#80 COVID Decoded: Science and Society in the New Normal

Ekaterina An [0:00] Hello listeners and welcome to season five of Raw Talk. So the last six months have been a bit surreal as the world grappled with the COVID-19 pandemic. And we just wanted to say, we hope that you're all doing well. Stay safe and take time for yourself. Like many of you, we've been trying to keep up with the rapid pace of COVID-19 discovery and the evolving public health situation since March. And, as we adapt to the new normal, it's clear that the current pandemic has far-reaching effects on health, research, society, and even our planet. So over eight weeks this summer, we hosted COVID decoded, a series of live stream discussions all about COVID-19. We spoke with neurologists and epidemiologists, experts in public health, mental health, climate change and health equity, scientists at the forefront of developing COVID-19 tests and leaders of the COVID-19 Immunity Task Force. We learned so much from this series and wanted to kick off our new season by bringing you the highlights of the discussions and our reflections and lessons learned. Before we begin, we wish to acknowledge the slant on which the University of Toronto and our podcasts operates. For thousands of years, it has been the traditional Land of the Huron Wendat, the Seneca and most recently, the Mississaugas of the Credit River. Today, this meeting place is still the home to many Indigenous people from across Turtle Island, and we are grateful to have the opportunity to work on this land. Today's episode will feature all of the COVID decoded hosts, the reflections on the series and highlights from the livestream discussions. My name is Kat, and I will be your host of hosts. Now, one last thing before we jump into today's discussion. To celebrate almost half a decade of Raw Talk, we are hosting a 'Friendraiser' and need your help to spread the word. If you like what you hear, share the show with a friend and you will receive your very own Raw Talk podcast sticker in the mail. Check out the link in our show notes to participate. Well alright, let's get into it.

Yagnesh Ladumor [2:00] Hi, I'm Yagnesh. I did Coronaviruses 101.

Ekaterina An [2:04] Next we've got Jesse, who's joining us remotely today.

Jesse Knight [2:07] Hello, I'm Jesse. I hosted the Mathematical Modeling and Epidemiology episode, and also episode on intersections with climate change.

Ekaterina An [2:14] And Eryn?

Eryn Tong [2:15] Hi everyone. This is Eryn, and I hosted the Psychological Impacts episode, and also the Health Equity Lens episode.

Ekaterina An [2:20] Next up, we've got Nathan.

Nathan Chan [2:22] Hi, I'm Nathan, I hosted Public Health Policy.

Ekaterina An [2:25] And, grace.

Grace Jacobs [2:25] Hi everyone. This is Grace, I hosted our episode on immunity.

Ekaterina An [2:28] And our final hosts Thamiya is not able to join us today, but she hosted the discussion on COVID-19 testing. Now we'll be pulling some clips from our live stream audio, but if you'd like to hear the full discussion, all of the links are available in our show notes. So I guess a good place to start is way back in March when everything first went into lockdown. We had been hearing about this novel coronavirus for weeks at that point. But, it felt like everything just happened very suddenly. One day we were going into the lab and then the next everyone was being told to stay home, businesses were closing down, hospitals were preparing for this huge wave of cases. Do you remember how you were all feeling around the start of the pandemic? Nathan, let's start with you.

Nathan Chan [3:08] Sure. Uh, I know you mentioned March but I'm going to actually scroll back a bit to late December early January. I was on Raw Talk Podcast, and we were doing the uh, prep for the episode on pandemics. So you know this was this had come up, right in January, we had been talking to a whole bunch of public health experts, and then towards the end of January, we couldn't even find public health experts to talk to, because it was just so difficult to find someone who could talk on, about this new COVID-19, at the time we didn't even know it was called COVID-19. We called it the novel Coronavirus. So, come around March, how did I feel about this pandemic? You know, I haven't heard my discussion, having seen the lockdown in Wuhan and you know, chatting with the people on pandemics on the pandemics episode, I was kind of seeing this as like, well about time, you know, this, this was gonna happen. I will say that like I was more concerned about not myself personally, because I'd been kind of like keeping track of this from the pandemics episode, but rather actually I was more concerned about people around me.

Ekaterina An [4:08] And Grace, what about you?

Grace Jacobs [4:09] I think in general, we were all feeling a lot of uncertainty. And uh, just generally like worry about the situation because we were being, kind of kicked out of our labs, and some of us are unable to do our research. Some of us at least were having our research disrupted in terms of, kind of our everyday that we were used to.

Ekaterina An [4:27] Yeah, that's a really excellent point. Since most of us on the team are graduate students, the pandemic has also had an impact on our research. And in our final stream with Dr. David Naylor, who's the co chair of Canada's COVID-19 Immunity Task Force, he made a really excellent point about the impact of the pandemic on research trainees and young investigators specifically.

Dr. David Naylor [4:49] The biggest worry is, to me not so much collaboration, but, you know, we put a whole bunch of young people on ice because we've suspended some of our usual activities, labs were closed for a long time, young investigators who weren't in this field would be struggling to make their way. Some o-, some senior investigators, younger investigators pivoted and capitalized on COVID funding. But the response capacity we have in science in Canada was built over decades. And we can't have this event. And, you know, being a situation where we don't continue building that capacity across the board. And to me that, you know, one of the big lessons of this terrible epidemic is Canada needs strong science capacity, it has to build the next generation, it has to sustain the current generation of scientists that can't be focused only narrowly, some of the people are doing the best work pivoted from other areas. So that to me is is the bigger long term concern, collaboration right now is brilliant. But let's make sure we build capacity at home to continue to do our fair share in the years ahead.

Ekaterina An [5:55] So was your research impacted by the pandemic? And how are you coping with that? Yagnesh, maybe you can start us off.

Yagnesh Ladumor [6:02] Sure. So I work in a wet lab in uh, I work with cells, so I have to go in on weekends, on random times to go and replenish the media, which means to feed the cells basically. So, what I ended up having to do, since we had locked down for three months was I just had to freeze them all. So uh, you freeze them all at minus 80. And they, you can re-thaw them, but this is not a very efficient process. You lose a lot of cells, and I was working on making a specialized gene engineered cell line. And right after I had isolated it, I had to put it on ice, pretty much. So, my project was in ice for three months, and I think I was coping with it, okay, like my PI is very uh, nice and supportive. So I didn't have that pressure. But outside of that, it is quite jarring to be honest. Like, I can't work on my, something that I've dedicated so much time to. And that's affecting, like how fast I can graduate. So let's, I'd say I'm doing okay, overall, but could be better.

