The Decibel - A doctor answers your current COVID questions

Episode Date: October 3, 2022

We wanted to find out from you, our listeners, what you’re thinking about COVID-19 – especially as restrictions are disappearing and new vaccines are available.Infectious disease specialist, Dr. L...isa Barrett is on the show to answer the COVID-19 questions you have right now, like: When you get sick, is there any way to tell if it’s COVID-19 or the flu or a cold? How long should you isolate if you have COVID-19? What’s the right time frame to get a bivalent vaccine – and what does bivalent mean?Questions? Comments? Ideas? Email us at thedecibel@globeandmail.com

Transcript
Discussion (0)
Starting point is 00:00:00 Hi, I'm Mainika Raman-Wilms, and you're listening to The Decibel, from The Globe and Mail. We wanted to check in with you, our listeners, to find out what questions you have about COVID-19. These days, there's new vaccines, less restrictions, and many of us are back in the office and back to school. There's a lot to think about. And you had some good questions about COVID. So we've brought in an expert to help answer them. When we talk about virus in the community around us, I think of it as a lot, some, or none. And it is not none. It is definitely more than some. And it sits firmly in the a lot category. Dr. Lisa Barrett is a medical doctor as well as an assistant professor and researcher
Starting point is 00:00:53 at Dalhousie University in Halifax. She's an infectious disease specialist and also a member of Nova Scotia's expert vaccine panel. Today on the show, she'll answer your COVID questions. This is The Decibel. Lisa, thank you so much for being here today. Oh, it's a pleasure. Before we get into our listener questions, and we do have a lot of them, I want to just start by getting a broad lay of the land here when it comes to COVID. How much COVID is actually circulating in Canada right now?
Starting point is 00:01:34 Well, I tend to have moved away from the words waves to think of this as a choppy sea. It's got lots of depth. There's lots of virus around. And when I leave my house, I presume I'm going to be in the company of people who have COVID, whether they know it or not. So still lots of COVID around. It's certainly not gone. And we likely will see the choppiness of the waves, if you will, increase a little bit in the next few weeks. And can we put this into perspective a bit? Like how many cases are we seeing now compared to the height of Omicron when it first hit back in December or January earlier this year? You know, it's really tough to tell given the way we've changed testing strategies,
Starting point is 00:02:20 both PCR tests that require medical experts to take them and the availability of rapid tests. So in terms of the case numbers, although we are nowhere near the peak numbers of reported cases, we aren't reporting cases. When we look at hospitalizations and people in ICU, there are certainly far, far fewer in hospital, particularly with respiratory syndromes for COVID, but many, many folks who are in hospitals who have COVID and other medical problems likely made worse by their COVID. So I'm very careful when I answer that question. While we don't have as many people with very bad lung disease, thank you vaccines. There are a lot of side effects with COVID that can make your heart disease worse,
Starting point is 00:03:09 your kidney disease worse. And a lot of those folks are still in our hospitals right now. So this actually rolls really well into our first question that we got from our audience. This is on the topic of how much COVID is out there. Leon from Instagram wanted to know, are people still dying of COVID like in the beginning?
Starting point is 00:03:30 The answer to that is absolutely not. Again, thank you, natural immunity or exposure immunity and vaccines. the fact that we think Omicron as a virus itself produces a different type of disease that may not be as severe in most people, but we are also probably underestimating the number of COVID caused or COVID associated deaths. And so still an important pathogen in our world. Not novel anymore, but certainly not benign enough that I think of it as a new normal. I still put it into my bucket of things that I worry about and am concerned about from an infectious disease perspective. Lots of COVID measures are being dropped or have already been dropped in Canada, including just this past Saturday, the lifting of all COVID-19 measures at the Canadian border.
Starting point is 00:04:31 So that means no more masks on trains and planes, no vaccine requirements. And so Minoja Chan asked, are masks really not needed anymore? Well, I would say in a respiratory season, I really hope that we can, as a group of people, as a society, as good citizens, think about respiratory season a little differently than we used to. And that doesn't mean it's catastrophic. It doesn't mean that we have to go around living in fear. However, we've learned and shown really quite well with COVID that not only does COVID go away, but flu goes away if we wear some masks. And we keep people with chronic lung disease, something called COPD, among other things, a heck of a lot healthier, safer, and out of hospital.
Starting point is 00:05:18 So are masks not really needed? Well, I would argue, as we start to think about a new respiratory hygiene culture in respiratory virus season, that if you want to keep those around you and yourself as healthy as possible, masking in public places is a pretty reasonable thing to do, in fact, and you should feel very comfortable if you want to do it, doing it without fear of stigma or scorn, definitely. This is actually, that's an interesting point you bring up, because I think there's a little bit of, could be a little bit of judgment around this too. Like a few months ago, it was almost the judgment if you weren't wearing a mask, and now you're the odd person out often if you are wearing a mask. And this is also a question from our audience. You know, wearing
Starting point is 00:06:03 a mask is equal to being judged out in the world. And so people are kind of feeling that. I guess, does it matter if you're the only one wearing a mask in a situation? Like if you're at a concert or something, if you're the only one wearing a mask, is that really going to make a difference? The science around this, exactly how much benefit there is if you are a sole mask wearer in a sea of other people is pretty weak. However, I would say think about it this way. If you're in a space with absolutely no mask and no filter to all the respiratory particles around you, you're going to get a lot of many things arguably, you know, for example, at a concert, there may be some other things you'd like to filter out as well. But it still helps to have a form of mask, the better fitting your mask, and the more layers, then the better your protection is for longer.
