The Bridge with Peter Mansbridge - Three Years Later, What Did We Learn?

Episode Date: March 20, 2023

Do you remember those days of March 2020?  Looking back today it seems like a long time ago, and just how confused we were trying to understand how to live with a pandemic. How long would it last? Would we survive?  One of those who helped listeners of The Bridge through it all was Dr Isaac Bogoch and he joins us today to talk about what we went through and where we are now.  Plus, could this be the real story of the 400 highways?

And hello there, Peter Mansbridge here. You are just moments away from the latest episode of The Bridge. Our focus today is on COVID, welcome to Monday. Monday, the first day of spring. Who'd know it though? When you look around, see some of the temperatures that are in different parts of the country. You know, well below zero on the prairies. Significantly below zero in Alberta. Lots of new snow in parts of Ontario.

Maritimes. Atlantic Canada. Still cold. So, but it's going to change. You know that saying, March, like a lion out like a lamb. Can we get to the lamb part now? I'm ready. You're ready. We're all ready. So let's get at it. Okay, we are going to talk about COVID today, three years on. I don't think about it three

years ago. our lives changed. You know, we argued about that at the time. Are things really going to change because of this? This pandemic may only last a couple of weeks or months. It lasted. We changed.

Lots of things about us changed. The way we perceive each other, the way we work, the way we play, you name it. Things have changed. Will it last that way? Will we go back eventually to where we were before? I used to think so.

Maybe not so much. Maybe future generations will. Not sure ours will. Anyway, we're going to talk about COVID. Isaac Bogoch is with us, as he was throughout the worst days of COVID. And we'll get his take on where we are now and what we learned from all this. But first I wanted to pick up on something I said. I guess it was a week or 10 days ago I did a little thing on the 400 Series highways in southern Ontario.

Now, they're some of the busiest highways in the country, and most people, no matter where you live, know about the 401, you know, the highway that basically connects from Quebec City to Windsor. Heavily traveled, especially by commercial traffic. Trucks, big semi-trailers, constant. Anyway, it's a busy highway. But it's not the only 400 series highway in southern Ontario. And I rattled off a bunch of them and I said

you know I don't know this for sure but I've heard and you know the legend carries on that the 400 series highways were all named after Canadian squadrons in the RCAF during the second world war and I thought that's nice I wanted to believe that. You know, one may be part just through myth is true. But is that really the way it started?

Apparently not. Not according to Christine Lee, who wrote me a great little letter from London, Ontario. And she says, you know, Peter, you can keep believing that if you want. And it's a nice thing to want to believe in. But here's the story. The 400 series highways are basically, you know, they're four lane highways. That's where the four comes from. Some cases today, they're much-lane highways. That's where the four comes from. Some cases today, they're much more than that. They're like 16 or 20-lane highways.

But it all started with the idea of four. They are numbered, says Christine, to reflect the Ontario Highway whose route they parallel. Okay, so the 401, the most famous of the highways, is the four-lane highway, originally, that parallels the route of Highway 1, the Trans-Canada Highway. It's true, that's what it does do. It parallels that route. The 407 parallels Highway 7. The 410 parallels Highway 10.

The 427 parallels Highway 27, and on and on and on. The 417, 16, 12, 5, so on. So there you go. You know, you live and learn with the bridge. Now, Christine, I have no reason to doubt Christine. She sounds like pretty knowledgeable on this. And it makes sense when you look at a map and you look at the old highway that it parallels,

that these various 400 series highways parallel now i want to believe as i said and as christina acknowledges i want to believe that something had to do with the squadrons in the rcaf during the second world war as well but maybe maybe i'm wrong I'm probably wrong but a part of me, a part of my heart will keep it there, right? Okay I sometimes listen back to some of the

podcasts we did when the bridge basically started I mean it started in 2019 during the election campaign. And it was kind of an experiment. And it sounds very different than it does today. But we did it and then we kind of backed off, occasionally did a podcast, maybe once a week or so. And then when the pandemic hit, I thought, I got to keep this going. I got to start it up again daily because it's, you know, it's information.

