Ep. 68: When (and How) Does COVID-19 End?
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As the global vaccination campaign continues, questions abound: Is it safe to mix and match different vaccines? When is the optimal time to get my second dose if I’m aiming to maximize the resulting immunity? And: Will COVID-19 ever end? Medcan’s Medical Advisory Services team of expert physicians join host and CEO Shaun Francis (above right) to break down the latest information and provide need-to-know guidance. Featured in this episode is Medcan chief medical officer Dr. Peter Nord (lower right), clinical director of travel medicine Dr. Aisha Khatib (lower left) and senior medical consultant Dr. Matthew Burnstein (above left).
LINKS
Here are the preliminary results from the U.K. study on mixing and matching vaccines and the Spanish one, which both suggest combining doses may be safe.
Read the latest survey results from the International Air Transport Association that found 81 percent of people will feel confident about travelling again once they’re fully vaccinated.
Learn more about Medcan’s Medical Advisory Services. To enlist their guidance to assist with your organization’s occupational health and wellness, email corporatesales@medcan.com.
INSIGHTS
World Health Organization guidance suggested that countries keep borders open, yet most countries are pursuing policies that are 180 degrees away from that, notes Shaun. The MAS docs cite the Atlantic bubble, and the Australian policy of a strict border closure, as examples of border closures effectively reducing the spread of COVID. However, border closures can only ever work as a temporary solution that buys time. “You can’t keep the borders closed forever and just hope the virus goes away,” says Dr. Nord. While border closures are in effect, countries have to boost vaccination rates, because otherwise, infections could become widespread again as soon as the borders reopen. [Time code: 9:20]
Early data on the efficacy of mix-and-matching vaccines look promising. A recent study from the U.K. analyzed what happens when AstraZeneca is first dose and Pfizer is the second. Preliminary results indicate that the vaccines remain effective, though there did seem to be an uptick of mild side effects, like fever and headaches, that last for a few days. A similar study conducted in Spain found a strong immunoglobulin response from mixing doses. “There’s no reason to believe one can’t safely combine vaccines,” says Dr. Burnstein. “It’s just that we don’t have the real-world experience yet to prove it.” [Time code: 12:45]
When will the world be ready to travel again? Potentially very soon, for people who have been fully vaccinated, at least. According to the International Airport Transport Association (IATA), most people feel safe about travelling after receiving both doses of the vaccine; more than 80 percent feel more confident about travelling with some kind of document that proves their vaccine status. Scottish travel agency Skyscanner has also found that people are more likely to travel to a country that also has a high vaccination rate. “People are looking for safety, and they’re looking for that kind of immunity,” says Dr. Khatib. “But we’re just not quite there yet. I think it’s going to take a little bit of time.” [Time code: 16:26-20:40]]
While vaccine-rich populations may be eager to travel soon, Dr. Khatib also reminds us that it will take much longer for the entire industry to bounce back. In fact, IATA estimates that travel rates won’t fully return to pre-pandemic levels until 2023. This follows past travel trend lines during international crises: Global travel fell 30 percent during the SARS outbreak, then took about 11 months to recover; during the 2008 economic crash, travel dropped 50 percent and took 19 months to rebound. [Time code: 21:30]
When’s the best time to receive your second dose? Lots of discussion about that in Canada, where the wait has been extended from the manufacturers’ initial guidelines. However, new trials with the AstraZeneca vaccine are indicating a stronger immune response if there’s a slightly longer wait between doses, up to 16 weeks. “It's actually showing in the real world to be actually more protective, immune-wise,” says Dr. Khatib. [Time code: 24:35]
The good news is that all the COVID vaccines continue to be effective against new variants of concern, including the B.1.617, which originated in India. That said, it’s estimated that just a single vaccine dose is only 33 percent effective against the B.1.617 variant, while there’s about an 81% efficacy rate with both doses. “We’re going to start to see a push to get those second doses out,” to make sure we’re better protected against emerging variants, explains Dr. Khatib. [Time code: 26:39]
So when does COVID end? “That begs the question of a fourth or fifth wave,” says Dr. Nord. “Only when the globe literally has a 75 percent vaccination are we going to be able to see this thing die.” Until then, there will likely continue to be flare ups, but at least we know we have health measures to address rising cases as vaccination efforts continue. “It will probably become like the cold or the flu,” adds Dr. Khatib. “We just have to get it tamped by vaccination, but I don’t think we can actually ever eradicate COVID-19 at this point.” [Time code: 27:25]
When (and How) Does COVID-19 End? final web transcript
Christopher Shulgan: I have this image of where society is right now. Yes, the vaccination campaign is proceeding, numbers are dropping, things seem like they're getting better, but we've all been in this place before. The image I have of society is of someone who's been asleep for a year. They wake up, put on their shoes, go outside into the sunshine—but are they really awake? Could they possibly still be dreaming? We're not really sure what to think.