Starting point is 00:06:57 Let's jump to vaccines. And we have a lot of questions about the bivalent vaccines in particular, especially because it's now available across Canada. Eligibility depends, of course, on where you live. But can you first off just tell us, Lisa, what makes this bivalent vaccine different from the previous vaccines? A bivalent vaccine contains the older version of the virus, the one we know produces immune responses
Starting point is 00:07:24 because that's what's been studied. So the manufacturers have added in that old or what we call ancestral version of the spike protein from COVID, as well as the Omicron spike protein genetic blueprint. And so what you're getting is both the ancestral, because tick, we've got all the studies done, that those are responses that are robust and happen in most people. And then this new and updated version that gives a real refresh to your immune system and updates your response to the latest version, if you will. It's like when you update your app on your phone to the most recent version, it works
Starting point is 00:08:04 better. And that's the presumption with this Omicron bivalent vaccine. And now with this bivalent vaccine, is there still a use for the older vaccines, the original ones? In Canada at the moment, the older vaccines are still recommended for your primary series. So first and second doses, those vaccines that are the ancestral or original version are useful for people who have not had vaccines, their first two at least. A lot of people had questions about when they should get this shot.
Starting point is 00:08:37 So let's get into these. Marissa from Instagram again says that they got their fourth booster in July. When should I get the Omicron specific one? There's lots of different timelines out there. Yeah. And this all comes down to have you had COVID itself in the intercurrent period in between right now and when you last had your booster?
Starting point is 00:08:58 Because that resets your timeline for when you should get your next dose. So by reset, that means, I guess, yeah, what is, what exactly does that mean by reset? Yeah. So if you get COVID infection, you basically have had a very, very good booster, if you will. Not that I'm recommending everyone go out and get natural infection as their booster. COVID is not a lot of fun. But the next thing that comes into play is how old you are. If you are an older person, your immunity tends to wane more quickly. And the same is true as if you have a lot of medical problems or a poor immune system. In those folks, we recommend waiting the 120 days for the moment. Other people who are younger, who don't have any significant medical issues,
Starting point is 00:09:47 the recommendation is to wait at least 168 days between your doses. And the reason is not because we're trying to spare vaccine. It's because your body needs time to recover in between. All those cells, your immune cells need to take a little break in between, or else you run the risk of getting a diminished or smaller response to the vaccine if you get it too early. Okay. So this actually goes to another question we had. Audrey asked, if I recently had COVID-BA5, so this is, I guess, the latest subvariant of Omicron, should I get the bivalent vaccine?
Starting point is 00:10:23 Does it matter what subvariant strain you I get the bivalent vaccine? It doesn't matter what sub-variant strain you've had before you get this vaccine? We don't know the answer to that. We're learning the answer to that as we go. However, as you might expect, not everyone got diagnosed who had COVID, and almost certainly not everyone knows what version of the virus they have. So what we don't know is exactly how much better it is to match your vaccine to what's circulating right now versus the BA.1. A good example of that would be we currently have BA.1.2 virus blueprint in our vaccine that's in Canada, our bivalent. In the US and parts of Europe, they have an updated mRNA vaccine that has BA4-5 Omicron and the original version. And people are wondering, is it better to get the BA4-5 than the.1.2? We don't quite know. We presume the more closely matched
Starting point is 00:11:27 your vaccine is to the circulating virus, that it may have a slightly, for want of a better word, boostier effect than the previous version. But we also know that the previous version, even against BA.1.2, the one that's in the bivalent in Canada right now, still produces a boost to your immunity based on the results out of Europe, even if BA4-5 is circulating. The boosters are really important. And I think it's also really important for us to understand what boosters do and don't do. So let's be clear. Boosters are not here. Additional doses are not here to prevent you from getting infected. There may be a small window where you do have a little bit of protection, but its job is not to prevent
Starting point is 00:12:15 infection. It's to prevent very bad disease and to boost and refresh your responses, to update your responses. So if you're expecting to get a booster dose, and change all the other stuff you should be doing when virus is so high in the community, that's not going to happen, you really should still be doing all the other stuff, the masking, the handwashing, staying home when you're sick. We'll be right back. We are coming up to flu season, of course. So Wendy, Wendy Roberts asked, how close can I get my next COVID shot and my flu shot? We're not recommending that people have to space them out.
