Full Comment - Time to end our ‘warped risk perception’ of COVID

00:00:00.000 Hi, I'm Anthony Fury. Welcome to the latest episode of Full Comet.

00:00:06.680 In December, we had a conversation on this show with Dr. Neil Rao about how the Omicron variant,

00:00:11.760 while probably very transmissible, would prove mild, and that the time had come to stop obsessing

00:00:16.780 over case counts and isolation rules and move forward and find a way to get on with our lives.

00:00:22.140 There were no thoughts at all of being plunged into lockdown again, and then it happened.

00:00:27.120 Quebec and Ontario are in lockdown. Other provinces have brought in added restrictions.

00:00:31.420 What on earth is going on? Surely it doesn't need to be this way. Our guest today has been on the

00:00:36.700 front lines dealing with COVID patients since day one, and he breaks it all down for us. Dr.

00:00:41.580 Suman Chakrabarty, an infectious diseases physician at Trillium Health Partners in Mississauga,

00:00:45.940 joins us now. Dr. Chakrabarty, great to have you here. Great to be here. How are you today?

00:00:51.080 Doing okay. I'm doing this virtual school stuff, so it's a bit difficult, but managing through it.

00:00:58.700 Yeah, no kidding. Well, let's get into it then, because I know you're doing the virtual school

00:01:01.700 stuff. You're also someone who's on the front lines. You've been treating COVID patients since

00:01:05.080 the first wave. Right now across Canada, we've got Quebec under such strict rules that they have

00:01:11.420 police patrolling the streets to enforce curfews. We have Ontario back into lockdown. We have either

00:01:17.080 school closures or at least delays pretty much all across the country, but I must ask, given what we

00:01:22.660 know about Omicron right now and a lot of confirmation that, well, yes, this is a milder

00:01:27.140 variant, would you say the punishment fits the crime? Is the reaction we're seeing right now

00:01:32.260 proportional to the actual challenges that we are now facing? Yeah, you know, I've been thinking a

00:01:38.640 lot about this, and, you know, when I look at what's going on, I understand why the reaction is as it

00:01:44.880 is, you know, when you look at these numbers that we've been, the case counts, we've been following

00:01:49.140 for the past, you know, two years, this is something that has really dictated our actions, and these

00:01:54.960 numbers are, you know, off the chart from what we've seen in the past, but when you look at what's

00:01:59.780 happening on the ground, we are absolutely seeing pressure in the hospitals. There's a lot of patients.

00:02:04.820 The patients overall are less sick than they were in the third wave, but, you know, I think it's

00:02:09.640 important for us to look at other parts of the world, South Africa, Denmark, UK, they're having

00:02:15.600 similar situations, but they didn't necessarily have to go into lockdown, and it really does bother

00:02:20.780 me that this is kind of what has been associated as the response in any of these situations, so

00:02:26.860 in my mind, I understand the reaction, but I do think that especially two years in, with 90% or so

00:02:34.560 people fully vaccinated on the ground, that this is an overreaction. When we see those other

00:02:40.740 jurisdictions, we have heard from some people in Ontario, well, you can't use South Africa because

00:02:45.120 of this or that reason, because of them having a younger average population base. You can't use

00:02:49.540 Denmark because of this or that. You can't use this jurisdiction. You can't use the US because they

00:02:53.320 have a different hospital capacity system. We're kind of always told why the pathway must always lead

00:02:58.000 to lockdowns in Ontario. We're not really generally given the argument as to why maybe we can go in a

00:03:04.100 different direction. I think there is actually something to that point. You don't want to be

00:03:08.480 completely taking a place like South Africa and just mapping it onto what will happen here in Canada.

00:03:15.620 The circumstances are different, different demographics, different rates of vaccination,

00:03:20.240 et cetera, et cetera. But I do think it's important for us to look at other places and at least take some

00:03:25.740 of the experience and mold it to our situation. I think that there is a hesitation to have any sort of

00:03:32.660 positive type of spin on things. For example, it is true that overall that Omicron is milder, though we are

00:03:41.840 seeing an expansion in hospitalizations. So those things can, both things can be true at the same time. But I'm

00:03:48.020 noticing that the bias tends to be towards believing anything that's going to have a negative outcome.

00:03:53.920 How did we get to that point that that's the general attitude that we seem to have among officials and many

00:03:58.660 people in the public that we have to sort of gravitate towards the negative as opposed to, oh, great, here's

00:04:04.240 the here's the light at the end of the tunnel? It's a good point. I think a lot of this has to do with the

00:04:10.120 communication style since the beginning. There's been a lot of fear based rhetoric, at least here in

00:04:16.060 Ontario and in Canada abroad. There's been a lot of moralization, you know, making people internalize the

00:04:22.240 fact that if you get COVID, it's because you did something wrong. Now, I, you know, I do like the

00:04:28.020 idea of saying initially that we're in this together, which it's impacted us all very differently.

00:04:33.120 You want to have that unified front, but that did devolve later into blaming, shaming, a lot of finger

00:04:40.420 pointing. And I think that that now has kind of morphed into people that have a very warped risk

00:04:47.140 perception of what COVID actually is. And we're seeing a lot of this that, you know, any sort of

00:04:52.220 positive note on this is immediately met with, well, you're trying to deny the existence, you're

00:04:57.740 trying to minimize. And that's certainly not the case. That's certainly not what I'm trying to do.

00:05:02.100 But it's important for us to look at the whole picture and the nuance.

00:05:05.560 Do you think it's possible that earlier on, or even right now, prior to going into these lockdowns,

00:05:10.800 that we did gravitate towards a more personal risk assessment situation? Dr. Kieran Moore, Ontario's

00:05:15.240 chief medical officer, prior to Christmas, he said, well, no, there's not going to be any more

00:05:18.620 lockdowns. Yes, schools are definitely going back. And he was asked by one reporter, it was a press

00:05:22.700 conference I was participating in. I remember one of the reporters said, should people cancel their

00:05:26.480 Christmases? And he said, no. And then he said, well, I have faith in the people of Ontario to make

00:05:32.300 informed decisions and develop their own personal risk assessments. I thought, wow, it's very

00:05:36.100 interesting to hear him talk that way. Clearly they did a reversal and now you're not allowed to decide

00:05:40.500 whether or not you can go to the restaurant or not because the restaurants are closed. But how would you

00:05:44.740 recommend we think about and talk about a personal risk assessment notion?

