Episode 2： Dr. Jennifer Grant
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Summary
In this episode, Dr. Jennifer Grant, a medical microbiologist and infectious diseases physician at the University of British Columbia, shares her perspective on the SARS coronavirus outbreak in China, and why we should all be worried about it.
Transcript
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Welcome to Full Comment with Anthony Furey. Thanks for joining us. Canadians are currently
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dealing with the most significant upheaval we have collectively faced throughout our lifetimes.
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For over a year now, we've been grappling with a new emerging virus and with the various
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restrictions and lockdowns that officials enacted in response. Are we making the right choices?
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What if some of them are the wrong choices? What if we're doing things wrong? What do we do now?
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Is it too late to change paths? What are some of the issues that we should be discussing
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that we should be focusing on right now? I know we can really get lost in the details discussing
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COVID-19. You know, should we have stores open at 10% capacity or 25% capacity? What age group should
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be allowed to access this or that vaccine on this or that week? But I wanted to step back a bit from
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that and take a bird's eye view look at what we've been doing in Canada throughout the course of the
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pandemic. And I think our guest today is the perfect person to help us with just that. Dr. Jennifer
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Grant is a medical microbiologist and infectious diseases physician in Vancouver. She's a clinical
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associate professor at the University of British Columbia. Dr. Grant, hello, welcome.
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Yeah, thanks so much for joining us on the program, Jen. You're just a great person to have take a look
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at this issue here. Of course, this, you know, huge thing that's been changing our lives for the past
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year from your perspective as an infectious diseases physician. And I want to start really at the
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beginning and before the beginning in terms of what your community, persons who are experts in
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infectious diseases, were kind of expecting in terms of pandemics, what you thought would happen,
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when you thought it would happen. You know, prior to February 2020 or January 2020, whenever things
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really hit the fan in Wuhan, what was your professional perspective on pandemics and what we
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were to expect? So pandemics are much like death and taxes. It's not a question of if, it's a question
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of when. And we've seen that multiple times, even in our lifetimes. Certainly in my career, the HIV
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pandemic was sort of our first taste of that. We know that influenza pandemics are an inevitability,
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and that we see them every 20 to 40 years of varying severities. And we had had a hint of the
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potential for coronavirus with both SARS coronavirus and MERS coronavirus, which for whatever biological
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reason decided to stay relatively geographically restricted. But anyone who knows anything about
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infectious disease knows that the next pandemic is inevitable. What components of what we're seeing
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right now surprised you in terms of this? Or is it such that anything was always possible and nothing
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is a surprise in terms of the way this is rolled out in its sort of medical sense? I think the big
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surprise about SARS-CoV-2 was its almost perfection, if you want to use that word, in terms of its
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adaption to doing exactly what it's doing. So if you're a virus, we'll put ourselves into the heads of
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a virus, you want to be, in fact, if you really want to be completely non-pathogenic. But the viruses that
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we're going to care about want to be sufficiently non-pathogenic that they can be carried about
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the community by unknowing hosts and spread to other people. And that requires that you don't kill
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your host immediately. So if you look at the other coronaviruses like the MERS-CoV or the SARS-CoV-1,
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they are very pathogenic, and they kill their hosts if they're going to kill them quite quickly,
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and they give severe symptoms for those people who get sick. So the surprise with this virus,
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I think, was just how exactly in the sweet spot it was to get out unnoticed until it was able to
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cause quite a bit of disease, very widespread before being identified.
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There was a lot of confusion earlier on about just, you know, how bad is this virus,
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who's getting hard hit by it, and so forth. Although I know some people have countered with,
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no, we actually did really know all along. It was just sort of media coverage, the way information
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was, you know, making its way down through the line. I mean, what did we first think we were
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dealing with? There was a lot of, definitely when it comes to media and social media, those famous
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videos from Wuhan of people literally dropping dead in the streets or falling over in hospital
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hallways and so forth, you know, clinging on to themselves. It's still unknown whether those were,
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in fact, videos related to coronavirus or just repurposed things from TV shows or whatnot.
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But that was kind of the stuff that did the rounds there. And a lot of people thought that is what
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we would be dealing with in a very acute sense here in Canada. Of course, what materialized was very
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different. What was going on in those early kind of months where there was a lot of confusion?
