Full Comment - Episode 2： Dr. Jennifer Grant

00:00:00.000 Welcome to Full Comment with Anthony Furey. Thanks for joining us. Canadians are currently 0.98

00:00:09.720 dealing with the most significant upheaval we have collectively faced throughout our lifetimes.

00:00:14.140 For over a year now, we've been grappling with a new emerging virus and with the various

00:00:18.300 restrictions and lockdowns that officials enacted in response. Are we making the right choices?

00:00:23.940 What if some of them are the wrong choices? What if we're doing things wrong? What do we do now?

00:00:28.260 Is it too late to change paths? What are some of the issues that we should be discussing

00:00:32.620 that we should be focusing on right now? I know we can really get lost in the details discussing

00:00:37.020 COVID-19. You know, should we have stores open at 10% capacity or 25% capacity? What age group should

00:00:43.240 be allowed to access this or that vaccine on this or that week? But I wanted to step back a bit from

00:00:47.400 that and take a bird's eye view look at what we've been doing in Canada throughout the course of the

00:00:51.340 pandemic. And I think our guest today is the perfect person to help us with just that. Dr. Jennifer

00:00:56.440 Grant is a medical microbiologist and infectious diseases physician in Vancouver. She's a clinical

00:01:01.480 associate professor at the University of British Columbia. Dr. Grant, hello, welcome.

00:01:06.280 Hello, thanks very much for having me.

00:01:08.060 Yeah, thanks so much for joining us on the program, Jen. You're just a great person to have take a look

00:01:12.740 at this issue here. Of course, this, you know, huge thing that's been changing our lives for the past

00:01:17.280 year from your perspective as an infectious diseases physician. And I want to start really at the

00:01:22.800 beginning and before the beginning in terms of what your community, persons who are experts in

00:01:30.380 infectious diseases, were kind of expecting in terms of pandemics, what you thought would happen,

00:01:35.480 when you thought it would happen. You know, prior to February 2020 or January 2020, whenever things

00:01:41.300 really hit the fan in Wuhan, what was your professional perspective on pandemics and what we

00:01:47.240 were to expect? So pandemics are much like death and taxes. It's not a question of if, it's a question

00:01:53.580 of when. And we've seen that multiple times, even in our lifetimes. Certainly in my career, the HIV

00:02:02.320 pandemic was sort of our first taste of that. We know that influenza pandemics are an inevitability,

00:02:10.060 and that we see them every 20 to 40 years of varying severities. And we had had a hint of the

00:02:19.720 potential for coronavirus with both SARS coronavirus and MERS coronavirus, which for whatever biological

00:02:28.280 reason decided to stay relatively geographically restricted. But anyone who knows anything about

00:02:35.620 infectious disease knows that the next pandemic is inevitable. What components of what we're seeing

00:02:42.800 right now surprised you in terms of this? Or is it such that anything was always possible and nothing

00:02:50.100 is a surprise in terms of the way this is rolled out in its sort of medical sense? I think the big

00:02:56.520 surprise about SARS-CoV-2 was its almost perfection, if you want to use that word, in terms of its

00:03:07.980 adaption to doing exactly what it's doing. So if you're a virus, we'll put ourselves into the heads of

00:03:15.720 a virus, you want to be, in fact, if you really want to be completely non-pathogenic. But the viruses that

00:03:24.200 we're going to care about want to be sufficiently non-pathogenic that they can be carried about

00:03:30.940 the community by unknowing hosts and spread to other people. And that requires that you don't kill

00:03:38.180 your host immediately. So if you look at the other coronaviruses like the MERS-CoV or the SARS-CoV-1,

00:03:46.860 they are very pathogenic, and they kill their hosts if they're going to kill them quite quickly,

00:03:52.220 and they give severe symptoms for those people who get sick. So the surprise with this virus,

00:03:58.520 I think, was just how exactly in the sweet spot it was to get out unnoticed until it was able to

00:04:09.100 cause quite a bit of disease, very widespread before being identified.