00:05:49.360 I think that is such an important thing going forward because we're going to have to have a

00:05:54.600 new perspective as we get into this post-pandemic period. I'm not saying that the COVID is going to

00:06:00.460 go away completely. It's not going to, but we do have to change the way we approach it, especially now

00:06:05.240 that look, again, 90% of people on the ground vaccinated. So we have to look at this differently.

00:06:10.240 And a lot of this is going to be a personal risk assessment. There are going to be people that

00:06:15.040 once these mandates for masking, for example, dropping, going to still be wearing their masks

00:06:20.220 for weeks and months to come. I get that. I think it's important for us to realize everybody has

00:06:25.560 different situations, different risk tolerances. And I don't think it's public health or the medical

00:06:30.540 authorities place to tell us what to do in our houses at this point in time. I think we're past that.

00:06:35.460 I think it's important for everyone to have their assessment, understand their risk tolerance,

00:06:40.480 understand their situations, and make their own decisions.

00:06:43.320 I know there's a lot of jokes about everybody thinking they're an armchair epidemiologist or

00:06:46.640 that old joke of, oh, I read things online on the internet for an hour, therefore I know better than

00:06:50.960 every other sort of top expert. But at the same time, I think there is still something to be said

00:06:54.720 for the fact that for two years now, average individuals have just been reading so much about

00:06:59.500 this and reading medical studies that they never would have thought to look at before. And I

00:07:03.360 appreciate that we don't have the schooling and decades of expertise to fully contextualize

00:07:08.660 those studies. But at the same time, we're kind of all in this COVID game together. And it's not

00:07:12.580 like we're all coming at it every day as if we know nothing. The general public has developed something

00:07:17.220 of an information base here about COVID.

00:07:19.820 Oh, I agree. And you know, it's actually kind of impressive. It's funny that I've actually learned

00:07:23.920 things from my own friends and colleagues who are not in medicine. So I think that the way that I look

00:07:31.180 at it, I always have something to learn from other people, because they provide a different

00:07:34.920 perspective. I think that's something that has been lacking a bit, you know, I think medical

00:07:39.180 expertise is absolutely important, public health, all that stuff. But when you look at the way that say,

00:07:45.680 decisions are made overall economics, benefits, and harms, trade offs, that type of thing,

00:07:52.260 I think it's important that we have to have other points of view here. And in general,

00:07:57.880 it's important that when we make decisions, it can't all be on science, it can't all be on

00:08:02.860 economics, it has to be looking at this in a holistic way. And, you know, I see it happening

00:08:08.420 a bit more now, but I wish it happened earlier.

00:08:11.660 You know, it's interesting, you should say that I was recently speaking with a retired

00:08:14.100 lieutenant colonel, his name is David Redmond, he's been speaking a lot the past year or so about

00:08:18.000 how to deal with COVID-19. After he served in the Canadian Armed Forces for many years,

00:08:22.480 he became the head of Alberta Emergency Management Office. And a point he's been trying to make is

00:08:26.620 actually the emergency management bureaus in all these provinces, they are supposed to be in

00:08:31.080 charge when there's a pandemic. And if you go to emergency management Ontario's website,

00:08:34.460 it says, you know, forest fires, disasters, nuclear accidents, pandemics, the things that

00:08:37.660 are under their purview, they've done nothing in Ontario. And I think similar for other provinces

00:08:41.700 on this, because from the beginning, it was okay, we have this health issue, put the chief medical

00:08:46.560 officer of health almost exclusively in charge. And I guess the original idea in emergency planning

00:08:51.320 was you have the emergency planner, head person who's in charge, and then you have, you know,

00:08:57.460 economy, business sector, all these different sectors, health, health is obviously hugely

00:09:02.000 important, but they're not the, maybe the most primary focus, but they're not the one in charge,

00:09:08.880 because there still needs to be someone to kind of delegate between the different interests.

00:09:13.060 Yeah, in my mind, actually, that makes a lot of sense. I think that having somebody who is,

00:09:19.640 first of all, also, not just looking at all the different sectors that are important,

00:09:23.860 but also trained in communication, I think that what I've learned, look, I'm learning myself about

00:09:30.500 media, I've been doing media for about 10 years now, much more in the last two years, right? And

00:09:35.380 it's difficult, and there's a way of doing it. And it takes some some training, some practice as well.

00:09:40.980 And, you know, in general, I think somebody who is just put on the face of COVID doesn't have that

00:09:47.340 initial training, which you need. So I think that the health part is absolutely important. But I

00:09:52.520 echo what you say that it needs to be somebody who can kind of look at all of these things together,

00:09:57.240 make these emergency decisions, which they are trained to do, and, you know, move forward in a more,

00:10:04.160 I guess, balanced way for the pandemic.

00:10:06.380 Dr. Chakrabarty, what are you seeing on the ground right now in the hospitals,

00:10:10.980 when it comes to Omicron, in ways that it's both similar and dissimilar from the delta wave,

00:10:15.540 from the first wave? How would you compare what's going on right now?

00:10:20.240 Dr. Yeah, it is certainly different. And the experience that we're having on the ground here,

00:10:25.340 based on my physician colleagues that I've just spoken to around the world,

00:10:29.440 you've probably seen even posts on Twitter, it's certainly different than it was from the alpha and

00:10:35.920 delta wave. So first of all, I want to make crystal clear that I'm not saying that this,

00:10:41.540 you can't get sick from Omicron, you certainly can. Whereas initially, with alpha and delta,

00:10:47.360 when we had our waves, well, maybe I should say more alpha for us, our third wave, is that people

00:10:52.980 were coming in sick, very, very sick, requiring a lot of oxygen, because they had bad pneumonia called

00:10:59.000 hypoxia. And certainly, we still do see some of that on the ward. But a lot of what we're seeing

00:11:05.140 now is people coming in with Omicron, who are medically fragile. And it's not so much that their

00:11:11.820 lungs are affected, and they need a lot of oxygen, but the Omicron has pushed over other more chronic

00:11:17.880 illnesses. So to give you an example, let's say a 78 year old guy with diabetes, mild dementia,

00:11:24.760 and the Omicron has made him sick enough that his blood sugars have gotten out of control,

00:11:30.520 he's starting to fall down because he's dizzy and dehydrated. This is something that we see often in

00:11:35.840 internal medicine. But now Omicron is kind of acting as that trigger. So we're not seeing our ICUs being

00:11:43.120 filled up, but we are seeing a lot of people coming in with this type of illness. And that takes a lot of

00:11:48.660 staffing to be able to deal with. We can do it. But it is a stress on the system, especially in the

00:11:56.320 context of staffing shortages. When we see rising hospitalization rates in Ontario, it's no longer

00:12:02.740 the case that it is exclusively or the vast majority of people going into hospital are the unvaccinated.

