Full Comment - Time to stop being always afraid of COVID

00:00:00.000 Hi, thanks for joining us for the latest episode of Full Common. I'm Anthony Fury.

00:00:08.480 For some Canadians, the pandemic is done, finished, over. They've been vaccinated,

00:00:13.040 they see the numbers are crashing, and they're now out and about living their lives.

00:00:16.780 Several provinces have even ended all restrictions, including mask mandates,

00:00:21.000 BC, Alberta, Saskatchewan. But some people are saying, uh-uh, not so fast. That Delta variant 1.00

00:00:26.660 is coming, and it's gonna hit hard, despite the vaccines. Keep your masks on, folks. We may need

00:00:32.100 to mask up again. And as for those vaccines, well, we need controversial vaccine passports that even

00:00:36.860 mandate annual booster shots in them. Are these just people who can't let go, or is this all

00:00:41.860 accurate and we need to remain afraid of COVID? Martha Fulford is our guest today, an associate

00:00:47.500 professor of McMaster University and an infectious diseases physician based out of Hamilton Health

00:00:52.360 Sciences. Martha, thanks so much for joining us today. Thank you for inviting me.

00:00:56.660 Yeah, it's a very interesting place we're at in the pandemic discussion right now in Canada,

00:01:00.700 because, well, I guess some people would like to say, well, we're not really in a pandemic anymore.

00:01:04.240 They're looking at the summer weather. Things are happening. Kids are playing in their sports

00:01:07.760 leagues. And, well, like I said, in some provinces, people are just living life like they were before.

00:01:12.600 But other people are saying, watch out. This is false assurances. There's a lot that's gonna hit us

00:01:17.400 soon, and it's gonna be difficult, and this thing is ever-changing. What's your sort of broad

00:01:21.760 picture on what's actually going on right now? Are we pretty much in the clear, or is there

00:01:26.140 going to be another very challenging hurdle around the corner?

00:01:30.360 It's a very good question. And the answer, of course, depends on people's interpretation of

00:01:35.900 what we need to worry about as well as their risk tolerance. And we do have a drop in numbers

00:01:44.440 over the summer. We also saw this last year. It was seen everywhere in the world last year.

00:01:51.940 And that would be because there is a degree of seasonality to coronaviruses. So I think part of

00:01:57.720 what we're seeing this summer is the summer hiatus. On the other hand, one thing that's fundamentally

00:02:05.920 different now, and this is where I think you're seeing different perspectives, is that we have been

00:02:12.540 able to vaccinate people. And so this is a really good window period for us, because the numbers are low.

00:02:19.040 They're going to almost certainly remain low. And it does allow us to get as many vulnerable adults

00:02:25.980 vaccinated as possible. And the thing that the vaccines have done for us is fundamentally changed

00:02:33.240 what we're dealing with. COVID, during our second and third waves, did end up with a lot of people

00:02:42.980 being hospitalized, particularly our vulnerable adults. The vaccines, while not eliminating COVID,

00:02:49.320 are really remarkable at how effective they are preventing severe disease, hospitalization,

00:02:54.920 and death. I mean, there's never zero risk. So for us, in Canada, what was the pandemic,

00:03:03.440 and a pandemic is an infectious disease that is being seen in multiple countries, it's crossing

00:03:09.420 borders. And clearly, it's affected pretty much everywhere in the world, is now becoming more of

00:03:13.680 what we would describe as an endemic infection, something that is there, but it becomes more of

00:03:20.540 a background virus, if that's the right word, something that we would deal with on an annual

00:03:27.340 basis, as we deal with influenza, as we deal with the other normal circulating coronaviruses. Most years,

00:03:33.900 we see four different coronaviruses. There are quite a few of us that believe that this will become

00:03:38.580 our fifth circulating coronavirus. So the interpretation in Canada, where we are, I think

00:03:43.860 depends on the comfort level with the vaccination, and the comfort level with learning to coexist with

00:03:50.800 the virus. Well, it's interesting that when you talk about phrases like risk tolerance and comfort

00:03:55.080 level, I mean, it does seem like what you're saying is how the individual really interprets the

00:04:00.620 situation. And yet, we're still in a position where, despite the fact there's been a relaxing of

00:04:05.080 pretty much, well, many measures in pretty much all provinces, Ontario is still relatively strict,

00:04:09.960 Quebec as well, but other provinces easing them. I mean, are we at this situation now where it's no

00:04:15.760 longer talking about, you know, should the government shut down the gyms or what have you, but well,

00:04:19.620 okay, if you personally feel that you need to make different decisions in life, we'll go ahead and do

00:04:25.660 that. And, you know, we've been informed about this for well over a year now, we've been talking it out,

00:04:29.440 and by all means, keep doing that. But the idea that there's a sort of all hands on deck, society

00:04:34.980 wide, mandated response to it, maybe is the time for that coming to an end? At some point, we have

00:04:41.820 to figure out how we're going to move forward, because clearly, the only COVID is not the only

00:04:48.120 thing we're dealing with. And there has been enormous, enormous collateral damage, which I don't

00:04:56.180 think we've even begun to calculate or figure out what the long term cost of lockdowns and our response

00:05:03.040 has been. And so we do need to figure out how to balance what we're doing and how we're going to move

00:05:07.560 forward in a situation where we try to minimize harms across all sectors and not just COVID harms. And I

00:05:15.560 feel very strongly about this, that our approach should be one of all aspects of public health should be total

00:05:20.100 harm minimization and not only COVID. And so with the threat of hospitalization, really under control, the

00:05:30.140 vaccines have essentially defanged and declawed the virus. And this includes the variants includes delta. So

00:05:39.620 while people might still get delta, what we're not seeing in the vast majority of people is progression to severe

00:05:46.100 disease and the need for hospitalization. And so COVID is never going to be zero risk, but it will be

00:05:53.200 manageable risk. And so for a lot of people, it's getting that message out that with the vaccines

00:06:02.740 protecting our vulnerable seniors, and our vulnerable adults that have the comorbidities, the risk of

00:06:08.840 overwhelming the healthcare system is essentially not there anymore. So we also need to decouple, we need to

00:06:15.360 separate the total case counts, which will not be really very relevant if they're mild disease in

