Transcript: Coronavirus Contagion | Feb 18, 2020

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and spotted blue tie.

A caption on screen reads "Coronavirus contagion. @spaikin, @theagenda."

Steve says ANY TIME A VIRUS SUCH AS THE NEW CORONAVIRUS OR SARS FLARES UP, PUBLIC HEALTH AGENCIES AND DISEASE SPECIALISTS KICK INTO HIGH GEAR TO SAFEGUARD THE GENERAL POPULATION AND HEALTH CARE WORKERS WHO WILL BE ON THE FRONTLINES. HOW EXACTLY DO THEY DO THAT, AND HOW WELL IS IT GOING THIS TIME? LET'S ASK: DR. SUSY HOTA, MEDICAL DIRECTOR OF INFECTION PREVENTION AND CONTROL AT THE UNIVERSITY HEALTH NETWORK AND AN ASSOCIATE PROFESSOR OF INFECTIOUS DISEASES AT THE U OF T's MEDICAL SCHOOL...

Susy is in her thirties, with straight chestnut hair in a bob. She's wearing a black blazer and a white blouse.

Steve continues AND MARIO POSSAMAI, WHO WAS A SENIOR ADVISOR ON THE SARS COMMISSION AND CURRENTLY A CONSULTANT IN OCCUPATIONAL HEALTH AND SAFETY ISSUES.

Mario is in his fifties, clean-shaven, with short white hair. He's wearing glasses, a gray suit

Steve continues IT'S GREAT TO HAVE YOU HERE AND YOU BACK HERE. YOU WERE HERE A LONG TIME AGO, WEREN'T YOU.

Mario says ABOUT TEN YEARS AGO.

Steve says INDEED, WHEN WE TALKED ABOUT SARS. DR. HOTA, LET'S START WITH THIS. IT'S BEEN A MONTH BEFORE PEOPLE HEARD ABOUT THE CORONAVIRUS, NOW WITH AN OFFICIAL NEW NAME, COVID-19. HOW MUCH MORE DO WE KNOW TODAY ABOUT HOW INFECTIOUS THIS DISEASE IS THAN WE KNEW A MONTH AGO?

The caption changes to "Susy Hota. University Health Network."
Then, it changes again to "The news on COVID-19."

Susy says I THINK WE KNOW QUITE A BIT MORE. AS WE GET EXPERIENCED WITH CASES AND PEOPLE START TO PUBLISH THEIR EXPERIENCES, WE START TO SEE INFORMATION THAT'S COMING ACROSS CONSISTENTLY. I THINK ONE OF THE THINGS WE KNOW IS THAT THIS IS TRANSMITTING FROM PERSON TO PERSON, AND WE LOOK AT SOMETHING CALLED A BASE OF REPRODUCTIVE NUMBER OR AN RNO, IT WHICH TELLS YOU ON AVERAGE IF SOMEONE IS INFECTED WITH THE VIRUS, HOW MANY OTHER PEOPLE COULD BE INFECTED BY THAT INDIVIDUAL.

Steve says WHAT'S THAT NUMBER?

The caption changes to "Susy Hota. University of Toronto."

Susy says AND SO RIGHT NOW EIGHTS LOOKING LIKE IT'S SOMEWHERE BETWEEN TWO AND THREE FOR THIS VIRUS, PROBABLY CLOSER TO TWO. THAT HELPS TO GIVE US A REFERENCE COMPARED TO OTHER VIRUSES WE'RE MORE FAMILIAR WITH IN TERMS OF HOW INFECTIOUS IT IS.

Steve says IT SOUNDS LIKE A RELATIVELY SMALL NUMBER AS OPPOSED TO... YOU KNOW, WE'RE NOT TALKING THOUSANDS HERE, RIGHT?

Susy says YOU HAVE TO PUT IT IN CONTEXT. SO IT'S COMPARABLE TO WHAT WE SEE WITH SARS, FOR EXAMPLE. HOWEVER, WHAT WE ARE SEEING IS THAT WE ARE CONTINUING TO HAVE THESE CHAINS OF PERSON-TO-PERSON TRANSMISSION THAT HAPPENS ON AND OFF WITHIN, YOU KNOW, CHINA WE'RE SEEING QUITE A BIT OF IT, BUT ALSO OUTSIDE OF CHINA. AND SO IN THAT SENSE IT'S BEHAVING A LITTLE BIT DIFFERENTLY THAN WHAT WE SAW WITH SARS IN TERMS IT WAS MORE LIMITED IN WHERE WE SAW THE INFECTIONS OCCUR.

Steve says ARE WE GETTING A MORE ACCURATE PICTURE TODAY OF HOW DEADLY IT IS?