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So a lot of that confusion is natural at the very beginning of a pandemic. What we usually see as
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pandemics start are the extreme cases. That's what twigs our attention. So if you think about the 2009 H1N1
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pandemic, it came across initially for the first few cases that were identified in Mexico as being
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extremely severe. What we learned afterwards as we did more testing, as we saw the broader view of the
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virus, is the mortality rate went down. We saw that with this virus as well. When we first started getting
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notification, it seemed to be matching SARS-CoV-1. The mortality rate was around six or seven percent
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of the identified cases. And that was actually quite worrisome. And it looked like it was going
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to be the very same thing again. But the natural history of these things is that once you've identified
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those very severe clusters of people who twig your attention, when you do the broader look, you realize
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that, in fact, there's a much broader spectrum of disease, much of which has gone unnoticed. And that
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over the next several months, you get to a more realistic assessment of what the viral pathology is
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likely to really be. In the case of this virus, I don't know that we are there yet, as we are sort
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of understanding how many people through serial surveys and whatnot have been unknowingly infected.
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Yeah, I was going to ask about that, because right now we are, of course, hyper attentive to the idea
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of, you know, just, you know, wear your mask, keep away from anyone in the grocery store, and then we're
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going to have apps to alert us if we were close to anyone who, you know, tested positive regardless of
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symptoms and so forth. But to your point, back, you know, over a year ago, it was just what are the most
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extreme cases? To what degree was the virus actually circulating around society? And I know there continue
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to be studies and, and sort of lab work and so forth done to determine just how, how great a volume of
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people actually have these antibodies? Did it actually come to the West Coast much earlier than we thought?
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What's your current perspective on all of that? When coronavirus actually hit Canada, hit North
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America, you know, do a whole lot more people have it than, than we say right now? I mean,
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obviously it stands to reason, obviously it's, it's more than the official numbers, but just how much
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more? So the, the quick answer to that is nobody knows. And so I'm going to break that question down
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because there's quite a few questions in there. In terms of timing, they've actually gone and looked
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at wastewater samples historically. And it seems like the, the SARS-CoV-2 was probably much wider
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spread than originally thought, even in December of 20, 2019. And, and it may be that in fact,
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the Wuhan area was the first major detected super spreader event rather than necessarily being the
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origin. We'll probably never truly know that. We'll never know if somebody who happened to
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transit through Wuhan ended up somewhere else in the world. Well, to a certain extent, it kind of
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doesn't matter. We are where we are right now. And it was undoubtedly much wider spread at the time
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that it was identified in Wuhan than was initially thought. Again, just masquerading as your common
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garden variety, a cold or a flu virus. Jen, we had this period in the spring of 2020 where the virus
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was most acutely spreading and also having the worst outcomes in long-term care homes. And that
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was a period where obviously there was no vaccine at all, but there also really wasn't much treatment
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at that point. I'll embarrass myself if I try and list the names of the actual drugs that people in
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your profession have figured out are the ones to, to actually do a really good job helping people deal
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with coronavirus when they're hospitalized with it. But, but there was a couple of months there where
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I feel like it was probably pretty, I don't know if scary is the right term, but kind of uncertain
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terrain in terms of just, you know, what's really going to happen here. I'm thinking, you know,
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I guess, April, May, 2020, what was going on during that period?
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I think that was probably the scariest time for everybody because we were dealing with a number of
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unknown variables. We didn't know what the mortality rate was or wasn't. We didn't have a 100% clear
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handle on nature of spread. We had all sorts of unexplained cases that we now probably can explain
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with the knowledge that it was much more widespread than originally thought. But at the time we didn't
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know. So it seemed like the cases were cropping out of nowhere. That was a time when we started
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looking at mathematical models that were based on the, again, information that it was natural at the
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time to have had, but with a, with a much higher mortality than is probably correct. And without sort
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of stratifying the different risks per age, which would have given a much more
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sophisticated understanding of what was likely to happen. At that point, we went into planning mode,
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which is completely appropriate and prepared for the worst case scenario. And it turns out that that
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did not, at least in my jurisdiction, develop as expected. And so then we had to sort of take a step
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back and rethink the approach. Now, that's a really interesting period where we went into first
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lockdown, shut everything down. We don't know what this is. We don't know how it spreads. We don't
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know who dies from it and so forth. And then, and I appreciate that a lot of people were really nervous
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at that point in time. And then we learned a bit more, you and your colleagues in the profession
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learned about treatments, learning who's getting it and so forth. And we had a bit of a summer in
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Canada. And I think some people were able to enjoy some times there. And then we hit into the second
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wave and a second lockdown. And here where I am in Ontario, we're now in a third lockdown. And I feel
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like things started to change a bit in terms of how we talk about the virus, how the information gets
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out there. And I think a lot of, a lot of public frustration and anxiety and confusion really set in.
