Omicron in Ontario, Part 1: An infectious-disease expert on rapid spread and new fears

TVO.org speaks with McMaster University’s Zain Chagla about lockdowns, the health of our health-care system, and why so much is now out of our hands
By Matt Gurney - Published on Dec 14, 2021
Zain Chagla is an associate professor at McMaster University, in Hamilton. (The Agenda)

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This is the first instalment in a three-part series looking at what we do and don't know about the Omicron variant.

In just a few short weeks, the so-called Omicron variant of COVID-19 has swept the globe at a remarkable pace. The virus seems to be extremely contagious. We will have large outbreaks all over the world, including in Canada and in Ontario, specifically, before medical experts and scientists have a good understanding of how lethal it will prove, to both the unvaccinated and the vaccinated, whose doses may not fully work against the new, highly mutated variant.

Early indications from South Africa, where Omicron was first identified, do not yet show a clear signal that Omicron is producing serious illness at the same rate it’s producing infections. But it’s far too soon to say anything with confidence. In the coming days, TVO.org will speak with experts about what we know about Omicron and what kind of shape we are in to combat it.

Today, we speak with Zain Chagla, an infectious-disease expert and associate professor at McMaster University, in Hamilton.

Matt Gurney: Well, here we are again, I guess. I’d kind of hoped we were done with these chats. I confess to you that I am totally confused. I have no idea what’s happening. I think part of that is just risk-assessment fatigue on my part. That part of my brain is fried. But this new variant is also just moving incredibly fast. What do you and your colleagues know about what we’re up against. Does anyone know anything?

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Zain Chagla: This is it. There’s just so many unknowns, right? South Africa is a big learning lesson for all of us. A lot of people got infected very quickly. There are obstetricians there that are talking about 30 per cent of their delivering women having COVID when they’re walking into the hospital, though not many seem seriously sick. That’s a big number for a variant that was only discovered a few weeks ago. And now we’ve seen it in countries all over the world. This is really exponential growth. There is also obviously some degree of immune evasion and re-infection even among those who’ve had COVID or are vaccinated. All of that presents a lot of question marks in terms of what happens and what’s going to happen relatively soon, given how fast it seems to have emerged across the world.

Gurney: Let’s talk about that speed. I don’t want to sound crazy, but I can’t think of anything that moves as fast as this. We got used to COVID-19’s earlier variants, and they spread too well for our purposes, but not like this. Are you aware of other viruses out there that can go global this fast?

Chagla: Measles in a very vulnerable population without any immunity could spread this rapidly, because it’s one of the most infectious pathogens known. Chicken pox could rip through a community pretty quickly. But in populations that already have some immunity? We don’t normally see spread this fast. Even influenza, there are limits to how it spreads in a community and how fast it goes around the world. People talk about seasonality of viruses. Omicron is spreading in South Africa, which is in its summertime, and spreading in North America, which is in the wintertime. So there’s not really that much seasonality to this — it’s just spreading around the world.

Gurney: Is this faster than an influenza?

Chagla: We don’t test everyone for influenza like we are currently testing people for COVID-19. We use hospital-admission rates to estimate community burden. But influenza is a November to March kind of thing. And I can’t think of anywhere where we’d see an infection rate of 30 per cent of a population in a localized area in less than two weeks. That is remarkable spread for a virus. This is reaching a point we haven’t seen in this pandemic and in a population that likely has been infected with COVID-19 in the past. So this is not what we’d call a “naive” population, with no immunity. This population has some immunity. 

Gurney: When Delta came out earlier this year — and I don’t want to sound like I’m making light of this — but wow. It was easy to see right away that something was happening. I remember the scientists and local officials were like, yeah, we’re studying the new variant to see how deadly it is. And I was thinking, uhh, look at the news. Guys, they’re throwing bodies in the rivers because they can’t burn them fast enough. Or they’ve run out of wood for funeral pyres. There was an obvious humanitarian catastrophe running in parallel to the scientific study of the new variant. That isn’t happening in South Africa. And I’m encouraged by this! But should I be? Is this thing potentially so fast that it’s gone global before anyone has had the chance to get seriously ill and maybe we’re about to start seeing a catastrophe?

Chagla: We are just so early into this. You’re right: with Delta, we heard about growth in India. And then we started realizing it was something new, and then we started seeing, oh, God, a significant number of people have been taken down by this, and it’s causing problems. People then also thought India would have had a lot of immunity, and we realized it didn’t have as much as we thought. Huge numbers of people got Delta in a very short time, and a lot of them died. Health-care systems became clogged. And that was that. 

