The fourth wave COVID playbook

A feature interview with one of Toronto’s most trusted experts during the pandemic, Dr. Isaac Bogoch, infectious disease specialist at the University of Toronto and Toronto General Hospital

Is a vaccine passport of some sort an inevitability for Ontario?

I’ve thought about this a lot. I don’t know if it’s inevitable. But we should at least be prepared. And we should have the infrastructure set up now. So that, if there is a change of mind, we can implement it seamlessly. And it’s something that would take a little bit of time to set up properly, in terms of documentation, in terms of communication, in terms of organization between all the stakeholders, including the general public. And you should do the heavy lifting now.

What should we expect in terms of increased cases with a return to school?

It’s concerning, right. So schools in particular, obviously, we’ve got to watch this like a hawk. It has been painfully obvious for a long time that kids can get this infection, and kids can transmit this infection. It’s also clear that kids just tend to not get as sick as adults, but they can still get sick and land in the hospital. It’s just much less likely. But of course, it can happen.

The Delta variant is that tough?

There’s not a lot of wiggle room for error with a very transmissible Delta variant. I think we will definitely be seeing outbreaks in schools. I think that’s a given. We saw that without the Delta variant, and we’re certainly going to see it with Delta, but, of course, we can mitigate the degree and breadth of these outbreaks with the mitigation efforts that we have. And if you look in the crystal ball, months and months ahead, we will have data on the safety and efficacy of vaccination in a younger cohort, including the five to 12-year-olds, and it would come as no surprise that there will be safe and effective vaccines for that age cohort.

What’s the timeline for that vaccine?

I think we’re looking at, you know, winter 2021 to early 2022. Initially I was thinking Halloween to Christmas, maybe toward the Christmas end of the spectrum.

Do you have kids? What advice do you have for talking to them about this?

I have two kids. We talk about COVID non-stop in my house, and I’m not the one initiating it. It’s my kids all the time. I tried. I don’t want to talk about COVID because I do that all day. And I try to escape it at night. But you know, obviously, if my kids bring it up, I listen. I love that old adage of “treat children like adults and treat adults like children.” Maybe I should rephrase that. I like the old adage to some extent: “treat children like adults and treat some adults like children.”

Are we all going to get boosters this fall?

For the population at large? Let me try to be careful with my words because we currently all don’t need boosters. But we should at least be open-minded that that might be a possibility. And that might be, you know, late fall, winter or even beyond. But when you hear about the United States saying boosters for everybody, I think there’s many of us that are a little bit skeptical. And if they have any data, we haven’t seen it yet. But the data that is available is not compelling. Obviously, we should be open-minded to emerging data that demonstrates that people need boosters. I just haven’t seen compelling data yet.

Should we not be using cloth masks any longer? What’s the latest?

I still think, you know, high-quality masks are the way to go; a good fit, snug around the nose and mouth …  (not neck masking). And the public health agency of Canada, I think, has very reasonable guidance on their website about three layers and covering the mouth and nose snugly. I think that’s fine.

When will we return to work en masse?

I think if we take more of a mid- to longer-term view, people are going to get back in the office. You know, whether or not businesses change and say, “You know what, working from home is more cost effective,” for whatever the reason, there might be a lot of people working from home, but I firmly believe that COVID is going to end. And, you know, it’s probably going to end with a whimper, not a bang. It’s going to be drawn out over a while, and it’s not going to go away for a long, long time. But eventually, we will return, and, you know, the office downtown will return, and sitting in giant stadiums cheering for your sports team or listening to music and spilling beer on each other’s laps, because we’re sitting on top of each other, that’s going to return. I’m not entirely sure when, but it will.