Why Omicron means ‘we have to stop counting cases’
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Summary
In this episode, Dr. Neil Rao, an infectious diseases specialist and medical microbiologist at Halton Healthcare in Oakville and Humber River Hospital in Toronto, and an assistant professor at the University of Toronto, joins us to talk about concerns about a new strain of coronavirus, Omicron.
Transcript
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Hello, I'm Anthony Fury. Thank you for joining us for the latest episode of Full Comet.
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Omicron, Omicron, Omicron. That's all we hear now with the news about COVID-19.
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But what are the facts behind the fears? Are we in for a rough winter? Or is society on the cusp
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of learning to live with the virus? Dr. Neil Rao is an infectious diseases specialist and
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medical microbiologist at Halton Healthcare in Oakville and Humber River Hospital in Toronto,
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and he's an assistant professor at the University of Toronto. He joins us now to answer these
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questions. Welcome, Neil. Great to have you on the podcast. Thanks for having me. Let's get into the
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latest concerns around Omicron. Pretty new variant, but boy, when we first heard about it, the headlines,
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they came pretty heavy. They came pretty fast. And then the travel bans came immediately after that.
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Omicron. Yeah, quite a name. You know, it's interesting that we had travel bans initiated
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even after we knew it was in Canada, and in multiple countries. And now we're up to around 60
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countries. Yet we still have travel bans. And what shocks me is that we have not learned from previous
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mistakes when it comes to trying to stop a virus through travel bans. It hasn't worked with all of
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the other variants that originated abroad. The UK strain, the Brazil strain that didn't take off.
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There was even another South African one that didn't take off. And now this is the next one.
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And yet we still think travel bans and isolating some Southern African nations will solve the problem.
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And we're being criticized proudly by the WHO, by many countries in the world. We are not
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showing diplomatic leadership as a woke country that we're supposed to be.
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But hold on a second. It's interesting because you said we didn't learn the lessons previously,
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but there were politicians out there, opposition politicians, Ontario Premier Doug Ford.
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They were saying to the federal government, we need to learn the lessons from past waves. And
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those lessons tell us we do have to urgently rush to close the borders. And they're saying,
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we didn't do it first in the first wave. We didn't do it soon enough. Now we need to do it sooner
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now with this Omicron variant, but you're saying, well, not so fast. That's not necessarily the
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So if you look at the very first COVID classic from Wuhan, even that virus had spread in numerous
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European nations in November and December of 2020, before we were calling this COVID-19 in March.
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So this vision that we could have kept it out somehow would take clairvoyance. There is a
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collective folly on the part of all political stripes, this belief that we can keep it out
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through travel restrictions. Yes, it originates from abroad. So it's seeded from abroad. But unless
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you lock yourself up and play, say, Cuba, or you play Manitoulin Island, or you play New Zealand,
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you cannot keep this virus out for good. Even New Zealand couldn't keep it out for good. So
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an island nation may have an advantage, but at the end of the day, you cannot keep this virus out.
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As long as you have the interchange of people between yourselves and other places.
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We have an open-ish border with the US. Even during lockdown, we had at least 100,000 people
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a day crossing the border as truckers for commercial reasons, whatever. There's no way you can stop a
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respiratory virus, be it the flu, be it coronavirus, with travel restrictions. These are hold it back
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measures for a while, but they don't stop it. We already have the virus here, and we already
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have people who are vaccinated. So what are we trying to stop? We're trying to stop the wind.
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Dr. Rao, one thing that is kind of confusing about Omicron is there has been disproportionate
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concerns, or greater concerns, I should say, than there were for previous variants. You mentioned
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out of Brazil. You mentioned a couple others. It's not just original Delta and Omicron. There
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were a few others there. We had news reports about it. Oh, here's a new variant. What's going on about
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it? Is it worse? Is it milder? And I feel like we're in a similar situation with Omicron that
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many officials have said, we don't really know what's different about this. Might be more lethal.
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Probably not. I think they seem to be ruling that out, that it is more likely less lethal,
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maybe more transmissible. Why are we having more concerns? Why are we seeing more government action,
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more we must do something in relation to Omicron than, for example, the Brazil variant you bring up?
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What is different about this particular variant that does or does not justify that course of action?
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So that is the $128,000 question for sure. Why is it different? I think part of what's different
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is that they are seeing a lot of people with a prior history of infection being reinfected.
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And I think the other fear is that this is topped onto our acknowledgement and acceptance of the fact
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that the vaccine is leaky. Even with regards to Delta, we're seeing reinfections. We are seeing people
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who have been vaccinated actually ending up being the source of transmission unwittingly.