People want information. They were begging for information during those days. And so that's when we started, and it kind of took off, and that's when other people got interested. A number of bidders wanted to buy the rights to the bridge, and eventually we settled on a deal with SiriusXM, and that's who we are with now and happy to be with them. It's been a great little partnership.

But those early days, when I listened back to some of those, boy, we didn't know much, right? We just didn't know what we were dealing with. And we weren't sure how long it was going to last, how long it, and what impact it would have on our lives. We knew it was serious. It was clearly serious. And it wasn't just us.

It was happening around the world. Were we going to escape at the worst of it? Would there be a vaccine? Remember in those early days, the thinking was it takes five to ten years to come up with a vaccine.

That's what history had taught us. But suddenly there seemed to be some indication, you know, there were new ways of doing things and there were new ideas on the vaccine front and it may take a lot less time. And as it turned out, that's exactly what it did do. The first vaccines were out by the end of that first year. But it was a very difficult time and it was scary.

So where are we now? During that period we started, every Monday we talk about COVID and we talk to a number of different doctors in different parts of the country in Toronto and Hamilton in Halifax and Edmonton and each week we'd kind of alternate get a different take from different places on what was happening and one of those doctors is Isaac Boguch from the University Health Network in downtown Toronto, who, like his colleagues,

not only the ones we talked to, but his colleagues in different parts of the country, were working, you know, 18, 20-hour days throughout the worst of it all, and for some considerable length of time. So I called him up over the weekend and said, Doctor, we've got to talk again. It's been a while, but we've got to talk again.

I want to find out where we are and what we've learned through all this. And that's partly by popular demand. A lot of you have been asking, I've got to bring back the doctors. So here we go. Here's my conversation with Dr. Isaac Bogoch. So I guess the last time we talked, you were still probably dealing with COVID almost 100% of the day with COVID almost 100% of the day, if not 100% of the day. What's your day like now? How much time do you spend dealing, talking,

working on COVID? Oh, thankfully, it's a tiny fraction of that. I mean, there's still issues that come up from time to time. Sadly, people are still getting sick. Obviously, it's still here. But from every aspect, from a clinical aspect, from a supporting government aspect, from a media aspect, from just thinking about it aspect, it's now a tiny fraction of the day. Grateful for that. But obviously, we still recognize that it is it's still around uh and we still got to take it seriously well tell me about that how much of it is still around and how seriously should we still be taking it i think it's fair to recognize that the vast majority of canadians have been vaccinated with two doses of a vaccine. Most people, many people, especially more at risk

people have had booster doses, not to say that the booster campaign is perfect. And then of course, depending on the area in Canada you're in, most people have been infected and recovered from infection. All this to say is that we have a significant degree of community level immunity and community level protection. That's helping us stay out of hospital. It doesn't seem to significantly reduce the risk of infection, although it does to a smaller extent, but it's really keeping us out of hospital to a much greater extent. So if you think about, for example, this winter, we had COVID in the hospital, we had, you know, we had, you saw the wastewater surveillance go up, we saw increasing burden

in the community. But if you look at this winter, versus one winter ago, and versus two winters ago, it's night and day, like it's not even close. I mean, sure, we saw people in hospital, but I remember last year, and two years ago, we saw people in hospital, but I remember last year and two years ago, we were overwhelmed. Like people might not remember, but we had tents set outside of hospitals. We ran out of ICU capacity in the spring of 2021. You know, we had a massive initial Omicron wave in winter 2022. So it's night and day. Obviously, it's not over. But I mean, from a healthcare utilization standpoint, it's completely different and so much better now. You know, you seem to hear, you know, a lot of people, I got to be careful with the way I describe whether it's a lot of

people. You hear a lot of stories where people say, oh, yeah, I had COVID. I had it, you know, a couple of weeks ago. It was, you know, kind of set me back for a couple of days, but that was it. And, you know, we just move on. I'd had, you know, my shots and I had my boosters. I had my vaccines. And, you know, they talk about it as if it was like the common cold. Well, for many, I'd even say most people, it is. It is.

