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Confronting COVID-19: a special webcast with McGill health experts

welcome to today’s special alumni
webcast preventing koban 19 my name is Derek Cassoff and I’m the managing
director of communications at McGill’s office of university advancement and
greeting you live from the safety of my new home office my basement
checking in remotely as well our two of McGill’s leading experts on infectious
disease and population and global health Dr. Marcel Behr is the co-director of
the McGill interdisciplinary initiative and infection and immunity and interim
director of McGill’s infectious diseases division welcome dr. behr Thank You
Derek for having me and we’ve got dr. Timothy Evans inaugural director and
associate dean of the school of population and global health in the
McGilll’s Faculty of Medicine welcome Dr. Evans thanks Derek and thanks for having
me back. and thank you both for taking time out of I’m sure what our
very busy schedules. So we’ve received well over a hundred questions from
alumni all over the world in the last 24 hours and we’ll try to get to as many of
these as we can we’d originally scheduled 45 minutes for this both
doctors have told me they’re willing to stay on a little bit longer if need be
so we’ll try not to take too much of your time but we’ve got some wonderful
questions that have come in but before we get into them I’m curious to know a
little bit about how infectious disease experts and professors of global health
such as your spouse it’s just so just yourselves spend your days in the height
of a pandemic dr. Behr what does a typical day look like for you these days
well thank you for asking typical day feels a little bit frenzied
I’m getting probably 10 times min more emails ten times more text a lot of
questions a lot of good questions a lot of thoughtful questions and a typical
day like today I started off and I put my phone aside so I could have 15
minutes to have a cup of coffee and relax and during that time my Fitbit
rang two times and my phone was nowhere near me so I had to hang up on my Fitbit
and by the time I went back to phone the other person wasn’t available because no
one yes I managed to get to the hospital I’m still working at the hospital he
says I’m the division director of a hospital unit and I’m trying to help as
best as possible made our Hospital plans here and also
try to help as much as possible make sure that all the people my division
have the resources and also occasionally some mental health breaks and so that
they get some moments away from all of this great well I our hats go off to all
of you in the healthcare system of course working double duty to try to get
all of us through this dr. Evans what about yourself what what are your days
look like now well I only wish I could get as many emails as Marcel and so but
I know very busy and I’ve been working with the planning and Emergency
Operations Committee at McGill University and as you can imagine the
implications for moving and complying with the government’s recommendations
with respect to these two weeks and and most likely beyond March 30th are very
very important ones to think about how to manage in addition because of my past
and global health I’ve been interacting with the
Government of Canada and also many of our international partners all of whom
are doing their very best I think to figure out how how to respond to the
evolving situation I do have the benefit of working from home and I’m lucky to
have my family with me so that’s a little bit of a dividend and we’re doing
well at the moment the biggest thing I have troubles with is my own personal
behavior and I’m just going to put up this little cartoon to show you really
what I’ve been dealing with and and if you can see that and this is a picture
dog telling me not to touch my face and I have borrowed the plastic container
that prevents my dog from putting its paws on its face and to try and
reinforce that so the short message there as I’m trying to walk the talk on
the recommendations of behavior change which are so important in in managing
the epidemic and pandemic at this point in time
mm-hmm well for what it’s worth I’ve spent my entire life trying to get out
of a horrible habit I have which is being a nail biter and within two weeks
I finally have long nails so it didn’t take much to get me to to stop that
habit so let’s get to let’s get into some of the conversation so sort of the
frame this eight days ago the World Health Organization came out and
declared covid 19 : 19 outbreak to be a pandemic and said it was not a word to
be used like me it’s hard to imagine how much their lives have been completely
upended in a week or so since then so we’ll start with you dr. Evans why did
the w-h-o make this declaration and what was its significance so the reason they
made the declaration is they had definitive evidence of community
transmission in a growing number of countries and so early on when it was
felt that cases appearing in other countries were simply a function of
people who had traveled from the initial epicenter in Wuhan or in some of the
other countries there was still some thought that there would not be
widespread community transmission of the virus and other countries and I think
when we saw the announcement on the end of the pandemic it was abundantly clear
to everybody at that point and has become even more clear since that we do
have a pandemic meaning we have transmission at community level in
virtually every country of the world right now so the significance is massive
because we are dealing with a with a pandemic and every country and every
individual in every country needs to be part of the solution and I think this is
the real clarion that there isn’t any part of the world that is exempt from
this and therefore we all have to rally together and do as best as we can an
environment of still unfortunately significant uncertainty great thank you
and I think we’ll get to some of those specifics about what we can do to
protect ourselves over the next 45 minutes or so dr. Behr we actually
received as you might imagine many questions from alumni related to the
science and the microbiology of this virus essentially people want to know in
various forms and what is the lifespan of the virus how exactly is it attacking
our body and how is it able to replicate itself and spread so quickly compared to
more traditional influenza viruses so so thank you Derek
so first off the the life cycle of this virus is probably similar to other
respiratory viruses in that it comes into our eyes our nose or our mouth
through activities such as nail biting which you have literally stopped to do