00:12:08.220 There seems to be a more diversified group right now. What's going on there? What's the difference

00:12:13.860 between vaccinated and unvaccinated persons who are winding up in hospital with Omicron?

00:12:18.660 This is a very important point. So first of all, I think that the vaccination is still showing that

00:12:23.720 the people who are getting the sickest, so those who are primary COVID pneumonia, requiring high

00:12:29.740 amounts of oxygen and putting on a ventilator, those are by and large individuals who haven't

00:12:35.120 gotten vaccinated. It's still the case. But it is also true that those have become the minority of

00:12:41.900 what we're seeing. It's just that when you get to a point where 90% of the population

00:12:46.300 is vaccinated, you're going to see people in hospital who are fully vaccinated. And that is

00:12:53.520 a lot of these older individuals who have their chronic medical conditions decompensated. So

00:12:59.700 the majority of those are vaccinated. But then again, the majority of those are not in the ICU

00:13:05.360 requiring ventilation. So the patient balance has shifted, but it is still showing on the whole,

00:13:13.200 vaccination is still doing an amazing job of preventing severe illness. And in this case,

00:13:19.920 going on a ventilator and death. Dr. Chakrabarty, a number of months ago, six months ago,

00:13:25.280 nine months ago, we could see messages from Ontario Premier Doug Ford, from Jason Kenney,

00:13:29.060 from Justin Trudeau saying, go get your vaccine, get your two shots, and then we can live life again.

00:13:35.180 Then we can get back to normal. Now I see Justin Trudeau has made a social media post saying,

00:13:39.400 get your booster shot, and then you can go back to normal. Some people are getting a little cynical

00:13:45.400 in response to seeing these postings, particularly when they're being told, okay, a fourth dose is now

00:13:50.480 being rolled out for persons in long-term care homes, very elderly, and people who have high-risk

00:13:56.500 conditions. But as they see the booster shot being rolled out, they're beginning to wonder,

00:14:01.960 am I going to continue to see these goalposts shift when it comes to vaccines? How would you

00:14:06.240 respond to that? Yeah, I hear that. And, you know, I think that initially with the vaccine,

00:14:12.580 the fact that this is going to be our key out of here was certainly something that including

00:14:16.760 myself thought. And I think what has been the bit of the disappointment is, first of all,

00:14:21.500 the vaccine is amazing at preventing severe complications, such as, you know, hospitalization

00:14:28.180 and death. But I think one of the disappointments has been it's not so good at reducing transmission.

00:14:33.180 And I think that we are still seeing that happening in the community. And there's a lot of

00:14:38.060 ongoing transmission. One thing I will say, though, is that one issue with at least the response in

00:14:45.120 Ontario, I can speak for the best is that we've still had, even though we want to, you know, move

00:14:51.140 forward, there's still been a laser focus on cases. And, you know, it's been a big problem,

00:14:58.440 because hospitalizations, and especially in the ICU, that is the metric you really want to look

00:15:03.420 at. And we're seeing that right now with that with Omicron, with the expansion and hospitalizations.

00:15:08.700 But the issue is that when the numbers go up, I think that there's a lot of knee jerk responses.

00:15:13.480 And that's been an issue. I think that this wave will crest and crash soon. I do think it'll take a

00:15:19.220 little bit longer for the hospitalizations to decompress. But the point is, we can't keep chasing this

00:15:25.280 count. We have to look at more impactful and more informative metrics. And then our response has to

00:15:33.600 now change is that we can still be back to normal. But we have to remember that each time the numbers

00:15:38.960 go up, we can't constantly be going back to lockdown and restrictions. We have to put an end to that and

00:15:45.000 move into the post pandemic period. It still seems that there are a lot of people who adhere to what

00:15:49.600 we could call the COVID zero mentality, the idea that there must not be any COVID in society and the

00:15:54.480 objective of various restrictions and lockdowns is to eliminate COVID. And I feel like haven't we kind

00:16:00.540 of debunked that notion like over a year ago, and yet there are still individuals who think that the

00:16:05.540 idea is to just get those case counts to zero. Yeah, and I will say to be charitable to that,

00:16:12.620 I understand why people don't want to have a lot of transmission in the community. I get that because

00:16:17.380 people are worried about complications. There is a lot of worry. People talk about long COVID,

00:16:22.740 which thankfully, isn't as common as it was initially described once we have more studies

00:16:28.060 on it. But the thing is that even if people understand that we're never going to eliminate

00:16:33.620 it, I think that also strategies at this point that are really trying to suppress it,

00:16:38.760 we have to look at the trade off and the cost that's involved with that. One interesting thing

00:16:43.680 that I've noticed about Delta, and especially Omicron, is that a lot of our efforts that we've been

00:16:49.620 trying for the past two years to suppress cases do not work very well, especially with Omicron. So I

00:16:55.460 think that, you know, we saw this wave coming at us, I don't think anything we would have done to

00:17:01.180 try to intervene would have changed that. And we see this around the world, it's called what I call

00:17:06.460 a whiplash curve, it goes up hard, and it comes down hard as well. And that's independent of what you

00:17:11.900 do. And that's just the virus doing what it does, its ability to really infect people. And thankfully,

00:17:17.660 the vast majority of those are minor. And that's why I think it's important for us to realize that

00:17:22.880 we cannot be putting in all of this focus on a virus that is generally causing mild cases in the

00:17:29.780 community, we have to focus our attention on the people who are at the highest risk of bad outcomes

00:17:35.480 and hospitalization. And that's part of what happened. I think it was about a week ago now,

00:17:40.280 where the criteria for testing has changed. And that's going to be one of the big things that's

00:17:45.500 that's part of our altered perspective and focus going forward.