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What do you think really happened after we sort of grabbed our bearings and to your point,
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things in your jurisdiction, and I believe pretty much in most jurisdictions didn't turn out as bad
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as was what first feared, but it kind of feels like we're doing the same response right now than we
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did then. So to understand the full nature of that, you need probably a social psychologist rather
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than infectious diseases specialist. I think there's a number of themes going on. I do put a fair amount
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of blame on the nature of social media. It, there has been, from my observation, the sort of rational
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medical response, which admittedly does not make great headlines, talking about how we know actually
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a fair amount, how we know what we can do to mitigate risk. Unfortunately, that does not get as much
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attention, clicks, playtime, as do the more sensational points of view. Because of the nature of our
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psychology as people. And so I feel like this is the pandemic that Twitter is driving, and it gets
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to a point where public officials can't, I don't want to say can't, that's not, it's unfair to say
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they can't manage, but they're in a, they're put in a position where what they're saying is not perceived
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as being credible. And so they have to change their message, despite the science, to placate the,
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um, the Twitterverse. Yeah, I found it interesting that, you know, initially, a lot of public health
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communications are about making sure people take this seriously. So even if they're not sure if this or
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that intervention is going to work, well, let's do all we can to take it seriously, take our precautions
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and so forth. But I think one of the consequences of that was it led people to believe that things were
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risk factors that weren't risk factors. Like I feel like there are many millions of people in Canada
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who would believe that anybody can get coronavirus at any time in any setting and anybody can have a
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serious outcome and be hospitalized and die of it. And obviously, I know there's a, you know, one in
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however many millions odds where I guess, you know, every scenario is conceivably possible. But
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generally speaking, correct me if I'm mistaken, that is not the case that we have a lot of information
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about things that are safe, unsafe, people who are high risk, people who are not high risk,
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and so forth. But I feel like that that doesn't get communicated, perhaps for just what you're
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saying, because it doesn't fit in a tweet. Absolutely. And certainly, speaking to my
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relatives who are elderly, they are absolutely convinced that if they get the coronavirus,
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they will die. Now, their risk is much higher than I'm sure they would like it to be. So for a
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community dwelling elder, the risk is somewhere between 2.5 and 5% of death once you
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contract the disease, unvaccinated. But again, that's much higher risk than you'd like. But you
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have a 95 to 97.5% chance of doing well. So I think that we've gone from a subtle, nuanced discussion
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about risk to an absolute black and white, you either die or you don't, which is which is probably
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incorrect. Looking at our population structure, and this is true, actually, also of SARS and SARS-1
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and MERS-CoV, young people are generally speaking at incredibly low risk, certainly at lower risk than
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many of the other risks we take in day to day living, such as driving a car, which is probably
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the highest risk for any of us under the age of about 50. Dr. Jennifer Grant is our guest, a medical
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microbiologist and infectious diseases physician in Vancouver, and a clinical associate professor at
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the University of British Columbia. Facebook recently updated their policies for what classifies
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as misinformation and things that you're not tolerated to discuss on Facebook and posts will be
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removed and so forth. And one of them, they said, posts that downplay the severity of the virus,
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for instance, saying it's just the flu, or that call into question the official death tally. And I read
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that and I thought, well, we have a bit of a problem on our hands, because I appreciate that in older age
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cohorts, yes, coronavirus is definitely more serious than the flu. But we've got pediatric experts and
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an expert such as yourself, Jen, who are saying, well, actually, influenza is more serious in
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children. So there's, you know, one of those Facebook red flags, and then saying, oh, the death
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count is, you know, not what it is, and so forth. Well, we've got Statistics Canada saying that about
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10% of coronavirus deaths were people who died of something else like cancer, but had coronavirus at
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the time. So, okay, I know they're not doing, you know, full blown conspiracy theory talk at
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Statistics Canada. But the facts they present in the nuance seem to, you know, cause trouble with what
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Facebook is putting as their rules, you know, to your point about how a lot of this, this, this online
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discussion is almost getting in the way of a more nuanced conversation.