Susy says WE ARE. AGAIN WE'RE SUMMARIZING MORE AND MORE CASES OF PEOPLE INFECTED WITH THE VIRUS AND IT LOOKS AS THOUGH ABOUT 2 percent OF CONFIRMED CASES, LAB-CONFIRMED CASES, ARE RESULTING IN DEATH. NOW, THE PROBLEM IS WE DON'T KNOW THE FULL EXTENT OF PEOPLE WHO ARE ACTUALLY INFECTED WITH MUCH MORE MILD ILLNESS, AND SO LIKELY IT'S LOWER THAN THAT.

Steve says AND, AGAIN, THAT RELATIVELY SPEAKING IS A PRETTY GOOD NUMBER?

Susy says I THINK... YOU KNOW, IT'S GOOD OR BAD. IT ALL DEPENDS ON HOW MANY PEOPLE END UP GETTING INFECTED WITH THIS. BECAUSE THERE'S NO PRE-EXISTING IMMUNITY AMONG THE POPULATION WITH THIS NEW VIRUS, THIS HAS THE POTENTIAL TO INFECT QUITE A FEW PEOPLE OVER TIME. YOU HAVE TO WATCH WHAT THE NUMBERS ARE DOING AND ALSO SEE IF THERE ARE ANY TRENDS IN TERMS OF SOME RISK GROUPS BEING AT HIGHER RISK OF DYING, AND RIGHT NOW, IT DOES APPEAR AS THOUGH THOSE WHO ARE OVER THE AGE OF 80 TEND TO BE AT HIGHEST RISK OF DYING FROM THE DISEASE.

Steve says WHICH TAKES US NOW TO MARIO POSSAMAI. WHAT DIFFERENTIATES WHAT WE'RE EXPERIENCING RIGHT NOW FROM A FULL-BLOWN PANDEMIC?

The caption changes to "Mario Possamai. Sars Commission."

Mario says WELL, YOU KNOW, A PANDEMIC IS KIND OF A SOFT DEFINITION. YOU KNOW, IT'S REALLY SUSTAINED TRANSMISSION, YOU KNOW, IN A NUMBER OF AREAS. RIGHT NOW WE HAVE MAJOR, MAJOR CASES IN CHINA, OF COURSE. A FEW CASES HERE. YOU KNOW, MORE CASES IN HONG KONG AND EUROPE AND THE U.K. BUT WE'RE NOT THERE YET. BUT I THINK, YOU KNOW, THE MAJOR DIFFERENCE WITH SARS IS THAT SARS WAS PRIMARILY TRANSMITTED IN HOSPITALS. HERE WE'RE HAVING, YOU KNOW, MORE SPREAD THAN THE
[indiscernible] POPULATION. I GOT AN e-mail AT 4:00 THIS MORNING AND IT SHOWED THAT... IT LOOKED AT 74,000 CASES IN CHINA, AND THEY FOUND THAT ABOUT 1 percent WERE ASYMPTOMATIC. SO THEY WERE LAB-CONFIRMED AS BEING CARRIERS OF THE VIRUS. THERE ARE A LOT OF WRINKLES LIKE THAT COMING OUT THAT ARE IMPORTANT AND INTERESTING. YOU KNOW, AS OUR KNOWLEDGE EVOLVES ABOUT THIS NEW CORONAVIRUS.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says BUT TO BE CLEAR THEN, IF SARS, WHICH ONTARIO EXPERIENCED I GUESS 16 YEARS AGO... 17 YEARS AGO NOW. 17 YEARS AGO... IF THAT WAS MOSTLY AN ILLNESS THAT WAS TRANSFERRED IN HOSPITALS, TRANSMITTED IN HOSPITALS, AS OPPOSED TO THIS ONE, THEN THIS ONE'S WAY WORSE, RIGHT; IS THAT FAIR TO SAY?

Mario says ABSOLUTELY. SO EARLY ON IN SARS OUTBREAK, NO ONE KNEW WHETHER IT WAS GOING TO BE COMMUNITY-SPREAD. AND IN FACT THERE WAS AN EARLY PLAN AND DR. HOTA AND I WERE TALKING ABOUT. IT WAS BASED ON THE PANDEMIC PLAN. ONTARIO DID NOT HAVE A PANDEMIC PLAN IN THOSE DAYS. SO THERE WERE PREPARATIONS FOR COMMUNITY SPREAD. LUCKILY WE DIDN'T HAVE TO SEE THAT. BUT I THINK YOU KNOW IT GIVES YOU A TASTE OF, EVEN IF IT'S RESTRICTED TO HEALTH CARE FACILITIES, WHAT DAMAGE, YOU KNOW, AN OUTBREAK CAN DO.