00:04:14.180 There was a lot of confusion earlier on about just, you know, how bad is this virus,

00:04:18.620 who's getting hard hit by it, and so forth. Although I know some people have countered with,

00:04:22.000 no, we actually did really know all along. It was just sort of media coverage, the way information

00:04:26.020 was, you know, making its way down through the line. I mean, what did we first think we were

00:04:31.020 dealing with? There was a lot of, definitely when it comes to media and social media, those famous

00:04:35.240 videos from Wuhan of people literally dropping dead in the streets or falling over in hospital

00:04:41.260 hallways and so forth, you know, clinging on to themselves. It's still unknown whether those were,

00:04:45.080 in fact, videos related to coronavirus or just repurposed things from TV shows or whatnot.

00:04:50.300 But that was kind of the stuff that did the rounds there. And a lot of people thought that is what

00:04:56.700 we would be dealing with in a very acute sense here in Canada. Of course, what materialized was very

00:05:01.440 different. What was going on in those early kind of months where there was a lot of confusion?

00:05:05.440 So a lot of that confusion is natural at the very beginning of a pandemic. What we usually see as

00:05:16.200 pandemics start are the extreme cases. That's what twigs our attention. So if you think about the 2009 H1N1

00:05:26.560 pandemic, it came across initially for the first few cases that were identified in Mexico as being

00:05:34.380 extremely severe. What we learned afterwards as we did more testing, as we saw the broader view of the

00:05:42.800 virus, is the mortality rate went down. We saw that with this virus as well. When we first started getting

00:05:51.180 notification, it seemed to be matching SARS-CoV-1. The mortality rate was around six or seven percent

00:05:58.200 of the identified cases. And that was actually quite worrisome. And it looked like it was going

00:06:03.620 to be the very same thing again. But the natural history of these things is that once you've identified

00:06:09.120 those very severe clusters of people who twig your attention, when you do the broader look, you realize

00:06:19.740 that, in fact, there's a much broader spectrum of disease, much of which has gone unnoticed. And that

00:06:27.340 over the next several months, you get to a more realistic assessment of what the viral pathology is

00:06:35.720 likely to really be. In the case of this virus, I don't know that we are there yet, as we are sort

00:06:44.540 of understanding how many people through serial surveys and whatnot have been unknowingly infected.

00:06:51.440 Yeah, I was going to ask about that, because right now we are, of course, hyper attentive to the idea

00:06:56.000 of, you know, just, you know, wear your mask, keep away from anyone in the grocery store, and then we're

00:07:00.160 going to have apps to alert us if we were close to anyone who, you know, tested positive regardless of

00:07:04.380 symptoms and so forth. But to your point, back, you know, over a year ago, it was just what are the most

00:07:08.300 extreme cases? To what degree was the virus actually circulating around society? And I know there continue

00:07:13.420 to be studies and, and sort of lab work and so forth done to determine just how, how great a volume of

00:07:19.880 people actually have these antibodies? Did it actually come to the West Coast much earlier than we thought?

00:07:24.100 What's your current perspective on all of that? When coronavirus actually hit Canada, hit North

00:07:29.480 America, you know, do a whole lot more people have it than, than we say right now? I mean,

00:07:33.580 obviously it stands to reason, obviously it's, it's more than the official numbers, but just how much

00:07:37.660 more? So the, the quick answer to that is nobody knows. And so I'm going to break that question down

00:07:45.500 because there's quite a few questions in there. In terms of timing, they've actually gone and looked

00:07:50.500 at wastewater samples historically. And it seems like the, the SARS-CoV-2 was probably much wider

00:07:58.940 spread than originally thought, even in December of 20, 2019. And, and it may be that in fact,

00:08:07.180 the Wuhan area was the first major detected super spreader event rather than necessarily being the

00:08:14.600 origin. We'll probably never truly know that. We'll never know if somebody who happened to

00:08:20.640 transit through Wuhan ended up somewhere else in the world. Well, to a certain extent, it kind of

00:08:28.440 doesn't matter. We are where we are right now. And it was undoubtedly much wider spread at the time

