Transcript: COVID-19 and Pandemics: What We Knew | Aug 28, 2020

Nam sits in the studio. She's in her early forties, with shoulder length curly brown hair. She's wearing glasses, a gray blazer over a pale blue blouse, and a golden pendant necklace.

A caption on screen reads "COVID-19 and pandemics: What we knew. Nam Kiwanuka, @namshine, @theagenda."

Nam says COVID-19 CAME OUT OF THE BLUE FOR MANY OF US BUT 20 YEARS AGO TVO'S PROGRAM STUDIO 2 TOOK NOTE OF HOW DEADLY DISEASES WERE START TO GO TRAVEL BEYOND OUR CUSTOMER MAYOR RYE BOUNDARIES. DR. KEVIN KAIN IS A PROFESSOR OF MEDICINE AT THE UNIVERSITY OF TORONTO AND CLINICIAN SCIENTIST AT UNIVERSITY HEALTH NETWORK AT TORONTO GENERAL HOSPITAL. HE SPOKE TO TVO THEN AND WE WELCOME HIM BACK IN THE PROVINCIAL CAPITAL TO FIND OUT MORE WHAT WHAT WE HAVE LEARNED LEARNED ASSISTANT...

Kevin is in his seventies, clean-shaven, with short white hair. He's wearing a printed white shirt.

Nam continues HIGH DOCTOR CAIN, GOOD TO TALK TO YOU. WE SPOKE TO YOU 20 YEARS AGO AND WE SPOKE TO YOU ABOUT A PANDEMIC, AND PRETTY MUCH THAT IT WAS GOING TO HIT FAST. WHAT CAN WENT THROUGH YOUR MIND WHEN THE WORLD STARTED TO SHUT DOWN OVER COVID-19?

The caption changes to "Kevin Kain. University of Toronto."

Kevin says WELL MANY THINGS WENT THROUGH MY MIND BUT I GUESS PERHAPS THE MOST SAD ENGINEER WAS THAT YOU KNOW WE'RE SUPPOSED TO LEARN FROM HISTORY BUT WE JUST SEEM TO KEEP REPEATING IT. I MEAN THIS IS LITERALLY ALMOST A PARALLEL VERSION OF WHAT HAPPENED TO TORONTO IN 2003 WITH THE FIRST SARS VIRUS, CORONAVIRUS 1. GENNIE MERGING IN A SIMILAR SCENARIO PREDICTABLE AND THEN BEING TRANSMITTED GLOBALLY WITH HUGE ENCARNACION MOM IQALUIT IMPACTS. THIS IS MORE CONTAGIOUS SO IT ADDS A WHOLE NEW CAN DIMENSION.

Nam says WHAT WOULD YOU SAY, I WAS JUST SHARING BEFORE WE TAPED THAT I HAD ANY LARRY WHY YEAH AND ENDED UP GETTING CEREBRAL MALARIA, AND I WAS GARY GANT THINKING THAI WOULD BE FINE. SO DO YOU THINK THERE'S PA PART OF US, MAYBE THAT'S WHY WE'RE FINDING OURSELVES IN THIS SITUATION, BECAUSE YOU SAY THAT THIS WAS PREDICTABLE?

The caption changes to "Kevin Kain. Toronto General Hospital."

Kevin says YEAH, I MEAN I THINK MANY PEOPLE ARE SHOWN THAT THERE'S THINGS WE DO TO PROMOTE AND NOT ONLY TO EMERGE BUT WE DISSEMINATE THEM QUICKLY WITH RAPID MOVEMENT OF PEOPLE AND GOODS, BUT THE FACT THAT WE'RE STILL DOING THE SAME THING THAT CAUSED THESE THINGS TO EMERGE, WE'RE STILL NOT REVERSING COUNTRIES IN TERMS OF MONITORING AND SURVEILLANCE PLANS, IT'S REALLY NOT DOING THE STEPS WE COULD HAVE AND SHOULD HAVE DONE NOT ONLY TO PREVENT THIS ONE BUT THERE WILL BE SUBSEQUENT ONES.