00:06:21.520 the community, from the need to actually have our hospital system overwhelmed from it so that we can't

00:06:28.620 provide other aspects of care. So it is a balance we need to find. And given that we are Canadians have

00:06:35.960 done a remarkably good job at the vaccination, people have really stepped up to the plate. We have very high

00:06:43.500 vaccination rates, and they are still steadily climbing. If we could focus in on any pockets of

00:06:50.840 vulnerable adults that are not vaccinated, then we probably are in a very good position in our country 1.00

00:06:57.820 to say that the pandemic phase, the severe phase is coming to an end, and we do need to move on. And that

00:07:06.340 does mean relaxing measures. It doesn't mean paying no attention to COVID. It doesn't mean not keeping track of

00:07:12.820 what's going on. It doesn't mean sentinel surveillance sites. But it does mean that we have to acknowledge

00:07:17.560 some way of allowing most of us to move forward and coexist with this virus as we coexist with other

00:07:25.120 respiratory viruses.

00:07:27.260 And Dr. Fulford, when you talk about acknowledging these facts about, you know, the vaccines and so

00:07:32.200 forth, the efficacy of it, what's going on with these variants, it does seem to be sort of the key issue

00:07:38.100 right now, acknowledging the positives and what they entail. But I find in so much of the discussion

00:07:42.800 right now, whether it's on social media, or in traditional media, or even among people like Dr.

00:07:48.400 Teresa Tam, who are saying up in press conferences, well, remember, the vaccines are not 100% perfect.

00:07:53.280 And you're like, well, yeah, you pick up any sort of medical, you know, device at Shoppers Drug Mart,

00:07:58.540 and there's always something on there about how, you know, whatever this pill you're taking, or I know they

00:08:02.520 say it on the condom labels, and so forth, not 100% perfect, and so forth. You're like, well, why is she

00:08:06.320 focusing on the sort of 0.5% negative, to the detriment of the 99% positive?

00:08:13.320 Yeah, I think we've, there has been a bit of a tendency the last year and a bit to zero in on

00:08:20.880 the things that aren't going well, and maybe not focusing as much on the things that have gone well.

00:08:26.640 There are some very good news stories. I know it sounds odd to say that, but there are some very

00:08:32.060 good news stories that have happened during this pandemic. One of them actually is the remarkable

00:08:38.320 development of the vaccines. I mean, this is technology that builds on things that had been

00:08:44.360 happening in science for a long time. We had learned how to identify viruses. If you think back to

00:08:50.880 how long it took to say identify HIV, it took a few years before we even figured out what this virus was,

00:08:56.100 that our ability to do sort of sequencing of viruses meant that we could identify this within days.

00:09:03.320 That's remarkable. It also is remarkable that we had this messenger RNA technology. This is something

00:09:09.320 that's been built on for decades. This is not a new thing that popped out of the blue,

00:09:15.580 but it's almost like COVID arrived in time for this technology to hit prime time. There's incentive

00:09:22.220 to use it so that we could ramp up and produce the vaccines really quickly, and they're extremely

00:09:27.400 effective. It would be nice if we could have the messaging, these vaccines are well over 90% effective,

00:09:35.600 particularly once you've had both doses, at preventing severe disease hospitalization and death.

00:09:41.600 It's true it's not 100%, but it is very close to that, because if we focused on that,

00:09:48.740 it's a much more positive pro-vaccine message than constantly dwelling on the very, very,

00:09:54.280 very small number of breakthrough, of what people are calling breakthrough infections,

00:09:58.520 case numbers. But even then, if the breakthrough infections, as they're being called,

00:10:04.100 don't end up being hospitalized or requiring, causing severe disease, that's still a success.

00:10:11.420 Because again, we have defanged this virus. So it's not going to be zero cases. And this is

00:10:18.360 one of the really important messages that I think people have to understand. COVID is not going to

00:10:22.480 disappear. But if we have essentially managed to render it not severe, that's an amazing accomplishment.

00:10:32.160 And I do wish we actually spent more time talking about the positives. The other very positive story

00:10:39.260 about COVID, which again, is really undersold, is the degree to which it did not cause severe disease

00:10:46.460 disease in young people, children and adolescents and adults. I do actually think that as a society,

00:10:52.260 we should minimize the amount of virus that is circulating overall. But it is actually one of

00:11:00.720 the incredibly positive stories that children were spared. We did not know that in March of 2020,

00:11:06.680 when everything shut down the first time. But this is something that we should be celebrating.

00:11:11.640 And it just somehow seems that we seem not able to look at the very positive things that have come

00:11:19.700 out of this. And we keep dwelling on the catastrophe, so catastrophizing everything.

00:11:24.860 Well, Dr. Fulford, let me get your thoughts on the situation with kids right now. Because

00:11:28.540 now, of course, summer in Canada, we've got, you know, adults who don't know each other,

00:11:34.180 who are going to the gym, working out maskless and so forth. And you know, that's fine.

00:11:38.040 And yet in Ontario, there's conversations about, oh, well, I hope the schools will actually open

00:11:42.640 in September. And are they going to have to wear masks? And you have to wear them outdoors? And

00:11:46.040 are they going to be able to play sports and so forth? And you're like, how can we have such a

00:11:49.240 disconnect here where adults who are, you know, in a higher risk age category are living much more

00:11:53.800 freely than in some sense, kids are right now, who, to your point, we have found that, well,

00:11:58.980 there's some great news here, COVID is really not hitting kids all that seriously.

00:12:01.780 Yes, the experience for children during this pandemic has been very different depending

00:12:08.200 where you live. Ontario has been remarkably conservative, and risk averse, to say the least.

00:12:18.680 It's no secret, we've had the longest school closures anywhere in the country. And it is no

00:12:27.120 secret that there has been really catastrophic harm done to our children as a result of this. And this

00:12:33.860 is, I think the United Nations called this a generational catastrophe. There are obviously 0.98

00:12:41.120 there are other, I mean, many children around the world have been impacted. And if you are a child

00:12:48.640 in British Columbia, or Alberta or Saskatchewan, things are essentially back to normal. If you're a child

00:12:56.960 or teenager in British Columbia, schools never closed again after September, well, actually, I think of June

00:13:04.440 of last year. Masking in classrooms was not mandatory for elementary school children. If you are a child in

00:13:15.280 Europe, depending on the country, you never had school closures, really, it's how we prioritize things.

