Infectious disease expert Dr. Lisa Barrett answers viewer questions about COVID-19: Part 5
HALIFAX -- The information surrounding COVID-19 can be overwhelming and, at times, hard to understand.
Some of the most rigid restrictions around the COVID-19 pandemic are being eased as every province goes at its own speed.
Scientists continue to work around the clock on vaccines and treatment as society becomes more at ease with the idea of living with COVID-19. But there are still a lot of questions.
Many Maritimers have had questions about the virus itself and how to deal with it. Particularly, when some of the messaging continues to change, as the science community learns more about the disease.
Dr. Lisa Barrett sat down with CTV News Atlantic anchor Steve Murphy on Tuesday night to provide answers to the ever-changing questions about COVID-19.
Dr. Barrett is a medical doctor and clinician scientist with expertise in infectious disease and human immunology.
In addition to a PhD and MD from Memorial University, an internal medicine residency at Dalhousie University, and an infectious disease fellowship at the University of Toronto, her training includes post-doctoral training at the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.
During her training at the National Institute of Health in Maryland, Dr. Barrett worked with prominent American physician and immunologist, Dr. Anthony Fauci, who is a member of the coronavirus task force in the United States.
Below is a transcript of the interview:
1. We recently learned that the first Canadian clinical trials for a potential vaccine are in fact being led by your colleagues, researchers at Dalhousie University. What can you tell us about that?
Dr. Barrett: There are several vaccines that will be tested in Canada in the coming months. The first of which is a vaccine trial which is a first in Canadian humans, which is being run by CanSino Biologics, a company out of China who is working with Canada’s National Research Council. Once all of the science is put together, in the next couple of weeks, that trial will start to be tested at the Canadian Centre for Vaccinology at Dalhousie University.
2. So how long does it take for a clinical trial of any kind to produce some results we can take to the bank?
Dr. Barrett: First the vaccine starts what we call phase one trials, they are done in a very small number of people to ensure that healthy people can get the vaccine and it’s safe. That can take up to seven months or even longer. Then they move on to phase two trials, where a larger number of healthy people take the vaccines and we see how the vaccine acts in those people and we look for signs that they are actually responding favourably to the vaccine.
As you know, a vaccine is there to educate your immune system about the infection it might run into. So we look for antibodies and other signs that your immune system is responding well in phase two, which takes several more months. Then in phase three we find out whether or not the vaccine is actually protective against a challenge, and that would happen during a regular viral season with this virus, where we would see if people who were vaccinated were less likely to get the infection than other people.
So the short answer is it’s going to take a while if this vaccine or others will truly work.
3. How certain is it that there will be an effective vaccine for this particular virus.
Dr. Barrett: It’s a great question because I think people assume that we will get a vaccine that is completely sterilizing and completely prevents people from getting an infection. It’s far more likely that out of the five or six vaccines that we will test, and we hope that several of them will work, but its far more likely that those vaccines will be somewhat protective vaccines that will help prevent the disease but won’t be perfect. So we really have to consider this as we move forward and think about multiple strategies; vaccines, and treatments, and continuing to wash our hands, in order to completely combat this virus.
4. What is going on so far as treatments for managing COVID-19?
Dr. Barrett: Around the globe there are multiple agents that are being used to attempt to treat this virus and its infection. Some of them are to directly inhibit the virus itself, and others are to ramp down the infection of the immune system that causes so much havoc in the lungs when people get the infection. Here in Nova Scotia, we’ve started a treatment trial that will be offering various different therapies that are used for other diseases at the moment and seeing if they actually prevent the progression of disease for people with really bad COVID-19 related illness. So that’s going on right now in Nova Scotia and will continue for the next year.
5. Does that include hydroxychloroquine which President Trump now says he’s taking?
Dr. Barrett: Yes it does include hydroxychloroquine as a treatment, not to prevent infection. We use it very carefully, it is a safe medication, but it is safe in very particular people who have normal heart rhythms and who are monitored. And for that reason we are doing this in a study, which is the only way people should be accessing and taking hydroxychloroquine for this infection at the moment.
It’s a pretty good thing to be in Nova Scotia right now as we have treatment trials and vaccine trials going on at the same time.