Nam says AND SPEAKING OF MALARIA, MUCH OF YOUR CAREER HAS BEEN SPENT STUDYING MALARIA, WE HAVE A CLIP OF YOU, ARE YOU READY FOR IT. IT'S FROM 20 YEARS AGO ON REQUEST REQUEST JULY 2ND, 20 YEARS AGO.

A clip plays on screen with the caption "March 2, 2000. Studio 2."

As fast clips show gloved hands operating a microscope, Kevin says
CANADIANS ARE SOME OF THE BEST-TRAVELLED POPULATIONS IN THE WORLD. IT'S ESTIMATED 3 TO 5 MILLION OF US TRAVEL INTERNATIONALLY EVERY YEAR WITH LARGE NUMBERS OF PEOPLE GOING TO AND THROUGH AREAS WHERE MALARIA IS NOW RAMPANT. WE HAVE HAD AT LEAST 7 PEOPLE DIE OF MALARIA IN ONTARIO AND QUEBEC IN THE LAST FEW YEARS.

A younger Kevin sits inside an office and says CANADA CAN BOAST ONE OF THE HIGHEST RATES OF IMPORTED MALARIA IN THE WORLD SO WE SHOULD BE VERY PROUD OF THAT STICK BUT OVER THE LAST FIVE YEARS WE HAVE AMELIE REPORTED SOMEWHERE BETWEEN 550 AND OVER A THOUSAND CASES OF MALARIA EACH AND EVERY YEAR.

The clip ends.

Nam says WHAT LESSONS HAVE YOU LEARNED STUDYING MALARIA THAT CAN BE APPLIED TO COVID-19.

Kevin says WE HAVE TAKEN A HOLISTIC APPROACH, IT'S A SERIOUS PROBLEM AND WE HAVE SPOKEN OF IT GLOBALLY. BUT MANY INFECTIONS INCLUDING COVID ARE IN SIMILAR WAYS. MANY GET INFECTED OWNED A FEW GET CRITICALLY ILL. IF WE CAN IDENTIFY THEM EARLY WE CAN ENSURE SURVIVAL AND OUTCOME. THE PROBLEM IS WE DON'T HAVE GOOD TOOLS DO DO THAT SO EVEN WITH COVID THE MAJORITY OF PEOPLE WILL HAVE SELF LIMITED UNCOMPLICATED DISEASE AND A SMALLER PROPORTION NEED TO BE IN HOSPITAL AND NEED TO BE SUPPORTED. AND ALL THESE ARE SETTINGS THAT ARE NOW GETTING THE BRUNT OF COVID, THEY HAVE NO GOOD TOOLS TO DO THAT, THEY HAVE LIMITED OXYGEN AND NOT MUCH IN THE WAY OF VENTILATORS SO THEY NEED TO KNOW WHEN THEY FIRST IDENTIFY SOMEONE ARE THEY GONNA BE COME CRITICALLY ILL, DO I NEED TO PUT THIS PERSON IN HOSPITAL, OR CAN I SAFELY SEND THAT PERSON HOME. THAT'S THE SAME PROBLEM WE FACE WITH ALL INFECTIONS. ABOUT A BILLON OR MORE PEOPLE GET A FEVER EVERY YEAR AND THE GREAT MAJORITY OF THOSE WILL RESPOND WITHOUT ANYTHING. UNCOMPLICATED SELF RESULT. MAYBE ONE OR TWO percent BECOME MORE SEVERE, SO WE NEED TOOLS TO FIND THAT 1 OR 2 percent AND WE NEED TO FOCUS OUR RESOURCES ON THOSE TO '78 PROVE OUTCOME. MALARIA IS THE SAME CASE. SO WHAT LAB HAS BEEN DOING IS TRY TO DEVELOP TOOLS THAT WILL ALLOW US RAPIDLY 5 MINUTES WITH AN INEXPENSIVE 1 dollar TEST TO ALLOW HEALTH CARE WORKERS EVERYWHERE IN THE WORLD, COVID MALARIA, SEPSIS, IDENTIFY THE CHILDREN AND ADULTS WHO NEED TO BE IN HOSPITAL AND SUPPORTED WHILE SAFELY SENDING OTHERS, THAT CAN BE MANAGED AT HOME, AND SAVE RESOURCES.