Jesse Knight [7:10] You know, I actually was kind of fortunate in that um, you know, my research to get put on hold and in, in a way. But, I was actually able to do a little bit of research on COVID, um, because my lab does mathematical modeling research. So I was looking into the serial interval of COVID and the generation time, which is basically the, the average amount of time between subsequent infections. And so I was able to kind of feel like I was contributing to the solution, in a way working on some of that stuff. But, on the other hand, we had a lot of conversations with our lab, as we were pivoting towards COVID research a little bit, you know, how much can we really put on hold all those other commitments that we made to, to other grants and, and community members that we were working with for that previous research and um, making sure that we really weighed the pros and cons of, you know, how we're spending our time.

Ekaterina An [7:57] Sounds like everyone's had to go through a lot of changes and adjustments, whether it's putting your research on hold, or, you know, kind of pivoting, what you're studying. And I know, as a podcast, one of the biggest changes that we had to make was our annual live event. So we were in the midst of planning, you know, a 200-person live podcasting event on climate change and health around the time that the pandemic was declared. So obviously, we had to make some changes. And after much discussion, we landed on the topic and format of what is now the COVID Decoded series. And honestly, I think when we decided to do livestream discussions with experts on the subject of COVID-19, I don't think any of us really understood what we were getting into. And as a podcast, we're definitely very used to relying on our editors to make us all sound good. But with a live stream that really wasn't an option. So in terms of hosting, what were some of the biggest challenges with moving to the livestream format. And Eryn, as one of the co-organizers of this event, maybe you can tell us a little bit about that.

Eryn Tong [8:57] You know, as a host, I think a lot of us had plenty of experience being a host on a regular season. But again, I think like Kat mentioned, we always have the safety blanket of our audio engineers to, you know, cut out inconcise language to cut out filler words and we really didn't have that option. And I think that also added a bit of anxiety to hosting the livestream, because we don't have that safety blanket and also that it's going to be recorded permanently on YouTube, which was an added layer of anxiety. And then in terms of the actual day of, I think learning how to juggle everything while live was a big adjustment. Learning how to handle all the logistical challenges offline with the team, while still being engaged in the discussion with the guests, was definitely something that I learned to do.

Ekaterina An [9:45] Yagnesh, you were our first livestream host. Any comments on that experience?

Yagnesh Ladumor [9:49] I really enjoyed it. But before then, uh we had like two weeks I know, me and you were sitting in that small room along with uh, Alex trying to figure out like every little detail, try to put up the our poster up behind to make it look like a new show. Yeah, it was, it was kind of fun and uh, very nerve-racking at that point. So yeah, once I got started and got over the jitters, it was just like a normal podcast interview.

Jesse Knight [10:16] Yeah, it was all, it was all very stressful, but at the end of the day, I think people understand these days that technology, you're limited by it. But on the other hand, we appreciate the fact that we can even have these kind of opportunities because of technology in the first place. So-

Grace Jacobs [10:32] Also a shout out to, especially on the technical side of things, Alex, but also Richie and Nathan and other members of our team who, every day that we were recording, as well as a lot of time on top of that, were kind of in our like makeshift studio, troubleshooting, making sure everything went smoothly, all the different components that were involved in making the livestream, still kind of professional and look as good as it did.

Ekaterina An [10:56] Yeah, thanks for that Grace, definitely could not have done it without our team. And, you know, despite all of those difficulties, I think that our team really came through and put together a great series of discussions. I definitely learned a lot from each livestream and it really helped me wrap my mind around the research on COVID and the wider impact of the pandemic. Actually, our very first stream with Dr. Karen Mossman, virologist and vice president of research at McMaster University was super informative in terms of understanding what the SARS-coV-2 virus was, and how it was different from the original SARS virus back in 2003.

Dr. Karen Mossman [11:28] The two viruses are I think, at the protein level about 95% similar. So we're not surprised that SARS-2 uses the same receptors as the original SARS, but that it can't be as simple as that because, you know, the the symptoms and the ability to transmit are very different. You know, the original SARS was more of a lower respiratory tract infection, not an upper, the original SARS didn't transmit as efficiently. But it did have a higher mortality rate. Whereas when you have predominantly an upper and nasal sort of infection, that's partially what really lends itself to that transmission. Because any cough, any sneeze, runny nose, um, saliva, I mean it when you have a really upper respiratory tract and nasal type of infection, transmission is much more robust than if it's a really deep lower respiratory tract infections. And another subtle difference with this virus is and again, it could be due to those, you know, its 5% changes, but 5% is still you know, quite a bit at the protein level, you know, the ability to have the infections that are the asymptomatic infections. There were very few asymptomatic infections that we understood with the original SARS, if you really develop that lower respiratory tract infection, you know, and almost everyone that has symptoms was positive. You know, now we know there's a lot of asymptomatic carriers, and that enabled spread. And I think that's really why, you know, we're seeing we're seeing such robust spread. If you don't know you have it, it's hard, it's easier to quarantine and to protect yourself, if you know you're infected. If you don't know you're infected, it's so much easier to spread the virus.

Ekaterina An [13:24] So Yagnesh, you hosted the conversation with Dr. Mossman. Can you tell us more about what you learned about asymptomatic transmission.

Yagnesh Ladumor [13:31] So with the lower respiratory versus upper respiratory, I think that's a good point that she brought up because in one of the first large seroprevalence studies that came out of Spain, in early July, I'd say the majority of the Spanish population was tested as seronegative, the SARS-CoV-2 infections and even in hotspot areas, the infection rates aren't very high. And most PCR confirmed cases actually do have detectable antibodies. But a substantial portion of the people that did show symptoms, did not have PCR tests, and at least a third of the infections that were determined through serology were asymptomatic, which is huge. 33% of the population that had it didn't show any symptoms. And as Dr. Mossman mentioned, it's huge in how this virus transmits. So I think that's a very good point.

