Full Comment - Reasons to keep calm over COVID

00:00:00.000 Did you lock the front door?

00:00:04.060 Check.

00:00:04.620 Closed the garage door?

00:00:05.780 Yep.

00:00:06.300 Installed window sensors, smoke sensors, and HD cameras with night vision?

00:00:09.780 No.

00:00:10.620 And you set up credit card transaction alerts, a secure VPN for a private connection,

00:00:14.060 and continuous monitoring for our personal info on the dark web?

00:00:17.080 Uh, I'm looking into it?

00:00:19.600 Stress less about security.

00:00:21.360 Choose security solutions from Telus for peace of mind at home and online.

00:00:25.220 Visit telus.com slash total security to learn more.

00:00:28.780 Conditions apply.

00:00:30.000 When I found out my friend got a great deal on a wool coat from Winners, I started wondering,

00:00:35.480 is every fabulous item I see from Winners?

00:00:38.560 Like that woman over there with the designer jeans. 1.00

00:00:41.300 Are those from Winners?

00:00:42.820 Ooh, or those beautiful gold earrings?

00:00:45.300 Did she pay full price?

00:00:46.640 Or that leather tote?

00:00:47.660 Or that cashmere sweater?

00:00:48.880 Or those knee-high boots?

00:00:50.320 That dress?

00:00:51.100 That jacket?

00:00:51.780 Those shoes?

00:00:52.460 Is anyone paying full price for anything?

00:00:55.800 Stop wondering.

00:00:57.040 Start winning.

00:00:57.980 Winners.

00:00:58.560 Find fabulous for less.

00:01:00.000 Whether you own a bustling hair salon, or a hot new bakery,

00:01:05.000 you need business insurance that can keep up with your evolving needs.

00:01:08.820 With flexible coverage options from TD Insurance, you only pay for what you need.

00:01:13.000 TD.

00:01:14.160 Ready for you.

00:01:15.100 Hello, I'm Anthony Fury.

00:01:22.000 Thanks for joining us for the latest episode of Full Comment.

00:01:25.140 Please consider subscribing if you haven't already done so.

00:01:28.000 I hope you had a good summer, and I hope you had a normal summer.

00:01:30.900 The most normal summer you've had in the past couple of years.

00:01:34.120 Because, of course, the COVID-19 pandemic is now over.

00:01:37.180 And I pause, because that line, spoken right now, typically gets one of two reactions.

00:01:42.600 Those who, I guess, nod in agreement, and those who strenuously object.

00:01:46.080 Who say, it's not over just because you say it is.

00:01:48.500 Well, which one is it?

00:01:50.160 There are hardly any more COVID rules on the books, and for months now,

00:01:52.640 life in Canada has gone on normally for the vast majority of people.

00:01:56.220 Yet some people contend that this will change in the fall as respiratory virus season kicks in,

00:02:01.380 and that things may take a turn for the worse.

00:02:04.960 Is that accurate?

00:02:05.900 Should we be concerned, or is this just fear-mongering?

00:02:08.920 Maybe instead of pushing to bring back rules,

00:02:11.280 should we push for inquiries into what happened the past two years?

00:02:14.200 Do we need to talk about things, relitigate things,

00:02:16.580 whether we made the right choices, on a whole number of fronts, whatever your perspective.

00:02:20.440 We've also begun something of a national conversation into our healthcare system,

00:02:23.760 whether or not it's adequately equipped to deal with the challenges we face,

00:02:26.800 COVID or otherwise, if it's time for healthcare reform.

00:02:31.300 Dr. Isaac Bogosh joins us now to discuss all this and more.

00:02:34.620 He is a staff physician at Toronto General Hospital

00:02:36.760 who is on the front lines of COVID throughout it all

00:02:39.120 and became a familiar face on television and radio to Canadians

00:02:42.120 seeking help and advice navigating the pandemic.

00:02:45.340 Dr. Bogosh, great to have you on the podcast.

00:02:47.900 Thanks for having me on, Anthony.

00:02:49.000 Really happy to chat.

00:02:49.980 Yeah, thanks so much for joining us.

00:02:51.400 Well, I'll throw the, I guess, the both super tough but super simple question.

00:02:56.640 Is the COVID-19 pandemic right now over?

00:03:00.480 So, short answer, no, it's not.

00:03:04.060 Longer answer, we're in a much better place right now than we were a year ago and two years ago.

00:03:11.140 And you can't act like it's 2020 anymore and you can't act like it's 2021 anymore.

00:03:15.680 But it's still here.

00:03:17.060 We had a summer wave.

00:03:18.700 It wasn't as significant from a healthcare utilization standpoint as other prior waves.

00:03:24.420 But it's still here.

00:03:25.940 And I think if we say that it's over, it might, well, I think it conveys an inaccurate message.

00:03:32.440 Just because there aren't really any mandates or we're not seeing much in the way of public health restrictions

00:03:42.320 and public health measures, that doesn't mean the infection ceases to exist.

00:03:46.180 It's here.

00:03:46.820 We're having waves.

00:03:47.980 It's impacting people.

00:03:49.040 It's impacting our healthcare system.

00:03:51.240 And I think we can have open, honest, transparent conversations about, you know, what it is,

00:03:55.960 how to protect ourselves, how to protect those around us, how to ensure that we can live as

00:04:01.160 normal a life as possible, but still acknowledge that it is here and still is impacting us.

00:04:06.760 What's the difference between saying the pandemic is still happening and saying, well, there's

00:04:11.620 this new respiratory virus on the scene.

00:04:13.700 I wish it didn't exist.

00:04:14.920 I wish it went away.

00:04:15.640 But we know it's pretty much here to stay.

00:04:17.260 And now it's just in the backdrop of our lives like these other viruses.

00:04:20.380 Is that the same thing or are those two different things to say?

00:04:23.800 I think it's a lot of semantics and a lot of nuance.

00:04:27.840 And again, just because you say the pandemic, if someone says the pandemic is still here,

00:04:32.860 that doesn't mean that we should, you know, jump right to, you know, make a connection.

00:04:38.400 They'll lock down or anything like that.

00:04:40.760 No, of course not.

00:04:42.000 It just acknowledges that the virus is still here.

00:04:44.460 The virus is still around.