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So because we have this waning immunity problem, if you superimpose waning immunity, even to Delta
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or any other variant with a new strain that seems to avoid immunity, wow, we're going to have
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exponential growth and we're going to be overrun. That's where the logic falls apart. So yes,
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one thing is probably going to happen. We're going to have more cases of Omicron. That one I can bet
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on. I'm not betting anything on that one because I know that's going to happen. What the impact is
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going to be on the healthcare system is the bigger point of the date. So let's go back to what's
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happened with all variants. Initially, they said they're more transmissible and they might be more
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deadly. And they are initially more transmissible because there are fewer people immune to the new
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variant. And then as time goes on, we realize that immunity builds up either through natural
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infection or through vaccination. And in fact, they're not as deadly as we originally thought
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because we identified the sickest patients first. And then we realized there's a whole bunch of mild
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cases out there, which softens what seems to be a deadly strain to a strain that sometimes can kill,
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but it's not as deadly as we first thought. I think the same kind of thing may happen here with
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Omicron, except that they found the disease more in younger people and mild disease. And probably what's
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going to happen is that in some places you're going to see severe disease from Omicron because
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COVID seems to pick off people who are older and those with immune system problems. There's a huge
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slope of risk that increase as you get older. The difference this time is that people are either
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vaccinated or have seen COVID classic or COVID alpha or COVID delta for the most part. So if you don't
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have what we call an immunologically naive population, a population that has never seen the
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virus like Bergamo, Italy, in February 2020, you're not going to see Bergamo, Italy or New York City,
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you're going to see some impact on the healthcare system, but it's not going to be a tsunami. So what
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do we need to worry about? We have to prepare a healthcare system for the potential of a surge again.
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Hopefully we plan for the worst and hope for the best. We learn from our lessons of surge
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planning last year and improve on it and create more intensive care unit capacity in every province
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of Canada. And we watch this, but we don't resort to some of the other blunt instruments to try and
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control it like travel bans and slowly school closures and lockdowns and trying to shut down
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society. Because at the end of the day, you can't stop this virus for good. Someone compared this to
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being attacked by a swarm of bees and going underwater. And then you come up for air and the bees are still
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there. And that's what this is turning into. This virus can't be stopped. It can't be eradicated.
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The COVID zero folly has been completely debunked now. Even the original COVID zero proponents have
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admitted that this was an impossibility. So we have to, to some degree, live with it. And we have to
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mitigate rather than trying to eliminate the virus. What to do to mitigate is the matter of debate.
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And you're going to see different opinions from different experts on this.
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On an individual level, there's a lot of questions about, should I be concerned? Should I be anxious
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moving forward with Omicron, moving in to the holiday season? Dr. Rao, would you say that a person
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who is not a senior, younger than a senior, and who is vaccinated against COVID, should they increase
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their level of alarm right now? Or should they not be concerned?
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I don't think they should be concerned from an individual risk perspective. From the perspective
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of the potential to transmit to other people, yes, there is a theoretical concern. But on the other
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hand, if those other people have been vaccinated with at least two, if not three doses of vaccine,
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I don't think it's such a big concern. Now, if you're a healthcare worker, and you're working in a bone
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marrow transplant unit, or you're working with elderly people in a long-term care facility, and you have
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this disease, if the people you're working with have not received three doses of vaccine, or don't respond
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well to vaccine, we could see transmission in healthcare settings for sure. So that's a concern. But that's a
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very isolated part of the population. That's not the whole population. So we can't tell everyone to stop
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celebrating everything because of this isolated concern, which is a serious concern for me as a
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physician. But at a societal level, looking at this from 30,000 feet above sea level, I don't think it's
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as big a concern. From an individual risk perspective, we're even attacking now kids with
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vaccinations. So we're going after that whole population, whether it makes sense or not, because
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we fear long COVID in children. So we're even targeting that age group to protect them from the
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remote potential of long COVID if they get this disease, but they don't die from it.
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So the vaccine still has some value, even against variants. I suspect that even with the Omicron,
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there's going to be partial protection, but it won't be as good as it was against COVID Classic or some
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of the other variants. Perhaps, but time will tell. Dr. Rao, you used the phrase leaky vaccine. Now,
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in previous months, the big push for getting pretty much everybody vaccinated,
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the justification for vaccine passports and vaccine mandates was that a vaccine is not just
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protecting you from having a serious outcome, but it is significantly limiting transmission,
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your ability to transmit the virus to others. Now, there seems to be more of a question mark
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lingering over that as we see stories of there was a party, there were 50 people there, they were all
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vaccinated, half of them have tested positive for COVID-19 after that party. What does leaky vaccine
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mean now? And how do we approach the idea of your vaccination? Okay, you feel you maybe don't need
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it, you're in the prime of your health, but you're getting it to protect others. Where does the science
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stand on that now? So I want to say how this originated. First of all, we thought this was like
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the measles vaccine. The initial reports with the Pfizer trials showed 95% of vaccine efficacy,
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enviable numbers. But then we realized those Pfizer trials, the Pfizer vaccine that many of us have
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received, were actually looking only at people with symptoms. So if it prevents symptomatic infection by
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95%, that's lovely. But we didn't look carefully at people who get the infection without symptoms.
