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Confronting COVID-19: a special webcast with McGill health experts

welcome to today's special alumniwebcast preventing koban 19 my name is Derek Cassoff and I'm the managingdirector of communications at McGill's office of university advancement andgreeting you live from the safety of my new home office my basementchecking in remotely as well our two of McGill's leading experts on infectiousdisease and population and global health Dr.

Marcel Behr is the co-director ofthe McGill interdisciplinary initiative and infection and immunity and interimdirector of McGill's infectious diseases division welcome dr.

behr Thank YouDerek for having me and we've got dr.

Timothy Evans inaugural director andassociate dean of the school of population and global health in theMcGilll's Faculty of Medicine welcome Dr.

Evans thanks Derek and thanks for havingme back.

and thank you both for taking time out of I'm sure what ourvery busy schedules.

So we've received well over a hundred questions fromalumni all over the world in the last 24 hours and we'll try to get to as many ofthese as we can we'd originally scheduled 45 minutes for this bothdoctors have told me they're willing to stay on a little bit longer if need beso we'll try not to take too much of your time but we've got some wonderfulquestions that have come in but before we get into them I'm curious to know alittle bit about how infectious disease experts and professors of global healthsuch as your spouse it's just so just yourselves spend your days in the heightof a pandemic dr.

Behr what does a typical day look like for you these dayswell thank you for asking typical day feels a little bit frenziedI'm getting probably 10 times min more emails ten times more text a lot ofquestions a lot of good questions a lot of thoughtful questions and a typicalday like today I started off and I put my phone aside so I could have 15minutes to have a cup of coffee and relax and during that time my Fitbitrang two times and my phone was nowhere near me so I had to hang up on my Fitbitand by the time I went back to phone the other person wasn't available because noone yes I managed to get to the hospital I'm still working at the hospital hesays I'm the division director of a hospital unit and I'm trying to help asbest as possible made our Hospital plans here and alsotry to help as much as possible make sure that all the people my divisionhave the resources and also occasionally some mental health breaks and so thatthey get some moments away from all of this great well I our hats go off to allof you in the healthcare system of course working double duty to try to getall of us through this dr.

Evans what about yourself what what are your dayslook like now well I only wish I could get as many emails as Marcel and so butI know very busy and I've been working with the planning and EmergencyOperations Committee at McGill University and as you can imagine theimplications for moving and complying with the government's recommendationswith respect to these two weeks and and most likely beyond March 30th are veryvery important ones to think about how to manage in addition because of my pastand global health I've been interacting with theGovernment of Canada and also many of our international partners all of whomare doing their very best I think to figure out how how to respond to theevolving situation I do have the benefit of working from home and I'm lucky tohave my family with me so that's a little bit of a dividend and we're doingwell at the moment the biggest thing I have troubles with is my own personalbehavior and I'm just going to put up this little cartoon to show you reallywhat I've been dealing with and and if you can see that and this is a picturedog telling me not to touch my face and I have borrowed the plastic containerthat prevents my dog from putting its paws on its face and to try andreinforce that so the short message there as I'm trying to walk the talk onthe recommendations of behavior change which are so important in in managingthe epidemic and pandemic at this point in timemm-hmm well for what it's worth I've spent my entire life trying to get outof a horrible habit I have which is being a nail biter and within two weeksI finally have long nails so it didn't take much to get me to to stop thathabit so let's get to let's get into some of the conversation so sort of theframe this eight days ago the World Health Organization came out anddeclared covid 19 : 19 outbreak to be a pandemic and said it was not a word tobe used like me it's hard to imagine how much their lives have been completelyupended in a week or so since then so we'll start with you dr.

Evans why didthe w-h-o make this declaration and what was its significance so the reason theymade the declaration is they had definitive evidence of communitytransmission in a growing number of countries and so early on when it wasfelt that cases appearing in other countries were simply a function ofpeople who had traveled from the initial epicenter in Wuhan or in some of theother countries there was still some thought that there would not bewidespread community transmission of the virus and other countries and I thinkwhen we saw the announcement on the end of the pandemic it was abundantly clearto everybody at that point and has become even more clear since that we dohave a pandemic meaning we have transmission at community level invirtually every country of the world right now so the significance is massivebecause we are dealing with a with a pandemic and every country and everyindividual in every country needs to be part of the solution and I think this isthe real clarion that there isn't any part of the world that is exempt fromthis and therefore we all have to rally together and do as best as we can anenvironment of still unfortunately significant uncertainty great thank youand I think we'll get to some of those specifics about what we can do toprotect ourselves over the next 45 minutes or so dr.