Ekaterina An [14:27] Speaking of testing, our sixth episode was focused on COVID-19 testing, and in particular, our guests Dr. Adeli, head of clinical biochemistry at SickKids, and Mary Kathryn Bohn, one of his graduate students, clarified the difference between the two types of tests that can be done. First, there are viral PCR tests, which assess whether you have an active infection. And then there's also antibody testing, which can detect the presence of antibodies against SARS-CoV-2.

Mary Kathryn Bohn [14:54] So I think the most commonly used test right now, is of course the PCR test, the molecular test for the viral RNA to detect current infection. So that would be for example, if someone was presenting with some clinical symptoms that were similar to COVID, and presented to an emergency department or a hospital, they could get tested in order to see if they were actively infected. On the other hand, you could also use this for screening. So for individuals who are about to have surgery, or about to enter perhaps a long-term care facility, you can determine if there is an active infection there.

Ekaterina An [15:26] So the test that Mary Kathryn is referring to in this clip is the one that's done using the nasopharyngeal swab. Just out of curiosity, has anyone here gotten tested?

Grace Jacobs [15:35] I haven't actually gotten tested. But everyone I talked to who has says, it's really uncomfortable, but it doesn't hurt.

Nathan Chan [15:40] Okay, I'm gonna have to beg to differ. So I had the misfortune of having to go and visit an ER about two weeks ago. And in visiting an ER, they make everybody get a COVID test. And uh, painful is one word, I would maybe use to describe it? It's, it felt like somebody was taking a pick into my brain. Um, which was not nice. I mean, like, I, if frankly, like, if I wanted to get tested, like I would get tested again. But like, I would rather just not get infected in the first place. Because it was not a pleasant experience.

Yagnesh Ladumor [16:12] The closest analogy I'd say is like someone trying to pull your brain out through your nose. It's not fun, but...

Ekaterina An [16:18] And that's not painful?

Yagnesh Ladumor [16:19] Actually not painful. Like it was just uncomfortable. You know, like someone doing it with surgical precision,

Nathan Chan [16:25] Okay, but like, there are parts of my head and face that I did not know existed, until I got my COVID test.

Ekaterina An [16:32] Good to know. So if any of you who haven't gotten the test, there you have it. So the second type of test that we discussed was the antibody test, which is not being done widely yet. But I'll let Mary Kathryn explain.

Mary Kathryn Bohn [16:46] The tests that are currently available at Health Canada, they're not testing for whether these antibodies can be used to combat the virus, just that you have them. If you're antibody positive, that doesn't necessarily mean that your um, viral tests may be negative. So you can be positive for both tests and therefore, if you detect antibodies, it doesn't necessarily mean that you're totally past the infection. They tell you nothing about the immunity status. So that would require more specialized tests, which what we would call a neutralization assay, and those tests aren't really broadly available right now. So just because you have or let's say you test positive for these antibodies doesn't mean that you are immune to prior or previous infection.

Ekaterina An [17:25] So there's a lot we still don't know about antibody testing and immunity for the COVID-19 virus. But Mary Kathryn made it clear that continuing testing should be a key part of our public health strategy moving forward.

Mary Kathryn Bohn [17:36] I think the consensus among laboratory professionals has been test, test, test. Test as much as possible, especially for molecular testing, not only in people who present with symptoms, but also as we alluded to earlier, for screening purposes, when you know, someone may be undergoing surgery where there's a risk of aerosolization or if they're going in to an area with more at-risk populations. So I think the availability of testing and particularly molecular testing has been really key in guiding public health decisions in terms of exposure, um, in many different populations. I think antibody testing hasn't yet got there in terms of its use in public health, but I think in the next few months, we'll definitely see these serological assays playing a much greater role.

Ekaterina An [18:22] A current key role of antibody tests has been in the large scale seroprevalence studies that are led by Canada's COVID-19 Immunity Task Force co-chaired by Dr. David Naylor. Dr. Naylor was a guest in our last episode focused on immunity and Canada. Grace, as the host of this livestream, did anything stand out to you about the results of these studies?

Grace Jacobs [18:41] In our discussion, Dr. Naylor shared findings that over 20,000 Canadians have been tested so far, using sources like Canadian Blood Services, and Héma-Quebec, and that the general prevalence in the population seems to be around 1%. So this is about three times higher than the rates we're currently finding using tests for active infections. And for context, in the study that Yagnesh mentioned earlier, the prevalence in Spain has been found to be around 5%. So this low prevalence really highlights the high susceptibility to the virus that Canadians still have, and the need for continued precautions to prevent outbreaks.

Yagnesh Ladumor [19:12] The same things have also been seen in pets. So there was a study of about 700 Italian pets. And they found that about 3 to 4% of the pets actually had antibodies to the COVID virus so it mirrors very similarly to humans. What's not known though, currently is whether they can infect humans again.

Ekaterina An [19:35] It sounds like research on the SARS-CoV-2 virus and the development of these tests has been moving quite rapidly. And it's been cool to see how quickly scientists can pivot from their typical research to study the new coronavirus, and to establish collaborations globally to do that. But we've seen this type of enthusiastic response to pandemics and epidemics before. In our final livestream with Dr. David Naylor, he called for continued investment in immunology research and public health.

Dr. David Naylor [20:00] We need to invest in virology, we need to keep investing in immunology, we need to keep the science substrate going. And I do worry that we, we get focused on virology after every fresh outbreak or epidemic of any proportion, just as we get focused on public health for a year or two. And then this kind of thinking goes into advance, there will be more zoonoses, there will be more outbreaks. They may come faster with global warming and the crowding of the planet. And I think we need to be on alert for more of the same and the years ahead, and that's simply an imperative in terms of the science and the public health investments need to be made in the future.

Grace Jacobs [20:41] Dr. David Naylor has been a huge advocate for science research and funding in Canada. You can hear more about that and from him on Episode 65: Investing in Knowledge, the Life Cycle of Research, as well as Episode 66: Investing in Tomorrow, Why are you Voting Science.

Ekaterina An [20:55] And this idea of continued investment and planning, essential in our ability to respond to future waves of COVID-19, or other future pandemics, was echoed by Dr. Vivek Goel, member of the Governing Council for CanCOVID, the National Research platform for COVID-19 research, in our fourth installment of the COVID Decoded series.