00:04:46.200 There are still waves.

00:04:47.800 We're still having, you know, people get sick and die from it and to a higher rate than

00:04:53.980 other viruses and other ailments.

00:04:58.680 Like it still is a significant issue in Canada, whether we want to acknowledge it or not is

00:05:03.940 a different story.

00:05:04.740 But like if you were to walk through the hospitals or look at the death certificates or look at

00:05:09.560 who's impacted by this, it's still having an impact.

00:05:12.660 It absolutely is.

00:05:14.200 You know, and in the same sentence, I'll say it's having much less of an impact now as it

00:05:20.500 did before.

00:05:21.220 We're in a much better place in a much different place.

00:05:24.100 And of course, the rules and the regulations and the policies have to adapt to the current

00:05:29.400 situation and to the updated science.

00:05:31.580 But still, it's still here.

00:05:34.800 And, you know, obviously we've had debates.

00:05:36.940 What is pandemic?

00:05:37.920 What is endemic?

00:05:39.120 You know, if we want to call this endemic, we could.

00:05:42.880 But endemic still means, you know, significant disruptions on our health care system and

00:05:48.120 significant impact on on individuals and communities, particularly vulnerable individuals

00:05:53.320 and more vulnerable communities.

00:05:54.420 So would you say that what we could perhaps see this fall in this winter would be greater

00:06:02.620 than what you think we're going to see with COVID-19 for the next 10 or 20 years?

00:06:07.060 Or are you saying that what we're going to see this coming fall is what we should get used

00:06:12.260 to seeing for quite some time with this particular virus in terms of volume of deaths and hospital

00:06:18.800 capacity?

00:06:20.680 I honestly don't know the answer to that.

00:06:22.200 I really don't.

00:06:23.020 I mean, short term is a lot easier to predict than longer term.

00:06:27.240 But over the short term, listen, we know that, for example, in Canada, we've got a few

00:06:31.780 things that we have to contend with.

00:06:33.620 Number one, yeah, at some point in the late fall, we'll probably see a rise in COVID.

00:06:38.320 I think that's pretty clear.

00:06:39.480 There's definitely some seasonal variation to this.

00:06:42.220 So that's that's going to happen.

00:06:44.140 Number two, we're going to see other respiratory viruses, including the flu.

00:06:47.640 Like you look at the southern hemisphere, that's often an imperfect but still somewhat

00:06:51.500 decent metric for what we're going to see in the northern hemisphere during our winter.

00:06:56.220 And they had a pretty decent flu season, not decent, a pretty impactful flu season in

00:07:02.080 Australia, for example, especially when we compare it to the last couple of years where

00:07:05.460 it was largely absent.

00:07:06.480 So we're going to see flu and other respiratory viruses.

00:07:09.040 We know that brings people into hospital as well.

00:07:11.580 Then on top of that, you know, we've got other strains on our health care system that we had

00:07:17.880 even before COVID, like every winter, every winter.

00:07:21.300 You'd always see the headlines, you know, hallway medicine's an issue or we're overwhelmed.

00:07:25.320 So we have to add that on to the existing pressures of the health care system.

00:07:30.480 And then on top of that, I mean, it's not a secret that health care has been a really

00:07:34.760 challenging place to work in over the last two and a half years.

00:07:37.080 We had a ton of people leave.

00:07:38.560 We have tremendous staffing challenges.

00:07:41.060 So we just don't have the same capacity to manage even smaller waves.

00:07:47.060 So we're going to have a wave.

00:07:48.080 I can't tell you how big it's going to be, but we're going to have one.

00:07:50.560 But it's tough right now when it shouldn't be that tough.

00:07:54.000 And if you fast forward a few months when it's going to get tougher, I mean, we still

00:07:58.520 have to provide Canadians with the health care that they deserve.

00:08:01.420 It's just harder and harder to do it with all the pressures and fewer hands on deck.

00:08:05.860 How should Canadians then conceptualize what's going to happen then?

00:08:10.160 Because when you referenced before COVID, there were the headlines, this hospital or Ontario

00:08:15.360 hospitals in general overwhelmed at 110%, whatever the number was.

00:08:18.900 And I don't think Canadians were unsympathetic to people in your position who are dealing

00:08:24.740 with these volumes.

00:08:25.560 But I think it was kind of like, all right, well, that doesn't really have too much to

00:08:28.120 do with my specific daily life.

00:08:29.620 Unless, of course, I happen to go to the hospital and face a really long wait time and I'm frustrated

00:08:34.580 by it.

00:08:34.920 But it was seen as this other thing happening somewhere else.

00:08:38.020 Yet, of course, the past two years, the idea of hospitals being overwhelmed was something

00:08:42.460 that was seen as our collective burden to bear and manage and restrictions are brought

00:08:47.780 in.

00:08:48.400 When we talk about upcoming hospital challenges, is this really a sectoral specific issue that

00:08:54.300 is about government providing adequate services or and the public can no longer, well, let's

00:09:00.080 face it, be stressed out about it, have anxiety over it?

00:09:03.660 How do we respond to it?

00:09:06.800 Yeah, there's lots of different ways.

00:09:08.500 One is we can ignore it and stick our heads in the sand and just hope it gets better.

00:09:12.240 But we know that's obviously not going to be a successful approach.

00:09:16.020 The other one is to see, you know, we're obviously talking about health care and the

00:09:19.180 hospital sector, but it extends well beyond the hospital sector and to other aspects of

00:09:23.760 health care as well.

00:09:24.500 And we know people have had tremendous difficulty reaching their primary care provider or other

00:09:29.720 health care, public health, whatever their health care needs are.

00:09:32.560 So the whole health care sector is stretched.

00:09:35.440 And then, of course, it extends well beyond that.

00:09:37.200 We know that this has impacted every other sector as well.

00:09:40.220 We've had, you know, staff absences due to illness, outbreaks in, you know, indoor settings

00:09:49.100 and office settings as well.

00:09:50.760 So, again, like this is not doom and gloom, not at all.

00:09:54.280 Like, really, truly, I can't stress this enough.

00:09:56.920 Things are so much better now than they were before.

00:09:59.880 There's excellent evidence to suggest that.