00:11:10.580
And some of the British trials with the AstraZeneca vaccine started to show, even in the early days,
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that it was more like 60 or 70% vaccine efficacy, not 90%. And then what happened over time is we
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realized that the vaccine efficacy looks really good. If you give people the vaccine in the middle
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of an outbreak. But as time goes on, there's waning immunity. So in other words, you're not current
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after about six months, the way you were six months ago, it doesn't mean you're down to zero. But it's
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almost like the tank of gas is slowly being used up as the car is running. So you're down to half tank,
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or maybe 60% tank. And so once you have a sizable proportion of people who don't have complete
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protection, even vaccinated people can be infected. They can be unwittingly transmitters. And in fact,
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when they're infected, they often are infected without symptoms. So they keep marching in and out,
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all that symptom screening you do and temperature screening you do doesn't stop you from being
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exposed to them, they can walk into a restaurant, they can walk into a long term care facility,
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they can walk into my hospital. And there's nothing you can do to stop that it doesn't mean
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they shouldn't get the vaccine. But you have to accept and manage our expectations of what the
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vaccine will give the way the vaccine could reduce transmission and probably does to some degree,
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is that it does decrease your risk of getting infection by say 50 or 60% rather than 90%. So
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if you don't get infected, you can transmit. But once you do get infected, if you're the other group
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that gets reinfected from having had infection before, or if you're the group that gets infected
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despite being vaccinated, you still can transmit. There were examples early in the summer, in Cape
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Cod, where there was a big party fest in Provincetown, Massachusetts, where they found that people who
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were vaccinated seem to be transmitting as much as those who weren't. And the arguments, oh, wait a
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minute, people who are vaccinated, their virus level goes up and down for a shorter period of time
00:13:02.760
than those who are not vaccinated. And then there was a British household study, which kind of was
00:13:09.460
the nail in the coffin for that belief, showing that if you are vaccinated, and you have the disease,
00:13:16.360
you transmit as easily to household members as those with natural infection. Or as those,
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so actually, let me just retake that again. The British household study showed that if you're
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vaccinated and you have disease versus someone who is naturally infected, the rate of transmission
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to household members was similar. So the vaccine doesn't reduce transmission if you happen to get
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infected. And so you had a household study plus the Provincetown, Massachusetts, Barnstable,
00:13:47.040
Massachusetts outbreak. And these were sad stories that kind of were the end of innocence. It was no
00:13:52.480
longer the measles vaccine. And now we have to take stock of this and accept this, manage our
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expectations. It's good that we have achieved almost 90% vaccination rates in people over 12.
00:14:05.260
But we are not going to be able to vaccinate our way out of this pandemic. There will be new variants
00:14:10.520
even after Omicron that come their way. This virus has the ability to mutate to change itself.
00:14:17.400
The virus is almost like, I jokingly say, it's like the iPhone. You know, there's a new version
00:14:22.240
of the iPhone. Once the market is saturated with enough iPhones, it creates a new version. So it
00:14:27.460
can get into the hands of more people. That's what this virus is like. Once enough people are immune
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to it, either through vaccination or through prior infection, this virus will evolve and create a new
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variant. There's a belief out there that the reason variants form is because we haven't vaccinated
00:14:42.340
enough people in underdeveloped countries and Southern Africa. But let's not forget that the
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alpha variant emerged in the UK when they had some of the highest vaccination rates in the world compared
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to other countries. So high immunity is also a form of evolutionary pressure against the virus
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to evolve and make itself more infectious. The virus's goal is to infect more people. So if there's a
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mutation that compromises the ability of the virus to infect more people, it's not going to prosper.
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It's going to be like a fringe political party. If the right mutation occurs to transmit more easily,
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it becomes a major political party. It's a little bit like political parties developing popularity
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from grassroots. You know, it's en masse in France coming from nowhere. So it's that idea that you can
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get the right combination of mutations to allow for more transmission, even amongst a previously
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immune or partially immune population that drives these variants. Omicron is going to be something
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that comes and goes. You're going to have waves at different times in different countries.
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And we need to see what the impact is on hospital admissions and on deaths. We have to stop counting
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cases because you can end up with a situation where there are lots and lots of cases, but with not so
00:16:00.880
much health impact in populations that have either seen other variants or that are highly immunized or that
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have been hard hit in the past. Dr. Rao, you mentioned the phrase age of innocence, and that
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really stuck out to me because I think a number of months ago, the overwhelming vast majority of
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people were of the opinion, all right, there's vaccines available. Hallelujah. Line up. Let's get
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them. Let's post our selfies of us getting them, and then we'll get the second one. And then we're
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pretty much done with this. Now, opinions are splintering a little bit beyond the way they were
00:16:31.840
traditionally splintered. I think previously people who were happy to go along with everything
00:16:36.080
now are raising their hand with a few questions. I want to read you two news headlines I have in
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front of me here, both very recent ones. CTV News Vancouver. Some BC residents will be eligible for
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a fourth COVID vaccine dose, officials say. And then I've got CNBC over in the US. Pfizer CEO says
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fourth COVID vaccine doses may be needed sooner than expected due to Omicron. Now, if I can extend your
00:16:57.160
your new iPhone example there, I think there are some people who say new iPhone, got to get it right
00:17:02.880
away, got to get the new thing. And other people who say, I don't know, I have the iPhone from two
00:17:07.260
ago. It's really not that different from the new one. Like, I guess I'll get it when this current
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phone dies. I'm not going to be the person who lines up in the tent in front of the Apple store
00:17:14.280
not doing it. And I feel like with the vaccines, there's a split of opinion. Now there are many people
00:17:18.820
who say, all right, give me the booster shot as we're calling the third dose. And maybe those people
00:17:23.520
say, all right, give me the fourth shot. There are others who say, you know what? I got the two
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doses. I feel fine. I'm just not concerned about this stuff anymore. It's just not a priority.
