In conversation with…
Dr. Jason Kindrachuk
Prairie Manufacturer’s editor, Jeff Baker, spoke with Dr. Jason Kindrachuk, Assistant Professor in the Department of Medical Microbiology & Infectious Diseases, University of Manitoba, and Project Leader at the University of Saskatchewan’s Vaccine and Infectious Disease Organization (VIDO), to learn more about why diseases like COVID-19 happen, why some diseases run rampant while others don’t, and what we can look forward to as vaccines roll-out around the world.
Jeff Baker (JB): Why do these animal-to-human diseases and pandemics happen?
Dr. Jason Kindrachuk (JK): When we look at infectious diseases, about 60 to 70 per cent of all emerging infectious diseases are of animal origin, which means they’re moving from animals in into humans (or vice versa).
The reason why they happen is that over the eons of time that viruses and different pathogens had time to develop and evolve, certain ones have become reliant on being in animals, including humans.
For a virus to survive, it has to be able to continue to make copies of itself so that it has progeny, and those progenies go on. It’s kind of like us having kids. But the problem is that when we think about animals and higher biological organisms (like humans), we also developed immune systems to counteract those pathogens when we face them.
For viruses and these other emerging pathogens to survive, they have to be able to find a balance with that immune system. They have to be able – in some animal – to balance that immune response so they’re able to continue creating copies of themselves and move from animal to animal, but they don’t want to overstimulate the animal so much it starts to show signs of disease and ultimately dies.
The problem is that in nature we have animals that are able to carry these really horrible diseases and show no signs of symptoms or consequences of carrying them.
But we also have to look into our behaviours and things like climate change, and how all these things are combining their effects. Are we making incursions into areas or regions that we never would have previously? That puts us in greater contact with these animals that carry these viruses.
Climate change is even affecting the migratory patterns and behaviours of animals, and that puts us into closer contact in locations that never saw this sort of mixing or animal presence before.
It’s really complex.
JB: Why do some diseases go pandemic, while others don’t? How did SARS-CoV-2 get to the point of causing more than 112 million cases of COVID-19, but other coronaviruses (like the ones that cause SARS or MERS) didn’t?
JK: A lot of it comes back to the transmission patterns of these viruses. I’ll use Ebola for comparison because right now we’re seeing an increase in cases. We saw what happened in West Africa in Sierra Leone, Guinea, and Liberia (and beyond) from 2014 to 2016.
The Ebola virus is able to move from one infected person to one other person, and you needed to have direct contact between those people. That virus doesn’t move through respiratory droplets or aerosols, so it’s not an airborne virus. That limits its ability to spread as it’s only moved from one person, to one person, to one person.
The coronaviruses behind the original SARS and MERS are similar in the extent that we don’t – or we didn’t – see community transmission. Most of the SARS transmission occurred between people with very close contact – usually within healthcare settings or with people that are caregivers. As long as you can contain those cases, you’re able to limit the virus’ ability to spread through the population.
The virus behind COVID-19 is very different. We’re looking at a virus able to move from one infected person to two or three others, but we also know that in certain situations, that spread can actually be amplified now into dozens of people based on a bunch of different factors, and not just in healthcare settings, but broadly in the community too.
When we when we look at things that become pandemic and those that don’t, it’s just a difference in the nature of each virus and their abilities and methods to spread. We just need to look at smallpox, various strains of influenza, and now COVID-19.
JB: Why do these pandemics keep happening? Are they increasing in frequency?
JK: The fact is that our perception of how long pandemics have been occurring is is very short in in terms of the planet’s whole timeline. We have some sense that smallpox goes back thousands of years. Influenza, certainly. We’re now looking back into the 1800s and earlier for other pandemics that were occurring then. We’ve also got historical writings that would indicate we’ve been seeing pandemics of some sort throughout history.
Part of it is just the fact that we are, unfortunately, in close contact with animals and nature that are able to pass these viruses on.
Now, are they increasing in frequency? Certainly, emerging infectious diseases and outbreaks are are increasing in frequency. Pandemics, it’s tough to say.
For example, we see some type of influenza pandemic about every eight years, but we’re dealing with a very short period of time to be able to say how they’ve actually been increasing in the past. Really, the question over the next few centuries is going to be: are we going to see pandemics actually increasing in frequency, or is this something that just happens very sporadically?
Really, I think a lot of it is, unfortunately, a case of the right virus in the right place at the right time. That’s just what happens.
In China, there’s recently been a study that looked at biological samples for coronaviruses, and they discovered hundreds of brand-new coronaviruses that were never identified before.
When they looked at villagers who lived in close proximity to some of these bat roosts, they found that those people had antibodies against some of the viruses. That starts to tell us that these viral spillover events and interspecies infections that we often think of as infrequent and sporadic events, well, they’re actually occurring to a much higher degree of frequency than we’ve ever appreciated.
JB: Looking forward, do you see a point where COVID just becomes part of our regular existence and possibly just another less-serious infection?
JK: I think we’re certainly starting to see a lot of discussion about that being a likely consequence, and I think part of this comes from when we look at a transmission over the past 14 months.
Transmission has been cyclical for different reasons, so we’re seeing ebbs and flows, but we’re not seeing massive decreases. We’re seeing the disease being somewhat sustained, even with a lot of restrictions in place.
