a lot of variability between people.

That's number one. And I think people forget that sometimes. Many folks, especially if they're vaccinated, really do have mild symptoms. But those mild symptoms, often people are describing to me in the hundreds of people I've heard about in the last two weeks, a massive headache that does not go away for days in people who've never had a headache before, and not the kind of niggly headache that you can put to one side, it's quite market. And sore throat, we have seen people coming to hospital with sore throat, that's been bad enough that they've sought medical attention. Some people won't have those symptoms, but they're common. And a lot of people showing up

with some GI symptoms when I say that nausea, diarrhea, and a lot of dehydration. And that's the people coming to hospital. People in the community generally have those similar symptoms before going on to get cough or some shortness of breath. But they're much milder. There's the word. However, they don't feel great. And a lot of folks, especially if they're vaccinated, do seem to be getting a fever. And when you get a fever, you feel crappy in case no one's noticed. Myalgias, so muscle aches and pains, and really just no get up and go, a lot of fatigue. So, to your point, it all depends, I guess, what you think mild is. There are people who tell me, didn't know I had it. And I'm like, that's great. But every biologic thing that happens in a person

comes in the form of a bell curve, if you will. Most people fall in the middle and have fairly not too bad symptoms that kind of put them in bed for three or four days, but they're in bed for three or four days, let's be clear. And then on the one side, there's a few people who have almost no symptoms and a few people that we talk about a lot that might end up in hospital. So, there really is a spectrum of disease. Not all people have mild symptoms. We've tried to kind of look at different parts of the world to give us an indication of how long we may be dealing with this because it seemed to have taken hold in Asia and then in parts of Africa on this one, on Omicron,

and in Europe before it kind of gets here and it tails out there before it tails out here. So it's not a clear picture right now because a lot of Europe is still battling this thing tough. But you look at southern Africa and some of the countries saying, you know, we've peaked and we're on the downslope. You see the UK starting to say that. Some debate around that, but they seem to be suggesting that they've peaked.

Do you take any of that to mean anything in terms of what we're likely looking at in terms of how much longer? Definitely wouldn't discount that. South Africa is a little bit different, different age range, different medical problems or not. administrative databases where you've got to be able to afford to get care and tend to have, you know, people who have access to tests and care aren't always the general population as well. So I take everything with a grain of salt outside our provinces and country in terms of comparison. The UK does look like they're starting to come down. I do take that into account. We don't appear to be coming down yet. At least in most provinces, there's not a clear sense that we've reached a

peak. And do I think it's going to be faster than other waves? Yes, partially because of vaccination, but also because this is so transmittable that people get infected pretty quickly and the incubation period is shorter. So that's likely to play into the shape of the curve that we see in terms of infections. If we're lucky, we might be able to spread it out a bit so that our healthcare system is able to deal with the folks as they come in and be able to provide care for COVID, for their other problems, and for the other things that hospitals need to look after in terms of people with other illnesses than COVID. So I'm hoping we can spread it out a bit. But I do think we're already seeing that exponential change in Ontario in terms of ICU beds, hospitalizations. So that's telling me that we may have, one, some really rough weeks coming.

But two, also, if people are looking for some hope of things, the comedown should be quicker as well. When you say spread it out a bit, what do you mean? Yeah, not spread it around, but spread it out a bit. So, I mean, if we were to get rid of all the public health measures that we know reduce transmission of COVID, then we would see this and the numbers and the infections go skyrocket. And that 0.2, 0.3% of hospitalizations would be vastly overwhelming, because you're talking about a denominator in the millions of people all sick all at once. If we take that million people or however many people that are in your province who are

likely to get this virus, and you do it X number per week by keeping your public health measures in place, then you have a chance of being able to still look after people when they come to hospital. But I hope people realize how close to capacity or beyond capacity health systems are, we're softballing it a little bit in our public domains right now, how bad things are. Tell me, explain that to me. Yeah, I think people worry about causing fear in the population by saying our hospital systems are overwhelmed. But in many places they are, and we've seen a couple of

provinces make that declaration within the last number of days, New Brunswick on Thursday or Friday. I think it was Quebec a couple of days ago. And within our own province here in Nova Scotia, we, I mean, there were days in the last week where we've had zero available ICU beds. You know, we're not counting all the numbers of people in hospital with COVID. We're just counting the people who are in with respiratory symptoms sometimes. And that leaves out a whole lot of people who are sick. So, you know, if it takes four hours for emergency medical services to bring someone from another location because we don't have enough ambulances, we've got a problem. And that's where we all are. So, if people take your mild word, and they take the let's just get her done and everyone get infected

concept and apply it in the next three to four weeks, we will see people who will die of both COVID and other things in a very preventable way. And that is probably going to be on the backs of vulnerable people, because those are the people who get sickest. And that is not a very Canadian concept as far as I'm concerned. We're so close. We just need to hang in and spread the infections out a little bit with these usual public health measures a few more weeks. Okay, so what do you mean when you say we're so close? I mean that we've got boosters being rolled out everywhere, and that does seem to help. It does improve the effectiveness of the protection against hospitalization, at least for up to 12 weeks, we think, from some of the United Kingdom data.