00:17:50.720 Well, let's talk about that for a moment, because this was quite a press conference

00:17:53.380 that Dr. Kieran Moore, Ontario's chief medical officer of health did where he said,

00:17:57.600 all right, we're not going to do pretty much any more isolation rules of close contact individuals.

00:18:03.140 So long as you're vaccinated, you don't have to do that at all. Just,

00:18:06.460 you know, if you have symptoms, well, then you should go get tested. But otherwise,

00:18:09.440 no, no isolation. And people who are found to be positive for COVID-19

00:18:13.040 only have to stay home for five days now, no longer 10 days. And that was something that I

00:18:18.360 think a lot of people found very interesting. There's initially a lot of applause. And then

00:18:23.160 there's also the news that widespread testing is no longer going to be available in Ontario,

00:18:27.140 no more PCR testing for asymptomatic individuals, and they're not going to be

00:18:31.260 handing out rapid tests at the liquor store anymore. They wanted to basically narrow the focus,

00:18:36.340 repurpose all of those resources towards high risk individuals towards the hospital setting,

00:18:40.440 retirement homes, long-term care, the places where people, if they get positive with COVID-19,

00:18:45.480 I guess it could go on to be something serious. What did you make of that announcement? Because

00:18:49.220 it's, well, I know those rules haven't been flipped around, but they've been overshadowed by the fact

00:18:54.140 that we've now been put into lockdown. Absolutely. It was a bit contradictory when the lockdown happened,

00:18:58.820 but I think this is a key part of going forward is realizing that now, look, because of vaccination,

00:19:05.540 this is where I'm going to really, really push the benefits of vaccination. We have gotten to a point

00:19:10.800 where those who are vaccinated, which is almost 90% of the eligible people, and it's even higher than

00:19:17.120 that. When you look at the highest risk people, the vaccine works excellently to prevent hospitalization

00:19:22.760 and death. So it's personal protection. So when you look at that, we can now go back to,

00:19:27.760 let's say 2017, where in the winter months, we get thousands of people who get respiratory viruses,

00:19:34.360 rhinovirus, parainfluenza, influenza, et cetera, et cetera. And every single time somebody gets a

00:19:40.920 fever and they're up in bed for a couple of days, you don't test that person to find out what they

00:19:46.060 had, even if it's influenza, which we know causes hospitalizations. What you do do is get a general

00:19:52.440 idea of what's going on in the community. And you especially test the people who are coming to

00:19:56.940 hospital because you can do something about that. For COVID, it's a similar thing now. For the vast

00:20:02.460 majority of people in the community, this has now become something that's not going to cause you to

00:20:06.880 be hospitalized. So if somebody gets a cold for a couple of days and you're febrile, you stay home

00:20:11.980 from work and you can go back when you feel better. The thing is, though, what we do want to do is

00:20:16.440 identify those people where, you know what, you're a 70-year-old person who has had a renal transplant.

00:20:22.460 That person we do want to identify because we could give them treatments and other types of

00:20:28.180 things to help prevent hospitalization. That's where we need to put our efforts. We can't be

00:20:33.420 looking at the most minor of cases, which is thankfully what it is due to vaccination, because

00:20:38.820 again, we're not going to be able to focus on other non-COVID things which have fallen to the

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00:21:45.560 I feel like there's a lot of public misconception about what the actual concerns among, uh, among

00:22:03.960 healthcare providers, among senior bureaucrats in the health system is that I think some people,

00:22:08.440 and to go back to our discussion about the COVID zero-minded, I think there are still some, uh,

00:22:13.260 some double vaccinated people in their thirties who are very fearful of themselves contracting COVID-19

00:22:19.060 and whatever. I guess that's the right for their own risk assessment and believe the lockdowns

00:22:23.060 are about stopping them from coming into contact with COVID-19. Whereas when one listens closely to

00:22:28.320 those press conferences, it seems pretty clear that the predominant or pretty much the only

00:22:32.960 justification for the lockdowns is just that there are 300 persons in ICU with COVID-19.

00:22:37.600 They're worried it's going to rise and they just want to shut things down to stop more transmission

00:22:42.280 because of those hospital numbers. But they're not particularly, I mean, they don't want anybody

00:22:46.600 to get COVID, but they're not particularly bothered by the idea that 3,000, 4,000, uh, healthy 35 year

00:22:53.000 old double vaccinated people are going to get this thing because they believe to your point,

00:22:56.440 it will be very mild.

00:22:57.100 Yeah, exactly. And, you know, I think there is, has, I mentioned it at the very beginning,

00:23:02.140 the warped risk perception and I don't blame people by the way, for having a risk perception

00:23:07.120 that's, that's, uh, um, not accurate because the messaging that's been given for the past

00:23:12.020 two years has been a fearful one. Right. Um, so I think that, uh, uh, that's one of the things

00:23:17.960 that's important for us to help with as we move is changing the messaging around COVID. Um, and again,

00:23:23.660 I, I'm not trying to, uh, um, trivialize what's happened to people who have had a bad case of

00:23:29.540 COVID and are younger, but one other thing to kind of keep in mind is that the lockdown

00:23:33.840 is something that I've been critical of because it does help to, uh, shield people who are able

00:23:38.780 to stay home. Right. Um, if you work, uh, in an office job, you can stay home. That's great.

00:23:43.280 But the issue is, is that while we were taking videos of lineups at home sense and people having

00:23:49.180 crowds outdoors at Trinity Bellwood, you remember that, right? You know, what I saw in the third

00:23:56.860 wave with alpha was just factory worker after factory worker, after logistics worker, after,

00:24:02.140 you know, people that are working in the manufacturing and logistics sector. I work in Peel, uh, and it's,

00:24:08.300 it's the biggest manufacturing sector in Canada. And these individuals were in being affected by COVID.