and then it finds cells in our respiratory mucosa where it enters and
then it replicates viruses are not self-replicating like bacteria they need
to borrow our cells to live and to replicate so they have to enter cells
they replicate and then when there is shedding at a later point we have a
current of median incubation period and the three to five days or so when you
are sick then it comes out of those things secretions and goes to other
people the question is I think one of the part of the questions is why is this
different than with traditional viruses like influenza currently the estimates
of what’s called the R naught or the transmissibility or how many second
infections are caused by first infection are generally on the order of two to
three and classically for a disease like influenza B R naught was perhaps lower
perhaps closer to one so that suggests that every case is causing more
secondary cases now what I don’t know and I’m not sure if other people know
but I would invite him to give his input is whether this is because there’s a
higher viral load and people are shedding more virus so you’re more
likely to transmit or whether there is actually less pre-existing immunity so
that everybody who is infected is more likely to get disease because this is a
new virus and people are presumably not immune so whether it’s a pathogen
determinant or a host determinant that is resulting in this higher or not is
something that I think is currently uncertain Tim do you have any further
thoughts on that and no I would agree that we don’t have
definitive evidence on that although a very interesting study from China just
emerged this week which suggested that about 86 percent of the transmission of
the infection in China and during the epidemic the peak of the epidemic was
likely to be due to people who were asymptomatic so not showing active signs
of infection so there is some suggestion I think based on that that this this
virus can transmit quite efficiently whether it’s due to viral load or host
issues related to lack of immunity I think we’ll we’ll only answer that
question when we have a test for whether or not people are showing antibodies to
the virus did I just follow up on Tim’s point about the majority of transmission
being from asymptomatic people I’d like to suggest that before we think that
everybody who is asymptomatic is therefore transmissible we should
remember that there is the per capita risk of transmitting in the per
population risk so on a per individual risk if you are sick and you’re sneezing
and things are coming and you’re crying and you’re blowing your nose clearly you
are going to be shedding water virus asymptomatic people however when there’s
a population of four million people and then the force of transmission from
asymptomatic people will become more evident in my okay well thank you both
for for that dr. Evans on our first webcast on this subject over a month ago
now back when we thought this was still what we knew it was still contained
mainly to China at the time you spoke a lot about the concerns you had that in
this global interconnected world that we live in we’re really only as strong as
our weakest link and I’m sure that when you were thinking about countries that
would be the weakest link you were not thinking about places like Italy or the
United States so what does it tell you about this outbreak and even some of the
world’s most scientifically advanced nations have been unable to contain the
virus and stop its spread we simply unprepared I think the short
answer that question is yes and and I think we underestimate the shared risk
that we all have with respect to global pathogens and I can’t emphasize how
important it would have been for all countries to move much much more quickly
in ramping up their preparedness and response and the best manifestation of
that is in testing and so if you look at South Korea which has done a very good
job in managing the outbreak they are the country that has tested the most
there up close to 300 thousand tests their test rates per million population
are climbing up over 5,000 per million and if you compare that to Canada we’re
probably somewhere around 500 4 million tests way under tested at the moment so
we can’t sit back and think we’re doing particularly well and if you compare
that to places like the United States they may be at 50 tests per million at
the moment that’s two orders of magnitude too low there needs to be as
the director-general of the World Health Organization says testing testing
testing I can’t emphasize how important that is that’s the best mark that’s your
understanding where those infections are who the contacts are and where you need
to direct resources to get on top of it so yes the weakest links are in the
systems that sometimes think that they’re not going to get this as opposed
to having great scientific might if you’re on your heels here unfortunately
you’re going to pay for it mm-hmm dr. behr hi I just like to add that the
interconnected which highlights our weakest point is
also highlighting some of our new strengths and I’ve been incredibly
impressed following on Twitter and other social media some of the really tireless
investigators who are putting out blogs putting out ideas sharing their thoughts
their insights people who are putting viral genome sequences online in order
to infer whether there is multiple importations of the virus or to show
that their spread of the virus in Washington State so there has been some
some major advantage of our interconnected world is that the
dissemination of information and ideas has been quite remarkable and I’d like
to just give a shout out to some of the people who’ve been writing very
influential ideas and appends on this mmm-hmm now here in Quebec in particular
the government has taken what appears to be a very very aggressive actions move
either close down most public gathering spaces such as gyms ski hills movie
theaters not to mention all the schools and starting this when there were just a
handful of confirmed cases in the province do you gentlemen think that
this has been the right approach and one that other jurisdictions should be
looking to emulate him go ahead thanks Marcel. Derek I think that in
general the policy of social distancing which is inherent in these policies of
shutting down big institutions and discouraging gatherings in large
gatherings and places is is the right policy so I think that it is the
appropriate action at this point of time it will be a difficult one to sustain
and so we need to be conscious of that and I think we also need to be conscious
of some of the real differences that are taking place across countries in the
implementation of this policy in the UK and Australia for example they haven’t