Behr we actuallyreceived as you might imagine many questions from alumni related to thescience and the microbiology of this virus essentially people want to know invarious forms and what is the lifespan of the virus how exactly is it attackingour body and how is it able to replicate itself and spread so quickly compared tomore traditional influenza viruses so so thank you Derekso first off the the life cycle of this virus is probably similar to otherrespiratory viruses in that it comes into our eyes our nose or our mouththrough activities such as nail biting which you have literally stopped to doand then it finds cells in our respiratory mucosa where it enters andthen it replicates viruses are not self-replicating like bacteria they needto borrow our cells to live and to replicate so they have to enter cellsthey replicate and then when there is shedding at a later point we have acurrent of median incubation period and the three to five days or so when youare sick then it comes out of those things secretions and goes to otherpeople the question is I think one of the part of the questions is why is thisdifferent than with traditional viruses like influenza currently the estimatesof what's called the R naught or the transmissibility or how many secondinfections are caused by first infection are generally on the order of two tothree and classically for a disease like influenza B R naught was perhaps lowerperhaps closer to one so that suggests that every case is causing moresecondary cases now what I don't know and I'm not sure if other people knowbut I would invite him to give his input is whether this is because there's ahigher viral load and people are shedding more virus so you're morelikely to transmit or whether there is actually less pre-existing immunity sothat everybody who is infected is more likely to get disease because this is anew virus and people are presumably not immune so whether it's a pathogendeterminant or a host determinant that is resulting in this higher or not issomething that I think is currently uncertain Tim do you have any furtherthoughts on that and no I would agree that we don't havedefinitive evidence on that although a very interesting study from China justemerged this week which suggested that about 86 percent of the transmission ofthe infection in China and during the epidemic the peak of the epidemic waslikely to be due to people who were asymptomatic so not showing active signsof infection so there is some suggestion I think based on that that this thisvirus can transmit quite efficiently whether it's due to viral load or hostissues related to lack of immunity I think we'll we'll only answer thatquestion when we have a test for whether or not people are showing antibodies tothe virus did I just follow up on Tim's point about the majority of transmissionbeing from asymptomatic people I'd like to suggest that before we think thateverybody who is asymptomatic is therefore transmissible we shouldremember that there is the per capita risk of transmitting in the perpopulation risk so on a per individual risk if you are sick and you're sneezingand things are coming and you're crying and you're blowing your nose clearly youare going to be shedding water virus asymptomatic people however when there'sa population of four million people and then the force of transmission fromasymptomatic people will become more evident in my okay well thank you bothfor for that dr.

Evans on our first webcast on this subject over a month agonow back when we thought this was still what we knew it was still containedmainly to China at the time you spoke a lot about the concerns you had that inthis global interconnected world that we live in we're really only as strong asour weakest link and I'm sure that when you were thinking about countries thatwould be the weakest link you were not thinking about places like Italy or theUnited States so what does it tell you about this outbreak and even some of theworld's most scientifically advanced nations have been unable to contain thevirus and stop its spread we simply unprepared I think the shortanswer that question is yes and and I think we underestimate the shared riskthat we all have with respect to global pathogens and I can't emphasize howimportant it would have been for all countries to move much much more quicklyin ramping up their preparedness and response and the best manifestation ofthat is in testing and so if you look at South Korea which has done a very goodjob in managing the outbreak they are the country that has tested the mostthere up close to 300 thousand tests their test rates per million populationare climbing up over 5, 000 per million and if you compare that to Canada we'reprobably somewhere around 500 4 million tests way under tested at the moment sowe can't sit back and think we're doing particularly well and if you comparethat to places like the United States they may be at 50 tests per million atthe moment that's two orders of magnitude too low there needs to be asthe director-general of the World Health Organization says testing testingtesting I can't emphasize how important that is that's the best mark that's yourunderstanding where those infections are who the contacts are and where you needto direct resources to get on top of it so yes the weakest links are in thesystems that sometimes think that they're not going to get this as opposedto having great scientific might if you're on your heels here unfortunatelyyou're going to pay for it mm-hmm dr.

behr hi I just like to add that theinterconnected which highlights our weakest point isalso highlighting some of our new strengths and I've been incrediblyimpressed following on Twitter and other social media some of the really tirelessinvestigators who are putting out blogs putting out ideas sharing their thoughtstheir insights people who are putting viral genome sequences online in orderto infer whether there is multiple importations of the virus or to showthat their spread of the virus in Washington State so there has been somesome major advantage of our interconnected world is that thedissemination of information and ideas has been quite remarkable and I'd liketo just give a shout out to some of the people who've been writing veryinfluential ideas and appends on this mmm-hmm now here in Quebec in particularthe government has taken what appears to be a very very aggressive actions moveeither close down most public gathering spaces such as gyms ski hills movietheaters not to mention all the schools and starting this when there were just ahandful of confirmed cases in the province do you gentlemen think thatthis has been the right approach and one that other jurisdictions should belooking to emulate him go ahead thanks Marcel.