Nam says ARE YOU SAYING THAT THE TOOLS THAT WE NEED IS RAMMED TESTING?

Kevin says THE TOOLS WE NEED ARE RAPID TRIAGE TESTS, THE SAME WAY THAT YOUR HOSPITALS GET OVERWHELMED WITH COVID, LET'S USE COVID AS AN EXAMPLE. YOU WANT TO BE ABLE TO NOT MISS ANYONE WHO NEEDS TO BE ADMITTED, WHO MIGHT NEED TO BE IN ICU, WHO NIGHTS NEED TO BE ON AN EXTENSIVE THERAPEUTIC BUT YOU DON'T WANT TO OVER ADMIT PEOPLE AND OCCUPY YOUR BEDS, PARTICULARLY PEOPLE THAT WILL DO FINE, THEY CAN BE MANAGED MORE SAFELY AT HOME ISOLATION. SO THE SAME FOR OTHER INFECTIONS, WHETHER THAT'S MALARIA OR BACTERIAL INFECTION, MOST OF US WILL DO WELL. WE NEED BETTER TOOLS TO FIND THE PEOPLE THAT WON'T DO WELL SO THAT WE CAN FOCUS LIMITED HEALTH RESOURCES NOT ONLY IN RICH COUNTRIES BUT PARTICULARLY IN LOW-INCOME COUNTRIES TO MAXIMIZE BENEFITS, TO IMPROVE SURVIVAL BUT NOT WASTE THEM. IF WE OVER ADMIT 50 percent OF PEOPLE WE DON'T FOCUS OUR RESOURCES ON WHERE THEY WOULD DO BETTER.

Nam says IN 1904 WILLIAM OSLER WHO HAS BEEN DESCRIBED AS THE FATHER OF MODERN MEDICINE SAID "MY PATIENTS ARE NOT DYING FROMM THEIR INFECTIONS, THEY ARE DYING FROM THEIR REACTIONS TO THEM." HOW DOES WHAT HE SAID APPLY TO WHAT'S HAPPENING DURING THIS PANDEMIC?

Kevin says YEAH, IT GOES BACK TO WHAT I WAS SAYING, THAT ALL OF THESE VERY DIFFERENT INFECTIONS SHARE COMMON PATHWAYS AND THAT ACTUALLY LEADS TO DEATH. WE CAN IDENTIFY THOSE PATHWAYS EARLIER. THAT'S WHAT OSLER WAS DESCRIBION AS A REACTION.DESCRIBING AND THOSE PATHWAYS CAN BE IDENTIFIED IN A FINGER, A MARKER OF THEM CAN BE IDENTIFIED IN A FINGER PRICK BLOOD SAMPLE THAT CAN BE DETECTED BY INEXPENSIVE TESTS, WHAT THAT ALLOWS US TO DO IS RAPIDLY FIND THE PEOPLE, WHETHER IT'S COVID, SEPSIS MALARIA, DENGE OR WHATEVER THE INFECTION THAT ARE TRACK TO GO SOMETHING SEVERE, SO THAT MEANS THEY CAN BE REFERRED AND ADMITTED, AND ALSO IT SUGGESTS THAT WE CAN HAVE COMMON THERAPIES THAT WOULD BE USEFUL AGAINST A BROOD RANGE OF INFECTIONS THAT ARE SEVERE. SO THOSE REACTIONS THAT OSLER WAS REFERRING TO REALLY COME DOWN TO OUR IMMUNE SYSTEM. IT GETS OVER ACTIVATED AND DAMAGES OUR BLOOD VESSELS SO IF WE CAN IDENTIFY THOSE PROCESSES THAT ARE HAPPENING IN PEOPLE WHEN WE FIRST SEE THEM, WE CAN TREE AGE AGE THEM, WE CALL IT SAFE MANAGEMENT, TO ACCEPTED PEOPLE HOME AND THEY CAN BE MANAGED AT HOME ISOLATION IN THE CASE OF COVID.

Nam says UH-HUH.