00:10:02.280 It's just that I think if we keep pretending that it's 2019, we're going to get smoked again

00:10:07.720 and again, and we can take some simple steps to create safer indoor spaces to protect ourselves,

00:10:12.600 to protect those around us so that this just has less of an impact.

00:10:15.600 We're not going to stop waves.

00:10:17.640 We're not.

00:10:18.020 But we can limit their impact on on us and in our communities.

00:10:22.540 So, like, it is here.

00:10:26.040 But again, like, let's just take a step back and look at the last three waves.

00:10:29.880 You had a winter wave, which was awful.

00:10:31.660 That was Omicron.

00:10:32.520 Everybody got it.

00:10:33.580 It was terrible.

00:10:34.800 And then you had a spring wave that was also Omicron, BA2.

00:10:38.960 No mitigation efforts.

00:10:40.360 Kids were still in school.

00:10:41.400 But, like, between our really, really high vaccination rates in Canada, plus a lot of

00:10:47.220 people having previously been infected rather recently, you had, like, from a health care

00:10:52.720 standpoint, you know, a much smaller wave, like a really small wave.

00:10:56.600 And again, very little in the way of mandates, very few masks, no restrictions on how many people

00:11:04.700 in indoor spaces.

00:11:06.340 And, you know, you had a wave, but it wasn't nearly as significant as the prior one.

00:11:10.980 And we just we're coming out of a summer wave now.

00:11:13.440 It's summer.

00:11:14.240 We have a BA5 wave.

00:11:15.660 Again, very little in the way of restrictions.

00:11:17.640 Yeah, I get it.

00:11:18.340 It's summer.

00:11:18.820 Kids are out of school.

00:11:19.520 People are spending time outside.

00:11:20.980 But again, like so many people have been infected and recovered, plus or minus have been vaccinated

00:11:26.100 that we just see an impact, but just much less of an impact of this wave.

00:11:32.480 So I think we have to think of this as, listen, we're a very highly vaccinated country.

00:11:37.720 Yeah, there's room for improvement on boosters and in vulnerable populations.

00:11:41.520 But in general, we're doing pretty good.

00:11:44.840 Yeah, we don't want anyone to get infected, but we can't ignore that a ton of people have

00:11:48.880 been infected and recovered from infection, especially over the last six months.

00:11:53.280 And that really goes a long way to building up community level protection and community

00:11:59.700 level immunity, such that when we have the next wave that rolled through town, it just

00:12:04.280 has less and less impact at a societal level.

00:12:07.620 And we saw that over the last two waves.

00:12:09.380 Very little restrictions, very little mandates.

00:12:12.820 Two sizable waves rolled through town.

00:12:15.940 And yeah, of course, people got sick.

00:12:17.960 That was sad.

00:12:18.620 Some people died.

00:12:19.400 That's sad.

00:12:19.940 But from a health care system standpoint, from a death standpoint, it just was a much

00:12:24.720 smaller wave versus prior waves.

00:12:27.300 So, Dr. Bogosh, does the general public kind of know what they need to do now in terms of

00:12:32.240 the if you're sick, stay home, something that a lot of people say we should have been doing

00:12:35.900 that a bit more in the before times anyway, in terms of that people say, oh, no, I can soldier

00:12:40.060 in in the office.

00:12:40.940 I can I can do it.

00:12:41.760 Yeah, OK, please, please stay home that.

00:12:44.040 And then people who are high risk, I think we've been talking about for two years, they can

00:12:47.640 adequately identify whether they are or not, and then they can respond accordingly.

00:12:51.460 And then when it comes to, for instance, something I'm very passionate about, kids and

00:12:55.160 COVID rules, I don't want my kids to even hear the phrase COVID again.

00:12:59.280 You know, the small children, zero rules, zero, just leave them alone and we'll just

00:13:03.740 figure it all out.

00:13:04.460 Is that something we can do here?

00:13:05.920 I mean, are we are we informed enough that the people who need to do things a little

00:13:09.960 differently are now empowered to do so?

00:13:12.080 And that's that's kind of it.

00:13:13.460 I think we're getting there, but I'd say there's a couple of points there.

00:13:17.900 I mean, I agree with some of that.

00:13:19.120 I don't agree with all of that.

00:13:20.500 But I think there's right.

00:13:22.220 You know, on the one hand, we are probably way more health literate right now as a country

00:13:28.540 compared to, you know, 2019.

00:13:31.240 Right.

00:13:31.400 We're having public conversations of words like mRNA and rapid test.

00:13:36.800 And it's like, did you ever dream in a million years you'd hear public debates over

00:13:41.040 brands of vaccines like this is pretty impressive?

00:13:44.500 So, yeah, on the one hand, sure, we're much more health literate and savvy, especially in

00:13:49.400 the realm of public health and infectious diseases as a country.

00:13:52.100 So that's one point.

00:13:52.940 The second point is we also see the tremendous and profound negative impact of misinformation

00:13:59.660 and disinformation from a well-funded anti-science movement.

00:14:05.660 And again, I'm not saying that's impacting everybody, but that does impact a proportion

00:14:10.500 of Canadian society and makes things more challenging.

00:14:13.740 Number three.

00:14:14.080 What specifically do you mean by that?

00:14:16.100 Because I hear these words bandied about a lot, misinformation, disinformation, and it's

00:14:20.980 always interesting to drill down and say, what are we talking about here?

00:14:23.540 Sure.

00:14:24.760 Basically, misinformation, meaning unintended but wrong information about COVID, science,

00:14:31.600 vaccines, et cetera.

00:14:33.280 Disinformation, meaning purposeful, meaningful, false information, subverting public health,

00:14:42.520 science, medicine, and creating mistrust.

00:14:46.240 And again, it's here.

00:14:46.940 We can't ignore it.

00:14:48.160 It's here.

00:14:48.540 It's amplified on social media.

00:14:50.480 And it's a problem.

00:14:51.400 I'm not saying it's a problem for 100% of Canadians, but there are some that will listen 0.59

00:14:56.460 to this and make poor decisions for themselves, whatever that may be, and it might cause harm

00:15:01.820 to themselves or others.

00:15:03.620 So I would say we're very well, we've got certainly more health.

00:15:07.600 Point one, a lot of health literacy.

