Time to end our ‘warped risk perception’ of COVID
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Summary
In December, we had a conversation on this show with Dr. Neil Rao about how the Omicron variant, while probably very transmissible, would prove mild, and that the time had come to stop obsessing over case counts and isolation rules, and move forward and find a way to get on with our lives. There were no thoughts at all of being plunged into lockdown again. And then it happened.
Transcript
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Hi, I'm Anthony Fury. Welcome to the latest episode of Full Comet.
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In December, we had a conversation on this show with Dr. Neil Rao about how the Omicron variant,
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while probably very transmissible, would prove mild, and that the time had come to stop obsessing
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over case counts and isolation rules and move forward and find a way to get on with our lives.
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There were no thoughts at all of being plunged into lockdown again, and then it happened.
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Quebec and Ontario are in lockdown. Other provinces have brought in added restrictions.
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What on earth is going on? Surely it doesn't need to be this way. Our guest today has been on the
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front lines dealing with COVID patients since day one, and he breaks it all down for us. Dr.
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Suman Chakrabarty, an infectious diseases physician at Trillium Health Partners in Mississauga,
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joins us now. Dr. Chakrabarty, great to have you here. Great to be here. How are you today?
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Doing okay. I'm doing this virtual school stuff, so it's a bit difficult, but managing through it.
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Yeah, no kidding. Well, let's get into it then, because I know you're doing the virtual school
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stuff. You're also someone who's on the front lines. You've been treating COVID patients since
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the first wave. Right now across Canada, we've got Quebec under such strict rules that they have
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police patrolling the streets to enforce curfews. We have Ontario back into lockdown. We have either
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school closures or at least delays pretty much all across the country, but I must ask, given what we
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know about Omicron right now and a lot of confirmation that, well, yes, this is a milder
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variant, would you say the punishment fits the crime? Is the reaction we're seeing right now
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proportional to the actual challenges that we are now facing? Yeah, you know, I've been thinking a
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lot about this, and, you know, when I look at what's going on, I understand why the reaction is as it
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is, you know, when you look at these numbers that we've been, the case counts, we've been following
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for the past, you know, two years, this is something that has really dictated our actions, and these
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numbers are, you know, off the chart from what we've seen in the past, but when you look at what's
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happening on the ground, we are absolutely seeing pressure in the hospitals. There's a lot of patients.
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The patients overall are less sick than they were in the third wave, but, you know, I think it's
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important for us to look at other parts of the world, South Africa, Denmark, UK, they're having
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similar situations, but they didn't necessarily have to go into lockdown, and it really does bother
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me that this is kind of what has been associated as the response in any of these situations, so
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in my mind, I understand the reaction, but I do think that especially two years in, with 90% or so
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people fully vaccinated on the ground, that this is an overreaction. When we see those other
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jurisdictions, we have heard from some people in Ontario, well, you can't use South Africa because
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of this or that reason, because of them having a younger average population base. You can't use
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Denmark because of this or that. You can't use this jurisdiction. You can't use the US because they
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have a different hospital capacity system. We're kind of always told why the pathway must always lead
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to lockdowns in Ontario. We're not really generally given the argument as to why maybe we can go in a
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different direction. I think there is actually something to that point. You don't want to be
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completely taking a place like South Africa and just mapping it onto what will happen here in Canada.
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The circumstances are different, different demographics, different rates of vaccination,
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et cetera, et cetera. But I do think it's important for us to look at other places and at least take some
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of the experience and mold it to our situation. I think that there is a hesitation to have any sort of
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positive type of spin on things. For example, it is true that overall that Omicron is milder, though we are
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seeing an expansion in hospitalizations. So those things can, both things can be true at the same time. But I'm
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noticing that the bias tends to be towards believing anything that's going to have a negative outcome.
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How did we get to that point that that's the general attitude that we seem to have among officials and many
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people in the public that we have to sort of gravitate towards the negative as opposed to, oh, great, here's
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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
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communication style since the beginning. There's been a lot of fear based rhetoric, at least here in
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Ontario and in Canada abroad. There's been a lot of moralization, you know, making people internalize the
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fact that if you get COVID, it's because you did something wrong. Now, I, you know, I do like the
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idea of saying initially that we're in this together, which it's impacted us all very differently.
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You want to have that unified front, but that did devolve later into blaming, shaming, a lot of finger
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pointing. And I think that that now has kind of morphed into people that have a very warped risk
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perception of what COVID actually is. And we're seeing a lot of this that, you know, any sort of
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positive note on this is immediately met with, well, you're trying to deny the existence, you're
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trying to minimize. And that's certainly not the case. That's certainly not what I'm trying to do.