Christopher Shulgan: I'm Christopher Shulgan, the Eat Move Think executive producer, saying let's put aside any questions about the metaphysical nature of reality. What we're aiming to do with this episode is provide some certainty. Solid guidance from the experts.
Christopher Shulgan: Medcan has a group of occupational health physicians—the Medical Advisory Services team—who provide guidance on COVID-19, as well as any and all matters that have to do with human wellness to some of Canada's largest corporations. It's been six weeks since they've last been on the show, and since then, advice on about a dozen different issues with respect to COVID-19 has changed. So our host, the Medcan CEO, Shaun Francis, felt like it was a good time to check in with them again.
Christopher Shulgan: Is it safe to mix and match different vaccines? When is the optimal time to get my second dose if I'm aiming to maximize the resulting immunity? And will COVID-19 ever end? Discussing these questions—and many others—are Medcan's chief medical officer, Dr. Peter Nord, clinical director of travel medicine Dr. Aisha Khatib, and senior medical consultant, Dr. Matthew Burnstein. Moderating their discussion is our host, Shaun Francis. Here's Shaun.
Shaun Francis: Hi, it's Shaun Francis and our latest episode of Eat Move Think. I'm here with most of the members of our Medical Advisory Services team, including our chief medical officer, Dr. Peter Nord, senior medical consultant, Dr. Matthew Burnstein, and the clinical director of our travel medicine, Dr. Aisha Khatib. Thanks for joining, folks.
Aisha Khatib: Thanks for having us.
Shaun Francis: Why don't I start off our session and ask for just a brief update, Dr. Peter Nord. What is the situation right now with the vaccines? More specifically in Ontario, but the rollout across Canada. I know we're lagging behind the United States. And we've had some issues on not just supply, but also guidance on AstraZeneca. What happened there? Why did we flip flop with respect to should you have it, should you not have it? And where does it stand now, Dr. Peter Nord?
Peter Nord: Yeah, you almost have to feel sorry for the folks at AstraZeneca. They put out this terrific vaccine. Yes, it certainly has this rare blood-clotting issue. But they've just had a series of unfortunate missteps, you know? And as a result, the public health authorities have been literally flip-flopping. I mean, when it first came out, it was like, not in over 65. We don't have the data. Oh, we have the data, now it's totally safe. But if you're under 50, then that's the bad thing. So, you know, if you're between 55 and 65 ... so it was just really frustrating for people to kind of get a handle. And as a result, there's been a bit of a pall that's put on AstraZeneca. And, you know, it's a great vaccine. It works extraordinarily well. We do have this rare blood-clot situation. We're talking about, you know, one person every 60,000 to 100,000 having this blood clot issue.
Peter Nord: But I like to just focus on the UK. So the UK today is completely open. The pubs are open, the theatres are open, they're basically back to normal life, and they did it all completely with AstraZeneca. In their whole country, they had 242 cases of this blood-clot situation. But at the end of the day, they're open. So we should kind of go to school on what's been happening in the UK, and forget the flip-flopping, and continue with the guidance of get the first vaccine you possibly can. If it's AstraZeneca, just go for it.