shut schools at this point in time and I think this will be interesting to see
in fact either that’s a strength insofar as those children are not at risk or
overly exposed and perhaps develop herd immunity faster than they might if they
were isolated and whether or not and we can manage looking at the consequences
perhaps the unintended consequences of keeping children at home which may put
more stress on parents or more contact with grandparents and therefore
adversely increase the risk of transmission to the elderly so I think
the in some I think in general the policy is the right one I think there is
some active and healthy discussion on on what the risks and benefits are of
social isolation or social distancing for the youngest part of our population
or something yeah I’d like to follow up with two two ideas there in first
I just want to underline what Tim just said is I think that universities are
engines of thought and ideas and I think it should be healthy to ask questions
about this and try to understand while we all conceptually agree with social
distancing to what extent is social distancing helpful in to what extent
will social distancing potentially lead to problems in some vulnerable
populations so there has to be an ongoing conversation it would be nice to
have a single answer but I think universities were created as as places
where we can have these conversations in the civil tone I’d also like to point
out just as a discrete example you asked me what my day was like today I went on
shore retreat here in Montreal I got on a bus and the bus was closed at the
front but the back door was open the sign at the front was taped and it said
you had to social distancing stay away from the driver so I got a free ride
because I wasn’t allowed to use my opus pass and I thought this was a beautiful
compromise that the infrastructure the STM is there and it’s available and it’s
helping people to move and the people who have to shop after shop
people have to get to work after you get to work while at the same time I’m
respecting the drivers need for space and and the driver need not fear that
I’m going to be bringing the virus onto the bus and infecting that driver so I
think for each situation we have to try to find that delicate balance between
providing the services and not amplifying the epidemic great thank you
well even these in his opening remarks you’ve answered many of the questions
that have come in but I’d like to actually get to some of the direct
questions we did receive from our alumni from email and social media I’ll start
with the the first one it comes in from Rafael Nunez and it’s probably the one
question that is top of mind for most people which is how long should we
expect to be in this period of social isolation so I’ll take it first if
you’re okay Tim I think the two questions about should we be in self
isolation and that’s the private question and then the societal question
the current recommendations if he traveled from abroad you should be in
self isolation for 14 days as is my wife and is my daughter they came back from
London last Saturday they are staying at home I kept some of the outside duties
so as an individual level please stay at home for 14 days how long will the
societal effort at social distancing be propagated or continued that is
something I do not know and that’s why I defer to Tim because he may have some
better insights on that thanks Marcel I am I don’t have the crystal ball on that
I do think as soon as we have a test that shows whether or not people are
developing immunity to the virus that that will help us understand it whether
we can relax social isolation measures so if we have a test which shows that
many people are showing antibodies to this virus and then that would suggest
that we can begin to relax some of the social isolation measures particularly
for the lower risk populations so I think I don’t
put everything back to science but I think if there’s a huge priority
scientifically it’s to accelerate the development of a of a blood test that
would allow us to know whether somebody has developed antibodies to this farz
but to follow on that Tim I think we need not only a test but we will need
test results and it’s one thing to know that an individual is immune but we will
need to know what percent of society needs to be immune and for that we not
only need to just be able to have the scientific capacity but we’ll also have
to have the scale up that the test can be offered to large numbers of people
absolutely so too early really to put a timeframe on when we can go back to
meaning are normalized and back to work in school correct so here’s another
question that’s come in probably not surprising from Tony ripped in ski it
was wondering if the virus will be less effective once we get warmer weather and
if so why so Marcelo gonna try first here I think there’s you know there’s
reason to think when we see flu and colds these seem to be winter phenomena
in Canada so there’s reason to hope that this could be a winter problem that’s
less of a summer problem if that’s the case then there’s also reason to fear
that it’ll become a winter problem again next November’s so I think we have to be
cautious about using the warmth to relax things now if we’re not ready to ramp
things up again in the fall but we also have natural experiments where if you go
on to some of the dashboards now and look at the number of cases in Canada
and the number of cases in Australia which is a country with a similar
population the number of cases is the same and I would submit that most places
in Australia have much more warm or hot weather today than we’re experiencing in
Montreal today so I don’t see any evidence from the natural global
epidemiology that it’s a cold hot phenomena if it is maybe that’s okay but
if it if it is we also have to remember that we will
the winter next winter mm-hmm okay the next question here I’ll try to
pronounce this name well it’s from gazia Xhosa bocce an excellent question
what are the steps to take if one starts feeling symptoms who do we call and what
do they actually do to help patients our people advised to stay at home to recover
because hospitalization is not necessary or is it because there’s not enough
spaces and care left so it sounds like a medical question so I guess that’s
directed at the head of infectious diseases
I think the measures to take are largely the same as you would have done one
month or one year or one decade ago if you got a cold if you had a common cold
and you felt miserable and you want it to stay in your bed and have chicken
soup stay at home stay in your bed and take chicken soup if you are feeling too