Derek I think that ingeneral the policy of social distancing which is inherent in these policies ofshutting down big institutions and discouraging gatherings in largegatherings and places is is the right policy so I think that it is theappropriate action at this point of time it will be a difficult one to sustainand so we need to be conscious of that and I think we also need to be consciousof some of the real differences that are taking place across countries in theimplementation of this policy in the UK and Australia for example they haven'tshut schools at this point in time and I think this will be interesting to seein fact either that's a strength insofar as those children are not at risk oroverly exposed and perhaps develop herd immunity faster than they might if theywere isolated and whether or not and we can manage looking at the consequencesperhaps the unintended consequences of keeping children at home which may putmore stress on parents or more contact with grandparents and thereforeadversely increase the risk of transmission to the elderly so I thinkthe in some I think in general the policy is the right one I think there issome active and healthy discussion on on what the risks and benefits are ofsocial isolation or social distancing for the youngest part of our populationor something yeah I'd like to follow up with two two ideas there in firstI just want to underline what Tim just said is I think that universities areengines of thought and ideas and I think it should be healthy to ask questionsabout this and try to understand while we all conceptually agree with socialdistancing to what extent is social distancing helpful in to what extentwill social distancing potentially lead to problems in some vulnerablepopulations so there has to be an ongoing conversation it would be nice tohave a single answer but I think universities were created as as placeswhere we can have these conversations in the civil tone I'd also like to pointout just as a discrete example you asked me what my day was like today I went onshore retreat here in Montreal I got on a bus and the bus was closed at thefront but the back door was open the sign at the front was taped and it saidyou had to social distancing stay away from the driver so I got a free ridebecause I wasn't allowed to use my opus pass and I thought this was a beautifulcompromise that the infrastructure the STM is there and it's available and it'shelping people to move and the people who have to shop after shoppeople have to get to work after you get to work while at the same time I'mrespecting the drivers need for space and and the driver need not fear thatI'm going to be bringing the virus onto the bus and infecting that driver so Ithink for each situation we have to try to find that delicate balance betweenproviding the services and not amplifying the epidemic great thank youwell even these in his opening remarks you've answered many of the questionsthat have come in but I'd like to actually get to some of the directquestions we did receive from our alumni from email and social media I'll startwith the the first one it comes in from Rafael Nunez and it's probably the onequestion that is top of mind for most people which is how long should weexpect to be in this period of social isolation so I'll take it first ifyou're okay Tim I think the two questions about should we be in selfisolation and that's the private question and then the societal questionthe current recommendations if he traveled from abroad you should be inself isolation for 14 days as is my wife and is my daughter they came back fromLondon last Saturday they are staying at home I kept some of the outside dutiesso as an individual level please stay at home for 14 days how long will thesocietal effort at social distancing be propagated or continued that issomething I do not know and that's why I defer to Tim because he may have somebetter insights on that thanks Marcel I am I don't have the crystal ball on thatI do think as soon as we have a test that shows whether or not people aredeveloping immunity to the virus that that will help us understand it whetherwe can relax social isolation measures so if we have a test which shows thatmany people are showing antibodies to this virus and then that would suggestthat we can begin to relax some of the social isolation measures particularlyfor the lower risk populations so I think I don'tput everything back to science but I think if there's a huge priorityscientifically it's to accelerate the development of a of a blood test thatwould allow us to know whether somebody has developed antibodies to this farzbut to follow on that Tim I think we need not only a test but we will needtest results and it's one thing to know that an individual is immune but we willneed to know what percent of society needs to be immune and for that we notonly need to just be able to have the scientific capacity but we'll also haveto have the scale up that the test can be offered to large numbers of peopleabsolutely so too early really to put a timeframe on when we can go back tomeaning are normalized and back to work in school correct so here's anotherquestion that's come in probably not surprising from Tony ripped in ski itwas wondering if the virus will be less effective once we get warmer weather andif so why so Marcelo gonna try first here I think there's you know there'sreason to think when we see flu and colds these seem to be winter phenomenain Canada so there's reason to hope that this could be a winter problem that'sless of a summer problem if that's the case then there's also reason to fearthat it'll become a winter problem again next November's so I think we have to becautious about using the warmth to relax things now if we're not ready to rampthings up again in the fall but we also have natural experiments where if you goon to some of the dashboards now and look at the number of cases in Canadaand the number of cases in Australia which is a country with a similarpopulation the number of cases is the same and I would submit that most placesin Australia have much more warm or hot weather today than we're experiencing inMontreal today so I don't see any evidence from the natural globalepidemiology that it's a cold hot phenomena if it is maybe that's okay butif it if it is we also have to remember that we willthe winter next winter mm-hmm okay the next question here I'll try topronounce this name well it's from gazia Xhosa bocce an excellent questionwhat are the steps to take if one starts feeling symptoms who do we call and whatdo they actually do to help patients our people advised to stay at home to recoverbecause hospitalization is not necessary or is it because there's not enoughspaces and care left so it sounds like a medical question so I guess that'sdirected at the head of infectious diseasesI think the measures to take are largely the same as you would have done onemonth or one year or one decade ago if you got a cold if you had a common coldand you felt miserable and you want it to stay in your bed and have chickensoup stay at home stay in your bed and take chicken soup if you are feeling toosick to manage at home or because you have a pre-existingdisease and this is exacerbating your pre-existing disease and one year agoyou would have gone to the hospital because you were too sick to stay athome right now if you're too sick to stay at home go to the hospital thathasn't changed I understand there's a fear of going tothe hospital and acquiring infections and making things worse but on the otherhand the general indications for hospitalization haven't changed which isthe hospital can offer you a level of care you cannot get in your home so ifyou are fortunate enough to get the care you need at home stay at home if itseems you need oxygen because you're not able to breathe well if it seems thatyou have completely uncontrolled fever and you're unable to function those arethe same reasons to go to the hospital the hospitals now have in place testingfor the virus SARS to convey that causes the Z's kovat19 so you will be asked questions when you enter the hospital it will ask thescreening questions they will put you in separate rooms and they will do thetesting that is necessary but fundamentally the reasons to come to thehospital haven't changed if you have any uncertainty about it to quebecgovernment has put a 1 877 number at the government of Quebec websiteI have not memorized it I have it on my cell phone here I'd have tolook it up while talking I'm not sure if I can but you can certainly share it andand for the people listening from other jurisdictions most governments haveposted toll free appliance great thank you dr.