6. Are face shields safer to use than masks in protecting both the wearer and the persons encountered?
- Ray Stapleton
Dr. Barrett: It depends where you are and what you’re doing. If you’re a healthcare worker, sometimes a mask and a face shield are both important parts of protective equipment. However, if you are outside in your community around people who don’t have symptoms, which are the only people you should be around at this point, then a procedural mask or one of the reusable masks is sufficient, as long as your keeping about six feet of distance and not touching your face without washing your hands. So at this point, there is no real reason why people should be going around with face shields on, as long as people are adhering to the rules of staying at home when they have symptoms and not touching their face without washing their hands.
7. Should you be wearing a face shield without a mask?
- Joseph MacKenzie
Dr. Barrett: In a hospital setting, where you have to have both droplet and contact precautions we recommend both a face shield and a mask. However, outside in the community, if you decide to wear a face shield, just be aware that it won’t protect you from things that may be able to come down and under the shield, unless your wearing a mask. If I were to choose and I was outside in the community doing regular things that I’m supposed to do, I would choose to wear a mask instead of a shield alone.
8. Will everyone be able to have the antibody testing to see if we had COVID-19 unknowingly when the test becomes available? I, like many others, had an awful cough that lasted months in December!
- Amanda Cousins
Dr. Barrett: I never say never. Academically and from a public health perspective, it will be very interesting to go back and look at leftover information and see if we can find any evidence of this virus before we knew about it, but we don’t know the answer right now.
As for antibody testing, the tests that are available and becoming available commercially at the moment are becoming more specific and more sensitive, and at some point soon we’re hoping to have a reliable test that can tell you if you’ve been exposed to this virus before. Those are coming, and there are some that are becoming licensed at Canada. At that point, it will be very important as we move forward that we think about who to test and when to test them to determine if people have experienced this virus before.
It would be very difficult to test everybody for antibody testing, and that really shouldn’t change what your practice is. The best advice I have is do a test when you have something you’re going to change about either your treatment or how you behave. Right now, everyone should behave, even if they have antibodies, as if they could be infected or reinfected with this virus, until we determine whether people are protected by immunity after being exposed and also whether the tests really work as well as we think they should. So if you’re not going to change anything, you’re not sick, and you just want to know for curiosities sake, we really have to test the people who need to know; healthcare workers, people who could become very sick again if they were sick before. We’re going to prioritize people a little bit at first, but eventually we’ll get around to it and follow public health’s direction on who to test and when, once the tests become available.
9. Will COVID-19 go away on its own?
- Kevin Coones
Dr. Barrett: That would be nice, but I don’t think we’re going to see that happen. MERS, another coronavirus almost went away on its own, SARS has not come back in large numbers anywhere else. So those coronaviruses have gone away pretty quickly, but it’s not as likely to happen with this particular viral infection. So chances are, no, it won’t go away on its own, we’re going to have to build herd immunity over time, we’re going to have to develop treatments and we’re going to have to get vaccines, and we’re going to have to keep remembering to wash our hands and not touch our faces.
10. This is going to have to become permanent changed behaviour, it’s not something we’re ever going to abandon?
Dr. Barrett: Well the same could have been said for influenza when we have no good treatments and no good vaccines. However, over time with technology and science, and research and innovation, thankfully a lot of it going on in Canada, I think we’re going to make great strides going forward. We’re social humans, we like touch and talk and socialization, and eventually we’re going to get back there but it may be a lot longer than people like.
11. Some studies seem to indicate that the COVID-19 infection rate is as much as 15 times greater than "official government numbers?"
- Bob Davison
Dr. Barrett: It depends what you mean by ‘government numbers’. What we report, or what is reported by public health, each day in the news are the number of people who have been tested who are positive. I do believe that those are exactly the numbers of people who have been tested who they find positive, that’s definite. Is it possible that there are more people out there, that didn’t seek medical attention or testing? Probably, don’t forget that we think about 80-85% of people who get this virus get very minimal symptoms, and some may not get symptoms at all. It’s not unreasonable to think that maybe 10 times more people have had the infection that we don’t know about yet.
You mention the antibody test, that’s going to be a great way of eventually doing what we call surveillance, to determine exactly how many people have been infected.
This is the fiveinterview in a series of COVID-19 Q&A's with Dr. Lisa Barrett: