Dr. Phil Shin on third wave of COVID

COVID-19 second wave Q & A with Dr. Phil Shin of North York General

The chief of medicine and medical director of critical care at NYGH on the new pandemic phase, the challenges and the coming vaccines

The last time we spoke with Dr. Phil Shin, the COVID-19 virus was just starting to take hold in the city’s hospitals. Elective surgeries were cancelled and the hospitals were preparing for the worst. Now, after months of relative calm, the second wave is here. How is it different? What have we learned? TRNTO.com checked in with the North York General physician to get an update.

How is the situation at North York General regarding COVID?

The COVID numbers at our hospital have been increasing slowly over the last number of weeks. The non-COVID hospital volumes have been very high. So our in-patient units and emergency departments are near or at full occupancy, which is not unusual for this time. And so the thought of having additional COVID patients certainly increases, I think, our anxiety.

How do you feel the second wave of COVID-19 is compared to last spring?

You know, I think, at the present time, the total numbers of patients is less than the first wave for a number of reasons. I think the difference this time around is that the hospital has taken a lot of effort to try to maintain non-COVID services to patients who really need them. So surgeries and procedures and clinics were cancelled in the first wave. And we’ve been prioritizing, keeping them open and maintaining them to provide care. And I think that there has certainly been a strain on mental health services due to the adverse effects of social isolation. And I think that’s become magnified over time. And I think we are, as a result, kind of seeing significant strain, even with lower total numbers of COVID-19 patients in our hospital and in the ICU because of the higher numbers of non-COVID patients.

How close do you think you are to making those decisions about pushing back some elective surgeries and things like that?

I would say that there are no immediate plans right now. We’ve tried to work with the region and the province to be aware of certain numbers and volumes in total that might necessitate the ramping down of services. So there is a ramp down strategy. At the same time, I think a lot of local factors come into play, when hospitals have outbreaks or local increases in volumes, that can be a lot more influential in determining whether our hospital is going to be able to maintain all of our services or not as opposed to total provincial numbers. 

In terms of treatment for COVID-19, what have we learned from the first wave that’s helped with regard to being more effective in treating the virus?

I think the lesson learned from the first wave is that sticking to the basics is really important. In fact, the impact of new drugs and therapies has been relatively small. Some treatments like steroids have been shown to improve survival in hospital and ICU patients. But many of the studies on antiviral drugs, like hydroxychloroquine or remdesivir, have been disappointing thus far and are not showing clear evidence of benefit. There are other studies ongoing that are related to treatments like convalescent plasma where we don’t have final results yet. And so when I talk about sticking with basics, we really need to treat these patients like any hospitalized or any critically ill patient and focus on best practices for providing mechanical ventilation, nutrition, physiotherapy and optimizing the types of sedation that they’re getting, for example, to really optimize their chance of having a good outcome.

What are your thoughts on the idea that has come up over the last couple of days with regard to those advocating for a “COVIDzero” strategy?

I do think it’s really important to acknowledge that there’s a lot of uncertainty as to what the best strategies are to take, from a public health perspective, in terms of controlling COVID-19, and try to identify the things that we know for sure about COVID that are less clear. The things that we know for sure are that this is a disease that is highly contagious, especially when there are super-spreader events where one individual can infect many people, and that in a small percentage, but overall a large number of people, can cause severe disease that leads to hospitalization, ICU admissions and death. What I think is really unclear is how do you balance it and whether or not trying to balance transmission and the economy is really possible. I think COVIDzero is taking the approach that the middle ground has really not been working and it’s just going to lead to a growing number of cases and a need for more restrictions and potentially lockdowns.

We’ve been hearing lately about the good news about the potential COVID-19 vaccine candidates. What are your thoughts on the news from both Pfizer and Moderna?

I think the promising aspects of the vaccine information that we’ve had recently is that both the Pfizer and the maternal vaccine [for pregnant women] have demonstrated effectiveness. I think they were over 90 per cent effective in the human studies that had been done at this point. The other important piece, the initial safety data, appears to be very reassuring. And in addition, there are reports that they may be available for administration to the public by the new year. And so those things are all very positive. I think the challenges that remain include the logistics of distribution and storage, globally and locally. The Pfizer vaccine in particular needs to be stored at a very low temperature. How to transport that across the world as well as storing it within hospitals is going to require a lot of effort. And then I think, importantly, how we’re going to ensure public trust that the vaccine is both effective and safe will need to take a lot of effort.

When do you see the vaccine rolling out? 

According to what I’ve read, I think the expected time frame would be spring 2021. There may be some available before that, but in terms of being able to organize all the logistical challenges that I mentioned about distribution and storage plus then developing a clear framework of how to fairly distribute it both among different countries but also within countries to various patients, to various groups is going to take some time. So that would be the time frame that I have in mind.

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