What we are seeing in South Africa is reassuring — health care is not collapsing, but it’s still very, very early. And it has a different population. The average age in South Africa is 27; the likelihood is that a lot of people were infected in the first three waves in South Africa. And the ones that, unfortunately, succumbed to their infection are not represented in this population, because they’re not here anymore. The major concern is that, yes, in South Africa, much of the disease is mild. But here, let’s say 25 to 30 per cent of the population gets infected, despite being vaccinated or having had a prior infection. If even a small percentage of them become seriously ill, you know — we all know — how tight the hospital system is. How many beds are lacking. And we have probably fewer human health-care resources than we did at the beginning of the pandemic, because of staff burnout and losses. That’s going to have an impact. Unless Omicron is much less dangerous, much less even than the original COVID-19, even a small rate of serious illness in a huge population of infected people will put pressure on hospital beds, on ICU staff, on ventilators, and it could again put us in a position where we’re trying to avoid a health-care-system crisis.

Gurney: When will we know? Right now, the news from South Africa is encouraging, but do we need to wait another week? Ten days? When can we be confident that we know what Omicron is? And will that be a process of science or a matter of observation?

Chagla: It’s observation. When we start estimating how many people are infected and see what the impact is on health care, we’re going to get a better sense. But it takes a couple of weeks for people to get sick enough to land in hospital. It takes a couple of weeks after that for them to get sick enough to die. We’re probably going to be in January before we start seeing the real impacts of this. Unfortunately, there’s a lot coming up in terms of the holidays. The virus is going to spread through communities because we will have people gathering, we have travelling. All our communities are going to be seeded with Omicron. I think we’re going to get a sense of what the health-care-utilization piece is going to be early in the new year. If it’s good news, at that point, we’ll breathe a sigh of relief. But if it’s not, then it’s going to be a pretty dark January and February to get through this.

Gurney: A few days ago, on Twitter, you had a tweet that was really stark. And I don’t say this to flatter you, but you’ve been so level-headed throughout the pandemic. We’ve spoken a bunch of times, on the record and off, and you’ve never lied to me. You’ve helped me know when to worry and when not to worry. And a few days ago, you were tweeting about Omicron disrupting society so badly we had to think about problems with essential services, including food distribution! And I started paying attention. So let’s talk about that tweet. What are you worried about?

Chagla: Yeah. Let’s talk a scenario where the projections come true. Health-care utilization is one piece we talk about, but the sheer numbers of potential Omicron cases are also a problem. 

The way we’ve handled COVID-19 since the beginning has been isolating cases and contacts for 10 to 14 days. Look at our projections for Omicron now. We’re talking 10,000 cases a day, and they’d each have maybe five close contacts. So you’re now talking about 60,000 people a day that need to go into isolation because of COVID spreading in the community. Do that for 10 days! You can’t just take 600,000 people out of society and expect everything to be okay. 

The people who get COVID are disproportionately the people who are essential workers, health-care workers, front-line workers. They are the ones that are running the services in our communities; they’re not the people at home, who can kind of shelter for the next couple of months. 

I think we do need to start talking about the fact that we can’t isolate every single contact out there. It’s going to be impossible for us to have people to care for patients for COVID and non-COVID reasons. With the sheer numbers, we’re going to have to take a look at, okay, what is going to be the collateral damage of isolation. It’s not going to be as simple as saying, “Okay, we’ll just get someone else to work tomorrow,” and it’ll be fine. If everyone who runs the grocery store and everyone who runs the fire station, if everyone who runs a hospital, is knocked out in a few weeks because their kids get it in school and bring it home or there’s a social event, and all those people are knocked out, that’s going to have collateral damage. There’s going to be serious repercussions. 

We just heard about this in London, Ontario. A community exposure knocked out 25 surgeons overnight. They’re not infected, but they’re now forced to isolate, and dozens of surgeries are now cancelled. This will ripple out across all of society. We need to have a Plan B for what happens if we have tens of thousands of people being exposed to Omicron every day. 

Gurney: So, going back to your tweet: you’re not worried about mass death. Like, you’re not saying that the food-distribution system will fail because everyone is dead. But you’re worried we’ll have all the grocery stores closed because all their workers are at home in isolation for 10 days.

Chagla: Exactly. I mean, you know what’s going to be problematic? School outbreaks. I work in a hospital where a lot of people send their kids to the same five or 10 high schools. If you see one of those high schools have a big outbreak, and those parents have to stay home to deal with their kids who get infected, there’s going to be a problem. Like, we are going into Christmas, we already lose staff, and then all of a sudden, we suddenly knock out 40 staff on a given day — that’s a crisis. We’ll be dealing with that immediately.

Gurney: You mentioned above a Plan B. What’s a good Plan B?