sick to manage at home or because you have a pre-existing
disease and this is exacerbating your pre-existing disease and one year ago
you would have gone to the hospital because you were too sick to stay at
home right now if you’re too sick to stay at home go to the hospital that
hasn’t changed I understand there’s a fear of going to
the hospital and acquiring infections and making things worse but on the other
hand the general indications for hospitalization haven’t changed which is
the hospital can offer you a level of care you cannot get in your home so if
you are fortunate enough to get the care you need at home stay at home if it
seems you need oxygen because you’re not able to breathe well if it seems that
you have completely uncontrolled fever and you’re unable to function those are
the same reasons to go to the hospital the hospitals now have in place testing
for the virus SARS to convey that causes the Z’s kovat
19 so you will be asked questions when you enter the hospital it will ask the
screening questions they will put you in separate rooms and they will do the
testing that is necessary but fundamentally the reasons to come to the
hospital haven’t changed if you have any uncertainty about it to quebec
government has put a 1 877 number at the government of Quebec website
I have not memorized it I have it on my cell phone here I’d have to
look it up while talking I’m not sure if I can but you can certainly share it and
and for the people listening from other jurisdictions most governments have
posted toll free appliance great thank you dr. Behr oh there are going be
just just to add on that as I think that many people feel if they have cold like
symptoms then they should go and get tested and I think what Marcel is saying
actually if you have a cold treat it like air cold symptoms which could
potentially be symptoms compatible with covid infection stay home if you’re
feeling well enough to stay home and I think that also helps in terms of
preserving the social distancing and avoiding unnecessary exposure for people
who can stay at home so I think that side of it is is particularly important
because everybody has naturally a lot of anxiety that a cold symptom may be an
indication of coded infection I think in that point as well when we look at the
number of tests that are being done today in in Canada a net of the at-risk
population that are being tested ninety-five percent of those tests are
negative so the vast majority of people being tested for Kovan at the moment are
testing negative it’s a very small proportion and I say that because the
likelihood that if you do have symptoms of a cold that they are a cold or a flu
as opposed to Govan is still much higher than individuals having Kovac great so
you – Tim – reinforcing those message the counter side – if you have messages
if you have a cold stay at home and the counter side to that is if you have
sudden squeezing chest pain and you think you have a heart attack go to the
emergency because you think you have a heart attack if you have the signs of a
stroke that we’ve all been learned are the signs of a stroke
go to the emergency the hospital is open all the specialists all the specialties
are here all the specialists are here so please do not fear going to the hospital
if you have a medical need come to the hospital we are here for you
great thank you the next question is from Irwin freed on a similar vein
should you be tested if you think you may have come into contact with someone
who has cold at 19 currently we are not recommending
testing people who think you were in contact with somebody we are testing
people for a variety of reasons we’re testing in Canada we’re testing Quebec
were testing symptomatic people we’re testing new admissions to the hospital
for instance we do not have the scope to test everybody right now even people who
have a cult or a home and I’m not coming to us we are not testing everybody who
has a common cold and going beyond that to the person next to them who doesn’t
have the common cold would really stretch our capacity for testing so that
is not recommended okay here’s a question from Toby Gilsig we have read
that the risk of contracting the Cova 19 virus is higher for those with
compromised immune systems as well as those with overactive immune systems
should these individuals stop taking medications related to suppressing their
immune systems so so thank you for that question I am I was fortunate to be able
to ask my colleague Don VIN who’s an infectious disease specialist whose
expertise is the immune response to infectious diseases about that very
question recently and he wanted to reinforce that first of all there’s two
steps of the question is immune compromised a risk group and one step is
are they more likely to get infected and the other step is if infected are they
more likely to have severe disease at this point dr. van is unaware of any
data speaking to either of those and several groups are working on it and we
also have to concede that immune compromised is what we call in medicine
a heterogeneous group there are people who are on a steroid inhaler for asthma
and there’s people who just had a bone marrow transplant for
leukemia and it’s hard to put that completely varying group of patients
into one group and call it the immune compromised group there may be some
groups that are higher risk than other groups and clinical researchers are
trying to determine that the second part of the question is if you have a heart
transplant and you are living today because somebody gave through a bequest
and through the autopsy process a heart to you so you are walking on the street
continue your anti-rejection medicines do not lose that art now this is not the
time to stop the standard medicines that you need for your transplant the
standard medicines that you need for you lupus
there is no recommendation to withhold immunosuppressive drugs and make your
other conditions worse oh great thank you I got one more medical question and
then I’ve got a whole bunch for you doctor if it’s don’t worry but this one
came out in a few different ways Kimberly you has in particular is asking
is it safe to take ibuprofen and why are physicians in France saying otherwise so
my understanding is that there’s an association between ivory Griffin use
and poor outcomes what is unclear in the absence of what’s called a clinical
trial is whether there is something that’s called confounding by indication
which is did the ibuprofen make people worse or did the people who were doing
worse take the ibuprofen at this point we don’t know but the Association has
been concerning enough that the w-h-o has pronounced against ibuprofen because
in general when you think of any medicine for any intervention you have