00:24:14.220 And oftentimes we're living in houses of six plus people and bringing it home to their entire

00:24:19.500 family. This is what the engine was driving the pandemic initially, but this is not an area that's

00:24:26.100 going to be stopped by a lockdown. And that's why the lockdown sounds initially like it could do

00:24:31.300 something, but I think it just downloads the risk onto people who are essentially, uh, unable to work

00:24:37.620 from home. And we're getting a false sense of security on that.

00:24:40.380 One thing I do find very interesting, and I think it's driving to perspectives being slightly

00:24:44.940 different is now it seems that those communities that you mentioned who were hard hit, I guess

00:24:49.260 they've already unfortunately been hard hit by the virus. So now Omicron is going through, uh,

00:24:54.620 different demographics, different communities that weren't previously used to being hard hit.

00:24:59.020 And this is no longer about fear of the unknown or the abstract, or, well, let's tell those people

00:25:03.660 in Peel to stay home for 14 days. Now there are, there are different catchments of people who are

00:25:09.740 encountering this virus and hearing from their friends. Oh, I've tested positive and sharing those

00:25:13.580 stories that haven't had these personal experiences before.

00:25:16.620 Dr. Justin Marchegiani

00:25:17.580 It's a very, very good point. And I think that, uh, one thing that we noticed that,

00:25:21.580 that our Delta wave, that was our fourth wave, it was fairly blunted. And the question was,

00:25:26.460 why was that? And, uh, one thing that I've talked with multiple of my colleagues is the idea of

00:25:31.980 immunity debt is that a place like Peel and Toronto, Northwest Toronto, especially there was so much

00:25:38.940 transmission happening, even between waves that there was a lot of accrued immunity. So then when

00:25:45.180 the Delta came through, we didn't get affected by it as much because the people were affected, uh,

00:25:51.260 previously our unvaccinated cohort actually had quite a bit of immunity with it. And I think that's one

00:25:57.580 thing that you have to either be exposed now or later or get vaccinated. There's a, you can't

00:26:03.500 lock down forever and hide. And Omicron has really shone a light in that sense is that it's really,

00:26:08.780 really going through communities. Thankfully for people who have been vaccinated, it's mild.

00:26:13.740 And it's actually even mild for the majority of people who haven't been vaccinated. But the point is,

00:26:18.300 it's finding you. And one note you mentioned is unknown. By no means do I want to say that I didn't

00:26:24.540 take COVID seriously, but I will say that I was fearful for my life in, um, uh, April of 2020,

00:26:31.820 when you saw it coming at us and the first couple of cases landed in Canada. Uh, my, my wife will tell

00:26:37.900 you that I, you know, I was waking up at night. I couldn't sleep. I was anxious all day. It was

00:26:41.740 terrible. When I saw my first couple of cases of COVID, I was still scared, but as time went on and it

00:26:48.780 became more familiar to me, you know, these are individuals that I've seen severe respiratory

00:26:54.220 cases before I've seen severe TB. And these are people that I've seen before. These are patients

00:27:00.300 that I've been seeing my whole career. I became a bit more comfortable with it. I wasn't as fearful.

00:27:05.260 I was careful, but I wasn't fearful of the unknown. And that really helped me psychologically. And I think

00:27:11.580 that fear of the unknown has affected people for the entire pandemic, many people until now.

00:27:17.660 And it's quite something Suman, because a number of your colleagues who, who also work in ICUs

00:27:22.380 across Ontario, who, who I have spoken with or interviewed for, uh, for various news articles

00:27:27.340 or on this podcast, they have similar views. They are the people who are in closest contact with the

00:27:33.740 persons with the most severe cases, with the highest viral viral load to transmit. I appreciate that you

00:27:38.860 wear a quality PPE when you're interacting with these patients, but it's still quite something that

00:27:43.660 those of you who are, you know, right in the fire are some of the, I don't want to say most

00:27:48.380 relaxed. Cause I know there are people who are in total denial of what's going on here, but you,

00:27:51.580 you are, you're saying you don't want to lock down because of this. I mean, the, the fear has been

00:27:55.660 brought down by that firsthand experience. Yeah, absolutely. And I think that at the same time,

00:28:02.220 I know the range of what happens. I'm seeing the sickest people, uh, you know, we are seeing the

00:28:07.500 people come into hospital and yeah, in, in our, uh, Delta wave, that wavelet we had,

00:28:12.300 I was seeing individuals coming in over and over and over again, who were severe

00:28:16.780 and unvaccinated. So I knew the, the elements going into this and what was coming out the other

00:28:22.540 end. But I think that, uh, it is important to note that, that irrational fear, the fear of,

00:28:27.980 for example, uh, walking by somebody outside and getting COVID. I wasn't afraid of that. Right.

00:28:33.420 Uh, you know, hugging my, uh, a friend that I hadn't seen in a long time. I wasn't afraid of

00:28:38.380 that. And I think that part was helped by having worked in this, uh, area for the past two years.

00:28:44.380 One other thing I find very interesting right now, because there are 15,000, uh, new cases a

00:28:49.980 day in Ontario. I understand the number is probably a lot higher, but 15,000 people being confirmed by

00:28:54.220 testing being told, yes, you have Omicron variant is while unfortunately a hundred of those or whatever

00:29:00.300 the number is will wind up in hospital for the other 14,000. These are people who are learning.

00:29:05.660 And I guess their immediate family members are learning as well, that this can be something

00:29:09.260 very mild, that it's not something to be concerned about in my own neighborhood. I can tell you,

00:29:13.420 I was walking down the street just the other day, and there were two people, uh, talking and I walked

00:29:17.740 by them and I heard the line. If I hadn't been told it was Omicron, I would have thought it was just a

00:29:23.500 cold. What's the big deal. And I also tell you, I live in a neighborhood that I know is one of the

00:29:27.740 most COVID skittish and I think all of Ontario. So it was kind of telling that, wow, I'm, I'm,

00:29:32.620 people are on the street openly saying, I got this thing. It was so mild. What's going on?

00:29:40.060 Very true. And actually, you know, I heard this, uh, in previous waves as well, is that, uh,

00:29:44.620 I think understandably the focus is on the sickest of the sick, right? But even with, uh, uh, alpha,

00:29:51.100 which by the way was the first one that really kind of brought it home that young people can get sick.