Steve says THIS ONE IS CLEARLY NOT RESTRICTED. OF COURSE, THE EPICENTRE WAS CHINA, BUT THEN, OF COURSE, WE'RE NOW SEEING IT ON CRUISE SHIPS NOW AND WE'RE SEEING THE IMPACT THAT'S HAVING, NEVER MIND ON THAT INDUSTRY, BUT ANYBODY WHO MIGHT HAVE BEEN ON THE WRONG CRUISE SHIP AT THE WRONG TIME. WHAT DOES IT TELL YOU ABOUT THE FACT THAT HUNDREDS OF PEOPLE WHO ARE ON CRUISE SHIPS ARE NOW GETTING INFECTED?

Mario says WELL, YOU KNOW, THE STUDY THAT I GOT AT 4:00 THIS MORNING SAID IT'S PRETTY DARN OBVIOUS. THEY SAID THIS IS HIGHLY CONTAGIOUS. WE ALSO DON'T KNOW ENOUGH ABOUT IT, ABOUT TRANSMISSION DYNAMICS, ALL THESE THINGS. IT'S EARLY DAYS. I THINK THE OTHER IMPORTANT THING IS THAT, WHAT WE'RE SEEING NOW IS UNPRECEDENTED. ABOUT 10 YEARS AGO, THE CDC AND THE U.S. DEPARTMENT OF DEFENCE AND SOME OTHER GROUPS HAD A WORKSHOP. I WAS DOWN THERE WITH OTHER CANADIANS. IT WAS LOOKING AT, WERE THERE HISTORICAL EXPERIENCES, WHETHER IT WAS SPANISH FLU OR OTHER EPIDEMICS, THAT COULD HELP INFORM US IF WE HAVE TO DO BIG THINGS IN RESPONSE, QUARANTINE, THINGS LIKE THAT, THINGS THAT CHINA IS DOING NOW. THERE WERE NO HISTORICAL EXAMPLES. SO WHAT THEY'RE DOING IS UNPRECEDENTED. YOU KNOW, SHUTTING DOWN CITIES. CRUISE SHIP... QUARANTINING CRUISE SHIPS. SO THERE'S NO PLAYBOOK. I THINK SOME MISTAKES HAVE BEEN MADE. PROBABLY IN HINDSIGHT THE QUARANTINING OF THE CRUISE SHIP IN JAPAN WAS PROBABLY A MISTAKE.

Steve says WE'LL GET INTO SOME OF THIS IN A SECOND HERE. SUSY HOTA, LET ME ASK YOU THIS: IF YOU ARE FORTUNATE ENOUGH TO SURVIVE RECEIVING THIS VIRUS, WHAT'S IT GOING TO DO TO YOU?

Susy says MOST PEOPLE ARE RECOVERING AND HAVING NO SEQUALAE OF THE INFECTION. THOSE WHO END UP IN THE HOSPITAL AND NEED A HIGHER LEVEL OF CARE OR DIE FROM IT, TEND TO GET COMPLICATIONS EITHER FROM OVERWHELMING PNEUMONIA OR THE IMMUNE SYSTEM GETTING SO OVERSTIMULATED BY TRYING TO FIGHT IT OFF THAT YOU GO INTO A SHOCK KIND OF CONDITION. THAT'S WHAT WE'RE SEEING IN TERMS OF THE ACTUAL MORBID AT MORBIDITY OF IT. IF YOU RECOVER, WE'RE NOT SURE IF YOU'LL HAVE IMMUNITY FOR A PERIOD OF TIME OR IF YOU COULD BE REINFECTED WITH THIS VIRUS IN THE FUTURE, LIKE WE SEE WITH SOME OF THE OTHER CORONAVIRUSES THAT CIRCULATE EVERY YEAR IN NORTH AMERICA AND THROUGHOUT THE YEAR.

The caption changes to "Looking back: Our SARS experience."

Steve says CAN WE GO BACK NOW? LET'S GO BACK 17 YEARS WHEN SARS DID HIT MANY PLACES, INCLUDING THE PROVINCE OF ONTARIO. WHERE WERE YOU WHEN IT HIT?

Susy says SO I WAS ACTUALLY A MEDICAL RESIDENT DURING THAT TIME. SO I WAS ESSENTIALLY A FRONT LINE HEALTH CARE PROVIDER. I SPENT A LOT OF THE TIME DURING ONE OF THE WAVES IN SARS AT THE EMERGENCY DEPARTMENT IN MY HOSPITAL.

Steve says WHICH ONE?

The caption changes to "Susy Hota, @HotaSusy."

Susy says TORONTO WESTERN HOSPITAL. SO I WAS SEEING PATIENTS AT THE TIME. BUT I HAD A VERY DIFFERENT LENS TO WHAT WAS OCCURRING COMPARED TO NOW, BEING IN THE CONTROL TOWER AS OPPOSED TO RIGHT OUT THERE, YOU KNOW, SEEING PATIENTS.

Steve says YOU WERE ON THE FRONT LINES.

Susy says I WAS ON THE FRONT LINES.

Steve says SCARY?