Behr oh there are going bejust just to add on that as I think that many people feel if they have cold likesymptoms then they should go and get tested and I think what Marcel is sayingactually if you have a cold treat it like air cold symptoms which couldpotentially be symptoms compatible with covid infection stay home if you'refeeling well enough to stay home and I think that also helps in terms ofpreserving the social distancing and avoiding unnecessary exposure for peoplewho can stay at home so I think that side of it is is particularly importantbecause everybody has naturally a lot of anxiety that a cold symptom may be anindication of coded infection I think in that point as well when we look at thenumber of tests that are being done today in in Canada a net of the at-riskpopulation that are being tested ninety-five percent of those tests arenegative so the vast majority of people being tested for Kovan at the moment aretesting negative it's a very small proportion and I say that because thelikelihood that if you do have symptoms of a cold that they are a cold or a fluas opposed to Govan is still much higher than individuals having Kovac great soyou – Tim – reinforcing those message the counter side – if you have messagesif you have a cold stay at home and the counter side to that is if you havesudden squeezing chest pain and you think you have a heart attack go to theemergency because you think you have a heart attack if you have the signs of astroke that we've all been learned are the signs of a strokego to the emergency the hospital is open all the specialists all the specialtiesare here all the specialists are here so please do not fear going to the hospitalif you have a medical need come to the hospital we are here for yougreat thank you the next question is from Irwin freed on a similar veinshould you be tested if you think you may have come into contact with someonewho has cold at 19 currently we are not recommendingtesting people who think you were in contact with somebody we are testingpeople for a variety of reasons we're testing in Canada we're testing Quebecwere testing symptomatic people we're testing new admissions to the hospitalfor instance we do not have the scope to test everybody right now even people whohave a cult or a home and I'm not coming to us we are not testing everybody whohas a common cold and going beyond that to the person next to them who doesn'thave the common cold would really stretch our capacity for testing so thatis not recommended okay here's a question from Toby Gilsig we have readthat the risk of contracting the Cova 19 virus is higher for those withcompromised immune systems as well as those with overactive immune systemsshould these individuals stop taking medications related to suppressing theirimmune systems so so thank you for that question I am I was fortunate to be ableto ask my colleague Don VIN who's an infectious disease specialist whoseexpertise is the immune response to infectious diseases about that veryquestion recently and he wanted to reinforce that first of all there's twosteps of the question is immune compromised a risk group and one step isare they more likely to get infected and the other step is if infected are theymore likely to have severe disease at this point dr.

van is unaware of anydata speaking to either of those and several groups are working on it and wealso have to concede that immune compromised is what we call in medicinea heterogeneous group there are people who are on a steroid inhaler for asthmaand there's people who just had a bone marrow transplant forleukemia and it's hard to put that completely varying group of patientsinto one group and call it the immune compromised group there may be somegroups that are higher risk than other groups and clinical researchers aretrying to determine that the second part of the question is if you have a hearttransplant and you are living today because somebody gave through a bequestand through the autopsy process a heart to you so you are walking on the streetcontinue your anti-rejection medicines do not lose that art now this is not thetime to stop the standard medicines that you need for your transplant thestandard medicines that you need for you lupusthere is no recommendation to withhold immunosuppressive drugs and make yourother conditions worse oh great thank you I got one more medical question andthen I've got a whole bunch for you doctor if it's don't worry but this onecame out in a few different ways Kimberly you has in particular is askingis it safe to take ibuprofen and why are physicians in France saying otherwise somy understanding is that there's an association between ivory Griffin useand poor outcomes what is unclear in the absence of what's called a clinicaltrial is whether there is something that's called confounding by indicationwhich is did the ibuprofen make people worse or did the people who were doingworse take the ibuprofen at this point we don't know but the Association hasbeen concerning enough that the w-h-o has pronounced against ibuprofen becausein general when you think of any medicine for any intervention you haveto ask does the benefitting outweigh the risk in the case of ibuprofenthere is no proven benefit we have no way to quantify that ibuprofen to usegets rid of the virus or ibuprofen risk used makes you better so since there isno demonstrable benefit it is quite prudent to say don't take it becausethere is a potential risk but whether it's cause or consequence remains to bedetermined I agree with the recommendation and our own hospiceguidelines recommend against that class of medicines for a kovat case greatthank you here's a question from Kayla Gibbons dr.

