The Decibel - Is COVID over?

Episode Date: May 15, 2023

On May 5th the World Health Organization declared the end of the COVID-19 emergency. But what does that mean for the pandemic? How should we be thinking about the COVID virus now and what kind of risk are we still exposed to?It’s taken three years of social distancing, mask mandates, and varying degrees of lockdown to get to this stage, but what comes next is still a bit of a mystery. Today, Lisa Barrett, an infectious diseases specialist at Dalhousie University and a practicing clinician, how we can manage COVID now and where the disease could go from here.Questions? Comments? Ideas? Email us at [e-mail]

Earlier this month, the World Health Organization made a big announcement. The Emergency Committee met for the 15th time and recommended to me that I declare an end to the public health emergency of international concern. I have accepted that advice. That's WHO Director General Tedros Adhanom Ghebreyesus. It's therefore with great hope that I declare COVID-19 over as a global health emergency. So what does this announcement actually mean? And how should we be thinking about COVID now? Dr. Lisa Barrett is an infectious disease specialist at Dalhousie University. She's here to help us understand what's changed and what hasn't when it comes to COVID-19.

I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Lisa, thank you for being back on the podcast. Always nice to be here. So can I just start by asking you, is the pandemic over? Ooh, gosh, don't I wish it was entirely over. Different but not over is my pretty frank and clear answer. Okay, but we are out of the emergency state. So what has it taken for us to get out of that part? Looking at emergencies and something

where there was a significant threat of uncontrolled and unexpected consequences, that part now has changed because so many people have been exposed to this virus. We know more about the clinical course. And because we have a tool of prevention and or reduction of disease, we could say that although there is significant impact, that there is not an emergency that's an unpredictable entity quite as much. And therefore, the emergency part of the pandemic response has moved away from being the dominant part of our new peripandemic life. Peripandemic. That's an interesting one. I haven't heard that one yet, actually. So not post-pandemic, but peripandemic. Yeah, we're into the next phase. All pandemics go through phases. This is the next one where we've gotten some predictability, but not complete stabilization yet.

And what about Canada? What's the state of the pandemic in Canada? Well, I would say compared to other respiratory viruses that have a seasonality, and the long and medium term consequences of them are well known, we haven't quite gotten there. We are still seeing COVID. It's, everyone talks about decreases. And so that refers to the most recent reporting weeks or month. And definitely we're starting to see and continuing to see a decrease in cases, decrease in the amount of COVID, at least at the wastewater level, and in some situations directly measured numbers of COVID cases, but they are still, you know, very, very much higher than other respiratory viruses like RSV and influenza. Those ones had their blips, had their season and went back down to

usual. We haven't hit that. People don't seem to recognize that we haven't hit that seasonality yet with COVID. I think we probably still will, but that's not the case. So still quite a number of people who are getting COVID and coming into hospital with COVID. So when we say seasonality, so I guess this is like how we think about cold and flu season, right? The fall is cold and flu season, spring and summer, or summer, not so much. Is that what you mean when you're talking about COVID seasonality? Yeah. So respiratory viruses, particularly influenza and RSV in the Northern hemisphere, at least, tend to be highest for flu late November, December, and into January, February,

maybe even March. Respiratory syncytial virus or RSV tends to be a little later. And other coronaviruses, if we recall, COVID is a coronavirus. Other common cold coronaviruses also tend to go up in the fall, go back down. That's what I mean by seasonality, when those viruses come up and go back down, and they go back down to almost nothing in between times. And that's not what we're seeing with this particular coronavirus COVID at this point. Given all of this, Lisa, how should we understand the WHO announcement that the public health emergency is over? Yeah, I have spent a lot of time this week answering a lot of texts from folks, and I recognize that we all want this to be done.

It is amazing, to be honest, that a coronavirus of this magnitude that had this much damage associated with it has been brought down to a non-emergency between immunity, good science, and therapeutics, along with vaccines. I mean, it is incredible that it happened this quickly, to be honest. But it does mean, though we should celebrate that and continue to recognize the contributions there of research and science, it also means that because there's still virus hanging out, and it is still a pandemic, meaning we're not really, really certain what the medium long term impacts are. We're not really certain how to, you know, really, really well protect our most vulnerable. This is still not out of the pandemic stage. So it means life, though should be close to normal, should be approached. If we

are aware and cognizant of more vulnerable people in our communities, we should be really, really thinking about being deliberate with our health and health protection before we go completely back to normal and ask the question, do we really want to go back to being sick half of the year with respiratory viruses? Okay, well, let's get into some of these practical things then that we can be thinking about now. I want to ask you about risk. So in my day-to-day life in a Canadian city, going to work, taking transit, maybe going out for dinner every once in a while, what's my risk of catching COVID? You know, it's tough to know. There's still quite a bit of COVID around. And this version of COVID is very transmittable.