00:17:32.360
I'm not lining up for the subsequent ones. How should people be conceptualizing all of this now?
00:17:37.960
Well, it comes from the top. I think public health has to manage expectations. I think that's where the
00:17:43.380
problem is. If we keep going with the mantra that collectively we can beat this, collectively we can
00:17:48.440
stop this, we will have confused messaging. I think it's better to say congratulations to those of
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you who at least got two doses. We have achieved a massive, massive milestone. And let's target those
00:18:01.240
who we think are at risk with waning immunity. And we have some experience even with Delta as to who
00:18:06.600
can be hit hard, even though they are fully vaccinated. I saw a case of someone with a kidney
00:18:11.780
transplant in ICU, and she had been immunized four months ago with her second dose. So there are certain
00:18:18.080
people who don't take well just to two doses of vaccine. And it's appropriate to go after those
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people. We've gone after long term care in Canada and generally done that with third doses makes
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sense. The problem is when you universalize this like const categorical imperative, you kind of run
00:18:35.660
into a problem because what's your endpoint? As you said, then maybe we need a vaccine 2.0 Omicron
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derived vaccine. Are we going to do a nationwide revaccination campaign? That's not practical.
00:18:48.760
And also, what is the return on investment? I'm not even talking about money. I'm talking about
00:18:53.480
from a health outcomes perspective. And then in a way, money as well, and logistics. What are we
00:18:59.400
going to do? The other thing is, are we going to start making people's vaccine passports expired,
00:19:04.120
like a passport, and you have to reapply and show that you've got a third or a fourth dose?
00:19:08.940
This is a slippery slope. I think we have to ask questions, take stock of where we are,
00:19:15.860
gather information about Omicron in terms of its impact, look at where the impact is greatest.
00:19:20.920
One thing that's clear about all variants of COVID so far is that there is a huge impact on people who
00:19:26.460
are older. There has never been a variant that has started to take out young people. It's not
00:19:31.180
like influenza. That's clear, any variant. So why would Omicron suddenly be different? Even in South
00:19:37.140
Africa, lots of cases in young people, but we're not hearing about mass casualty deaths amongst
00:19:41.860
young people. There probably will be somebody with failing kidneys, who's 35 years old, who gets taken
00:19:46.620
out, put in an ICU and dies. Yes, that's possible. But I think in general, the overall template of how
00:19:54.340
this virus infects people, Omicron or not, is predictable now, where we're almost two years into
00:19:59.680
this. So I think we can make inferences and take stock of where we need to protect. I know it sounds
00:20:04.500
like focus protection, which sounds very Great Barrington. But at this time, I think a Great
00:20:10.680
Barrington-esque way of looking at this is not unreasonable. I think it's time for the whole
00:20:15.980
population, but public health leaders to start accepting this type of language. The more we move
00:20:21.700
away from bellicose language, we can beat this, we can eliminate this through our collective actions,
00:20:26.360
we can all stop this. The more we can move to a more nuanced, balanced approach, a mitigation
00:20:33.080
strategy, the better we will be. But I don't see that change happening yet. And unless other
00:20:37.980
countries start it, we've got a problem. We'll be back in just a moment after this message with
00:20:42.560
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When you say focused protection, if I can summarize, and let me know whether this is an accurate
00:22:05.700
summary or not, basically, if you are someone who is very much at risk of having a serious outcome
00:22:11.660
of this, your health profile, you're very elderly, you have some comorbidities, maybe you might want
00:22:16.000
to take some extra precautions, particularly during respiratory virus season, but if you're a younger
00:22:20.480
person, 20s, 30s, 40s, I don't know, 50s, you've got the vaccine, well, we're not shutting down any
00:22:26.380
stores or schools or businesses if you start to feel symptoms of something. Maybe you should get
00:22:32.200
tested or please stay home, so whatever you have, whether it's COVID or the flu or the cold, you're
00:22:36.580
not spreading it to others, let's be a responsible, health-conscious society. But otherwise, if you're
00:22:41.180
not someone who's needing that focused protection, live your life.