Evans maybe I'll let youjump in on this one for those who are self isolating and taking all thenecessary precautions to avoid the spread of the virus but as husbands orwives are still working and coming home to their families who have been selfisolating how can we make our own homes a safe place so I think I think this ischallenging in some respects and in terms of what the conditions are of aparticular home and that of course will vary but I think first and foremost isto really reinforce eyes good personal infection hygiene and that relates towashing hands avoid touching the face which is a very efficient transmissionof virus sneezing and coughing appropriately into elbows or Kleenexesand keeping surfaces clean if there's opportunity if the household hasmultiple facilities bathrooms then there may be a way that the individual who isself isolating can use one of the bathrooms or one of the bedrooms withoutothers having to use it so there may be depending on circumstances opportunitiesfor houses to accommodate a little bit more dedicated use of some parts of thehouse for the individual that's self isolating and if that is the situationthen it certainly makes sense to do that so I think those would be my suggestionson on that front of course anybody who is living with somebody who is selfisolating has to of course monitor their own symptoms and and should they developsymptoms and they should also report those mm-hmm a lot of questions havecome in as you might imagine about transmissionwhether the virus remains airborne and for how long I want to get to a specificone it's quite specific but I think that many people have this similar anxietycomes from Sharon Brandt who says she lives in a modern condo in downtownToronto and is wondering if she should turn off the air conditioning either orblower in her unit well the virus traveled into her apartment via the airthat way so so currently there's no evidence that viruses are traveling fromone room to the other there are infectious diseases liketuberculosis where it has been shown in the past that if you take the air from apatient room with tuberculosis and then bring that air into another room theguinea pigs can get sick and that's what's called aerosol transmission inthe case of corona viruses and most respire to attract infections theprimary route of transmission is what's called droplet transmission you sneezeyou cough something comes out and hits somebody's face or eye or whateverthat's the primary route of transmission we're talking in the hospital about whatare called aerosol generating procedures so an aerosol generating procedure iswhen somebody is very sick and they need to be intubated and at the time ofintubation they may die and there may be suction and then you can imagine wherethere will be kind of a cloud of virus floating around them for a short periodof time but with time it will settle and it will land on the ground or land onthe table and that's the surfaces that we have to clean if will not fly outinto the air and out the ducts in the top of the room and then transmitted tothe next rooms so my advice to somebody who is in a closed condo right now is ifthe weather is nice open the windows and enjoy a stream of air from outside andif you have a chance go outside and go to the nearest park and enjoy thebeautiful weather there's I see there's a lot of very good spirit of peopleseeing each other in the park and talking to each other and keepingdistance so I wouldn't stay in the condo but I wouldn't turn off the heat eithergreat a similar question from Beverly Baron Brahm was wondering do we know howlong the virus lasts on inanimate objects for example when we're buyinggroceries we have to worry about bringing them into our homesthere are of course studies looking at how long the virus lasts on plastic orglass or copper or cardboard and I'm not going to pretend I know the exact numberfor every surface I think the more pragmatic question is if I go to thegrocery store and I come home do I have to disinfect the outside ofevery Cheerios box and the answer is go to the grocery store wash your handstake things out wash your hands again and use good hygiene and remember thatwhen you're preparing your meal you should use all the good hygiene for allof the things in there if you're going to be handling eggs this is a time toremind yourself to wash your hands after cracking an egg this is the time to makesure that you don't use the same bread board for the chicken as you use for thesalad because this isn't the only microbe that we are encountering andcommon sense and hand-washing will help you to reduce your risk of manydifferent microbial exposures I've actually been thinking a bit about thatand you know one day hopefully soon we'll be out of this and beyond this isthis do you guys think this is gonna change the way we actually think aboutpersonal no hygiene forever will we be the generation that will never have tobe told again to wash your hands and not touch your face Tim the doctoreverything ok listen as somebody who's suffering from short-term memory deficitincreasingly I'm quite sure that we'll have to reinforce these messagescontinually and over time I think you're pointing Derek to I think one of thebenefits is that if we can exercise better infection and hygienethen we may not only slow the progression of kovat 19 but we may alsolimit transmission of other pathogens that Marcelo deals with all the timesome of which have a patient's ending up in the hospital like Salmonella andthings and so the what we say in economics the positive externalities thebenefit of this goes far beyond COBIT and I think it is right therebe some lasting effect but we will have to continually reinforce these sorts ofbehaviors just because they often get forgotten two or three years after thesome period of time after the scare so I think it's the right direction but Ican't imagine that we're gonna put public health officials out of work interms of detection hygiene okay so on that note I don't want to maybe soI go ahead babe just like to point out one of the great things about my job isI learned something new every day and I just learned about positive exponentialality so thank you very much Tim crazy but I do want to actually maybe use thiswe wanted to talk a little bit about the situation or the solutions beingdeveloped in some of the Asian countries and when the w-h-o had their pressconference last week announcing this to be a pandemic they did in fact singleout China and South Korea for praise for taking steps to slow down the spread Iread in certain media reports that part of that is cultural because these arecountries that have experienced serious outbreaks in the past whether it bestars or avian bird flu so maybe you can talk a little bit to us dr.