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Well, absolutely. And I would say that it's, if you can't question facts, there's a problem if you can
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back those facts up with data. Now, obviously, people say all sorts of things online, that are clearly
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wrong. And so there has to be a balance in there. But it's very problematic. The degree of power that
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Facebook has in that is problematic. And the inability to have a nuanced discussion is also
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problematic. Although I would put to the universe that possibly Facebook is not the place to be having
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nuanced discussions. Right. Fair enough. Going back to the kids conversation, and to your point,
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some people very resistant, very adamant to say, no, no, kids are, you know, they're still getting it,
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or kids are the secret super spreaders, and so forth. In Ontario, where I am, they've closed the
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schools again, for the third wave. And the justification, they acknowledge that children
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themselves are not actually spreading the virus in classroom, there's no in class transmission going
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on. But they've said, well, you know, there's community spread. So we have to close the schools
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because of that. And also mobility issues, something that they talk about, I'd say sort of below the
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fold, they don't talk about as their top lines in the press conference, but they get into a 20 minutes
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into it saying, well, we got these mobility charts, these anonymized cell phone data that show us people
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are driving around like it's not pandemic time. So we got to get those numbers down. They've learned
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that closing the schools is a good way to keep parents at home to bring that mobility data down.
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Do you think that any of that broader community spread, mobility data, are those justifications
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to close schools during this situation? So I would say no, I would say that there is no
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justification for closing schools, until you can show that it's more harmful to the children
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themselves to be in school. The problem is that cell phones, as far as I'm aware, don't spread
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the coronavirus. People are mobile for all sorts of reasons. And until you can show the direct
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line of children in school being the cause of spread, you're just using children as victims
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and a strategy that might be better done in some other way. What we're doing to our children right
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now is, in my opinion, appalling. We need to care for our children, which includes taking care of their
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mental, physical, and spiritual health, their economic health, and frankly, their physical
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health. Children are far more at risk from self-harm than they are from the coronavirus.
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Well, if I can throw back at you a line that gets thrown back at me, one of those snarky Twitter
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lines, people say, oh, well, that's all well and good. But try telling one of those children why
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their grandparents have died, or why mom or dad died, or why their grandparents died, because they
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brought the coronavirus back to them from school. What would you say to people who, based on my
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Twitter feed, there's a lot of people who like to say that? What I'd like to say is not appropriate.
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So, I think we really need to have a conversation about who is to blame for a virus. A virus is a
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virus. It's not a child's fault if they got a virus. It's not a child's fault that somebody else got a
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virus. And we know that children are the least likely to spread disease. They are far more likely
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to have got it in the community. And in fact, from personal conversations I've had with various
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public health officials, the risk of a child spreading is substantially less than 1%. So, I
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would ask that person, really, are you sure the grandparent got it from that child? Because
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directionality is incredibly hard to prove. So, on the one hand, we shouldn't, how can you blame
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children for happening to have a virus? That's just, that's nonsensical to me. We don't blame
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the adults who gave it to the kids. So, why would we blame in the other direction? It's just, it's, it's
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a false morality. It's scientifically incorrect. And it is just so unfair to put that on children.
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There's been a little bit of an emphasis on health officials on attempting to quantify sort of direct
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harms of lockdowns vis-a-vis a spike in overdoses. I know in BC, there's been a lot of looking into
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that data, suicide rates and so forth, deferred surgeries that have resulted in cancers and so
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forth, and cardiac issues. But I know there has not been anywhere in Canada a more formal cost-benefit
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analysis that takes into effect various things related to children and what we call quality-adjusted
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life years, sort of stunted growth, how education held back. Even people who've said, you know,
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I'm in university, but I'm in crisis now because life is a mess in university, so I'm dropping out
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and so forth. And what that means for society, what that means for that young person. How do we begin
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to robustly talk about this stuff? Because I feel like a lot of people are really at the sort of
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cover the eyes, plug the ears, see no evil, hear no evil kind of stuff.
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Yeah, it's really challenging. The problem is we can't quantify it now because those are harms that will
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be felt over the next 20 to 30 years in many cases. Obviously, suicides can be identified. And
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I believe it's Las Vegas opened their school system because children were dying from suicide.