Vaccination is likely going to help us get close to eliminating COVID-19 in certain regions of the world, but it isn’t going to happen across the globe simultaneously. The likelihood is North America and Europe will see their populations vaccinated in large part later this year and into early 2022, but there’s a massive percentage of the global population living outside of these areas, in Africa, South America, the Middle East and so on. A lot of these areas – and especially the low- and middle-income countries are probably not going to see vaccines until late-2022 or into 2023
What happens during that time is that the virus continues to move into the human population, and as it does, it continues to change or create variants. Ultimately, the virus just wants to be able to move from person to person, and it might just continue to be with us for the long term.
I think we’ve seen a shift where people are starting to prepare for the uncomfortable reality that COVID-19 might not be something we’re able to defeat; it may be another virus that we’re facing on an annual basis.
JB: There’s a lot of focus in Canada on national vaccine procurement and each province’s vaccination plans, but you’ve said before that COVID-19 can’t be seen as just a ‘regional’ problem; that we need to approach it from a global perspective.
Can we really claim ‘victory’ over COVID-19 if only one (or a small handful) of regions or countries get vaccines in arms?
JK: I think we have to look back to smallpox and the smallpox vaccination campaign, where in the 20th century, we saw the eradication of the disease. Smallpox actually killed more people than any of the other infectious diseases combined. It killed more than 300 million people worldwide in the 20th century alone.
We saw a period of vaccine inequality during the smallpox campaigns, where not everyone had access to the vaccines at the same time. While we were able to suppress transmission, it still took decades for us to move the vaccines through different regions of the world where they didn’t have the ability to manufacture vaccines, where there weren’t the healthcare settings to do this work.
I look at the situation right now with COVID-19, and we again see this inequality between places like Canada and places I work in Africa. There’s just not the same access to healthcare or to vaccines, and that creates a lot of inequality.
JB: Going forward in the next three to six months, maybe further out, what do the vaccines mean for us? What developments are on the horizon?
JK: First of all, all the vaccines have actually looked really, really good in being able to decrease severe disease and illness, which is important. We want to be able to save lives, and we want people to not get sick, which reduces the stress on the health care system. That’s critically important for us.
We know our long-term care facilities faced a disproportionate burden. Same thing with underserved communities and minorities, so vaccines are going to certainly change that. We will see a reduction in the toll of the disease in these communities.
If you get vaccinated, does that stop you from getting infected and stop you from being able to pass the virus on to other people? It’s likely, but we just don’t know yet for certain, that the vaccines reduce that period of possible transmission. We’re starting to see some data suggesting that, but if it doesn’t stop transmission, it should at least limit it.
From an infection prevention and control standpoint, we’re still going be doing physical distancing and masking until we get to a point where transmission rates across Canada are being not only suppressed, but they’re also being sustainably suppressed.
What we don’t want to see is a short-term decrease then, as restrictions ease, a going back to an exponential trajectory as we start to make behavioral changes.
JB: What can we learn, or what should we have learned by this point in this pandemic?
JK: That’s such a great question. I think that there’s so many of us that are frustrated because we’re looking at this and saying, ‘We’ve talked about this for years, about pandemic preparedness for disease X.’
We’ve talked about coronaviruses being a potential pandemic threat, that they were viruses of concern, but what happened? What did we do? What didn’t we do?
We saw it in 2015 with the coronavirus that caused the MERS outbreaks in the Middle East and South Korea.
We always have to appreciate that infectious diseases have had an extremely long time to move about the globe, to figure us out, and to figure out how to best move from person to person or from animal to animal. This isn’t something we fully understand, but we certainly have to be respectful of these diseases.
There are always going to be bad viruses out there, and we will continue to see them over time. We know with influenzas that we’re probably getting close to that pandemic trajectory again after the last in 2009. We have to be responsive, but we need to understand that being proactive is always better than being reactive.
We certainly saw with this go-round that we had a feeling that we had everything in place we had the ability to do surveillance and identify things quickly. And to be fair, we did. We identified extremely quickly what this virus was.
The problem was that, as a global community, we’re also reliant on a lot of the same resources. In a time of global crisis, we’re all going after the same products for testing, for PPE, and for vaccines. I think we have to figure out better strategies to be able to do that and be proactive.
COVID-19 Safety in the workplace
We’ve been living with the COVID-19 pandemic for just over a year, and doing all the things to reduce transmission of the disease can be tiring. Employers and employees need to re-up their COVID-19 safety game to keep themselves, their co-workers, and their friends and families safe.
Workplaces are constantly changing, and employers must continually assess the risk of COVID-19 transmission at their workplaces and apply controls to minimize that risk. Employers need to stay vigilant and ensure their COVID-19 protocols are understood and being followed through effective training and supervision.
The first and most important step to reduce the risk of COVID-19 transmission at any workplace is to implement policies to ensure that those who are sick are not entering the workplace.
Employers also need to apply the hierarchy of controls as an effective approach to COVID-19 safety. The hierarchy of controls is a system for controlling risk in the workplace that involves eliminating or reducing risks through controls ranked from the most effective and highest level of protection to lesser levels of protection.
• Workers need to maintain physical distance of at least 2 metres from other workers and members of the public. This can be done through work-from-home arrangements, establishing occupancy limits, rescheduling work tasks, rearranging work spaces and movement of people, or other means.
• Where physical distancing is not possible or cannot be applied consistently, the next level of control is the use of barriers if it is appropriate to the work task and the configuration of the workplace. Barriers must be designed, installed, and maintained correctly to be effective.
• Where physical distancing and barriers are not possible or cannot be consistently applied, the next level of control is masks. Masks should be required by workers for work processes and circumstances where they are interacting in close proximity to other workers or members of the public. Employers must ensure that masks are selected and used correctly.
• All of these measures must be supported by effective cleaning and hygiene practices, including handwashing, cough hygiene, and cleaning and disinfecting.