COVID wasn’t the last large-scale outbreak. The next one is right around the corner. In the last two decades, the world has experienced an alarming number of destructive outbreaks: SARS, MERS, Ebola, Zika and, of course, COVID-19. And although COVID is here to stay, it won’t always cause the level of disruption we’ve experienced to this point.

Still, if the recent past is a predictor of the future, we’re due for another major outbreak in 2023 or 2024, one that could cause substantial disruption—to travel, social interaction, the economy, and our very way of life. If we look at the last 13 years alone, we’ve had seven global public health emergencies, as defined by the World Health Organization. This cadence, of one event every two years, has been consistent, but it appears to be accelerating.

More than half of the world’s population now lives in cities, which are perfect places for viruses to spread. At the same time, we have never been more mobile. Billions of people travel around the planet every year. Humans have inadvertently become vectors for dangerous microbes, and it’s happening at unprecedented speed. These new diseases are primarily zoonotic, meaning that they originate in animals. They transfer to humans because we mass-consume other creatures and disrupt ecosystems. You may remember that a market in Wuhan, China, was ground zero for the COVID pandemic. Another example is the Nikah virus, a bat-borne disease that was first documented in domesticated pigs. Numerous Nikah outbreaks have occurred in humans around Asia in the last few years.

My friend is an infectious disease physician. who also runs a company called Blue Dot that tracks and forecasts outbreaks using analytics. According to our data, Canadians are the third-most internationally mobile population on Earth in terms of air travel per capita. Canada defines itself as a diverse microcosm of the world. That’s a huge strength, but it also means that we’re hyperconnected to global health risks. We share a long and porous land border with the United States, the world’s largest source of international air travel. If a virus is going to appear anywhere, it’ll likely be here.

Climate change also leaves us more vulnerable to outbreaks. Disease-causing insects, like ticks and mosquitoes, are living in new areas.

Climate maps of the world are changing, and so are infectious disease maps. Dangerous microbes also thrive in populations with a lack of housing and sanitation. The disparity between the world’s haves and have-nots is widening—not only between countries, but within them. This played out during COVID, as variants emerged in populations with limited access to vaccines.

If many factors are driving this problem, that means there are many ways to tackle it. In the world of health care, we often talk about primary, secondary and tertiary prevention. Primary prevention is about preventing the emergence of new diseases. On the individual level, one solution is to reduce our collective consumption of animals. At a higher level, it’s about respecting wildlife and mitigating our impact on ecosystems. If we don’t, we’ll see even more spillover of viruses to humans.

Secondary prevention is about early detection. That’s what Blue Dot does: we identify signs of outbreaks even before they’re widely reported, with the help of innovations like machine learning and data analytics. Businesses can be an incredible force for good in this arena by protecting the safety of their workers. I’d also like to see more health care providers tap into the analytics that companies like ours produce. There’s no clinician on Earth who can continuously monitor what’s happening around the globe. That’s where data comes in.

Tertiary prevention is about attenuating an outbreak’s impact, which can be accomplished by clearly communicating complex biomedical information to the public. More than ever, Canadians need to understand what kinds of actions are appropriate, depending on how viruses are (or aren’t) at play in their locations. Ultimately, if we want to create a more resilient world, we need to get faster, smarter, and better coordinated. If there’s anything that can move faster than an outbreak, it’s our ability to spread knowledge through the internet.

We must be able to detect the early signs of danger, understand the risks and mobilize responses that are commensurate with the situation at hand. To mitigate the effects of the next outbreak, we, as individuals, businesses, and governments, need to invest in and focus on prevention. If we don’t, we may find ourselves back in the middle of an outbreak, and much sooner than we ever imagined.

Q&A with a doctor in one of Canada’s long COVID clinics on the real dangers of the diagnosis, “I’ve seen marathon runners who can’t walk a block without being short of breath”

Dr. Angela Cheung works at one of Ontario’s long-COVID clinics.

The lockdown era of the COVID-19 pandemic is—hopefully—over for good, but even as the last of the mask mandates are dropped, many Canadians are still in it for the long haul. Long COVID, which occurs when symptoms of the virus persist four to 12 weeks after infection, has been linked to everything from brain fog to insomnia and even organ damage. Doctors are only now beginning to understand the full scope of the condition.

Dr. Angela Cheung, a senior physician scientist with Toronto’s University Health Network, recently helped to establish 18 long-COVID clinics across five provinces to provide care for Canada’s long haulers—and to map out what they’re in for. Here, she explains the extent of long COVID’s damage, how it’s burdening the already inundated health-care system and why it’s not all in your head.

What inspired you—and other physicians—to open Canada’s long-COVID clinics?

