On Thursday April 16 at 7:30 p.m. EST, the Globe and Mail’s health columnist André Picard answered reader questions during an Instagram Live

Friday, April 17, 2020

The Globe and Mail

As the information and advice around the new coronavirus changes, The Globe and Mail’s André Picard answered your questions about COVID-19 on Instagram Live .

André, The Globe’s health columnist, was joined by moderator Madeleine White to break down the latest scientific evidence, government policies and public-health advice concerning the pandemic.

When is this going to be over?

Madeleine: Starting with the most important and most asked question first: When is this going to end?

André: None of us know. We haven’t had an epidemic like this before, so there are a lot of unknowns. The best we can do is take clues from other countries that are a little ahead of us, where they’ve managed to flatten the curve and what they’re doing.

The implied question here is, “When are we going to be able to get back to work? When will our kids go back to school?”

It’s probably going to be many months. We’re going to see some sort of gradual return to – I don’t want to use the word “normal” because I think there’s going to be a new normal.

Some countries, like Denmark, this week are allowing children to return to school if they’re under the age of 10. I think that’s the kind of thing we’re going to see: a slow trying out of things. I think hospitals are going to open up because a lot of patients are not being taken care of and don’t have COVID-19. I think we have to get back to doing basic medical care, schooling, outdoor work, and then we’ll see.

How do we improve senior care?

Madeleine: How can we prevent more deaths of the elderly?

André: There is a lot being done, but the question is, “Is it being done quickly enough?”

We know the reasons why this is happening: People working in too many homes, carrying the virus around. Underpaid staff with no sick leave. People crowded in nursing homes.

That’s just a recipe for disaster.

We know all these things we have to fix long term. The question is how are we going to fix them in the short term. Alberta, B.C. and Ontario have all banned working in more than one facility.

But that change is going to take a lot of management. You can’t suddenly go from a workforce of part-time people working in 10 different institutions in a week, to only working in one. It’s going to take some really serious administrative input.

B.C. has handled it the most smartly: the public health officer has taken over staffing in every home – public or private, it doesn’t matter. She’s the boss. She assigns who is working. Nobody works in more than one home. That seems to have an impact.

Can I have a beer with my neighbour?

Madeleine: Is it okay if I have my neighbours over in the backyard and we sit two metres apart?

André: This is a big controversy. The Ottawa public health officer [this week] was asked about people who were having a beer with neighbours. Everybody got a beer and they sat in their own yards and yelled back and forth. She said that is not acceptable.

That shocked a few people.

But her argument was a slippery-slope argument. If you start doing that, the next thing you know, a few people coming over doesn’t seem so bad. It escalates. These questions are really difficult because they are about where you draw the line.

I often say that public-health rules are a bit like French grammar – every rule has exceptions. You have to find your comfort zone. I don’t tell people there are hard and fast rules. You have to find those practical solutions for yourself. Maybe you could have your neighbour over for a drink, but not a different neighbour every day. Don’t have five over.

But the big question people have is about going out for a walk or a run. And the answer always frustrates people: Of course, you can go for a walk, and of course you can go for a run, unless everybody does it. Everybody wants to go out and be alone. Then, we’re all together.

The best we can do is create better social-distancing spaces. I’m a big fan of Vancouver or Calgary, where they closed down streets. Close down streets so people can walk and still keep six feet apart.

Why aren’t we testing more?

Madeleine: Why can’t we seem to get testing ramped up for the general public?

André: There are political reasons, there are technical reasons. The big one now is the technical reason: It’s hard to get enough reagent. The chemicals used to do the testing are in short supply around the world. Doing the test is the easy part. The hard part is analyzing it: We have a limited number of labs. Many university and hospital labs are helping, which has allowed us to do a lot of tests in Canada.

We complain a lot, but relative to the rest of the world, we are about the fifth highest per capita. The issue in Canada is whether we are testing the right people. We have been really slow to test in nursing homes and we don’t test every single health care worker. We should test every person in the hospital, even if they’re not there for COVID-19. We have to focus on high-risk groups. Then we have to do random testing in the community, because one of the big unknowns is the number of people who have it, are not really sick, but are transmitting it to others. That’s the piece of the puzzle that we need if we’re even going to think about reopening society.

Madeleine: Can you explain the idea of an antibody test? Is it possible to roll that out?

André: We have a test, a swab in your nose that goes off to a lab. It tells you if you’re infected with COVID-19.

The other test is an antibody test. That’s a blood test that tells you if you have been infected – even if you didn’t know it. Probably a lot of people have been infected without being too sick. That’s probably going to tell us if people are immune or not.

The way viruses work is you have an antibody response, and then you’re resistant to getting that disease again. Not always 100 per cent. In theory, we should be able to do these antibody tests. If you’re immune or if you’ve been infected and you’re better, then you should probably be able to go back to work in society and not be at risk of getting infected. But there are many, many caveats. [The tests] are not very good. There are a lot of false negatives.

There’s new information emerging. In South Korea, a big study came out [this week] showing hundreds of people who, we thought were infected, got better and have antibodies. And they’re getting COVID-19 again.

What does that tell us? Either the test is no good, or maybe they’ve been reinfected, which is a really bad thing. Or it tells us that the virus can hide and be reactivated, sort of like herpes. That’s probably the worst-case scenario. That means we would be at risk, essentially forever. The government has been criticized for not buying millions of these tests, but I think they are right to hold out until there’s a better test.

How long will a vaccine take?

Madeleine: Where are we with a vaccine?

André: About 40 groups around the world are working on vaccines. A lot of promising stuff in vitro, in test tubes, we are doing well. Doing it in humans is much more difficult.

Realistically, probably we are 18 months away from a vaccine, maybe two years. Some more pessimistic researchers say we are never going to have a vaccine. We have actually never had a vaccine for a coronavirus. The common cold is a form of coronavirus. SARS and MERS are more deadly forms of coronavirus. We’ve never developed a vaccine for them. They are very tricky viruses – much more difficult than our childhood diseases, like measles, where we have had vaccines for 50 years.

Madeleine: That 18-to-24-month estimate is tossed around a lot. Is that generally how long it takes to get a vaccine out the door?

André: That’s the best-case scenario for doing all the steps.

Phase one is where you test the safety: does it kill people when you give them this? You have to rule that out. That’s done on animals and in the lab. Then, you have to test it on people. Then, you have to compare them.

There are stages: phase-one, phase-two, phase-three trials. At the minimum, those take a few months each. That’s where the 18 months comes in. That’s really the best-case scenario. But, around the world, there is unprecedented collaboration among scientists to try and get this done because it’s such a worldwide risk. This may be the fastest vaccine we ever develop.

Madeleine: Will we be socially distant until we do get the vaccine?

André: Well, the health minister in Britain yesterday said ‘we will have social distancing until a vaccine is commercially available.’ Which could have been a shocking thing to say.

But social distancing is going to have different definitions over time. We’re certainly not going to keep kids out of school for two years. We’re not going to stop visiting our friends or stop going to restaurants. But the new normal, maybe every table in a restaurant is six feet apart. We just don’t know.