00:29:55.500 Uh, you found that a lot of people were at home and they were doing okay. I think, by the way,

00:30:00.860 that's another thing that helped me is at the very beginning, I was helping to do call callbacks

00:30:05.660 of people who were at home, uh, who had gotten a positive test. And you get to see the spectrum.

00:30:10.300 I saw the sickest of the sick, but I also saw the people, including older people that didn't have, uh, 1.00

00:30:16.220 much in the way of symptoms apart from a stuffy nose and fever. And again, you know, I think that

00:30:21.340 people understand that I'm not trying to deny that the severe ones exist. I'm just trying to

00:30:26.140 also show that there is a spectrum and you're right with Omicron that, uh, many people who,

00:30:31.020 uh, were initially quite skittish, they went by and they didn't even realize that, oh, I just had a

00:30:36.460 cold. And I think that one thing I'll say to people is that would you have gone to a wedding

00:30:42.620 in the winter time? So indoors, uh, in, uh, December of 2018. And people would say, yeah,

00:30:48.780 many of us have gone, uh, you did that. And the thing is at that wedding, if you were a 75 year

00:30:52.860 old person with diabetes, there was a significant risk of contracting influenza there that would

00:30:57.420 have caused you to get quite ill. It could have caused you. The point is, um, back then people did

00:31:02.860 that, but it wasn't at the forefront of their decision. And I think that is what has to change

00:31:08.060 going forward is making risk calculations where COVID is no longer going to be the primary focus

00:31:13.660 of everything you do every day. It's going to take some time, but we'll get there.

00:31:17.900 Well, what's very interesting is we have now had two Christmases where we're told, well,

00:31:21.820 I don't know, watch out, either cancel your plans or rapid test in advance. If someone has symptoms,

00:31:27.660 don't do it. Or, or if there's a, an older person, a person, high risk, exclude them from it.

00:31:33.580 Yet we all know we have had Christmas gatherings in the past and some families,

00:31:37.020 it's pretty much every Christmas gathering. Cause if you're bringing 20 people together

00:31:39.980 indoors and hugging and kissing, you know, it's going to happen where the cold goes around,

00:31:43.820 the flu goes around, you get sick from these gatherings. And I wonder, are we going to change

00:31:49.420 for many years to come, how we approach those gatherings now, or are we going to just be able

00:31:54.060 to make the mental switch and do, as you say, acknowledge COVID's just in that roll call of

00:31:58.540 concerns or, or, or do you think psychologically we're going to have a challenge with these things

00:32:03.260 for the next 10 years? Uh, I think actually all three of those situations are true. I think that

00:32:08.460 there's going to be individuals who, you know, in two years will still be rapid testing before they go

00:32:12.860 out. Uh, uh, you know, there'll be individuals that just continue doing what they did and, uh,

00:32:17.340 people that just take some time. Uh, you know, I think one thing that I also want to mention is that

00:32:21.980 we often talk about, okay, there is a, let's say, uh, 80, you might, my father's 80 years old. Okay.

00:32:27.260 And he's a pretty healthy guy, although he is on immune suppression for rheumatoid arthritis,

00:32:31.580 he doesn't have a lot of other health conditions. Sometimes we don't think about asking them what

00:32:35.900 their risk perception is that, you know, if you're 85 years old, you know, you don't have,

00:32:40.380 uh, you know, 10 years to, well, maybe not, but I mean, on average, you don't have 10 years to be

00:32:47.500 sitting at home, not seeing your family. So I think that is also part of the risk assessment.

00:32:51.580 You can ask your older relatives, look, there's a risk here. Uh, but do you want to, uh,

00:32:56.860 participate? I think many of them will say, yes, they want to see their grandkids. They want to

00:33:00.780 see their kids. And I think that's part of the whole idea of family. And, um, uh, this is the

00:33:07.260 idea of being away from the people that you love for some people. They can do it in the, the name of

00:33:12.060 safety, but for many of us, it's been very difficult to do that. And that's something that I hope will

00:33:16.620 change, um, with, uh, the coming months, because it's been a tough two years being away from our loved

00:33:22.940 ones. I'm sure you've seen the stories. I saw one on CBC, one on CTV of elderly persons in long-term

00:33:29.500 care homes who opted for medically assisted dying instead of going into another lockdown,

00:33:35.580 which was presumably put in place for their benefit. And they said, no, I don't want to live

00:33:40.460 like this anymore. Yeah. That, uh, you know, I was thinking about that the other day and it, it, uh,

00:33:46.060 really, really breaks my heart. And I, I think that, uh, uh, maybe back in 2020, when we didn't

00:33:51.660 know what was going on, uh, we did a lot of these really drastic measures to keep people apart,

00:33:58.220 but to keep somebody in a nursing home, essentially like a prison for them, they can't, uh, do things

00:34:02.780 for themselves. They can't see their loved ones, or at least, um, the way they can see them is very

00:34:07.260 limited. Uh, I saw a couple of pictures of people seeing their, uh, mom and dad through glass,

00:34:12.220 um, during the lockdown period, that's tough. And for somebody to get to the point that they

00:34:18.380 don't want to live because of something like that, I think we really have to re-examine, uh,

00:34:23.740 what our, our response to this was. And there's a lot of people out there who

00:34:28.140 initially bought the response of, okay, we, we don't like this. We really hate it, but we get,

00:34:33.100 we have to do it. And I feel as the months go by, particularly now in Ontario, a lot of people

00:34:38.220 who were fine with almost every previous restriction, very frustrated right now. I

00:34:42.940 know what's happening in Quebec. I know what's happening in other provinces saying,

00:34:45.660 look, I got the double dose. Some, I got the triple, the kids have one or two vaccines.

00:34:50.300 I downloaded the vaccine QR code passport that was supposed to be in place of, uh, of having

00:34:55.180 any sort of lockdown to come. And now they're just like, no, I'm not buying any official or Doug

00:35:00.940 Ford or Justin Trudeau saying, all right, well, hashtag we're in this together. Uh, you know,

00:35:05.100 we just got to do this for two more weeks, which we know is not true. I mean, it's kind of insulting

00:35:09.180 to our intelligence now to say something's just going to be for two weeks. And there is a very

00:35:13.900 real palpable anger out there right now. And it's not from, I'm sure it includes those people who've

00:35:19.100 started protesting from day one that Doug Ford called Yahoo's, but it's a much broader catchment

00:35:23.980 of people. A lot of, a lot of regular folks who've just said, no, I ain't buying it anymore.