I’m a general internist, so I’ve been looking after COVID patients since March of 2020. In my group practice at Toronto Western Hospital, I was seeing more patients with lingering symptoms. I realized COVID wasn’t just an acute illness—some people weren’t returning to their usual activities after getting it. What we’ve seen with COVID reminds me of the early days of HIV, when people were struggling to understand the disease. At the beginning of the pandemic, I was reminded of a quote by the late tennis player Arthur Ashe, who was HIV-positive. He said, “Start where you are, use what you have, do what you can.”

How did the clinics get off the ground?

We got funding from the Canadian Institutes of Health Research for the Canadian COVID-19 Prospective Cohort Study, which is the first Canadian study to examine early outcomes for infected patients.

Our first one joined the study in August of 2020. After people heard about the clinic we were running, we started getting referrals from physicians and colleagues, and we connected with folks across the country who were willing to help. We’ve had family doctors, general internists, infectious-disease doctors, respirologists, and endocrinologists working with us, and we now have 18 sites across British Columbia, Alberta, Manitoba, Ontario and Quebec. We closed recruitment for the study back in March of 2022 after seeing more than 2100 patients, but we’re still treating people.

Are there any cases that stood out to you, in terms of their severity?

I’ve seen marathon runners—who had no other diseases prior to COVID—who now can’t walk a block without being short of breath. When I was working in the COVID ward, I saw 90-year-olds who were quite well and 40-year-olds who had to go to the intensive-care unit. A common idea is that it’s only people who are already unhealthy who will get sick and suffer from long COVID, but it’s not like that.

What kinds of mental health fallout have you seen?

We see anxiety and depression the most. Take the example of the marathon runner: they used to run without blinking an eye, and now they’re left wondering what the rest of their life will look like. Some patients have post-traumatic stress disorder from losing multiple loved ones during the pandemic.

There’s so much we still don’t know about long COVID. What do we know?

We know that the COVID-19 virus enters the cells through something called the ACE2 receptor, which is found throughout our bodies. That’s why we tend to see many different symptoms—in our gut, lungs, brain, heart and kidneys. We know that the more recent variants, like Omicron, may pose a lower risk of long COVID compared to previous strains. We also know that it affects women more, usually those between the ages of 35 and 65. Right now, we’re trying to understand why some people can’t get rid of their symptoms. Our group in Montreal has done genetic analyses that show there are two different types of variants that may predispose someone to long COVID. The science is moving forward pretty quickly, so every week, we learn something new.

What is the prognosis for long COVID?

We don’t currently have a cure, but we’re treating symptoms and seeing improvements. If a patient has fatigue, resting and pacing themselves is important. If a patient is coughing—and their chest X-ray is normal— we give them steroid inhalers. For congestion, we give nasal sprays. Long COVID isn’t something that goes away in a day or two.

Have any long-haul patients told you they’ve had trouble accessing care?

There is a lot of frustration. People sometimes have trouble getting doctors to believe that they still have physical symptoms of the virus. Some people make assumptions that these symptoms are due to anxiety, not from the virus. Our health-care system is also very overwhelmed—actually, it’s stretched for everything, not just long COVID. I do think that we need to start thinking more creatively in terms of how we can look after everyone. It’s not just physicians who are stretched.

Do you think governments are taking the effects of long COVID seriously enough?

I’m not a public health official;. COVID still exists. My perspective is that we should still be wearing masks, and we don’t need a mandate to wear them. You don’t need someone to tell you to use an umbrella when it’s raining.

Canada announces new travel restrictions as the world braces for Omicron

Politics Insider for Dec. 1, 2021: Omicron sparks new restrictions; new vaccine questions; and a political challenge

International travelers at Toronto Pearson International Airport in Mississauga, Ontario, on Nov. 28, 2021.

International travelers at Toronto Pearson International Airport in Mississauga, Ontario, on Nov. 28, 2021.

Omicron measures: Canada announced Tuesday that air travellers from all countries except the United States will need to take COVID-19 tests when arriving in Canada, CBC reports, as the world braces for the Omicron variant.

The tests will be required of all travellers, regardless of their vaccination status, Health Minister Jean-Yves Duclos said today. The requirement will also apply to Canadian citizens and permanent residents. Incoming travellers will have to self-isolate until they receive results of the test. Duclos said the new testing requirement will go into effect “as quickly and as much as possible over the next few days.”

The government also added Egypt, Malawi and Nigeria to its restricted list. Travellers from 10 countries will have to quarantine in designated facilities.

The world is waiting for scientists to figure out how effective vaccines are against Omicron. Dr. Isaac Bogoch, an expert at Toronto General Hospital, said we will have to wait to find out, but he thinks available vaccines will still prove useful in the fight against COVID-19: “It would be extremely unusual for a variant to emerge that completely erases the protective immunity of vaccines. It might chip away at some of the effectiveness but it would be extremely unusual that our vaccines, and or vaccine programs, are now rendered useless.”