00:13:24.080 The rationale for what we were doing for the closures, the rationale for all of this was to prevent

00:13:32.880 community transmission, which would prevent severe disease in adults and thus overwhelming the

00:13:39.200 health care system. With adults vaccinated, we should not be seeing that. Again, we will always

00:13:46.160 have some hospitalizations, and it's true of all respiratory viruses, it's never going to be zero.

00:13:50.800 So when we talk about restrictions for children, it would be, I think it's important to understand

00:13:57.840 exactly what we're trying to accomplish when we recommend that. The children are not the group that

00:14:03.920 ends up in hospital. Some may, if you look at the numbers of children that do end up hospitalized,

00:14:10.880 that have happened in Canada, if you look at the United States, if you look at the UK,

00:14:17.520 the children who are unwell from COVID, almost all of them do have comorbidities.

00:14:24.000 And fortunately, even that cohort do very well. So how do we balance this? And I guess

00:14:30.480 I personally feel that schools, normal learning, normal extracurricular activities

00:14:40.800 are fundamentally important for our children and adolescents. This is the future of our society.

00:14:46.400 The longer this has gone on, the more clear reports are of harm, the more clear reports there are

00:14:52.480 of children just leaving the school system. In Ontario alone, the estimates are that they're

00:14:59.040 in the range of 100,000 children that just left the school system, not because they chose to,

00:15:05.360 but essentially that they just were lost. There's no incentive left. There's no sports,

00:15:10.960 there's no music, they can't be with their friends. Online learning has been a catastrophe for a large

00:15:15.840 number of children. They're completely disengaged. And how do you even re-engage that? And so our

00:15:22.000 conversation shouldn't actually be about restrictions anymore. We're hospitalizations

00:15:27.840 under control. We're vaccinated remarkably well. We know now that children aren't going to be the

00:15:33.360 group that ends up in hospital. The harm to the children at this point, to me, completely outweighs any

00:15:40.640 conceivable benefit of having restrictions in schools. If we are in a situation where we see

00:15:46.480 really high transmission rates, where we're seeing children becoming severely ill, it's a completely

00:15:53.040 different conversation. But one of the things that's lacking is what are we trying to achieve now

00:15:59.680 by doing this? And I don't see this conversation. People are scared. They're very risk-averse. People

00:16:06.080 are scared. They say everything has to be safe. Right. And you try to tease out safe from what?

00:16:12.160 So they're not actually at risk from COVID. Our adults are safe now. We never actually saw

00:16:18.640 transmission, but very much transmission in schools. We certainly didn't see, you know, huge, massive

00:16:28.800 school outbreaks. And again, there's a whole conversation about what the definition of outbreak is.

00:16:34.640 Right. And we know from other jurisdictions, this is important if we look at Ontario,

00:16:38.800 where things have been very restrictive, that we can look at other jurisdictions. We can see

00:16:43.520 how schools have been kept open. So instead of picking on the most

00:16:48.160 severe examples, we can also look at the many thousands of schools that were open, where no disaster

00:16:54.880 happened, where elementary schools, children were not masked. I mean, I think we could learn.

00:17:00.480 But more important for me is what are we trying to achieve? And the fundamental objective should be

00:17:10.080 the absolute best for the health, for the wellbeing, for the future of our children. And it shouldn't

00:17:15.680 just be fear of COVID. And I struggle because the masking, the physical distancing, the cohorting,

00:17:23.840 all of these restrictions were essentially to prevent transmission to adults and overwhelming

00:17:30.800 the healthcare system. And so with that under control, I do think it's important to have a really,

00:17:39.200 a really honest conversation about what is truly in the best interest of our children for their future.

00:17:45.520 I haven't heard that in Ontario yet. The recent document put out by the Hospital for Sick Children

00:17:53.120 and the Ontario Science Table is actually a very balanced document. If you read it through

00:17:58.240 from beginning to end, it talks a lot about the fundamental importance of in-person learning.

00:18:03.280 It discusses many of the harms that have happened to our children. It has a very reasonable scale-up, scale-down

00:18:10.400 algorithm so that if hospitalization and severe disease is low, then we should actually allow kids

00:18:21.120 to be kids. Whereas if we start to see a lot of pressures in the community, we see a lot of

00:18:27.760 pressures on healthcare system, then we can revisit this. And this is an interesting discussion point

00:18:34.880 because this comes back to decoupling cases from hospitalizations, because we will see numbers going

00:18:41.360 up in the fall. This is what happens with respiratory viruses. But if we don't see a surge in our hospital

00:18:48.080 system, then we should just continue to have a risk tolerance for this. And again, I would urge anybody

00:18:56.400 who is worried about this to look at what has occurred in other more permissive jurisdictions. We can look

00:19:03.360 at British Columbia, we can look at Alberta, even Quebec with the most strict of all the, some of the

00:19:09.920 lockdowns, things with their curfews never shut down their schools. And we could absolutely be learning

00:19:15.040 from different school systems in Europe. And I just, I haven't seen that conversation happening a lot

00:19:22.960 at the government level in Ontario yet. I'm hopeful that whatever plan is put in place is a good plan,

00:19:29.040 but none of us have seen it, of course, yet.

00:19:31.040 Well, you touch upon something very interesting, Dr. Fulford, comparing jurisdictions. So we've got,

00:19:35.360 you know, the United States and Canada, which are not our different states or different provinces. I

00:19:39.360 mean, is it different in terms of, you know, various geography and demographic makeups and age and so

00:19:45.440 forth? Sure, you know, they're not identical, but they're also not like wildly, you know, different

00:19:49.840 universes there. And yet, we're, I think we've been encouraged to not really compare jurisdictions. I

00:19:55.920 mean, wherever you are in Canada or the US, I mean, people talk about this as if it's in a silo,

00:20:00.480 and I feel like those places that have made great progress, why are we not learning more about them?