Shaun Francis: And does that guidance play through at all age groups? Because I know now, they've said you can have the vaccine as young as age 16.
Peter Nord: Yeah, so the latest research coming out from some of the mRNA vaccines is down to age 12. So 12 to 17 is now actually safe. So that's great. So we have to ask ourselves, like, why are we actually vaccinating young people who tend not to get sick? Thankfully, one of the great silver linings of this COVID-19 is that kids are predominantly spared, and that just leads us to the question of transmissibility. So if we're vaccinating children to save the population that is unvaccinated in the community, because they're a vector of transmission, then okay. But we actually don't have that data yet. We're assuming that children that are vaccinated will transmit the virus less easily to their parents, to their grandparents back at home. But we don't really know that right now. Those studies are very difficult to do. We would assume there is some not insignificant reduction in the transmissibility, but as we're sitting today, we can't say that for sure. So at the end of the day, we have to say, okay, why are we actually vaccinating our children? Is it to protect people in the home? Increasingly, the folks in the home have been vaccinated already.
Shaun Francis: That's a good question. But there is a shortage of vaccines in Canada. And, in fact, even more seriously globally. And so we're vaccinating children. And there's two issues. One is that we're not giving the second dose to our most at-risk in the timeframe recommended by the clinical trials. And then there's people globally who are gravely at risk who haven't had a single dose. How should Canada be looking at this in light of those two issues, Dr. Aisha Khatib?
Aisha Khatib: It's definitely been a contentious issue, especially given that it almost seems like we were vaccinating plus-18 in hotspots. And there's this whole population between 18 to 60 that we're kind of waiting to open up. And then we really jumped straight to over-12, and this potentially lower-risk population. The other thing is, as you mentioned Shaun, is this huge issue of vaccine inequity around the world. So around the world right now there's about 22 per 100 people being vaccinated. So up to date, there's been 1.7 billion people in the world who've received at least their first dose. Now the problem with that is 75 percent of those people who have been vaccinated have been in 10 countries. And those are going to be in high-income countries. And that has huge implications for people living in lower- or middle-income countries, where potentially a lot of these new variants could arise because you have increased transmission, you have less control over the infection rates, and then you have less resources.
Aisha Khatib: I'm kind of starting to hear in a lot of the—even the travel world is this idea that great, our countries are being vaccinated here in Canada and the United States. The pandemic is, you know, close to being over, but that's not a reality right now. And I think we really need to look at hitting this globally, and realizing that we can't really stand siloed within our countries to get vaccinated, because even though we may be in our bubbles and we may have our vaccines, remember that this pandemic started through travel, right? COVID-19 spread at supersonic speeds through commercial air travel. And the reality is that, at some point, that's going to start to open and there's going to be movement of people again, and you're going to have what we call these immuno-privileged and immuno-deprived populations starting to mix. And the other issue that arises is potentially how effective are these vaccines going to be with different variants that are arising? And those are a lot of unknowns right now as well.
Matthew Burnstein: Well, I was only going to say that it's certainly to our advantage as a country and for the Western world, to help to vaccinate second- and third-world countries as quickly as we can. But it's always that balancing act between paying yourself first. How much do you keep for yourself? How much do you give to others at any point in time? The good news is, in Canada we've ordered 400 million doses of vaccine, which I think we're obligated to pay for. And I think once we've got ourselves to a good spot, I think Canada, I'm hoping will be very generous, as Canada generally is, and donate those vaccines. And it'll come back to our benefit in the years to come.
Shaun Francis: Yeah, it is interesting that prior to COVID, the general public health consensus on a pandemic was not to close borders. In fact, even with this pandemic, if you recall at the beginning, the guidance was closing borders does not help at all. You cannot stop it. And we've really done a total 180° where every country has closed its borders. What's our take on this, Dr. Matthew Burnstein?