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But it's important for us to look at the whole picture and the nuance.
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Do you think it's possible that earlier on, or even right now, prior to going into these lockdowns,
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that we did gravitate towards a more personal risk assessment situation? Dr. Kieran Moore, Ontario's
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chief medical officer, prior to Christmas, he said, well, no, there's not going to be any more
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lockdowns. Yes, schools are definitely going back. And he was asked by one reporter, it was a press
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conference I was participating in. I remember one of the reporters said, should people cancel their
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Christmases? And he said, no. And then he said, well, I have faith in the people of Ontario to make
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informed decisions and develop their own personal risk assessments. I thought, wow, it's very
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interesting to hear him talk that way. Clearly they did a reversal and now you're not allowed to decide
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whether or not you can go to the restaurant or not because the restaurants are closed. But how would you
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recommend we think about and talk about a personal risk assessment notion?
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I think that is such an important thing going forward because we're going to have to have a
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new perspective as we get into this post-pandemic period. I'm not saying that the COVID is going to
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go away completely. It's not going to, but we do have to change the way we approach it, especially now
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that look, again, 90% of people on the ground vaccinated. So we have to look at this differently.
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And a lot of this is going to be a personal risk assessment. There are going to be people that
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once these mandates for masking, for example, dropping, going to still be wearing their masks
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for weeks and months to come. I get that. I think it's important for us to realize everybody has
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different situations, different risk tolerances. And I don't think it's public health or the medical
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authorities place to tell us what to do in our houses at this point in time. I think we're past that.
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I think it's important for everyone to have their assessment, understand their risk tolerance,
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understand their situations, and make their own decisions.
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I know there's a lot of jokes about everybody thinking they're an armchair epidemiologist or
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that old joke of, oh, I read things online on the internet for an hour, therefore I know better than
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every other sort of top expert. But at the same time, I think there is still something to be said
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for the fact that for two years now, average individuals have just been reading so much about
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this and reading medical studies that they never would have thought to look at before. And I
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appreciate that we don't have the schooling and decades of expertise to fully contextualize
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those studies. But at the same time, we're kind of all in this COVID game together. And it's not
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like we're all coming at it every day as if we know nothing. The general public has developed something
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Oh, I agree. And you know, it's actually kind of impressive. It's funny that I've actually learned
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things from my own friends and colleagues who are not in medicine. So I think that the way that I look
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at it, I always have something to learn from other people, because they provide a different
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perspective. I think that's something that has been lacking a bit, you know, I think medical
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expertise is absolutely important, public health, all that stuff. But when you look at the way that say,
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decisions are made overall economics, benefits, and harms, trade offs, that type of thing,
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I think it's important that we have to have other points of view here. And in general,
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it's important that when we make decisions, it can't all be on science, it can't all be on
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economics, it has to be looking at this in a holistic way. And, you know, I see it happening
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a bit more now, but I wish it happened earlier.
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You know, it's interesting, you should say that I was recently speaking with a retired
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lieutenant colonel, his name is David Redmond, he's been speaking a lot the past year or so about
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how to deal with COVID-19. After he served in the Canadian Armed Forces for many years,
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he became the head of Alberta Emergency Management Office. And a point he's been trying to make is
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actually the emergency management bureaus in all these provinces, they are supposed to be in
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charge when there's a pandemic. And if you go to emergency management Ontario's website,
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it says, you know, forest fires, disasters, nuclear accidents, pandemics, the things that
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are under their purview, they've done nothing in Ontario. And I think similar for other provinces
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on this, because from the beginning, it was okay, we have this health issue, put the chief medical
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officer of health almost exclusively in charge. And I guess the original idea in emergency planning
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was you have the emergency planner, head person who's in charge, and then you have, you know,
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economy, business sector, all these different sectors, health, health is obviously hugely
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important, but they're not the, maybe the most primary focus, but they're not the one in charge,
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because there still needs to be someone to kind of delegate between the different interests.
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Yeah, in my mind, actually, that makes a lot of sense. I think that having somebody who is,
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first of all, also, not just looking at all the different sectors that are important,
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but also trained in communication, I think that what I've learned, look, I'm learning myself about
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media, I've been doing media for about 10 years now, much more in the last two years, right? And
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it's difficult, and there's a way of doing it. And it takes some some training, some practice as well.
