Episode SummaryIn 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!SHOW SPONSORBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Transcript:KK: Welcome to ‘Solving Healthcare’ I’m Kwadwo Kyeremanteng. I'm an ICU and palliative care physicianhere in Ottawa and the founder of ‘Resource Optimization Network’ we are on a mission to transformhealthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and theirfamilies because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a betterhealth 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 andsay, this is it, my friends. I think what motivated us to get together today was, we want to learn, wewant 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 ofelevate the voices of reason and balance, and so on. So, before we get started, I do want to give acouple of instructions for those that are online. If you press NL into the chat box, you will be able to getthis. 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 togive a quick plug to our new initiative. Our new newsletters now on Substack. Everything is on therenow our podcasts our newsletter. So, all the updates you'll be able to get through there. I'm just goingto put a link in the chat box. Once I find it. Bam, bam, bam. Okay, there we go. There we go. That's itright there, folks. So, I feel like the crew here needs no introduction. We're gonna do it. Anyway, we gotDr. Zain Chagla, we got Dr. Stef Baral, we got Dr. Sumon Chakrabarti back in full effect. Once again, like Isaid, we were we chat a lot. We were on a on a chat group together. We were saying how like, we justneed to close this out, we need to address some of the issues that we've seen during the pandemic. Talkabout how we need to learn and deal with some of the more topical issues du jour. So, I think what we'llstart with, well get Sumon to enter the building. If you're on Twitter, you're gonna get a lot of mixedmessages on why you should be fearful of it or why not you should be fearful of it. So, from an IDperspective, 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 ofmove to the next stage that doesn't involve us talking about COVID all the time. But so yeah, I think thatwe've had a bit of an alphabet soup in the last year with all these variants. And you know, the most oneof the newest ones that we're hearing about recently are BQ 1, xBB. I think that what I talked aboutwhen I was messaging on the news was taking a step back and looking at what's happened in the last 14months. What that is showing us is that we've had Omicron For this entire time, which suggests a levelof genomic stability in the virus, if you remember, variants at the very beginning, you know, that wassynonymous with oh, man, we're going to have an explosion of cases. Especially with alpha for the GTAdelta for the rest of, of Ontario, and I'm just talking about my local area. We saw massive increases inhospitalizations, health care resources, of patients having been sent all over the province. So, it was itwas awful, right. But you know, I think that was a bit of PTSD because now after anybody heard theword variant, that's what you remember. As time has gone on, you can see that the number ofhospitalizations has reduced, the number of deaths has reduced. Now when omicron came yeah, therewas an explosion of cases. But you know, when you look at the actual rate of people getting extremely illfrom it, it's much, much, much less. That was something that, you know, many of us were secretlythinking, Man, this is great when this happened. So now where we are is we're in January 2023, we'vehad 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 thesenew variants are their immune evasive, they tend to be not as they're not as visually as, I see this in myown practice, like all of us do here. You know, they are, well, I'm kind of piecemeal evolution of thevirus. Now, there's not one variant that's gonna blow all the other ones out of the water, like Oh, microndid or delta. Right. I think this is a good thing. This is showing that we're reaching a different stage of thepandemic, which we've been in for almost a year now. I think that every time we hear a new one, itdoesn't mean that we're back to square one. I think that this is what viruses naturally do. And I thinkputting 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 toexpect what future variants like, obviously, is there's no crystal ball, but someone alluded to the ideathat 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, inhistory, right. Even though we've lived with coronaviruses, there probably was a plague ofcoronaviruses. What was the Russian flu is probably the emergence of one of our coronaviruses areseasonal 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 tothem. This is part of RNA replication of the virus is going to incorporate some mutations and survival ofthe fittest, the difference between 2020, 2021, 2022, and now 2023 is the only pathway for this virus tokeep 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 Ithink that the big difference here is that that protection, that severe disease, right, like the COVID, thatwe saw in 2020/2021, you know, that terrible ICU itis, from the COVID, you know, for the level ofantibody T cell function, non-neutralizing antibody functioning mate cell function, all of that that's builtinto, you know, humanity now through infection, vaccine are both really, you know, the virus can evolveto evade some of the immunity to cause repeat infections and, you know, get into your mucosa andreplicate a bit, the ability for the virus to kind of, you know, cause deep tissue infection lead to ARDSlead to all of these complications is getting harder and harder and harder. That's us evolving with thevirus and that's, you know, how many of these viruses as they emerge in the population really have kindof led to stability more than anything else? So, yes, we're going to see more variants. Yes, you know, thisis probably what what the future is, there will be some more cases and there may be a slight tick inhospitalizations 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 thisdisease goes moving forward.KK: Yeah, absolutely. Maybe Stef we could pipe it a bit on, the idea that, first of all, I just want toreinforce like as an ICU doc in Ottawa with a population of over a million we really have seen very littleCOVID pneumonia since February 2022. Very minimal and it just goes to show know exactly whatSumon and Zain were alluding to less virulent with the immunity that we've established in thecommunity, all reassuring science. One question I want to throw towards Stef, before getting into it. Youdid an interview with Mike Hart. As you were doing this interview, I was going beast mode. I was hearingStef throw down. I don't know if you were, a bit testy that day, or whatever. There was the raw motionof reflecting on the pandemic, and how we responded and far we've gone away from public healthprinciples, was just like this motivator to say, we cannot have this happen again. I gotta tell you, boys,like after hearing that episode, I was like ‘Yeah, let's do this’. Let's get on. Let's go on another, doanother show. I'm gonna leave this fairly open Stef. What has been some of the keyways we'veapproached this pandemic that has really triggered you?SB: Yeah, I mean, so I guess what I'd say is, in some ways, I wish there was nobody listening to this rightnow. I wish there was like, I don't know what the audience is. I don't know if it's 10 people or underpeople, but I think it's like, I wish nobody cared anymore. I want Public Health to care. I want doctors tocare, we're going to keep talking because you know, Kwadwo, you've had folks in the ICU we we'vewe've seen cases in the shelters, we have outbreaks, like public health is always going to care aboutCOVID, as it cares about influenza cares about RSV, and other viruses, because it needs to respond tooutbreaks among vulnerable folks. That will never stop COVID, it was just clear very early, that COVID isgoing to be with us forever. So that means tragically, people will die of COVID people. I think that, youknow, there's that that's a reality, it's sometimes it's very close to home for those of us who areproviders, as it has for me in the last week. So COVID never ends. I think the issue is that like when doesCOVID And as a matter of worthy of discussion for like the average person? The answer is a long timeago. I mean, I think for the folks that I've spoken to, and the way that we've lived our lives as a family isto focus on the things that like bring folks joy, and to kind of continue moving along, while also ensuringthat the right services are in place for folks who are experiencing who are at risk for COVID and seriousconsequences of COVID. Also just thinking about sort of broader systems issues that I think continue toput folks at risk. So, one: I think it's amazing, like how little of the systematic issues we've changed,we've not improved healthcare capacity at all. Amazingly, we've not really changed any of the structuresthat put