to ask does the benefitting outweigh the risk in the case of ibuprofen
there is no proven benefit we have no way to quantify that ibuprofen to use
gets rid of the virus or ibuprofen risk used makes you better so since there is
no demonstrable benefit it is quite prudent to say don’t take it because
there is a potential risk but whether it’s cause or consequence remains to be
determined I agree with the recommendation and our own hospice
guidelines recommend against that class of medicines for a kovat case great
thank you here’s a question from Kayla Gibbons dr. Evans maybe I’ll let you
jump in on this one for those who are self isolating and taking all the
necessary precautions to avoid the spread of the virus but as husbands or
wives are still working and coming home to their families who have been self
isolating how can we make our own homes a safe place so I think I think this is
challenging in some respects and in terms of what the conditions are of a
particular home and that of course will vary but I think first and foremost is
to really reinforce eyes good personal infection hygiene and that relates to
washing hands avoid touching the face which is a very efficient transmission
of virus sneezing and coughing appropriately into elbows or Kleenexes
and keeping surfaces clean if there’s opportunity if the household has
multiple facilities bathrooms then there may be a way that the individual who is
self isolating can use one of the bathrooms or one of the bedrooms without
others having to use it so there may be depending on circumstances opportunities
for houses to accommodate a little bit more dedicated use of some parts of the
house for the individual that’s self isolating and if that is the situation
then it certainly makes sense to do that so I think those would be my suggestions
on on that front of course anybody who is living with somebody who is self
isolating has to of course monitor their own symptoms and and should they develop
symptoms and they should also report those mm-hmm a lot of questions have
come in as you might imagine about transmission
whether the virus remains airborne and for how long I want to get to a specific
one it’s quite specific but I think that many people have this similar anxiety
comes from Sharon Brandt who says she lives in a modern condo in downtown
Toronto and is wondering if she should turn off the air conditioning either or
blower in her unit well the virus traveled into her apartment via the air
that way so so currently there’s no evidence that viruses are traveling from
one room to the other there are infectious diseases like
tuberculosis where it has been shown in the past that if you take the air from a
patient room with tuberculosis and then bring that air into another room the
guinea pigs can get sick and that’s what’s called aerosol transmission in
the case of corona viruses and most respire to attract infections the
primary route of transmission is what’s called droplet transmission you sneeze
you cough something comes out and hits somebody’s face or eye or whatever
that’s the primary route of transmission we’re talking in the hospital about what
are called aerosol generating procedures so an aerosol generating procedure is
when somebody is very sick and they need to be intubated and at the time of
intubation they may die and there may be suction and then you can imagine where
there will be kind of a cloud of virus floating around them for a short period
of time but with time it will settle and it will land on the ground or land on
the table and that’s the surfaces that we have to clean if will not fly out
into the air and out the ducts in the top of the room and then transmitted to
the next rooms so my advice to somebody who is in a closed condo right now is if
the weather is nice open the windows and enjoy a stream of air from outside and
if you have a chance go outside and go to the nearest park and enjoy the
beautiful weather there’s I see there’s a lot of very good spirit of people
seeing each other in the park and talking to each other and keeping
distance so I wouldn’t stay in the condo but I wouldn’t turn off the heat either
great a similar question from Beverly Baron Brahm was wondering do we know how
long the virus lasts on inanimate objects for example when we’re buying
groceries we have to worry about bringing them into our homes
there are of course studies looking at how long the virus lasts on plastic or
glass or copper or cardboard and I’m not going to pretend I know the exact number
for every surface I think the more pragmatic question is if I go to the
grocery store and I come home do I have to disinfect the outside of
every Cheerios box and the answer is go to the grocery store wash your hands
take things out wash your hands again and use good hygiene and remember that
when you’re preparing your meal you should use all the good hygiene for all
of the things in there if you’re going to be handling eggs this is a time to
remind yourself to wash your hands after cracking an egg this is the time to make
sure that you don’t use the same bread board for the chicken as you use for the
salad because this isn’t the only microbe that we are encountering and
common sense and hand-washing will help you to reduce your risk of many
different microbial exposures I’ve actually been thinking a bit about that
and you know one day hopefully soon we’ll be out of this and beyond this is
this do you guys think this is gonna change the way we actually think about
personal no hygiene forever will we be the generation that will never have to
be told again to wash your hands and not touch your face Tim the doctor
everything ok listen as somebody who’s suffering from short-term memory deficit
increasingly I’m quite sure that we’ll have to reinforce these messages
continually and over time I think you’re pointing Derek to I think one of the
benefits is that if we can exercise better infection and hygiene
then we may not only slow the progression of kovat 19 but we may also
limit transmission of other pathogens that Marcelo deals with all the time
some of which have a patient’s ending up in the hospital like Salmonella and
things and so the what we say in economics the positive externalities the
benefit of this goes far beyond COBIT and I think it is right there
be some lasting effect but we will have to continually reinforce these sorts of
behaviors just because they often get forgotten two or three years after the
some period of time after the scare so I think it’s the right direction but I
can’t imagine that we’re gonna put public health officials out of work in
terms of detection hygiene okay so on that note I don’t want to maybe so
I go ahead babe just like to point out one of the great things about my job is