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And, you know, in general, I think somebody who is just put on the face of COVID doesn't have that
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initial training, which you need. So I think that the health part is absolutely important. But I
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echo what you say that it needs to be somebody who can kind of look at all of these things together,
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make these emergency decisions, which they are trained to do, and, you know, move forward in a more,
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Dr. Chakrabarty, what are you seeing on the ground right now in the hospitals,
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when it comes to Omicron, in ways that it's both similar and dissimilar from the delta wave,
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from the first wave? How would you compare what's going on right now?
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Dr. Yeah, it is certainly different. And the experience that we're having on the ground here,
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based on my physician colleagues that I've just spoken to around the world,
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you've probably seen even posts on Twitter, it's certainly different than it was from the alpha and
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delta wave. So first of all, I want to make crystal clear that I'm not saying that this,
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you can't get sick from Omicron, you certainly can. Whereas initially, with alpha and delta,
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when we had our waves, well, maybe I should say more alpha for us, our third wave, is that people
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were coming in sick, very, very sick, requiring a lot of oxygen, because they had bad pneumonia called
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hypoxia. And certainly, we still do see some of that on the ward. But a lot of what we're seeing
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now is people coming in with Omicron, who are medically fragile. And it's not so much that their
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lungs are affected, and they need a lot of oxygen, but the Omicron has pushed over other more chronic
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illnesses. So to give you an example, let's say a 78 year old guy with diabetes, mild dementia,
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and the Omicron has made him sick enough that his blood sugars have gotten out of control,
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he's starting to fall down because he's dizzy and dehydrated. This is something that we see often in
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internal medicine. But now Omicron is kind of acting as that trigger. So we're not seeing our ICUs being
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filled up, but we are seeing a lot of people coming in with this type of illness. And that takes a lot of
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staffing to be able to deal with. We can do it. But it is a stress on the system, especially in the
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context of staffing shortages. When we see rising hospitalization rates in Ontario, it's no longer
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the case that it is exclusively or the vast majority of people going into hospital are the unvaccinated.
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There seems to be a more diversified group right now. What's going on there? What's the difference
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between vaccinated and unvaccinated persons who are winding up in hospital with Omicron?
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This is a very important point. So first of all, I think that the vaccination is still showing that
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the people who are getting the sickest, so those who are primary COVID pneumonia, requiring high
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amounts of oxygen and putting on a ventilator, those are by and large individuals who haven't
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gotten vaccinated. It's still the case. But it is also true that those have become the minority of
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what we're seeing. It's just that when you get to a point where 90% of the population
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is vaccinated, you're going to see people in hospital who are fully vaccinated. And that is
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a lot of these older individuals who have their chronic medical conditions decompensated. So
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the majority of those are vaccinated. But then again, the majority of those are not in the ICU
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requiring ventilation. So the patient balance has shifted, but it is still showing on the whole,
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vaccination is still doing an amazing job of preventing severe illness. And in this case,
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going on a ventilator and death. Dr. Chakrabarty, a number of months ago, six months ago,
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nine months ago, we could see messages from Ontario Premier Doug Ford, from Jason Kenney,
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from Justin Trudeau saying, go get your vaccine, get your two shots, and then we can live life again.
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Then we can get back to normal. Now I see Justin Trudeau has made a social media post saying,
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get your booster shot, and then you can go back to normal. Some people are getting a little cynical
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in response to seeing these postings, particularly when they're being told, okay, a fourth dose is now
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being rolled out for persons in long-term care homes, very elderly, and people who have high-risk
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conditions. But as they see the booster shot being rolled out, they're beginning to wonder,
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am I going to continue to see these goalposts shift when it comes to vaccines? How would you
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respond to that? Yeah, I hear that. And, you know, I think that initially with the vaccine,
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the fact that this is going to be our key out of here was certainly something that including
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myself thought. And I think what has been the bit of the disappointment is, first of all,
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the vaccine is amazing at preventing severe complications, such as, you know, hospitalization
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and death. But I think one of the disappointments has been it's not so good at reducing transmission.
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And I think that we are still seeing that happening in the community. And there's a lot of
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ongoing transmission. One thing I will say, though, is that one issue with at least the response in
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Ontario, I can speak for the best is that we've still had, even though we want to, you know, move
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forward, there's still been a laser focus on cases. And, you know, it's been a big problem,
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because hospitalizations, and especially in the ICU, that is the metric you really want to look
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at. And we're seeing that right now with that with Omicron, with the expansion and hospitalizations.
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But the issue is that when the numbers go up, I think that there's a lot of knee jerk responses.