Dr. Vivek Goel [21:13] So first of all, I think we need to be honest with the population about the vaccine. And I agree with you, it's one to two years, uh not operation warp speed, and not by December like Donald Trump is promising. Um, and then we as he also said, we have to be honest that it will take several more years to roll out a global campaign, because it's not just a you know, we will have to prioritize in Canada, but we'll have to prioritize around the world. And you know, we're going to be looking at getting at least 5 billion doses to people around the world to get to levels of herd immunity. We also don't know if the vaccine will need to, we'll have to do it annually, like flu or so on. So I think we have to be honest with people about how long it's going to take, and what that's going to look like. And I think we also have to be ready for a Fall wave and for continued sporadic outbreaks. We can't just keep saying, we're gonna have to go back into another lockdown. If we can't manage it, we have to be ready. And we know a lot more than we did back in March. We know about which kinds of communities the outbreaks were in, which kinds of work settings, let's make sure that they're prepared, so we don't have outbreaks in meatpacking plants, and long term care facilities, um, homeless shelters, agriculture workers. Like we know the settings in which we've had the outbreaks and so we should really be focusing on those. We know the people that are most likely to get hospitalized and die. And so we need to make sure we have the supports for those. But we also know that there's a lot of people who are much lower risk.

Ekaterina An [22:51] So what do you all think about the idea of preparing for a pandemic? Nathan, let's start with you.

Nathan Chan [22:57] You know, after especially 2003, the IHR 2005, those are the International Health Regulations, they were created in the aftermath of the 2003 SARS pandemic. And then since then, we also have at least in Ontario Public Health, Ontario Toronto Public Health, all these coordinating public health agencies that were also created as an aftermath of the IHR. And so I think we can prepare for a pandemic. I think it's difficult, though, to prepare for the most severe event possible. Like this is a, an example of a situation or a tail risk that is very, very, very large and long, and difficult to deal with and hard to quantify. And so you know, we ca- I think we can prepare for pandemics to an extent. We can prepare for them by like, doing what the IHR prescribe, monitoring your populations for, you know, abnormal symptoms and the spread of contagious infections. But it could be harder, I guess, to prepare for the most severe outcome, when, you know, it just never happens.

Grace Jacobs [24:01] I think where you're kind of getting at too is there's kind of like a cost-benefit analysis there too. Of course, it's really incredibly important to prepare for pandemics but like, how many resources we put into that and how extensive that preparation is, would obviously be an upfront cost. And kind of finding the balance there with like how much it would benefit us when we do actually have a pandemic.

Yagnesh Ladumor [24:22] I will say in contrast to what Nathan said and a little bit to what you said, as well Grace, that we've known about coronaviruses and bats since the first outbreak. So while things have been moving, and it's hard to take like a holistic approach to a, like once-in-a-century event like uh, how this pandemic has been spreading, I will say, we do need to continue support for basic research into these topics, so we can be better prepared at just the basic general knowledge level of uh, in some of these cases, so I think we could definitely do a lot better as well.

Jesse Knight [25:05] Yeah, just want to echo those points both, actually, because I do think the public health response has been pretty successful, like we've known what to do. And then it's just a matter of implementation and one hand, but then I think one of the things we hadn't really considered is, what are the downstream implications of those kind of more hardline measures and, and the you know, public health kind of had an idea of what needs to get done, but you know, the economic suffering and what that means for people in their day-to-day lives on a, on a really long timescale, like we're looking at right now, I don't know if those kind of conversations had been happening in those spheres.

Yagnesh Ladumor [25:38] I think you can definitely learn things from the first wave, as we've heard and plan for it, we know where most of the outbreaks are likely to occur. And we know ways to stop it.

Eryn Tong [25:51] But even within Canada, and I think Dr. Goel alluded to this, there are communities that are at greater risk, and that have potentially fewer resources, and so that we can very well plan for in advance and that is very much a public health concern, and also one that we need to take very seriously.

Ekaterina An [26:08] Those are all excellent considerations. And just jumping off Eryn your last point, we've heard repeatedly that the COVID-19 pandemic has been shining a light on the inequities in our institutions. And across all of our discussions, our guests commented on the disproportionate impact of the virus on marginalized and racialized groups in particular. In our seventh episode, Eryn approached the pandemic through the lens of health equity to try and unpack some of these systemic underlying issues. Dr. Ceinwen Pope, a guest on this episode and medical resident in the University of Toronto's Public Health and Preventive Medicine program summarized this idea perfectly.

Dr. Ceinwen Pope [26:42] There are these underlying health inequities, meaning there are differences in health outcomes between different groups of people that are unfair and systemic in nature. And so by breaking it down that way, different levels of exposure, different levels of susceptibility and severe disease, and different levels of the way you're treated after the disease, you can see very clearly how all of these systems of inequality that are underlying our society are contributing to exacerbation of COVID-19, and why they're being concentrated in these groups.

Ekaterina An [27:21] So Eryn, you hosted this stream. What did you take away from your conversation?

Eryn Tong [27:25] So I think we had an incredibly long and fruitful discussion with Dr. Pope that we just heard from, as well as Dr. Roberta Timothy. And I think the main thing that was just very clear is that, you know, inequities and systemic racism are so deeply rooted within our colonial societal structures and they impact the health outcomes of black, indigenous racialized, marginalized communities within our entire history up to present day. We also discussed in the episode this term of "syndemics", which is the idea that there's essentially two pandemics that are happening parallel. One is of COVID, of course, and the parallel pandemic is of inequality. And I think that that really resonated and stuck with me.

Ekaterina An [28:09] Echoing the point Dr. Pope made about how different levels of exposure and susceptibility can affect health outcomes. Dr. Jeff Kwong, program leader of the Populations and Public Health program at ICES, expanded on this in Episode Four.

Dr. Jeff Kwong [28:22] I think it boils down to two factors. I think it boils down to workplaces and housing, you know, think of where do we spend most of our time either at work or at home. And so I think it's not as much about, you know, visible minority groups and immigrants as much as where people are working and where people are living, and that these workplaces may be unsafe for them. So if you're able to work from home, then that's, you know, a much safer environment. But if you have to go out to work, and you're potentially exposed to the virus, so a lot of the people who had to continue working through this pandemic, you know, were at risk of exposure. And a lot of these people were visible minorities and immigrants. You know, there are jobs such as, like personal support workers and nursing homes, or they work in, you know, food processing facilities. So these are just some examples where they may be working in close contact with others, they either don't have access to personal protective equipment, or they don't have training on how to use it, and then they're going home, where there may be a crowded living conditions. So there may be um, many people living in an apartment or in a house, you know, multi-generational families, where it would be hard to maintain physical distancing with others. And so then they introduced the virus into the household and it spreads to the household, and maybe one of the other people in that household also has to go to work and then they bring it to their workplace and so on and so forth. This was how we were seeing it spread in March and April and May.

