The Decibel - What you need to know about COVID this fall

Episode Date: September 13, 2023

The COVID-19 fall surge is upon us. But this year it’s different. Cases are rising again in Canada, reversing a trend from when cases were decreasing for most of 2023. And once again, there are new variants circulating.The Globe’s National Health Reporter Kelly Grant explains why we’re seeing a rise, what the Canadian government and public health experts say we should do about it, including when new boosters are available this fall.Questions? Comments? Ideas? Email us at [e-mail]

I know we all wish COVID-19 no longer existed, but people are still getting infected and vaccination continues to be one of the most effective ways to protect ourselves against serious outcomes. That's Health Canada's chief medical advisor, Dr. Supriya Sharma. On Tuesday, officials announced that an updated COVID-19 vaccine will soon be available to Canadians. This comes as COVID cases are on the rise.

Again. Yes, we've been here before. Many times. And a lot of us are tired of hearing about it. But it is important to think about how we approach COVID today. It's not yet clear whether COVID will settle into a predictable seasonal pattern like flu. We do usually see more respiratory viruses around in the fall. And that's the season we're heading into. And that's

why we need to talk about it now. Kelly Grant is the Globe's national health reporter. Now, because we have been in a good place in terms of the numbers. It has been a long time for some people since they've had either a vaccine or an infection. And so the power of that combined immunity is starting to wane and people are starting to get infected again. People like myself. After avoiding it since the start of the pandemic,

I got COVID last month. Lots of other people are getting sick too. So today, Kelly's on the show to tell us how we should be thinking about COVID this fall. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Kelly, thank you so much for being on the show. Thanks for having me. So we're seeing an uptick in COVID cases right now in Canada. What's actually going on?

So first of all, with case numbers right now, we have much less of a sense right now of what the case numbers actually are. Just way fewer people get lab tests for COVID than was the case earlier in the pandemic. But we do have a couple of indicators that are letting us know that we are seeing an uptick. One of them is that the test positivity rate is up. So I think the most recent numbers from the public health agency had the national test positivity rate up at 13.4%. And that's up from 11.6% a couple weeks before that. So that is one indicator that is rising. Another is we are seeing some signals in the wastewater testing to suggest that the amount of virus out there is beginning to go up. We're also seeing an uptick in hospitalizations. So the most recent numbers for the week ending September 5th, there were 2,165 beds across the country that were filled with COVID patients.

And that's up from 2,125 a week before that. But for some context, when we were at the height of the Omicron wave in the winter of 2022, there were days when there were more than 10,000 people in Canadian hospitals with COVID. Wow. Okay. So that's very different than when we were talking about, you know, late 2021 there or early 2022. I want to go back to the first stat that you mentioned there, the test positivity rate. What do we mean when we say that? So we mean what percentage of the tests in labs that are actually being done for COVID are coming back positive. So a couple of provisos here. First of all, most of us probably know that at this point, if you're getting tested for COVID, you're probably doing it yourself with a rapid test at home. And if you have a mild case, you know, you stay home,

you lay in bed for a couple of days, and then you head back to your life. And nobody in officialdom ever knows that you had COVID. But if you're sick enough to interact with the healthcare system, either you go to see your doctor, you wind up in hospital, then you'll still get a lab test for COVID. And those lab tests are still collected and evaluated at a national level. So we would expect that tests given to people who have really strong symptoms of COVID are likelier to come back positive than if, say, you were testing everybody on the street regardless of their symptoms. An important thing to make sure everybody understands is that any case counts you see publicly now are vast underestimates because, again, most people never go to a lab to get

tested now. And it's those lab results that wind up in the public numbers we see. Yeah, so that's a subset of probably all the COVID that's out there. But you said the test positivity rate was 13.4% recently. And that's up from 5.7% at the beginning of July. So that is quite different than the beginning of the summer. We are definitely seeing a difference there. Yeah, we absolutely are. Can we put this into context, Kelly?

