Dr. Lisa Barrett: ‘Every day that we live through this we’re ticking off more immunity’

As we slog through yet another pandemic winter, many are exhausted by the never-ending nature of it and weary of the ongoing uncertainty.

The Halifax Examiner reached out to Dalhousie University infectious disease specialist, physician and researcher Dr. Lisa Barrett to talk about this current wave, people’s fears, and why she believes there’s light at the end of the tunnel and things will look much better this spring.

Here is our conversation, edited for brevity and clarity.

Halifax Examiner (HE): What do you say to the many exhausted folks who just feel hopeless about where we’re at right now?

Dr. Lisa Barrett (LB): It’s an understandable feeling. It’s been a long haul, and every time we feel like we’re making progress, there seems to be something that takes things backwards. What I tell people is, remember that we’re still not done with the pandemic, and that means change. But we’re, geez, 400% ahead of what we know about COVID, what we can expect from it, and how we can treat it and avoid it. 

For people who don’t feel like we’re making progress, it’s really super helpful to reflect on how far we’ve come, expect that there’s going to still be more change coming, but if you look at every three months, we’re headed consistently in the right direction. That’s the way I look at it. 

HE: You’ve said there’s reason to be hopeful we’ll be in a much better place this spring. Can you elaborate on that?

LB: The things I look at are number one, we have the ability to have vaccines that prevent really bad illness and death in most people. Can’t underestimate that. Not only do we have the technology and the science, but we also have the supply now to get those doses out to people. Third doses or boosters for those who need it, and vaccine down to folks who are five years and older. That’s a key, core part for me of why I have hope around this.

Even with Omicron, where this current vaccine is not as good at preventing all infection, it is still good against preventing hospitalization and death and that’s after a third dose. 

Kids are getting vaccinated. People of similar ages hang out together. If you’ve got a whole cohort of people who aren’t vaccinated at all, they become if you will a weak link in terms of stopping or decreasing spread in our community. Now those kids who go to school together and play together and learn together, they started getting vaccinated. That’s a big bonus that does cut down on spread.

Then we’ve also got as of the next few days access to yet another tool (antiviral Paxlovid, recently authorized by Health Canada) in terms of early treatment. If we can get early treatment out to people once they have COVID, that’s another thing that both prevents spread, hopefully, but also severe disease. To me that’s very important.

Those are big tools in our toolbox that are going to allow us to be able to control spread and not break our health care system so we can’t look after anything else. That’s why I see this as a positive thing going forward.

HE: So you feel that there’s light at the end of this tunnel?

LB: I do. I absolutely do. I think we’d be silly to take away all of our precautions that keep us going in the right direction too fast. We need those third doses out. We need kids (vaccinated) too, and that’s going to take a couple of months. But if I phrase it a different way, instead of months, that’s eight weeks. That’s nothing. We’ve been doing this for 52 times 2 weeks. 

So eight weeks? We can do anything for that length of time. Then we start to get into late spring, May, and then you’re outdoors, you have other options for not always being inside. Ventilation gets better even as we’re finishing up with the final boosters, third doses and we can look at things a little differently.

Spring looks good, I think. The pandemic won’t be over because we’ve got the rest of the world, but certainly how people interact with each other can start to take on a meaningful tone. 

HE: We keep hearing the word mild in some circles to describe Omicron. How would you characterize it and what’s your messaging to Nova Scotians?

LB: I’m not a big fan of the word mild for it right now. Mainly because I think what people think about is something like the usual common cold that really doesn’t land many people in the hospital. The other thing is we need a couple of seasons of people getting exposure to virus over time in a controlled way because that adds, it builds on, our ‘immunity sophistication’ if you will, and we need that. 

Although for the vast majority of folks who were vaccinated in particular, Omicron doesn’t land them in the hospital, I’ve talked to a lot of people with COVID in the last four weeks personally as a physician. They aren’t feeling great, and they certainly feel much more taken out than they do with the usual common cold. That includes some young and healthy people. There are lots of folks who are not going to end up in hospital and a few that aren’t even going to know they’ve been infected. But that’s not the majority. 

I would say be careful about this. Mild implies that this is not a significant illness and it is. Our vulnerable people, even with two vaccines, end up getting sick. Until we get those folks boosted, I really do think we have to keep these infections spaced out. If folks are going to see or be around or have in their family unit people who are vulnerable, we just have to be careful until we’ve finished getting all those tools — including the vaccines and early treatment — out there. 

HE: We hear a lot of people talk about endemic. Can you clarify exactly what endemic means and how we’ll know when we’re there? 