Evans aboutwhat exactly is happening in these countries specifically China SingaporeSouth Korea that the rest of the world might want to take some lessons from andare we as you know citizens of liberal democracies in the West willing to go sofar as to abide by some of these measures yeah it's a great question andand Derek let me first state that a number of the countries that you referto are liberal democracies and so I think it's very important to recognizethat there are a number of countries outside of China including SingaporeSouth Korea Thailand where you have active democracies that are certainlyvery different from the political system in China however more fundamentally ifyou look at what's being done there is a tremendous amount to learn and and as Imentioned earlier I believe if you have to put a countryup on a pedestal at the moment not to jinx them but to simply say theirexperience has a lot that the rest of the world can learn from and that'sbeyond China it is South Korea and if you look at the extent to which theyhave been on top of testing since early February and the weight the way in whichthey've ramped that up it is absolutely I think the way to go and I can't stressthat enough because in our own country I think we still are not scaling up ourtesting and I've communicated this to various government officials but I thinkwe need to move it up at least another log order tenfold in order to get on topof this so that's number one lesson number two you have differentexperiences with respect to lock down China it seems as if it was quiteimportant and effective the Korean Minister of Health said that lockdownactually created more problems than it was worth because people because ofissues related to compliance and people knowing the lockdown was coming withwould move and and that created problems with getting compliance with testing soI think that sort of experience is it is extremely important the third is how tothink about managing the surge that will be felt on your hospital infrastructureand we know everywhere that there is likely going to be a very steep increasein need for hospitalization and in particularly intensive care withventilators I think the experience of China South Korea in acceleratingexpansion of that infrastructure and the human resources to deal with that hasa tremendous amount for us to learn from so I think those are our lessons thatare not conditional on politics other than political will and I think whatwe're seeing as our leaders are stepping up but what we really need to see istangible clear plans on testing and in particular on supporting the surgecapacity for hospital care in order to secure public confidence that we'reactually doing everything that we can to to manage this pandemic I'd like to justadd that I think there's many natural experiments going on in the world andit's there's a risk of oversimplifying and saying China is doing well becausethey are communist or Italy is doing well because people kiss each other onthe cheek twice and there are so many different countries and there are somany different factors between health care systems and social norms and Ithink we should definitely know we should be very prudent about justcomparing to and saying it's because of one leader or one country and we have tothink through all of the possible facets and then we have to converge thepossible facets into actionable intelligence and as Tim says one of thethings that seems to transcend all boundaries and borders and politicalparties is that testing is good and more testing is bettercan i Derick just to come in and not to continue on this but I do think also thereporting on testing is particularly important and then just drawing onMarcelle suggestion of learning from other countries if you go to the UKDepartment of Health website they report on the epidemic every day by startingsaying this number of people have been tested this number people testedpositive this number tested negative and if you look at that and if the mediastarted reporting on the numbers tested and in particular the numbers testingnegative then it would change perceptions that everybody every newcase means that everybody is getting infectedI think this is the sort of communication that would help manage Xperspective both with politicians but also with the public and I think thesesorts of data are real data and very helpful in putting risk in betterperspective so I do think there's an opportunity to learn from betterpractices on reporting which are not only what government reports but how themedia picks that up and also reports well I appreciate that dr.

Evans but I'mjust wondering well I appreciate the reassurance that some of these testresults might provide us is it not a bad thing that the population is a bitscared right now and therefore more abiding of social distancing and othermeasures I think and in the year I don't think there's any issue here withrespect to the extent to which people are aware that this is a serious threatand I think by putting things into perspective it's not to suggest somehowthat we're not dealing with a very serious problem but it doesI think behoove us not to paint everything as an Armageddon scenariowhen in fact the data don't support it and I think it's a responsibility forgood governance to present the data as they are or as best as we understandthem so I think that's a difference it's not to suggest telling people the truthis is is the same as saying don't be concernedwe're simply suggesting tell us the situation really as it is and thencontinue on no one is suggesting that we're going to back off on any of themeasures that we're taking with respect to social distancing and active testingand getting people into care as appropriate so being cognizant of timeand I appreciate the fact that you're both willing to stay on maybe a few moreminutes I do have a few more scientific questions maybe I'll turn to you dr.