Matthew Burnstein: Closing borders has been effective. Atlantic Canada had a very successful bubble for a long period of time. New Brunswick had outbreaks mostly along border communities in Edmundston. Halifax in Nova Scotia has outbreaks mostly related to travel of people into Nova Scotia. In British Columbia, they've blocked off in your health region, although they've started to open up because the numbers have started to come down. And it was shockingly successful. And I think Australia is planning to close until 2022, which will certainly have impacts on much of their economy, but it will allow them to fully vaccinate their population, and allow the world around them to be much more fully vaccinated.
Peter Nord: I was just going to say, Matthew, I think that's the takeaway is that—your last comment is it buys us time, right? So closing the borders, it's a temporary solution. It's not a permanent solution. You can't have the borders closed forever, and just hope that the virus goes away. You use that time to vaccinate your population, or you hope that there's global herd immunity, and your population's small enough that it won't be an issue. But ultimately, if your population doesn't have the depth of prevalence of antibody protection, as soon as the borders open, you're going to get infected again.
Aisha Khatib: Exactly, Dr. Nord. I totally agree with that. It's just slowing down that transmission risk to kind of help get the infection rates and transmission under control with the resources that you have. The problem that Australia is facing right now is that yes, they've closed all their borders, but their vaccine uptake is incredibly poor. And people just don't have that incentive, or maybe that fear to motivate them to get vaccinated. That's going to be a problem when they do tend to open up the borders, because now they're going to potentially be exposed to newer variants and new viruses that their population hasn't been exposed to.
Aisha Khatib: The other thing that's important to note is the World Health Organization actually does not encourage these border closures and travel restrictions. And they set that up from the very beginning. So there's a lot of different stakeholders at play in regards to governments and economy and trade, and even the free flow of personnel and medical equipment and vaccines. And that's why they're kind of looking towards other potential means. And for example, yellow fever is one of the vaccines that was used to decrease that risk of infection between borders under the international health regulations, and that's actually one of the ways that they're looking at potentially rolling out the COVID-19 vaccines for different countries. Right now, as Shaun mentioned, there's about 120 countries that are completely closed.
Shaun Francis: Even if we have 400 million doses coming, we don't have enough today. The border with the US is shut. If it wasn't shut, we could go down and get our second dose in any of the border cities on the US side. Can I mix and match my doses? So if I had an AstraZeneca in Toronto, for example, could I go to Buffalo and get a Pfizer as my second dose?
Matthew Burnstein: That's a really good question, and a really important question, and one that we're starting to get information on. There's a very large study that combined COVID vaccine or Com-CoV study in the UK, which is looking at that very question. Last week, they started to release some data on combining a Pfizer with an AstraZeneca and an AstraZeneca with a Pfizer, just looking at side effects. And it seemed that giving the Pfizer after the AstraZeneca resulted in a few more days of illness in about 30 percent of the people who had the vaccine by combining them. Although at the same time, a Spanish study was done looking at the same issue. A smaller study, about 600 people mostly over the age of 60, and saw no increased side effects when you combined the vaccines.
Matthew Burnstein: But the Spanish study looked at immunoglobulin response when you combined the vaccines, and the immunoglobulin response was very strong. And so it appears at least on paper that you get a very good and healthy response when you combine the vaccines. There's no reason to believe one can't safely combine vaccines, but we don't have the science yet to prove it.
Matthew Burnstein: The National Advisory Committee on Immunization at this point in Canada is suggesting no need to mix and match, stick with what you had. In Ontario, we're giving people the second dose of AstraZeneca to people who've had the first dose. We're running out of Moderna vaccine in Canada. And in Quebec at least, they've said that you can—if you had Pfizer the first time or Moderna the first time, you can have Pfizer the second time and vice versa, because they're both mRNA vaccines, and very similar. But depending upon where you are in the world, you've got different approaches in—I was just reading about this this morning. In France, your second dose, if you're under 55 should be something other than AstraZeneca. In Finland, they've said less than 65 get something other than AstraZeneca as your second dose.
