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