bear maybe we can do some quick rapid-fire here and try to get through afew of these questions from Erika can the coronavirus get into our waterand survive if I understand the question is about our drinking water and notgoing canoeing or swimming in the water in Canada right now and there's noevidence that it is transmitted through our water supplies okay what aboutsomebody Janet Bock actually was asking about but the fact that our librariesare closed people are considering sharing books and DVDs and magazineswith each other is it overreacting to think that doingthis could be dangerous it's not a complete overreaction becausewe're being told to wash our hands and try to keep things clean if you are inthe house with somebody and you're sharing a DVDwell we actually also have many options to get ebooks and to download things sothat if you don't want to go across town to meet somebody to pick up a magazinesee if this is the time that you should consider getting out electronicsubscription it's the same content it's just you don't get to turn the pagesmm-hmm question from Nicholas Matt Oh Sian should we be wearing masks eventhough they are deemed to be only partially effective well there that'ssort of two questions and the one question is our masks partiallyeffective and it gets that question depends on effective at what and forwhat but I think the main question there is should a healthy asymptomatic personwho is well going to the park wear a mask and I say the answer is no when Iwalk to work I don't wear a mask when I walk home I don't wear a mask shouldhealth care workers wear a mask if they go into a room with somebody who haskovin 19 or a suspect took over 19 yes what math should they wear they shouldwear the mask that their infection control officers have deemed necessarydepending on the severity of the illness and the procedures going on there areclear directives in the health care system about when to wear a mask and whoto wear a mask but people who are walking to the park and back that is notone of the reasons to wear a mask okay I've got two more quick ones here onefrom the taniel brand asking about the potential impact of Kovan 19 on pregnantwomen are there any extra steps you would recommend they take to protectthemselves I am unaware of an association between Co mid-nineteenand adverse effects in the woman nor I am unaware of any data uncovered 19 andadverse effects on the fetus I am sure that these data will be accruing withtime the outbreak started around early November according to the genomicepidemiology data so in terms of birth outcomes we would not have past 9 monthsso we will have to wait until 9 November plus 9 monthsTim can do that faster than me I'm gonna guess that's August 1 but I don't thinkwe know the answer on either those it's a good question for which I think thedata are still waiting mm-hmm and we cannot do an entire webcast withouttalking about our pets Tim Sellars was asking he says he's been practicingsocial distancing and walking his dog to the park I stay away from the other dogwalkers but my dog plays with other dogs is this a potential problem there is noevidence that dogs are spreading coronavirus to their owners and I amalso unaware of any evidence that cats are spreading gröna virus to theirowners I have seen firsthand that when dogs go to the dog run they do not dosocial distancing and they do all kinds of things that we would normally thinkwould be really good at spreading all kinds of microbes but we're not awarethat that's going to change with Kogan 19 nor am i aware that the dogs areactually going to follow our guidelines I think we have to let our dogs playmm-hmm great now dr.