00:20:04.880 I mean, we're always bludgeoned to say, listen to the experts and so forth. And of course, I

00:20:08.720 accept that line in the broad strokes of it. But, you know, there are experts in all of these states

00:20:14.720 and all of these provinces and the chief medical officer of, you know, Michigan or whatever state,

00:20:18.800 that's a person who's gone to a prestigious university, and they have the same credentials

00:20:22.800 as the Ontario person does, the Quebec person, or what have you. And yet, they're all

00:20:26.880 actually going in slightly different paths here. So I feel like there's a best practices that could

00:20:30.480 be explored that, in some sense, isn't. We've been pushed away from it. We're usually very worldly

00:20:35.440 people. But all of a sudden, we've kind of become cloistered in how we talk about COVID.

00:20:40.480 I think it'll be very interesting when we try to do a bit of a look back as to some of the

00:20:46.640 different factors that came into play. There has been a lot of polarization of views.

00:20:54.080 There has been perhaps, unfortunately, a lot of politics with what should be a public health measure.

00:21:00.560 The learning from other jurisdictions, I mean, I think in March of 2020, none of us really knew

00:21:07.520 what we were going to be facing. And there were some fairly catastrophic images being spread around

00:21:13.040 the world and some fairly catastrophic modeling that was put out. Unfortunately, the modeling,

00:21:19.120 well, fortunately, fortunately, the modeling was actually very, very wrong. Unfortunately,

00:21:24.880 it seems to have stayed in people's brains that this is what the impact would be. Why we're not

00:21:31.440 looking at what's not worked in different jurisdictions, I'm not sure. There's a little

00:21:36.080 bit of picking and choosing. I'm afraid of looking at different models, depending on, I guess, what

00:21:42.400 narrative one wants to support. I am very pro-education and pro-schools reopening for children.

00:21:51.760 So I would like to look at the jurisdictions where schools have been kept open and say,

00:21:54.960 well, how did they do this? How did it work? What did they do? Because those children are going to 0.77

00:22:01.440 do better. They're going to have an advantage for their future lives to the children who have been

00:22:08.720 cloistered, who have had educational interruption, who have had a lot of the mental health and physical

00:22:13.200 health impacts of being locked down. And if we're going to advocate for our children,

00:22:19.920 it would be nice to look at, okay, who kept their schools open throughout this? What did they do that

00:22:24.560 worked that didn't work? Because that is going to be where we should move. And a year over a year into

00:22:31.040 this, we should absolutely be sharing information and looking at what's worked. If we don't want to

00:22:36.640 look even beyond our own borders, we could absolutely be looking across Canada. And I do

00:22:42.320 hold British Columbia up as a model because they did keep their schools open. They had very different

00:22:49.360 restrictions in terms of what they did and that the children were allowed to do a lot more.

00:22:54.320 And overall, their curves were identical. I don't think that there was any difference in how COVID

00:23:00.480 behaved. But children in British Columbia have had a significantly better and less harmful experience

00:23:06.720 than children in Ontario. And that is unfortunate. We should be looking at that. And we should

00:23:13.200 absolutely be learning from what has worked in a place like British Columbia.

00:23:17.120 Right now, one of the more divisive conversations happening in Canada right now is the matter of

00:23:21.280 vaccine passports. It's a subject of so many newspaper columns, editorials, people are debating it,

00:23:26.400 whether it's on the television or just, you know, amongst their friends and so forth. The notion

00:23:31.040 that one needs a vaccine passport, not just to say travel to a different country or to accept new

00:23:37.040 arrivals to Canada, but a province-wide mandated one that would apply to pretty much everywhere you go,

00:23:43.520 to the workplace, to businesses. Also, if provinces are not going to opt for a province-wide mandate,

00:23:49.440 as a few of them have said they're not going to do, then businesses themselves should be taking that

00:23:54.880 on, some people say. And we've already seen a lot of heated discussion when a business does say,

00:24:00.320 yes, I am taking on this vaccine passport or no, I am not. And then there's various

00:24:04.880 shaming for the respective positions that are taken and so forth. How do you feel about this

00:24:09.040 conversation right now? I think it's pretty clear I'm pro-vaccine. I'm an infectious disease

00:24:13.920 specialist after all. And with regards to the COVID vaccine, I personally have probably administered

00:24:19.280 several thousand because I've been helping out at the vaccine clinics for, since I guess,

00:24:24.720 early February. So I am very much in favor of the vaccination program as it's being rolled out.

00:24:32.880 I think it's fundamentally changed the impact of what we're dealing with because it means that

00:24:38.720 what has become a very dangerous situation has become more of an endemic one.

00:24:42.000 Right.

00:24:43.440 But when we talk about actual, something like a vaccine passport, what is the objective? So this

00:24:50.720 is a public health measure and I'm always uncomfortable when I have, when I hear sort of

00:24:56.720 private sector companies or individual institutions deciding we're going to start implementing a public

00:25:02.080 health measure and what the exact rationale for it is. Public health, of course, should be about

00:25:09.600 harm reduction. It should be about risk mitigation, about education, about encouragement. It shouldn't

00:25:16.160 be about policing or about punishment or about exclusion. And that's just fundamental public health basics.

00:25:25.280 So if we look at the vaccination program, we're very high in Ontario and across Canada. We will see a

00:25:36.240 marked decrease in hospitalizations from this. And I'm basing this on what we've seen from long-term

00:25:40.640 care where we essentially have 100% vaccinated, even with the Delta variants. It really is a dramatic

00:25:47.680 change. You can certainly see it from the United Kingdom, which as of Monday of this week is

00:25:52.320 essentially what they were calling Freedom Day, that while their cases are going up a lot,

00:25:58.800 the hospitalizations are down. So if you're going to say you're going to have a vaccine passport,

00:26:03.840 you have to prove you're vaccinated. How is this going to be enforced? Is this really to promote

00:26:13.920 public health or is it to discriminate against people who, for whatever reason, can't be vaccinated?

00:26:20.800 How will we accommodate medical exemptions? Because there are people who require medical exemptions.

00:26:26.880 How is this going to be kept confidential? I mean, I am, as I said, very pro-vaccine. I'm perfectly

00:26:32.720 willing to say up front that I am fully vaccinated and was happy to be so. But I don't really want to

00:26:39.040 be giving my medical history to, you know, the guy at the grocery store or to enter whatever.