Chagla: If you want to get critical staff back to work, people that are essential for society, you get them tested on day one, you get them rapid-antigen tests for a few days, you get them tested on day seven. And if they’re negative at that point, the odds are, they’re probably not going to have COVID. There is data showing that fully vaccinated people, even if infected, are contagious for a shorter amount of time. You could probably trim it even down to five days — they still need to do rapid tests, but you can end isolation at day five if they have no symptoms. You can start mobilizing people back into society quicker and still have a little bit of that public-health part. 

But another piece I should mention. We’ve seen it at the beginning of every school year, whenever a kid gets a runny nose, a test result takes four days to come back. If we’re getting 10,000 cases a day, our testing and tracing system won’t last. It’ll go underwater in days. We won’t have enough people or places to actually test people. If someone has mild symptoms but they have to wait a week for a test and then another week for results, that’s not going to work. We aren’t going to be able to test everyone with no symptoms or very mild symptoms. And that means we won’t be able to use the same kind of public-health policies we’ve relied on so far.

Gurney: As we’ve covered above, we don’t know a lot. There’s so much we don’t know. But this thing is moving fast. So based on what we do know, now, what’s prudent to do? What should we start doing now?

Chagla: Capacity limits should be looked at. That’s probably not unreasonable. Also, there’s enough data to show that boosters are probably something that should be considered here, especially for restoring some immunity in people and lowering the amount of symptomatic disease, probably more about severe disease, in the vulnerable. So let’s go all-in and get people their booster shots. You know, the 50-year-olds opened up today — my mother was in that group. I spent a couple of hours trying to figure out where the hell to get her a shot and finally got her one near my house in a couple of days. We need to mobilize mass-immunization drives for boosters. 

I know that people are talking about lockdowns already. Look, lockdowns are a means to an end. I could understand that when Delta came to Canada, we wanted to extend the lockdowns a little longer just to make sure people got vaccinated. I totally agreed. That was the means to the end: get more people vaccinated. If Omicron is here, and it’s what we think it is, lockdowns won’t work. It will just be waiting for you the moment we open up. We have to be rational about what we can and can’t mitigate. These variants are showing up, and they’re becoming even harder and harder and harder to control with public-health measures. The goal has to be getting our immunity as high as possible. This virus keeps evolving and getting more transmissible and harder to control. We are going to be vulnerable to variants from all over the world. 

Gurney: You mentioned your concerns about a lockdown above. I’ve been very understanding of the earlier ones. I agreed with them. But I don’t think I’d do it again. And I’m not saying that that is a smart intellectual decision. It may be a terrible decision. But I think I’m reaching my limit of how much disruption I’ll tolerate and how disrupted I’ll let my kids’ lives be. I don’t want them to miss another day of school or one more hockey game, and I don’t think I’m alone in feeling that way. I don’t even have a question here. I just needed to say that.

Chagla: This is the reality, right? A lot of people are fatigued by this. A lot of people have faced not only the mental-health hardships but also the economic hardships of lockdowns and capacity measures and everything along those lines. Omicron is not disappearing. It’s going to be there tomorrow. If the health-care system goes belly-up, and we have nothing else to offer, well, maybe that’s a lockdown. But the fact of the matter is Omicron is going to be there tomorrow and the next day, or it’ll be outcompeted by the next variant, and it’s going to get to a point where avoiding infection is not going to be possible. 

And I know it’s hard for people to accept this, but we’ve been incredibly lucky to have variants that are still countered really well by our vaccines and that we were able to buy enough time to get those vaccines to people. But, at the end of the day, this virus is not leaving the Earth. We have the tools to mitigate spread, but, as you say, people want their lives back, they want the schools open and Leafs and Raptors games, and they also want a health-care system that can care for them if they have COVID or have something else. It sucks that we have this virus on our soil, but it could be replaced by something even worse. We are lucky to have the vaccines we have.

So, again, I think we have to be reasonable with what we do over the coming weeks and months. Using our most extreme measures can only be a temporary thing, and it won’t bring Omicron under control. It’s hard to reflect on, and this is why I’ve been so concerned about what the isolation measures do for us, in the sense that we could get collateral damage. We are trying to protect society, but we may not get what we want out of these measures. With the sheer numbers we may see over the next few weeks, we have to be very, very reasonable and take a path forward that mitigates harm in most ways. And we do everything we can to keep people out of the hospitals. That’s important. 

One thing I’ll add is there are therapeutics coming down the pipeline. I’ve probably prescribed more monoclonal antibodies than anyone else in Canada to this point at our pilot clinic. Stuff like that needs to be doubled down on — this is our way to live with this virus. This is the way that we can keep people out of the hospital. But those types of therapies also need support to get off the ground. They’re not going to exist in a bubble. I don’t think people understand that we can’t get rid of this virus. It keeps showing us that it will come back. Omicron has shown us that something that starts in sub-Saharan Africa is here in just two weeks.