Is there any way to compare where we are now versus where we were the same time last year with COVID? So I think the most useful way to do that is to look at the number of people with COVID who are in hospital nationally. And the Public Health Agency of Canada data from this time last year shows that we were somewhere between 5,000 and 6,000 people in hospital with COVID per day. So you know, that's almost three times the amount we see right now. And do we know about how serious those cases are? Like for people who do end up in the hospital, how sick are they? So the vast majority are on regular wards.

Very few of them are in the ICU. So right now, again, most recent numbers from the public health agency are that of all those people in hospital, only 65 are in the ICU and 58 of them are mechanically ventilated. So and we know like if you're younger and healthier, generally this is it doesn't hit you as hard, right? It seems it seems to be like we're hearing like symptoms of a cold or a flu. But this can be more serious for people who are elderly or immunocompromised. I guess what can be, I guess, the complications for people in those situations? So for people who are elderly in particular, they've always been the ones hardest hit by this virus. And especially if they have multiple comorbidities, things like COPD or heart problems or other sort of health problems that older people

often have, then this can really exacerbate all of those conditions. And it's often people in that situation that we see winding up in hospital. For people who are younger and healthier, this tends to be more like a very bad cold or a minor or bad case of the flu, depending on how hard you get hit. Okay. I want to ask you about the COVID waves, because the past few years, we've always been talking about these waves of COVID that kind of come and go. They used to last kind of weeks or months,

but what do we know about how the virus is spreading right now? I think what we know is that it is spreading much less than it has at times in the past, but it still has a variability that hasn't quite settled into a seasonal rhythm. So we do still see waves. We're at a pretty low ebb right now, but beginning to see a rise.

Whether this becomes a big wave yet, we don't know. We will have to see. But in general, it hasn't settled into a really predictable seasonal pattern yet. Give it another couple of years and it may turn out to be more definitively one of the winter viruses that we can kind of anticipate every year. And I guess how these viruses interact with each other like last year we were talking about the the quote triple demic right of three different viruses at the same time that's I guess that's where the concern is because that's the strain on the health care system. Yeah, and what happened with the tripledemic last year that was really the most interesting and had the biggest impact on the health care system was that COVID remained a problem,

not as bad as in past years, but still certainly remained something that had an effect on the healthcare system. But flu and RSV, two other viruses that had all but disappeared for the previous two seasons, they came roaring back, and they were especially hard on children. And those viruses really sent a ton of babies, especially, to the hospital and made for a very difficult season for people who work in pediatric care and for children themselves. Yeah. Earlier this summer, I think a lot of people remember, we started to hear about this new variant that scientists were concerned about. And then we kind of haven't heard about that so much. Can you kind of catch us up? What happened with this new variant that they were watching? Well, the reason we haven't heard about it as much is mostly because it's been a good news story. Kind of rare when we're talking about

COVID, so that's good. That's true, right? We'll take them where we can get them. So the variant is another sub-lineage of Omicron. It's called BA.2.86. And the reason why scientists around the world were concerned about this when it was first identified in late July was because it had so many changes to its genetic sequence from the other variants that were circulating most prominently. The last time we saw such a dramatic change in the genetic sequence of the virus was when we went from Delta to Omicron. And I think all of us still have nightmares from that period because the virus changed so substantially and became so much more transmissible that, I mean, it felt like everybody in the world was infected within weeks with that strain. And obviously, Omicron really changed the course of the pandemic. In the case of BA.2.86, the reason why it's a good news story is because we haven't seen anything like that level of spread. We found out on Tuesday that Canada has now identified 11 cases of that new variant.

And that's just over the last couple of weeks. So that is much less spread than we feared might be the case. If this thing had a real fitness advantage over the other circulating variants, we would have seen far more cases of that variant by now. You know, it's a competition out there for the variants. And so far, this one is not winning. The other piece of good news is that there has been a limited amount of lab testing of the newly reformulated vaccines against this variant. And it seems that those vaccines should work well against BA.2.86. But I would say the biggest thing is if this thing was going to be a huge, scary problem by now, we would know. We'll be back in a minute.