May do more: Justin Trudeau told reporters the government may have to do more, Global reports.

Patience: In Maclean’s, Patricia Treble lays out what we know so far—not that much—about Omicron.

Omicron entered our lexicon at exactly 12 p.m. Eastern Time on Nov. 26, according to Google Trends, which recorded a massive spike in online searches. Since then, searches have only increased as people scour the web for news on the newest variant of concern. So new is the variant, however, that researchers are scrambling to unravel its secrets—likely for few weeks but possibly more—and pleading for patience.

Bans questioned: Even as Canada tightened travel restrictions, news was breaking that the variant had already spread to Europe before South Africa raised the alarm, raising questions about the fairness and efficacy of restrictions on African nations, the Globe‘s Geoffrey York reports from South Africa.

Over 60s stay home: The World Health Organization has urged those over 60 not to travel because of the increased risk posed by the variant, the New York Post reports.

Vaccines for poor countries: Opposition politicians and medical groups are urging the Liberals to support a global initiative to temporarily waive intellectual property restrictions on COVID-19 vaccines, CTV reports. The government says it will discuss the issue with the World Trade Organization.

Same spiel: The situation reminds Isabelle Hachey, writing in La Presse (translation), of the fight over AIDS drugs for Africa, and points out that Big Pharma can be expected to do whatever it can to prevent losing out on income.

The 168 member states of the WTO should take the opportunity to try to reach a consensus on the temporary lifting of patents protecting vaccines. So far, they have failed to come to an agreement. One can imagine that Big Pharma is doing everything to discourage them. The sums at stake are pharaonic. If we go by the past, it may be a long time before the member states come to an agreement. Millions of Africans died of AIDS before the WTO adopted the Doha agreement in November 2001, after years of intense activism.

Challenging times: In the Star, Susan Delacourt writes that the variant presents a challenge for the political class, because polling shows Canadians are anxious and depressed because of the pandemic.

But all signs are pointing already to a large, looming morale crisis, which politicians are going to have to struggle to contain in the days and weeks ahead. Just when Canadians were starting to plan holiday gatherings and winter trips to sunnier climes—and a long-awaited return to normal — the threat looms again of more lockdowns and renewed travel restrictions. So what does the political class have left in its arsenal — after nearly two years of this pandemic — to head off what could be the biggest wave yet of COVID-19 fatigue?

No jab? No travel: Unvaccinated travellers over the age of 12 can no longer board a plane or passenger train in Canada, CP reports. A grace period ended Tuesday.

Finished fight: In Maclean’s, your correspondent takes the temperature of the anti-carbon tax foes, who once looked like they might win, and concludes that the fight seems to have gone out of the main players, having lost in court and in several elections.

Ontario Premier Doug Ford, who won support from grassroots Ontario Tories by opposing a carbon tax, was happy to fight too. Manitoba’s Brian Pallister, who had a carbon tax plan of his own, joined in after Trudeau stood next to him and used him as an example of a co-operative premier. Behind the scenes, Stephen Harper was cheering the premiers on. “Let the other guys do a carbon tax, because we can all win the next federal and provincial elections on that issue alone,” he said in speeches. It did not seem far-fetched: in 2008, the Liberals lost an election built around Stéphane Dion’s Green Shift (a mix of carbon taxes and tax cuts). Today, Pallister is gone, Kenney is setting new records for unpopularity, Ford is no longer talking much about the carbon tax he once loved to attack, and Moe is complaining. “They’re complaining but complying,” says Tim Gray, executive director of Environmental Defence, about the carbon tax.

Make it work: In the Post, Tasha Kheiriddin ponders the pandemic hybrid Parliament and concludes that it might be fine.

Virtual participation might even enhance productivity in certain contexts, such as committees, which could continue sitting even when Parliament is not. The ability to hear witnesses remotely could expand connection between legislators who would otherwise not be able to present themselves in person. The reality is that, with the work-from-home revolution, some form of hybrid Parliament is probably here to stay. We had better make it work.

Bio:

Dr. Bill Pomfret of Safety Projects International Inc who has a training platform, said, “It’s important to clarify that deskless workers aren’t after any old training. Summoning teams to a white-walled room to digest endless slides no longer cuts it. Mobile learning is quickly becoming the most accessible way to get training out to those in the field or working remotely. For training to be a successful retention and recruitment tool, it needs to be an experience learner will enjoy and be in sync with today’s digital habits.”

Every relationship is a social contract between one or more people.  Each person is responsible for the functioning of the team.  In our society, the onus is on the leader.  It is time that employees learnt to be responsible for their actions or inaction, as well.  And this takes a leader to encourage them to work and behave at a higher level.