00:26:48.320 How do we ensure confidentiality? And so public health measures shouldn't be up to individual

00:26:56.480 institutions. And there should be a good public health rationale for it. And if we can meet our

00:27:02.880 public health goals without some sort of a mandatory feature like this, wouldn't that be better?

00:27:12.160 And so I'm uncomfortable with the idea. We already saw with some of the other public health measures

00:27:19.920 that people couldn't comply. And sometimes it was because maybe they didn't understand, maybe

00:27:29.280 they couldn't for medical exemptions, that it really didn't lead to people being kind and saying, oh,

00:27:34.320 okay, you can't wear it for whatever reason. It became very exclusionary and at times almost

00:27:38.960 very unpleasant. Right. We certainly saw a lot of naming and shaming and blaming, which is highly

00:27:45.840 unfortunate. A virus is not anybody's fault. This is a pandemic that's happened. We've seen previous

00:27:50.960 pandemics. I mean, we had H1N1 in 2009. We don't point fingers when a pandemic happens. We will see

00:28:00.240 future pandemics. This is inevitable. There will be another pandemic at some point, maybe another

00:28:06.320 coronavirus. More likely, I would expect another influenza virus. And how we approach this is also

00:28:13.360 precedent for the future. As a society, do we want to mandate health requirements? I mean,

00:28:20.000 maybe the answer is yes. But I think that we should all take a step back and be really thoughtful about

00:28:26.000 what we're trying to accomplish by doing this. Well, what is accomplished is protected.

00:28:31.520 What is accomplished by the vaccine passport? Because I find like, you know, we had a certain 0.98

00:28:38.720 COVID absolutism, if I can use that phrase. So you're at the grocery store and there's one person

00:28:42.800 who's not wearing the mask. Who knows why they're not wearing the mask? Is it that big of a deal?

00:28:47.200 Whatever the reason, medical exemption or the person is just, you know, refusing to do it or whatever,

00:28:51.440 it's like, is it a huge deal if there's one guy who's not doing it? Again, vaccines, we've crossed the

00:28:56.240 80% threshold, as you say, lots of efficacy there, lots of good news to celebrate. So there's a

00:29:01.360 certain, and to your point, the numbers increase day by day, there's a certain catchment of people

00:29:05.840 who are going to not get it for whatever reason. And why are people who are double vaccinated with this

00:29:13.520 very efficacious vaccine, why are they kind of almost stressed about the absence of a vaccine

00:29:20.320 passport to the point of this sort of manic energy that now seems to have possessed some people? I mean,

00:29:25.760 that's the part that kind of concerns me. And that, you know, is the social fabric being

00:29:30.400 frayed a bit with the stuff that I feel like is largely red herring?

00:29:37.920 There has been a lot of anxiety, obviously, in our society over the last year, a lot of fear.

00:29:44.160 There are people who, despite being fully vaccinated and actually being very low risk

00:29:50.000 category for any kind of severe disease, even if they did get COVID pre-vaccine,

00:29:53.840 are absolutely terrified still. And I do wonder if part of this isn't a manifestation of that.

00:30:02.160 I also think that there may be a bit of a misunderstanding with regards to what the

00:30:06.640 vaccines are going to do. And there seems to be on the part of some people thought that perhaps

00:30:12.160 it's going to make COVID go away. It's not helpful. I'm sorry, because I know you're part of the media,

00:30:18.720 but it's not helpful when the media hammers in constantly things like discussing the very small

00:30:25.120 number of breakthrough cases instead of talking about how good they are. We, of course, are battling

00:30:31.600 a lot of misinformation online from all comers. And so there are lots of different features. But I guess

00:30:39.360 if before we did something like just say, we're going to have a vaccine passport, which will be very

00:30:45.920 hard to enforce, it would be very difficult to figure out how to do this, it's going to end up

00:30:50.000 discriminating against certain people, to actually look at, okay, we've vaccinated this many people. This is

00:30:55.840 what we've seen with our hospitalization rates. Which group are not vaccinated? Go in and target maybe vulnerable

00:31:02.080 groups. Is it because of these groups that are already marginalized, that have already got a

00:31:08.800 distrust of the healthcare system? They're already somewhat excluded from many aspects of our society.

00:31:16.720 Instead of further excluding them, maybe it would be far more productive and efficacious and have

00:31:23.600 long-term impact to actually go to those groups and say, okay, what's happening? Why aren't you vaccinated?

00:31:28.640 I know some of the people that have been vaccinated in the clinic are people who were started to be

00:31:33.760 able to come and we had walk-ins because they don't have a telephone, they don't have a cell phone,

00:31:39.680 they don't have a computer. They're very marginalized people to start with. And this is the group that

00:31:45.360 in some ways is going to be most impacted by doing things like demanding vaccine passports. And so again,

00:31:52.480 it's maybe not the kindest approach to public health. It seems an easy one to do, but I think

00:32:00.000 there are a lot of questions about how you would do this and what the point of it is. And this is,

00:32:04.880 of course, why in Ontario, we actually said we didn't think it was necessary at the public health level

00:32:10.720 because we're getting there without the need to do something like this. There are certain sectors

00:32:17.360 within our society where it might be a different conversation. I think asking frontline healthcare

00:32:23.920 workers like me to be vaccinated is actually not unreasonable. As a condition of employment,

00:32:31.280 because I know there's been past situations where nurses unions have actually gone to court over the 0.99

00:32:35.760 flu shot. Yeah. Yeah. We've never done it before, though we are in general required to show that we're

00:32:42.640 immunized against hepatitis B, against chickenpox, measles, mumps, rubella. We have strongly encouraged

00:32:50.160 influenza vaccination. I'm not going to say yes or no, but I have always felt it incumbent on me to do

00:32:59.040 everything conceivable I can to ensure that I don't potentially put one of my very highly immunocompromised

00:33:04.400 patients at risk, which is very different than the general society situation. And it's not from COVID

00:33:10.320 alone. It's this, this, I would have had the same answer 10 years ago, that there are certain areas

00:33:16.880 where I do think there have to be conversations about how best to protect our vulnerable patients.

00:33:22.880 And that would be long term care settings, frontline healthcare workers. So there are groups where I

00:33:27.840 think it's a conversation that could be had, I don't know what the answer will be. Because again,

00:33:31.920 one has to think about how do you deal with medical exemptions? How do you deal with there's all sorts of

00:33:36.400 questions that you need to go through. But to have a vaccine passport to go to the movies,

00:33:43.280 or to go shopping, it seems a little bit unusual to me. Those are low risk settings to start with.

