Episode Summary
In this livecast episode, we welcome back Dr. Zain Chagla, Dr. Stefan Baral, and Dr. Sumon Chakrabarti to address some of the issues we've seen throughout the pandemic, new variants and what to expect with future variants, discussing what we've done well over the past few years, misinformation, the effect of social media and the messaging on Twitter, the role media plays and the influence of experts on policy, public health agencies, booster shots to combat new variants and who actually needs them, where we are at with public trust, and much more!
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Transcript:
KK: Welcome to ‘Solving Healthcare’ I’m Kwadwo Kyeremanteng. I'm an ICU and palliative care physician
here in Ottawa and the founder of ‘Resource Optimization Network’ we are on a mission to transform
healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their
families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better
health care system that's more cost effective, dignified, and just for everyone involved.
KK: All right, folks, listen. This is the first live cast that we have done in a very long time, probably a year.
Regarding COVID, we're gonna call it a swan song, folks, because I think this is it. I'm gonna be bold and
say, this is it, my friends. I think what motivated us to get together today was, we want to learn, we
want to make sure we learned from what's gone on in the last almost three years, we want to learn that,
in a sense that moving forward the next pandemic, we don't repeat mistakes. We once again, kind of
elevate the voices of reason and balance, and so on. So, before we get started, I do want to give a
couple of instructions for those that are online. If you press NL into the chat box, you will be able to get
this. This recording video and audio sent to you via email. It'll be part of our newsletter. It's ballin, you'll,
you'll get the last one the last hurrah or the last dance, you know I'm saying second, secondly, I want to
give a quick plug to our new initiative. Our new newsletters now on Substack. Everything is on there
now our podcasts our newsletter. So, all the updates you'll be able to get through there. I'm just going
to put a link in the chat box. Once I find it. Bam, bam, bam. Okay, there we go. There we go. That's it
right there, folks. So, I feel like the crew here needs no introduction. We're gonna do it. Anyway, we got
Dr. Zain Chagla, we got Dr. Stef Baral, we got Dr. Sumon Chakrabarti back in full effect. Once again, like I
said, we were we chat a lot. We were on a on a chat group together. We were saying how like, we just
need to close this out, we need to address some of the issues that we've seen during the pandemic. Talk
about how we need to learn and deal with some of the more topical issues du jour. So, I think what we'll
start with, well get Sumon to enter the building. If you're on Twitter, you're gonna get a lot of mixed
messages on why you should be fearful of it or why not you should be fearful of it. So, from an ID
perspective, Sumon what's your what's your viewpoint on? B 115?
SC: Yeah, so, first of all, great to be with you guys. I agree, I love doing this as a as a swan song to kind of
move to the next stage that doesn't involve us talking about COVID all the time. But so yeah, I think that
we've had a bit of an alphabet soup in the last year with all these variants. And you know, the most one
of the newest ones that we're hearing about recently are BQ 1, xBB. I think that what I talked about
when I was messaging on the news was taking a step back and looking at what's happened in the last 14
months. What that is showing us is that we've had Omicron For this entire time, which suggests a level
of genomic stability in the virus, if you remember, variants at the very beginning, you know, that was
synonymous with oh, man, we're going to have an explosion of cases. Especially with alpha for the GTA
delta for the rest of, of Ontario, and I'm just talking about my local area. We saw massive increases in
hospitalizations, health care resources, of patients having been sent all over the province. So, it was it
was awful, right. But you know, I think that was a bit of PTSD because now after anybody heard the
word variant, that's what you remember. As time has gone on, you can see that the number of
hospitalizations has reduced, the number of deaths has reduced. Now when omicron came yeah, there
was an explosion of cases. But you know, when you look at the actual rate of people getting extremely ill
from it, it's much, much, much less. That was something that, you know, many of us were secretly
thinking, Man, this is great when this happened. So now where we are is we're in January 2023, we've
had nothing but Omicron, since what was in late November 2020, or 21? Maybe a bit later than that.
And x BB, if you remember, be a 2x BB is an offshoot of BH two. Okay. Yeah, if you're noticing all these
new variants are their immune evasive, they tend to be not as they're not as visually as, I see this in my
own practice, like all of us do here. You know, they are, well, I'm kind of piecemeal evolution of the
virus. Now, there's not one variant that's gonna blow all the other ones out of the water, like Oh, micron
did or delta. Right. I think this is a good thing. This is showing that we're reaching a different stage of the
pandemic, which we've been in for almost a year now. I think that every time we hear a new one, it
doesn't mean that we're back to square one. I think that this is what viruses naturally do. And I think
putting that into perspective, was very important.