Susy says PART OF IT IS THE MENTALITY OF MEDICAL RESIDENTS. YOU JUST KIND OF DO YOUR JOB. I DIDN'T FEEL AFRAID. I KNEW SOMETHING WAS GOING ON THAT I NEEDED TO BE PAYING VERY CLOSE ATTENTION TO. THERE WAS A LOT OF CONFUSION. THINGS WERE CHANGING DAY TO DAY IN TERMS OF WHAT KINDS OF MEASURES WE WERE ASKED TO TAKE. IT WAS STRESSFUL AND IT WAS DIFFICULT. I WON'T LIE ABOUT THAT. BUT I DIDN'T FEEL AFRAID. I FELT AS THOUGH I HAD TO PUT MY FAITH IN THE PEOPLE MAKING THE DECISION... DECISIONS ON WHAT WE NEEDED TO DO TO PROTECT OURSELVES AND HEALTH CARE FACILITIES AND I DID IT.

Steve says WAS THAT FAITH INDICATED?

Susy says YES, I THINK IN THE END, YOU KNOW, PEOPLE WERE TRYING VERY, VERY HARD TO PROTECT HEALTH CARE WORKERS. MARIO HAS ALREADY MENTIONED THAT SARS WAS AN INFECTION THAT REALLY DISPROPORTIONATELY AFFECTED PEOPLE WHO WORKED IN HEALTH CARE FACILITIES.

Steve says 44 DEAD.

Susy says 44 DEAD. AND SOME WITHIN MY HOSPITAL. SO PEOPLE WERE VERY ACUTELY AWARE OF THAT. AND IT'S HAD A LONGLASTING IMPACT AS WELL AS I'M NOW FACING THESE OTHER EMERGING INFECTIOUS DISEASES AND NOW A NEW CORONAVIRUS. ONE OF THE FIRST ASSUMPTIONS THAT PEOPLE MADE WAS, OH, MY GOD, THIS WAS ANOTHER SARS. SO A LOT OF MANAGING THIS PROBLEM WITHIN HOSPITALS HAS TO DO WITH MAKING SURE THAT YOUR STAFF ARE WELL AWARE OF WHAT'S GOING ON AND WELL-INFORMED AND THAT THEY ALSO CAN PUT THE SAME FAITH THAT I WAS ABLE TO PUT INTO OUR INFECTION CONTROL TEAM.

Steve says NOW, THANKFULLY, MARIO, WE'VE HAD VERY... I MEAN, RELATIVELY SPEAKING, VERY, VERY FEW CASES IN THE PROVINCE OF ONTARIO SO FAR, WHICH IS THE GOOD NEWS. DO YOU BELIEVE THAT HEALTH CARE WORKERS WORKING IN HOSPITAL SETTINGS IN OTHER PROVINCES AROUND CANADA ARE AS Ñ WELL-PROTECTED AND WELL OFF." APPARENTLY THEY ARE HERE IN THE PROVINCE OF ONTARIO?

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Mario says NO, I MEAN, THAT'S A REAL CONCERN. I'VE BEEN INVOLVED... NURSING TEAMS HAVE BEEN INVOLVED AS WELL. THE PUBLIC HEALTH AGENCY OF CANADA HAS TAKEN AN ODD POSITION WHERE THEY, INSTEAD OF TAKING THE ONTARIO POSITION, WHICH IS TAKING A PRECAUTIONARY APPROACH, A PRECAUTIONARY APPROACH THAT WAS RECOMMENDED, CORE RECOMMENDATION FROM THE SARS COMMISSION, THE PRINCIPLE OF BEING PRECAUTIONARY IS NOW PART OF THE PUBLIC HEALTH LAW. THE PUBLIC HEALTH INSTITUTE OF CANADA DECIDED THAT, YOU KNOW, THEIR GUIDANCE IS THAT A HEALTH CARE WORKER GOING TO CONTACT WITH A POSSIBLE CORONAVIRUS CARRIER ONLY HAS TO WEAR A SURGICAL MASK. IN ONTARIO, BECAUSE WE KNOW SO LITTLE ABOUT HOW THIS NEW VIRUS IS TRANSMITTED, YOU KNOW, IS TAKING A PRECAUTIONARY APPROACH AND THEY'RE SAYING, WE HAVE TO MAKE SURE THAT HEALTH CARE WORKERS HAVE A HIGHER LEVEL OF PROTECTION, WHICH IS THE N-95 RESPIRATOR. YOU KNOW, ON THE POSSIBILITY, WHICH MIGHT BE REMOTE, THAT PERHAPS THERE IS AIRBORNE PRECAUTION. SO ONTARIO HEALTH CARE WORKERS ARE BEING WELL-PROTECTED, I THINK. THE PROVINCE OF MANITOBA IS GOING IN THE DIRECTION THAT WE'RE FOLLOWING THE PUBLIC HEALTH AGENCY ARE LESS PROTECTED. IT'S WORRISOME BECAUSE IMAGINE YOU'VE GOT A NURSE WHO MAYBE LIVES IN ONTARIO NEAR THE MANITOBA BORDER AND THEY'RE WORKING IN MANITOBA. BY CROSSING THE BORDER, THE GUIDELINES IN PLACE THERE WILL BE LESS PROTECTIVE THAN MAYBE HIS OR HER COLLEAGUES ARE IN ONTARIO.