our leg limitations on the on the pressures on the health system, none of that has changed. Allof it has been sort of offset and downloaded and just like talking about masks and endless boosterswhen we've never really gotten to any of the meaty stuff. As you said three years into it, andeverybody's like, well, it's an emergency. I'm like, it was an emergency and fine. We did whatever wasneeded, even if I didn't agree with it at the time. But irrespective of that, whatever that was done wasdone. But now it's amazing that like the federal money expires for COVID In next few months, and allwell have shown for this switch health guys got became millionaires like a bunch of people, I don't mindnaming and I don't care anymore. These folks, these Grifters went out and grabbed endless amounts ofmoney. These cash grabs that arrival, the ArriveCan app with, like these mystery contractors that theycan't track down millions of dollars. So it's like all these folks like grabbed, you know, huge amounts ofmoney. And I think there's a real question at the end of it of like, what are we as a country? Or youknow, across countries? What do you have to show for it? How are you going to better respond? Andthe answer right now is like very little, like we have very little to show for all this all these resources thathave been invested, all this work that has been done. That I think should be the conversation. That tome needs to be this next phase of it is like billions and billions and billions of dollars trillion or whatever,like 10s of billions of dollars were spent on what? and what was achieved? And what do we want to donext time? And what do we have to show for it? that, to me feels like the meat of the conversationrather than like silly names for these new variants that do nothing but scare people in a way that isn'thelpful. It does not advance health. It doesn't you know, make the response any more helpful. It justscares people in a way that I think only detracts them from seeking the care that we want them to beseeking.KK: Yeah, I think you brought up a point to about or alluded to how some of this was the distraction.That was one of the points that really stuck home is that we, we didn't really dive into the core s**t, thecore issues. This is why at the end of it all, are we that much more ready for the next pandemic that wellsee, you know, and so like maybe Sumon, what do you think in terms of another tough one, are weready for the next pandemic? Do you think we've done enough? do we think are in terms of what we'veinvested in, how we've communicated to the public. The messaging to the public. Are we learning? Is myquestion, I guess.SC: I'm a clinician and I don't work with the public health and the policy aspect as closely as Stefan does.But I will say that, obviously, I've been in this realm for quite a long time, since in ID, I think that, youknow, what that's important to remember is that for SARS 1 we actually had this document thatoutlined all of this, you know, masking, social distancing, what to do with funding and all that kind ofstuff. Basically, I was actually interviewed about this, I remember back way back in 2020, and half of itwas basically just thrown out the window. I think that a lot of what happened is that fear came indecisions were made from emotion, which is, by the way, understandable, especially in April 2020. I'veshared with you guys before that, in February 2020, I was waking up at night, like nervous, that I wasgonna die. I that that's where I was thinking I it was, it was terrible. I completely understand makingthose decisions. I think as time went on, I wish that, you know, there's a bit more of public healthprinciples. You know, making sure that we're dealing with things without, you know, stepping onpeople's bodily autonomy, for example, you know, doing things in an equitable way, where you, youknow, we all know that every intervention that you do is squeezing a balloon, you must remember theunintended consequences, I think that we did. So, kind of putting that all together. I think, right now, aswe stand in Canada if we do have another pandemic. I fear that a lot of these same mistakes are goingto be made again, I should say, a disruptive pandemic of this because it's not forgotten H1N1, thepandemic it that was a pandemic, right. It wasn't nearly as disruptive as COVID was, but I do think thatinquiry and like you mentioned at the beginning, Kwadwo was talking about what we did, well, we didn'tdo well, and making sure the good stuff happens, and the bad stuff doesn't happen again, because this islikely not the last pandemic, in the information age in our lifetimes.KK: Zain, was there anything that stuck out for you? In terms of what you'd really want to see usimprove? Or whether it is messaging, whether it is public health principles, does any of those stick out inyour mind?ZC: Yeah, I mean, I think the one unique thing about this pandemic that is a lesson moving forward andfor us to kind of deal with I think we talked about messaging. This was the first major pandemic thatoccurred with social media and the social media era, right, and where, information, misinformation,disinformation, all the things that were all over the place, you know, we're flying, right, and there doesneed to be some reconciliation of what's been we have to have some reconciliation of some of thebenefits of the social media era in pandemic management, but also the significant harms the people,you know, we're scared that people got messaging that may not have been completely accurate, thatpeople had their biases as they were out there. I will say even that social media component penetratedinto the media. This is also the first time that I think we saw experts you know, including myself andSuman and all of us you know, that you know, could be at home and do a news interview on NationalNews in five minutes and be able to deliver their opinion to a large audience very quickly. So, you know,I think all of that does need a bit of a reconciliation in terms of what worked, what doesn't how youvalidate you know, good medical knowledge versus knowledge that comes from biases how we evaluatepsi comm and people you know, using it as a platform for good but may in fact be using it you know,when or incorporating their own biases to use it for more, more disinformation and misinformationeven if they feel like they have good intentions with it. I you know, I think this is a, you know, for thesociologists and the communications professionals out there, you know, really interesting case exampleand unfortunately, I don't think we came out the other side. Social media being a positive tool, it mayhave been a positive tool, I think in the beginnings, but, you know, I think I'm finding, it's nice tocommunicate with folks, but I'm finding more harm and more dichotomy and division from social mediathese days is compared to the beginnings of the pandemics where, you know, I think, again, there's justbeen so much bias, so much misinformation so much people's clouds and careers that have been, youknow, staked on social media that it's really become much, much harder to figure out what's real andwhat's not real in that sense.KK: Absolutely, I fully agree Zain. At the beginning, in some ways, I'll tell you, ICU management, thatwhole movement for us to delay intubation, as opposed to intubation early, I really think it was pushedby in social media. So, I think it saved lives, right. But then, as we got through more and more thepandemic, wow, like it, like the amount of just straight up medieval gangster s**t that was going on thatin that circle, in that avenue was crazy. Then just like, I mean, this might be controversial to say, I don'tknow, but news agencies got lazy, they would use Twitter quotes in their articles as, evidence, or asproof of an argument. It's like, what is happening? It? Honestly, when you think about it, it was it wascrazy. It still is crazy.ZC: Yeah. And I think expertise was another issue. Right. And, you know, unfortunately, we know of, youknow, certain experts that were not experts that weren't certified that weren't frontlines and a varietyof opinions and various standpoints and epidemiology, public health, intensive care, infectious diseases,whatever is important. But, you know, there were individuals out there that had zero experience thatwere reading papers and interpreting them from a lens of someone that really didn't have medicalexperience or epidemiologic experience, that chased their clout that made money and, we know someexamples that people that eventually had the downfall from it, but you know, at the end of the day,those people were on social media, and it penetrated into real media, and then that is a real lesson forus is that validation of expertise is going to be important. You know, as much as we allow for anyone tohave an opinion, you know, as they get into kind of real media, they really have to be validated that thatopinion comes from a place that's evidence based and scientific and based on a significant amount oftraining