Kevin says SO, ALSO, OSLER WAS ABSOLUTELY ON THE MONEY, YOU'LL SEE PAPERS NOW COMING OUT DESCRIBING HOW COVID HOST RESPONSE IS ACTUALLY A MAJOR DRIVER AND IN BAD OUTCOMES FOR COVID BUT THAT'S THE SAME A STORY WITH SEPSIS. SEPSIS REALLY IS YOUR OWN HOST RESPONSE IS WHAT HURTS YOU. NOT THE ORGANISMS SO MUCH. THE ORGANISM BECOMES SECONDARY, IT'S HOW YOU RESPOND TO IT AND REQUEST WE IDENTIFY THE PEOPLE WHO ARE NOT RESPONDING WELL AND THEN CAN WE INTERVENE IN THAT RESPONSE TO IMPROVE AN OUT COME. THAT'S REALLY A NEW PARADIGM OF THE WAY WE NEED TO TREAT SEVERE INFECTION. IRREGARDLESS OF IDEOLOGY.

Nam says WHEN YOU MENTIONED STARS BEFORE SARS BEFORE, I REMEMBER WHEN SARS HIT TORONTO, HOW WE WERE ALL ON GUARD. I ABSOLUTELY REMEMBER TRAVELING TO THE STATES AND PEOPLE SAYING AWAY FROM ME WHEN THEY FOUND OUT I WAS FROM TORONTO BUT NOT AS MANY PEOPLE WERE AFFECTED AS THERE HAVE BEEN WITH COVID-19. WHAT DID WE LEARN THEN THAT SHOULD HAVE HELPED US BUT MAYBE WE WEREN'T AS VIGILANT?

Kevin says I THINK WHAT WE LEARNED THEN IS THAT THE ORIGIN OF THIS THING IS DRIVEN BY HUMAN BEHAVIOUR, THE ORIGIN OF THESE TORONTO VIRUS ESSIEN TESTING HUMAN POPULATION, SIMILAR TO MOST EMERGING DISEASES, THEY ALL SHARE THEMES THAT MOST OF THESE AGENTS, THEE PATHOGENS ARE NATURALLY FOUND IN AN ANIMAL RESERVOIR, AND THEN THEY ARE GIVEN AN OPPORTUNITY TO JUMP TO HUMANS. WE CALL THAT A ZOONOSISZOOMOSIS, BASICALLY A BUG LEAKED FROM A BAT IN THIS CASE OFTEN TO AN INTIER MEDIA HOST INTO US. THE THING WE SEEM TO FORGET IS WE'RE THE ONES CREATING THAT PROBLEM. WE'RE THE ONES THAT BRING ANIMALS TOGETHER IN CLOSE QUARTERS FOR EXAMPLE IN THESE WET MARKETS THAT WOULD NEVER NORMALLY BE IN THE SAME SPACE TOGETHER. ALLOWING MICROBES TO JUMP INTO A HOST AND THEN WITH HUMANS ALL ABOUT INTO HUMANS. SO WE TEND TO DEMONIZE MIKE ROBES AND THINK THAT THEY ARE TERRIBLE BUT I THINK IF YOU LOOK AT EMERGING INFECTIONS THEY HAVE GOT HUMAN PHYSIOTHERAPISTS ALL OVER THEM. WE ARE THE MAJOR DRIVERS OF OUR OWN PROBLEMS AND WE NEED TO PUT OUR, YOU KNOW, OUR ANTI-INTO THE POTS IN TERMS OF THE RESPONSIBILITY FOR DRIVING THESE, IF WE CONTINUE TO ALTER ENVIRONMENTS, DO UNUSUAL ANIMAL HUSBANDRY WE'RE CREATING THESE PANDEMICS AND THESE PROBLEMS. SO WE NEED TO PUT OUR ACTIVITY IN THE PROBLEM BUT IN A SENSE.

Nam says WE'RE BEING TOLD THAT IN ORDER FOR LIFE TO GO BACK TO NORMAL THE ONLY WAY THAT CAN HAPPEN IS IF YOU DO GET A VACCINE. IS THAT THE WRONG WAY TO APPROACH THIS?