LB: I have been hearing people tossing this word around for a while. It’s part of my world because I do infectious diseases and it’s becoming part of Public Health’s world. But it wasn’t always their thing because Public Health deals with many, many things and infectious diseases are only a tiny part of it. In infectious disease, we deal with the word endemic all the time. Basically it means that a particular infection, if we’re talking about infections, is at a level of commonality that you expect it to be present over time without ever entirely going away. 

But what it doesn’t mean is that suddenly ‘Oh it’s endemic, means it’s mild,’ or, ‘Oh, it’s endemic, you just learn to live with it.’ Well, the learning to live with it has to take into account how serious the disease is, its seasonality. Endemic does not mean it stays around low all the time. It may, but it may also surge and regress, surge and regress with seasons or over years. 

There are many endemic infections. For example, malaria in parts of the world is endemic because it’s common and it comes and goes in those areas. It does not mean that it is mild or that it does not cause significant health problems.

I think it’s really important that we understand that true infectious disease virology people don’t talk about endemic until we’ve figured out a virus enough to know what it is as a disease, how it’s changing, and what its pattern is. We don’t have that figured out yet for COVID-19, so we have to be careful. 

We can all say things like ‘Gotta learn to live with it.’ We have to learn to balance deaths, hospitalizations, and other non-hospitalizable illness that still take a lot of people off work given the way this virus looks right now.

We need to figure out what it does, how it does it, when it does it, and how vaccines are going to affect it — which we still haven’t fully figured out — and how building immunity in our communities is going to look before we can switch from just less precautions. Which is not ‘Let it rip.’ Some places are doing that. But I think that does indicate just a little bit of not quite knowing what the word endemic means when people use it right now.

HE: What do you say to parents who are sending their children to school but are extraordinarily reluctant to do so? 

LB: It always has to be based on your own child. I do think that. And if you have a very, very high risk child and you decide the right answer for your family is to not do full in-person learning right now, that’s OK. I do think, though, that parents need to recognize that the highest risk places are often not the classrooms alone. 

If you’re going to be worried about that, please also be worried about large and varied play dates where it’s unstructured play, likely without masks. Worry about other team situations, especially if they’re not masked and indoors. Worry about other things as much because it’s really about the community virus that puts your kids at risk and what we do as parents and family, friends around unvaccinated or under-vaccinated kids. 

We’ve got to be the adults, and if we really want to protect kids from getting infected, then we need to do a little bit of restricting ourselves as well. Other things to think about obviously other than those public health measures, is recognising that the vast majority of kids do not get super sick. Knowing who’s vulnerable and making sure if your child happens to be one of those vulnerable folks from a breathing perspective on a good day or they have immune system problems, etc., make sure you take a different approach. But for the most part, yes, we do recognize that this illness in children does seem to be generally pretty mild. It’s a balance. 

HE: Continuing with schools, if children are running around in gyms unmasked and doing vigorous activity, are they more at risk in that sort of scenario? 

LB: It is dependent on many factors. We used to say that we keep schools safe by keeping community virus low. Right now, we’re keeping community virus just barely from being burst. So indoor unmasked activity, particularly with a lot of shouting and close contact for an extended period of time — because it’s time-related as well — that certainly could be a place that’s less protected than more protected, so it is a consideration. Do I think that there should be no gym? No, not necessarily. But where there are options to do activities outside or with more distancing and some masking, I think it’s a perfectly reasonable thing to do right now. 

HE: Regarding long COVID, what do we know about the possible implications thus far?

LB: There’s still a lot of work even to define what is long COVID in terms of symptoms. Mainly because we don’t do great in medicine with either understanding or being able to fix syndromes that involve multiple parts of your body, all at the same time, in different ways, in different people. And so that’s a challenge. 

We can’t even give you a good sense of exactly how long people may feel unwell and in exactly what ways. I do think that it’s important for that research to be done before we all start deciding on pontificating about exactly what long COVID is.

It is likely to be some form of chronic, low level immune activation that causes people to have the symptoms they have, and figuring out how to treat that is very challenging. It’s generally directed towards symptomatic treatment at this point. So if something hurts, trying to do things to mitigate or reduce that feeling as opposed to really understanding it yet for focused treatment. 

What does it mean for people? If they feel like they have symptoms that might be related to that kind of syndrome, do talk to your primary provider about it. But expect that what that person is going to tell you is not ‘Here’s a pill that fixes it,’ but more ‘Here’s some strategies that help you live with it and feel better until we think eventually this gets better over the course of months.’

HE: You talk a lot about the importance that volunteers have had and continue to have on Nova Scotia’s pandemic response. Why has that been so important?