KK: Absolutely. Zain just to pick your brain to like, I got this question the other day about, like, what to
expect what future variants like, obviously, is there's no crystal ball, but someone alluded to the idea
that this is what we're to expect. You feel the same?
ZC: Yeah, absolutely. It's interesting, because we have not studied a Coronavirus this much, you know, in
history, right. Even though we've lived with coronaviruses, there probably was a plague of
coronaviruses. What was the Russian flu is probably the emergence of one of our coronaviruses are
seasonal coronaviruses. You know, I think we had some assumptions that Coronavirus is when mutate,
but then as we look to SARS, cov two and then we look back to see some of the other Coronavirus has,
they’ve also mutated quite a bit too, we just haven't, you know, put names or other expressions to
them. This is part of RNA replication of the virus is going to incorporate some mutations and survival of
the fittest, the difference between 2020, 2021, 2022, and now 2023 is the only pathway for this virus to
keep circulating is to become more immune evasive. This is what we're seeing is more immune evasion,
we're seeing a variant with a couple more mutations where antibodies may bind a little bit less. But I
think that the big difference here is that that protection, that severe disease, right, like the COVID, that
we saw in 2020/2021, you know, that terrible ICU itis, from the COVID, you know, for the level of
antibody T cell function, non-neutralizing antibody functioning mate cell function, all of that that's built
into, you know, humanity now through infection, vaccine are both really, you know, the virus can evolve
to evade some of the immunity to cause repeat infections and, you know, get into your mucosa and
replicate a bit, the ability for the virus to kind of, you know, cause deep tissue infection lead to ARDS
lead to all of these complications is getting harder and harder and harder. That's us evolving with the
virus and that's, you know, how many of these viruses as they emerge in the population really have kind
of led to stability more than anything else? So, yes, we're going to see more variants. Yes, you know, this
is probably what what the future is, there will be some more cases and there may be a slight tick in
hospitalizations associated with them. But again, you know, the difference between 2020/2021/2022/
2023 is a syrup prevalence of nearly 100%. One way or another, and that really does define how this
disease goes moving forward.
KK: Yeah, absolutely. Maybe Stef we could pipe it a bit on, the idea that, first of all, I just want to
reinforce like as an ICU doc in Ottawa with a population of over a million we really have seen very little
COVID pneumonia since February 2022. Very minimal and it just goes to show know exactly what
Sumon and Zain were alluding to less virulent with the immunity that we've established in the
community, all reassuring science. One question I want to throw towards Stef, before getting into it. You
did an interview with Mike Hart. As you were doing this interview, I was going beast mode. I was hearing
Stef throw down. I don't know if you were, a bit testy that day, or whatever. There was the raw motion
of reflecting on the pandemic, and how we responded and far we've gone away from public health
principles, was just like this motivator to say, we cannot have this happen again. I gotta tell you, boys,
like after hearing that episode, I was like ‘Yeah, let's do this’. Let's get on. Let's go on another, do
another show. I'm gonna leave this fairly open Stef. What has been some of the keyways we've
approached this pandemic that has really triggered you?
SB: Yeah, I mean, so I guess what I'd say is, in some ways, I wish there was nobody listening to this right
now. I wish there was like, I don't know what the audience is. I don't know if it's 10 people or under
people, but I think it's like, I wish nobody cared anymore. I want Public Health to care. I want doctors to
care, we're going to keep talking because you know, Kwadwo, you've had folks in the ICU we we've
we've seen cases in the shelters, we have outbreaks, like public health is always going to care about
COVID, as it cares about influenza cares about RSV, and other viruses, because it needs to respond to
outbreaks among vulnerable folks. That will never stop COVID, it was just clear very early, that COVID is
going to be with us forever. So that means tragically, people will die of COVID people. I think that, you
know, there's that that's a reality, it's sometimes it's very close to home for those of us who are
providers, as it has for me in the last week. So COVID never ends. I think the issue is that like when does
COVID And as a matter of worthy of discussion for like the average person? The answer is a long time
ago. I mean, I think for the folks that I've spoken to, and the way that we've lived our lives as a family is
to focus on the things that like bring folks joy, and to kind of continue moving along, while also ensuring
that the right services are in place for folks who are experiencing who are at risk for COVID and serious
consequences of COVID. Also just thinking about sort of broader systems issues that I think continue to
put folks at risk. So, one: I think it's amazing, like how little of the systematic issues we've changed,
we've not improved healthcare capacity at all. Amazingly, we've not really changed any of the structures
that put our leg limitations on the on the pressures on the health system, none of that has changed. All
of it has been sort of offset and downloaded and just like talking about masks and endless boosters
when we've never really gotten to any of the meaty stuff. As you said three years into it, and
everybody's like, well, it's an emergency. I'm like, it was an emergency and fine. We did whatever was
needed, even if I didn't agree with it at the time. But irrespective of that, whatever that was done was
done. But now it's amazing that like the federal money expires for COVID In next few months, and all
well have shown for this switch health guys got became millionaires like a bunch of people, I don't mind
naming and I don't care anymore. These folks, these Grifters went out and grabbed endless amounts of
money. These cash grabs that arrival, the ArriveCan app with, like these mystery contractors that they
can't track down millions of dollars. So it's like all these folks like grabbed, you know, huge amounts of
money. And I think there's a real question at the end of it of like, what are we as a country? Or you
know, across countries? What do you have to show for it? How are you going to better respond? And
the answer right now is like very little, like we have very little to show for all this all these resources that
have been invested, all this work that has been done. That I think should be the conversation. That to
me needs to be this next phase of it is like billions and billions and billions of dollars trillion or whatever,
like 10s of billions of dollars were spent on what? and what was achieved? And what do we want to do
next time? And what do we have to show for it? that, to me feels like the meat of the conversation
rather than like silly names for these new variants that do nothing but scare people in a way that isn't
helpful. It does not advance health. It doesn't you know, make the response any more helpful. It just
scares people in a way that I think only detracts them from seeking the care that we want them to be
seeking.