rather than just regurgitating or applying one small skill set and being an expert in many otherthings.KK: SumonSC: So we're just gonna add really quickly is that, in addition to what Zain saying. When this stuff bledover from social media to media, the thing that I mean, at least what it seemed like is he was actuallyinfluencing policy. That's, I think that's the important thing is, so you can have 10 people 20 peopleyelling, it doesn't matter if they're extreme minority, if it's influencing policy that affects all of us, right.So, I think that's important.KK: I'll be honest with you, like, I got to the point where I really hated Twitter, I still kind of hate Twitter.Okay. It was conversation. I remember Sumon that you and I had I don't remember it was we weretexting. I think we talked about this. But the fact that policy could be impacted by what we're throwingdown the facts or the messages that we were doing on media that this can impact policy, you had tolike, especially when there was some badness happening, we had to step up. We had to be a voice oflogic, whether it was mandates, whether it was you know, lockdown school closures, whatever it mighthave been like, the politicians, we heard about this politicians looking at this, the mainstream medialooking at this, and for us not to say anything at this point, like we had, we had to do something Sorry,Stef, you're gonna jump in?SB: Yeah, I think I think what was interesting to me to see and I think a clear difference between H1N1was that in a lot of places, and including in Ontario, across the US, where this sort of emergence of theselike the science tables, these task forces, these whatever you want to call them, it was like a new bodyof people often whom had never spent a day in a public health agency. Often academics that you know,are probably good with numbers, but really don't have a lot of experience delivering services, you know,all of a sudden making decisions. So I think there's a real interesting dynamic that when you compare,for example, Ontario and British Columbia, one has this science table one does not, and just howdifferent things played out, I mean, given it's a, you know, an end of have to, or no one in each camp,but I think what you see is like, there's a place there where like public health or you know, let's say,Sweden, you know, as a public health agency that didn't strike up its own taskforce that used itstraditional public health agency. I think was in a place to make more like reasoned and measureddecisions, and just was better connected, like the relationships exist between the local healthauthorities and the provincial health authorities and the national ones. I think when you set up these,the one thing that I hope we never do, again, is that something like the science table never happensagain. That's not to sort of disparage most of the people. Actually, most of the folks on the science tableI like, and I respect, say many of them, maybe not most, but many of them, I like and respect, but it isthe case that there was it was they weren't the right group of people. They weren't representativeOntarians he was like, ten guys and two women, I think, I don't know many of them white, they weren'trepresentative socio economically, racially diverse, anything. They didn't have the right expertise onthere. I would have liked to see some like frontline nurses on there to say ‘listen, this stuff is silly’ orsome frontline, whoever just some frontline folks to be say ‘listen, none of the stuff that you're sayingmakes any sense whatsoever’. And luckily, there was some reason, voices on there, but they were theminority. But luckily, they prevailed, or we would have had outdoor masking and even tougherlockdowns. I don't know how folks really; it was really close. I think we fortunately had thatrepresentation, but that should have never even happened, we should have had public health Ontario,being its agency and making recommendations to the ministry and to the government. There shouldhave never been a science table. Then second thing, I just want to say I've we've talked about thisforever and I do think we should talk about this more, not in the context of like this, this podcast, but isalso just absolutely the role of the media. I do want to say that, like historically, media had to do a lot ofwork, they had to go to universities or hospitals and ask for the right expert, and then the media orcomms team, ‘you should really talk to Zain Chagla’ Because he has good example, you know, it givesgood expertise on this or you start to like, I don't know, like Dr. so and so for this or that, and they puttogether the right person, they organize the time and then they talk. Now you know that it was reallylike the story I think was more organically developed on based on what the experts had to say. Nowyou've got reporters, for people who are not from Ontario, there's a sports reporter in the city ofToronto that I looked historically, I can't see that they've ever done anything in public health suddenlybecame like the COVID reporter in the city of Toronto, for a major newspaper. It's like this person hasnot a clue of what they're talking about, just like has no clue they've never trained in. I don't disparagetheir sports reporter like why should they? but they became the voice of like public health for like theaverage person. It just it set us up where that person just had a story and then just found whateverpeople on Twitter that they could to like back up their story irrespective to drive controversy, to driveanger towards the government based on sort of political leanings. Even if maybe my political leaningsare aligned with that person, it's a relevant because it's not about politics, it's about public health. So Ithink the media, we have to think about, like, how do we manage the media's need for clicks and profit,you know, during this time, in with, like, their role as like, the responsible are an important part of like,you know, social functioning, in terms of the free press. So, I, there's no easy answers to that. But I'll justsay, I think there was a fundamentally important role that the media played here. And I have to say, itdidn't play out positively, in most places.KK: I gotta say, like, this is gonna be naive talk. But we're in a pandemic, there had to be so many of ushad a sense of duty, like, I was surprised at the lack of sense of duty, to be honest with you. Even if youare about your cliques, ask yourself, is this is this about the greater good here? Is this really gonna get usfurther ahead? I've said this a few times on my platform, I would have a balance of a mess. The balancedmessage on was usually one specific network that would bail on the interview. They would literally bailon the interview because my message might not be as fearful. What the actual f you know what I mean?Like it's crazy.(?) I will say there were some good reporters. I don't want to say that that you know, there were someincredible folks. I was talking to someone the other day, I won't mention who but I think the mark of thegood reporter was, you know, they have a story, they want to talk about it. They contacted us. And theysaid, what time can we talk this week, right? They didn't say I need to get this filed in three hours. If yousay you need to get this filed in three hours, the expert you're gonna go to is the one that's available inthe next three hours, right? They wanted to hear an opinion, they wanted to get multiple opinions onthe table, but they would carve out the time so that everyone could give their story or, what theiropinion was or what evidence they presented. They made sure it rotated around the experts rather thanthe story rotating around being filed. I think it's important and, you know, you can get a sense of certainthings that are on the need to be filed this day, or even on the 24/7 news cycle, where they may not beas well researched, they're they're a single opinion. They're quoting a Twitter tweet. Now, I think insome of these media platforms, you can just embed that Twitter tweet, you don't even have to, youknow, quote it in that sense, you just basically take a screenshot of it basically. Versus again, thosearticles where I think there was there more thought, and I think there were some great reporters inCanada, that really did go above and beyond. Health reporters, particularly that really did try to presenta picture that was well researched, and evidence based, you know, with what's available, but therecertainly are these issues and it's not a COVID specific issue, but with media ad reporting, in that sense.Yeah, it's and it's important to say like, it's not actually just the reporter, it's the editors, its editorialteams, like I had said, OTR discussions with reporters very early on, I've tried to stay away from themedia, because I think the folks who have done it, I've done it well. But it was interesting, because BobSargent, who sadly passed away, an internal medicine physician, and an amazing mentor to manyclinicians in Toronto. Put me in touch with a