00:33:49.840 This is not where we're seeing huge outbreaks before, we're going to see fewer outbreaks because

00:33:54.720 of the vaccines, we're going to see fewer hospitalizations. So again, when you talk about

00:33:59.040 something like a vaccine passport, what is the reason, the goal? And it's a longer term question

00:34:05.600 I'm asking. It seems sort of attractive, I think, short term. And as I say, I mean,

00:34:12.800 some provinces have decided to do this. A lot of places that started with vaccine passports got rid

00:34:17.600 of them because they realized it was actually very unwieldy, difficult to try to do.

00:34:21.680 But there's also an interesting precedent, as a society, to say that we're going to allow government,

00:34:27.280 we're going to have mandatory healthcare requirements across all segments of society.

00:34:33.040 Which, again, I mean, maybe Canadians want this, but it's certainly I think a very important question

00:34:39.120 to ask. Is this where you want to go as a society to require medical interventions at different levels?

00:34:45.040 And it's fine, it's a pandemic, but this does set a precedent in terms of requiring certain things.

00:34:51.760 So before one, I think, jumps into the idea, I think it would require a lot of thoughtful conversation,

00:34:58.240 a lot of thoughtful debate about how you're going to do it, how you're going to implement it,

00:35:02.480 what the goal is. Will it really change anything? Is doing this going to change the pandemic at all?

00:35:10.560 Will it change any situation? Will we actually have some transmission? Probably not.

00:35:14.720 Not. So these are very important conversations to have before jumping into saying, oh, this is what we

00:35:19.920 should be doing. Well, let's jump into one angle of this, which is vaccines and kids, because there's

00:35:25.440 a lot of perspectives out there and a lot of chatter on that aspect. Vaccines are not approved for children,

00:35:30.640 for small children under 12, I believe, anywhere in the world. In Canada, there is one vaccine,

00:35:35.200 the Pfizer vaccine, which is approved for 12 to 17 year olds. And actually quite a lot of teenagers,

00:35:40.000 a high percentage rate take rate has already unfolded in Canada for that. There's been discussions about

00:35:44.640 risk benefit analysis in terms of things like myocarditis flaring up. And then you take the

00:35:48.880 frequency of that and compare it to the frequency of a risk of having severe COVID in those ages. And

00:35:55.200 that's when you have some medical authorities saying, well, hold on a second, the risk benefit

00:35:59.600 maybe doesn't line up here. And yet we also have people who are still pushing the idea, well, I don't

00:36:04.240 know if I should take my kids back to school because they're not vaccinated yet and so forth. So a wide

00:36:09.200 array of perspective here where a lot of people are saying, and even some jurisdictions saying,

00:36:14.480 we don't even know if we want the kids to be vaccinated or at least to not push it aggressively

00:36:19.840 among smaller age cohorts. How should we talk about this issue?

00:36:25.440 Again, it's a very fraught and emotional conversation or topic. Certainly, most jurisdictions in Europe have

00:36:33.520 decided not to vaccinate all teenagers routinely. They're selecting children with very high risk comorbidities.

00:36:42.160 But they haven't actually broadly decided to vaccinate teens. Other jurisdictions, I think Canada and the

00:36:52.640 US are probably at the front of the line. I believe Israel is also vaccinating teenagers have elected to

00:36:58.080 do this. The conversation when we start to talk about vaccinating younger people is very different, of course.

00:37:04.000 This is not a virus that makes them particularly sick. And so when you talk about vaccinating younger

00:37:12.000 people, you need to be very, very sure that the adverse profile of the intervention, in this case,

00:37:19.840 the vaccine, that is very safe because this is a situation where the risk from COVID is exceptionally low for

00:37:27.760 this group. So you want to make sure that vaccines are exceptionally safe. And this would be particularly

00:37:32.080 important in even younger children and the teenagers, that we don't end up inadvertently causing harm.

00:37:38.080 So the risk benefit conversation, there's an individual risk benefit conversation where

00:37:42.160 there are some people who are saying that they perceive the risk of myocarditis as being much higher

00:37:46.320 than the risk of COVID. And you're saying, I don't want to be vaccinated. I want to wait until we've got final

00:37:50.880 dose of regimens or things like that. The argument for vaccinating teenagers, of course, is that it overall

00:38:04.240 decreases the amount of virus circulating in the population. And these are both, I think, valid

00:38:11.360 arguments. We have come down in Canada saying we would like to vaccinate teenagers because we would like to

00:38:18.080 reduce the overall amount of virus. The countries that have just vaccinated adults did actually see a

00:38:24.960 significant drop overall in numbers in kids. It'll be interesting to monitor that. But again,

00:38:33.520 if our objective is to decrease severe disease, hospitalization and death, we have seen that

00:38:40.400 successfully happen with the vaccine of the adults. If our objective is to get rid of COVID,

00:38:48.080 that's a whole different conversation. We'll see. I mean, I don't know when we'll have enough

00:38:54.160 information on vaccines for younger children. That requires a lot of conversation. They might have a

00:39:02.480 different schedule. They definitely require less of the amount of vaccine. We need longer follow-up,

00:39:10.720 I think, in terms of ensuring that they respond the same way into their safety.

00:39:14.160 And we'll see. But you're right. Not every jurisdiction has decided to vaccinate

00:39:20.400 younger people. And the rationale being that they weren't the people landing in hospital. And so,

00:39:26.560 again, it's a risk tolerance conversation as to whether or not one thinks it's worth it. My perspective

00:39:33.440 has been I will ensure that I answer any questions people have. I discuss the pros and cons. I discuss the

00:39:40.240 possible side effects. And as long as it's an informed decision, I have absolutely no concerns

00:39:47.360 about vaccinating a teenager and certainly have been doing so. But I would also respect the decision

00:39:53.280 of somebody to say, I'd like to defer it or I'm just not ready right now. I want to see for more

00:39:56.960 information. I think that's also a very legitimate response for the very low risk person. Whereas I

00:40:02.080 I would strongly, strongly, strongly encourage the higher risk of members of our society and

00:40:07.600 adults to be vaccinated, it really has fundamentally changed what we're dealing with.