LB: I really and truly believe that part of the very early and sustained success we had — in addition to the public health part — was the fact people felt they had a role. Whether that was getting tested, because that’s a volunteer activity as well when you didn’t have to, and putting all those kits together. And we still do that to get them out to schools. We have people still making up test kits to go to schools and some work places, and libraries in rural areas. I mean, thousands of volunteers and hundreds of thousands of hours of activity have gone into this cumulatively and sustainedly. 

I think it’s not just about the activity of getting tested or putting the kits together, it’s the fact that people felt they had a purpose. And when they were asked to do more as individuals, they already felt engaged in a lot of ways. That’s many people. This I’m making up, but I believe Nova Scotians saw that the province included volunteers in the response and I think they felt more included, even if they weren’t actually the volunteers. 

That was invaluable, and I hope we continue that going forward. Even as we start to go into therapeutics and the like, if there are ways to support people in your small community to help them get tested or get to a test site or to register your elderly neighbour on the report and support tool, I hope that people continue to do that with and for each other because it’s made us very special in how we’ve approached this. 

HE: You recently tweeted that we’re in the ‘hardest, grey zone time’ and described this as a final squeeze when it comes to volunteers. Can you elaborate on that?

LB: End of the pandemic is not what I’m talking about when I say that. I’m talking about the end of this part of the pandemic where we had the biggest, most general restrictions. And that’s until the virus changes or something changes. 

It’s important to recognize that we get reprieve in the middle of all this. Maybe sustainably, maybe not yet, but we’re certainly into that time where there’s no exact science on how to go between the B.C. approach of ‘We’re not contact tracing, we’re not testing anyone, we’re just going to pretend that this is the way it is now’ to the still very test-based approaches with lots of contact tracing in some other places. Somewhere in the middle is probably the right answer. 

How fast do you shift? That’s what I meant by the grey zone. So I don’t know that there are right or wrong answers. I do know if we start to see more people dying or getting hospitalized with a vaccine-preventable disease, then we need to rethink again. But right now, we’ve got some good things going, I think. 

HE: Countries are now keeping an eye on the Omicron subvariant BA.2. What do you say to people who feel this is a never-ending cycle and something from which we’ll never emerge? 

LB: Think flu. Influenza. It changes not every year, but most years. Some years it changes so much and it’s so different from the vaccine and previously-seen-by-our-body versions that they have the potential to cause pandemics or to cause big outbreaks. But yet we don’t have to shut everything down because we have 200 years of natural and vaccine immunity. 

That’s why this won’t always be forever. Maybe I’m wrong. Maybe we’ll see something in the fall that causes us to need to do this for six weeks. But again, we have natural exposure and vaccines backing us up now, which is the difference from before compared to flu. We’re just not quite there yet. We’re getting so close. 

I hope we remember as a society that what we’re trying to do is limit vaccine preventable, bad things that happen around the most vulnerable without overly attacking other people and shutting down a health system. 

So until this gets a little calmer in our system, a little bit of caution. Are there going to be variants? There will be. Are most of them going to cause a great deal of angst? Probably not. There might be one or two of them over the next 10 years, maybe. But we’re backed up now by vaccines and we’re backed up by natural exposure, and that’s going to be the difference between this and what causes a pandemic like before.

HE: Is there anything you think that we individually, as well as provincial and federal governments, should be doing right now that might be helpful?

LB: I do think keeping people’s social circle low-ish until we’re out of this respiratory season, which is spring. I can’t sanction anything other than that right now because the cases peaking and the cases getting lower were a human-made thing. We did that with precautions and restrictions. So if we pull that too quick, we’re going to regress and we don’t have any capacity to do that. I think what we should be doing is not lockdowns, but certainly while we’re getting boosters out and learning a bit more, we just need to keep that closer-to-home approach in terms of our social interaction with some general common sense masking and hand-washing stuff. 

Just don’t get rid of it too fast, that’s all. That would be my one thing. I do think that government should be a little more verbal about that because when they (people) hear ‘We don’t care about contact tracing,’ they hear ‘Everything’s OK.’ And that’s not quite fair to our vulnerable people, I don’t think. 

HE: Is there anything I neglected to ask that you think would be important to articulate?

LB: I hope people see the difference in where we are now. Every single day that we get controlled infections in the community plus vaccines, we’re building the arsenal at a population level for the next version, the next variant, the next season of respiratory viruses. And that will include COVID 19. Every day that we live through this we’re actually ticking off more immunity, and that is so important. If we can get that message out to people, that’s very hopeful.

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