00:35:28.940 Yeah. And you know, I was an individual at the very beginning thought that we,

00:35:33.980 this sucks, but we have to do it, the lockdown, but as time has gone on and I've seen the, um,

00:35:39.900 people that are getting affected, the fact that the lockdown measures are not really 0.89

00:35:43.820 targeting or doing much for that situation, seeing what's happened in other jurisdictions

00:35:47.980 around the world. Uh, I, I understand that anger and frustration, especially now we're two

00:35:53.340 years in and I know Anthony, I sound like a broken record, 90% or close to eligible people

00:36:00.220 on the ground, fully vaccinated. And you know, we're in a situation where we're in lockdown for

00:36:05.020 potentially more than two weeks schools out. We know all of the, uh, benefits of having kids in

00:36:11.340 school. It's just really, really, um, uh, frustrating for all of us. And there are other places that aren't

00:36:17.580 doing this. And I wish we would be able to fall, follow the example, but I think the other thing I will

00:36:22.460 say, even when we were open, uh, for the last couple of months, there was always that specter

00:36:28.700 of, uh, the other shoe dropping that, you know what, do what you want now, but we're going to be

00:36:33.660 in lockdown again. And I really want some kind of guarantee that when we come out of this, uh,

00:36:38.780 that we don't go into lockdown again. And I know that part of it is our fragile healthcare system,

00:36:44.460 uh, that has been the kind of central tenant of all of this. Uh, it can't be fixed quickly,

00:36:49.660 but that's something that has to be looked at for the future because we can't keep doing this.

00:36:55.100 Let's talk about the fragile healthcare system. I've gotten very frustrated at seeing the same

00:37:00.300 senior healthcare officials and bureaucrats and hospital CEOs. You know, I'm not talking about

00:37:04.980 the frontline heroes, but I'm talking about the people who are paid a lot of money to effectively

00:37:09.780 manage the healthcare system. And for them to turn around very recently and say, ah, 300 persons in ICU

00:37:16.200 and COVID got to shut the schools. I find that a real abdication of responsibility. It is frustrating

00:37:24.040 is not the right word to know that there are people who are basically given a blank check.

00:37:29.000 I know they'd like more. I know they'd say they're not giving the blank check, but we have poured,

00:37:33.100 we've gone into debt to the tune of hundreds of billions of dollars in this nation to deal with COVID.

00:37:38.560 And you're telling me that we have a milder variant and you have to shut down my kid's school

00:37:44.380 because there's 300 people in a hospital bed. Don't put that on me. Figure it out.

00:37:52.260 That's a really good point. I think that when you look at this, initially it made sense. Look,

00:37:58.440 we have to protect our resources, but now I agree. When you look at it, we are being

00:38:03.460 shouldered with the burden of protecting the healthcare system where it should be

00:38:07.460 something that protects us. Right. So I'm, I'm very frustrated by that. The other thing is,

00:38:12.480 you know, even taking a step back, the idea of lockdown and restriction being a first line public

00:38:20.260 health measure to me is, is, is amazing. It's incredible. It's hard for me to believe that,

00:38:28.260 you know, what happened in the initial wave, first wave, we saw what happened in China or from

00:38:33.420 what we saw on the news, we saw what happened in Bergamo, Italy, and also what happened in New York

00:38:39.040 City. And that was kind of imprinted on us. That's sort of been this narrative in our head that if

00:38:44.640 we don't do the right thing, we're going to have a New York City where there's refrigerator trucks

00:38:49.520 outside hospitals to bring all the dead bodies. Right. And that has kind of permeated this entire

00:38:55.380 last two years. And, you know, maybe it could be accurate, but I think the thing is at this point in

00:39:01.680 time, we can't really get to that situation again, presumably, especially because of vaccination,

00:39:06.060 we have to be able to take a step back and have faith in the fact that we're protected and do other

00:39:12.340 things to protect the vulnerable. And I think one of them was the shifting the testing and realizing that

00:39:18.240 what China started back in, frankly, in what was it, 50 February 2020, by locking down their entire 0.88

00:39:24.640 population. That's not a general public health measure that we've used at least for long periods of

00:39:30.100 time in the past. And I don't think we should ever go back to that again, at least as a first line.

00:39:35.600 We really, really need to figure this out for the future when we do have other pandemics.

00:39:39.780 It's interesting you should say first line, because there are a number of things that I can

00:39:43.500 only speak to Ontario just because I've studied so many of the particulars, but I know there are

00:39:47.600 similar things in Alberta, in Quebec, in that there are other things that can be done in terms of

00:39:53.260 dealing with healthcare resources. I know in BC, they had originally during the first wave put out a

00:39:57.820 notice saying, if you have recently retired from the BC College of Physicians, you will be called

00:40:02.540 back into duty. I know there's talk about taking second year, third year nursing students, however

00:40:06.820 many years they're in, I'm not sure, and putting them right there in ICUs. A number of other very

00:40:11.680 creative options like that, that I, maybe to a small degree, they have been done or are being done,

00:40:16.700 but they're just not being done. And I go, guys, there's a list of things that can happen and should

00:40:23.400 happen surely. And I'd like your innovation and creativity to make these happen in terms of the

00:40:29.400 senior healthcare bureaucrats making these calls. But to your point, it seems like, oh, lockdowns,

00:40:33.420 like the people accept them, the people take them. It's kind of easy for us to do it. Okay. Lockdowns.

00:40:38.120 Yeah. And you know, another thing that I think goes along with that is the idea that we have a lot

00:40:43.920 of control over this. I think that there are many people who believe that the second wave happened

00:40:48.960 because, you know, I hear all the time, Doug Ford did this, or we opened too soon, or blah, blah, blah.