Steve says I SEE, AS I ASSUME YOU DO TOO, ACTUALLY LOTS OF PEOPLE WALKING AROUND WITH THESE MASKS ON RIGHT NOW.
AND I GUESS A COUPLE OF THINGS. NUMBER ONE, TO THE EXTENT THAT WE KNOW THIS IS NOT AN AIRBORNE VIRUS...

Mario says RIGHT.

Steve says SO THOSE MASKS ARE USELESS, OR NOT... I DON'T KNOW. YOU TELL ME. NOT REALLY NEEDED, I GUESS, OR WHAT?

Susy says I THINK AT THIS POINT NOT REALLY NEEDED IN THE GENERAL PUBLIC, THAT'S FOR SURE. I MEAN, THERE ARE DIFFERENT TYPES OF RESPIRATORY PROTECTION. THERE ARE THESE TIGHT-FITTING N-95 RESPIRATORS THAT YOU HAVE TO ACTUALLY MAKE SURE SEAL SO YOU HAVE VERY GOOD PROTECTION AND A FILTER OF THINGS THAT ARE TRANSMITTED BY AIRBORNE ROUTE, INFECTIOUS PARTICLES. AND THERE ARE THE LOOSE-FITTING MASKS YOU HAVE OVER YOUR NOSE AND MOUTH THAT ACT AS A BARRIER. THEY'RE USED FOR DIFFERENT TYPES OF INFECTION. FOR THINGS THAT ARE TRANSMITTED BY AN AIRBORNE ROUTE, LIKE TUBERCULOSIS OR MEASLES, IT IS IMPORTANT TO HAVE ONE OF THOSE TESTED N-95 RESPIRATORS. SOME ARE WEARING THEM IN PUBLIC AND THEY'RE NOT NECESSARILY FITTED TO THEIR FACE AND THERE'S DEFINITELY NO REASON TO BE USING IT. ALL SIGNS POINT TO THIS AS BEING SOMETHING THAT'S TRANSMITTED THROUGH LARGE RESPIRATORY DROPLETS. IF IT WAS AIRBORNE, WE WOULD SEE A MUCH HIGHER ATTACK RATE, MANY MORE PEOPLE INFECTED. IN TERMS OF THE PRECAUTIONARY PRINCIPLE MARIO HAD MENTIONED, THERE IS A LOT OF VALUE TO THAT IN THE EARLY STAGES OF AN EMERGING INFECTION BECAUSE WE DON'T KNOW ENTIRELY HOW IT'S TRANSMITTED. AND ALSO IN HEALTH CARE FACILITIES, WE'RE VERY MINDFUL OF SOME OF THE THINGS WE DO THAT MIGHT GENERATE AEROSOLS OR SMALLER PARTICLES THAT CAN INFECT AS OPPOSED TO OUT IN THE PUBLIC OR JUST IN ROUTINE CARE OF A PERSON. IN MY VIEW, I THINK WE HAVE TO BE CAUTIOUS WHERE IT'S IMPORTANT TO DO SO. IN OTHER WORDS, WHEN THINGS ARE HAPPENING IN HOSPITALS THAT ARE MORE INVASIVE AND CAN GENERATE AEROSOLS. OTHERWISE, LET'S BE JUDICIOUS ABOUT THE USE OF MASKS IN PUBLIC, FOR EXAMPLE, WHERE IT'S REALLY NOT NECESSARY.

Steve says I WANT TO ASK YOU ABOUT CHINA. MARIO, IN YOUR VIEW, HAS CHINA BEEN A GOOD INTERNATIONAL PUBLIC HEALTH CITIZEN IN ITS HANDLING OF COVID-19?

Mario says WELL, I THINK THAT'S A VERY COMPLEX QUESTION BECAUSE WHAT WE'RE SEEING DIFFERENT ASPECTS OF CHINA ON DISPLAY. YOU KNOW, ON THE ONE HAND, YOU'VE GOT THE ARRESTS OF THE INITIAL DOCTOR WHO WAS A WHISTLEBLOWER. THERE'S, YOU KNOW, THE CONTAINMENT THAT'S PART OF AN AUTHORITARIAN REGIME TO CLAMP THAT DOWN.

Steve says THEY ARRESTED HIM. THEN THEY SAID HE DIED. THEN HE DIDN'T DIE. AND THEN THEY CONFIRMED HE DIED. HE WAS THE WHISTLEBLOWER. ANYWAY...