Ekaterina An [29:55] As the host of this livestream, Nathan, what did you take away from the discussion with your guests?

Nathan Chan [30:00] You know, I found it actually really comforting to hear this being explained, this association between COVID and marginalized communities. I think very early on, there was a really legitimate worry that certain communities, immigrants, for whatever reason, black people, Chinese people were at a disproportionate risk of negative outcomes from COVID. So for example, I remember very early on, there was a study that was talking about how Chinese people or East Asians have higher levels of ACE-2 receptors in their lungs, and therefore might be at greater susceptibility. And so, now seeing that kind of research come up very early, it was hard to kind of contextualize and understand and basically say, like, is this a real effect? And then kind of since then, we've now seen a lot more research come out, and it's actually no, you know, certain races, for example, are not actually more susceptible because of something about their race, per se. It's rather about how their identities interact with social determinants of health, and how the social determinants of health themselves are disproportionately affect certain communities.

Eryn Tong [31:03] That reminds me of a quote, which is that race in and of itself is not the risk factor, it's racism. And I think, you know, having these conversations and bringing all of these issues to light are so important for all of our understandings and, and learnings moving forward.

Ekaterina An [31:18] And you know, in Episode Two, Dr. Sharmistha Mishra, infectious disease physician and mathematical modeler at St. Michael's Hospital, told us about how COVID-19 transmission models are accounting for these different levels of risk and support, and why these data are so important.

Dr. Sharmistha Mishra [31:33] So it's becoming inevident in how the epidemic has evolved, thinking about congregate settings, whether you know, fixed or due to social constructs that limit physical distancing, for example, or limited with respect to infection prevention control practices, and supports a priori or before the outbreak. And so that that led to um, increased transmission. So thinking about those elements, and particularly those, that level of heterogeneity with onward transmission, because that will influence not just for casting down the road, particularly when we get closer to an R of one, you know, we really fluctuate according to sort of these heterogeneities. But second, is just from an intervention perspective, you know, sort of this one size, shoe fits all approach, where we just reduce one element of our equation, and with these contact rate, could apply very differently across if there is actual heterogeneity, both because the baseline risks might be different, but also because access to interventions and testing and supports might also be different. So heterogeneity, and risk, heterogeneity and access and, or inequities really, could sort of continue to drive transmission, which we might miss out on if we don't think about that in our transmission model. That's not to say every transmission model has to have it. But if one of our questions is, you know, what role does heterogeneity play? What interventions? How do we distribute interventions? What do we need to think about for protecting vulnerable populations or facilitating support so that we reduce transmission across vulnerable populations and settings? Then we need to be thinking about that in our transmission model mechanistically.

Ekaterina An [33:16] Jesse as the host for the discussion with Dr. Mishra, can you unpack that clip for us?

Jesse Knight [33:21] Yeah, so it gets back to some kind of fundamental theories in epidemic modeling that honestly are like two decades or more old, is some really early research basically showed that even just a small kind of core group, and sometimes that framing is even problematic, because it attributes kind of a responsibility of that group on an individual level that we try to avoid. But you know, the role of a core group in kind of, it's most important to reach them with the interventions, because if you don't, then epidemic can kind of smolder. And if you were to measure the epidemiological characteristics that might facilitate transmission outside that core group, you'd say, oh, this epidemic is going to die out on its own. But if you haven't kind of collected data on that group, and also simulated them appropriately in the model, and then use that infor- information to prioritize interventions to them, you may assume that some intervention that is kind of generic and applied to the whole population might solve the epidemic. And it really isn't sufficient for those key populations.

Ekaterina An [34:18] And on the topic of data, and in response to the disproportionate impact of COVID-19 on Black and Indigenous communities, there's been ongoing discussion about collecting race-based and socioeconomic data. There are definitely benefits and limitations of collecting this information and our guests on the seventh livestream touched on this. Here's Dr. Roberta Timothy, director of Health Promotion at the Dalla Lana School of Public Health.

Dr. Roberta Timothy [34:41] You want the data to be able to do real active change work. And it needs to be done by people who are experiencing the violence and people who have done research in this area, people who already know how to do amazing programming, right, and want the data to kind of, the data is used to, to show what we already know, that there's this disparities and hopefully can create programs that can change disparities, including responsibility and accountability from the government. The government needs to be accountable for health disparities and public health, health disparities in this province and to change so the data should be able to be used to do so. So it's not data for data, don't collect data for data. We're collecting data to create equitable change, and health equity programs for people who have been exploited and violated within the system.

Ekaterina An [35:28] Eryn, can you walk us through the pros and cons of collecting race-based data that you discuss with your guests?

Eryn Tong [35:33] All of this is very much needed. There are also various risks to collecting this type of data, which we definitely discussed more in depth in the episode. Part of this risk involves the misuse or misinterpretation of the data that can help to perpetuate racism, or discrimination if the data is not owned and collected properly, by Black Indigenous health researchers as well. And, you know, it kind of touches on what Dr. Timothy highlighted um, within the clip, which is that we can't just collect data for data, it needs to be tied with intervention and resource development. And we also need to hold the government accountable in these endeavors. Quantitative data really can't capture or reflect the humanity behind people that are most deeply affected. And this can only be done through sharing the stories and continuous learning of the people that are actually affected.

Ekaterina An [36:24] As you just touched on, Eryn, one of the disadvantages of race-based data collection is that it cannot capture the stories and provide the context behind the numbers. And in our third livestream, Donna Alexander, a social worker and former vice president of the Black Health Alliance, help provide some of that context behind the multi-layered psychological impact of the pandemic for Black communities.