Evans I want to ask you a bit about vaccines I know we spokea little bit this about this on our last webcast do you have any update or anynews on when the world might see a vaccine and well I think that's itdepends who you ask but I think what I'm hearing is that the earliest would bewithin a year to 18 months and that would be the very earliest there aresome vaccines that are now in what we call phase 1 clinical trials and we'reseeing more and more candidates but the phase one needs to go to phase 2 phase 3so there's a distance and not all candidates in phase one make it throughand secure with evidence that there actually have the potential to be aneffective vaccine so my understanding and Marcio may have more to add on thisbut that the various barrier list we see a vaccine is one year to 18 months andthat's I think if all goes well with the current candidates that are into testingit may well take longer as we've seen in the context of HIV and we've beenlooking for a vaccine since well well over 20 years and and we still haven'tgot a vaccine for HIV so not to take away hope and not to take away any ofthe importance of investing and trying to accelerate the development ofvaccines as we have through something called the coalition for epidemicpreparedness and innovation sepi but it may be longer than a year's18 months so from my advantage if you're creating a new product whether it's anew vaccine or a new treatment there is a due process that involves preclinicaltesting phase 1 phase 2 phase 3 trials and that takes time in order foreverything to be done correctly if you have a product that's already FDAapproved for a completely different indication then you can fast-track anddo something called like an off target or off label study and that's what someof the trials that are in the New England Journal are at looking at drugsthat were developed for something else whether they could work for Kove it thesame principle could in theory apply if other vaccines that are already goinginto people happen to have some off-target effect again sokovia timeaware of people talking about that and and looking at whether there are ways toinvestigate that but I am unaware of something that is an already licensedvaccine that has activity against Ovid but that is the fastest route I canimagine to a covert vaccine although that's a veryexploratory idea right now we did get one question which I would like tomention here from Alexandre satorious who's asking if there's actually a needfor volunteers so either help with the important research or to help with anyof the testing so that question is is well-receivedI have heard I've had that contact from professors at McGill who were trained asdoctors another country who were volunteered to put on their white coatsand stethoscopes and come and step in and help in the clinic in any waypossible I have had contact and emails from students who are in research lab orwho have been in research labs offering to volunteer and help with diagnostictesting in the microbiology labs we don't yet have a place for that but wealready are starting to see for instance that are some of the people who havetrained and retired are signing up to come back into the ranks of the workforce and we have people who have the license but are doing extra training whohave signed up during the period of extra training to come back and helpwith for instance Kovich clinics so we're starting to see that our workforceis increasing as people who have left the workforce are coming back and arevolunteering and the next level may be that we will ask for volunteers to alsosupport them as we grow frapp our workforce is good andcuriously because of the reason that nobody is travelling everybody is intown nobody's overseas nobody's at meetingsso we are okay now but as tim has alluded to before we're probably justbefore the surge and what our capacity is when the surge hits remainsundetermined right now let me just add a few things to Marcel's great responseand that relates to one for everybody who's in who has their health and hasexpertise in one domain of the other it's really important now to think abouthow you can be part of the solution and I think it's a mistaketo assume that existing structures governmental or hospital or publichealth have all the resources they need the grim reality is they don't and sojust as an example my discussions with the government of Canadathey're very receptive to the idea that we you know we've got a greatepidemiology unit at McGill they'd love to have two or three of our bestepidemiologists to help them strengthen the daily reporting on the epidemic andand if we can do that we would love to do itmanaging supply chain for all of the different parts of the Diagnostics thatare needed that nasopharyngeal swabs the transport media the reagents those arethings that require innovative solutions in in the current context and mightbenefit from entrepreneurs who understand how to source these sorts ofcommodities quickly and efficiently and that scale and aren't necessarily thesorts of things and experience that some of the desk officers who are responsiblefor that have experience with so I think the intent of that question is isabsolutely the right spirit and let's see how you in your own experience andexpertise can play some positive role to strengthening the response and I thinkif we do that collectively that's going to make a significant difference inmanaging and responding to the current situation now that would be a greatquestion to perhaps end on but I do have to ask you this next one I know theanswer I'm hoping you can each answer in one word but it's such a great questionfrom Peter Lippmann is there any rational explanation for the apparentlyoverwhelming obsession with toilet paper no dr.

Evans okay so let me ask you onefinal question I have one of my own which I'm hoping to maybe end on on somesome some good hope but as you know we're hit every daywith an onslaught of grim statistics and bar graphs is there any one data pointwe should be looking out for either in our local communities or the globallevel that would give us all a sense of hope or relief that the spread is infact slowing down and we're nearing the end of this nightmare so from my view Icoming back to what Tim said before the number of tests the number test positiveI don't know what the percent positive means from Canada to Germany to Korea ifI don't know who is getting tested so I would not use the percent positive testthe number of tests could be useful or not but as you roll out more testing thenumber of positives goes up I'm not sure if that's the oneso my grim answer sadly when I look at dashboards and I look at Italy versusGermany versus China versus South Korea I'm looking at deaths I know it's a verysad statistic there was a fantastic YouTube video looking at the obituarypages in the barrack remote newspaper in Italy showing that obituaries went fromone and a half pages to ten pages and if I see that the number of deaths goesdown today then I can be optimistic that the number of transmissions went down 14to 21 days ago I know it's a sad statistic but that's a hard statisticand it's a very meaningful statistic so that's the one that I'm currentlytracking right so as somebody who's a little bit more optimistic and isobsessed with with tracking the imperfect data on on numbers tested andnumbers testing positive I think the important statistic to look at is thenumbers testing negative and if that continues if that trend is trendingdownward then I think recognizing that most of the people that are being testedare high risk and then that is a sign that I think will lead 14 to 21 dayslater too much more definitive sign of progresswhich is decreased deaths but you can certainly see that trend in in SouthKorea and I think if people recognize that we're talking about 90 or 95percent of people testing negative going down going up to 96 to 97 98 those areindications not only that we're moving in the right direction but still themajority of people are not getting covin 19 great well hopefully that dayis not far away for many of us in the world so we are at the top of the hourand that about wraps up the time we do have today time and over times before wesign off I would like to remind everyone that this video will be available atthis same link very soon after our recording ends so feel free to watch itagain if you'd like or shared with others who may not have been able totune in in real time I'd also like to invite you to keep an eye out for moreemails from the guild I promise you there will be fewer than you're used tobut we are committed to providing our community with the news and informationyou need to stay safe and to stay informedincluding more webcasts with our academic experts and finally I wouldlike to extend a sincere thank you to dr.

Evans and to dr.

bear for joining ustoday and for sharing some incredible insights with all of us I know yourschedules are quite packed and we really appreciate the time you took out of yourdays to speak with us today and I hope we'll have a chance to connect againsoon Thank You Derek Thank You Derek thanks MarcelCarol thank you you.

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