We have third doses for people who exposed now on top of their vaccine. along with having access to other tools like early treatments, which are coming online hopefully soon, when we get those tools, natural exposures plus boosters and vaccines plus some early treatments, then we have the ability to tolerate far higher levels of virus in the community without sending people to hospital all the time. And when you're talking about early treatments, are you talking about therapeutics? levels of virus in the community without sending people to hospital all the time. And when you're talking about early treatments, are you talking about therapeutics? Yeah, there are some therapeutics that are coming down the line, just as we have for influenza, for people with, you know, within a few days of starting symptoms that can be used in people who have lots of risk factors for bad disease. We can give them these treatments and hopefully this will either reduce or prevent them from becoming sicker over time. Doesn't replace vaccines at all,

but adds another piece in that lets us live with community virus. Generally, what are we doing right? And when I ask that, I don't just mean the things you've mentioned there in terms of vaccines and boosters and early treatments. And I appreciate that different provinces have different rules and restrictions in place. But generally, what are we doing right? The ability to communicate, and I think the public health agency has been doing that and reminding people that we can't be quite done yet. I think that's been done well.

I don't know if people are hearing it quite yet, but I think that's been done well. I don't know if people are hearing it quite yet, but I think that's been done well. I think a delayed but important recognition that testing does play a role and we need to have access to rapid tests for individual people has started to become a thing that is happening across Canada. And we're going to need that to shore up these efforts over the next little while. And I think Canadians, in many cases, are listening to what they're being told and accepting a lot of the time that we've got a little bit more to do. So policy wise, I think there's some good things going on. Individual wise, I think there's some good things going on. Individual wise, I think there's some good things going on. And we just need to make it clearer, I think, for people in the messaging, why it's going to be different in four or eight weeks, if we just hold the course now, and what the consequences are, if we don't do that. Okay.

I got to pick you up on that last point as a last question. When you throw around that timing of four to eight weeks, tell me about what's going through your mind to come up with those numbers. Yeah, and I should be careful about that because I don't mean that we're done with this and no one's ever going to hear the word COVID again. And I will never, ever, ever talk about COVID ever again publicly. I wouldn't mind that to be honest. But I do think after we get through the winter respiratory season and this surge, this isn't a wave, this is a surge, then we can start to have some good conversations about shifting things. Boosters are out.

Got some access to treatment. And then, to me, kids are vaccinated. We've been through a whole bunch of exposure. And after that eight weeks, we start to think about things like just testing people when they have no symptoms to figure out where spread is. Just telling people if you've got respiratory symptoms, stay home, regardless if it's COVID or not, and then come back when you feel better, good respiratory etiquette. And that's what I mean in four to eight weeks, coming back to a world where we're closer to things being normal, maybe some masks are still hanging around for a little while into the beginning of summer. But we're starting to see

that we would be able, hopefully, if this Omicron swift up, swift down idea holds true, hopefully then we're looking at a different type of world because we've done all the right things in the middle. And so, while I'm not talking normal, I'm talking a heck of a lot closer to living as opposed to subsisting, if you will. And on the current situation, we're still a ways away from the end of the surge, right? Yeah. I mean, when I say 48 weeks, I mean four weeks in terms of just getting through the acute part, the very, very highest hospital numbers. Eight weeks is really, you know, when we're going to start to see, I think, hopefully,

numbers starting to appreciably come down in hospital. And then by the end of that, we're into, you know, the end of March. And then we have that bridge period between the end of March and when people are out of school. Hopefully, by then, that would have given us, for kids who were just getting vaccinated, their second dose would be in. We're going to, I think, have a different kind of June, but until we get there, it's four to eight weeks of the surge, four to eight, well, eight weeks after that for another piece. And then hopefully we can start thinking about things a little differently if we keep our vaccine and booster rates up high and

we continue to evolve in terms of what our vaccines look like. I will ask you one more last question. And it's only because I can recall when we talked, I think it was in, I don't know, it was in the spring or the early part of the summer when Nova Scotia for the first time was getting hit. And we're talking of numbers that were, you know, like 20 or 30 as opposed to two or three. And you were pretty worried about the direction things were taking.

And now we're looking at numbers much greater than that. And obviously far greater than that in a lot of parts of the country. but you seem, I don't want to say less worried, but you seem less freaked by about it than you were back then. Different situation. Again, we've got the combination of vaccines, knowledge about the course, the disease. We have some therapeutics. We have the ability. Vaccines are not in such short supply.