couple of reporters. He's like, you know, you're a publichealth person, you should really talk to these reports. We had this; can we talk to you privately? It wasso weird. This was summer of 2020. So, we had a very private discussion where I said ‘Listen, I haveconcerns about lockdowns for like, these reasons’ I think it's reasoned, because it's not it, I've got noconspiracy to drive, like, I've got no, there's no angle in any of it. So, but it was just fascinating. So, theywere like we might be able to come back to you, and maybe we'll try to do a story around it. Then theycame back and said, we're not going to be able to pursue it. I said that's fine. It's no problem. It just sortof showed that I think, similar as academics, and clinicians, and all of us have been under pressure basedon everything from like CPSO complaints, the complaints to our employers, to whatever to just saw, youknow, the standard attacks on Twitter. I think there was also a lot of pressure on reporters based on thiswhole structure, and of it. So I think, I don't mean to disparage anybody, but I do think the point thatyou made is really important one is. I'll just say, in our own house, you know, my wife and I both werelike talking at the beginning of this and being like, what do we want to know that we did during thistime? So, my wife worked in person, as a clinician alter her practice all throughout her pregnancy? Shenever didn't go, you know, she did call she did all of that, obviously, I have done the work I've done interms of both clinically and vaccine related testing. But this just idea of like, what do you want toremember about the time that you would like what you did when s**t hit the fan? And, you know,because first, it'll happen again, but just also, I think it's important to sort of, to be able to reflect andthink positively about what you did. Anyways,KK: I hear you both, part of it, too, for me, I'll just straight up honesty. In some ways, I'm just pissed, I’mpissed that a lot of the efforts that were that a lot of people put into to try and get a good message outthere. The backlash. Now people reflecting saying, ‘Oh, I guess you did, you know, many of you do tohad a good point about lockdowns not working out’. I know it may be childish in some way, but it's just,you know, a lot of us have gone through a lot to just try and create a balanced approach. I think therewas a little bit of edge in this voice, but I think it comes with a bit of a bit of reason to have a bit of edge.I think in terms of the next couple questions here are areas to focus on. A lot of people in terms of like,decisions regarding mandates, boosters, and so forth, like we talk a lot about it on public health, it's thedata that helps drive decisions, right. That's really what you would think it should be all about. So, one ofthe many questions that were thrown to us, when we announced that this was happening was, the needfor like, almost like universal boosters, and Sumon, I'll put you on the spot there, at this stage in thepandemic, where I'm gonna timestamp this for people on audio, we're on January 10th, 2023. There aresome questions that we get, who really needs to push through to we all need boosters? What's yourthoughts on that?SC: So, I think that one of the things that I said this, as Zain makes fun of me throughout the pandemic, Icame up with catchphrases, and my one for immunity is the way that we've conceptualized immunity inNorth America. I think a lot of this has to do with an actual graphic from the CDC, which likens immunityto an iPhone or a battery, iPhone battery. So, iPhone immunity, where you have to constantly berecharging and updating. I think that has kind of bled into the messaging. That's what we think of it. Iremember back in I think it was October of 2021, where they were also starting to talk about the thirddose. The third dose, I think that at that time, we knew that for the higher risk people, it was probablythe people who would benefit the most from it. We had Ontario data from it was I think, was ISIS.There's vaccine efficacy against hospitalization, over 96% in Ontario in health care workers 99%, if you'reless than seventy-seven years of age, yet this went out, and everybody felt like they had to get thebooster. So, I think that the first thing that bothered me about that is that there wasn't a kind ofstratified look at the risk level and who needs it? So now we're in 2023. I think that one of the big thingsapart from what I said, you know, who's at higher risk, there's still this problem where people think thatevery six months, I need to recharge my immunity, which certainly isn't true. There wasn't a recognitionthat being exposed to COVID itself is providing you a very robust immunity against severe disease, whichis kind of it's coming out now. We've been we've all been talking about it for a long time. And you know,the other thing is that the disease itself has changed. I think that I heard this awesome expression, thefirst pass effect. So, when the COVID first came through a completely immune naive population, ofcourse, we saw death and morbidity, we saw all the other bad stuff, the rare stuff that COVIDencephalitis COVID GB GBS tons of ECMO, like 40-year old’s dying. With each subsequent wave asimmunity started to accrue in the population, that didn't happen. Now we're at a different variant. Andthe thing is, do we even need to be doing widespread vaccination when you're with current variant, andyou can't be thinking about what we saw in 2021. So, putting that now, all together, we have as Zanementioned, seroprevalence, about almost 100%, you have people that are well protected against severedisease, most of the population, you have a variant that absolutely can make people sick. And yes, it cankill people. But for those of us who work on the front line, that looks very different on the on the frontlines. So, I really think that we should take a step back and say, number one: I don't think that thebooster is needed for everybody. I think number two: there are under a certain age, probably 55 andhealthy, who probably don't need any further vaccination, or at least until we have more data. Numberthree: before we make a widespread recommendation for the population. We have time now we're notin the emergency phase anymore. I really hope that we get more RCT data over the long term to seewho is it that needs the vaccine, if at all. And you know, who benefits from it. And let's continue toaccrue this data with time.KK: Thanks Sumon. Zain, are you on the along the same lines assume on in terms of who needs boostersand who doesn't?ZC: Yeah, I mean, I think number one: is the recognition that prior infection and hybrid immunityprobably are incredibly adequate. Again, people like Paul Offit, and we're not just talking about youknow, experts like us. These are people that are sitting on the FDA Advisory Committee, a man thatactually made vaccines in the United States, you know, that talks about the limitations of boosters andprobably three doses being you know, The peak of the series for most people, and even then, you know,two plus infection probably is enough is three or even one plus infection, the data may suggest maybe isas high as three. Yeah, I think, again, this is one of these things that gets diluted as it starts going downthe chain, if you actually look at the Nazi guidance for, you know, bi-Vaillant vaccines, it's actuallyincorporates a ‘should’ and a ‘can consider’ in all of this, so they talked about vulnerable individuals,elderly individuals should get a booster where there may be some benefits in that population, the restof the population can consider a booster in that sense, right. And I think as the boosters came out, andagain, you know, people started jumping on them, it came to everyone needs their booster. Andunfortunately, the messaging in the United States is perpetuated that quite a bit with this iPhonecharging thing, Biden tweeting that everyone over the age of six months needs a booster. Again, wereally do have to reflect on the population that we're going at. Ultimately, again, if you start pressing theissue too much in the wrong populations, you know, the uptake is, is showing itself, right, the peoplewho wanted their bi-Vaillant vaccine got it. Thankfully the right populations are being incentivized,especially in the elderly, and the very elderly, and the high risk. Uptake in most other populations hasbeen relatively low. So, people are making their decisions based on based on what they know. Again,they feel that that hesitation and what is this going to benefit me? and I think as Sumon said, theconfidence is going to be restored when we have better data. We're in a phase now where we can docluster randomized RCTs in low-risk populations and show it If you want the vaccine, you enter into acluster randomized RCT, if you're in a low-risk population, match you one to one with placebo. You wecan tell you if you got, you know, what your prognosis was at the end of the day, and that information isgoing to be important for us. I