Mario says YOU HAVE THAT. YOU HAVE TOP MEDICAL PEOPLE IN CHINA BEING ABLE TO PUBLISH REALLY FRANK ANALYSES AND PAPERS IN ALMOST REAL TIME. THERE WAS A PAPER PUBLISHED IN THE LANCET OVER THE WEEKEND BY FOUR PHYSICIANS WHICH WARNED ABOUT THE SUB-CLINICAL TRANSMISSION BUT BY PATIENTS. SO, YOU KNOW, I THINK THERE'S A LOT GOING ON THERE...

The caption changes to "Handling the outbreak in China."

Steve says HOW ABOUT NUMBERS? HOW MUCH CONFIDENCE DO YOU HAVE IN THE NUMBERS COMING OUT FROM CHINA THESE DAYS?

Mario says I THINK THE NUMBERS RIGHT NOW ARE PRETTY GOOD FROM EVERYONE THAT I'VE TALKED TO. YOU KNOW, THE STUDY THAT I GOT AT 4:00 THIS MORNING, YOU KNOW, THEY ANALYSED 74,000 CASES. THE ANALYSIS SEEMS PRETTY RIGOROUS TO ME. I THINK THAT THERE IS... AGAIN, COMPETING FORCES IN CHINA. I THINK THE MEDICAL PEOPLE WANT TO GET IT OUT. THEY WANT TO COOPERATE WITH EVERYONE. I THINK...

Steve says THE POLITICAL PEOPLE ARE SCARED.

Mario says YEAH.

Steve says YEAH.

Mario says EXACTLY.

Steve says SUSY HOTA, LET ME GET YOUR VIEW ON THIS AS AN INFECTIOUS DISEASE SPECIALIST. DO YOU SEE CHINA TAKING THE KINDS OF STEPS THAT YOU, AS A SPECIALIST IN THIS AREA, WOULD WANT THEM TO BE TAKING?

A picture shows two people walking along an otherwise deserted bridge in a city with huge apartment buildings.
Other pictures show health care workers in protective suits, and people wearing masks on the streets.

Susy says I THINK THEY'RE TRYING TO GO ABOVE AND BEYOND RIGHT NOW, YOU KNOW, IN TERMS OF THE TYPES OF QUARANTINE AND LOCK-DOWN MEASURES THAT HAVE BEEN PUT INTO PLACE, TRYING TO DO WHATEVER IS POSSIBLE TO CONTAIN IT AS MUCH AS POSSIBLE. I MEAN, WHETHER THAT'S GOING TO WORK, NOBODY REALLY KNOWS AT THIS POINT IN TIME. WE'RE WATCHING VERY CLOSELY. I DO THINK IT'S BEEN... YOU KNOW, I FEEL CONFIDENT THAT AT LEAST THERE'S A LOT OF COOPERATION BETWEEN CHINA AND THE W.H.O. AND THEY ARE REPORTING THINGS MUCH QUICKER THAN WHAT WE EXPERIENCED IN THE PAST WITH SARS, FOR EXAMPLE.

Steve says ALTHOUGH, XI JINPING WE'RE TOLD KNEW ABOUT THIS FOR A MATTER OF WEEKS BEFORE HE WENT PUBLIC WITH IT.

Susy says YES. IT SOUNDS CONCERNING FOR SURE. WE HAVE TO REALIZE THAT IN THE EARLY STAGES OF ANY KIND OF INFECTIOUS DISEASE THAT'S EMERGING, YOU WANT TO BE SURE OF WHAT'S GOING ON BEFORE YOU MENTION IT. SOMETIMES THERE ARE DELAYS IN GETTING INFORMATION, IN GETTING THE DATA TOGETHER. SO WE DO HAVE COULD BE CONSCIOUS OF THAT.

Steve says THERE HAVE BEEN SOME REALLY STRANGE-LOOKING PICTURES ON THE INTERNET ABOUT THIS ATTEMPT AT A QUARANTINE ANYWAY. WE WANT TO SHOW... CAN WE SHOW THIS NOW? DO YOU WANT TO ROLL THIS VIDEO HERE, SHELDON? THIS IS A VIDEO OF CHINESE PARAMEDICS WHO ARE ATTEMPTING TO ENFORCE THE QUARANTINE AND, YOU KNOW, SOME PEOPLE JUST DON'T WANT TO GO.

A clip plays in which people in white protective suits drag people wearing masks down a hallway.

Steve continues AND, YOU KNOW, IT'S OBVIOUSLY VERY INTENSE AND EMOTIONALLY DISTURBING TO THE FAMILY INVOLVED. BUT I DO WANT TO KNOW, LIKE, WHAT DO YOU MAKE OF THAT WHEN YOU SEE THAT?