We have tests that are mostly available so people can figure out from a spread perspective what's going on. And those things reassure me. I am not impressed with some of the messaging that's confused people around the holidays. I think we did, you asked me what we did well, and I love talking about the good things. We didn't, we messed up. We should have told people your health systems are going to be crushed in January if you behave with this little bit of laissez-faire. And we didn't do that well. We tried a little bit, but we weren't clear enough. So am I freaked out? No. Am I a bit disappointed we are exactly where we are in this province? Yeah, I am. We confuse people a bit. And good news, I think we can turn that around in the next

weeks if we put our minds to it and help people remember we just don't have the resources to look after folks unless we keep on this track. So yeah, I'm not as freaked out, if you will. Lots more tools and knowledge. I'm a big fan of tools and knowledge. But we can do better, too. So we should do better. The preventable sickness and death is not a Canadian concept from my perspective. Well, I hope they're listening. Because, you know, I watched this weekend and, you know, I don't know what it was like in Nova Scotia, but I watched this weekend in Ontario and they had, you know, at a time when they've closed schools and they've closed movie theaters and they've closed gyms and all that. The malls are open and they're packed.

Packed. Yes. And I would say, though, the biggest places that are, at least when people were still contact tracing, the biggest number of situations where people have been infected has been at informal indoor unmasked activity. Everybody in front of you right now has to be considered a contact. So, choose your bits wisely. And if you don't know where people are, sorry, you know, drinks and dinner with four different couples every different night of the week just is not a good strategy. Good advice. All right. Listen, you know, as always, I love talking to you. You always make me feel, even in the difficult moments, more comfortable about it all. And I don't know how long we're going to keep doing this, but it's always great to be able to know that I can talk to you when I'm confused

and to your colleagues in the epidemiologist business, if you wish. I don't know what you guys are going to do when this finally does end. I'm going to become an underwater basket weaver, quite frankly. Yeah, that sounds. Got it all planned out. Yeah, I bet. Well, listen, thank you for spending some time with me again. I really, really appreciate it.

It's good to talk to you, Dr. Barrett. Yeah, it was good to see you as well. Very much so. I hope your Christmas was lovely. And yours too. Our feature interview with Dr. Lisa Barrett, getting this week started and getting a sense from her as to where we are in the big picture, not only in the world, but obviously primarily in Canada.

So we thank Dr. Barrett as we, as we always do. She joined us from Halifax. She's at the Dalhousie University, as well as a leading figure on Nova Scotia's fight against COVID. Okay, we're going to take a quick pause. When we come back, something you may not have known

about COVID, a benefit of COVID. And welcome back. Peter Mansbridge in Toronto. This is The Bridge. You're listening on SiriusXM Canada, channel 167, Canada Talks, or on your favorite podcast platform. And yes, as we always say, we're glad you're joining us, no matter what method you're using to connect with us.

All right, before we go today, you know, I call this a benefit of COVID. I don't know whether we can use that word benefit about COVID at all. I guess we could in terms of the incredible scientific gains that have been made over these last couple of years in determining this fight against this virus. But here's one that I guess was unexpected. You remember when this started, it didn't take long after, you know, the first kind of month of lockdowns that some of us started to notice and i can remember mentioning it more than a few times on this podcast that um because of lockdowns because planes weren't flying as much because cars weren't driving as much.

The things kind of looked cleaner out there. Gardens looked greener. The air seemed better. And that was a side benefit. Gave us a sense of a world with less pollution. So anyway, I see this story pop up in the inside science section of ABC News, its website. And the headline is, why was there less lightning during COVID lockdowns? I'm just going to read a couple of sentences from this. In the spring of 2020, as the coronavirus spread and many places in the world imposed lockdowns,

humans used less energy and many spent more time in their homes. As a result, air and water became cleaner, fewer animals were killed by vehicles, and the world grew quieter. Now researchers think they have found another impact of the lockdowns, less lightning in the spring of 2020. That's the period of which they were studying. Scientists believe the tiny particles in the atmosphere called aerosols contribute to lightning and human activities such as burning fossil fuels release aerosols. A study published last year showed that since humans released fewer aerosols during lockdowns,

the concentration of aerosols in the atmosphere decreased. Last month, researchers at the American Geophysical Union meeting in New Orleans, yes, they didn't have any rules against gatherings, they presented findings showing that this drop in atmospheric aerosols coincided with a drop in lightning. Earl Williams, a physical meteorologist at the Massachusetts Institute of Technology, MIT, who presented the research, said the team used three different methods to measure lightning. All results showed the same trend.

That is, a diminished lightning activity associated with a diminished aerosol concentration. Now, the article goes on. It's much longer than that. But that gives you the highlights. So if you were wondering, if you were sitting there in one of your lockdown sleepless nights

going, I haven't seen any lightning lately. Well, now you know why alright that wraps it up for this first day of the week for The Bridge I'm Peter Mansbridge thanks so much for listening

hey guess what we'll be back in 24 hours.