don't think that policy of boosting twice a year, or once a year is gonnaget people on the bus, every booster seems like people are getting off the bus more and more. So, wereally do have to have compelling information. Now, as we're bringing these out to start saying, youknow, is this a necessity? especially in low-risk populations? How much of a necessity is that? How muchdo you quantify it in that sense? And again, recognizing that, that people are being infected? Now, thatadds another twist in that sense.KK: Yeah, and we'll talk a little bit about public trust in a bit here. But Stef, you were among someauthors that did an essay on the booster mandates for university students. As we've both alluded toZain, and Sumon there's this need to be stratified. From an RCT booster point of view that we're not wellestablished here. When Stef’s group looked at university mandates and potential harm, when we'redoing an actual cost benefit ratio there, their conclusion was that there's more room for harm thanbenefits. So, Stef I want you to speak to that paper a bit.SB: Sure. So, I will say this, I don't actually have much to add other than what Zain and Sumon said. Runa vaccine program we are offering, you know, doses as it makes sense for folks who are particularlyimmunocompromised, multiple comorbidities and remain at risk for serious consequences related toCOVID-19. We'll continue doing that. And that will, you know, get integrated, by the way into like, sortof a vaccine preventable disease program, so offering, shingles, Pneumovax, influenza COVID. And alsowe want to do a broader in terms of other hepatitis vaccines, etc. That aside, so this, this isn't about, youknow, that it was really interesting being called antivax by folks who have never gotten close to avaccine, other than being pricked by one. Having delivered literally 1000s of doses of vaccine, so it’salmost it's a joke, right? but it's an effective thing of like shutting down conversation. That aside, I thinkthere's a few things at play one as it related to that paper. I find it really interesting, particularly foryoung people, when people are like, listen, yes, they had a little bit of like, inflammation of their heart,but it's self-resolving and self-limiting, and they're gonna be fine. You don’t know that. Maybe sure we'llsee what happens with these folks twenty years later. The reality is for younger men, particularly, thishappens to be a very gender dynamic. For younger men, particularly, there seems to be a dynamicwhere they are at risk of myocarditis. I don't know whether that's a controversy in any other era for anyother disease, this would not be a controversy would just be more of a factual statement, the data wereclearer in I'd say, probably April, May 2021. I think there's lots of things we could have done, we couldhave done one dose series for people who had been previously infected, we could have stopped at two.There are a million different versions of what we could have done, none of which we actually did. In thecontext of mandating boosters now for young people, including at my institution, you were mandated toget a booster, or you would no longer be working. So obviously, I got one. There's a real dynamic ofwhat is it your goal at that point? because probably about 1011 months into the vaccine programbecame increasingly clear. You can still get COVID. Nobody's surprised by that. That was clear even fromthe data. By the way, wasn't even studied. I mean, Pfizer, the way if you just look at the Pfizer, Moderna,trials, none and look to see whether you got COVID or not, they were just looking at symptomaticdisease. That aside, I think that it just became this clear thing where for younger men, one or two doseswas plenty and it seems to be that as you accumulate doses for those folks, particularly, it's alsoimportant, if somebody had a bad myocarditis, they're not even getting a third dose. So, you're alreadyselecting out, you know, some of these folks, but you are starting to see increased levels of harm, as itrelated to hospitalization. That what we basically did, there was a very simple analysis of looking ataverted hospitalization, either way, many people say that's the wrong metric. You can pick whatevermetric you want. That's the metric we picked when terms of hospitalization related to side effects of thevaccine versus benefits. What it just showed was that for people under the age of 30, you just don't seea benefit at that point, as compared to harm that's totally in fundamentally different. We weren't talkingabout the primary series, and we weren't talking about older folks. So indeed, I think, you know, thatwas that was I don't know why it was it was particularly controversial. We it was a follow up piece tomandates in general. I'll just say like, I've been running this vaccine program, I don't think mandateshave made my life easier at all. I know, there's like this common narrative of like mandates, you know,mandates work mandates work. I think at some point, and I'll just say our own study of this is like we'rereally going to have to ask two questions. One: what it mandates really get us in terms of a burdenCOVID-19, morbidity, mortality? and two: this is an important one for me. What if we caught ourselvesin terms of how much pressure we put on people, as it relates to vaccines right now, in general? Thevery common narrative that I'm getting is they're like, oh, the anti Vax is the anti Vax folks are winning.And people don't want their standard vaccines, and we're getting less uptake of like, MMR andstandard, you know, kind of childhood vaccines, I have a different opinion. I really do at least I believesome proportion of this, I don't know what proportion, it's some proportion, it's just like people beingpushed so hard, about COVID-19 vaccines that they literally don't want to be approached about anyvaccine in general. So, I just think that with in public health, there's always a cost. Part of the decisionmaking in public health as it relates to clinical medicine too. It's like you give a medication, theadvantage and then you know, the disadvantages, side effects of that medication. In public health, thereare side effects of our decisions that are sometimes anticipated and sometimes avoidable, sometimescan't be anticipated and sometimes can't be avoided. You have to kind of really give thought to each ofthem before you enact this policy or you might cost more health outcomes, then then you're actuallygaining by implementing it.KK: Yeah, number one: What was spooky to me is like even mentioning, I was afraid even to use a termmyocarditis at times. The worst part is, as you said, stuff, it's young folk that were alluding to, and for usto not be able to say, let's look at the harm and benefit in a group that's low risk was baffling. It reallywas baffling that and I'm glad we're at least more open to that now. Certainly, that's why I thought thatthe paper that you guys put together was so important because it's in the medical literature that we'reshowing, objectively what the cost benefit of some of these approaches are. Sumon: when you think ofmandates and public trust, that Stef was kind of alluding to like, every decision that we madethroughout this thing. Also has a downside, also has a cost, as Stef was mentioning. Where do you thinkwe are? In terms of the public trust? Talking about how the childhood vaccines are lower. I don't knowwhat influenza vaccine rates are like now, I wouldn't be surprised if they're the same standard, but whoknows them where they're at, currently. Based on your perspective, what do you think the public trust isright now?SC: Yeah, as physicians, we obviously still do have a lot of trust in the people we take care of. People arestill coming to see us. I wish they didn't have to because everyone was healthy but that's not the case. Ido think that over the last two and a half, we're coming up on three years, I guess right now, that peoplethat we have burned a lot of trust, I think that mandates were part of it. I do think that some of it wasunavoidable. It's just that there's a lot of uncertainty. There was back and forth. I think that one thingthat were that concern me on social media was that a lot of professionals are airing their dirty laundry tothe public. You could see these in fights, that doesn't, that's not really a good thing. We saw peoplebeing very derisive towards people who were not listening to the public health rules. You know what Imean? There's a lot of that kind of talk of othering. Yeah, I think that that certainly overtime, erodedpublic trust, that will take a long time to get back, if we do get it back. I think that the bottom line is that,I get that there are times that we have to do certain things, when you have a unknown pathogen comingat you, when you don't really know much about it. I do think that you want to do the greatest good forthe, for the population or again, you always must remember as Stefan alludes to the cost of what you'redoing. I do think that we could have done that much early on. For