00:15:09.080 Part two, we can't ignore misinformation, disinformation.

00:15:12.600 And part three, I think one of the more important parts, too, is we've got different senior political

00:15:20.240 and public health leaders saying different things.

00:15:24.300 Right.

00:15:24.380 And I think that causes confusion in the general public.

00:15:29.660 That leads to mistrust.

00:15:32.060 And at the end of the day, people tune out.

00:15:33.860 And if we had reasonable, and how, yeah, good luck, we're going to define reasonable, but

00:15:39.940 reasonable, coordinated messaging that's science-driven, that's data-driven, that's

00:15:45.940 reflective of whatever we want to agree upon is what Canada wants to do collectively, which

00:15:52.280 again, is hard to do.

00:15:53.260 I think that would go a long way.

00:15:54.740 But you've got, you know, Dr. A saying this, Dr. B saying something totally different, you

00:16:01.060 know, public arguments and spats and policies that are contradictory.

00:16:07.640 We have a lot of policies that are out of date as well. 0.89

00:16:10.400 And, you know, the public's not stupid.

00:16:11.740 They can see this. 0.91

00:16:13.840 And I think that fuels a lot of mistrust and people tune out.

00:16:18.820 And, and that's a problem because obviously we want common sense rules.

00:16:23.420 We want rules that are updated.

00:16:25.300 We want meaningful policy to protect individuals and, and, and, and communities.

00:16:31.740 And, and, you know, there's going to be a time where we're going to say, you know what,

00:16:34.900 hey, everyone should get this booster vaccine and we want reasonable uptake for that.

00:16:39.380 But if people are tuned out, you know, that we're just, we're just not going to see people

00:16:43.820 make smart decisions for themselves or others.

00:16:45.560 And sadly, I think there's a lot of that.

00:16:47.140 So yeah, misinformation, I guess, from, from one category, from, you know, random online

00:16:52.580 voices who are not credentialed to talk about what they're talking about, but I want to

00:16:56.320 get your thoughts.

00:16:56.760 And I guess when, when you talk about doctors being inconsistent in what they're saying or

00:17:00.220 disagreeing with each other, I don't know if misinformation is the term, but people

00:17:03.820 overselling things.

00:17:05.660 I felt there was a lot of frustrations.

00:17:07.740 I had a lot of frustrations with, again, talking about kids and COVID really almost looking to,

00:17:12.000 to, to ham up the severity of the issue with children.

00:17:15.320 You just weren't allowed.

00:17:16.280 I know you weren't allowed to say, you know, COVID is, COVID is not as bad as the flu or

00:17:20.560 COVID is no worse than the flu kind of thing.

00:17:22.620 But when it came to children, the data set kind of has consistently shown that was more

00:17:26.420 or less accurate when it came to, uh, deaths, a lot of things, particularly around the kids

00:17:30.580 numbers, lots of fighting over that.

00:17:32.220 And one kind of goes, I wish we could have talked about these numbers more openly rather

00:17:35.860 than doing, uh, the Ontario science table had, had the phrase, I know they didn't invent

00:17:39.500 the phrase, but behavioral sciences nudging to, I guess, I don't want to call it stretch

00:17:43.800 the truth a little bit to, I guess, make people not let their guard down.

00:17:47.620 I think we just got to be honest, right?

00:17:49.520 Just be honest.

00:17:50.280 And, and, and, you know, obviously, uh, open, transparent conversations about what the data

00:17:55.540 is, but here's what we see.

00:17:57.720 We see a lot of, you know, preconceived, or we see a lot of these ideology based, uh,

00:18:03.520 decisions and, and opinions and people will cherry pick data to suit their preconceived

00:18:09.360 ideology.

00:18:10.420 And that's unfortunate because, you know, you see people digging in their heels, uh,

00:18:16.340 you know, a lot of disagreements over policies, uh, and people using, you know, cherry pick

00:18:22.840 data to drive certain policies.

00:18:24.480 And it's, it's unfortunate because like, you know, we can take a look at what data is available,

00:18:31.420 determine the quality of the data.

00:18:33.100 Not all data is created the same, you know, have open discussions about it.

00:18:36.760 It doesn't mean you're anti-vax or anti-science or anti-this or anti-that.

00:18:40.320 Just have a meaningful discussion about what the data shows and make reasonable policy around

00:18:44.940 it.

00:18:45.160 Like with kids, kids is a great example.

00:18:46.760 That's a great example.

00:18:48.220 Like, obviously kids can get COVID.

00:18:50.200 We know that.

00:18:51.020 Obviously kids can transmit COVID.

00:18:52.700 We know that all the data available shows that kids just don't get as sick compared to

00:18:57.120 older adults.

00:18:57.880 They don't, they just don't.

00:19:00.180 Yes.

00:19:00.720 Some kids can get sick and that's really sad.

00:19:03.560 And we don't want them to, of course, we don't want anyone to, but compared to older cohorts,

00:19:07.720 kids just don't get as sick pound for pound as adults.

00:19:10.700 It's okay to say that.

00:19:11.660 It's okay to acknowledge that.

00:19:13.220 The other thing that's okay to say and okay to acknowledge is, you know, the vaccines will

00:19:18.180 reduce that already really small risk of severe illness pretty significantly.

00:19:22.320 They do.

00:19:23.280 They just do.

00:19:24.400 And there's great data to back that up.

00:19:26.120 People get mad saying, oh, God forbid we should vaccinate the kids, but they do. 0.76

00:19:30.260 It's also okay to say that these vaccines are really, really good, but of course they're

00:19:34.260 not perfect.

00:19:35.400 Nothing's perfect.

00:19:36.140 And we can talk about what the waning immunity means over time, what the risk of adverse events

00:19:44.300 is, including myocarditis.

00:19:46.320 Like these are, you just have to have open and transparent conversations without cherry

00:19:50.180 pick data to give people a good idea of what, you know, what the science shows, how the policy

00:19:56.180 is created from the science so that people can make smart decisions for themselves.

00:19:59.740 Once you start selectively using data or buffing up one area or, you know, negatively discussing

00:20:06.020 another area that you might disagree with, I think, again, people lose trust, they dig

00:20:10.040 in and then you've lost the public and here we are.