00:08:36.640 that it was identified in Wuhan than was initially thought. Again, just masquerading as your common

00:08:43.900 garden variety, a cold or a flu virus. Jen, we had this period in the spring of 2020 where the virus

00:08:51.760 was most acutely spreading and also having the worst outcomes in long-term care homes. And that

00:08:57.740 was a period where obviously there was no vaccine at all, but there also really wasn't much treatment

00:09:02.200 at that point. I'll embarrass myself if I try and list the names of the actual drugs that people in

00:09:07.700 your profession have figured out are the ones to, to actually do a really good job helping people deal

00:09:12.320 with coronavirus when they're hospitalized with it. But, but there was a couple of months there where

00:09:15.600 I feel like it was probably pretty, I don't know if scary is the right term, but kind of uncertain

00:09:19.640 terrain in terms of just, you know, what's really going to happen here. I'm thinking, you know,

00:09:23.340 I guess, April, May, 2020, what was going on during that period?

00:09:28.180 I think that was probably the scariest time for everybody because we were dealing with a number of

00:09:34.520 unknown variables. We didn't know what the mortality rate was or wasn't. We didn't have a 100% clear

00:09:43.700 handle on nature of spread. We had all sorts of unexplained cases that we now probably can explain

00:09:53.300 with the knowledge that it was much more widespread than originally thought. But at the time we didn't

00:09:58.980 know. So it seemed like the cases were cropping out of nowhere. That was a time when we started

00:10:05.680 looking at mathematical models that were based on the, again, information that it was natural at the

00:10:13.140 time to have had, but with a, with a much higher mortality than is probably correct. And without sort

00:10:19.860 of stratifying the different risks per age, which would have given a much more

00:10:26.260 sophisticated understanding of what was likely to happen. At that point, we went into planning mode,

00:10:36.960 which is completely appropriate and prepared for the worst case scenario. And it turns out that that

00:10:42.400 did not, at least in my jurisdiction, develop as expected. And so then we had to sort of take a step

00:10:50.740 back and rethink the approach. Now, that's a really interesting period where we went into first

00:10:58.220 lockdown, shut everything down. We don't know what this is. We don't know how it spreads. We don't

00:11:02.200 know who dies from it and so forth. And then, and I appreciate that a lot of people were really nervous

00:11:06.960 at that point in time. And then we learned a bit more, you and your colleagues in the profession

00:11:12.240 learned about treatments, learning who's getting it and so forth. And we had a bit of a summer in

00:11:16.580 Canada. And I think some people were able to enjoy some times there. And then we hit into the second

00:11:21.660 wave and a second lockdown. And here where I am in Ontario, we're now in a third lockdown. And I feel

00:11:26.460 like things started to change a bit in terms of how we talk about the virus, how the information gets

00:11:32.660 out there. And I think a lot of, a lot of public frustration and anxiety and confusion really set in.

00:11:39.500 What do you think really happened after we sort of grabbed our bearings and to your point,

00:11:44.560 things in your jurisdiction, and I believe pretty much in most jurisdictions didn't turn out as bad

00:11:48.920 as was what first feared, but it kind of feels like we're doing the same response right now than we

00:11:55.220 did then. So to understand the full nature of that, you need probably a social psychologist rather

00:12:04.160 than infectious diseases specialist. I think there's a number of themes going on. I do put a fair amount

00:12:15.020 of blame on the nature of social media. It, there has been, from my observation, the sort of rational

00:12:25.740 medical response, which admittedly does not make great headlines, talking about how we know actually

00:12:36.640 a fair amount, how we know what we can do to mitigate risk. Unfortunately, that does not get as much

00:12:45.080 attention, clicks, playtime, as do the more sensational points of view. Because of the nature of our

00:12:55.400 psychology as people. And so I feel like this is the pandemic that Twitter is driving, and it gets

00:13:02.840 to a point where public officials can't, I don't want to say can't, that's not, it's unfair to say

00:13:10.740 they can't manage, but they're in a, they're put in a position where what they're saying is not perceived

00:13:15.620 as being credible. And so they have to change their message, despite the science, to placate the,