Donna Alexander [36:45] I think that our community, my community has been hit especially hard with this virus, right. And I think in some respect, the virus was the straw that broke the camel's back, because we were already as a vulnerable community, we were already coping with so many other issues, right, in terms of, you know, social exclusion, all the other social factors. And then we had, you know, what was going on in terms of, you know, the racial tensions and the the trauma resulting from that, right. So in terms of her own of the mental health impact, it was an added factor for us, right. We also, a lot of us started to experience the racial stress, racial trauma, and the racial battle fatigue that came with that, right. Because we, yes, we're in the middle of the pandemic, but like, one of my coworker would say, racism didn't go into quarantine. Right. And so even in Toronto, where you see there were presence of nooses in certain environments, right. And so, you know, that's why I say that to a lot of us, it's cumulative. Right? And so the impact and the community, and I can't speak obviously, for the for the entire community. But I think, you know, in general, that you know, a lot of us it's, it's, yes, it's the it's the COVID related anxiety, but it's also the racial trauma that we were dealing with. It's that oppression. So it's so multifaceted and multi-layered, right, in terms of, of all the mental health issues, that that's been going on in general for the general population, but in particularly for, for the African diaspora. And the lack of control, you know, the lack of control that we, that some of us feel, so it's multilayered for us.

Ekaterina An [38:34] I think another important aspect of this conversation on health equity in the time of COVID is the ability of groups to adapt to a crisis. Chúk Odenigbo, PhD student and director of Ancestral Services, of Future Ancestor Services, highlighted the need for systemic solutions to these systemic problems.

Chúk Odenigbo [38:51] So it's a systemic issue. So societal delegations getting angry with an individual because they're going out within that two week time frame. Additionally, going out, getting angry individuals because they're not wearing a mask ignores the fact that it's not that individual. It's a societal issue. And then we see the same thing again, climate change. I know we should be talking about difference with products brand, much to market, which exact same thing with curmudgeons were really angry about other person because they got a plastic bag from the shopping mall. They didn't bring it on the usable box. But what if their mother of four, a single mother of four, who just didn't have time to run home and grab a reusable bag, and reusable bags, like five bucks apiece. You know, if you're working two jobs to like, accommodate four kids, for that five bucks is important for you. It's all of these different things where we need to like have conversations about it [unclear audio...], do we actually have equal access to putting in place measures that protect the environment and protect ourselves in terms of COVID and disease resilience?

Ekaterina An [39:51] I think Chúk brings up a lot of interesting and important points here. And this conversation really made me reflect on the individualistic and collectivist aspects of our society.

Jesse Knight [40:00] It's a balance in Canada, I think we're all willing to make these personal sacrifices on a short term basis, like social distancing, and, you know, sacrificing our social life and these sorts of things and wearing a mask. But when we're talking about the systemic level changes that we kind of heard about a minute ago, we're not, we're not really willing to make those changes, and you know, pay higher taxes, essentially, to fund the social programs that might solve some of these systemic issues, that's really gets a lot of pushback. And, and same thing with our dependence on energy resources. And, yeah, there's, there's certain things that we're not willing to give up. And so I think that really pushes back against this idea that we are a socialist kind of society.

Ekaterina An [40:39] Absolutely. And while this pandemic has been devastating for much of the world, and we certainly do not want to make light of its impact, a theme that did come up throughout our discussions was the potential to use this opportunity to make those sustainable changes and to shake up the status quo. The pandemic has taken an incredible toll. And there's definitely a lot that we can learn on a scientific, societal and even personal level. And on that individual level, Dr. Timothy challenged us to reflect and critically examine our own roles within our society.

Dr. Roberta Timothy [41:10] Think about the people who are being impacted gravely within this context, and, and rethink how you're going to act. Unlearn and challenge what you think you know. The, the surveillance of Black folks and Indigenous folks by police need to be challenged, because it's something that is preventing people from leaving their house, it's something that is creating continued structural violence, and it does impact our health, and our health access. So policing and looking at how to change that is really critical. Decolonizing your ideologies and practices are also really important. And something I always say, how do you change yourself, we have to change the structural system, we have to also change ourselves. So what is your accountability for the next steps?

Ekaterina An [41:54] And so jumping off of that clip, what changes have you been trying to implement? And how are you keeping yourselves accountable? As the host of this conversation, Eryn, maybe we'll start with you.

Eryn Tong [42:04] I think in general, the period of this pandemic has definitely allowed and afforded a lot of time for self reflection in many areas of my personal life. But I think a big part of this reflection has also been taking time to reflect on my own biases and assumptions and ideologies. And especially as dialogue surrounding COVID health inequities, and as BLM ramped up, I think that all of these conversations within myself, but also with people around me, are very much needed. And just having sort of those candid and open discussions about, you know, how we look at the world and how we respond to the world, I think are just so important in terms of personal accountability. And so yeah, I think in general, it's just been a really excellent and much needed time for reflection.

Grace Jacobs [42:52] And building off of that, in terms of changes that I've been trying to implement, and echoing Eryn, as well, is that taking the time and prioritizing, just educating myself. There's a wealth of resources out there that are continually being added to. I've definitely been taking the time to explore these. And I encourage our listeners to as well.

Jesse Knight [43:11] Yeah, and I think that's so important, especially because one of the themes that's come out of these conversations, I think, has been how exhausting it can be to be asked about how you can help if you're, you know, part of these groups who are racialized and marginalized. And so, you know, at some point is not your responsibility, and other people have, should go and do the work themselves before relying on you to kind of tell them how to think or how to feel. Also, I did want to mention that as a podcast, we had taken some time to reflect on these things and examine some resources and had some training. And one of the outputs from that has been for the first time a code of conduct, which basically is going to encapsulate our commitment to representing issues of racialization and marginalization in the content, and also in the guests of our podcast, and also obviously maintaining a really inclusive and positive space as a community.

Ekaterina An [44:00] So as everyone's been mentioning, the pandemic has allowed for a lot of time for self-reflection and connection as Dr. Rima Styra, Associate Professor of Psychiatry at U of T and guest on episode three reminded us.

Dr. Rima Styra [44:11] A lot of altruism that we've actually seen in the community where people cared about each other, and they were concerned about each other. They wanted to protect themselves, but they also wanted to protect others. And it would be really nice to see this kindness and caring, moving forwards, as time goes on. I also think that there's been a lot of self-reflection by people. And one of the big things that I think's happened is that people have a sense of gratitude as well. That we've been able to move forwards, but realize that there are many, many things that we still need to change and that we need to look at the positives, but also to look at the fact that there are many, many opportunities for us to improve at this point.