Kevin says I THINK IT'S REACTIVE. IT'S LIKE, YOU KNOW, IN... HUMANS, WE'RE REALLY, YOU KNOW, WE THINK WE'RE A VERY CLEVER PRIMATE BUT THERE'S NOT A LOT OF EVIDENCE TO SUPPORT THAT. WE KNOW THAT WE NEED TO PREVENT THINGS, WE KNOW THE STUFF WE CAN DO TO DO THAT BUT WE TEND TO WAIT UNTIL IT'S A HUGE PROBLEM AND TRY KIND OF REVERSES AT IT. SO MITIGATING THE EMERGENCE OF INFECTION, EARLY MONITORING AND OUR OTHER MAJOR PROBLEM IS ANY MICROBIAL RESISTANCE, CONTROLLING THE USE OF ANTIBIOTICS IN ANIMALS AND HUMANS, WE'RE A MAJOR DRIVER OF OUR OWN PROBLEMS AND WE NEED TO ADDRESS THAT THE FRONT AND FOREMOST TO PREVENT THESE THINGS FROM I IT MERGING A VAN DER AND SPREADING IN THE FIRST PLACE.

Nam says I KEEP THINKING, WHAT IF WE DON'T FEINSTEIN A VACCINE, WHAT THEN?

Kevin says THEN I GUESS WE'LL MOVE TOWARDS SOME SORT OF HERD IMMUNITY WHICH IS TO BE DEFINED. THERE'S SOME EVIDENCE THAT PEOPLE ARE GETTING CONSISTENT IMMUNITY FOLLOWING INFECTION, ALTHOUGH THAT'S DEBATABLE, BUT THIS IS NOT AN EFFICIENT CONTRACEPTIVE OR SIMPLE WAY TO MANAGE A PANDEMIC.

Nam says EVEN IF A VACCINE BECOMES AVAILABLE STUDIES ARE SHOWING THAT THERE ARE PEOPLE WHO ARE HESITANT TO GET IT AND OTHERS WHO REFUSE TO GET THE VACCINE BECAUSE THEY DON'T BELIEVE IN VACCINATIONS. HOW DO WE MANAGE THAT THEN?

Kevin says THAT IS A HUGE PROBLEM. AND I THINK, I DON'T CLAIM TVO IS THE SOLUTIONS BUT I THINK WE NEED TO DO A MUCH BETTER JOB OF SCIENCE, LITERACY, IN OUR EDUCATIONAL SYSTEM SO THAT PEOPLE UNDERSTAND THE RISKS AND BENEFITS OF THINGS THAT ARE DONE IN HEALTH CARE. NOTHING HAS HAD MORE OF A POSITIVE IMPACT ON HUMAN HEALTH THAN VACCINES, THEY ARE THE MOST COST-EFFECTIVE THING WE HAVE EVER DONE. SO HOW HAS THIS BEEN TURNED, TWISTED, INTO A DANGER, IS REALLY BEYOND ME. OUR IMMUNE SYSTEMS A ARE AMAZING, THEY ARE USED TO IN OUR EVOLUTION HANDLING THOUSANDS OF MICROBIAL INSULTS ALL THE TIME. WE LIVE IN A STERILE WORLD WHERE OUR IMMUNE SYSTEM, THEY NEED SOMETHING TO DO, THIS IS HOW WE EVOLVE, THIS IS HOW THEY PROTECT TUESDAY. SO GIVING A VACCINE IS SIMPLY GIVING AN OPPORTUNITY IN A SAFEWAY FOR YOUR BODY TO FEED CHOLERA, TYPHOID, MALARIA IN A WAY THEY RESPOND APPROPRIATELY AS OPPOSED TO DEATH. IRRATIONAL NOT TO SEE THE VALUE IN THAT. BUT OF COURSE THEY NEED TO BE DEVELOPED AND TESTED SAFELY. SO IT'S IRONIC, THE SAME TIME THAT WE BUILT VERY AMAZING SAFETY PROCESSES INTO VACCINE DEVELOPMENT THAT WE SEE RUSSIA GOING BY THEM WITHOUT SAFETY AND EFFICACY TRIALS. SO, AGAIN, THIS IS NOT THE WAY FORWARD. WE HAVE A GOOD WAY FORWARD.