00:13:23.920 um, the Twitterverse. Yeah, I found it interesting that, you know, initially, a lot of public health

00:13:30.240 communications are about making sure people take this seriously. So even if they're not sure if this or

00:13:35.420 that intervention is going to work, well, let's do all we can to take it seriously, take our precautions

00:13:40.060 and so forth. But I think one of the consequences of that was it led people to believe that things were

00:13:45.960 risk factors that weren't risk factors. Like I feel like there are many millions of people in Canada

00:13:51.360 who would believe that anybody can get coronavirus at any time in any setting and anybody can have a

00:13:57.120 serious outcome and be hospitalized and die of it. And obviously, I know there's a, you know, one in

00:14:00.620 however many millions odds where I guess, you know, every scenario is conceivably possible. But

00:14:05.180 generally speaking, correct me if I'm mistaken, that is not the case that we have a lot of information

00:14:10.380 about things that are safe, unsafe, people who are high risk, people who are not high risk,

00:14:14.300 and so forth. But I feel like that that doesn't get communicated, perhaps for just what you're

00:14:18.560 saying, because it doesn't fit in a tweet. Absolutely. And certainly, speaking to my

00:14:25.560 relatives who are elderly, they are absolutely convinced that if they get the coronavirus,

00:14:31.800 they will die. Now, their risk is much higher than I'm sure they would like it to be. So for a

00:14:37.320 community dwelling elder, the risk is somewhere between 2.5 and 5% of death once you

00:14:42.860 contract the disease, unvaccinated. But again, that's much higher risk than you'd like. But you

00:14:51.940 have a 95 to 97.5% chance of doing well. So I think that we've gone from a subtle, nuanced discussion

00:15:02.880 about risk to an absolute black and white, you either die or you don't, which is which is probably

00:15:11.240 incorrect. Looking at our population structure, and this is true, actually, also of SARS and SARS-1

00:15:19.380 and MERS-CoV, young people are generally speaking at incredibly low risk, certainly at lower risk than

00:15:27.420 many of the other risks we take in day to day living, such as driving a car, which is probably

00:15:33.500 the highest risk for any of us under the age of about 50. Dr. Jennifer Grant is our guest, a medical

00:15:39.900 microbiologist and infectious diseases physician in Vancouver, and a clinical associate professor at

00:15:44.780 the University of British Columbia. Facebook recently updated their policies for what classifies

00:15:50.040 as misinformation and things that you're not tolerated to discuss on Facebook and posts will be

00:15:54.880 removed and so forth. And one of them, they said, posts that downplay the severity of the virus,

00:16:02.620 for instance, saying it's just the flu, or that call into question the official death tally. And I read

00:16:08.480 that and I thought, well, we have a bit of a problem on our hands, because I appreciate that in older age

00:16:13.500 cohorts, yes, coronavirus is definitely more serious than the flu. But we've got pediatric experts and

00:16:20.460 an expert such as yourself, Jen, who are saying, well, actually, influenza is more serious in

00:16:25.340 children. So there's, you know, one of those Facebook red flags, and then saying, oh, the death

00:16:29.600 count is, you know, not what it is, and so forth. Well, we've got Statistics Canada saying that about

00:16:33.300 10% of coronavirus deaths were people who died of something else like cancer, but had coronavirus at

00:16:38.480 the time. So, okay, I know they're not doing, you know, full blown conspiracy theory talk at

00:16:42.540 Statistics Canada. But the facts they present in the nuance seem to, you know, cause trouble with what

00:16:47.660 Facebook is putting as their rules, you know, to your point about how a lot of this, this, this online

00:16:53.360 discussion is almost getting in the way of a more nuanced conversation.