00:22:45.840
So, Grandpa, give your hockey tickets to your grandchildren. That would be an idea if Omicron
00:22:51.040
becomes a big wave. That's something I said in the early pandemic, and it wasn't well accepted,
00:22:55.600
but I think at this time, that's an option if you're really scared, having had three doses and
00:23:01.040
you're 80 years old, and you still think that this could take you out, fine, give up your hockey
00:23:05.760
tickets, so don't go to those big mass gatherings. But you have to still shop for groceries. You can't
00:23:10.560
use Uber Eats for the rest of your life. You know, at some point, you have to live, but you can make
00:23:15.280
decisions that reduce your risk a little bit. You can decide to wear a mask vigorously and even go for
00:23:21.320
the N95 mask. It makes you feel good. It's hard to do, but you can do it. But at some point, we all
00:23:25.900
have some risk tolerance. And you can also decide to cut off all of your younger family and not see
00:23:29.680
them for Christmas. But what about quality of life, not just quantity of life? I mean, having bonding
00:23:35.440
with your family members as a grandparent can be a big deal. And losing that for a whole year or as
00:23:40.600
many have or a year and a half, I think at some point, life goes on and you need to have those quality
00:23:45.340
life experiences, not simply just living numerically longer years. One of the most tragic
00:23:50.940
things that I have seen during the pandemic is those reports of family members who said that
00:23:55.840
their mother, their grandmother, a person in their late 80s, person in their 90s, there were about two
00:24:01.080
or three examples of this that were publicly discussed. People put them on their Instagram
00:24:04.740
accounts. I suspect there's probably a couple other examples that didn't get news stories written
00:24:09.440
about them, where that elderly person said, I'm actually going to opt to end my life now because
00:24:15.720
I do not want to go into a lockdown. I don't want to be cooped into my room for 14 days. It's not
00:24:20.140
quality of life. I would rather spend time with the grandkids. That is being denied to me. And there
00:24:24.000
were actually at least two examples of a doctor-assisted suicide from persons in long-term care facilities
00:24:30.640
who said, I'm checking out because of this second wave or third wave lockdown.
00:24:34.100
Well, the unintended consequences are manifold and it took a long time for the news cycle to start
00:24:41.200
realizing this. And these are sometimes not measured in numbers. They're just anecdotes
00:24:45.840
and cause and effect between mental health outcomes and COVID are hard to draw straight
00:24:50.860
lines between. So therefore people say, hey, it would have happened anyway. And they justify this.
00:24:55.580
But there is an obsession with COVID-related mortality at the expense of everything else,
00:25:00.580
including delayed care, delayed surgery, delayed diagnoses. We now hear about it, but the cause
00:25:06.960
and effect arguments are sometimes ignored. And I hope we don't repeat those mistakes. Another
00:25:12.260
bigger mistake I see being made now is the drastic use of quarantine. And it sounds minor, but the
00:25:20.180
consequences of quarantine are massive. So let me give you an example. You've got a healthcare worker
00:25:24.640
who gets exposed to a case of Omicron in the community or at work. I say, hey, your vaccine isn't
00:25:30.280
really foolproof. Stay off work for 14 days. And you keep doing that in every single industry.
00:25:36.660
Slowly, it's a game of the cooties, right? Everybody's at home with their kids. A kid comes
00:25:41.880
home with Omicron. The parents are now isolated with them. You can't staff anything. You can't
00:25:47.660
drive up. You can't get buses going. You can't get subways going. You can't get people to work
00:25:52.300
because public transit doesn't work. Some of those people going to work happen to work in long-term
00:25:55.940
care. People who are elders in long-term care get ignored because they're poorly staffed.
00:26:01.780
People can't run food industries and services, supply chain. There are a whole bunch of nefarious
00:26:06.480
consequences, absolutely nefarious consequences of overuse of quarantine. And what I see with Omicron
00:26:13.040
is a complete loss of faith in the vaccine to the point where even if someone's vaccinated, we decide
00:26:19.540
they should be set aside. This, to me, is the tsunami that's coming. It's a tsunami of quarantine,
00:26:25.880
not of the disease. We're even doing it for travelers now. We're saying even if you're
00:26:30.020
vaccinated, you have to go home and isolate until you have a negative test. So we started
00:26:35.140
now in a way to treat vaccinated people as if they're unvaccinated, at least for a few days.
00:26:40.460
So if we start treating exposures to Omicron differently from exposures to non-Omicron, we are down a
00:26:48.160
slippery slope. And I really fear this as the biggest consequence of the response to Omicron.
00:26:53.720
One of the things that I was consistently fearing is that public opinion would never evolve beyond
00:26:58.780
accepting continual lockdowns. And I am someone who always appreciated the argument for focused
00:27:03.320
protection and things that Dr. Sinitra Gupta was arguing from the beginning, one of the leaders
00:27:08.440
of the Great Barrington Declaration. And it always disheartened me that public opinion, if you believe
00:27:13.700
the polls in Canada, was typically that two-thirds of people were very much in support of closing
00:27:19.860
schools, doing this, doing that, locking down. And one-third had some caveats. Recent polling
00:27:25.800
suggests that we are finally seeing a shift. I'd like to read to you, Neil, some numbers from a
00:27:30.640
Maro public opinion poll, asking Canadians a variety of questions. I'll read a couple of them to you.
00:27:35.840
I'm already having to cancel or postpone travel plans because of this new COVID-19 variant.
00:27:42.200
72% disagree. The new variant is causing my workplace or my ability to work to take on new
00:27:48.560
precautions. 73% disagree. Whatever this new COVID virus variant may be, the current vaccines or
00:27:55.780
people's own immunity will protect them from what it could amount to. 62% agree. So we have a situation
00:28:03.800
where it seems things are flipping. And now it is two-thirds of people who are saying,
00:28:09.000
okay, this is a real thing. We hope to take some precautions, but let's live our lives now.