Nam says A LOT OF RESOURCES RIGHT NOW ARE BEING SPENT ON TRYING TO I GUESS CONTAIN COVID-19 AND YOU HAVE BEEN STUDYING PANDEMICS FOR A VERY LONG TIME. DO YOU WORRY THAT RESOURCES ARE BEING TAKEN FROM STUDYING SOMETHING LIKE MALARIA AND T.B.?

Kevin says OH, ABSOLUTELY. I THINK THAT THERE WILL BE A BAD BACKDROP TO THIS WHERE PROGRAMMES IN AFRICA FOR MEASLES VACCINATION, MEASLES IS A MASSIVE KILLER, WE HAVE HAD HUGE OUTBREAKS AGAINST VACCINE, ANTI-VACCINE LOBBIES HAVE HAD CERTAINLY A... HAVE CONTRIBUTED TO THIS PROBLEM. MALARIA CONTROL PROBLEM. THINGS THAT ARE IMPORTANT BECAUSE THEY CAUSE DEALT AND ILLNESS IN MILLIONS OF PEOPLE ARE BEING PUSHED TO THE SIDE OR ARE BEING DISRUPTED SO NOT ONLY WILL YOU HAVE COVID ISSUES, WE'LL HAVE A NEGATIVE IMPACTS ON ALL OUR OTHER IMPORTANT HEALTH PROGRAMMES TO CONTROL OTHER GLOBALLY IMPORTANT DISEASES LIKE YOU THE BETTER QUEUE LOW HIS, AND MALARIA, AND IMPACTS OF THE WHOLE GENERATION ON THIS PLANET.

Nam says WE HAVE ANOTHER CLIP FROM YOUR 2000 PROGRAM ON PANDEMICS. LET'S TAKE A LOOK.

In another clip, Kevin says THE MOST DIFFERENCE BETWEEN THE PLAGUES THAT SWEPT EARLY HUMAN CIVILIZATION IS BECAUSE OF THE SPEED AND VOLUME AT WHICH PEOPLE AND GOODS MOVE NOW, WE'RE COMPRESSING TIME. A DISEASE THAT KILLED A SMALL CHILD IN A FOREIGN COUNTRY YESTERDAY CAN KILL YOURS TODAY AND BE A GLOBAL PANDEMIC TOMORROW.

The clip ends.

Nam says NOW THAT YOU'VE WATCHED THAT PROGRAM YOU WERE ON 20 YEARS AGO DO YOU... I KNOW YOU'RE A VERY KIND PERSON BUT DO YOU KIND OF FEEL LIKE SAYING "I TOLD YOU SO."

Kevin says NO.
[LAUGHTER]
THAT DOESN'T GET US ANYWHERE, I JUST WOULD LOVE TO SEE US BECOME COLLECTIVELY AS A SPECIES MORE PROACTIVE IN AREAS WHERE WE KNOW THE UP-FRONT COSTS WILL WAY BENEFIT THE DOWNSTREAM AND PREVENT HUGE COSTS AFTERWARDS. IN FACT IF THE WET MARKET FOR THIS SCENARIO HAD NOT BEEN ALLOWED TO CONTINUE AND THIS VIRUS HAD NOT BEEN ALLOWED TO GENERATE, SPREAD INTO AN INTIER MEDIA HOST AND THEN GO GLOBAL, THAT WE WOULD HAVE ALL THESE RESOURCES TO DO PROGRESSIVE WORK, RATHER THAN REINVENTING THE WHEEL. NOW WE CAN'T PUT THE GENIE BACK IN THE BOTTLE. I THINK WE JUST NEED TO LEARN AND, YOU KNOW, ALL THE CLICHES, HISTORY WILL REPEAT ITSELF IF WE DON'T LEARN. WE DON'T SEEM TO BE LEARNING AND I THINK THAT WE NEED TO REVISIT THAT REALLY COLLECTIVELY ONCE THIS THING IS CONTAINED. AND STOP THE NEXT PANDEMIC FROM AGAIN DERAILING THE PLANET'S ECONOMY AND ITS FUTURE, PARTICULARLY FOR THE NEXT GIGS GENERATION OF CHILDREN.