00:20:13.160 Well, I think the vaccine issue, and tell me if you agree or disagree, is one of those

00:20:16.560 issues where there was risk of waning trust based on the almost absolutism with which it

00:20:21.900 was discussed and the aggressiveness with which it was pushed.

00:20:24.780 And we didn't give people breathing room about it and didn't give them room to talk it

00:20:28.180 out. A phrase that was said quite a lot and is now kind of teased by a lot of people is

00:20:32.340 that the safe and effective mantra.

00:20:34.580 And I just think what those terms mean have changed.

00:20:36.720 When we first said, when we first heard that the vaccines were safe and effective, I think

00:20:40.860 effective back then when it was first rolled out meant it stops transmission.

00:20:45.280 It just halts this thing in its tracks.

00:20:47.080 Well, we found out that's inaccurate.

00:20:48.540 When the phrase safe was first rolled out, well, that was before we pulled AstraZeneca for under

00:20:52.720 40, before we pulled Moderna in, what is it, under 30 males.

00:20:56.740 I mean, okay, well, what we mean by safe has shifted because we've clearly determined that

00:21:00.880 some catchments, some criteria are not safe for some individuals.

00:21:04.400 So again, we've kind of eroded the way we use these phrases.

00:21:08.840 So can we talk about this more openly now?

00:21:11.720 So like anything else, there's a lot to chat here, but in general, like anything else, you

00:21:16.620 talk about what is the benefit, what is the risk, what are the alternatives, and what is

00:21:23.020 the context, you know, AstraZeneca is a great example, right?

00:21:26.800 I mean, this was a, it was rolling out during the third wave.

00:21:30.300 If you talk to people who work in hospitals, I'm not going to put words in other people's

00:21:33.840 mouths.

00:21:34.240 Sure.

00:21:34.340 But that was by far the lowest point of the pandemic for many of us that work in the hospital.

00:21:39.260 We were just getting destroyed.

00:21:41.820 The ICUs were overflowing.

00:21:44.080 It's not every day.

00:21:45.200 Never in my life have I heard about adults admitted to pediatric ICUs, tents set up outside

00:21:52.260 a hospital because we didn't have enough beds, bringing in healthcare providers from other

00:21:57.000 provinces.

00:21:57.660 We, Ontario was getting pummeled in the spring of 2021.

00:22:03.060 So when you're having a conversation about AstraZeneca, you have to talk about what are

00:22:08.000 the benefits?

00:22:08.820 Yeah, this is going to keep you out of hospital.

00:22:11.280 It will.

00:22:12.140 What are the risks?

00:22:12.920 Yeah, there is a risk and it's, you know, there's a range, probably about one in 60 to

00:22:17.460 one in 80,000 of a pretty severe blood clot.

00:22:20.720 That's there.

00:22:21.700 What is the context?

00:22:23.520 Well, your healthcare system is disintegrating around you.

00:22:28.660 There's COVID everywhere and we're dropping like flies.

00:22:31.620 And that doesn't just mean you're at risk, vulnerable populations.

00:22:34.640 We were admitting, you know, 20, 30, 40 year olds to the hospital as well during that time.

00:22:39.820 And that's appropriate context.

00:22:41.600 And then the alternatives, the alternatives were, well, you can, if you're lucky enough

00:22:46.640 and you can wait it out, if you can isolate, not everyone has the privilege to isolate.

00:22:52.200 Maybe you'll, you won't get COVID.

00:22:54.320 But those are things that you have to have open conversations and contextualize it.

00:22:59.500 But yeah, of course, when you have the gift of MRNA vaccines and other alternatives and

00:23:04.840 there's lower rates and your hospital system is under much better control and you have

00:23:09.100 more capacity.

00:23:09.940 Sure.

00:23:10.100 You can have different conversations.

00:23:11.860 Same is true for, um, uh, you had to, I was, I'm just losing it.

00:23:17.140 I forget which one you were saying.

00:23:18.560 You had another great example, but, uh, AstraZeneca, I believe was, was one of them.

00:23:22.120 Yeah.

00:23:22.360 The other one being Moderna pulled for, for males under 30, uh, nationwide.

00:23:27.020 Absolutely.

00:23:27.560 Oh, the other one too, is, um, the risk of transmission.

00:23:30.300 Listen, if you're asking that question about, you know, COVID vaccines, reduced transmission

00:23:34.760 and you asked, you know, in December of 2020 and in early 2021, we were dealing with the

00:23:43.480 ancestral strain of COVID.

00:23:44.660 And when we were dealing with the alpha variant, uh, in the spring of 2021, and I would say

00:23:49.700 to some extent, even during, uh, later on in the year when we had our Delta variant, yes,

00:23:54.640 that was accurate.

00:23:55.960 The vaccines really did have very good protection against reducing your risk of getting this

00:24:01.080 infection.

00:24:01.640 No, it's not perfect, but it was good.

00:24:04.120 And they really significantly reduce your risk of onward transmission.

00:24:07.920 But that all changed with Omicron.

00:24:09.960 I mean, Omicron changed the game that just the, the, the rate of protection that these

00:24:16.660 vaccines had against infection and onward transmission declined substantially with the

00:24:22.820 Omicron variant, which really emerged around December of 2021 and which we currently have

00:24:28.280 now.

00:24:29.000 Okay.

00:24:29.640 It's not like they do nothing, but they do very little, uh, compared to what they did

00:24:34.100 before for protection against infection transmission.

00:24:36.040 I would say they still do a remarkable job in protecting us against severe infection.

00:24:41.420 But yeah, if you're like, like you point out, if your policy is created to say, listen,

00:24:46.300 we're, we're, we're, we want vaccines here because we want to stop transmission.

00:24:50.440 I'm sorry.

00:24:51.380 It, it just doesn't cut it.

00:24:53.100 Like you can reduce your risk of transmission, but to a much, much, much smaller extent compared

00:24:57.780 to before.

00:24:58.340 So again, open, honest conversations about what they do, what they don't do and appreciating

00:25:02.980 that things change with time as the virus changes and as we accrue more data.

00:25:07.420 Let's get Dr. 0.53

00:25:08.300 Isaac Bogosh's thoughts on university COVID mandates right after this break.

