Full Comment - Why Omicron means ‘we have to stop counting cases’

00:00:00.000 Hello, I'm Anthony Fury. Thank you for joining us for the latest episode of Full Comet.

00:00:07.580 Omicron, Omicron, Omicron. That's all we hear now with the news about COVID-19.

00:00:12.800 But what are the facts behind the fears? Are we in for a rough winter? Or is society on the cusp

00:00:18.520 of learning to live with the virus? Dr. Neil Rao is an infectious diseases specialist and

00:00:23.400 medical microbiologist at Halton Healthcare in Oakville and Humber River Hospital in Toronto,

00:00:27.940 and he's an assistant professor at the University of Toronto. He joins us now to answer these

00:00:33.220 questions. Welcome, Neil. Great to have you on the podcast. Thanks for having me. Let's get into the

00:00:38.820 latest concerns around Omicron. Pretty new variant, but boy, when we first heard about it, the headlines,

00:00:46.260 they came pretty heavy. They came pretty fast. And then the travel bans came immediately after that.

00:00:51.960 Omicron. Yeah, quite a name. You know, it's interesting that we had travel bans initiated

00:01:00.540 even after we knew it was in Canada, and in multiple countries. And now we're up to around 60

00:01:06.320 countries. Yet we still have travel bans. And what shocks me is that we have not learned from previous

00:01:12.900 mistakes when it comes to trying to stop a virus through travel bans. It hasn't worked with all of

00:01:19.960 the other variants that originated abroad. The UK strain, the Brazil strain that didn't take off.

00:01:27.020 There was even another South African one that didn't take off. And now this is the next one. 0.98

00:01:31.240 And yet we still think travel bans and isolating some Southern African nations will solve the problem.

00:01:37.880 And we're being criticized proudly by the WHO, by many countries in the world. We are not

00:01:42.520 showing diplomatic leadership as a woke country that we're supposed to be.

00:01:46.280 But hold on a second. It's interesting because you said we didn't learn the lessons previously,

00:01:49.760 but there were politicians out there, opposition politicians, Ontario Premier Doug Ford.

00:01:54.060 They were saying to the federal government, we need to learn the lessons from past waves. And

00:01:58.620 those lessons tell us we do have to urgently rush to close the borders. And they're saying,

00:02:03.300 we didn't do it first in the first wave. We didn't do it soon enough. Now we need to do it sooner

00:02:07.700 now with this Omicron variant, but you're saying, well, not so fast. That's not necessarily the

00:02:12.520 lesson from previous waves.

00:02:14.400 So if you look at the very first COVID classic from Wuhan, even that virus had spread in numerous

00:02:21.160 European nations in November and December of 2020, before we were calling this COVID-19 in March.

00:02:27.900 So this vision that we could have kept it out somehow would take clairvoyance. There is a

00:02:34.420 collective folly on the part of all political stripes, this belief that we can keep it out

00:02:39.320 through travel restrictions. Yes, it originates from abroad. So it's seeded from abroad. But unless

00:02:44.580 you lock yourself up and play, say, Cuba, or you play Manitoulin Island, or you play New Zealand,

00:02:50.660 you cannot keep this virus out for good. Even New Zealand couldn't keep it out for good. So

00:02:54.720 an island nation may have an advantage, but at the end of the day, you cannot keep this virus out.

00:03:01.040 As long as you have the interchange of people between yourselves and other places.

00:03:04.580 We have an open-ish border with the US. Even during lockdown, we had at least 100,000 people

00:03:09.900 a day crossing the border as truckers for commercial reasons, whatever. There's no way you can stop a

00:03:14.560 respiratory virus, be it the flu, be it coronavirus, with travel restrictions. These are hold it back

00:03:20.180 measures for a while, but they don't stop it. We already have the virus here, and we already

00:03:24.700 have people who are vaccinated. So what are we trying to stop? We're trying to stop the wind.