And that's true even for people with all of their vaccines being up to date and having had COVID in the past. It is still mutating. It is still moving as a virus. And therefore, there is still risk of being exposed to COVID at this point, far more so than any of the other respiratory viruses. So I'm more likely to get COVID than I am to get the flu right now then? You're far more likely at this point to run into COVID than other things,

even if you've been fully vaccinated and had COVID in the past. Now, the next question is, do you care if you're going to get a sniffle or you're not going to feel super unwell? Well, that's a great point. You may not feel super unwell. To be frank, there are still some signals, even with vaccination, even with therapeutics, where there are some types of inflammation and autoimmune diseases that we're starting to see a little more after people have had COVID. I don't mean post-COVID syndrome or the post-infectious syndromes we see, but things like diabetes, some premature or earlier than expected heart disease. So we don't understand that altogether. So when I'm thinking about my risk, I do wonder if I know everything I need

to know yet about this virus before I just assume even if I don't get super sick, that it's not going to affect me if that makes sense. Right now, as a human with a pretty good immune system, all my doses had COVID before I go out and the way I think of it is probably going to run into COVID. I know mostly that I'm probably not going to get super sick immediately, but I may have some long-term or medium-term impacts. It can lead to some, rarely, but present, can lead to some other diseases. So I think about all that before I even start. And then I go, okay, more importantly, what do I need to do this week? Do I need to be well for work? Am I going to be

around some vulnerable people? Am I going to be around some vulnerable people? Am I going to be around vulnerable people who have to be around me and they don't get to make a choice indoors in a crowded space? And that's how I approach risk at this point. That's complicated. It's not a soundbite, but that's where we sit right now, not just about COVID, but about many of the health issues that are around viruses and respiratory viruses in the community. It's an interesting kind of assessment that you're making there. You're basically going through your plans for the week. You're figuring out who you might be putting at risk. So when we're talking about the risk mitigation things that we're so familiar with now, like the social distancing and the masking, how do those play into your assessment?

Boy, it's tough right now, folks. Really. And I don't think we've helped along the way. I don't know that we could have done it differently too much, but people have taken to camps of this is right and this is wrong. And it's really tough because none of the tools or layers of risk mitigation in and of themselves are perfect. None of the tools that we really cool concert at the East Coast Music Awards. And I don't have to go see my vulnerable parents and or my patients who are transplant patients within a week. I might go and not mask knowing that my vaccines are up to date and I don't have any symptoms and hopefully no one else does too. I kind of might hang out on the edge of the room if it's a terrible, very small, hot speaker ridden room. Just saying that might be what one would do if one were doing that last weekend. But I am aware that if I wanted to go and see the show, but had to make some commitments the next week, had to be at an important talk, had to be on an airplane and give a really big

talk at a conference, I might mask and be there. I might also stay on the edge of the room and I might stay slightly less time if I wanted to make sure. So it's very nuanced. Some people say that's silliness, masks work or they don't, treatment works or it doesn't, vaccines work or they don't. And of course, none of that is true. It's cumulative layers, awareness of your status of being well, using tests if you want to and you're symptomatic. Those are all bits together that I still think we're going to have. Everyone's like, that's a lot of work. I'm like, I look both ways before I cross the street and try not to turn left at an intersection at the busiest times of the day because I know that's when accidents happen. It's the same thing. It's normalizing this

as a strategy for being well. This is not about disease or COVID. This is a strategy for being well more of the time. We'll be right back. Lisa, I want to ask you about the possibility for new COVID variants, because for the last few years now, we've kind of constantly been hearing about new variants that were more contagious and the possibility of a new variant that's more contagious. So could something like that still emerge and change things? I think it could. Of course, I'm not a hardcore virologist.

I'm a viral immunologist in my other life. So I think more about the immune response. But yes, because we are actually generating more pressure on the virus to mutate as we develop better immune responses and we fight back ourselves against the virus more. It is common to accelerate change in a virus and make it mutate away from that pressure. It's kind of like it's going around the roadblock of our immunity and finding a way around. So almost certainly, we would expect that to happen, just like we expect it to happen with influenza. Saying something's expected and going, of course, we knew that was going to happen,

doesn't always mean it's excellent when it does. Every so often, influenza shifts instead of drifts in how it mutates. And it's so different from what our bodies have seen before that we have pandemic influenzas. Like our previous, you know, it was called the swine flu a few years back. So RNA viruses do this. Yes, it's expected. And what's our best tool against being caught flat footed, if you will, again, it's to be very, very diligent on the surveillance. That also means we have to test and know if someone asks, I don't think we're ready to just call this another respiratory virus. It's still moving more quickly and we still don't understand why some people are immune and others aren't and exactly what the medium and long-term consequences are. It's not really ready for prime time as a usual virus yet.