Nam says DOES COVID-19 WORRY YOU?

Kevin says YES. I THINK IT'S LIKE OTHER SEVERE INFECTIONS, THAT WE ALSO TEND TO IGNORE, PEOPLE MAY NOT KNOW BUT SEPSIS, COVID IS A SEPSIS SYNDROME SO IT'S A SYNDROME WHERE, WHETHER IT'S A BACTERIAL INFECTION WHICH IS WHAT WE'RE USED TO IN OUR ICU'S, CAN PRODUCE ORGAN FAILURE AND DEATH, LEADING CAUSE, IT CONSTITUTES, YOU KNOW, 41 MILLION CASES A YEAR AND 11 MILLION DEATHS, IT'S A MORE COMMON CAUSE OF DEATH THAN ALL OF THE CANCERS COMBINED YET YOU DON'T HEAR ABOUT IT. SO I THINK THIS NEEDS TO BE BROUGHT FOREFRONT, PARTICULARLY BECAUSE THE BURDEN OF THESE DEATHS IS IN YOUNG CHILDREN IN LOW AND MIDDLE-INCOME COUNTRIES WHICH, AGAIN, ARE THE FUTURE OF THIS PLANET, THE PEOPLE THAT ARE GONNA REALLY NEED THE SPECIFIC SCENARIOS THAT ARE NOW BEING DEALT OUT TO THEM.

Nam says WE HAVE BEEN HEARING SOMETHING CALLED, WELL MAYBE I'M MAKING THIS UP, PEOPLE BEING FATIGUED WITH ALL THE LOCKDOWN MEASURES THAT HAVE BEEN IN PLACE TO TRY TO CONTAIN THE SPREAD OF COVID-19. WOULD YOU SAY THAT THE FIRST WAVE IS OVER?

Kevin says HMM. UMM, IT DEPENDS WHERE YOU ARE. I'M NOT SURE IN THE UNITED STATES, AS HAS ALREADY BEEN STATED SEVERAL TIMES, THEY HAVE EVER FINISHED THEIR FIRST WAVE. I THINK EVERY PANDEMIC WE HAVE HAD FROM RECORDED HISTORY ALWAYS HAS A SECOND WAVE SO, YOU KNOW, IT CLEARLY MOTIVATES US TO ASSUME IT'S GOING TO HAPPEN AND BE PREPARED. I DON'T THINK THIS IS GONNA GO QUIETLY INTO THE NIGHT AND UNTIL WE HAVE AN EFFECTIVE VACCINE BUT WE DON'T KNOW. WE REALLY DON'T KNOW.

Nam says HOW WOULD YOU ASSESS CANADA'S RESPONSE TO COVID-19?

Kevin says UMM, I THINK AT MANY LEVELS WE DID A GOOD JOB, AT SOME WE DID NOT DO A GOOD JOB, OBVIOUSLY LONG-TERM CARE FACILITIES FOR EXAMPLE, WAS A MAJOR FAILURE. BUT I THINK IN OTHER WAYS THE PUBLIC RESPONDED APPROPRIATELY, THEY FOLLOWED ADVICE, ALTHOUGH IT CHANGED A LOT, IT WAS GEM LEON TARGET, AND I THINK THAT WE HAVE DONE WELL. COULD WE HAVE DONE BETTER, YES. BUT WE HAVE DONE WELL.

Nam says WHERE DO YOU THINK WE COULD HAVE DONE BETTER?

Kevin says WELL LONG-TERM CARE FOR SURE.

Nam says UH-HUH.

Kevin says AND EARLIER RESPONSES AND, YOU KNOW, DEALING MORE WITH IMPORTED CASES. BECAUSE CLEARLY A LOT OF THESE CAME FROM THE U.S. IN THE EARLY DAYS AND MITIGATING CASES THAT CONTINUE TO COME IN OR AT LEAST HAVING BETTER SYSTEMS TO DEFINE THEM AND OBSERVE THEM AND PREVENT THEM.

Nam says AND WHEN YOU LOOK AT WHAT'S HAPPENING AROUND THE WORLD GLOBALLY, WHAT ARE WE DOING RIGHT AND WHAT ARE WE DOING WRONG?