00:28:15.620
Well, that's a good thing. I think when it comes to travel, because we live in a country which has
00:28:19.840
a not-so-great climate at least half of the year, when you impair people from leaving this climate who
00:28:25.880
have the means to do so, you create hostility. And some of those people are voters on the left,
00:28:32.520
not just on the right. They're not just the evil rich people. And so once you start hitting the
00:28:38.060
entire electorate and inconveniencing the entire electorate, as a politician, you have to be careful.
00:28:44.100
Because right now we had a situation where this was very polarized along political lines. It was
00:28:49.820
seen as very left-wing to be pro-lockdown, pro-containment, and it was the evil Trumpian view
00:28:56.200
that we would let it rip. And even people like Sunitra Gupta, who you spoke of, was actually a
00:29:02.400
left-of-center Brit. She was being criticized as being Trumpian, ironically. But now we're starting
00:29:08.240
to see across all political lines that people are having some skepticism and concern that this is
00:29:14.340
a never-endum. So I think that's a positive thing. I'm also seeing in some of the other mainstream
00:29:20.300
media publications in Canada, an openness to seeing the other side of this, talking even about
00:29:26.160
moving goalposts in the CBC, or some columnists in the Globe now saying that, you know, that the
00:29:30.940
patience is wearing thin, and we need to think about other strategies. So maybe the debate is changing,
00:29:36.620
but I still think it's extremely political, and it's seen as very woke to chase down every case of
00:29:41.980
COVID. And unless public health leaders change their messaging, I don't think it's going to change
00:29:46.360
in Canada right away. Or unless the US starts shifting away from trying to be containment
00:29:52.380
focused without saying it, or everyone will ignore what's happening in Britain. But unless other more
00:29:58.100
socio-democratic governments in Western Europe start doing the same thing, I don't think we're
00:30:03.480
going to change so much. We seem to look to our left and look to our right and find the most cautious
00:30:07.740
person and emulate them and even exceed them. That seems to be the culture right now of our federal
00:30:12.760
government. Let's see how long it takes our government to lift the travel ban to those
00:30:17.640
Southern African countries. It'll be interesting. I think we'll be the last.
00:30:22.300
And yet you're basically, you began our conversation basically saying you'd lift them right away.
00:30:27.400
At least the travel ban I would. As for the testing, I think we could use antigen tests at the airport
00:30:33.000
and get people out of jail right away. We can't keep using PCR tests over and over again. PCR tests pick
00:30:39.020
up people with historic infections as well. It may be more sensitive to be used in a hospital setting
00:30:44.400
when I'm trying to figure out if a patient has it. When it comes to screening people without symptoms,
00:30:49.160
PCR encourages delays, cost, and inconvenience for people. And sometimes it even finds things
00:30:55.700
that don't matter. The next thing we're going to do is PCR kids at school and eliminate them because
00:31:00.040
they had an infection four months ago that doesn't matter today. That's the next faulty with testing
00:31:04.380
that I see coming. We're going bananas with testing. There's even a clarion calling out to
00:31:08.880
offer antigen tests to parents, which sounds great. But before you know it, it'll be permissive. If you
00:31:13.500
don't have an antigen test negative, you can't come to school. We're going to be creating an NBA bubble
00:31:17.700
of schooling. I'm very worried about that. The consequences are massive. What's happening in
00:31:22.900
Toronto is kids are going to be sent home with rapid tests over the Christmas break. Each kid will get a
00:31:28.580
certain number of tests. And I say, okay, fine. If there's a scenario where you go, man, I think my
00:31:34.480
kid has COVID right now. What do I do? Having a test at home is more convenient than having to go
00:31:40.460
line up at a medical center. I take the point on that. But I do find sending tests home for kids
00:31:47.320
who have been completely healthy for the past two years, a little creepy to be doing right now. I say,
00:31:52.780
what am I going to be doing with these tests lying around in my house?
00:31:55.280
Well, I mean, the CDC was covering a doctor who thinks this is just terrible, but we don't have
00:32:00.660
enough tests available for the general public. And that's been on Twitter yesterday. It's amazing to see
00:32:05.240
the loss of what we call diagnostic stewardship. I'm speaking now as a medical microbiologist.
00:32:09.920
You can't test the planet. You can't test everyone. You have to have selective strategies.
00:32:13.920
You need to make inferences by testing a few people to decide what's going on in a population.