I learned something new every day and I just learned about positive exponential
ality so thank you very much Tim crazy but I do want to actually maybe use this
we wanted to talk a little bit about the situation or the solutions being
developed in some of the Asian countries and when the w-h-o had their press
conference last week announcing this to be a pandemic they did in fact single
out China and South Korea for praise for taking steps to slow down the spread I
read in certain media reports that part of that is cultural because these are
countries that have experienced serious outbreaks in the past whether it be
stars or avian bird flu so maybe you can talk a little bit to us dr. Evans about
what exactly is happening in these countries specifically China Singapore
South Korea that the rest of the world might want to take some lessons from and
are we as you know citizens of liberal democracies in the West willing to go so
far as to abide by some of these measures yeah it’s a great question and
and Derek let me first state that a number of the countries that you refer
to are liberal democracies and so I think it’s very important to recognize
that there are a number of countries outside of China including Singapore
South Korea Thailand where you have active democracies that are certainly
very different from the political system in China however more fundamentally if
you look at what’s being done there is a tremendous amount to learn and and as I
mentioned earlier I believe if you have to put a country
up on a pedestal at the moment not to jinx them but to simply say their
experience has a lot that the rest of the world can learn from and that’s
beyond China it is South Korea and if you look at the extent to which they
have been on top of testing since early February and the weight the way in which
they’ve ramped that up it is absolutely I think the way to go and I can’t stress
that enough because in our own country I think we still are not scaling up our
testing and I’ve communicated this to various government officials but I think
we need to move it up at least another log order tenfold in order to get on top
of this so that’s number one lesson number two you have different
experiences with respect to lock down China it seems as if it was quite
important and effective the Korean Minister of Health said that lockdown
actually created more problems than it was worth because people because of
issues related to compliance and people knowing the lockdown was coming with
would move and and that created problems with getting compliance with testing so
I think that sort of experience is it is extremely important the third is how to
think about managing the surge that will be felt on your hospital infrastructure
and we know everywhere that there is likely going to be a very steep increase
in need for hospitalization and in particularly intensive care with
ventilators I think the experience of China South Korea in accelerating
expansion of that infrastructure and the human resources to deal with that has
a tremendous amount for us to learn from so I think those are our lessons that
are not conditional on politics other than political will and I think what
we’re seeing as our leaders are stepping up but what we really need to see is
tangible clear plans on testing and in particular on supporting the surge
capacity for hospital care in order to secure public confidence that we’re
actually doing everything that we can to to manage this pandemic I’d like to just
add that I think there’s many natural experiments going on in the world and
it’s there’s a risk of oversimplifying and saying China is doing well because
they are communist or Italy is doing well because people kiss each other on
the cheek twice and there are so many different countries and there are so
many different factors between health care systems and social norms and I
think we should definitely know we should be very prudent about just
comparing to and saying it’s because of one leader or one country and we have to
think through all of the possible facets and then we have to converge the
possible facets into actionable intelligence and as Tim says one of the
things that seems to transcend all boundaries and borders and political
parties is that testing is good and more testing is better
can i Derick just to come in and not to continue on this but I do think also the
reporting on testing is particularly important and then just drawing on
Marcelle suggestion of learning from other countries if you go to the UK
Department of Health website they report on the epidemic every day by starting
saying this number of people have been tested this number people tested
positive this number tested negative and if you look at that and if the media
started reporting on the numbers tested and in particular the numbers testing
negative then it would change perceptions that everybody every new
case means that everybody is getting infected
I think this is the sort of communication that would help manage X
perspective both with politicians but also with the public and I think these
sorts of data are real data and very helpful in putting risk in better
perspective so I do think there’s an opportunity to learn from better
practices on reporting which are not only what government reports but how the
media picks that up and also reports well I appreciate that dr. Evans but I’m
just wondering well I appreciate the reassurance that some of these test
results might provide us is it not a bad thing that the population is a bit
scared right now and therefore more abiding of social distancing and other
measures I think and in the year I don’t think there’s any issue here with
respect to the extent to which people are aware that this is a serious threat
and I think by putting things into perspective it’s not to suggest somehow
that we’re not dealing with a very serious problem but it does
I think behoove us not to paint everything as an Armageddon scenario
when in fact the data don’t support it and I think it’s a responsibility for
good governance to present the data as they are or as best as we understand
them so I think that’s a difference it’s not to suggest telling people the truth
is is is the same as saying don’t be concerned
we’re simply suggesting tell us the situation really as it is and then
continue on no one is suggesting that we’re going to back off on any of the
measures that we’re taking with respect to social distancing and active testing
and getting people into care as appropriate so being cognizant of time
and I appreciate the fact that you’re both willing to stay on maybe a few more
minutes I do have a few more scientific questions maybe I’ll turn to you dr.