Let's continue to talk about vaccines here, because there are a number of different variants circling. And we know that there's updates to vaccines to address these different changes. And just on Tuesday, Health Canada was making an announcement about vaccines. So where are we at with vaccines that are available here in Canada? So Health Canada announced on Tuesday that it has approved a reformulated version of Moderna's Spikevax vaccine. It targets the sub-lineage of Omicron known as XBB.1.5. Health Canada is also reviewing a vaccine from Pfizer and another one from Novavax, both of which also target that same variant. So this is supposed to be targeting the stuff that's, or the virus that's circulating now then? Well, that's supposed to, I think, is the key word in your question there. The decision to target XBB 1.5 was actually at the request of U.S. officials.

They asked the vaccine companies to pick that strain as their target back in June when they were making their vaccine decisions. Canada and basically every other country followed suit. The U.S. often leads the way on these kinds of things because they are, you know, such a big and lucrative market for the drug makers. And XBB1.5 was the predominant variant in June when that decision was made. It is not the predominant variant today. The predominant variant in Canada today is actually another sort of member of the Omicron family that's quite similar to XBB15. Officials with Public Health Agency and Health Canada have both reassured us on Tuesday that this new version of the vaccine should perform quite well against the variants that are circulating now. And so what is the advice on getting a booster? Like, should people be going out and getting a vaccine? Back in June, the National Advisory Committee on

Immunization put some recommendations out on that very question. And what they said was that if you haven't had a vaccine dose or an infection in the last six months, you should go out and get a shot of the new updated version of the vaccine for the fall. I guess the other question, though, is like boosters are available, but are people getting them? Like we've always been talking about the, you know, what is the uptake of vaccines? Are we seeing an uptake of boosters in Canada? So with each subsequent booster that has been rolled out, uptake has fallen. Now, the Public Health Agency of Canada's most recent numbers are unfortunately, I think, not a great picture of what booster uptake is. They've got numbers from the first six months of this year that show for adults, only 6.6% got a shot of any kind during that period.

And for people over 80, just under 22% got a shot during that period. Now, the really important proviso is that the nasty recommendation for that period was basically that only the elderly and the very immunocompromised needed a spring booster. So I would take those numbers with a grain of salt. I think, unfortunately, they're not the best picture of how Canadians feel about boosters. And the hope is that there will be a much higher uptake of the fall booster campaign as public health moves more in the direction of COVID vaccines being rolled out once a year in the fall and given with your flu shot. So you get your annual boosters together, essentially get your flu shot and you get your COVID shot in the fall then is the idea. That's the hope. This really gets back to the consistent problem, though,

that we've been hearing about since the beginning of the pandemic, Kelly, though, with the challenges for public health communication, right? Getting out messages to the public. And it's harder even now, I think, when people are tired of hearing about COVID. With you reporting on this, the people you're talking to, like, how do public health officials communicate in a way that I guess really breaks through people's intense exhaustion around COVID? Well, Dr. Teresa Tam and Dr. Howard New, who are the chief public health officer and deputy public health officer, were asked about this on Tuesday at the news conference in a couple of different ways. And Dr. New said, you know, obviously that they're aware of some of this sort of COVID fatigue that all of us have. And so that when they think about rolling out the vaccine campaigns this year, they're thinking about doing a couple of different things. One is that they need different channels to try to approach people. They need people to hear from their family doctors, to hear from their pharmacists, and to hear from leaders in their communities who they trust, people like faith leaders and that sort of thing. They're also really making a push to make getting vaccines as easy and convenient as possible.

