Ep. 18: Is The Lockdown Doing More Harm Than Good?
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By devoting so much of our attention to stopping the spread of COVID-19, with lockdowns, with physical distancing measures, by closing borders and many businesses, are we ignoring the possibility we could be harming population health in other ways? That’s what host Shaun Francis explores with Dr. Vivek Goel, member of the federal government’s COVID-19 Immunity Task Force and vice-president of research and innovation, and strategic initiatives, at the University of Toronto.
Mentioned in this episode:
Vivek Goel’s podcast is What’s Next and it’s produced by the University of Toronto.
He’s on the federal government’s COVID-19 Immunity Task Force.
Find the POST Promise here and here’s the federal government press release.
The Toronto Star article in which Vivek argues the lockdown and the COVID-19 policy of eradication is doing more harm than good.
Highlights from Shaun’s conversation with Vivek Goel:
Shaun: I've been an avid reader of your comments in the Canadian media, especially more recently in the Toronto Star, where you made a very interesting comment regarding how we have to be careful in our fight against the pandemic.
Vivek: The goal was to deal with an unknown virus, a new virus, for which there was no pre-existing immunity in the population. The goal was not to completely eradicate the disease. These non-pharmacological interventions: social distancing, limiting mass gatherings and so on, [they’re] not meant to be a long-term intervention. And now the comments that I've been making in the media are really around the fact that there are serious consequences from those public health measures. They include all the people that haven't had medical visits, surgeries, and you know, that could be cancer patients who have gone undiagnosed or who have been diagnosed but haven't been able to get the treatment or the surgeries that they need. Cardiac patients waiting for their surgery or their treatments. But there are also people waiting for hip and knee replacements who are in agony, because the procedures are being delayed. There's all the impacts on children. We know that early childhood development is one of the strongest predictors of lifelong health and social outcomes. There's some people saying that, particularly disadvantaged children, whose parents are working, they don't have time to home tutor them—[they’re] going to wind up being essentially a year behind in their schooling, when we do get back hopefully in the fall.
Shaun: We have this situation with the lockdown, we have people who are economically disadvantaged providing our supply chain, so that those who are fortunate enough to work in technology jobs, or jobs supported by technology, can work from home. And then you have a whole other cohort of people that don't have the good fortune of being in that type of industry, who aren't working at all. You have one group, who in effect is supporting society so that we can continue to function but is disproportionately becoming infected, and having worse consequences as a result. So we haven't really approached it from an equitable philosophy, have we?
Vivek: No. This takes us to how we get out of these lockdown measures, which we haven't had, I think, a serious debate in society about. We now know a lot more about the disease, than we did back in early March. We know that the vast majority of the deaths are occurring in people over the age of 70. We know that most of the deaths in the people that require intensive care unit and ventilators in the younger populations are people with pre-existing health conditions. So we have to take more of a risk-based approach to thinking about the disease. So are there people who can start to go about their daily lives, still practising precautions? Don't go out if you have symptoms, don't go out if you've been in contact with a known case. You have to do your 14 days of isolation. Wash your hands frequently. Don't touch your face and mouth. Don't shake hands. Like, there's a whole set of precautions to take. But then educate people, treat them as adults. Give them that information and let them go about their daily lives, and put our resources into protecting the people that are at higher risk. Put our resources into the settings where we know we've been getting lots of outbreaks. If we take that much more strategic approach, that would allow a lot of people to start to get back to work. It would allow kids to start to have social interactions and restore their development, and it would get our society moving again.
Shaun: How does that approach differ from what we're seeing?
Vivek: One of the things that I talked about was the medical model versus the population health model.What I've been describing is the population-health perspective. We look at the entire population, how it's doing, what the consequences for the population are. The medical model, and I'm not saying this is wrong, I'm just saying this is the perspective, would be where you're seeing the patients. So you think of an emergency room physician or an ICU doctor, they're seeing the cases that are coming through their hospitals. And they're saying, this looks awful. I have to avoid this. Virtually all of our public discourse has been informed by the medical model where people are focused on COVID-19, and they're seeing what the consequences are and saying we have to avoid every case. The danger I see is that we are now educating or telling our population, that's the only way: we have to try to stamp out every single case. That's going to be very hard to do. It's going to come at a very costly price for us in health terms, as we've talked about, and it may be unachievable.
Shaun: I recall at the beginning of the pandemic, some infectious disease experts likening the pandemic to throwing your hands in the air to stop the wind. Yet it seems that is, in fact, what we're trying to do.
Vivek: When people are asked about how we get out of this, the response is often, we're going to get a vaccine. That's certainly something to hope for and to work towards, because that is one route out, right? So we stay kind of locked up as much as possible for as long as we can, and hope that a vaccine comes through. There's some hope. There's 100-plus candidates under development now, some have entered into human trials—but the fastest any vaccine has ever been developed in human history is four years. The average time for vaccines is about eight years. We have significant viral diseases such as hepatitis C, and HIV, for which we've never been able to develop a vaccine despite decades of research. When we do get a vaccine, it may work, but it may only partially work. It may require multiple doses. It may only work for certain populations. So there's all sorts of risks with the vaccine strategy. It took us decades to eradicate smallpox. So the eradication-containment type of mindset, which again, comes from the biomedical perspective, it's hopeful, but the promise to our population that it's the vaccine that's going to get us out of this, I think is an exercise that will lead to a lot of disappointment in the coming months when people start to say, "Well, where is it? Are we going to be like this forever?"
Shaun: Why do you think we're not hearing this?
Vivek: We hear it in other jurisdictions. Japan has taken a very rigorous approach to things. Avoid close contact, avoid fully enclosed spaces, avoid crowded spaces, but they've not had arbitrary one metre, two metre, right? So they've taken an approach that allows people to have a more nuanced interpretation and make judgments for themselves. We've all talked about Sweden, they took a much more nuanced approach. They unfortunately had the same situation we had in Ontario and Quebec with their long-term care facilities. And, you know, the regret that the Swedish state epidemiologist has shown is actually about what they could have done better in that situation. But he said he wouldn't change the fact that he kept restaurants open and so on. So there is conversation in different parts of the world. In Canada, if we think back in May, in Quebec, the premier and the director of public health actually did talk about a lot of the things that I'm talking about. But there was a huge public backlash and Quebec had to delay some of its reopening plans. And I think it's because we have overemphasized the prevention of individual cases of COVID. We've made people very, very afraid of COVID disease, that has led to sort of almost political impasse.
Please subscribe and rate us on your favourite podcast platform. Eat Move Think host Shaun Francis is Medcan’s CEO and chair. Follow him on Twitter @shauncfrancis. Connect with him on LinkedIn. And follow him on Instagram @shauncfrancis. Eat Move Think is produced by Ghost Bureau.
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