00:32:18.720
Just like a political poll, you don't phone every single voter before an election to find out the
00:32:22.620
popularity of a party. You take a sample, a representative sample. The idea of testing
00:32:28.180
people without symptoms, a seek and destroy approach to stop what is the sniffles for most
00:32:33.620
kids, like it or not, is crazy. I think we have to be more strategic. It's one thing if you have an
00:32:38.380
outbreak, if you use testing to let kids stay, as they've done in New York City, and as we are
00:32:43.100
starting to roll out here. But once you start sending tests home, there is a slippery slope where we
00:32:48.740
will say, unless you have a negative test, you can't come to school. The loss of schooling is
00:32:53.740
one of the biggest, biggest errors of COVID-19. And our country is no superstar in this area. Some
00:33:00.280
provinces were better than others. BC was better than Ontario during wave two. But we have made a
00:33:06.460
blunder keeping kids out of school through COVID-19, as has the US. And we cannot repeat that mistake
00:33:13.820
because of Omicron. The schools must stay open, just as the trains must run, just as the buses must run,
00:33:18.820
just as grocery stores must stay open. They're like an essential service. And testing is almost
00:33:24.320
a dangerous tool that can be misused. Neil, you referenced a doctor appearing on television saying
00:33:30.300
alarmist things about testing. What is your sense of where the medical community at large is at right
00:33:36.880
now? You were an early voice speaking out for a more balanced approach and a more evolved response
00:33:41.720
to COVID-19. It was always unclear what the general medical opinion was, because there's been a lot of
00:33:47.260
doctors vocal on Twitter, getting their likes, getting their retweets, getting their invites
00:33:51.420
onto the news to say more alarmist things, to tell people how they should be living their lives.
00:33:57.200
But there were many people in the medical community I heard from them. They wrote to me.
00:34:01.200
Many of them were very senior. Many said, please don't quote me, who said, we're not so sure about this
00:34:05.700
direction. And I can't help but feel that the number of people in the medical community who are now
00:34:11.000
saying, guys, let's get over this. Let's do the focus protection, that that number is only increasing.
00:34:16.480
What are you seeing and hearing from your colleagues in the community?
00:34:20.540
So yes, it's increasing, but I still think it's a minority view. And I still see a lot of this.
00:34:25.900
I see a lot of this, you know, keep it quiet. I feel this way. I don't want to say it. Don't quote me.
00:34:31.440
That's the problem. And then the other thing is the people on Twitter get disproportionate media
00:34:36.660
attention. It's almost an advertising service for the media. In fact, maybe Twitter should just start
00:34:40.640
their own news service and take out the middleman. No ideas. No ideas. I'm being sarcastic. It's a sad
00:34:49.040
loss. It's a sad loss of journalistic integrity. If Twitter is the is the fountain of experts,
00:34:54.940
and the fountain of information, if news becomes a synopsis of Twitter, we have descended into madness,
00:35:00.800
we've lost our fifth estate. So there is no question that if you look at media in Canada,
00:35:07.620
my view is still a somewhat minority view. I think it was maybe a fringe view at the beginning. Now
00:35:13.240
it's a minority view. But there are a number of doctors who are starting to slip who contact me
00:35:19.160
as well and say, you know, this is getting to be too much or can't we give up on at least this?
00:35:24.120
I think denying the value of vaccine and imposing restriction on people, despite vaccination,
00:35:30.080
having instituted controversial vaccine passports, I think that will be the breaking point,
00:35:35.640
even for some doctors, but definitely for society. The other thing is a lot of doctors' views are
00:35:40.500
shaped by how society feels about their views. So people who are on the news as physicians, if they
00:35:45.680
have a stringent view, but the population is moving to a more relaxed view, they become unpopular. The
00:35:51.460
news producers don't put them on because they get negative feedback. So there's sort of an
00:35:56.440
interaction between public opinion and what the doctors say as well.
00:35:59.900
I find it very interesting how the news discussion has been here in Canada, because if you open
00:36:05.620
the New York Times, the Washington Post, New York Magazine, I can go on, pretty centrist,
00:36:12.100
liberal media, read by many Democrats. They have a lot of news features, op-ed columns,
00:36:18.000
investigative pieces asking, do teenagers actually need to get two doses of the vaccine?
00:36:23.080
Are masks actually effective? What's the point of school closures? I'm not saying those are
00:36:28.080
necessarily their editorial positions, but they're breaking down all of these big picture conversations
00:36:33.040
and looking at all sides of it. And that's a very normal thing for them to do. And that's perhaps
00:36:38.000
what's empowered many U.S. states to live more normally. I get the idea early on, let's all make
00:36:43.840
fun of Florida and say it's Trump this and that. Bottom line is most states right now are living more
00:36:49.720
or less like Florida. Many very left-leaning states, democratic politicians are flat out speaking out
00:36:55.420
against things like vaccine passports. Yes, I know some governors are bringing them in,
00:36:59.340
but it's far more nuanced there. The conversation is leagues ahead of where we are here.
00:37:05.580
Well, you have a big mosaic in the U.S., many different states with their own governance
00:37:09.960
and their own ability to make decisions, which maybe is a great thing. And I think in Canada,
00:37:13.920
there's not so much diversity of practice. At the beginning, I think between BC and Alberta versus
00:37:19.600
the rest of Canada, there was a difference. Right now, there seems to be a homogeneity in terms of
00:37:25.020
public health measures and practice. It doesn't feel too different to be in one place or the other.
00:37:30.320
Alberta got roundly criticized for trying to be more pragmatic, but the rise and fall of Alberta's
00:37:36.040
epidemic may not have so much to do with the reinstitution of restrictive measures as people
00:37:40.420
think. There are other natural history elements to COVID-19 that people forget. Wave one ended without
00:37:46.900
masks and without vaccine mandates. People forget. Our memories are short. But then once we have all
00:37:53.820
these things, we say things improved because of these mandates, because of these measures.