00:03:29.040 Dr. Rao, one thing that is kind of confusing about Omicron is there has been disproportionate

00:03:33.860 concerns, or greater concerns, I should say, than there were for previous variants. You mentioned

00:03:39.460 out of Brazil. You mentioned a couple others. It's not just original Delta and Omicron. There

00:03:43.980 were a few others there. We had news reports about it. Oh, here's a new variant. What's going on about

00:03:48.260 it? Is it worse? Is it milder? And I feel like we're in a similar situation with Omicron that

00:03:53.040 many officials have said, we don't really know what's different about this. Might be more lethal.

00:03:58.720 Probably not. I think they seem to be ruling that out, that it is more likely less lethal,

00:04:03.200 maybe more transmissible. Why are we having more concerns? Why are we seeing more government action,

00:04:10.000 more we must do something in relation to Omicron than, for example, the Brazil variant you bring up?

00:04:15.520 What is different about this particular variant that does or does not justify that course of action?

00:04:19.980 So that is the $128,000 question for sure. Why is it different? I think part of what's different

00:04:26.460 is that they are seeing a lot of people with a prior history of infection being reinfected.

00:04:33.040 And I think the other fear is that this is topped onto our acknowledgement and acceptance of the fact

00:04:40.160 that the vaccine is leaky. Even with regards to Delta, we're seeing reinfections. We are seeing people

00:04:45.540 who have been vaccinated actually ending up being the source of transmission unwittingly.

00:04:51.560 So because we have this waning immunity problem, if you superimpose waning immunity, even to Delta

00:04:59.080 or any other variant with a new strain that seems to avoid immunity, wow, we're going to have

00:05:06.720 exponential growth and we're going to be overrun. That's where the logic falls apart. So yes,

00:05:11.900 one thing is probably going to happen. We're going to have more cases of Omicron. That one I can bet

00:05:15.720 on. I'm not betting anything on that one because I know that's going to happen. What the impact is

00:05:21.300 going to be on the healthcare system is the bigger point of the date. So let's go back to what's

00:05:26.200 happened with all variants. Initially, they said they're more transmissible and they might be more

00:05:30.060 deadly. And they are initially more transmissible because there are fewer people immune to the new

00:05:34.700 variant. And then as time goes on, we realize that immunity builds up either through natural

00:05:39.200 infection or through vaccination. And in fact, they're not as deadly as we originally thought

00:05:44.080 because we identified the sickest patients first. And then we realized there's a whole bunch of mild

00:05:47.840 cases out there, which softens what seems to be a deadly strain to a strain that sometimes can kill,

00:05:53.600 but it's not as deadly as we first thought. I think the same kind of thing may happen here with

00:05:58.440 Omicron, except that they found the disease more in younger people and mild disease. And probably what's

00:06:04.520 going to happen is that in some places you're going to see severe disease from Omicron because

00:06:09.740 COVID seems to pick off people who are older and those with immune system problems. There's a huge

00:06:15.260 slope of risk that increase as you get older. The difference this time is that people are either

00:06:21.520 vaccinated or have seen COVID classic or COVID alpha or COVID delta for the most part. So if you don't

00:06:29.500 have what we call an immunologically naive population, a population that has never seen the

00:06:34.640 virus like Bergamo, Italy, in February 2020, you're not going to see Bergamo, Italy or New York City,

00:06:41.220 you're going to see some impact on the healthcare system, but it's not going to be a tsunami. So what

00:06:47.640 do we need to worry about? We have to prepare a healthcare system for the potential of a surge again.

00:06:52.560 Hopefully we plan for the worst and hope for the best. We learn from our lessons of surge

00:06:58.760 planning last year and improve on it and create more intensive care unit capacity in every province

00:07:03.380 of Canada. And we watch this, but we don't resort to some of the other blunt instruments to try and

00:07:10.460 control it like travel bans and slowly school closures and lockdowns and trying to shut down

00:07:15.560 society. Because at the end of the day, you can't stop this virus for good. Someone compared this to

00:07:20.820 being attacked by a swarm of bees and going underwater. And then you come up for air and the bees are still

00:07:26.400 there. And that's what this is turning into. This virus can't be stopped. It can't be eradicated.