00:25:15.520 For children in Ontario, they will face no mandatory COVID rules in elementary schools,

00:25:20.320 in high schools.

00:25:20.980 As a parent, I'm appreciative of that.

00:25:22.960 I'm glad they don't have to wear the masks and face other rules.

00:25:25.220 But if they're going to some universities in Ontario, they actually will face mask mandates

00:25:30.640 at a few universities and Western university getting the most headlines for having the most,

00:25:35.100 I guess, stringent rules.

00:25:36.600 We should say a booster mandate in addition to a mask mandate.

00:25:41.100 Dr.

00:25:41.340 Isaac Bogosh, what do you think of universities going a bit rogue from provincial recommendations

00:25:46.700 and saying we're going to bring in these stricter rules?

00:25:50.440 Well, I tease it apart.

00:25:52.040 I talk about masks differently than vaccines.

00:25:54.280 When we talk about the vaccines, for starters, I think we are, you know, moving away from

00:25:59.720 the mandate era.

00:26:01.260 And obviously, that's a, in my value judgment, is that's a good direction to be moving in.

00:26:07.640 And I will come out and publicly say that I very much agree that people should be vaccinated.

00:26:12.960 They absolutely should be.

00:26:14.660 But, you know, I think, like anything else, we need to know what is, like, what's the goal?

00:26:19.720 What are we trying to accomplish here?

00:26:21.240 You know, we're dealing with, for example, in universities, 18 to 22-year-olds.

00:26:26.060 Like, is the risk here to prevent more serious infection in that population?

00:26:30.040 Well, you know, these are individuals who've had two doses of a vaccine.

00:26:33.820 And most of them have had an infection and recovered from infection.

00:26:37.300 So how many of that age cohort did you see in hospital?

00:26:40.540 How many 19-year-old boys and girls did you encounter?

00:26:43.720 Otherwise healthy, yeah.

00:26:44.700 Like, otherwise healthy, two-dose vaccination, 18 to 22-year-olds, like, without underlying

00:26:51.720 medical conditions, close to zero, I think.

00:26:55.640 Yeah.

00:26:55.920 And some have underlying medical conditions.

00:26:58.100 We can't ignore people.

00:26:59.080 Like, I would never exclude them.

00:27:01.000 And those people, you know, sadly, those individuals are overrepresented in hospital,

00:27:05.760 people with medical comorbidities.

00:27:07.240 So, but without medical comorbidities, very few, few to none who have been vaccinated.

00:27:13.020 The other interesting thing, though, is, you know, if the goal is to reduce transmission,

00:27:17.680 yeah, I think you can acknowledge that the vaccines and the boosters still reduce transmission,

00:27:23.860 but just to a much, much, much smaller extent.

00:27:26.840 They do, compared to before.

00:27:28.780 So you're not getting nearly the same bang for your buck in terms of reducing transmission.

00:27:34.140 And I think, you know, when you're saying third dose, there's just more and more evidence

00:27:39.340 pointing in the direction that people who've had two doses plus infection really have, you

00:27:47.100 know, based on, I'm timestamping this to, you know, August and September of 2022, but you

00:27:52.520 really have this, it's almost equivalent, if not equivalent to three doses of a vaccine.

00:27:59.380 So, you know, you sort of have to ask yourself, what's the, what's the goal of this policy?

00:28:04.580 And does this policy accomplish what we're, we're setting it out to do?

00:28:08.780 And you think too, I mean, again, I think these vaccines are in general safe, but yeah,

00:28:14.160 you can't ignore that.

00:28:15.520 There are side effects associated with them, however rare.

00:28:18.580 And again, people will debate about what the actual rate is, but we know that myocarditis

00:28:22.500 is the risk is greater than zero, especially in younger, younger men.

00:28:28.840 And, you know, I, I think we can acknowledge that as well.

00:28:32.160 So when we were making a policy, I want to look at, you know, what do we try to accomplish

00:28:37.060 here?

00:28:37.560 What are the, and how can we do this?

00:28:40.200 I mean, listen, and obviously university is a very different setting than, for example,

00:28:43.740 I don't know, a long-term care facility or a hospital.

00:28:46.940 Like, so I think the, you've got to have the right policy for the right, for the right

00:28:51.940 area, but nuanced conversations, looking at what the goals are and creating a policy to

00:28:55.740 achieve those goals is the right, right thing to do with total transparency as to how you're

00:29:00.080 doing it.

00:29:01.180 Dr. Bogoch, looking back, do you believe that we pretty much made the right choices?

00:29:05.580 I mean, I've, I've written, I've argued that we do need some sort of investigations, public

00:29:08.820 inquiries only because of the gravity of what happened the past two years, both in terms of

00:29:13.140 the health crisis and that, that we did unprecedented edicts in our lives, things that governments

00:29:17.780 really haven't done before in, in modern history.

00:29:21.900 And I was always a big advocate for giving people a bit more breathing room.

00:29:25.220 If whatever the number of diehard unvaccinated people are, 9% of people, they really, really

00:29:29.960 don't want this thing for whatever reason.

00:29:31.480 Okay.

00:29:31.800 Just give them a bit of space.

00:29:33.260 I don't think we necessarily need to box them in as much as we did, or, you know, like

00:29:37.580 a small number of people just didn't want to wear the mask in the grocery store.

00:29:40.480 Okay.

00:29:40.720 We don't need to call the cops.

00:29:41.700 It's not a good use of resources kind of thing.

00:29:44.160 Do you feel confident with the advice and the recommendations and the things that happened

00:29:49.420 that those more extreme things, the, you know, you can't have your uncle over for dinner

00:29:53.160 at this particular period of COVID?

00:29:56.520 Yeah.

00:29:57.040 So I think for starters, yeah, in general, I think it's a very important thing to look

00:30:02.180 back and study this.

00:30:04.360 And if we can do this with some objectivity, we'll be doing something right.

00:30:08.980 What I fear is that.

00:30:10.060 That's the caveat.

00:30:10.820 We're not, there's no way.

00:30:12.060 Well, that's exactly it.

00:30:13.280 Like if we can have conversations in good faith about this, I think we can generate a

00:30:19.540 lot of meaningful discussion because, and we need to, because we're going to face this

00:30:25.800 again, whether we like it or not.