00:40:11.360 Dr. Fulford, one thing that you have spoken about before, and a number of other people in Canada,

00:40:16.320 of course, is about the unintended consequences of lockdowns, the various harms that have been

00:40:21.280 caused in our society in a number of aspects, particularly to children. And we're now getting to a point where

00:40:25.920 there's much more discussion about the things that have been caused a sort of societal damage and toll

00:40:31.600 that this lockdown approach has actually brought upon society now that we're pretty much out of

00:40:36.240 these lockdowns in Canada. What is the task ahead of us, either as a government or for healthcare

00:40:42.240 professionals such as yourself and your colleagues, in terms of grappling with all of this? I feel like

00:40:46.880 there's things that we're probably not even aware of right now that are going to sort of come out,

00:40:51.600 we're going to learn about ramifications for months to come, for years to come.

00:40:56.320 Oh, I think it's going to be enormous. We've missed huge numbers of cancer screening,

00:41:03.440 routine colonoscopy, routine pap tests for cervical cancer, routine breast screening.

00:41:11.600 These cancers don't go away, of course. So there's a lot of concern that we're going to see an

00:41:16.240 increase in cancer diagnoses, but also presenting a lot later, which means that the

00:41:21.600 prognosis is not as good. We have absolutely huge surgical wait lists. This is just on the medical

00:41:32.960 side. We have seen some catastrophic impact on the mental health of children, developmental issues,

00:41:42.320 their milestones, the eating disorders, the depression, the anxiety. And children,

00:41:48.640 because they're developing when they're young and they're teenagers, these are the very formative

00:41:53.360 years. And so this will have an impact for their entire lives. So it's very hard to know what the

00:41:58.560 cost is going to be long term. I think we're going to, you know, be still counting the cost for

00:42:04.240 probably decades. There has been a marked increase in overdose deaths in the last year. There have been

00:42:12.960 an increase in overall sort of drug abuse. We know there have been problems with domestic violence. And

00:42:18.880 of course, we have had spouses, partners, and their children locked into situations that were dangerous.

00:42:25.280 And we've shut down a lot of the support services, the shelters, people people could go to for support.

00:42:35.920 We shut down a lot of sexual health clinics, the STI clinics. So we have already started to see

00:42:43.920 increases in sexually transmitted infections because people just didn't have access to a lot of resources.

00:42:48.480 The economic impact is going to be massive, of course, we've had a lot of lost businesses,

00:42:55.200 we've had financial hardship. And some of the impacts of that take a lot longer. But people's

00:43:00.800 emotional health is very important. People who are no longer financially stable, whose economic situations

00:43:09.840 are now very poor, that has an impact on health, we know very, this is very clearly delineated,

00:43:16.160 the link between economics and health. And the lower the socioeconomic class of person is,

00:43:23.280 the more likely they have chronic health conditions. So there will be a lot of impact from that.

00:43:27.600 And then the debt alone, who knows what that will be. But that's a burden for our children to pay.

00:43:32.720 And these are difficult things to count. I've made this comment before, it's very easy to count

00:43:38.160 a COVID case. It's not so easy to count depression that's going to last for a decade. It's not so easy

00:43:45.760 to count what the impact of an educational interruption is. Two years of lost education

00:43:51.040 is absolutely massive for a child's future. And in terms of overall years of life lost,

00:43:58.240 if you count it over the lifespan of our young people, I would venture to guess we're going to

00:44:03.360 have a lot more years of life lost because of that than we'll have had from COVID directly.

00:44:07.840 But that's a future payment. We don't even know, we haven't even started to count

00:44:12.160 the collateral damage that's occurred in our societies.

00:44:15.760 Dr. Fulford, one thing in terms of long-term harms that people who are still very concerned

00:44:20.240 about coronavirus and are reluctant to, I guess, fully accept the vaccine efficacy and fully say

00:44:26.400 farewell to lockdowns is the phenomenon of long COVID. And there have been, I guess,

00:44:31.200 not as many studies about long COVID as there is about, you know, more traditional,

00:44:34.880 what's going on with COVID and hospitalizations and all those numbers and so forth. So the

00:44:38.960 conversation gets very blurred, I think, talking about this phenomenon of long COVID.

00:44:43.360 To what degree is this phenomenon actually happening, playing out? What is the prevalence

00:44:48.160 of it? And to what degree should people be concerned about this? Is this a big concern?

00:44:51.920 We have people saying, okay, I understand I get double vaccinated. I'm not going to die of

00:44:55.840 coronavirus. That's great. But you know, I still don't want to get COVID. I still got to mask up

00:44:59.760 or what have you because if I get COVID, I could get long COVID and that could be

00:45:04.560 a lifetime of a debilitating chronic issue or something like that, however they conceptualize

00:45:09.440 that. How should we talk about long COVID? So I'm going to refer to it as a post-infectious

00:45:16.800 syndrome. And the reason I'm doing that is very deliberate because we know that post-infectious

00:45:22.240 syndromes happen. We see them after influenza. We certainly see them after the other coronaviruses.

00:45:28.640 There's a gastrointestinal infection called Campylobacter that can trigger Guillain-Barris

00:45:34.960 syndrome and ascending paralysis. A lot of respiratory tract infections that sometimes cause

00:45:42.000 neurologic issues in children. Fortunately, they're by and large very self-limited.

00:45:46.320 COVID. And so the concept of a post-infectious syndrome is not new. It's something we deal

00:45:54.240 with all the time. COVID, of course, has hit us. It's a tidal wave of infections and most post-infectious

00:46:02.800 syndromes do hit four to six weeks later. And so it's not uncommon to start to see post-infectious

00:46:10.160 syndromes. And when you have a huge denominator, you're going to have a huge numerator. So when

00:46:16.000 we think of long COVID, I suspect that we've got more than one thing going on, sort of post-COVID.