KK: Yeah, I think you brought up a point to about or alluded to how some of this was the distraction.
That was one of the points that really stuck home is that we, we didn't really dive into the core s**t, the
core issues. This is why at the end of it all, are we that much more ready for the next pandemic that well
see, you know, and so like maybe Sumon, what do you think in terms of another tough one, are we
ready for the next pandemic? Do you think we've done enough? do we think are in terms of what we've
invested in, how we've communicated to the public. The messaging to the public. Are we learning? Is my
question, I guess.
SC: I'm a clinician and I don't work with the public health and the policy aspect as closely as Stefan does.
But I will say that, obviously, I've been in this realm for quite a long time, since in ID, I think that, you
know, what that's important to remember is that for SARS 1 we actually had this document that
outlined all of this, you know, masking, social distancing, what to do with funding and all that kind of
stuff. Basically, I was actually interviewed about this, I remember back way back in 2020, and half of it
was basically just thrown out the window. I think that a lot of what happened is that fear came in
decisions were made from emotion, which is, by the way, understandable, especially in April 2020. I've
shared with you guys before that, in February 2020, I was waking up at night, like nervous, that I was
gonna die. I that that's where I was thinking I it was, it was terrible. I completely understand making
those decisions. I think as time went on, I wish that, you know, there's a bit more of public health
principles. You know, making sure that we're dealing with things without, you know, stepping on
people's bodily autonomy, for example, you know, doing things in an equitable way, where you, you
know, we all know that every intervention that you do is squeezing a balloon, you must remember the
unintended consequences, I think that we did. So, kind of putting that all together. I think, right now, as
we stand in Canada if we do have another pandemic. I fear that a lot of these same mistakes are going
to be made again, I should say, a disruptive pandemic of this because it's not forgotten H1N1, the
pandemic it that was a pandemic, right. It wasn't nearly as disruptive as COVID was, but I do think that
inquiry and like you mentioned at the beginning, Kwadwo was talking about what we did, well, we didn't
do well, and making sure the good stuff happens, and the bad stuff doesn't happen again, because this is
likely not the last pandemic, in the information age in our lifetimes.
KK: Zain, was there anything that stuck out for you? In terms of what you'd really want to see us
improve? Or whether it is messaging, whether it is public health principles, does any of those stick out in
your mind?
ZC: Yeah, I mean, I think the one unique thing about this pandemic that is a lesson moving forward and
for us to kind of deal with I think we talked about messaging. This was the first major pandemic that
occurred with social media and the social media era, right, and where, information, misinformation,
disinformation, all the things that were all over the place, you know, we're flying, right, and there does
need to be some reconciliation of what's been we have to have some reconciliation of some of the
benefits of the social media era in pandemic management, but also the significant harms the people,
you know, we're scared that people got messaging that may not have been completely accurate, that
people had their biases as they were out there. I will say even that social media component penetrated
into the media. This is also the first time that I think we saw experts you know, including myself and
Suman and all of us you know, that you know, could be at home and do a news interview on National
News in five minutes and be able to deliver their opinion to a large audience very quickly. So, you know,
I think all of that does need a bit of a reconciliation in terms of what worked, what doesn't how you
validate you know, good medical knowledge versus knowledge that comes from biases how we evaluate
psi comm and people you know, using it as a platform for good but may in fact be using it you know,
when or incorporating their own biases to use it for more, more disinformation and misinformation
even if they feel like they have good intentions with it. I you know, I think this is a, you know, for...