00:16:57.120 Well, absolutely. And I would say that it's, if you can't question facts, there's a problem if you can

00:17:08.700 back those facts up with data. Now, obviously, people say all sorts of things online, that are clearly

00:17:14.800 wrong. And so there has to be a balance in there. But it's very problematic. The degree of power that

00:17:24.080 Facebook has in that is problematic. And the inability to have a nuanced discussion is also

00:17:32.480 problematic. Although I would put to the universe that possibly Facebook is not the place to be having

00:17:38.880 nuanced discussions. Right. Fair enough. Going back to the kids conversation, and to your point,

00:17:43.680 some people very resistant, very adamant to say, no, no, kids are, you know, they're still getting it,

00:17:48.680 or kids are the secret super spreaders, and so forth. In Ontario, where I am, they've closed the

00:17:52.820 schools again, for the third wave. And the justification, they acknowledge that children 0.66

00:17:57.240 themselves are not actually spreading the virus in classroom, there's no in class transmission going

00:18:03.020 on. But they've said, well, you know, there's community spread. So we have to close the schools

00:18:07.600 because of that. And also mobility issues, something that they talk about, I'd say sort of below the

00:18:13.900 fold, they don't talk about as their top lines in the press conference, but they get into a 20 minutes

00:18:17.720 into it saying, well, we got these mobility charts, these anonymized cell phone data that show us people

00:18:22.840 are driving around like it's not pandemic time. So we got to get those numbers down. They've learned

00:18:26.920 that closing the schools is a good way to keep parents at home to bring that mobility data down.

00:18:31.540 Do you think that any of that broader community spread, mobility data, are those justifications

00:18:37.140 to close schools during this situation? So I would say no, I would say that there is no

00:18:44.760 justification for closing schools, until you can show that it's more harmful to the children

00:18:51.320 themselves to be in school. The problem is that cell phones, as far as I'm aware, don't spread

00:19:00.020 the coronavirus. People are mobile for all sorts of reasons. And until you can show the direct

00:19:09.480 line of children in school being the cause of spread, you're just using children as victims

00:19:16.880 and a strategy that might be better done in some other way. What we're doing to our children right

00:19:22.340 now is, in my opinion, appalling. We need to care for our children, which includes taking care of their

00:19:31.140 mental, physical, and spiritual health, their economic health, and frankly, their physical

00:19:36.360 health. Children are far more at risk from self-harm than they are from the coronavirus.

00:19:42.480 Well, if I can throw back at you a line that gets thrown back at me, one of those snarky Twitter

00:19:47.300 lines, people say, oh, well, that's all well and good. But try telling one of those children why

00:19:51.680 their grandparents have died, or why mom or dad died, or why their grandparents died, because they

00:19:56.540 brought the coronavirus back to them from school. What would you say to people who, based on my

00:20:01.640 Twitter feed, there's a lot of people who like to say that? What I'd like to say is not appropriate.

00:20:07.700 Fair enough.

00:20:08.180 So, I think we really need to have a conversation about who is to blame for a virus. A virus is a

00:20:20.660 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

00:20:28.640 virus. And we know that children are the least likely to spread disease. They are far more likely

00:20:38.020 to have got it in the community. And in fact, from personal conversations I've had with various

00:20:45.000 public health officials, the risk of a child spreading is substantially less than 1%. So, I

00:20:51.420 would ask that person, really, are you sure the grandparent got it from that child? Because

00:20:57.300 directionality is incredibly hard to prove. So, on the one hand, we shouldn't, how can you blame

00:21:05.040 children for happening to have a virus? That's just, that's nonsensical to me. We don't blame

00:21:12.220 the adults who gave it to the kids. So, why would we blame in the other direction? It's just, it's, it's

00:21:18.400 a false morality. It's scientifically incorrect. And it is just so unfair to put that on children.

00:21:29.020 There's been a little bit of an emphasis on health officials on attempting to quantify sort of direct

00:21:35.020 harms of lockdowns vis-a-vis a spike in overdoses. I know in BC, there's been a lot of looking into

00:21:41.680 that data, suicide rates and so forth, deferred surgeries that have resulted in cancers and so

00:21:46.960 forth, and cardiac issues. But I know there has not been anywhere in Canada a more formal cost-benefit

00:21:52.060 analysis that takes into effect various things related to children and what we call quality-adjusted

00:21:57.080 life years, sort of stunted growth, how education held back. Even people who've said, you know,

00:22:02.020 I'm in university, but I'm in crisis now because life is a mess in university, so I'm dropping out

00:22:06.280 and so forth. And what that means for society, what that means for that young person. How do we begin

00:22:12.120 to robustly talk about this stuff? Because I feel like a lot of people are really at the sort of

00:22:16.400 cover the eyes, plug the ears, see no evil, hear no evil kind of stuff.