bear maybe we can do some quick rapid-fire here and try to get through a
few of these questions from Erika can the coronavirus get into our water
and survive if I understand the question is about our drinking water and not
going canoeing or swimming in the water in Canada right now and there’s no
evidence that it is transmitted through our water supplies okay what about
somebody Janet Bock actually was asking about but the fact that our libraries
are closed people are considering sharing books and DVDs and magazines
with each other is it overreacting to think that doing
this could be dangerous it’s not a complete overreaction because
we’re being told to wash our hands and try to keep things clean if you are in
the house with somebody and you’re sharing a DVD
well we actually also have many options to get ebooks and to download things so
that if you don’t want to go across town to meet somebody to pick up a magazine
see if this is the time that you should consider getting out electronic
subscription it’s the same content it’s just you don’t get to turn the pages
mm-hmm question from Nicholas Matt Oh Sian should we be wearing masks even
though they are deemed to be only partially effective well there that’s
sort of two questions and the one question is our masks partially
effective and it gets that question depends on effective at what and for
what but I think the main question there is should a healthy asymptomatic person
who is well going to the park wear a mask and I say the answer is no when I
walk to work I don’t wear a mask when I walk home I don’t wear a mask should
health care workers wear a mask if they go into a room with somebody who has
kovin 19 or a suspect took over 19 yes what math should they wear they should
wear the mask that their infection control officers have deemed necessary
depending on the severity of the illness and the procedures going on there are
clear directives in the health care system about when to wear a mask and who
to wear a mask but people who are walking to the park and back that is not
one of the reasons to wear a mask okay I’ve got two more quick ones here one
from the taniel brand asking about the potential impact of Kovan 19 on pregnant
women are there any extra steps you would recommend they take to protect
themselves I am unaware of an association between Co mid-nineteen
and adverse effects in the woman nor I am unaware of any data uncovered 19 and
adverse effects on the fetus I am sure that these data will be accruing with
time the outbreak started around early November according to the genomic
epidemiology data so in terms of birth outcomes we would not have past 9 months
so we will have to wait until 9 November plus 9 months
Tim can do that faster than me I’m gonna guess that’s August 1 but I don’t think
we know the answer on either those it’s a good question for which I think the
data are still waiting mm-hmm and we cannot do an entire webcast without
talking about our pets Tim Sellars was asking he says he’s been practicing
social distancing and walking his dog to the park I stay away from the other dog
walkers but my dog plays with other dogs is this a potential problem there is no
evidence that dogs are spreading coronavirus to their owners and I am
also unaware of any evidence that cats are spreading gröna virus to their
owners I have seen firsthand that when dogs go to the dog run they do not do
social distancing and they do all kinds of things that we would normally think
would be really good at spreading all kinds of microbes but we’re not aware
that that’s going to change with Kogan 19 nor am i aware that the dogs are
actually going to follow our guidelines I think we have to let our dogs play
mm-hmm great now dr. Evans I want to ask you a bit about vaccines I know we spoke
a little bit this about this on our last webcast do you have any update or any
news on when the world might see a vaccine and well I think that’s it
depends who you ask but I think what I’m hearing is that the earliest would be
within a year to 18 months and that would be the very earliest there are
some vaccines that are now in what we call phase 1 clinical trials and we’re
seeing more and more candidates but the phase one needs to go to phase 2 phase 3
so there’s a distance and not all candidates in phase one make it through
and secure with evidence that there actually have the potential to be an
effective vaccine so my understanding and Marcio may have more to add on this
but that the various barrier list we see a vaccine is one year to 18 months and
that’s I think if all goes well with the current candidates that are into testing
it may well take longer as we’ve seen in the context of HIV and we’ve been
looking for a vaccine since well well over 20 years and and we still haven’t
got a vaccine for HIV so not to take away hope and not to take away any of
the importance of investing and trying to accelerate the development of
vaccines as we have through something called the coalition for epidemic
preparedness and innovation sepi but it may be longer than a year’s
18 months so from my advantage if you’re creating a new product whether it’s a
new vaccine or a new treatment there is a due process that involves preclinical
testing phase 1 phase 2 phase 3 trials and that takes time in order for
everything to be done correctly if you have a product that’s already FDA
approved for a completely different indication then you can fast-track and
do something called like an off target or off label study and that’s what some
of the trials that are in the New England Journal are at looking at drugs
that were developed for something else whether they could work for Kove it the
same principle could in theory apply if other vaccines that are already going
into people happen to have some off-target effect again sokovia time
aware of people talking about that and and looking at whether there are ways to
investigate that but I am unaware of something that is an already licensed
vaccine that has activity against Ovid but that is the fastest route I can
imagine to a covert vaccine although that’s a very
exploratory idea right now we did get one question which I would like to
mention here from Alexandre satorious who’s asking if there’s actually a need
for volunteers so either help with the important research or to help with any
of the testing so that question is is well-received
I have heard I’ve had that contact from professors at McGill who were trained as
doctors another country who were volunteered to put on their white coats