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So there are some of those harms that can be quantified, but a lot of them can't be. And a lot
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of them will be born out of the next 30 years. Now, there are some places trying to do that.
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So the OECD has a publication out, as does Simon Fraser University, looking at the likely economic
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consequences for the kids, for the, essentially quantify it by future earnings lost per day of
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education lost or something along those lines. And it's enormous. And for those people who say,
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well, yes, but it's, that's money. And we're talking about health. The truth is that wealth
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and health are so tightly linked that we actually have the science of the social determinants of
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health. So if you're, have more income, you can have better food, you can exercise, you have better
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housing, you engage in medical care more, all of those things makes you healthier, having not having
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those things makes you die earlier. People are also trying to quantify the number of children lost
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to the education system. And it's enormous. I saw a newspaper article saying that they're laying teachers
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off, they've lost so many kids. These are kids who are not completing their education. With a lower
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level of education, not only do you have lower economic output, but you end up with poorer health
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over the course of your lifetime. So people are trying to do it here and there. There is, in BC,
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to the credit of my colleagues, they have the unintended consequences group, and they are trying
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to pull those data together. But again, you can't pull future data together. That's, that's going to
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come in, in 10 to 15 years. Dr. Grant, correct me if I'm mistaken, but in, in infectious disease
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circles, epidemiological circles, public health community prior to Wuhan entering lockdown, this idea
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of shut everything down for a prolonged period of time is, is not really a thing. I mean, I've read
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the various pandemic preparedness plans that, that all levels of government have put together, and
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there's not really any discussion of this. It's about, you know, protecting people, minimizing illness
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to allow for the proper functioning of society. How, how are we, I don't even know how to ask the
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question, because whenever I try to say it, it kind of boggles the mind that I even have to ask the
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question, but how did we get to this point? I, I don't know. You're right. Every pandemic
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plan we've looked at has, that we've written, and ours is written in 2018, and it's still up on our
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website, and so I'm sure you've, you've seen it. It basically says, we don't close schools, because
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closing schools, even if, and this, and this was written for influenza, which children are known to
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spread. We don't close schools, because the harms to children are so high. No, we don't close
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businesses, because people need that to work. I don't understand how the narrative moved to
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shutting everything down is the best thing to do. Now, is the, is there some benefit to it? There
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probably is, but there needs to be a discussion about balancing harms and benefits, and that's the
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dialogue that seems to have gone missing at a societal level. You're, you're, you're bad if you
00:25:58.780
don't want more shutdown. Right. And, and, you know, some of that is probably fair. We, we, no one's
00:26:06.100
saying, let her rip. What we're saying is, that's fine, but let's find the sweet spot where we maximize
00:26:11.880
everybody's health. There's a perspective out there, dare I say, maybe an ideology, I don't know what to
00:26:17.480
call it, called COVID zero, which is something that I guess they've been working on achieving in New
00:26:22.180
Zealand, and perhaps in Australia, and there are definitely adherents of it here in Canada. It has a
00:26:26.780
spiffy logo and, and, you know, a mission statement and so forth. And the basic idea is
00:26:30.840
aggressive suppression of the virus until you get to near zero new daily cases. There's one document
00:26:37.040
I read that said, I think Canada has to stay in some form of restriction until 40 cases per day,
00:26:43.220
which is about, you know, one per million and so forth. I'm kind of confused by that, whether or not
00:26:48.680
it's even something we should aspire to, whether it's even possible if, you know, my understanding is
00:26:53.820
that this is becoming an endemic illness, meaning it is going to be around for the rest of my natural
00:26:57.980
life to some degree or another. Yet I do feel that idea has taken hold in, you know, persons in the
00:27:04.080
medical community, public health community, and also just a lot of members of the public who hear it and
00:27:07.520
think that that is an attractive idea, getting, you know, a complete elimination of coronavirus.