But of course, we have to acknowledge that this virus still disproportionately impacts older individuals and individuals with underlying health conditions that put them at greater risk for severe infection. And when we think of public health, the key word is public, right? We think about everybody. We don't just think about some people. We really have to think about the entire community, including those who are more vulnerable to this infection. So if you look at data from all over the world, including Canadian data, you can see who is hospitalized and who dies from COVID. And it's the rates are overwhelmingly, sadly, in favor of people who are over the age of 80. But you start to see the rates go up at around between 50 and 60 for hospitalization and death. But I mean, age is such a huge risk factor for more severe manifestations of illness.

And of course, other underlying medical conditions, immunocompromising medical conditions, you know, cancers and therapies, etc. So we know it's not, there's no secret, like we know who's at risk for more severe manifestations of the illness. And in fact, when we take a step back, we look at the spring vaccine recommendations by NACI. They really focused on that. They're basically saying, listen, we know what the vaccines do. We know what the vaccines don't do. We know what the limitations of the vaccines are. Here's who should get a vaccine. It really is people over the age of 65 and people with underlying medical conditions.

If you're six months out from your most recent vaccine or you're six months out from your most recent infection, notice how they didn't say everyone go out and get a booster vaccine at six months. They did. They really focused on those who are at greatest risk because everybody else has either been infected and recovered or been vaccinated or both and has a much, much, much lower risk for severe manifestations of the virus. Unfortunately, the vaccines just don't block illness as well as they used to. Earlier on in the pandemic, they did. They did a great job in stopping infection and preventing transmission. In the Omicron era, they just don't do as good a job. They do a little bit, but not nearly as much.

But the vaccines still do a remarkable job in protecting against more severe illness, and that's why we see the vaccine recommendations as they are. Are we past boosters now, or do you see another booster in our short future? I don't know. I think one of the annoying things is we totally squandered an opportunity to study this in a meaningful manner. there are ways that you can really address this question using prospective clinical trials. And instead of taking the time to set up the studies to really generate the data to effectively answer that question, we pissed around and we're using substandard data that's not as good. It still helps, but it's not as good.

I don't have a crystal ball. I wouldn't be surprised if we get a booster at some point, if it's recommended for, for example, adults at some point. A lot of this is wait and see. But I think that's a, it's also a really interesting question because it raises the issue of the vaccines, you know, doing a great job in preventing severe manifestations of infection and only temporarily stopping or lowering the risk of infection. And that's just that short lived is probably

going to last for a few months. And then and then you don't have that level of protection anymore. So what we really do need is better vaccines. And there's a ton of research and development looking at, they're called mucosal vaccines and other pan-coronavirus vaccines. But those are still in development. We're not going to see those come to market anytime in the 2023 calendar year. At least I'd be shocked if they did. So I think we just have to make do with what we have, which are the mRNA vaccines right now. And they're good.

They're just not obviously perfect. And we'll make do with what we have. When you think back, I want to do a little Monday morning quarterbacking here, if you want. When you look back the three years, you go into those horrible pre-vaccine days when we were really, really worried about what was going to happen here. Did we do everything right in those days? And I mean the overall we, all of us. Were there mistakes made in there, you know, not in a guilty way, just because we didn't know what we were dealing with in many ways.

Were there mistakes made there that made things worse? Yeah, I mean, I have incredible tolerance for policymakers in that time, right? It's easy to look back in the retrospective scope and say, oh, we didn't do this, we didn't do that. But remember where we were at that time, right? We're sitting in Canada, we had Wuhan implode. Then we were watching Northern Italy implode. Then we're watching New York City implode. Then Iran started to implode. But once it really hit New York, I think for a lot of Canadians, we realized this is really close to home. This is going to impact us. And we're about to get walloped. And we did. And we did. We didn't get walloped as significantly as other parts of the world, but we still got walloped. And of course, predictably, some communities, mainly lower income and racialized communities, and some areas like long-term care facilities got hit way harder than others. And I think if you talk to people in the field of infectious diseases and infectious disease epidemiology, we could have told you that, and we did before it happened. But, you know, of course, there was a lot of unknowns at that time.