Starting point is 00:12:58 You have to be well from a safety perspective and how your immune system works. It's fine to get them very close together or to space them out. Alana asks, should I vaccinate my toddler who's already had COVID before? Definitely, we're recommending that after a natural infection, either in adults or in children, that after the recommended number of days, you go ahead and get vaccinated. That varies a little bit, what the recommendation is, the timeframe in between in different provinces, but definitely check in with your GP. People wonder if it was a BA5. They're in a place right now, BA5 is circulating and their kids are getting vaccinated with the original version. Is that a problem? It's certainly not dangerous. And it and it'll
Starting point is 00:13:45 give them a good base to add to that natural infection immunity. And then hopefully we'll have more vaccines that are bivalent for kids soon. Okay, I want to get in one more question about vaccines before we turn to something else. And this is an interesting one about about long COVID, which we are hearing a fair bit about these days. So Carrie wants to know, are you less likely to develop long COVID if you are fully vaccinated? Yeah, lots of studies going on. And basically, the take home message is, it does seem that at least two doses of vaccine probably lower your risk of getting the symptoms that we call long COVID. We're not really sure what that means as an entity, as a disease yet, we're still learning, but it does seem to reduce your risk. How much
Starting point is 00:14:30 is not clear. And in particular, the reason we're not sure is that we're not sure yet if Omicron and BA4-5 Omicron actually induces as much long COVID as previous versions of the virus. So long and the short is, most likely, getting what we call your primary series of vaccines will likely reduce your risk of getting long COVID. How much and how much that makes a difference with subsequent doses of vaccine is not known yet. We were also looking at what people were searching on Google to find out what people were thinking about COVID. And it was interesting, a lot of the searches are people trying to figure out if they have COVID or if it's a cold or a flu or allergies or something else. So when you get sick, is there any way to tell if it's one of
Starting point is 00:15:20 these other things versus COVID? Oh boy, I wish there was an easy way to tell that because then we wouldn't be spending as much money as we are on rapid tests and PCR. There's really not a great way to rule in or rule out without a test. In the last little segment here, Lisa, let's talk about what to do when you do have COVID. Stephanie has asked,
Starting point is 00:15:46 public health rules are all over the place. What isolation advice should I follow? Yeah, this comes back to my whole hope that Canadians are coming to a respiratory season, respiratory virus season culture. And you're right, it's all over the map. I think basically most human beings want to stay in isolation until they feel well. Because A, it's no fun hanging out when you're feeling terrible with other people and being out in public or trying to work. And B, it is somewhat risky to other people around you. So staying home until you feel well enough to be outside is really important. Probably even if you're vaccinated and the people around you are vaccinated, you may be a risk to others for up to seven days. Some places have gone with five, some said seven. So consider staying
Starting point is 00:16:37 home until you're more well. And if you do need to be around others, either family members, public workmates, or vulnerable people, two strategies to consider. One, make sure you're wearing a well-fitted mask for that period of time after when you may still be somewhat infectious. Two, also if you have access, although we don't know that it's perfectly correlated, some people have decided to buy their own tests, rapid tests, and test their way out of isolation. If they're negative, they know that it's highly unlikely they're infectious to someone else. And at the same time, I think it's really important to note that some people who are immunocompromised or who are older may shed virus for a longer period of time.
Starting point is 00:17:21 And if you're feeling really terrible and it's longer than seven days, consider staying at home for a little longer than not. Let's talk about rapid tests here quickly, because I think many of us have heard about people who have symptoms and or they've been directly exposed to COVID and they still don't test positive on a rapid tests. Do rapid tests work with Omicron? The protein itself that is detected by the rapid tests is almost identical in Omicron as it is to the other viruses. And therefore, with lab strains at the same doses, the virus gets detected. What might be different though, in these situations, everyone in the house has Omicron, and this one person has symptoms and keeps testing negative on a rapid test. One, you may not be getting the little swab where it needs to go. Two, if you're vaccinated, you may actually have the virus, but it's at such a low level because of your vaccines that it's
Starting point is 00:18:21 very difficult to detect with the test. And or number three, you may just have a different virus, even though everyone else around you has Omicron. Just lastly here, Lisa, looking forward to our future with COVID. Lacey wanted to know, are there any new variants of concern? Like what comes after Omicron? Do we know? Yeah, there are several that are on the list. And the joy of all this testing, people think it's a bit of a pain to do all this testing and then all the travel and airport testing that was voluntary. I can tell you, it's given us a really, really good look at virus and how it moves early. Unfortunately, we're going to lose a lot of that now. But there are several variants of concern that are out there.
Starting point is 00:19:13 Similar idea, they look to have different transmission or look like they might escape immune responses that we've already built up. As of now, none of those have become fast-moving viruses. But the question asked is a great one, because if we don't keep track, we're going to lose track and be behind the eight ball again. Our vaccines can switch very quickly. It was June when the FDA told the manufacturer that they wanted an updated vaccine, and they had it and are rolling it out in the millions in September. If we don't have surveillance and we don't keep testing and keep watching those variants of concern, we're always going to be behind. Lisa, this was fascinating. Thank you so much for taking the time to answer all these questions. Thank you. This has been great. I love to hear what people are asking questions about. Before we go, I just wanted to thank all of our listeners who answered our call out for your questions.
Starting point is 00:20:11 I'm Mainika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.

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