Matthew Burnstein: In the UK, as Peter alluded to earlier, they've used AstraZeneca all along with everyone, and they see no issue with AstraZeneca with the first or second dose. And they're saying if your first dose was AstraZeneca, you get AstraZeneca as your second dose. There's no need to mix and match. Our challenge will be we may run out of AstraZeneca soon as well, because India doesn't want to ship it to anyone, and I wouldn't blame them. They've got a major outbreak, 300,000 people a day. And Moderna has had problems with shipping to Canada, so we may have no choice but to mix and match. And we mix and match vaccines all the time. The flu shot you get every year may be made by a different company. There's no reason to believe it's harmful. It's just that we don't have the real world experience yet to prove effectiveness. But we will in the next four weeks, which is probably around the same time most Canadians will be looking at their second dose.
Aisha Khatib: I was just saying in regards to that, I think the next question that a lot of people are going to ask is, "Okay, now I'm going to get my second dose. Do I need to quarantine when I travel? Is it okay to travel with those two doses?" And I know the CDC guidelines have come out to say that, you know, if you've had two doses of the vaccine in the United States that you don't need to quarantine. Right now in Canada, you are not excluded from quarantine, even if you have your two doses of the vaccine. Okay? There's no exceptions to those who are vaccinated, or if you've tested negative, or if you have recently recovered from COVID-19. So the quarantine still applies. And that's still in place right now because of the fact that potentially there are these risks of new COVID variants coming on. But also the fact is that that transmission piece of being able to potentially transmit the virus. We know that, yes, you'll be protected when you've got those vaccines on board, but you could be a carrier and potentially transmit it to somebody who may not be fully vaccinated or not vaccinated at all. And so that's why the current guidelines is to continue with quarantine as well as with the public health measures which is masking and distancing.
Aisha Khatib: The other issue that we don't know about with vaccinations is the duration of immunity. And so, because of these unknowns, at the moment, there are no exceptions for travellers with the border. This may change. So right now, we know that the 14-day quarantine that we see in Canada for international travellers coming in, it actually reduces your risk of COVID-19 transmission to the population between 97 to 100 percent. But there are studies looking at having a seven-day quarantine with testing at around day three, and that's actually shown to be anywhere between 95 to 99 percent effective at reducing transmission risk. So we may see, as we hit a certain threshold of people vaccinated, that we may reduce that quarantine.
Aisha Khatib: Regardless, I think one of the things that we need to know is, again, this vaccine kind of inequity around the world is that, until the vaccination is widespread around the world, one of the key things that's going to be still there between borders, whether you're vaccinated or not, is basically testing. So that testing pre-travel and potentially testing post-travel is going to be necessary because of the fact that you can still have infected persons that are asymptomatic, right? So whether you're vaccinated or not. And that's going to be a key factor and potential spread to different countries.
Aisha Khatib: And I think one of the things that we're going to probably see happening earlier on is these travel corridors or travel bubbles between countries that have a high threshold of people that are vaccinated. So it's very likely that you may see the US-Canada border open up once we hit a certain threshold, where that quarantine may decrease or go away if you're vaccinated. And we're starting to see that already with Europe. You know, they've opened up travel to vaccinated Americans, for example. And there's about 20 countries who've taken off the quarantine altogether. So lots of changes coming in this field.
Aisha Khatib: I just attended the International Society of Travel Medicine conference just last week, where this is a hot topic of debate among travel health professionals, air industry, cruise industry, business CEOs all around the world. It was interesting actually to see that IATA—so the International Air Transport Association—as well as Skyscanner has actually done these surveys of people to see whether they have that confidence in travelling with vaccine. And so 81 percent of people who did the survey through IATA felt more confident travelling with a digital document saying that they had been vaccinated. Skyscanner basically did a study showing that if a destination needed vaccination, people were more likely to travel there, as well as if that country had a higher rate of vaccination, people were also more likely to travel there as well. So I think that's a good sign. People are looking for safety, and they're looking for that kind of immunity, but we're just not quite there yet. And I think it's going to take a little bit of time.