00:30:27.940 This is not going to be the last pandemic.

00:30:30.860 Whoa, whoa, whoa.

00:30:31.480 What time horizon are you talking about here?

00:30:33.720 I wish I knew, but like, come on, look in the last 20 years, you had SARS.

00:30:38.040 That wasn't a pandemic, but that was bad.

00:30:40.400 No mandates, no lockdowns, no restrictions.

00:30:43.180 It was hospital-based.

00:30:44.620 It wasn't a community.

00:30:45.780 Right.

00:30:45.980 This was not a global event.

00:30:47.860 This was largely hospital-based in Toronto.

00:30:52.820 So different infection and therefore different rules.

00:30:55.780 But you've had SARS.

00:30:56.960 You've had a big Ebola viruses out of epidemics, way outside of areas that we previously thought

00:31:03.280 that we would see them.

00:31:04.600 You've had Zika throughout all of South America where, you know, it hadn't been seen before.

00:31:09.640 You had the Middle Eastern respiratory virus pop up in many different places, including

00:31:13.660 South Korea.

00:31:15.420 You've had an H1N1, the forgotten pandemic that started on a pig farm somewhere and spread 0.99

00:31:20.040 around the world.

00:31:20.900 Like you could see, we have the recipe of encroachment on environments, environmental degradation,

00:31:29.060 blah, blah, blah, where viruses can jump into humans.

00:31:32.300 Humans move all over the world quickly.

00:31:35.420 And if you have a transmissible respiratory virus, you can have another pandemic.

00:31:39.360 No one argues.

00:31:40.200 In the business, no one argues that that's, you know, a non-issue.

00:31:44.100 This is something that we think about a lot, even before COVID.

00:31:47.160 So we're going to have to figure out what to do with the next one.

00:31:50.000 And we have to also come to terms with some of the decisions that I think were the right

00:31:56.480 move at the right time and others that might have been disastrous.

00:31:59.720 And I think others, too, that might have, you know, maybe it was initially the right

00:32:04.500 move.

00:32:04.820 But then we sat on these policies long past their expiration date.

00:32:08.580 And we didn't evolve with the evolving science or situation on the ground.

00:32:15.060 I mean, here's a small one.

00:32:16.380 And again, people might yell and scream at me for this one.

00:32:19.120 But like, look at the Arrive Can app.

00:32:22.160 OK, like, obviously, there's bigger fish to fry.

00:32:24.160 But this is just one little thing that bothers me.

00:32:27.000 Like, you know, maybe you could argue at a time and place that that was the right thing.

00:32:30.420 They could get some meaningful data from this.

00:32:34.540 It would help screen people coming into the country. 0.98

00:32:37.700 But like, do we really need an Arrive Can app right now?

00:32:40.400 I don't think so.

00:32:41.540 I think it's time for this one to go.

00:32:43.420 And again, that's small potatoes compared to other big policies.

00:32:46.520 But I'm just saying, like, we could really apply this to a lot of different areas and

00:32:51.940 learn some big lessons.

00:32:54.180 But I think the big thing is, can we do this in an objective manner?

00:32:58.020 I have zero confidence that we can.

00:33:00.240 But if we can, and if we can get, you know, 20 smart people in a room from very different

00:33:05.040 backgrounds, maybe 100 smart people in very different backgrounds to critically appraise

00:33:11.300 our policies over time, look at what went well, what didn't go well from in a very objective

00:33:16.280 manner, I think we can learn a lot from this.

00:33:18.580 And it is interesting, though, that's important.

00:33:21.160 I think there's an underpinning philosophical divide of those who believe that when you're

00:33:24.740 facing a health crisis, whatever the severity, yes, the state should be doing these things

00:33:29.660 can do them moving forward.

00:33:30.980 Or those who say absolutely not.

00:33:32.840 This was once only and it's done.

00:33:34.480 Danielle Smith joined us on this podcast a number of episodes ago to say that one of the

00:33:38.820 main reasons she was running for Premier of Alberta was to make sure there can never be 0.83

00:33:42.820 lockdowns and heavy handed restrictions again, whatever the issue.

00:33:46.600 And I support that sentiment.

00:33:48.320 I support protecting the vulnerable, shoring up the health care, more allocation of resources.

00:33:51.980 And I think she, not to speak for her, but I think she said similar things.

00:33:54.360 But I'm all on board with never those sorts of things again.

00:33:57.320 And I think you're going to be able to get people who are highly intelligent, informed

00:34:00.180 people in that room and have a full split on that question I put forward.

00:34:05.460 And it's an irrevocable split.

00:34:06.600 Well, I think the other point though, is like, we're sort of approaching this with a COVID

00:34:11.600 mindset, but like, why does it have to be COVID?

00:34:14.520 And again, let's think about a theoretical situation that it's a much more virulent, powerful,

00:34:20.760 damaging virus, like, uh, you know, the 1918, uh, flu epidemic that killed well over 50 million

00:34:29.960 people. 0.60

00:34:30.660 Then we'll see our neighbors die and we'll go, oh crap, I'm not going outside because I don't 0.95

00:34:34.280 want to. 0.99

00:34:34.740 Maybe, maybe, maybe.

00:34:37.400 But then you think about what about essential workers who, you know, have no, you know,

00:34:42.960 that have to go to work or people that can't afford to stay home.

00:34:46.220 I mean, I just think we have to think about very different scenarios.

00:34:49.120 Like if you have something with, I'm just making it up.

00:34:51.300 What if it's got a, you know, there's bird flus that have, you know, 10 to 20% mortality

00:34:56.620 rates.

00:34:56.940 Like that's catastrophic.

00:34:58.740 And I'm not saying it's going to happen, but I'm saying that people that look at epidemics

00:35:02.160 and pandemics are watching this really closely.

00:35:05.160 Uh, you know, we just have to make the right decisions for the right situation and for the,

00:35:10.800 in the right context.

00:35:11.740 And it's not all going to be COVID.

00:35:13.640 And I'm not saying COVID was a cakewalk, right?

00:35:15.400 Like all the models think, estimate that over the last two, two and a half years, there's

00:35:19.740 been about, you know, 18 to 22 million deaths related to COVID.