example, Ontario, we were lockeddown in some areas, Ontario, GTA, we were locked down in some regard for almost a year and a half. Ifyou guys remember, there was that debate on opening bars and restaurants before schools. It's just like,I remember shaking my head is, look, I get it, I know you guys are talking about people are going to beeating a burger before kids can go to school, that might ruin everything. But the problem is, is that youmust remember that restaurant is owned by someone that small gym is someone's livelihood, you'remoralizing over what this is, but in the end, it's the way somebody puts food on the table. For a yearand a half, we didn't let especially small businesses do that. I'm no economist, but I had many familymembers and friends who are impacted by this. Two of my friends unfortunately, committed suicideover this. So, you know, we had a lot of impact outside of the of the things that we did that hurt people,and certainly the trust will have to be regained over the long term.KK: It's gonna take work. I think, for me, honestly, it's, it's just about being transparent. I honestly, I putmyself in some in the shoes of the public and I just want to hear the truth. If we're not sure aboutsomething, that's okay. We're gonna weigh the evidence and this is our suggestion. This is why we'resaying this, could we be wrong? Yes, we could be wrong but this is what we think is the best pathforward, and people could get behind that. I honestly feel like people could get behind that showing alittle bit of vulnerability and saying ‘you know, we're not know it alls here’ but this is what our beststrategy is based on our viewpoint on the best strategy based on the data that we have in front of usand just be open. Allowing for open dialogue and not squash it not have that dichotomous thinking ofyou're on one side, you're on the other. You're anti vax, you're pro vax, stop with the labels. You know,it's just it got crazy, and just was not a safe environment for dialogue. And how are you supposed to he'ssupposed to advance.SB: Yeah, I do want to say something given this this is this idea of our swan song. I think there was thissort of feeling like, you know, people were like ‘you gotta act hard, you gotta move fast’ So I thinkeverybody on this, you guys all know I travel a lot. I like to think of myself as a traveler. In the early2020’s I did like a COVID tour, I was in Japan in February, then I was in Thailand, and everywhere Ilanded, there were like, COVID here, COVID here, COVID here. Then finally, I like got home at the end ofFebruary, and I was supposed to be home for like four days, and then take off. Obviously things got shutdown. It was like obvious like COVID was the whole world had COVID by, February, there may have beena time to shut down this pandemic in September 2019. Do you know what I mean? by November 2019,we had cases. They've already seen some and Canadian Blood Services done some showing someserological evidence already at that time. There was no shutting it down. This thing's gonna suck. Thereality is promising that you can eliminate this thing by like, enacting these really like arbitrary that canonly be described as arbitrary. Shutting the border to voluntary travel, but not to truckers. Everythingfelt so arbitrary. So, when you talk about trust, if you can't explain it, if you're a good person do it. If youdon't do it, your white supremacist. Kwadwo you were part of a group that was called ‘Urgency ofNormal’ you are a white supremacist. It's so ridiculous. You know what I mean? It creates this dynamicwhere you can't have any meaningful conversation. So, I really worry, unless we can start having somereally meaningful conversations, not just with folks that we agree with. Obviously, I deeply respect whateach of you have done throughout this pandemic, not just actually about what you say, but really whatyou've done. Put yourselves out there with your families in front of this thing. That aside, if we can't dothat, we will be no better off. We will go right back. People will be like ‘Oh, next pandemic, well, let'sjust get ready to lock down’ but did we accomplish anything in our lock downs? I actually don't think wedid. I really don't think we got anything positive out our lock downs, and I might be alone in that. I mightbe wrong, butut that said it needs to be investigated and in a really meaningful way to answer that,before it becomes assume that acting hard and acting fast and all these b******t slogans are the truthand they'd become the truth and they become fact. All without any really meaningful evidencesupporting them.KK: I gotta say, I'll get you Sumon next here, but I gotta say the idea of abandoning logic, I think that'sthat's a key point there. Think about what we're doing in restaurants, folks. Okay, you would literallywear your mask to sit down, take off that bloody thing. Eat, chat, smooch even, I mean, and then put itback on and go in the bathroom and think this is meaningful. Where's the logic there? You're on a plane,you're gonna drink something, you're on a six hour flight, you know what I'm saying.(?) During the lockdown, by the way, you're sending like 20 Uber drivers to stand point. If you ever wentand picked up food, you would see these folks. It'd be like crowding the busy restaurants all like standingin there, like arguing which orders theirs, you know what I mean? then like people waiting for the foodto show up.KK: I mean, that's the other point. The part that people forget with the lockdowns, tons of people willwork. I'm in Ottawa, where 70% are, could stay home, right? That's a unique city. That's why we werevery sheltered from this bad boy.(?) Aren’t they still fighting going back to the office?KK: Oh, my God. Folks, I'm sorry. Yeah, it's like 70% could stay home, but you're in GTA your area. That'sa lot of essential workers. You don't have that option. So, how's this lockdown? Really looking at the bigpicture? Anyway, sorry. Sumon you're gonna hit it up.SC: We just wanted to add one anecdote. I just think it kind of talks about all this is that, you know therewas a time when this thing started going to 2020. Stefan, I think you and I met online around that time.You put a couple of seeds after I was reading stuff, like you know about the idea of, you know, risktransfer risk being downloaded to other people. That's sort of kind of think of a you know, what, like,you know, a people that are working in the manufacturing industry, you're not going to receive them alot unless you live in a place like Brampton or northwest Toronto, where the manufacturing hub of, ofOntario and in many cases, central eastern Canada is right. So, I remember in, I was already starting touse this doing anything. And when I was in, I guess it would have been the second wave when it was itwas pretty bad one, I just kept seeing factory worker after factory worker, but then the thing that stuckout was tons of Amazon workers. So, I asked one of them, tell me something like, why are there so manyAmazon workers? Like are you guys? Is there a lot of sick people working that kind of thing? Inretrospect, it was very naive question. What that one woman told me that her face is burned into mymemory, she told me she goes, ‘Look, you know, every time a lockdown is called, or something happenslike that, what ends up happening is that the orders triple. So, then we end up working double and tripleshifts, and we all get COVID’ That was just a light went off. I was like, excuse my language, guys, but holys**t, we're basically taking all this risk for people that can like what was it called a ‘laptop class’ that canstay home and order all this stuff. Meanwhile, all that risk was going down to all these people, and I wasseeing it one, after another, after another, after another. I'm not sure if you guys saw that much, but Iwas in Mississauga, that's the hardest, Peele where the manufacturing industry is every single peanutfactory, the sheet metal, I just saw all of them. That I think was the kind of thing that turned me andrealize that we what we'll be doing. I'll shut up.ZC: Yeah, I would say I mean, I think Stefan and Sumon make great points. You know, I think that thatwas very apparent at the beginning. The other thing I would say is 2021 to 2022. Things like vaccinationand public health measures fell along political lines. That was a huge mistake. It was devastating. Iremember back to the first snap election in 2021. Initially great video of all the political partiesencouraging vaccination and putting their differences aside. Then all of a sudden, it became mudslingingabout how much public health measure you're willing to do, how much you're willing to invest in, andit's not a Canadian phenomenon. We saw this in the United States with the Biden and Trump campaignsand the contrast between the two, and then really aligning public health views to political views, andthen, you know, really making it very uncomfortable for certain people to then express counter viewswithout being considered an alternative party. It's