00:27:13.240
Oh, it's a very attractive idea. Wouldn't that be nice? I mean, if we could do it
00:27:18.380
at an acceptable cost, I think would be a wonderful thing to do. The problem is that the, at this point,
00:27:29.560
the costs would be, and costs, I don't mean financial, I mean, in terms of health, societal
00:27:36.640
cohesion, all of the things that make life worth living, would be enormous. And I am of the opinion
00:27:44.340
that it's not possible. If you look at places that have been severely locking down, like the Peel
00:27:52.080
region in Toronto, Toronto generally, essentially you've been in lockdown as hard as you can reasonably
00:27:58.140
get before we start impacting on people's ability to feed themselves. And it's not actually stopped
00:28:06.620
transmission. And so, you know, I think it's a reasonable thing to try. And if you're a isolated
00:28:14.080
island in the Pacific, you have a shot of doing that. I suspect that in Australia, New Zealand got
00:28:18.940
a little bit of a heads up because of further away, they were able to more effectively control their
00:28:24.700
borders. There is a, for anybody coming in on by ship, there's a good period of time between leaving
00:28:31.960
your port of exit and come and arriving. So they have a number of advantages that we really don't
00:28:38.160
have. By the time we got to the point where it was across all of our provinces, the chances that
00:28:44.720
we're going to get to that without a vaccine are exceedingly low. Let's talk about vaccines for a
00:28:51.480
minute here. Right now, there's a lot of concerns, I guess, that people have over various vaccines.
00:28:57.220
We're hearing statistics that, you know, five or 10 among 100,000 or a million or 2 million or whatever
00:29:02.260
adverse reaction, blood clots, those sorts of issues. What should people think about when they
00:29:07.840
see those headlines? So I think we need to be aware, and this speaks to sort of the general
00:29:14.220
sense that we're not at risk for anything ever that society seems to have come to in the past 20
00:29:22.060
years. But remember, people get blood clots every year. About one in a thousand people gets a blood
00:29:28.600
clot per year. And so if you give 5 million doses of a vaccine, there will be blood clots. The study
00:29:36.780
looking at the AstraZeneca vaccine, in fact, there were, I believe, 12 blood clots in the several
00:29:43.260
hundred thousand doses they used to study, but there were more in the control group than there were in
00:29:47.700
the vaccine group. So there's things that happen just by chance that are unrelated to the vaccine
00:29:54.660
and shouldn't make us worry. But that's what our regulatory agencies are there to do. That's why
00:30:00.020
there was a pause in the AstraZeneca vaccine. In general, vaccines are very safe. Certainly,
00:30:06.320
the initial study showed good safety of all the vaccines that have been deployed. Now, what happens,
00:30:13.300
though, and what we have to think about is the safety of the vaccine has to exceed the risk of
00:30:19.180
the disease. And that's where it's really important for us to understand to what degree any one individual
00:30:26.160
or any group is at risk of disease. So if you take a vaccine that has, for example, a one in a million
00:30:33.360
adverse event rate, which would be sort of in line with what we see normally. If you have a 5% risk of
00:30:39.680
death from disease, that's an obvious benefit to you. However, if your risk of disease is one in
00:30:46.460
2 million, you might not want to take the vaccine. And so we need a really detailed epidemiologic
00:30:51.160
understanding of what your precise risk is, so that when we get to the younger age groups,
00:30:57.920
we decide whether the vaccine offers more or less benefit than not being vaccinated.
00:31:03.600
I was attending his media press conference that one public health official was on. And I was asking
00:31:08.460
about will children's sports be greenlit this summer, outdoor sports, soccer, baseball, and so
00:31:12.740
forth. And the official responded by musing about vaccines and when they will or will not be available
00:31:20.020
for children. And I found it a rather odd response because, well, let me just ask you, Dr. Grant,
00:31:27.000
do kids even really need to get this vaccine? Is it that much of an issue?
00:31:29.960
Well, right now they can't get it because there's no vaccine approved for children.
00:31:35.340
There may be a small group of children because of the nature of their medical illness
00:31:40.200
where a qualified physician might look at the risk benefit and have a discussion with
00:31:46.640
children's parents. But widespread vaccination of children, certainly based on the numbers I've seen,
00:31:57.600
So when we use phrases like vaccine passports, which I understand is a bigger debate to elsewhere
00:32:03.720
in other countries here in Canada, there's not really discussion of formalizing that, but who
00:32:07.540
knows, you know, anything could come into play. Some jurisdictions mean it just in terms of this
00:32:13.220
is what you will need to get on and off a flight. Okay, fair enough. Others mean it more broadly,
00:32:16.920
this is what you'll need to go to the movie theater and so forth, or maybe even to show it when you
00:32:21.400
enter a restaurant. What do you think of that idea that people are going to need to show proof
00:32:25.560
of vaccination to sort of return to living their lives?
