Letter from an Infectious Diseases Specialist Email #24
Dr. Andrew Morris is a Professor in the Department of Medicine, Division of Infectious Diseases, at the University of Toronto, and a consultant in Infectious Diseases and General Internal Medicine at Sinai Health System (SHS) and University Health Network (UHN). He has been sending weekly email since our quarantine started in response to the dozens of personal emails he got from his network. You can follow Andrew on Twitter at @ASPphysician. I am sharing this with you so you can be informed by the experts rather than Facebook groups so you can make a decision that is right for YOUR family.
I am a girls’ basketball coach who doubles as an infectious diseases physician, and this is my 24th weekly email since the COVID-19 pandemic emerged. I am writing this after my Sunday night basketball buddies were astute enough to recognize that the CBC posted a news item yesterday with me identified as Alexandre Brolo, a Professor of Chemistry at the University of Victoria. There are worse fates.
I am covering more on school (of course) and university, influenza season, testing, and treatment. I was going to cover safe sex, but something tells me that many of you aren’t emotionally prepared to discuss that this week.
Back to School: I have been absolutely bombarded with emails and calls by people asking me all sorts of stuff around back to school. Much of it has been covered in my prior two emails, but there is obviously more to unpackage. The most important message I have for you is—do what you think is right for your and your child’s own personal circumstance. I cannot make a decision for you, nor can anyone else. The Provincial government is unquestionably rushing through things that should have been addressed 2 months ago, and parent and Public Health advocacy has nudged them a bit. If it were up to me, school wouldn’t start till around late September, to give more time for preparation. Also, if it were up to me, there would be regular 1-week breaks (which is really 9 days outside of school) to dramatically reduce transmission cycles and we’d just have a much longer school year. But those are apparently off the table. There ARE a few things you should be asking in your upcoming webinars, Zoom townhalls, etc. with your kids’ schools, school boards, etc.
1. Do you feel you are as ready as you should be to open school on the announced date? Would you feel more prepared if you delayed it by 1 or more weeks?
2. What other changes are you planning in the next few weeks to improve your infection control practices?
3. Do you have a database to track child and staff absenteeism, reasons for being absent, and an ability to quickly identify patterns of absenteeism?
4. What happens to a class if a child leaves with symptoms of COVID, or is later found to have attended class while infected with COVID?
5. What are you doing to prevent staff-to-staff transmission (e.g. staff room or teacher eating areas)?
6. What is your policy on supply teachers? Do you have an adequate number of supply teachers, assuming that many teachers are likely to be absent for several days because of illness, suspected, illness, or even to take care of their own kids at home?
7. Do you have staff that move between schools? (recalling that this is what landed our nursing homes into the catastrophe it was)
8. When do kids get to be mask-free at school?
We are expecting a lot from teachers and schools these days—as we should—because kids should be a priority. I will remind everyone, again, that school is low risk at present because there is so little COVID circulating in Ontario. It is a mantra that we need to keep following. But as soon as those numbers start to rise—and we can expect them to—then the risk of attending school becomes more tied to the mitigation efforts being taken by the schools and public health. You want school to continue? Do your part to keep disease transmission down.
Final word on schools: most schools will likely have at least one kid get infected this school year. That is not a reason for panic, and reduced class sizes, masking for all, etc. will dramatically reduce the consequences. I am optimistic that schooling can be done reasonably safely, but schools and school boards need to be nimble, dedicated to ongoing improvement, and will definitely need to reevaluate things on an ongoing basis if and when community transmission rises.
Back to University: I wrote previously about this, and will just remind everyone—we don’t have the risk they have in the US (and multiple US schools were shut down this week because of pretty massive outbreaks, including University of North Carolina and Notre Dame), but our universities are no safer. I have one daughter going away to university soon and she knows about the risks. She is an adult, and will do her best to stay safe and, well, there is not more that I can say. What I will say: universities holding in-person classes should only do so if absolutely necessary (e.g. labs); and frats/sororities … this isn’t a practice exam.
Influenza: There has been lots of alarmist discussion popping up around influenza. Influenza is an important infectious disease, and I encourage everyone to get vaccinated annually. But it is not going to be a big problem this upcoming season. Or, let me rephrase that, if influenza is going to be a big problem, so will COVID, because the main tools that prevent influenza from spreading (hand hygiene, physical distancing, masking, avoiding prolonged close indoor socializing) are the main ones that prevent COVID from spreading. The only difference: we also have a vaccine for influenza—and I encourage you to get your flu vaccine annually. I will also point out something else: influenza and other respiratory viruses put regular strains on our healthcare system and attack vulnerable people, but people somehow ignore its importance. A positive change from COVID is we will see fewer people dying or getting very sick from these other viruses—and I am someone who does see that occurring.
What is new on the treatment front? Well, in the US they have been giving convalescent plasma (i.e. stuff from people who have recovered from COVID that contains the antibodies against COVID), and we learned … next to nothing. It appears relatively safe, but have close to zero idea if it is beneficial. Thankfully, you cannot get it in Canada outside of a clinical trial, and so if I were to get sick with COVID, I would definitely get myself enrolled in a clinical trial if at all possible. The second treatment is remdesivir (rehm-‘des-ih-veer). Yup, pharmaceutical companies now deliberately make their drug names impossible to pronounce. This has been discussed for a long time. A Chinese trial showed it didn’t really help. A much larger US trial was halted early, and preliminary data was released showing that it did seem to help. They still haven’t released their final data and then, on Friday, a new trial was released that shows that it doesn’t really help. My conclusion: if it does help (which is a big IF), it certainly ain’t a game-changer, and the best we have is to do our best to prevent disease transmission of COVID + dexamethasone.
COVID testing: I brought this up on Twitter this week, and expect it to receive more attention in the coming weeks (with at least 1 newspaper article focusing on it). We don’t have home testing or any point-of-care (POC) testing approved in Canada. Such tests are similar to home pregnancy tests or rapid strep throat tests performed in drug stores. It is still early days, but I expect POC testing to be available outside of Canada in the coming 1-2 months. Health Canada’s stance has been that this kind of testing is problematic, and they won’t even consider them. They believe that less-than-perfect information in the wrong hands can lead to big problems. This might be true. Or it might not. My greatest concern: as we return kids back to school and more and more people get into situations where they will congregate, our need for testing will grow substantially. It will rapidly exceed the 30-35K (thousand) tests that Ontario can process daily, and delays in testing will mean longer turn-around times for all positive tests. This is a massive issue: we have roughly 2M students in public schools in Ontario. In a bad influenza season, ~10-15% are absent on any one day. Even 2% new symptomatic kids each day (i.e. 40K kids needing a COVID test) would exceed our lab capacity without even testing a single adult. Public Health, school boards, etc. need a better game plan than just expecting that our COVID Assessment Centres will help us out of concerns with infection transmission.
I’m moving to Denmark: Not really. But I took this quiz (Which government most closely matches your political views?) and it told me that the Danish government’s values are the ones that most match mine. I was only partially surprised. Denmark has high taxation but has an enterprising, market-driven, happy society that regularly is one of the happiest countries in the world. Not surprisingly, in a population of just under 6M, they have had only ~600 deaths. If only we had just 3700 deaths, rather than the ~9000 that we had. We aren’t, won’t, and can’t be like Denmark, but maybe we should borrow more than pastry and cheese from them.
Which government most closely matches your political views?Take this quiz and find out
p.s. As always, feel free to share to whoever might benefit from the emails and/or follow me on Twitter (@ASPphysician).
League of Moms / 08/25/2020