something we need to reflect on I think we havepublic health and public health messengers and people that are agnostic to political views but are reallythere to support the health of their populations, from a health from a societal from an emotional fromthe aspects of good health in that sense. You really can't involve politics into that, because all of asudden, then you start getting counter current messaging, and you start getting people being pushed,and you start new aligning values to views and you start saying, right and left based on what peopleconsider, where again, the science doesn't necessarily follow political direction. It was a really bigmistake, and it still is pervasive. We saw every election that happened between 2021 to 2022 is publichealth and public health messaging was embedded in each one of those and it caused more harm thangood. I think it's a big lesson from this, this is that you can be proactive for effective public healthinterventions as an individual in that society that has a role, but you can't stick it on campaigns. It reallymakes it hard to deescalate measures at that point when your campaign and your identity is tied tocertain public health measures in that sense.KK: Amen. I am cognizant of the time and so I'm gonna try to rapid fire a little bit? I think, there’s only acouple points that people hit up on that we haven't touched on. There was a push for mass mandates inthe last couple months because of of RSV and influenza that was happening. It still is happening in,especially in our extreme ages, really young and really old. Any viewpoint on that, I'll leave it open toalmost to throw down.(?) I think mass mandates have been useless. I don't expect to ever folks to agree with me, it's like it's aninteresting dynamic, right? When you go and you saw folks who were on the buses, I take the bus to theairport. Our subway in Toronto just for folks only starts at like, 5:50am. So, before that, you gotta jumpon buses. So the construction workers on the bus who were wearing masks during the when the maskmandates were on taking this what's called, it's like the construction line, because it goes down Bloorare basically and takes all the construction workers from Scarborough, before the subway line, get todowntown to do all the construction and build all the stuff that you know, is being built right now.Everyone is wearing this useless cloth mask. It's like probably the one thing that the anti-maskers who Ithink I probably am one at this point. The pro-maskers and all maskers can agree on is that cloth masksare useless. That's what 100% of these folks are wearing. They're wearing these reusable cloth masksthat are like barely on their face often blow their nose. So, to me, it's not so much about like, what couldthis intervention achieve, if done perfectly like saying the study you were involved with the help lead,it's like everybody's like, but all of them got COVID outside of the health care system, they didn't get itwhen they're wearing their N95. That's like, but that's the point, like public health interventions live ordie or succeed or fail in the real world. I was seeing the real world, I would love to take a photo but Idon't think these folks have been friendly to me taking a photo of them, but it was 100%, cloth masks ofall these folks in the morning all crowded, like we're literally like person to person on this bus. It's like aperfect, you know, vehicle for massive transmission. I just I just sort of put that forward of like, that'swhat a mask mandate does to me. I think to the person sitting at home calling for them, they are justimagining, they're like ‘Oh but the government should do this’. But they didn't. The government shouldbe handing out in N95’s. How are you going to police them wearing a N95’s and how are you gettingthem? It would be so hard to make a massive program work. I would say it's like if you gave me millionsand millions and millions of dollars, for me to design a mass program, I don't know, maybe I could pull itoff you really with an endless budget. But for what? So, I just think that like as these programs went outin the real world, I think they did nothing but burn people's energy. You know because some people itjust turns out don't like wearing a mask. Shocking to other folks. They just don't like wearing a mask.Last thing I'll say is that just as they play it out in the real world, I think we're functionally useless, otherthan burning people's energy. I'm a fervent anti masker at this point because it's just an insult to publichealth. To me everything I've trained in and everything I've worked towards, just saying these two wordsmask mandate, as the fix. That is an insult to the very thing that I want to spend my life doing .ZC: Yeah, I mean, three points, one: you know, masks are still important in clinical settings. I think we allunderstand that. We've been doing them before we've been continuing to do them. So I you know,that's one piece. Second: I mean, to go with the point that was raised here, you know, the best study wehave is Bangladesh, right? 10% relative risk reduction. It's interesting when you read the Bangladeshstudy, because with community kind of people that pump up masking that are really trying to educateand probably are also there to mask compliance. Mask’s compliance people, you get to 54% compliance,when those people leave compliance drops significantly. Right. You know, I think you have to just lookaround and see what happened in this last few months, regardless of the messaging. Maybe it's thecommunities I'm in, but I didn't see mass compliance change significantly, maybe about 5%. In thecontext of the last couple of months. You must understand the value of this public health intervention,Bangladesh has actually a nice insight, not only into what we think the community based optimalmasking efficacy is, but also the fact that you really have to continue to enforce, enforce, enforce,enforce, in order to get to that even 10%. Without that enforcement, you're not getting anywhere inthat sense. That probably spells that it's probably a very poor long term public health intervention in thecontext that you really must pump it week by week by week by week in order to actually get compliancethat may actually then give you the effects that you see in a cluster randomized control trial. Again, youknow, the world we live in is showing that people don't want to mask normally. Some people can, it's agood intervention for them, if they want to do it, I, we should respect everyone that wants to mask, Ithink that the, on the other side, you know, people showing, you know, disdain, and making fun ofpeople who are masking in public. It is also something we need to address and really need to supportpeople in their medical decisions. At the same time, there's a long-term effect of intervention. It's not,it's not gonna be useful, because people don't want to do it. And, you know, and the compliance issuesand everything else that comes from it. And, you know, the third thing I'll say, is, with every mandatecomes with enforcement. What does enforcement look like? Is it that you can't go to establishment X orY without a mask? If you're someone who's on the fringes with mental health issues with other issues,are you going to doctors to get mask exemptions, right? So, you know, again, you then push people tothe fringes, you may not get the compliance you want and again, you may start then cracking down oncertain populations that that are disproportionately affected by types of mandates and rules in thatsense.KK: 100%. SumonSC: You know, I heard a lot of good lines, in the last month or so, there's something called the ‘No TrueScotsman’ fallacy. That very well applies to mask mandates, lock downs. It was it was cool, because I'vebeen hearing these all throughout the pandemic, and then it makes sense, is the ideas, or what if we didthe mask mandate, right? What Stefan was saying, if we masked hard enough, if we had just done this,you know, that wasn't a mask mandate. If we locked down hard to Oh, that wasn't a lockdown. Youknow, this is a lockdown. Obviously. Now, a lot of that stuff is ridiculous, because we're three years out,and we saw that even China, you saw what happened there, but no place ended up by being able tocompletely keep it up, keep COVID away forever, so that the ‘No True Scotsman’ fallacy really applies. Ithink that the insightful thing that I read, and actually might have been Twitter too, is that if you aremaking a policy, and your explanation for why that policy didn't work, is because people weren't doingit, right. There's nothing, that doesn't mean something wrong with the people, it means it's a shittypolicy. I think that applies to any public policy, but for health ones, I think, especially at that that's thecase.SB: Yeah, I want to just finish, I want to pick up on something that Zain said, I've spent a big part of mycareer looking at, like the role of police and laws in public health. Obviously, I'm white. So, I'm not gonnasit here and say that I've lived