Shaun Francis: When do you think the Canadian border opens to the US?
Aisha Khatib: I mean, I can't predict that. However, you know, if we look at kind of what's predicted for opening up just within Canada in regards to indoor dining, outdoor dining, mass gatherings and whatnot, we're looking at trying to get about a 75 percent threshold of people who've been vaccinated with two doses, right? So you're not fully immunized until you've got those two doses on. And I think at that point, we probably will start to see the borders open up or relax a little bit. I suspect it'll probably maybe be late fall or late winter.
Aisha Khatib: In regards to recovery for travel, remember, like, it takes time. And the International Air Transport Association thinks that we're not really going to get a full recovery for travel until about 2023. Right now, we're about at 50 percent of where we saw people travelling pre-pandemic. And just to kind of give you an idea of these timeframes, if you look at other world crises that have happened in the past, for example, when the SARS outbreak happened, there was about a 30 percent reduction in travel worldwide. That took about 11 months to recover. After 9/11, there was about a 40 percent reduction in travel worldwide. That took about 14 months to recover back to baseline. And then the most current and big one was the global economic crisis in 2008, where travel dropped about 50 percent, and that took about 19 months to recover back to baseline. That recovery period they're looking at of about two years is about right, compared to other recoveries that we have seen from other world crisis situations that have affected travel worldwide.
Matthew Burnstein: Can I ask you to clarify something? Because I've been confused on this over the last week on people travelling from Toronto to Buffalo to get a vaccine. On the Canadian website, it says that if you get a note from your doctor that says a vaccine is medically required—and everyone requires a vaccine, so that's not a big deal—but that the US border is saying coming in for a vaccine isn't sufficient reason to come into the United States. I heard about people going across and doing it, but then I heard that people were being stopped at the border. So I just want to get clear for our podcast what the situation is today in Canada and the US in terms of going across. What's your understanding, Aisha?
Aisha Khatib: You know, part of it is a lot of people think that they're going to go down for the vaccine, and potentially be exempt from quarantine if they're just specifically going down for that vaccine. Again, they're not excluded from that quarantine right now even if they're vaccinated.
Matthew Burnstein: Okay.
Aisha Khatib: I think the idea is more for people who are already travelling across the border for work, okay? So things like essential workers, healthcare workers, people who are going back and forth already, and have that permission for exemption. It may be more accessible and easier, potentially, to get the vaccine while they're there because of the way it fits into their work schedule. I think that was really what it was meant to truly be, not for the average traveller.
Peter Nord: So short takeaway is, these days Canadians that are going down just for the purpose of vaccination are being turned back at the border. The American Border Services are not allowing Canadians in. And so for those people that were thinking they were just going to jump across—and actually, you know, Prime Minister Trudeau actually made some very public statements that fuelled this. There was this rush to get across the border, and then within about a week, the light bulbs went on and people said "No, no, no, no. Like, that's not on." "Essential" means, you know, essential cancer treatments, or something we couldn't access here or, you know, our ICU is full, so we're going to use some health care services south of the border. So now it's closed, there's no opportunity to do exactly that.
Shaun Francis: If you're looking to identify the optimal timing for the second dose, what would be your advice on that?
Aisha Khatib: I mean, basically, with the intervals for dosing for the vaccine right now for the mRNA vaccines, it's recommended to get your vaccine at 16 weeks, and that was extended by NACI. That differs from the 21 days or the 28 days that were initially in the studies and the monographs. However, that is obviously exceptions made to higher vulnerable populations, such as those with active cancer, those with transplant history, Indigenous populations, for example. And with AstraZeneca, the ideal timeframe—I mean, the monograph timeframe was the 12 weeks. However, we're actually seeing that if you actually leave the interval for a bit longer, you actually get a better immune response. So I think a lot of people think that it's kind of like when you get your first dose, your cup is half full, and then you get your second dose and you kind of top up. The immunity doesn't work like that. After your first dose of the Moderna or Pfizer vaccine, you're going to get up to about 92 percent effectiveness in a person who's healthy and well after about two to three weeks. And actually, that immunity tends to continue to build over time. And so it's showing in the trials that, for AstraZeneca, you're actually better immunity at 12 to 16 weeks out to get your second dose, which really just cements it and fortifies that memory.