00:32:29.340
I guess I would say that if we were going to do that, we should have done it on vaccines that
00:32:37.820
prevent much more high mortality diseases. So measles, for example, is an exceedingly high
00:32:45.400
mortality disease. It has a 1% mortality rate with current medical care. If you look at places in the
00:32:52.160
developing world, it has about a 10% mortality rate, especially, especially in children. But
00:32:56.780
the reason adults don't get sick is because they've all had measles as children, or that have been
00:33:01.300
vaccinated. So I don't know why this particular virus would be the virus on which we place that
00:33:09.560
from a medical professional point of view. I think that that severely impinges on the question of
00:33:15.720
consent. We don't impose medical procedures on people who don't want them. That's sort of the
00:33:23.780
inviolable nature of our own bodies and our own decision making. But this would actually be
00:33:31.620
tantamount to coercion. So essentially, if you don't get this vaccine, you're not going to be allowed to
00:33:38.120
live your life normally. From a philosophic point of view, I have significant concern about that.
00:33:44.640
We've never done it before. And yet we have very high vaccination rates. So I don't see why it's
00:33:49.820
necessary. If everyone else is vaccinated, who wants to be, they are protected from severe disease.
00:33:57.340
So the need to force that on the 5% or 10% of people who choose not to get vaccinated for whatever
00:34:03.840
reason strikes me as problematic. And that's not even talking about the people who can't get
00:34:11.520
vaccinated for some medical reason. Speaking about total compliance rates, one thing that I've
00:34:16.980
always found a little odd, over the past year, there's been a number of different, you know,
00:34:20.640
videos and stories out there of a person who, for whatever reason, didn't want to wear a mask in the
00:34:24.820
grocery store. You know, they said they had a medical exemption, they forgot the mask, they want
00:34:29.100
to be conscientious objectors, maybe they're conspiracy theorists, I don't know, they said they
00:34:32.800
didn't want to wear it. And then you see them being hauled out by police, and then they get into a
00:34:36.000
scuffle, and these people are being beaten by the cops. And I think, for not wearing a mask,
00:34:39.320
and I kind of think, you know, what is our approach to some of these rules and the enforcement from
00:34:44.360
it? I think if we said, please wear a mask in store at this point, I think we'd probably have
00:34:47.540
what 90% of people actually doing it. And, you know, I wonder what is the utility of this? You know,
00:34:54.880
is it theater of all of this to bring out the police and to call the cops, and you see someone not
00:34:59.660
wearing the mask? I'm not so much focused on just the mask issue per se, but sort of all of these
00:35:04.160
rules out there where we have to have sort of 100% compliance. And if one person doesn't go along,
00:35:09.960
we have very disproportionate reactions. There's one barbecue joint in Toronto, it became, I think,
00:35:16.060
an international story of a fellow who decided, well, I really want to keep the barbecue place
00:35:19.080
open and so forth. And at the end, they brought in, I think, 100 police officers to shut it down.
00:35:23.260
It was quite a scene. Yeah, I have to say, it's never historically been public health policy
00:35:31.320
to enforce the same with coercive measures. The one exception would be tuberculosis. So we do have
00:35:40.040
the right for somebody who has tuberculosis to, we can't force treatment on them, but we can make
00:35:46.820
them stay away from other people. So there is a precedent for it. But we generally speaking,
00:35:51.900
get much further with harm reduction and being encouraging. If you think about something like
00:35:59.840
HIV, we, in fact, have legal precedent saying that, you know, we'd really like it if you wore
00:36:09.300
a condom, please take all your antiretrovirals. But when people have knowingly had unprotected
00:36:15.860
sex with other people, we've said, well, that's not something, that's not a role for the police.