Ekaterina An [44:55] And in our fifth livestream, we discussed the intersection between the pandemic and the climate change crisis. Now it feels like a lifetime ago, but climate change was actually named the most pressing political issue at the last Canadian election. In reflecting on the parallels between the global responses to the COVID crisis and climate crisis, Gideon Forman, climate change policy analyst at the David Suzuki Foundation raised some very helpful lessons that we have learned from the COVID crisis that can be used to help address the climate crisis as well.

Gideon Forman [45:23] I mean, I think we have to be careful against you know, what I would call sort of silver lining, I mean, some, some of the commentary that's coming out of the pandemic, in the environmental movement is always, isn't it wonderful that we're, you know, seeing these improvements in things like air pollution. I think the first thing to say is that the pandemic is a terrible tragedy, full stop. It's been horrific for people around the world. And it's, and we're not finished with it yet. So we have to acknowledge that, first and foremost. It is quite extraordinary how we have adjusted the fact that we're flying much less, the fact that we're working from home so much more. That is all, I think, rather hopeful, because it shows that we could make big changes that could also address the climate crisis. It shows that we can work and drive less. It shows that we can have business meetings and fly less, right. And we can do it very quickly if we have to. So I think that's one of the key lessons is that we can, we can make big changes quickly if we need to as a society. I think the other thing that comes out of COVID, in terms of a lesson is that we have to listen to the scientists. I mean, when we look back on the early days of COVID, what came up again and again, was that our public health professionals, our medical officers of health, who after all, are scientists, first and foremost, they were taking charge. And in most cases in Canada, we were listening to them, right. They were telling our mayors and our premiers and our federal government what to do, and in large measure, the politicians listen to them. And on the climate crisis, likewise, we have to listen to our scientists, right? Our scientists are saying, our best scientists are saying we have to make dramatic reductions in our greenhouse gas emissions within the decade. And then finally, I think another lesson coming out of COVID is that if we want to we can work internationally, across silos in a quite non-partisan way. And I think we were seeing this in Canada as well. We're putting differences aside and working in a non-partisan way for the betterment of public health.

Ekaterina An [47:24] Do you think the lessons that Gideon mentioned can be successfully implemented in our efforts to address the climate change crisis? Nathan, maybe we can start with you.

Nathan Chan [47:31] So I think Gideon kind of hits it on the head here that, you know, when the need to take collective action appears, humans on Earth are able to do this. And we, I think it's the first time I think we to ourselves confirmed that we were able to do this was during uh, you know, in the late 90s and early 2000s, this whole ozone hole that was appearing in our atmosphere, and then all the actions that were taken to remove CFCs from all of the devices and refrigerators, etcetera, that were using them. So I think that, you know, there's this proof of concept that, yes, we can take action together, and that we can take action on something like the climate. This is something that is possible for us.

Grace Jacobs [48:11] I think that's a great point, um, but I think another point that Gideon also touches on is that one of the problems with the ozone layer, that was amazing how we tackled that, but after that there was the perception that, oh, we had solved the problem. And that we can move on and that we don't really necessarily need to worry about the other problems that need to be tackled related to climate change. So I think an important aspect as well, is to kind of maintain that momentum.

Yagnesh Ladumor [48:38] I will say a lot of this is very related to the time horizon of the issue, right? For more immediate issues, we have a lot more will. And I think that does cloud some of our judgment, because climate change isn't stopping. And we've seen this year has been one of the hottest years on record, we have the ice caps melting. And like you can't stop any of this without drastic action. As we heard, climate change is a huge topic for the elections. And now, it's completely overshadowed. And many regulations have been overturned, to help industry and help the economy. And while that's important, I think we also have to keep in mind that climate change isn't going anywhere. And we still need those regulations.

Nathan Chan [49:28] I guess I'll also add on to that too, because I like how you bring up time horizons and that, you know, the problem with the ozone layer was a very short time horizon. We could see this happening, it was deteriorating, we could tell what the agent was causing and then we could address the issue. With SARS, it was, it was kind of a bit of a like, you know, a drill for a pandemic. But at the same time, you know, same thing. It was a very immediate issue and we were able to deal with it very quickly. What's interesting about climate change is that it's you're right it's very long term. It's on a decade's long scale. And what's interesting about COVID then, is that it sits kind of an in between, between the short time horizons and extremely long time horizons. So I think this, in part will be a really interesting test for our society. Can we deal with at least a midterm issue, and deal with it successfully? And maybe that will give us more hope, then for something like a longer term issue, like climate change.

Yagnesh Ladumor [50:23] Just bouncing off that, the difference between COVID and climate change is also the outcomes are much more visible and quantifiable for COVID. Like you have people not getting infected, people are living longer that do get infected. Versus with climate change, it's it's gonna be a slow, gradual, very, dragged out process, right. Also not to get very political, but there's no political will there to look out for people 2050 years in the future.

Grace Jacobs [50:54] One last point, I just want to bring up in terms of, at the beginning of the pandemic, we thought that perhaps a positive aspect would be that there would be these decreases in carbon emissions because of this change of behavior. But I think we definitely need to be careful about that, and not kind of over emphasizing that, because one, in the end, the carbon emissions, the change is not really enough to kind of eradicate the impact of our behavior, up until this point. As well, secondly, we don't really know, or we're just kind of beginning to learn how the second wave of handling the pandemic is going to impact the environment.

Eryn Tong [51:33] And I think just tying together all of what we've just discussed, the outcomes of COVID are a lot more tangible, and we see it. We, all of us know of some person that's been affected, whether that's yourself or a family member, or a friend. Whereas with climate change, you know, you really aren't able to see those immediate outcomes, and therefore, the impetus for self accountability to, you know, create sustainable change, I think it's going to be a lot more difficult. And we've already experienced that with the climate crisis.

Ekaterina An [52:01] So I think a lot of excellent points were brought up. And I would definitely encourage everyone to listen to the full discussion on the topic of climate change and COVID. But our guest had a lot to say, on the intersection of these two crises. So the entire COVID decoded series was a really big undertaking for our team and a first for the podcast. And it was an incredible learning opportunity. And for me, at least, it was a nice, weekly constant to have throughout this pandemic. We've talked a lot today about our own reflections on the discussions that we had, but I wanted to pose one final question to all of you hosts. What was something you've learned about yourself and how you've coped throughout the pandemic? Grace, can you start us off?