00:07:31.460 The COVID zero folly has been completely debunked now. Even the original COVID zero proponents have

00:07:37.680 admitted that this was an impossibility. So we have to, to some degree, live with it. And we have to

00:07:42.780 mitigate rather than trying to eliminate the virus. What to do to mitigate is the matter of debate.

00:07:47.560 And you're going to see different opinions from different experts on this.

00:07:49.560 On an individual level, there's a lot of questions about, should I be concerned? Should I be anxious

00:07:56.120 moving forward with Omicron, moving in to the holiday season? Dr. Rao, would you say that a person

00:08:02.940 who is not a senior, younger than a senior, and who is vaccinated against COVID, should they increase

00:08:08.840 their level of alarm right now? Or should they not be concerned?

00:08:11.800 I don't think they should be concerned from an individual risk perspective. From the perspective

00:08:18.400 of the potential to transmit to other people, yes, there is a theoretical concern. But on the other

00:08:24.340 hand, if those other people have been vaccinated with at least two, if not three doses of vaccine,

00:08:29.940 I don't think it's such a big concern. Now, if you're a healthcare worker, and you're working in a bone

00:08:34.880 marrow transplant unit, or you're working with elderly people in a long-term care facility, and you have

00:08:42.220 this disease, if the people you're working with have not received three doses of vaccine, or don't respond

00:08:48.520 well to vaccine, we could see transmission in healthcare settings for sure. So that's a concern. But that's a

00:08:55.060 very isolated part of the population. That's not the whole population. So we can't tell everyone to stop

00:09:00.540 celebrating everything because of this isolated concern, which is a serious concern for me as a

00:09:06.520 physician. But at a societal level, looking at this from 30,000 feet above sea level, I don't think it's

00:09:11.660 as big a concern. From an individual risk perspective, we're even attacking now kids with

00:09:16.940 vaccinations. So we're going after that whole population, whether it makes sense or not, because 0.89

00:09:20.820 we fear long COVID in children. So we're even targeting that age group to protect them from the

00:09:28.400 remote potential of long COVID if they get this disease, but they don't die from it.

00:09:34.100 So the vaccine still has some value, even against variants. I suspect that even with the Omicron,

00:09:40.860 there's going to be partial protection, but it won't be as good as it was against COVID Classic or some

00:09:45.300 of the other variants. Perhaps, but time will tell. Dr. Rao, you used the phrase leaky vaccine. Now,

00:09:52.460 in previous months, the big push for getting pretty much everybody vaccinated,

00:09:57.040 the justification for vaccine passports and vaccine mandates was that a vaccine is not just

00:10:03.060 protecting you from having a serious outcome, but it is significantly limiting transmission,

00:10:09.080 your ability to transmit the virus to others. Now, there seems to be more of a question mark

00:10:13.660 lingering over that as we see stories of there was a party, there were 50 people there, they were all

00:10:18.740 vaccinated, half of them have tested positive for COVID-19 after that party. What does leaky vaccine

00:10:26.740 mean now? And how do we approach the idea of your vaccination? Okay, you feel you maybe don't need

00:10:33.740 it, you're in the prime of your health, but you're getting it to protect others. Where does the science

00:10:39.100 stand on that now? So I want to say how this originated. First of all, we thought this was like

00:10:44.700 the measles vaccine. The initial reports with the Pfizer trials showed 95% of vaccine efficacy,

00:10:51.340 enviable numbers. But then we realized those Pfizer trials, the Pfizer vaccine that many of us have

00:10:57.900 received, were actually looking only at people with symptoms. So if it prevents symptomatic infection by

00:11:04.000 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,

00:11:15.280 that it was more like 60 or 70% vaccine efficacy, not 90%. And then what happened over time is we

00:11:21.640 realized that the vaccine efficacy looks really good. If you give people the vaccine in the middle

00:11:26.320 of an outbreak. But as time goes on, there's waning immunity. So in other words, you're not current

00:11:33.020 after about six months, the way you were six months ago, it doesn't mean you're down to zero. But it's

00:11:38.380 almost like the tank of gas is slowly being used up as the car is running. So you're down to half tank,

00:11:43.960 or maybe 60% tank. And so once you have a sizable proportion of people who don't have complete

