On May 23, TVO.org published a conversation with David Fisman, a professor of epidemiology at the University of Toronto who also works with Ontario’s COVID-19 modelling group. Part of that conversation focused on his recent testimony to the House of Commons standing committee on health; in that section, he criticized the testimony of Richard Schabas, who had also been invited to speak. Specifically, Fisman suggested that Schabas lauds the Swedish approach to combatting COVID-19, which, Fisman said, involves “wanting to let things just burn on until you have herd immunity.”
“The idea of letting this thing rip,” Fisman said, “just seems to me unbelievably irresponsible.”
Schabas, a retired physician who was Ontario’s chief medical officer of health from 1987 to 1997, told TVO.org that he felt Fisman had misrepresented his argument. As such, TVO.org has given Schabas an opportunity to respond.
In his testimony to the parliamentary committee, Schabas expresses skepticism of the effectiveness of non-medical mask use, testing, and contact tracing. He also argues for the necessity of achieving immunity through significant community spread of the virus — a strategy often referred to as “herd immunity.” He further argues that crafting public policy on the assumption that a vaccine is imminent is a mistake.
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A majority of public-health officials in Canada and around the world — including in Germany, Hong Kong, South Korea, and Taiwan — disagree with this approach. They believe that non-medical mask use is necessary to help mitigate the spread of COVID-19. According to an organization of scientists and researchers called #Masks4All, more than 100 countries have mandated mask-use. Countries that have had success in controlling COVID-19, including Germany and South Korea, have done so via testing and contact tracing. This is not to suggest that one of these tools alone will eradicate the virus but that, when used in conjunction with physical distancing, they are effective at mitigating the damage it can cause.
Of 14.5 million Ontarians, more than 2,000 have died of COVID-19, and that’s with strict physical-distancing protocols in place. By comparison, Sweden — population 10.2 million — has seen nearly 4,500 deaths. In March, nearly 300 academics in the United Kingdom issued a letter urging the British government to avoid adopting the herd-immunity approach, stating that doing so would save “thousands of lives.” There is no proof that recovered COVID-19 patients have lasting immunity to the virus.
What follows is a condensed and edited version of our conversation with Schabas.
TVO.org: You feel as if your views were misrepresented in a previous interview. So I think we should talk about the things you felt were not representative. Does that sound fair to you?
Richard Schabas: Sure. I don’t know if you’ve read my testimony.
TVO.org: I’ve watched it.
Schabas: Okay. So I think that the things that were attributed to me, that I lauded the Swedish model (I didn’t even mention the Swedish model) and that I said we should “let ’er rip” — I didn’t say either of those things. I think it’s unfortunate.
I’d like to actually begin by thanking you for giving me this opportunity, because one of the most unfortunate deficits that we’ve had here in Canada with regard to COVID-19 is a real shortage of collegial discussion or debate, for reasons I don’t completely understand. Views on COVID-19 have become very polarized and antagonistic between people who should be colleagues. There are just so many uncertainties about COVID-19 and, even more so, uncertainties about what we need to do in a policy sense. It’s an issue that cries out for collaboration and discussion, not for polemics. So I think it’s important that different views get heard and talked about. Some will be right, and some will be wrong; that’s how science works. So I think this is very positive.
TVO.org: I hope it is positive. In watching your testimony, I was myself confused. The way that the Swedish approach is understood and discussed is that you try to protect elderly people, but you keep elementary schools open, and you keep businesses open, in the hopes of achieving herd immunity. In your testimony, you suggest opening schools, businesses, and cultural institutions — you call that a “top priority.” Can you help me understand how that approach differs from the Swedish approach?