00:36:19.620
Right. So this is, and I think we can both agree that that is much more personally damaging than a
00:36:27.900
person who isn't wearing a mask. So it's something that I find confusing. I don't think that it's
00:36:36.020
appropriate to use the police or punishing fines or other law enforcement mechanisms to enforce public
00:36:48.580
health policy. That's a personal opinion. But it certainly does become, it makes the whole
00:36:56.740
discussion just that much more high stakes. And as you say, I think it's disproportionate to get
00:37:03.380
beaten for not wearing a mask. Dr. Grant, where do we go next? There's certainly a great deal of
00:37:09.220
optimism that the pandemic will soon be behind us in terms of vaccines rolling out, maybe not as great
00:37:13.900
as we'd like them to be in Canada, but they're still happening. And long-term care vaccinations
00:37:17.880
are almost at like a hundred percent. And the death rate in LTCs has just dropped drastically
00:37:23.040
from coronavirus. While there are sort of third wave spikes, there does seem to be optimism towards
00:37:29.060
a light at the end of the tunnel. Then at the same time, I know we do have these fraught conversations,
00:37:33.760
vaccine passports, and we see some doctors on television saying wearing masks for, you know,
00:37:38.700
the foreseeable future and so forth. Where are we headed? What is the exit ramp?
00:37:43.860
Well, that's what we need as a society to sit down and discuss. We've not actually had a good
00:37:51.120
societal debate about what our goals are. So essentially, a lot of the contention has been
00:37:59.460
the zero COVID versus the peaceful coexistent sort of dichotomy. Now, what do we want? Are, you know,
00:38:08.180
are we as a society going to agree that we will continue everything we're doing until there are
00:38:14.380
no detectable cases? That's something we could decide to do. And if we do that, then we have to
00:38:19.100
have a long conversation about what that's going to cost us. Or do we say, well, once we have everyone
00:38:25.020
who wants a vaccine, have a vaccine and be largely protected from the adverse outcomes, do we then say,
00:38:31.900
well, then, you know, that's what we care about. And we'll keep our eyes out for, you know,
00:38:37.720
new variants that might be different or that might merit a different vaccine or a different strategy.
00:38:45.080
We have to have that conversation and we haven't. Unfortunately, the people dominating that
00:38:49.840
conversation are doing so in a way that really does gloss over the downsides of either strategy.
00:38:59.360
In my opinion, I think we need to move to peaceful coexistence.
00:39:05.240
I don't think we're going to eliminate the virus. I think once we get to a point where those people
00:39:09.860
at high risk are vaccinated, we stop spending our time worrying about case counts and more time looking
00:39:17.500
at how we make sure that our kids get the education caught back up and that our healthcare system
00:39:25.360
goes to a place where we don't end up overwhelmed every flu season in our hospitals and our ICUs.
00:39:34.080
You mentioned earlier the HIV AIDS pandemic. And I know there was a time in not too long ago history
00:39:39.740
where there was no such thing as say an AIDS hospice. Then those things were created. The healthcare
00:39:43.660
system, I guess, was expanding to deal with that challenge for a number of decades. Are we going to
00:39:51.180
have a time? Are we going to have to accept the fact that for the next 10, 20, 30 calendar years
00:39:55.520
or what have you, there will be, I don't know, two or three hospital beds in each region or I don't
00:40:01.160
know what the number is of people who are dealing with severe coronavirus outcomes and we just need
00:40:06.100
to address that fact. Is that something that's going to be happening in the endemic portion of this?
00:40:11.100
Oh, of course. But we do that every year with the flu.
00:40:13.800
I mean, we do everything we can to try and prevent the flu. We vaccinate our high-risk people.
00:40:19.380
But like coronavirus, flu adapts and changes every year. And we, every year, have numerous people in
00:40:27.660
our hospitals and in our intensive care units with the flu. And it's not just the flu. We have
00:40:33.340
numerous other viruses that do the same thing. We have human metanema virus. We have respiratory
00:40:37.220
syncytial virus in the right population. Those can be devastating. And that's why we have hospitals
00:40:44.480
to care for the sick. When they get ill with anything, we're there. Influenza and pneumonia
00:40:52.420
are one of our number one killers, especially in the elderly age group. So that's not going away.
00:40:58.700
Dr. Jennifer Grant, you are a medical microbiologist, infectious diseases physician
00:41:02.200
in Vancouver, a clinical associate professor at the University of British Columbia.
00:41:05.700
And we thank you so much for this great conversation. Thanks very much for your time.
00:41:11.020
Full Comment with Anthony Fury is a post-media podcast. This episode was produced by Andre Pru
00:41:16.380
with theme music by Bryce Hall. Kevin Libin is the executive producer. Thanks to our guest,
00:41:21.940
Dr. Jennifer Grant. The host is Anthony Fury. You can subscribe to Full Comment on Apple Podcasts,
00:41:28.300
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00:41:33.320
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