00:46:22.960 Anybody who's been in hospital, particularly if they're critically ill, do have problems. And

00:46:29.840 sometimes it's called critical illness myopathies. I mean, we know that this can

00:46:36.640 severely debilitate somebody and it can last a very long time, regardless of why the person was

00:46:41.280 in hospital. We have people who, I think, are just recovering from, not necessarily from being in

00:46:54.400 ICU, but who just have a bit of a time getting over this and it's going to be fine. We're going to have

00:47:01.040 people who truly do have post-infectious syndromes. It's going to be challenging because a lot of the

00:47:06.400 things that we would normally do for people to help them get over what are very real conditions

00:47:12.160 are, one of the things I've often recommended is to try to get back to normal routine,

00:47:18.000 sleep-wake cycle, exercise. People need their support structures. So overlying COVID has been

00:47:27.280 complete isolation of many members of our society. And so it would be very important to ensure that we

00:47:33.120 tease out true post-infectious syndromes from some of the impacts of being locked in, not having access

00:47:43.600 to support structure, not being allowed to exercise, not being allowed to do all the normal things you

00:47:48.080 would do to help yourself recover. So the issues are going to be, I think, very important to acknowledge

00:47:54.560 that we do see post-infectious syndromes. I actually suspect it's not going to be as high as some people

00:48:00.480 fear because we have a large denominator. Most post-infectious syndromes actually get better,

00:48:06.560 do have a full recovery. And what I've seen is usually in the range of three to six months.

00:48:13.920 But it's important to have control groups. In other words, we need to look at people who

00:48:18.320 have not had COVID, and we could do that with blood risk. We can do serology and look at people who have

00:48:23.680 had COVID and actually try to make sure that we understand what is the effect of COVID and what

00:48:31.440 is the effect of everything else that's happened because it's important. And it's important not to

00:48:38.000 label everything as long COVID. It's equally important to understand what is happening in terms

00:48:44.720 of post-infectious syndromes. As I say, I think that if you actually look at, without the emotional

00:48:51.440 overlay, if you actually look at the numbers, they're actually not that high. It is something

00:48:55.760 that does need to be studied and is being studied, but it should be studied with proper control groups

00:49:01.280 so that we know what's from COVID and what's not from COVID. At the moment, there's a bit of a

00:49:07.280 tendency to lump actually anything at all into long COVID, and that's not helpful either because it's

00:49:14.640 much easier than to dismiss a condition if it becomes the all-encompassing everything anybody's

00:49:19.440 feeling. Well, that's clearly not appropriate either. So we need to make sure that we're not

00:49:24.160 lumping in true other medical conditions, that we're not lumping in actual depression or anxiety,

00:49:29.920 which some people are definitely feeling, that we're not actually looking at some other infection,

00:49:36.160 that we're not confusing the situation, that we're not missing other diagnoses. And so the control

00:49:40.480 groups, I think, are going to be very important. Really, if we look at how many people have had COVID

00:49:47.280 in all the different countries in the world, I haven't seen that we're going to see

00:49:56.720 confirmed post-infectious syndromes that are really long. There will be some, but to me,

00:50:03.520 it's looking like it's going to be similar to what we see with other infections.

00:50:06.720 Dr. Fulford, to come full circle, all of these issues we've discussed, which are the current

00:50:11.680 sort of concerns and headlines about COVID-19 during the summer. And as we think about heading

00:50:17.120 into the fall, I mean, is it fair to sum up, generally how you've described all of this is

00:50:21.120 you have an optimistic approach to things. The vaccines are working. You know, yes, there are

00:50:26.480 variants. Yes, there are concerns. There are legitimate concerns. Yes, COVID is obviously a very

00:50:30.880 real thing to be concerned about, but we're empowered now with knowledge, with vaccines, with

00:50:35.040 a path forward, and we should be able to take those productive steps forward now.

00:50:39.920 Well, that would certainly be my take on it. I think we've had a really rough year in a bit.

00:50:45.120 We've learned a lot. There have been some remarkable accomplishments. We have, in Canada anyway, we are

00:50:52.160 in a very, very lucky position because we did get the vaccines and we have vaccinated very successfully

00:50:58.080 because it is a very different story in a lot of places. There are many, many parts of the world

00:51:02.320 where the pandemic is raging, where they haven't been able to vaccinate, and it's a different story.

00:51:10.160 And so we are getting a sort of almost like a, I don't want to call it two pandemics, but we are

00:51:16.160 in a very different position in Canada. We're extremely fortunate. We are going to be able to decouple

00:51:21.760 case counts from severity of disease. We are in a really good position. We probably can move forward,

00:51:29.840 and we are going to be able to coexist with it. And we should be grateful because we're probably over

00:51:36.240 the worst of it compared to very, very many parts of the world. So my take is optimistic. It's not one

00:51:42.240 of saying that you're just going to throw everything out of the window and that we're not going to keep

00:51:44.880 monitoring. But I do feel that we need to acknowledge where we are, and we need to acknowledge that we

00:51:52.560 have to move forward, that we have to look after all aspects of public health. It's a very standard

00:51:58.960 definition of health, which is that health is a state of physical, social, mental well-being,

00:52:04.240 and it's not just the absence of disease. And I think we need to remember that we have to start

00:52:09.120 looking after all aspects of our health, both at the individual and at the societal level. And that is

00:52:14.400 not just the physical, but it's the social, the mental. We need that to be a functioning society. And if we

00:52:19.680 end up in a position where we have caused such harm that we've fractured the fabric of our society,

00:52:25.760 that is not a win. And so we're lucky in Canada that we're in a position where we should start asking

00:52:33.600 and thinking about how we can co-exist with this virus. It will become an endemic virus. Yes, we're

00:52:39.360 going to see cases, but the good news is we're not going to see the massive degree of hospitalization

00:52:46.000 and morbidity mortality that we're seeing in the second and third waves. Dr. Martha Fulford,

00:52:50.720 thanks so much for joining us. Thank you for your time today. Thank you very much.

00:52:56.240 Full Comment is a post-media podcast. I'm Anthony Fury. This episode was produced by Andre Pru with

00:53:01.520 theme music by Bryce Hall. Kevin Libin is the executive producer. You can subscribe to Full Comment

00:53:06.560 on Apple Podcasts, Google, Spotify, or wherever you get your podcasts. You can help us by giving us a rating

00:53:12.080 or a review and by telling your friends about us. Thanks for listening.

Full Comment - August 02, 2021

Time to stop being always afraid of COVID

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