Schabas: I’m a public-health doctor by training and vocation. The fundamental worldview of public health is that the things that determine our health — we call them the determinants of health — are not typically what most people think they are. Most people who say, “Why are Canadians so healthy?” are going to talk about antibiotics and health care and that sort of thing. We spend a lot of time in public health trying to educate people that it’s really things that are much more fundamental to our way of life —things like education, like our relative absence of poverty, like our social connectedness. These are the things that have really made a huge difference in making us as healthy as we are in the 21st century. So, when I look at a problem like COVID-19, and, absolutely COVID-19 is a very serious problem, it has to be looked at in that broader context. Whatever we do to protect ourselves against COVID-19, to try to mitigate the impact of COVID-19 — at the same time, we shouldn’t do deeper and more lasting damage to the things that are ultimately much more fundamental to our health. So I would start with education; there is nothing more fundamental to our good health than education.
And, to educate children, schools have to be open. So, when I asked the House of Commons committee to look ahead, it’s not what’s happening now — it’s about the fall. I think everybody expects it’s very likely that there will be a recurrence of the disease in the fall, and, so far as I’m concerned, the opening of the schools or keeping the schools open shouldn’t be a negotiable thing. It is absolutely fundamental, and that’s a starting point. Whatever we do to control COVID-19 needs to work itself around three things: education, people being able to have their occupations — some people can work at home, but many have to go to work — and the third element is that we need to have medical care, elective medical care. That should be our starting point. Whatever we do to mitigate COVID-19, and I think there are many important things we can do to mitigate COVID-19, they need to fit into that context — because, if we don’t do that, then, in the long run, we are going to cause, in my opinion, far more damage. Far more lasting damage, far more severe damage to our public health than COVID-19 could ever cause.
TVO.org: The question was: How does your approach differ from Sweden’s?
Schabas: Well, I’m not all that familiar, exactly, with what they have done in Sweden. I know, for example, they did a poor job of protecting their elderly, so I didn’t characterize mine as a comparison to Sweden’s. I don’t know where that idea came from; I didn’t do that.
TVO.org: It seems to come from the idea that the plans are quite similar.
Schabas: In what way are they similar? You seem to know more about it than I do: How were they similar?
TVO.org: The Swedish approach, as we discussed, and as it is discussed publicly and has been written about, involves keeping schools and businesses open and hoping to achieve herd immunity. When I hear your approach — I’m not passing a judgment on it; I’m not a public-health professional — but I can see how your approach certainly seems a lot like that.
Schabas: And you’re entitled to that opinion. But I didn’t characterize it that way. My understanding is that Sweden also did a very poor job, like we did, of protecting its frail elderly. So that’s why, I think, Sweden has had as many deaths as it’s had. So I wouldn’t want to endorse that approach that had those serious shortcomings. But what I did say in my House of Commons testimony — and maybe this what you’re alluding to — is that the only real defence we ever have against a respiratory virus is from immunity. And we get immunity one of two ways: we either get infected and recover or we get a vaccine. And, while I think everyone agrees it would be wonderful to have a safe and effective vaccine available for COVID-19, it’s entirely uncertain when that’s going to happen. The best timeline I’ve seen is 18 months.
TVO.org: People are suggesting that, as we move forward, we should adopt such measures as increased distancing and mask use. Doesn’t that suggest there’s another way?
Schabas: But I don’t understand where that leads us. We know from our experience in Canada in the last 10 weeks that doesn’t stop infection. It’s not like we’ve had no infection in Canada. So we’re gradually getting the population infected; at the same time, we continue to have very substantial mortality rates. Central Canada, Montreal, and Quebec, in general, have had extremely high mortality rates — Montreal is among the hardest-hit cities, in terms of deaths, in the world. So that approach we’ve taken in Canada doesn’t prevent population infection.
We’re still heading in the same direction — that’s my point. It doesn’t change the fundamentals: that we either get immunity from infection in the population, which is what’s happening now in Canada, or we get immunity through a vaccine. And we have to face up to that. That there will be, until we get a vaccine, and unless we completely shut down in a manner like China has done (which I don’t think any serious person is suggesting is compatible with the Canadian way of life), we’re going to continue to get infections. It’s really just a matter of how long it takes us to get to population immunity and whether we get there before a vaccine or not.
This interview has been condensed and edited for length and clarity.