00:40:54.340 And the thing is, is that this is how viruses act, especially at this time of the year. And I think

00:41:00.520 that, yeah, there are things that we can do to brace for the impact, to protect the population

00:41:04.800 from getting severely ill, but waves happen. And I'll give you another example that the third wave

00:41:10.620 that we had, if you remember, was a wave on top of a wave. Well, that was alpha emerging from the

00:41:15.960 background. We can't control that. That's what happens, right? And I think that if that were

00:41:21.720 communicated a bit more clearly, it would have been, I think, better for the population. And one

00:41:27.480 thing I will say, you talked about creativity. I have an interesting perspective on this. Well,

00:41:31.920 I should say a different perspective. You might not find it interesting, but my wife was on the IMS 0.72

00:41:37.340 system. She's a nurse in our hospital system. And she was one of the key people for our hospital 0.80

00:41:42.500 who helped to load distribute. So we were getting hammered in the third wave at my hospital,

00:41:48.360 and she was able to help take patients and arrange for transfers around the province. And that was one

00:41:55.700 of the things that saved us during that. And you don't really hear about that very often. You hear

00:42:00.060 that there are hospitals that are overwhelmed, but the majority of patients in that wave was coming from

00:42:05.860 the GTA. And I think that that's one of the things that we could do. No one likes to do that. No one

00:42:11.580 likes to have to do that. But I think that before locking down, there are things that we can do to

00:42:16.080 make sure patients get the help that they need. Surge capacity, I think, is something that we need

00:42:20.880 to build into the system and just do something that we are not constantly held hostage by ICU and

00:42:27.080 hospital capacity. Lots of concerns about staffing resources as well, both because people are being

00:42:32.740 sent home because they've been deemed a close contact, although I understand those policies are

00:42:36.780 currently under revision. Lots of close contacts are now back on the job. People who have tested

00:42:41.540 positive for COVID-19 but are asymptomatic. A number of them, healthcare providers, are being

00:42:46.740 sent home for however many number of days. And of course, unvaccinated persons being put on the 1.00

00:42:52.080 sidelines. Although we have heard that I believe it's Niagara Health has just decided we're going to

00:42:55.960 bring vaccinated nurses back into the workforce. What are your views on all of this? Should we be

00:43:02.000 bringing back those healthcare providers who, for whatever reason, were not vaccinated into the fold?

00:43:08.140 The answer is absolutely yes. First of all, I think the idea of test, trace, isolate for the

00:43:16.820 community was something that we could do back in the first wave maybe, but now it's just impossible.

00:43:22.500 And Omicron has now crushed any hope of that at all. So we know that part. In the hospital, I think

00:43:28.340 that there has to be a trade-off that's made at this point in time. But we know that, for example,

00:43:33.380 this five-day thing, sorry, the 10-day and 14-day isolations, well, these are the things that we

00:43:39.540 were using in 2020. And we have good data that you don't need to isolate people for that long.

00:43:45.180 And we have only been forced into changing that now with Omicron. So I think it could have been

00:43:49.620 done before. But yeah, now you have to look at a point that, okay, if your entire staff is off

00:43:55.020 because of a vaccine mandate, or because they're isolating, then you can't look after people,

00:44:01.000 right? And then that's a terrible trade-off to make. So I think that there are some jurisdictions,

00:44:05.940 by the way, in the States that they're not even testing asymptomatic individuals. And so that's

00:44:11.100 one way of kind of focusing the people that are sick, keep them out of isolation, keep them out of

00:44:16.480 circulation while they're infectious, and bring them back as soon as possible. And for right now,

00:44:21.260 CDC mentioned five days, and Canada was looking at that as well. There's certain jurisdictions like

00:44:27.360 Hong Kong that we're doing, I believe, three days. And we get the fact that there are going to be

00:44:32.560 some people at the tail end of their infectivity. But the thing is, right now, there's so much

00:44:38.140 infectivity in the hospital anyway, we're isolating everybody, we're doing what we can, but we need

00:44:43.660 staff. And right now, that's going to be the most important thing. And we're going to have to

00:44:48.900 change the approach. I'm glad to see Niagara do what they did.

00:44:52.120 What do you think is going to happen in the weeks ahead for Canada? What do you hope will happen

00:44:55.760 in the weeks and months ahead here in Canada?

00:44:58.620 So what I think will happen, again, we're going to timestamp this conversation. We're at the

00:45:04.400 beginning of January, so I don't have a crystal ball. But what I do think that based on other

00:45:08.660 jurisdictions, this wave will crash fairly quickly. There'll be a tail end of hospitalizations,

00:45:13.720 and then we'll have a relatively quiet period. And I think that this will likely be our last

00:45:19.080 disruptive wave. But I think hand in hand with that is going to have to be a difference in our

00:45:25.840 approach. And that means that we can't be chasing case counts. We have to be looking at the metrics

00:45:31.640 that matter. And I think that, you know, hospitalizations and especially ICU are going to be

00:45:38.560 as important. And I also want to see a long term plan about a plan of what we can do to help buffer

00:45:45.740 our hospital capacity. So we have more ability to absorb surges. And I also want to know that

00:45:53.600 we have a plan that if something happens in the future, that we're not constantly having this

00:45:58.920 lockdown and restrictions hung over our heads, because I think that's been very anxiety provoking

00:46:04.000 people. I want to be able to say, okay, look, when next winter rolls around, we are going to see

00:46:09.600 respiratory viruses, we're going to be seeing sickness. And I want to be able to breathe easy

00:46:14.680 that pun intended, sorry, pun non intended. But I want to be able to breathe easy knowing that we have

00:46:20.220 this, we're going to have stress on the hospital, but we're not going to be locking the community down

00:46:24.180 because this is something that is, it causes very anxiety provoking for the population in general.

00:46:30.700 And I don't think it's, it's productive. Dr. Suman Chakrabarty. Thanks so much for joining us.

00:46:36.700 Thanks for your time. Thanks for having me. Full Comment is a post media podcast. I'm Anthony

00:46:41.880 Fury. This episode was produced by Andre Pru with theme music by Bryce Hall. Kevin Libin is the

00:46:47.520 executive producer. You can subscribe to Full Comment on Apple Podcasts, Google, Spotify, and Amazon Music.

00:46:54.060 You can listen through the app or your Alexa enabled devices. You can help us by giving us a rating or a

00:46:58.520 review and by telling your friends about us. Thanks for listening.

Full Comment - January 10, 2022

Time to end our ‘warped risk perception’ of COVID

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