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And that's been an issue. I think that this wave will crest and crash soon. I do think it'll take a
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little bit longer for the hospitalizations to decompress. But the point is, we can't keep chasing this
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count. We have to look at more impactful and more informative metrics. And then our response has to
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now change is that we can still be back to normal. But we have to remember that each time the numbers
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go up, we can't constantly be going back to lockdown and restrictions. We have to put an end to that and
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move into the post pandemic period. It still seems that there are a lot of people who adhere to what
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we could call the COVID zero mentality, the idea that there must not be any COVID in society and the
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objective of various restrictions and lockdowns is to eliminate COVID. And I feel like haven't we kind
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of debunked that notion like over a year ago, and yet there are still individuals who think that the
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idea is to just get those case counts to zero. Yeah, and I will say to be charitable to that,
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I understand why people don't want to have a lot of transmission in the community. I get that because
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people are worried about complications. There is a lot of worry. People talk about long COVID,
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which thankfully, isn't as common as it was initially described once we have more studies
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on it. But the thing is that even if people understand that we're never going to eliminate
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it, I think that also strategies at this point that are really trying to suppress it,
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we have to look at the trade off and the cost that's involved with that. One interesting thing
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that I've noticed about Delta, and especially Omicron, is that a lot of our efforts that we've been
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trying for the past two years to suppress cases do not work very well, especially with Omicron. So I
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think that, you know, we saw this wave coming at us, I don't think anything we would have done to
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try to intervene would have changed that. And we see this around the world, it's called what I call
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a whiplash curve, it goes up hard, and it comes down hard as well. And that's independent of what you
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do. And that's just the virus doing what it does, its ability to really infect people. And thankfully,
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the vast majority of those are minor. And that's why I think it's important for us to realize that
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we cannot be putting in all of this focus on a virus that is generally causing mild cases in the
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community, we have to focus our attention on the people who are at the highest risk of bad outcomes
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and hospitalization. And that's part of what happened. I think it was about a week ago now,
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where the criteria for testing has changed. And that's going to be one of the big things that's
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that's part of our altered perspective and focus going forward.
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Well, let's talk about that for a moment, because this was quite a press conference
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that Dr. Kieran Moore, Ontario's chief medical officer of health did where he said,
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all right, we're not going to do pretty much any more isolation rules of close contact individuals.
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So long as you're vaccinated, you don't have to do that at all. Just,
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you know, if you have symptoms, well, then you should go get tested. But otherwise,
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no, no isolation. And people who are found to be positive for COVID-19
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only have to stay home for five days now, no longer 10 days. And that was something that I
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think a lot of people found very interesting. There's initially a lot of applause. And then
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there's also the news that widespread testing is no longer going to be available in Ontario,
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no more PCR testing for asymptomatic individuals, and they're not going to be
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handing out rapid tests at the liquor store anymore. They wanted to basically narrow the focus,
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repurpose all of those resources towards high risk individuals towards the hospital setting,
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retirement homes, long-term care, the places where people, if they get positive with COVID-19,
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I guess it could go on to be something serious. What did you make of that announcement? Because
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it's, well, I know those rules haven't been flipped around, but they've been overshadowed by the fact
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that we've now been put into lockdown. Absolutely. It was a bit contradictory when the lockdown happened,
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but I think this is a key part of going forward is realizing that now, look, because of vaccination,
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this is where I'm going to really, really push the benefits of vaccination. We have gotten to a point
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where those who are vaccinated, which is almost 90% of the eligible people, and it's even higher than
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that. When you look at the highest risk people, the vaccine works excellently to prevent hospitalization
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and death. So it's personal protection. So when you look at that, we can now go back to,
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let's say 2017, where in the winter months, we get thousands of people who get respiratory viruses,
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rhinovirus, parainfluenza, influenza, et cetera, et cetera. And every single time somebody gets a
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fever and they're up in bed for a couple of days, you don't test that person to find out what they
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had, even if it's influenza, which we know causes hospitalizations. What you do do is get a general
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idea of what's going on in the community. And you especially test the people who are coming to
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hospital because you can do something about that. For COVID, it's a similar thing now. For the vast
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majority of people in the community, this has now become something that's not going to cause you to
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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.
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That person we do want to identify because we could give them treatments and other types of
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things to help prevent hospitalization. That's where we need to put our efforts. We can't be
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looking at the most minor of cases, which is thankfully what it is due to vaccination, because
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again, we're not going to be able to focus on other non-COVID things which have fallen to the
00:20:52.140
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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,
00:22:57.100
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.
00:25:17.580
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,
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
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
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
00:41:37.340
system. She's a nurse in our hospital system. And she was one of the key people for our hospital
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
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
00:44:58.620
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.
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