Mario says WELL, YOU KNOW, WHAT I THINK ABOUT IS THE FACT THAT DURING SARS HERE, WE HAD 30,000 PEOPLE, OR CLOSE TO THAT, IN VOLUNTARY QUARANTINE. AND I THINK OUR ISSUE IS, WHAT CAN WE DO... LOOK. I HOPE THINGS DON'T GO SIDEWAYS HERE AND WE NEVER HAVE TO FACE ANY KIND OF A MAJOR ISSUE. BUT I THINK WE HAVE TO PREPARE OURSELVES TO MAKE SURE THAT THERE'S THE SAME LEVEL OF VOLUNTARY COMPLIANCE IN PLACE AS WE HAD DURING SARS. THAT MEANS MAKING SURE THAT EMPLOYERS ARE PREPARED FOR IT, YOU KNOW, A LOT OF PEOPLE TO WORK FROM HOME, A LOT OF PEOPLE TO BE COMPENSATED IF THEY HAVE TO BE QUARANTINED. I THINK WHATEVER IS GOING ON THERE, I THINK WE HAVE TO PREPARE OURSELVES TO MAKE SURE THAT WE'RE ABLE TO EFFECTIVELY IMPOSE QUARANTINE AND GET VOLUNTARY COMPLIANCE BECAUSE YOU DON'T WANT THAT. YOU WANT TO MAKE SURE THAT PEOPLE... LIKE TORONTONIANS DID IN 2003, VOLUNTARILY COMPLY.

Steve says I DON'T KNOW IF YOU SAW THE PICTURES OF PEOPLE COMING OFF AIRPLANES AND THERE ARE, YOU KNOW, THERE ARE PEOPLE IN HAZMAT SUITS WAITING FOR THEM AT THE BOTTOM. AS THEY'RE WALKING OFF THE PLANES, THEY ARE JUST BEING SPRAYED. I MEAN, THIS IS NOTHING THE LIKES OF WHICH WE'VE SEEN HERE EVER BEFORE. WHAT DO YOU THINK WHEN YOU SEE THIS STUFF?

Susy says YOU KNOW, SOME OF THOSE MEASURES ARE LIKELY NOT NECESSARY. I THINK THAT CAN BE QUITE, YOU KNOW, FRIGHTENING FOR PEOPLE WHO ARE GOING THROUGH IT. YOU KNOW, PEOPLE ARE TAKING A VERY AGGRESSIVE STANCE WITH THIS. I THINK IT'S SORT OF, LET'S SEE WHAT WE CAN DO TO CONTAIN IT AND STOP IT FROM BEING A PANDEMIC. THE SAD THING IS SOMETIMES THESE VIRUSES ARE A COUPLE OF STEPS AHEAD OF US. WE CAN TRY AND SEE WHAT WE'RE ABLE TO ACCOMPLISH WITH IT. BUT YOU DO HAVE TO MODERATE THAT WITH THE SENSE OF FEAR THAT IT INVOKES. I THINK THAT'S SOMETHING TO BE CONSCIOUS OF.

Steve says WHEN WE DO HEALTH ON THIS PROGRAM, WE OFTEN INVOKE ANDRE PICARD, BECAUSE HE'S JUST SIMPLY THE BEST IN THIS COUNTRY ABOUT WRITING ABOUT THIS, AND HE HAD THIS TO SAY IN THE GLOBE AND MAIL A WEEK AGO. CAN WE BRING THIS UP, PLEASE, SHELDON?

A quote appears on screen, under the title "The big one." The quote reads "In recent years, we've seen the emergence of SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), H1N1 pandemic influenza, Zika virus, West Nile virus, Ebola, Lassa fever, Nipah virus, Crimean-Congo hemorrhagic fever -not to mention the resurgence of some age-old killers such as yellow fever, dengue and malaria.
The pathogenic threats that have flared up around the world with growing frequency in recent years are all, in a sense, a trial run for the Big One, the so-called 'Disease X' that scientists and public-health officials dread- one that spreads more readily and is more deadly than anything we've seen before."
Quoted from André Picard, The Globe and Mail. February 10, 2020.

Steve says LET'S GET INTO THIS A LITTLE BIT HERE. SUSY, SARS HAS NOT COME BACK. AT LEAST SO FAR, RIGHT? WE HAD IT 17 YEARS AGO. IT HAS NOT COME BACK. HOW CONFIDENT ARE YOU ABOUT COVID-19 BEING HERE NOW, BUT THAT'S IT?

The caption changes to "Looking ahead: What's next?"