I want to ask you about vaccines. Earlier this spring, in March, the WHO actually changed its recommendations around vaccines. Can you just catch us up, Lisa? What does the WHO now recommend about who should be getting vaccinated against COVID? Yeah, they're very clear that the people who are most vulnerable are the people who should be continuing to keep up to date with their vaccines. That's the long and the short of it. There are subtleties, there are bits and pieces. So older people and or people who have poor immune systems, mainly because we know that those are the people who could get and will get very sick with COVID.

If we don't keep them up to date, their immune systems don't have the ability to pivot to the new versions that keep showing up. and we want them to have the best protection. And so those are really the folks who we recommend having the best protection, which is the most up-to-date version of vaccines. And I don't know that we're talking about this that much yet, but those are also the people that are more vulnerable to long, not post-COVID, but actual infection that can last for months, actually. And we're really having trouble treating some of those folks. They're not common, but it's important because people should know if you're older with a bad, bad immune system on certain medications, when you get COVID, it could be for a very long time. So the WHO does highly recommend, especially for that group, that they get their vaccines and

continue to get them when they're available. And just to be clear, the recommendation, of course, was if you got your initial series of COVID, that was good. We're talking about boosters now, essentially, to kind of keep these vaccines up. I call them next doses, because every country has their own favorite way of describing them. But basically the take-home message is whatever is the next dose in your region, because that's often influenced at a public health level

by how much virus you have around, what viruses you have around. It's a little bit a nuance per region. And so I always tell people, get whatever the next dose is that is recommended, there is still interval benefit. So meaning additional add on value plus for those people to get an additional dose. And of course, the fall and spring doses would have been bivalent, meaning they have that newest or newer Omicron sequence,

which is a good match for the virus that's circulating at the moment. And so the WHO is not necessarily recommending for younger people who have good immune systems, they're not necessarily recommending a next dose at this time, Ben. Yeah. So they've said, if you would like to feel free, but you don't have to in order to feel that you've done your due diligence, but it's important to recognize who's around you. So while it's not for personal protection, it may well be that in your personal life, in your world, whatever you do for a living or in your social circle, you feel the best about getting an additional dose to kind of ramp up some antibody levels. Does that help transmission?

Well, probably not perfectly, but will it hurt? Nope. And it may provide a smidge of more protection. We've talked a little bit about vulnerable people who do have to stay more isolated, wear masks, be a little bit more vigilant in that way, because the world hasn't opened up in the same way for everyone. So I guess, Lisa, like, how do we reconcile their experience with this new reality for the majority of people who can kind of go about their day-to-day life in a lot of the same ways as it was before the pandemic? Yeah, I recognize some folks aren't quite comfortable

or there yet, but they can do more. But you're right. There is a difference. They go to the grocery store, to the theater, wearing a mask. They rarely go to restaurants. I don't know of many situations where restaurants have a, you know, a masking hour or an only, you know, symptom-free group hour, or we've all tested to come to the restaurant hour where they can all go out and feel more comfortable. And so life isn't the same. Some folks say that's their problem. It's overkill. Well, I think we're all in this together. And I think from a Canadian perspective, it's important for us to say, let's label this. There are still a lot of people out there, and that's a good chunk of humans who can't do the same things.

I won't speak for them because I'm not one of them. I do look after a lot of them. And they're still very quite distressed and morally distressed to a certain extent that they feel a little left out. approach again and normalize the fact that it might be okay for businesses to have a two hour period when folks test to go in there and feel like they can go into a restaurant with people of their age and type. And maybe that's something we should think about and discuss as a society, how to include. We spend a lot of time talking about accessibility and inclusiveness for a lot of different things from a physical access perspective. Maybe we should talk about that from an immunocompromised perspective as well.

Just lastly here, Lisa, we talked about seasonality a little earlier on. So eventually, do we expect COVID to become a seasonal disease like flu? I think we do, but there's enough differences with this virus that I'm not sure it's going to happen yet. So I say, I hope so. It would be usual for viruses of this type to do that. But it's doing enough unusual things. Like nobody who's immunocompromised on certain medications gets persistent influenza infection, really. But with COVID, they do.

So we don't know yet. Got a lot more to learn. And let's darn well hope it does become a seasonal virus that we can escape for chunks of time. Lisa, thank you so much for taking the time to speak with me again. Oh, no. Great talking with you. That's it for today. I'm Maina Kar Aram and Wilms.

Our interns are Andrew Hines, Tracy Thomas, and Wafa El-Rayis. Jay Coburn helped produce this episode. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show.

Adrian Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.