00:35:23.400 Like that's not anything to sneeze at.

00:35:25.220 That's absolutely horrible.

00:35:26.720 It's absolutely horrible.

00:35:28.360 And in the same breath, we can also say, Hey, they're, you know, lockdowns as horrible as

00:35:33.560 those are, you know, could probably reduce some transmission in the community, but also

00:35:39.140 have terrible negative consequences, which they do.

00:35:41.740 I mean, like it's okay to say that because it's true.

00:35:45.500 Dr. Bogosh, before we go, I want to get your thoughts on our conversation about national

00:35:49.460 healthcare for the longest time, for many years, we, we sort of looked down upon parts

00:35:56.200 of the American healthcare system.

00:35:57.400 And we had a bit of a narrative about the Canadian healthcare system.

00:36:00.760 But I know when we talked about Ontario, very aggressive lockdowns, a fourth lockdown, January

00:36:05.980 2022, Florida, none of it.

00:36:09.600 And then there was a lot of politicizing, a lot of mocking about, you know, Republicans

00:36:13.940 in Florida, but ultimately it seemed to come down to the fact that in Florida, they said,

00:36:17.240 well, we have the beds, you know, we encourage you to get vaccinated and take your precautions.

00:36:21.680 But if you get sick, we can, we can care for you.

00:36:24.160 In Ontario, we said, if there are 300 people in ICUs with COVID across the whole province,

00:36:29.700 we got to shut everything down.

00:36:32.220 We got to shut the schools down.

00:36:33.600 It's like, wow, do we maybe have a little bit of a resources problem here?

00:36:38.560 We have a huge resources problem here.

00:36:40.880 There, I used to work in the States.

00:36:42.620 I used to work in Boston.

00:36:43.920 One of the hospitals I used to work in, Massachusetts General Hospital, where I did a lot of my

00:36:47.320 training, basically added a, you know, turned their hospital into a giant ICU during

00:36:52.960 one of their nastier waves.

00:36:54.980 And there was a time where that hospital had basically more ICU beds than the province

00:37:01.920 of Alberta, right?

00:37:03.340 Like one hospital in Boston had more ICU capacity than Alberta.

00:37:07.380 That's crazy.

00:37:07.880 I mean, it is.

00:37:09.180 It is absolutely nothing.

00:37:10.620 And to your point, I mean, the fact that we had to collectively crap our pants when we

00:37:18.500 were over 300 people, you know, admitted to ICUs with COVID related illness in Ontario,

00:37:24.900 because we just weren't going to have the healthcare resources to care for people like

00:37:29.580 that's a problem.

00:37:31.100 That's a problem.

00:37:31.880 And actually, just like we chatted about earlier, the third wave, which again, wow, was that

00:37:38.040 bad.

00:37:38.340 We had 900 people in Ontario, ICUs at one point in time with COVID related illness.

00:37:43.480 I can't tell you how horrible and awful that was, because the standard of care that Canadians 1.00

00:37:48.000 deserve went down.

00:37:50.020 I mean, we were just working like dogs.

00:37:52.340 And it was terrible.

00:37:54.720 It was absolutely terrible.

00:37:56.440 So we definitely have capacity issues in terms of bed per capita, ICU beds per capita.

00:38:03.160 We need to retain healthcare providers, especially nurses. 1.00

00:38:08.460 We need to train more healthcare providers, including doctors and nurses, but other allied

00:38:12.580 healthcare providers.

00:38:13.760 I think we need to be creative about this as well.

00:38:15.920 We can talk about facilitating credentialing healthcare providers that might have trained

00:38:21.340 overseas that aren't working here.

00:38:22.780 Well, of course, maintaining the standards of care and the standard of education.

00:38:27.380 You know, I know privatization is a bad word in many areas, but I think Canadians would

00:38:34.300 be shocked to hear that there already is privatization within the Canadian healthcare system within, you

00:38:40.080 know, with some regards.

00:38:41.800 Obviously, it's got rampant.

00:38:43.620 I think, obviously, if we look at the United States and get terrified, but there's other

00:38:48.040 models that aren't in the United States that may work in Canada.

00:38:52.780 And obviously, the United States is not the healthcare system to model ours after.

00:38:57.300 There would be others that we could look at that may do this more successfully.

00:39:01.520 But of course, at the same breath, we have to keep healthcare for everyone.

00:39:06.320 We can't provide, you know, substandard care for people that might not be able to afford 0.95

00:39:12.640 it.

00:39:12.820 We have to work on accessibility.

00:39:14.640 And we really have to ensure that all 38 million of us have timely access to high

00:39:18.780 quality healthcare.

00:39:19.700 That's a nice platitude to say.

00:39:22.140 And I know people have been talking about this for decades.

00:39:24.620 I'm not going to pretend to have the right answer to get there.

00:39:27.520 Dr. Isaac Bogosh, thanks very much for all you do.

00:39:29.680 Thanks for joining us today.

00:39:31.340 My pleasure.

00:39:32.000 It's really great to chat with you, Anthony.

00:39:33.460 Great conversation.

00:39:34.300 All the best.

00:39:37.180 Great.

00:39:37.580 Thanks for your time, Isaac.

00:39:38.360 I appreciate it.

00:39:39.640 That went well.

00:39:40.260 Thanks so much for having me.

00:39:41.600 All right.

00:39:41.980 Take care.

00:39:42.340 Have a good day.

00:39:42.860 Have a good weekend.

00:39:43.380 Be well.

00:39:43.700 Be well.

00:39:44.180 See you, Andrew.

00:39:44.740 Thank you.

00:39:45.580 Full Comment is a post-media podcast.

00:39:47.840 I'm Anthony Fury.

00:39:48.620 This episode was produced by Andre Proulx, with theme music by Bryce Hall.

00:39:53.020 Kevin Libin is the executive producer.

00:39:55.500 You can subscribe to Full Comment on Apple Podcasts, Google, Spotify, and Amazon Music.

00:40:00.480 You can listen through the app or your Alexa-enabled devices.

00:40:03.320 You can help us by giving us a rating or a review, and by telling your friends about us.

00:40:07.140 Thanks for listening.

Full Comment - September 12, 2022

Reasons to keep calm over COVID

Episode Stats

Summary

Transcript