00:11:50.280 protection, even vaccinated people can be infected. They can be unwittingly transmitters. And in fact,

00:11:58.080 when they're infected, they often are infected without symptoms. So they keep marching in and out,

00:12:03.020 all that symptom screening you do and temperature screening you do doesn't stop you from being

00:12:07.160 exposed to them, they can walk into a restaurant, they can walk into a long term care facility,

00:12:10.840 they can walk into my hospital. And there's nothing you can do to stop that it doesn't mean

00:12:15.600 they shouldn't get the vaccine. But you have to accept and manage our expectations of what the

00:12:20.860 vaccine will give the way the vaccine could reduce transmission and probably does to some degree,

00:12:25.620 is that it does decrease your risk of getting infection by say 50 or 60% rather than 90%. So

00:12:31.460 if you don't get infected, you can transmit. But once you do get infected, if you're the other group

00:12:36.840 that gets reinfected from having had infection before, or if you're the group that gets infected

00:12:42.120 despite being vaccinated, you still can transmit. There were examples early in the summer, in Cape

00:12:48.860 Cod, where there was a big party fest in Provincetown, Massachusetts, where they found that people who

00:12:54.260 were vaccinated seem to be transmitting as much as those who weren't. And the arguments, oh, wait a

00:12:58.940 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,

00:13:22.620 so actually, let me just retake that again. The British household study showed that if you're

00:13:28.480 vaccinated and you have disease versus someone who is naturally infected, the rate of transmission

00:13:36.320 to household members was similar. So the vaccine doesn't reduce transmission if you happen to get

00:13:41.020 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

00:13:58.960 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

00:14:31.500 to it, either through vaccination or through prior infection, this virus will evolve and create a new

00:14:37.340 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

00:14:48.400 alpha variant emerged in the UK when they had some of the highest vaccination rates in the world compared

00:14:53.660 to other countries. So high immunity is also a form of evolutionary pressure against the virus

00:15:01.840 to evolve and make itself more infectious. The virus's goal is to infect more people. So if there's a

00:15:08.400 mutation that compromises the ability of the virus to infect more people, it's not going to prosper.

00:15:13.080 It's going to be like a fringe political party. If the right mutation occurs to transmit more easily,

00:15:18.780 it becomes a major political party. It's a little bit like political parties developing popularity

00:15:23.620 from grassroots. You know, it's en masse in France coming from nowhere. So it's that idea that you can

00:15:30.020 get the right combination of mutations to allow for more transmission, even amongst a previously

00:15:37.440 immune or partially immune population that drives these variants. Omicron is going to be something

00:15:43.240 that comes and goes. You're going to have waves at different times in different countries.

00:15:48.160 And we need to see what the impact is on hospital admissions and on deaths. We have to stop counting

00:15:55.200 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

00:16:06.840 have been hard hit in the past. Dr. Rao, you mentioned the phrase age of innocence, and that

00:16:11.780 really stuck out to me because I think a number of months ago, the overwhelming vast majority of

00:16:17.720 people were of the opinion, all right, there's vaccines available. Hallelujah. Line up. Let's get

00:16:22.640 them. Let's post our selfies of us getting them, and then we'll get the second one. And then we're

00:16:26.500 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

00:16:39.760 front of me here, both very recent ones. CTV News Vancouver. Some BC residents will be eligible for

00:16:45.400 a fourth COVID vaccine dose, officials say. And then I've got CNBC over in the US. Pfizer CEO says

00:16:51.100 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

00:17:10.860 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

00:17:26.680 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

00:17:54.740 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

00:18:22.880 people. We've gone after long term care in Canada and generally done that with third doses makes

00:18:28.640 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

00:18:42.500 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

00:20:41.720 more full comment.

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00:21:57.460 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 0.95

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 0.83

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 1.00

00:30:17.640 Southern African countries. It'll be interesting. I think we'll be the last. 1.00

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 1.00

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 1.00

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, 1.00

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 your Alexa-enabled devices. You can help us by giving us a rating or a review and by telling your

00:42:38.960 friends about us. Thanks for listening.

Full Comment - December 13, 2021

Why Omicron means ‘we have to stop counting cases’

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