experience around this, but it's what one thing that we know is that like,police interventions, or interventions that are based on using police don't affect people that look likeme, they just don't. I think what we saw in New York City very early was differential enforcement of likemasking laws, you see these videos of these aggressive police carrying guys off buses, slamming theirfaces into the countertops. Then on the other side of the city in rich part of New York, the police arewalking around handing out masks to people ‘Hey, you should think about putting this on’ It's thedifferential enforcement that happens that says to me, like police serve an important role in society. I'mnot here to complain about the role of police. I think once you start relying on police, in public health,like the whole thing is lost. You got to go back to the drawing board and start over. I think that like, ouralliance on police for the lockdown or alliance on police, and calling the police, as it related to mask isfor all of it meant that these were failed interventions, and particularly, again, affecting the very peoplethat we were expected to leave their homes that were getting more COVID. Then ended up on thewrong end of the police related to these mandates, don't go to public parks, when they don't havebackyards. It was just so so strange and design and so counter to what I think Canada likes to think ofitself as ‘Canadian values’ and progressive values that I actually have a tough time coming to terms withhow it even happened and what worries me even more is that it's gonna happen again.KK: We lost our way. I'm just gonna straight up say we lost our way. When we when we let our fear runour decisions as opposed to our values. This was when it was gone. As Canadians always figured, this iswhat a place where we stick up for those that can't stick up for themselves? It was I think that's probablywhere I had the hardest time. You mentioned how much this affected people that look like me or anyracialized communities like, this is a thing. This was like a beat down on racialized people like everything.school closures, you know what I mean? You talk about vaccine passports. You mean like, Oh, let medouble check, let me triple check. I haven't told anybody there’s a couple times in those restaurants,where it's like, double check, triple check. Let me make sure that second dose was there, like, I'm gonnareally check and make sure that this is a valid vaccine passport. Lockdowns? Who's the essentialworkers? I think we were okay with all this stuff because it didn't affect the most, more racializedpeople, the people that didn't have as much of a voice. This is what pissed me off, frankly. That it wasokay, that we were, whether it was you know, racialized community, whether it was kids, people thatwere vulnerable, and they can’t speak up for themselves, like, that's who we justified and said, Okay,we'll just keep doing what we're doing, despite the data, despite the data showing, like whether it'seffective or not. Whether you're looking at BC or Ontario that does completely different approaches,with the same results in the same country. This is what are people were doing, I gotta say it like it, just, itjust eat at me. Second point, I'll make one before going to Stef is, I think you may also good point aboutthe investment, like people have a certain amount of bandwidth in general, you're gonna say let's maskharder, let's duel these event interventions harder. One thing that As always, this was on a thicket,another live cast, that we did stuff, but when you said, let's focus on interventions, as opposed torestrictions, let's invest there, that makes so much sense to me. Especially when you know areas thatare going to be the hardest hit when you know, where were the most vulnerable. Let's invest there, putthe vaccines there, offer paid leave there, invest, where it's gonna give you the biggest bang for yourbuck. That to me, like if you think about all the money spent, wow. To have infrastructure to, to be ableto handle future pandemics like that point to, I think we can't overlook that, you know, when you investmore time and effort into areas that are less effective, you know, it's a distraction, it really, it really canbe a distraction. Anyway, StefSB: I just want to say that the last thing I would want for our province or our cities or our hospitals torelease just one data point, one data point. We often talk about, they're like, oh, in the end, it was only afew percent of people fired related to vaccine mandates. You know, I would just love them to releasethe demographics of who was fired. We know that there's like a lot of historical mistrust for it, by theway, good reason I meet a lot of people with like, I always think like a patient's making a rationaldecision, based on their own dynamic, their own history, most people are making rational decisions, itmight not be the decision I want them to make. It might not be the absolute, but it is like the rightdecision for themselves. Sometimes that decision was not to get vaccinated. I would just love for peopleto release that for the City of Toronto, the City of Ottawa, the province of Ontario to just release data onon our hospitals, what were the demographics of the people who were fired. My guess is just from whatI've seen, it's going to look really ugly in terms of people who say that they're supportive of particularlyracialized communities. So, I think that's part of it is that you can't overcome medical mistrust. In a five-minute conversation, you can't just be like, ‘Oh, trust me, now. I'm here to fix it now. Like, I know, like,generations have lied to you. But like, I'm, you could trust me now’ I mean you can't you can't just fixthat. Anyways, I just think that that's gonna be an important statistic. Otherwise, again, like, in a fewyears, I think the next pandemic that easily be in the next 5 to 10 years, so you know we're gonna beback here with vaccine mandates, lock downs, etc. Unless we'd like, more meaningfully explore whathappened.KK: Yeah. Thank you for that point. I must say this is a follow up. I do some talks on systemic racism.George Floyd was a part of that, but it was also seeing who was getting hardest hit throughout thepandemic. I hate giving those talks because it's like, it's, you know, if I'm being honest, it's a bittraumatic. You put yourself in a vulnerable spot talking about You know, tough times, but I think, youknow, this was another area that we just need to recognize that this is not this is not an equal problem.This is not a problem that's just hits up everyone equally, it really those that are racialized, it hits themost. I’m cognitive of the time. So, I think we're gonna, we're gonna wind up here. I just want to make acouple final points. I think, one: I really hope in the future that we, we learn about the negative impactsof having a fear narrative, like we want to be able to create trust, moving forward with public healthwith, and I really, truly, humbly believe that when we have that fear narrative, when we make decisionsfrom a place of fear that pulls us further away, pulls us further away from our values and, and makingcorrect decisions that decisions that will be more holistic. So that's one point I want to close on. Thesecond is: I think value of having this conversation, like a lot of people approach, I'm sure you guys getthis approach us talking about how having that kind of balanced view has been so valuable throughoutand having the conversation right now about, you know, where we've, where we, where we could havedone better, I honestly feel like it's healing for a lot of people. When we talk about things that weren'tlogical, their approaches that seem to, we're doing these things that didn't make sense. ‘I was trying todo the right thing, they told me after three vaccines that we'd be no more locked down, yet we lockeddown’ a lot of people who are looking for validation for the things that they've gone through. I thinkhaving conversations like this validates things, it also gives them hope that that the future we all of usare leaders that are on this panel with people that like us that are being able to have a voice can reallyadvocate for a better future when it comes to next time a pandemic like this happens. I want to thankour panelists, because I really think these conversations will make a difference, like many of the stuffthat we've done over the last few years clinically, from an information point of view, or acommunication point of view, it makes a difference. So, I want to thank Zain, Sumon, Stef for such agreat conversation, as usual. So, thank you, thanks for those that are that joined on Facebook. Onceagain, put NL in the in the chat box and you'll get a copy of this or, or subscribe to our Substack andyou'll get a version of this video and the audio. We really appreciate you guys signing in and you will notsee us hopefully for a very, very long time. All right, folks, thanks so much. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe
January 17, 2023