and stethoscopes and come and step in and help in the clinic in any way
possible I have had contact and emails from students who are in research lab or
who have been in research labs offering to volunteer and help with diagnostic
testing in the microbiology labs we don’t yet have a place for that but we
already are starting to see for instance that are some of the people who have
trained and retired are signing up to come back into the ranks of the work
force and we have people who have the license but are doing extra training who
have signed up during the period of extra training to come back and help
with for instance Kovich clinics so we’re starting to see that our workforce
is increasing as people who have left the workforce are coming back and are
volunteering and the next level may be that we will ask for volunteers to also
support them as we grow frapp our workforce is good and
curiously because of the reason that nobody is travelling everybody is in
town nobody’s overseas nobody’s at meetings
so we are okay now but as tim has alluded to before we’re probably just
before the surge and what our capacity is when the surge hits remains
undetermined right now let me just add a few things to Marcel’s great response
and that relates to one for everybody who’s in who has their health and has
expertise in one domain of the other it’s really important now to think about
how you can be part of the solution and I think it’s a mistake
to assume that existing structures governmental or hospital or public
health have all the resources they need the grim reality is they don’t and so
just as an example my discussions with the government of Canada
they’re very receptive to the idea that we you know we’ve got a great
epidemiology unit at McGill they’d love to have two or three of our best
epidemiologists to help them strengthen the daily reporting on the epidemic and
and if we can do that we would love to do it
managing supply chain for all of the different parts of the Diagnostics that
are needed that nasopharyngeal swabs the transport media the reagents those are
things that require innovative solutions in in the current context and might
benefit from entrepreneurs who understand how to source these sorts of
commodities quickly and efficiently and that scale and aren’t necessarily the
sorts of things and experience that some of the desk officers who are responsible
for that have experience with so I think the intent of that question is is
absolutely the right spirit and let’s see how you in your own experience and
expertise can play some positive role to strengthening the response and I think
if we do that collectively that’s going to make a significant difference in
managing and responding to the current situation now that would be a great
question to perhaps end on but I do have to ask you this next one I know the
answer I’m hoping you can each answer in one word but it’s such a great question
from Peter Lippmann is there any rational explanation for the apparently
overwhelming obsession with toilet paper no dr. Evans okay so let me ask you one
final question I have one of my own which I’m hoping to maybe end on on some
some some good hope but as you know we’re hit every day
with an onslaught of grim statistics and bar graphs is there any one data point
we should be looking out for either in our local communities or the global
level that would give us all a sense of hope or relief that the spread is in
fact slowing down and we’re nearing the end of this nightmare so from my view I
coming back to what Tim said before the number of tests the number test positive
I don’t know what the percent positive means from Canada to Germany to Korea if
I don’t know who is getting tested so I would not use the percent positive test
the number of tests could be useful or not but as you roll out more testing the
number of positives goes up I’m not sure if that’s the one
so my grim answer sadly when I look at dashboards and I look at Italy versus
Germany versus China versus South Korea I’m looking at deaths I know it’s a very
sad statistic there was a fantastic YouTube video looking at the obituary
pages in the barrack remote newspaper in Italy showing that obituaries went from
one and a half pages to ten pages and if I see that the number of deaths goes
down today then I can be optimistic that the number of transmissions went down 14
to 21 days ago I know it’s a sad statistic but that’s a hard statistic
and it’s a very meaningful statistic so that’s the one that I’m currently
tracking right so as somebody who’s a little bit more optimistic and is
obsessed with with tracking the imperfect data on on numbers tested and
numbers testing positive I think the important statistic to look at is the
numbers testing negative and if that continues if that trend is trending
downward then I think recognizing that most of the people that are being tested
are high risk and then that is a sign that I think will lead 14 to 21 days
later too much more definitive sign of progress
which is decreased deaths but you can certainly see that trend in in South
Korea and I think if people recognize that we’re talking about 90 or 95
percent of people testing negative going down going up to 96 to 97 98 those are
indications not only that we’re moving in the right direction but still the
majority of people are not getting covin 19 great well hopefully that day
is not far away for many of us in the world so we are at the top of the hour
and that about wraps up the time we do have today time and over times before we
sign off I would like to remind everyone that this video will be available at
this same link very soon after our recording ends so feel free to watch it
again if you’d like or shared with others who may not have been able to
tune in in real time I’d also like to invite you to keep an eye out for more
emails from the guild I promise you there will be fewer than you’re used to
but we are committed to providing our community with the news and information
you need to stay safe and to stay informed
including more webcasts with our academic experts and finally I would
like to extend a sincere thank you to dr. Evans and to dr. bear for joining us
today and for sharing some incredible insights with all of us I know your
schedules are quite packed and we really appreciate the time you took out of your
days to speak with us today and I hope we’ll have a chance to connect again
soon Thank You Derek Thank You Derek thanks Marcel
Carol thank you you

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