Grace Jacobs [52:42] Sure. So I think there have been a number of things that I've learned. So first, I feel like we can all relate to kind of suddenly being pretty isolated from your community. Definitely, kind of taught me a lot of gratitude for the relationships in my life, for my family, for just those regular interactions. Also my lab as well. Those regular interactions that I just suddenly had to really work a lot harder to maintain. Secondly, one of the things I've learned kind of is completely switching my working environment from my lab, and often coffee shops, to my home, was a really interesting experience. And I think kind of being able to wake up in the morning and control every aspect of my day in terms of, in terms of where I was and my time spent, and how I organize my day, I had a lot more control over that. Being able to wake up every day and kind of control your day and your environment a lot more than you necessarily would, before the pandemic kind of gave me an opportunity to think a bit more and learn a bit more about my strengths and weaknesses. What makes me productive, how I kind of manage my energy.

Ekaterina An [53:48] That's great. Yagnesh, what about you?

Yagnesh Ladumor [53:51] I learned how loud my neighbours are. Right when I have to work. More seriously, though, I will say I went through a lot of emotions, when this first started. Um, a lot of it is because I'm an international student, so my family is not in the country. There's a bit of anxiety there. Like my mom's a doctor, so she has to go deal with some of these uh high-risk populations, so it's just something that's always in the back of your mind, um... It's not something you can do anything about. I have started calling them more often, which is nice. We chat more. I'll definitely take that with me going forward. Because I think the, this just made us realize like how fragile everything is.

Ekaterina An [54:41] Nathan?

Nathan Chan [54:40] I saw a lot of my extrovert friends kind of struggle with the pandemic, especially within about like a month after lockdown started. So about April. And I as a self-proclaimed introvert did not really feel the same need to see people I guess? Like I was so happy working from home and just hermitting and was, but like, you know, coming around June, or like early July, I think it finally got to me then like, you know, it took me the better part of three months. Yes, introverts can actually get cabin fever and like desire to seek social interaction at some point eventually. But yeah, I, I learned that about myself that I actually, from time to time may actually seek social interaction.

Ekaterina An [55:27] And Jesse, how about you?

Jesse Knight [55:28] Yeah, I just want to echo that point about being an introvert, there was that meme going around, like, Oh, this is quarantine? This is just my day-to-day life. But uh, you know, I am, I have been privileged as well, like living with my girlfriend here in Kingston and also, there's been some other people in the house, her sister and everything. So, you know, reflecting on the privilege to, to have those social interactions, whereas you know, some people literally living alone, I think this would be especially,x especially hard on them. And then the other thing that I'm especially appreciative of is just how fragile our way of life is, when you, when you think about public transit and enjoying social outings or even shopping at bulk barn, like I really avoided the waste with that. So that's been a little bit hard to transition away from, but like Gideon said, you know, talking about things that we've learned from this um, the fact that we can make these huge systemic changes, is is kind of inspiring, and hopefully, we can make the most out of that.

Ekaterina An [56:23] And finally, Eryn?

Eryn Tong [56:24] Yeah, I think the biggest theme that you know, all of you have touched on is really just gratitude, I think, feeling so grateful for having a roof over my head, for healthy family, healthy friends, to be able to have the privilege to work from home, to have a job, to have the technology available to be able to connect with friends and family remotely. And I think maybe just one thing to finish this off is that I'm just also so grateful for this incredible team, um, that is our podcast team. I have honestly been so impressed by the way that we've all pulled together to create this incredible livestream series. Honestly, I don't think any of our listeners or any of our audience will know the amount of details and stress that we have overcome and that we have sorted out. Honestly, I still can't believe that we've managed to pull this off and that we're actually recording our wrap-up episode. So I just wanted to give a huge shout out to every single member of our team. And I'm just very grateful for each and every one of you.

Ekaterina An [57:25] And that was really sweet. Thank you, Eryn. And thank you to everyone for sharing your own lessons learned. It sounds like we've all had a chance to learn something new about ourselves. And also just appreciate everyone that we have in our lives. And you know, that sounds like a great place to wrap up today's episode. Thank you to all of our incredible guests for joining the COVID decoded series this summer. And we just want to leave you with one final clip from Dr. Timothy.

Dr. Roberta Timothy [57:50] This is an opportunity right now during COVID. The pain is real, the mistrust is real, but also the resistance and the hope is real. And I think you know we can do this but we have to continue to think differently. Think outside of that box. We've got to be accountable for historical and current day traumas and dramas I like to say and look towards the future with changing the systems that create this this violence and really create health equity path.

Ekaterina An [58:19] The COVID decoded series would not have been possible without the support of our pillar affinity sponsors, TD Insurance and mbna. Check out the link in our show notes for preferred insurance rates and credit card rewards for U of T alumni. You can also find the links to all of the full COVID decoded streams in the show notes. And finally, a very, very special thank you to the COVID decoded organizing team. Our hosts, Yagnesh, Jesse, Eryn, Thamiya, Nathan and Grace, our moderators, Melissa, Richie and Frank, our logistics team Zaynep and Stefania, and our audio engineer and livestream wizard, Alex.

Eryn Tong [58:54] And one final, very special thank you goes out to Kat who was the co-organizer of this whole event, as well as the host of the hosts today. So thank you, Kat.

Yagnesh Ladumor [59:05] And finally, we want to extend the most special thank you to our outgoing executive producers Mel and Grace, public relations execs, Kat and Eryn, and our promotions and social media exec Thamiya for all leaving the show for bigger and better things, after many of them started with this show four years ago. There's no doubt that all of us at Raw Talk are going to miss their passion for science communication, and podcasting expertise.

Ekaterina An [59:33] Raw Talk Podcast is a student presentation of the Institute of Medical Science in the Faculty of Medicine at the University of Toronto. The opinions expressed on the show are not necessarily those of the IMS, the faculty of medicine or the university. To learn more about the show, visit our website RawTalkPodcast.com and stay up to date by following us on Twitter, Instagram, YouTube and Facebook at Raw Talk Podcast. Support the show by using the affiliate link on our website when you shop on Amazon. Also, don't forget to subscribe on iTunes, Spotify or wherever else you listen to podcasts and rate us five stars. Until next time, keep it raw.