Aisha Khatib: So a lot of people were concerned about this initial extension of the dose intervals, but it's actually showing in the real world to be actually more protective immune-wise.
Peter Nord: Those numbers apply to real world, which means variance as well. These numbers include B.1.1.7, they've included all the sub-variants that we're seeing globally. Where during a study, you might have a more restricted or a narrow band of strains that you're actually competing against with the vaccine. So the real world is robust, because it incorporates multiple variants, and we're still seeing great results in that real world environment.
Aisha Khatib: And I think it's important, Dr. Nord, as well, to just touch on that, because a lot of people are concerned about the vaccine efficacy for B.1.6.1.7, which originated in India. And actually, Public Health England just came out that there actually has been success with the vaccines in effectiveness against this variant, which is really reassuring. The key thing, though, is that efficacy against the B.1.6.1.7, is you get about 81 percent efficacy, but it has to be after the two doses. After the first dose, you're only going to get about 33 percent against that variant. I think that's really going to be one of the reasons to push out those second doses sooner, just to get that protection against this potential variant that will have decreased vaccine effectiveness, and also potential risk for higher transmission and higher severity of disease.
Shaun Francis: How does COVID end in Canada? Or does it end?
Peter Nord: It begs the question of a fourth wave or a fifth wave. You know, are we going to see these echoes of what we've been dealing with? And I think we probably are, and it goes to that question that we touched on about global herd immunity. Only when literally the globe has 75 percent vaccination rates, are we going to be able to really see this thing die. Until then, we will see hotspots, we will see flare-ups. They will be muted because, in our country at least, we will have good, solid vaccination rates with a high prevalence, and it'll tamp these things down.
Peter Nord: And then of course, you know, the PPE, the mask-wearing, that'll be easy for us to get back on that if we need to, get back into some—hopefully not. I think the fact that we don't know how long our immune system is going to stay charged up against this strain that we're dealing with, and future strains, boy, it's going to be a constant battle for the next couple of years. And, you know, we might be looking at boosters that are primed just to the strain of the day. And that booster hopefully gets us six to 12 months of immunity. But that remains to be seen.
Shaun Francis: And do we count those people who've had COVID towards the vaccination rate? So in your example of if it's 75 percent, let's assume we won't get 75 percent fully vaccinated, but we might get, let's say 40 percent, but maybe 30 or 40 percent have had COVID. So can we total those two?
Peter Nord: Yeah, they're actually in parallel streams. We can count cases, and we can count morbidity and mortality. We're actually pretty good at that. And we can count vaccines distributed, and that's great. But bringing those two numbers together is very difficult.
Aisha Khatib: The other issue is potentially the reinfection risk, right? So with the P1 variant, we saw that people who had COVID before were being reinfected. Also, we don't know how long that immunity lasts after natural infection. Right now, the studies show anywhere between three to eight months, but that can wane earlier. We don't know the threshold for immunity, and so even if you've had COVID, it's still recommended to get that vaccine. The vaccine really kind of acts like a booster, and it'll protect you for longer immunity, for sure.
Matthew Burnstein: One of the reasons that the US may be doing so well, despite the fact that only 50 percent of their population is vaccinated—admittedly, almost 40 percent have had two vaccines—is that a large number of their population was already infected. And they had 35 million known cases of COVID, and that is probably just half of what really occurred. So they may have 70 million people with natural immunity, and 140 million people with immunity through vaccinations. And so that may be why, even though they've opened up very quickly, thrown away masks, thrown caution to the wind, their numbers are continuing to come down.
Shaun Francis: In fact, you could argue the pandemic is over in the US based on their numbers.