Kevin says WELL SADLY THE UNITED STATES HAS S DEMONSTRATING WHAT TO DO WRONG. I THINK MANY OTHER COUNTRIES HAVE DONE EXTREMELY WELL. AND ISLAND NATIONS, OBVIOUSLY, MAY HAVE HAD THE EASIEST JOB IN NEW ZEALAND AND AUSTRALIA IN RESTRAINING BUT QUICKLY KIT REAPPEAR. ONE OF THE MAJOR GAPS AND WE HAVE JUST BEEN FUND TODD DO THIS. ASKING THE QUESTION "WHAT DOES COVID DO TO PREGNANT WOMEN" AND WHAT IMPACT COULD IT HAVE ON MAKING A BIRTH OUTCOME UNTOWARD BUT NEURODEVELOPMENT AND OUTCOME OF THOSE CHILDREN EXPOSED IN VITRO IN THE WOMB. WE'RE LEARNING A LOT IN SCIENCE AND MEDICINE RECENTLY AND THAT SEEMS TO BE ONE OF THE MOST IMPORTANT AREAS WHERE A GRAM OF PREVENTION, PREVENTING INFECTIONS IN PREGNANT WOMEN CAN MITIGATE ALL SORTS OF LIFELONG PROBLEMS.

Nam says OKAY.

Kevin says AND I THINK ON...

Nam says FOR EXAMPLE?

Kevin says I'LL GIVE YOU A NORTH AMERICAN PROBLEM AND I'LL GIVE YOU AN AFTERNOON PROBLEM. SO WE FINISHED A STUDY LOOKING AT MALARIA IN PREGNANCY. 125 MILLION PREGNANT WOMEN ARE AT RISK OF MALARIA EVERY YEAR, EVEN IF THEY GET MALARIA AND IT'S QUICKLY TREATED IT'S ALTERED NEURODEVELOPMENT IN CHILDREN AND THAT PROBABLY WILL PERSIST FOR THEIR LIFE. IN NORTH AMERICA, FLEW IS A COMMON INFECTION, WE HAVE A VACCINE FOR IT, THE CENTRE FOR DISEASE CONTROL DID AN ELEGANT STUDY DECADES AGO THAT LOOKED AT DOES FLEW REALLY MAKE PREGNANCY OUTCOMES WORSE AND IT DIDN'T. BUT THEY REENROLLED THOSE CHILDREN 20 YEARS LATER AND THE RISK OF BIPOLAR DISORDER WENT UP FOUR TIMES. INFLUENZA DOES NOT CAUSE BIPOLAR DISORDER BUT OUR CURRENT UNDERSTANDING OF MANY NEUROPSYCHIATRIC DISORDERS, AUTISM, BIPOLAR, MAJOR DEPRESSION, SCHIZOPHRENIA, IS THAT WE HAVE GENETIC SUS ACCEPTABILITY BUT IT DOESN'T USUALLY MANIFEST, IT NEEDS A SECOND HIT. THE SECOND HIT CAN BE AN INFECTION IN A PREGNANT WOMAN BECAUSE IT ALTERS NEURODEVELOPMENT IN THAT CHILD AND MAKES THOSE DISEASES MORE LIKELY TO MANIFEST. SO THINK ABOUT THAT. A SIMPLE PREVENTION IN PREGNANCY FOR FLEW PREVENTING DECADES OF NEUROPSYCHIATRIC ILLNESS THAT COSTS NOT ONLY HUGE IMPACTS ON FAMILY AND COMMUNITIES BUT HEALTH CARE DOLLARS. THAT IS IN PART PREVENTABLE.

The caption changes to "Producer: Liane Kotler, @LianeKotler."

Nam says A LOT OF RIPPLE AFFECTS DOCTOR CAIN, I KNOW YOU'RE VERY BUSY AND WE APPRECIATE YOU MAKING TIME FOR US, THANK YOU VERY MUCH FOR YOUR INSIGHTS THIS EVENING.

Kevin says MY PLEASURE, THANK YOU.

Watch: COVID-19 and Pandemics: What We Knew