00:37:58.840
Teasing out cause and effect is one of the worst things with COVID. It's almost like I can find a
00:38:04.220
story that fits my conclusion because there's such a variety of outcomes. Like you've got Sweden with
00:38:09.420
lower vaccination rates, not seeing a resurgence, probably because a lot of the population has seen
00:38:13.880
the actual disease. You've got Ireland with any people vaccination rates still having an outbreak.
00:38:19.040
We don't talk about that. When Austria has a bad outbreak, we say, ah, see, they've got lower
00:38:23.520
vaccine rates. That's why they're having an outbreak. So we pick and choose the story that
00:38:27.740
fits our narrative. That seems to be the pattern of COVID. You make such a good point about the masks.
00:38:31.840
I vividly remember it was May 2020. So there you go. Two months after we started lockdown and I'm
00:38:37.860
walking around in the stores, no mask. And it wasn't until in Ontario, either the end of May or the very
00:38:43.880
beginning of June, where masks were mandated provincially. And that's why I've always had a
00:38:48.300
bit of a problem with the mask mandates. Cause I'm like, well, back when we thought this thing
00:38:51.860
actually could have been say, you know, killing younger, healthy men in their prime, such as
00:38:55.920
myself, I wasn't even wearing a mask then. And it wasn't mandated. And yet now I have to kind of
00:39:00.540
wear it absolutely everywhere by threat of law. Well, so yeah, we, again, it's, it's the categorical
00:39:06.440
imperative of Kant that I was referring to, you know, if it's good for a few, it should be good for
00:39:10.540
everyone. That's the craziness of this. Um, if we said with masks, look, let's look at people who
00:39:15.540
are front facing a server, uh, someone who is in a confined setting all day and they haven't been
00:39:22.920
vaccinated. You need to mask until then. That would make some sense, but we just went hog well to have
00:39:30.120
everyone doing it. And we had cloth masks, which don't filter very much. We had people enjoying making
00:39:35.580
masks that would have their own personal design, like sort of a fashion statement. It became
00:39:40.380
a collective folly, but I think our society wants something to glom onto as a collective
00:39:47.300
act. Like I think organized religion has been replaced by this desire for collective social
00:39:54.080
media action against a cause. And it's filling a void. It's providing succor to people that you can
00:40:00.600
be part of something bigger by collectively doing something. And social media has almost become the
00:40:05.680
pulpit. What happens next? The holiday season is upon us. We've got traditional respiratory
00:40:13.140
virus season, January, February munch. It seems inevitable that we're going to see cases increase
00:40:20.560
hospitalizations. I think the case counts are going to go up. Yes. I mean, either due to Delta
00:40:25.140
or this, the only thing is what could happen. Here's the silver lining. January rolls around and more
00:40:31.920
people have seen the virus and there's more immunity. Or maybe it goes on till February.
00:40:36.540
And then you're on the downside of the epidemic curve. And that is the propitious timing, the
00:40:42.240
opportunity for governments to start lifting restrictions. You can't do it on the upside.
00:40:46.620
You have to do it on the downside. So maybe this is when we will start to see a change of thinking,
00:40:54.040
a decision that certain things can't be reinstituted. The Ontario government tried to do that a bit.
00:40:59.620
I think they've held to it to some degree, saying we won't go backwards, but we will abstain from
00:41:03.660
liberating more. So at least they didn't have to go backwards. Maybe you will see that kind of
00:41:09.360
progression. I think also what could happen is that other countries, especially in Western Europe,
00:41:15.180
and it's not Boris Johnson, the Trumpian, it's other, it's Macron doing this. Maybe they start
00:41:22.760
saying we can't keep doing this. Even in Spain, BBC was quoting someone in Spain saying,
00:41:27.160
you know, we don't need vaccine passports because we have such high vaccination rates anyway.
00:41:31.460
Why are we doing this? And we still have an outbreak anyway. So maybe we will start to see
00:41:35.480
a change and a move away. I think it's going to be a long time for some restrictive policies to go
00:41:40.420
away. I've made an analogy with speed limits. You lower a speed limit, it can take years for it to
00:41:44.540
go back up. Take the 401 in Ontario, all right? It's going to be a bit like that, where it takes a
00:41:49.280
long time to rescind a restrictive policy. That's my political science way in here, that I think it's hard to
00:41:56.020
reverse restrictive policies in general for governments. It's much easier to be strict.
00:42:03.200
Worrisome stuff. And I think you've been proven true by that in the past 20 months. Dr. Neil
00:42:07.320
Rout, this has been a great conversation, bringing us up to speed on what we do or do not need to
00:42:11.760
worry about with Omicron where we will head in the next couple of months with COVID-19. Thank you for
00:42:16.480
joining us. Full Comment is a post-media podcast. I'm Anthony Fury. This episode was produced by
00:42:23.120
Andre Pru with theme music by Bryce Hall. Kevin Libin is the executive producer. You can subscribe
00:42:28.800
to Full Comment on Apple Podcasts, Google, Spotify, and Amazon Music. You can listen through the app or
00:42:34.420
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