Matthew Burnstein: [laughs]
Aisha Khatib: I would be cautious to say because, again, that herd immunity from natural immunity, we don't know how long that's going to last. And potentially right now, the US has still been pretty restrictive with their border control. So, you know, once you start getting exposure to different variants—and they've had variants pop up within the US as well, you know, I think it's still to be seen. And, you know, even here with us, we thought we were getting things under control back in January and February, and all of a sudden we have this, like, new second pandemic come up with these new variants. And so I think we need to be cautiously optimistic, and you know, to declare that a pandemic is over in one country, a pandemic, by very definition means the infection is in different regions and different countries. And I think we need to realize that we're really all in this together. This is a world issue, and we can't silo it just to one or two countries to say it's done there.
Shaun Francis: But on that basis, you could argue it may never be done.
Aisha Khatib: I don't think it will be. I think COVID will be circulating ongoing, and I think it's just going to be a matter of having that potential immunity to it. So it'll probably become like the cold or the flu that we see, where we still have severe cases. And I think we just need to get it tamped by the vaccination. So I don't think we can actually ever eradicate COVID-19 at this point, I think it's going to be with us.
Matthew Burnstein: I think it's good to remember that the only virus we've ever eradicated was smallpox, and that took 20 years. I think this is going to drift into the background and be like measles and mumps. And for those of us who had measles and mumps as kids in the '60s, we've got lifelong immunity. But every now and then you get an outbreak. We had an outbreak of mumps in Toronto just a few years ago. Small numbers, I think, 100, 200 cases, but I think COVID will be like that, or maybe more like the flu, and we get an annual vaccine for the years to come.
Aisha Khatib: Yeah, with smallpox, it was the biggest vaccination campaign in our history, and it was under international health regulations as well with the vaccine passports that were technically being used for smallpox as well at that time. So I think we can probably learn a lot from history.
Shaun Francis: Yeah, I guess, you know, in the US now, the CDC has said, if you're vaccinated, you no longer have to mask, nor be tested, nor quarantine. So really, they're moving quite quickly from counting cases, to really only looking at sick people. And I feel like well, Canada's still in the case-counting business. But from a US perspective, if you've stopped counting cases, stopped testing asymptomatic people, stopped recommending people to quarantine if they've come in contact, it's starting to feel, at least domestically in the US, like it's over.
Aisha Khatib: And we're starting to see that here in Canada as well. So for example, if you had the two doses of the vaccine and you've been exposed to COVID, or close contact, you don't have to isolate. And your family members don't have to isolate if you have that exposure to somebody. So those are recent Toronto Public Health and Ontario guidelines. So we are seeing those, and I think once we get a certain threshold of the vaccination in the community, we are going to start to reduce some of those restrictions as well. And we're getting there. We're getting there slowly and surely, we are. I think there's definitely light at the end of the tunnel, for sure. Definitely, these vaccines have given us a lot of hope.
Shaun Francis: So thank you Dr. Nord, Burnstein and Khatib. It's been a great session with you this morning. It's really difficult to get good information on where we're at with the pandemic as we've talked about. There's been so much changing of policy guidance, and I really appreciate everything you're doing to stay on top of it. It's super important for our patients and clients to be on top of it, and to try to parse through reams of data and deliver insightful advice that can be actionable. So I appreciate it and look forward to bringing more to our listeners in the future.
Christopher Shulgan: That's it for this episode. Are you responsible for an organization that could benefit from the guidance of Medcan's Medical Advisory Services team? Email corporatesales@medcan.com.
Christopher Shulgan: I'm executive producer Christopher Shulgan. Find show notes, links and full episode transcripts at EatMoveThinkpodcast.com.
Christopher Shulgan: Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg. Patricia Karounos did a lot of the heavy lifting on this one. Social media support from Emily Mannella.
Christopher Shulgan: Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow our host Shaun Francis on Twitter and Instagram @Shauncfrancis—that's Shaun with a U—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.
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