And, you know, you saw these policies globally of closing borders and and locking down and really trying to insulate the impact of this insight from impact of this as much as possible. There were probably to some extent it did. It probably did to some extent. You know, I think there's a lot of lessons learned, and I don't think we're really there just yet. Like, I think that we need to do a, oh, God, I was going to use the word of postmortem, but that's probably the wrong way. Not the right choice of words, no. Yeah, let's rephrase that. We really need to do a deep dive into looking at what some countries did, what other countries did, what worked well, what didn't work well, how to communicate better, how to have sound border policy. I still have a lot of tolerance for what countries did early on in the face of an unknown because there was a lot of fear.

And then you think about, too, more local policy. Myself and my colleagues and friends in the healthcare sector, we worked for an entire year on the ward, caring for patients with COVID-19 in the pre-vaccine era. We just wrapped ourselves up in saran wrap and saw our patients and tried to not get COVID. And, you know, like it was an extremely challenging time. It was an extremely challenging time. I obviously don't want to relive that ever again. And I know I'm not going to speak on behalf of the entire healthcare sector, but I'm pretty sure everyone would agree with me that they don't want to

experience that ever again either. So, I mean, that's a long-winded way of saying, I don't really know. And I think about this a lot, and maybe we'll have a future conversation where I can have a more coherent answer. And, you know, one of the criticisms of governments and the healthcare system, such as it was at the time, a hundred years ago, after that pandemic, was that once it ended, everybody kind of moved on and they didn't

act on what they could have learned from what they'd just gone through. Are we at the risk of the same thing happening here? I think it's happening. It's absolutely happening. We're going to start to see the predictable budget lines crossed out for epidemic and pandemic preparedness. We're going to miss many opportunities that we should be taking right now to really bolster Canadian capacity, but also global capacity to deal with emerging infectious disease threats. This is a huge concern. This is a huge concern, right? I mean, look, 51,000 Canadians dead, probably well over 20 million dead globally. I don't know how many trillions of dollars globally this costs, but someone's going to

add this up and the price tag is going to be extraordinarily expensive. Like prevention is key. And if we do have something, mitigation is key. There's a couple of things to remember. Number one, these are global phenomenon. They are not local phenomenon. So we actually do need a global plan, which means we need global buy-in, which means we need to build capacity in places where infections of epidemic and pandemic potential arise. We need early detection systems.

We need systems for global coordination to really mitigate these threats and identify and mitigate these threats as quickly as possible. That's a global issue. And Canada certainly has to play nicely in that, you know, with global partners to ensure that we have a good plan. We're miles away from that. Then there's Canada more regionally and locally. You know, we have a lot of work to do. Right. One of the things that, well, there's so many lessons we can learn and I'm not going to go through them all. But, you know, we clearly need a smarter plan. We need to be more swift in our action. We need sound policy. We need the, you know,

things like local capacity to develop PPE. We need local capacity to manufacture vaccines. We need surge capacity in healthcare sectors, both outpatient and inpatient. We need to harness private-public partnerships, which we didn't do very well during the pandemic, thinking that the government can manage all of this on their own. Of course they can't. So, you know, there are hints of signs of preparedness for us here in Canada, but I think we're a long way away from where we need to be in terms of if there was another global health threat like this, we're far from where we need to be.

What would you do differently if there was another one? What was the big lesson for you personally in all this, recognizing that it's still going on, but what was, what's been the big lesson for you? There's a lot. preparedness isn't just a checkbox saying that we've got ppe and storage oh we've got uh you know our surge capacity like these are these are there's there's a skill set uh that needs to be trained and uh I really think we need to, I'm not saying this well, but we really need to have developed this plan during peacetime and not just develop it,

but practice it so that we're ready for an emerging infectious disease threat. And that really involves sound coordination between federal, provincial, and municipal or local governments and federal, provincial, and municipal public health teams. It involves, you know, how we deal with surge capacity by bringing in, you know, our public sector, by bringing in our private sector. There's a lot that we can do to prepare for the next one. I think in terms of what can we do differently, all of this involves preparedness.

They've said that we should be prepared for more of these pandemics. It seemed like they were only once every hundred years, but they could be a lot more common given our world, given the population, given the various experimentations that are going on and, and the spread of viruses by modern day travel, air travel, et cetera, et cetera. Yeah. I mean, that cetera, et cetera. Yeah.