And that goes towards their idea of encouraging people to get their flu shot and their COVID shot at the same time. So they hope by making it fairly simple and fairly easy and tying it to the flu shot, coupled with trying to get influencers, not like social media influencers, but although those could be an issue too. But I mean, the kind of people who influence people's day-to-day decisions, that's who they're hoping can get the message out to people to go out and get your COVID booster. I really want to ask you about long-term care facilities, because we know, of course, the elderly are most affected by COVID, and we're learning more about how things were handled in some facilities early on in the pandemic. There was a recent Ontario ombudsperson's report that found that inspectors actually stopped, inspections stopped in facilities during the first seven

weeks at the start of COVID, which left a lot of people in a very vulnerable situation. And, you know, have we seen any improvements, I guess, in long term care across the country in order to to protect older people from this virus? The biggest improvement that we have seen for seniors who live in long term care homes is simply the availability of the vaccine. I mean, in most provinces, there have been campaigns in place where nurses and doctors are going into these homes and doing vaccine blitzes. And that's just without question, the best way to protect elderly Canadians in long-term care from COVID. All that being said, things are still very tough, I think, in the long-term care sector. One of the biggest problems to come out of COVID is that it had a huge effect on staffing. Working in a long-term care home is already a very difficult job, and I think the people who do it are angels

on earth. But the situation was so difficult through the pandemic in long-term care homes that a lot of workers like PSWs and nurses left the sector and don't want to come back. And so it was already difficult to get people to work in long-term care. It remains difficult. And, I mean, these are the people who provide the care. And when the staff is not there, the care is just not as good as it could be. So just before we end here, I think sometimes people are looking for a little practical advice here, right? As we're heading into the fall, people have questions about their personal protection. Should they be masking again?

Should they stock up on rapid tests? I guess what should people be thinking about as they head into the fall? Well, I think it's safe to say that public health officials would say the best thing you can do for yourself is go out and get that COVID booster, get your flu shot while you're at it, too. On the masking front, it was interesting, this news conference on Tuesday, the Health Canada and public health agency officials were wearing masks again. that their expectation is that masking will remain a personal choice through the season, with the possible exception of some hospitals that have kept mask mandates in place or may bring them back for the viral respiratory season. It is a layer of protection. We hope people have developed the habit to be able to use masks as needed during the respiratory season, not just for COVID, but for all the other respiratory pathogens that will be transmitted around this time. So I do think now is the time to get your masks ready

if you don't already have them. On the rapid test front, the officials were asked about it at the news conference on Tuesday. Dr. Tam mentioned that the federal government still has a stockpile of rapid tests, but that they've stopped sending them out to the provinces and territories because they've sort of indicated that the tests are COVID, then you can often find these tests for sale at places like pharmacies. There are still some giveaways happening through places like schools and public health offices. And so you still can get rapid tests.

And if you want to use them as a way of confirming what it is that you have, then they're still there and available. All I would say is if you use any rapid test, just a reminder that if it's negative, it may not mean you don't have COVID. The key is to probably do serial testing if you think you have COVID and you get a negative test. All that being said, regardless of what the virus is at the root of your winter illness, the public health advice is still wherever possible, stay home when you're sick, no matter what kind of virus you've got. Yeah. So it's really it's you kind of have to gauge your own. It's back to that gauging your own risk thing that we talked so much about there, too.

Yeah. I also think it doesn't hurt to remind people that we are in such a better place as a country than we were with COVID a couple of years ago. And that is something to feel grateful for and to celebrate. Maybe we do end on a positive note then. Yeah, there you go. Amazingly. Kelly, thank you so much for being here today. Thanks for having me. If you've been following the news and listening to The Decibel's coverage, you'll know about the Greenbelt and how the Ontario government has been handling it.

And you probably have a lot of questions, so we're going to answer them. Anything you want to know about the Greenbelt and how this saga has played out, just send us an email or a voice note to thedecibel at globeandmail.com, and you might be featured in an upcoming episode. Okay, that's it for today. I'm Mainika Raman-Welms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show.

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