00:22:20.860 Yeah, it's really challenging. The problem is we can't quantify it now because those are harms that will

00:22:26.120 be felt over the next 20 to 30 years in many cases. Obviously, suicides can be identified. And

00:22:32.100 I believe it's Las Vegas opened their school system because children were dying from suicide.

00:22:39.460 So there are some of those harms that can be quantified, but a lot of them can't be. And a lot

00:22:45.280 of them will be born out of the next 30 years. Now, there are some places trying to do that.

00:22:51.320 So the OECD has a publication out, as does Simon Fraser University, looking at the likely economic

00:23:00.660 consequences for the kids, for the, essentially quantify it by future earnings lost per day of

00:23:09.540 education lost or something along those lines. And it's enormous. And for those people who say,

00:23:16.660 well, yes, but it's, that's money. And we're talking about health. The truth is that wealth

00:23:21.540 and health are so tightly linked that we actually have the science of the social determinants of

00:23:28.480 health. So if you're, have more income, you can have better food, you can exercise, you have better

00:23:35.060 housing, you engage in medical care more, all of those things makes you healthier, having not having

00:23:41.560 those things makes you die earlier. People are also trying to quantify the number of children lost

00:23:47.920 to the education system. And it's enormous. I saw a newspaper article saying that they're laying teachers

00:23:55.280 off, they've lost so many kids. These are kids who are not completing their education. With a lower

00:24:00.020 level of education, not only do you have lower economic output, but you end up with poorer health

00:24:06.420 over the course of your lifetime. So people are trying to do it here and there. There is, in BC,

00:24:12.500 to the credit of my colleagues, they have the unintended consequences group, and they are trying

00:24:17.340 to pull those data together. But again, you can't pull future data together. That's, that's going to

00:24:22.960 come in, in 10 to 15 years. Dr. Grant, correct me if I'm mistaken, but in, in infectious disease

00:24:28.500 circles, epidemiological circles, public health community prior to Wuhan entering lockdown, this idea

00:24:35.520 of shut everything down for a prolonged period of time is, is not really a thing. I mean, I've read

00:24:42.280 the various pandemic preparedness plans that, that all levels of government have put together, and

00:24:46.480 there's not really any discussion of this. It's about, you know, protecting people, minimizing illness

00:24:51.460 to allow for the proper functioning of society. How, how are we, I don't even know how to ask the

00:24:59.260 question, because whenever I try to say it, it kind of boggles the mind that I even have to ask the

00:25:02.940 question, but how did we get to this point? I, I don't know. You're right. Every pandemic

00:25:09.700 plan we've looked at has, that we've written, and ours is written in 2018, and it's still up on our

00:25:15.200 website, and so I'm sure you've, you've seen it. It basically says, we don't close schools, because

00:25:19.860 closing schools, even if, and this, and this was written for influenza, which children are known to

00:25:24.720 spread. We don't close schools, because the harms to children are so high. No, we don't close

00:25:30.900 businesses, because people need that to work. I don't understand how the narrative moved to

00:25:36.680 shutting everything down is the best thing to do. Now, is the, is there some benefit to it? There

00:25:43.520 probably is, but there needs to be a discussion about balancing harms and benefits, and that's the

00:25:51.620 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,

00:31:53.480 does not seem like a high priority.

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.

00:38:58.200 Which path should we be pursuing?

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. 1.00

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.

00:41:09.660 Thanks for having me.

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 Google, Spotify, or wherever you get your podcasts. You can help us by giving us a rating or review

00:41:33.320 and telling your friends about us. Thank you for listening.

Full Comment - May 03, 2021

Episode 2： Dr. Jennifer Grant

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