I mean, that's a guarantee. Oh yeah. Guarantee. Like there's very few guarantees in life, but there, it is Garrett. We will, we will definitely have another pandemic. There will absolutely be another pandemic that there absolutely will be. The real question is when will it be and what will the organism be? But we will have another

pandemic for sure. That's certain. And as you point out, why? Well, you know, you think about what the viruses are that have epidemic and pandemic potential. There's spillover events from the environment and from non-human animals into humans. So you have urbanization, you have expansion of humans into or encroachment of humans into those environments. You have, you know, laboratories that are working on these so you can have accidental spillover events. Like there's a lot of different reasons why we're going to see more of this, but we're definitely going to see more of this. I don't know when, and I don't know the organism, but I know it's going to happen. And actually, if you look at the last 20 years, you know, some of these weren't pandemics,

but they certainly could have been. You've had, you know, SARS, you've had MERS, you've had a massive, you know, Zika virus epidemic in Latin America and the Caribbean, right? This is all human mobility and the spread of infectious diseases. You've had an H1N1 pandemic, often thought of as a forgotten pandemic, right? You had a massive Ebola virus epidemic in West Africa impacting over 30,000 people, killing over 11,000 people. And that was in West Africa. Prior to that, Ebola was mostly confined to Central Africa. You had international exportation of cases from the continent of Africa with that. You had obviously, you know, COVID. You have MPOCs, formerly known as monkeypox. Like you can see these are what we call emerging and re-emerging infectious diseases.

And the reasons why are increasing human mobility. You've got climate change with the expansion of vectors that will transmit infection. And you've got encroachment into areas or people in areas in closer contact to non-human animals where we know spillover events can occur. I mean, that's the sort of trifecta of why we're seeing what we're seeing. All right. last question. You've got to be honest here. Were there moments in all this over these last couple of years where you kind of looked at the ceiling and said,

why did I choose this for a job? The honest answer is that I was too busy to think it really was like I there was very little time for self-reflection um maybe that's happening now that things are settling down but 2020 2021 a lot of 2022 we just were working and there wasn't time to feel sorry for yourself or, uh, uh, you just saw your patients that on your zoom calls, you know, your work. Bet your family thought of it. Yeah. I'll leave that out of this conversation.

Listen, uh, as as always we thank you I know it's been a while since we last talked but it's great to touch base with you again and see where we are and get a sense of you know what you're thinking at this time as things as you say slow down a bit but they're still there good to talk

I was happy to chat okay take care be well Dr. Isaac Boguch University Health Network in Toronto I was happy to chat. Okay. Take care. Be well. Dr. Isaac Boguch, University Health Network in Toronto. And like so many of his colleagues in the healthcare business, in hospitals, clinics, doctors, nurses, various healthcare staff, they're all heroes in my eyes for what they've been through the last few years And I guess finally catching their breath in a way

But knowing as well at the same time That this is still going on for a lot of people And those people need their help Okay, we're going to take a quick break When we come back Something very different, but something that's impacting our world, especially the world of journalism, especially the world of newspapers,

and especially the world of small towns. Back with that right after this. And welcome back. You're listening to The Bridge on SiriusXM, Channel 167, Canada Talks, or on your favorite podcast platform. Launching a new week here of The Bridge. Glad to have you with us.

We passed, by the way, for those who are counting, over 7 million downloads. That's really 7 million downloads. Really in just the last couple of years since we started our relationship with SiriusXM. And that's great. Very proud of that fact. Do you live in a small town or have you lived in a small town? If you have, you know the importance of that community newspaper. It may come out daily.