Susy says MM-HMM. I MEAN, I THINK WE... THERE ARE A COUPLE OF DIFFERENT POSSIBILITIES AS TO WHAT'S GOING TO HAPPEN AFTER WE PEAK FROM WHAT'S GOING ON HERE. IT CAN FIZZLE OUT AND DIE, LIKE SARS. I THINK THAT SEEMS LESS LIKELY GIVEN THE WAY THAT THIS IS BEHAVING. THE NUMBER OF PEOPLE THAT ARE NOT THAT SYMPTOMATIC THAT CAN TRANSMIT TO OTHERS BUT, YOU KNOW, SO THERE ARE A FEW FEATURES THAT ARE DIFFERENT FROM SARS THAT MAKE THAT UNLIKELY. WE MAY SEE A COUPLE OF WAVES AND DIE DOWN OR MORE LIKELY, IT SEEMS, IT WILL BECOME SOMETHING WE SEE SEASONALLY. BUT, YOU KNOW, COVID-19 IS NOT BEHAVING LIKE WHAT I THINK ANDRE PICARD IS REFERRING TO IN TERMS OF THIS DISEASE X. WHAT WE'RE REALLY AFRAID OF IS SOMETHING WITH VERY HIGH MORTALITY RATES THAT CAN ALSO GO FROM PERSON TO PERSON VERY RAPIDLY AND CAUSE A HUGE WAVE OF DISEASE THAT WILL, YOU KNOW, KILL A LOT OF PEOPLE. NOW, VIRUSES DON'T TEND TO LIKE THAT, THOUGH. IF THEY KILL THEIR HOST, THEN THEY KIND OF END THEIR CYCLE. SO, YOU KNOW, I THINK THAT'S ONE OF THE REASONS WHY WE'VE BEEN SEEING SOME OF THESE MILDER THINGS COME FORWARD AND CAUSE DISEASE BUT NOT TO THAT EXTENT LATELY.

Steve says WHEN THESE EPIDEMICS COME FORWARD, WHAT DO THEY DO TO OUR HEALTH CARE SYSTEM AND THE RESOURCES THAT WE HAVE RIGHT NOW AND PRESUMABLY NEED MORE OF IN ORDER TO HANDLE THIS?

Mario says WELL, I THINK ONE OF THE THINGS THAT HAPPENS IS THAT, YOU KNOW, PEOPLE FORGET. SO SARS WAS 17 YEARS AGO. YOU KNOW, PEOPLE FORGET, YOU KNOW, WHAT HAPPENED, AND HOW WE HAVE TO PREPARE FOR THE NEXT ONE. AND THERE'S A STUDY THAT WAS PUBLISHED ABOUT A YEAR AGO. IT SAID THAT PEOPLE LOSE THAT MEMORY WITHIN LESS THAN A GENERATION. I THINK, YOU KNOW, WHEN I SAW THE FORD GOVERNMENT BRINGING OUT THESE PUBLIC HEALTH CUTS, I SAW, YOU KNOW, THAT'S A LACK OF INSTITUTIONAL MEMORY ABOUT WHY WE NEED PUBLIC HEALTH, AND I'M... I'M GLAD AND RELIEVED THAT THOSE CUTS DIDN'T GO FORWARD AND I HOPE THAT THE GOVERNMENT DECIDES TO TAKE THEM OFF THE TABLE.

Steve says WE HAVE A MINUTE LEFT. I'LL ASK YOU ONE LAST THING, DR. HOTA, WHICH IS VACCINE. WHAT'S THE STORY ON THAT?

Susy says VACCINES ARE IN DEVELOPMENT. PEOPLE ARE WORKING ON CANDIDATE VACCINES. THE PROBLEM WITH A VACCINE IS IT TAKES SO LONG TO MAKE. YOU HAVE TO FIND A CONSTRUCT THAT LOOKS LIKE IT MIGHT ACTUALLY WORK IN THE LAB SETTING AND TEST IT ON ANIMALS AND TRYING TO FIND A GOOD ANIMAL MODEL TO ACTUALLY DECIDE THAT, IF IT'S SOMETHING EFFECTIVE AND SAFE, AND THEN TRIAL IT IN A NUMBER OF HUMAN BEINGS TO SEE IF, AGAIN, IT IS EFFECTIVE AND SAFE. FINALLY THERE HAS TO BE A PHARMACEUTICAL COMPANY THAT'S WILLING TO MARKET THIS AND MASS-PRODUCE IT AND BRING IT OUT TO THE FIELD IN A SHORT TIME. I THINK THERE ARE A NUMBER OF CHALLENGES AHEAD WITH THE VACCINE DEVELOPMENT, BUT CERTAINLY SOMETHING THAT WE'RE LOOKING TO SEE, YOU KNOW, AS A FUTURE INTERVENTION.

Steve says WHO KNOWS? BY THAT TIME, THE THING MAY BE GONE.

Susy says IT'S POSSIBLE.

The caption changes to "Producer: Sandra Gionas, @sandragionas."

Steve says IT'S POSSIBLE. OKAY. REALLY APPRECIATE THIS UPDATE FROM BOTH OF YOU. DR. SUSY HOTA AND MARIO POSSAMAI FROM THE SARS COMMISSION.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Both guests say THANK YOU.

Watch: Coronavirus Contagion