Gurney: Everything we’re talking about above we could group together under “societal exhaustion.” I was saying to a colleague a few days ago, in one of my typical moments of bright happy optimism, wouldn’t this be a hell of a time for something totally unrelated to COVID-19 to come along? A bird flu? And arrive now, when we’ve wrung ourselves dry? Our political, financial, medical, and even societal reserves are exhausted. The tanks are empty. When you saw the first data on Omicron, what did you think?

Chagla: Long-term, we’ll need to keep developing better vaccines. We probably need a pan-coronavirus vaccine, because SARS-3 could be around the corner. This is our third coronavirus crisis or near-crisis. The first SARS. MERS. And now COVID, which is SARS-2. So, yeah. The work towards the pan-coronavirus vaccine is probably going to be a whole lot more important for us long-term than the vaccines we’re using currently. 

And I hate to say this, but our response globally to COVID-19 has been pitiful in the sense of not having global support for global pandemic response. We’ve been very fixated on our local issues. The next pandemic is going to start somewhere in the world and be here in 24 hours on a flight. If we’re not serious about being global partners with low-income countries and other places in the world, we’re going to get burned by the next one. It may be another variant. We thought Delta was going to be the last one, but Omicron just kind of came out and blew everything out of the water. And yet something like avian influenza or another SARS coronavirus could definitely cause societal disruption again, and we have to be cognizant of our global responsibilities. We can’t just act at home and assume it’s fine once our people are protected.

Gurney: Something we’re dancing around a bit here is something that’s awkward to say, and I wrote a column about this recently, but we were actually pretty lucky with COVID-19. It could have been a lot worse. Something that spreads like Omicron and kills like Delta could have collapsed our civilization. I know that sounds like hyperbole but … 

Chagla: Right. You’re right. Next time we might not be as lucky. Look. COVID-19 has, keeping everything in mind, less than 1 per cent mortality. SARS had 10 per cent, up to 20 per cent. MERS was about the same. And then what would we do? No one wants to hear this. Everyone is fatigued. But COVID was not the big one. This was practice. And look how we did. We have a lack of global partnerships. We have vaccine inequities. We have testing problems. We have an exhausted society. It is amazing how much damage to our society and to our economy COVID-19 did, and it could be worse next time. An influenza or a higher-fatality coronavirus could do a lot more damage to our society than we saw with COVID-19. We are so interconnected and something can start anywhere on Earth and ripple everywhere. It boggles the mind to even think this, but something else could come. Something worse could come. It could spread faster and have a higher mortality. That would be the big one. Knowing what we know now, with what happened in this pandemic and how inequitable it’s been, if a big one came, It would be hard for us to function as a society.

Agenda segment, December 10, 2021: Navigating Omicron

Gurney: And that’s not speculation. It’s happened before. I want to end with this. You knew more about this stuff than most of us at the very beginning. Think back to then, early 2020. Twenty-one months later, what have you learned? I don’t just mean emotionally, but what have you had to accept along the way?

Chagla: It’s exhausting, obviously. A lot of us have tried to keep our practices up while helping out, so it’s been a lot. But I don’t want to be a total downer. If something like Omicron had emerged in early 2020 instead of COVID-19, I would have been much more scared. In a population with no immunity, something like this, we couldn’t have stopped it. It would have ripped through and destroyed our society and would not have been possible to get it under control the way we can now, with immunity in something like 90 per cent of our population. That’s going to be our way out in the next little while. 

But this virus keeps throwing curveballs at us. Every day turns into a journey. We came into November thinking we were going to see some Delta growth over the winter months. Now we’re dealing with something that has explosive growth and is only a few weeks old. I only heard about it at the end of November. 

I hate to say this, but it’s getting out of our hands now. I always had this feeling that we could control things, that this virus would disappear if we got vaccinated, that we could do what Australia and New Zealand did — a lot of people were invested in that COVID-Zero mentality. I don’t think that anymore. This one’s out of our hands. This virus is around the world. It’s reached every corner of the Earth. It’s reaching animals. It’s spreading. It’s mutating. There are going to be parts of this virus and the way it spreads that are out of our hands. And I think we have to realize some of that too, moving forward. 

Australia and New Zealand were great examples of trying to lock down and contact trace every case, and eventually they just gave up and said, “We just need to vaccinate people and let people live.” We have to prepare to live with this virus, and that’s going to mean a lot of turmoil for years. But we’re going to get better vaccines and new vaccines that are going to really mitigate this, and better treatments. If you aren’t vaccinated, it’s time to get vaccinated. If you’re eligible, get your booster. Your immune system is going to be what gets you through this virus. Everything else is out of our hands at this point. 

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

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