More likely it comes out weekly. And it is your touchstone, your connection to that community. You know, I know when I'm in Stratford, the Beacon Herald, you know, it's an important newspaper. It keeps the 30,000, 35,000 people of Stratford in touch with what's going on in their community as best they can. After years of cutting back, slicing and dicing, and different ownerships. But we've all seen the struggles of small-town newspapers,

all newspapers really, but small-town newspapers especially, and basically just staying alive. It's costs are running high. Staffs have to be cut advertising is down a lot of things are hurting small town newspapers and as a result they're hurting small town knowledge of their community

I read this story the other day and it's interesting for two reasons. One, it further gives us an example of what it's like. And second, in a way it touches us too, even though it didn't happen in Canada. So here's the story. Small town in northern Texas in the Panhandle. Where once a week on Thursdays, in one little building that houses the local newspaper,

they used to raise a green flag at a certain point of the day on Thursdays. And what did that green flag signal? It signaled the fact that the paper, that week's paper, was available. And people tended to rush for that paper because it kept them in touch with their community, right? That's what it's all about. For 130 years, there was this tradition. The paper is called The Record, which is not an unfamiliar name for newspapers. It's down the street from here in Stratford,

you've got the Kitchener-Waterloo record. The record is one of those names that papers latch onto. It would usually be, in this particular case, the record, about 28 pages long, full of the words and photos of their neighbors and their neighbors' kids and, you know, what's happening in their town.

The final front page photograph captured billowing smoke. The banner headline yelled, Wildland Fire Blazes Path into Oklahoma, which is not far. The border into Oklahoma is not far. Now, I said the final front page. It was the final front page. Just a couple of Thursdays ago, March 14th, I think, where they said,

you know, that's it. They announced they were suspending, and that would be it, and the final paper. It offers a fresh reminder of how perilous the news business is for most local publishers. I'm reading here from the story that was written about the closure of the record. Offers a fresh reminder of how perilous the news business is for most local publishers and the communities they're part of. Rural newspapers like The Record face compounding threats. Not only do publishers face the same industry pressures of rising newsprint costs and an ever expanding internet and social media landscape, but unlike their big city peers, they also must navigate the challenges of serving a stagnant or declining population. Only a couple thousand people live in the town where the record was published.

So, why am I telling you this story? Because there's lots of examples of the same thing happening in different parts of Canada. Here's why. The record was published in the town of Canadian, Texas. I never knew there was a community in Texas called Canadian. But there it is, in the middle of an agricultural area. It's named after a tributary of the Arkansas River, and that tributary is called the Canadian River.

So they named the town Canadian. And the paper, a gritty little town newspaper, source of local news for more than 130 years, was called the Canadian Record. So there you have it. A little story that is a reminder to us all the difficulties that exist in journalism today. It's funny, the number of different angles to that story we've dealt with just in the last little while, right? The emergence and dominance of the internet, the impact of Twitter, the issues surrounding whether or not the media and journalism in particular can be believed. Now, some politicians are trying to close down segments of the media. Certain politicians scream, we don't trust the media.

We're not going to talk with the media. All this is having an impact on our world of journalism. And little stories about the Canadian record remind us of how this is going to make a difference. It'll make a difference in that town. That community won't know as much about itself as it did when the paper existed. They're not going to read about it in the Dallas papers

or even the Lubbock, Texas papers. Lubbock's not that far away from Canadian. If something awful happens in their town, that'll receive attention. Beyond that, nothing. Okay, I'm going to leave you with that thought. I'll give you a fast look ahead to the week ahead. Tomorrow, Brian Stewart joins us. Tuesday's

Ukraine story. But as we advertised last week, we're going to look tomorrow at two very specific angles. What happens if Ukraine wins? And conversely, what happens if Russia wins? Those are big questions. And Brian has been spending the last few days contemplating both those questions, and we're trying to deal with it tomorrow. So that should be interesting.

Wednesday, Smoke, Mirrors, and the Truth. Bruce will be by. Thursday is your turn. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. Don't be shy. Drop us a line. Remember to put your name and your town on that letter.

And keep things tight. I received a letter that came in during the night. It was like, it's got to be like four or five pages long. It's like really long. That doesn't help, you know, because I end up having to find one paragraph out of that, if it qualifies even at all. But also the ranter on Thursday will be back,

and then Friday is good talk with Chantelle Ibera and Bruce. So another great week ahead. Looking forward to every one of those programs. Looking forward to talking with you. So thanks so much for listening. I'm Peter Mansbridge. This has been The Bridge, and we'll talk to you again in 24 hours.