COVID-19: The week in review with epidemiologist David Fisman

TVO.org speaks with the University of Toronto professor about the testing, the numbers, and the outlook for Ontario
By Nathaniel Basen - Published on Apr 17, 2020
David Fisman is a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health. (facebook.com/DallaLanaSchoolOfPublicHealth)

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David Fisman, a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health, has been one of the most prominent critics of Ontario’s response to COVID-19.

TVO.org will be checking in with Fisman on an ongoing basis to get his insights into the week that was — and the week ahead — in the province’s fight against the coronavirus. We caught up with him on Thursday afternoon. 

TVO.org: What strikes you about the overall numbers — deaths, hospitalizations, total cases — this week?

David Fisman: Well, I think what we’re seeing — it’s probably been coming for a little while — this is the week that Ontario’s epidemic splits into two different things. What we see is that physical distancing and social distancing really seem to have, probably, settled things in the community. The numbers are going in some slightly confusing directions at the moment: non-intensive-care hospitalizations have risen a bit, but our ICU capacity from COVID-19 has actually gone down. So, that’s positive. A little confusing, but positive. At the same time, you have COVID-19 raging like wildfire in long-term-care institutions, and it’s now moving into hospital outbreaks and prison outbreaks. It’s almost like the community stuff has been settled down by physical distancing, but the disease has moved into these congregate-living settings. I don’t think we’ve seen a lot of death in shelters yet, but everybody knows that could come. We saw our first death in a prison today in Canada. There are hospital outbreaks, as well. So it’s sort of split into two epidemics. 

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In aggregate, it looks like we’re peaking in Ontario right now. We’re at the peak of the epidemic and starting to go down the other side. And, as Ontario goes, so goes Canada — so, in our forecast, Canada is at peak. Most other provinces, maybe all other provinces, are past peak at this point. Quebec is the closest to Ontario, and they’ve been past peak for a couple of days now. So it’s sort of a good news, bad news, medium news kind of day. 

TVO.org: What strikes you about Ontario’s testing numbers and approach this week? 

Fisman: Well, I’m a very big Ed Tubb fan, at the Toronto Star. So, I’ve been watching Ed’s frustration with the fancy-footwork with regards to how the numbers are released. I don’t know what the motivation is for that — I’m on the outside — but it doesn’t look like transparency. In terms of total test numbers, what you’re seeing is the numbers are going up. The per cent positives, though, I think, over the last week have fallen somewhat from 10 per cent to 5 per cent. So that nets out — the average new cases discovered per day by testing nets out at the same. That’s why the forecast models put as at peak. So we may even be a little past peak, but we’re there artificially because the test numbers are going up. That’s fine: better to have more testing than less testing, because if we’re not testing a lot, we don’t see this epidemic. 

TVO.org: How do you think public-health officials have handled the epidemic this week? 

Fisman: Well, I think that depends on what level. I’ve been a big fan of the federal response. I think Dr. Theresa Tam has had a decent amount of pretty unfair criticism. I think we have some local medical officers of health in Ontario who have just been outstanding and have been dealing with some pretty tough hands. My heart goes out to Dr. Eileen De Villa right now, given the situation with some of the deaths in long-term-care facilities. I think what you’ve seen from Dr. Vera Etches, in Ottawa; Hamilton has been amazing; Sudbury, Dr. Penny Sutcliffe has been amazing; Durham region — what you’re seeing is that a lot of these health units are being run by very able people, and the level of transparency in terms of how they’re reporting things out has been very impressive and new for us. I mean, Durham has had an individual-level line list on their webpage for about two weeks now. We’re not used to that sort of transparency in Canada. 

You then go up to the provincial level. I continue to be a bit frustrated with the mixed messages from Dr. David Williams and Dr. Barbara Yaffe — and the tendency to really dig in on points that have been obviously wrong for some time now. I think Dr. Williams finally acknowledged, either yesterday or the day before, for the first time, that asymptomatic and minimally symptomatic people may be important in the genesis of nursing-home infections. Well, of course they are. We’ve known for weeks now from a paper published in Science that, in China, unrecognized infections are huge drivers of this outbreak. I have an email from a colleague in Korea from March 19 that says, “You have to be aware that asymptomatic people is how this gets into nursing homes.” A lot of people have known this for some time. It’s reminiscent of Dr. Yaffe saying, “You don’t have to test more than three people in a long-term-care facility, and then you know there’s an outbreak, and it doesn’t change anything.” It’s reminiscent of Dr. Yaffe saying, “There’s no proof of community transmission,” when everyone damn well knew there was community transmission in mid-March. So I would be very concerned about the messaging coming out of the CMOH and the associate CMOH at the provincial level. 

As I’ve been saying — and I know I haven’t made many friends by saying this out loud, but someone has to say it — if you really believe that stuff, then you don’t understand the epidemic, and that’s a problem. If you don’t believe that stuff, and you know what’s really going on and how this works, then the fact that you’re standing behind a podium and digging your heels in, or sitting behind a table, as I guess they’re doing now — either of those scenarios is a problem for me. 

On a very personal note, I’ve been very impressed by Steini Brown, my boss at the University of Toronto. He’s a former assistant deputy minister and has brought a lot of academics into a process so that we now have good modelling going on. I think there are, I don’t want to forget anyone, at least six different modelling groups from Queen’s University, York University, McMaster University, U of T, and St. Michael’s Hospital who are working with data and trying to provide the province good guidance based on the data the province is providing. This is thanks to Steini. That’s a very different way of doing things in Ontario — data and transparency in Ontario are not usually two things that you talk about in the same sentence — and that has been a real bright spot. Kudos to him, because he did that in the face of some pretty strong headwinds. So that’s the week! 

TVO.org: What will you be looking for next week? 

Fisman: I think looking ahead to next week, we’ll talk about how people are starting to talk about climbing down and what we have to do to climb down. But we’re not there yet. If I had to guess.

I think I’m doing a podcast next week with a fellow — it’s called The Big Story, with Jordan Heath- Rawlings — and we’re going to talk about all the things I’ve been wrong about over the past four months and why I’ve been so wrong on so many things. 

TVO.org: Looking forward to it. Thanks, and talk to you next week.

Fisman: Take care — nice to chat with you. 

This interview has been condensed and edited for length and clarity.

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