These days there are more vaccines, fewer pandemic restrictions, and many Canadians are back in the office and back to school. There’s a lot to think about. That’s why The Globe’s daily podcast The Decibel asked listeners what questions they had about COVID-19 right now.
We invited infectious disease specialist Lisa Barrett on the show to answer your questions, such as: When you get sick, is there any way to tell if it’s COVID-19 or the flu or a cold? How long should you isolate if you have COVID-19? What’s the right time frame to get a bivalent vaccine – and what does bivalent mean?
The following is an excerpt from the episode with Dr. Barrett.
Before we get into our listener questions, and we do have a lot of them, I want to just start by getting a broad lay of the land here when it comes to COVID. How much COVID is actually circulating in Canada right now?
Well, I tend to have moved away from the words “waves” to think of this as a choppy sea. It’s got lots of depth. There’s lots of virus around. And when I leave my house, I presume I’m going to be in the company of people who have COVID, whether they know it or not. And we likely will see the choppiness of the waves, if you will, increase a little bit in the next few weeks.
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So this actually rolls really well into our first question that we got from our audience. This is on the topic of how much COVID is out there. Leeann from Instagram wanted to know, are people still dying of COVID like in the beginning?
The answer to that is absolutely not. Thanks to natural immunity or exposure immunity and vaccines, along with the fact that we think Omicron as a virus itself produces a different type of disease that may not be as severe in most people, but we are also probably underestimating the number of COVID-caused or COVID-associated deaths. And so still an important pathogen in our world. Not novel anymore, but certainly not benign enough that I think of it as a new normal.
Lots of COVID measures are being dropped or have already been dropped in Canada, including the lifting of all COVID-19 measures at the Canadian border. So that means no more masks on trains and planes, no vaccine requirements. And so, Manoja Chan asked: Are masks really not needed anymore?
I really hope that we can, as a group of people, as a society, as good citizens, think about respiratory season a little differently than we used to. And that doesn’t mean it’s catastrophic. It doesn’t mean that we have to go around living in fear. However, we’ve learned and shown really quite well with COVID that not only does COVID go away, but flu goes away if we wear some masks. I would argue as we start to think about a new respiratory hygiene culture in respiratory virus season, if you want to keep those around you and yourself as healthy as possible, masking in public places is a pretty reasonable thing to do, in fact. And you should feel very comfortable if you want to do it without fear of stigma or scorn.
This is also a question from our audience: Does it matter if you’re the only one wearing a mask in a situation like if you’re at a concert or something? Is that really going to make a difference?
The science around this, exactly how much benefit there is if you are a sole mask wearer in a sea of other people, is pretty weak. However, I would say think about it this way: If you’re in a space with absolutely no mask and no filter to all the respiratory particles around you, you’re going to get a lot of many things. It still helps to have a form of mask. The better fitting your mask and the more layers then the better your protection is for longer.
Let’s jump to vaccines then. We have a lot of questions about the bivalent vaccines in particular, especially because it’s now available across Canada. Eligibility depends, of course, on where you live. What makes this bivalent vaccine different from the previous vaccines?
A bivalent vaccine contains the older version of the virus, the one we know produces immune responses because that’s what’s been studied. So the manufacturers have added in that old, or what we call ancestral, version of the spike protein from COVID, as well as the Omicron spike protein genetic blueprint. And so what you’re getting is both the ancestral, because we’ve got all the studies done that those are responses that are robust and happen in most people. And then this new and updated version that gives a real refresh to your immune system and updates your response to the latest version, if you will. It’s like when you update your app on your phone to the most recent version. It works better. And that’s the presumption with this Omicron bivalent vaccine.
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And now with this bivalent vaccine, is there still a use for the older vaccines?
In Canada at the moment, the older vaccines are still recommended for your primary series. So first and second doses, those vaccines that are the ancestral or original version are useful for people who have not had vaccines.
A lot of people had questions about when they should get this shot. Marissa from Instagram says that they got their fourth booster in July. When should she get the Omicron-specific one? There’s lots of different timelines out there.
Yeah. And this all comes down to: have you had COVID itself in the winter period in between right now and when you last had your booster? Because that resets your timeline for when you should get your next dose. But the next thing that comes into play is how old you are. If you are an older person, your immunity tends to wane more quickly. And the same is true if you have a lot of medical problems or a poor immune system. In those folks, we recommend waiting 120 days. Other people who are younger, who don’t have any significant medical issues, the recommendation is to wait at least 168 days between your doses. And the reason is not because we’re trying to spare vaccine, it’s because your body needs time to recover, or else you run the risk of getting a diminished or smaller response to the vaccine if you get it too early.
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We are coming up to flu season, of course. So Wendy Roberts asked, how close can I get my next COVID shot and my flu shot?
We’re not recommending that people have to space them out. From a safety perspective and how your immune system works, it’s fine to get them very close together or to space them out.
Alanna asks, should I vaccinate my toddler who’s already had COVID before?
Definitely. We’re recommending that after a natural infection, either in adults or in children, that after the recommended number of days you go ahead and get vaccinated. That varies a little bit what the recommendation is, the time frame in between in different provinces, but definitely check in with your GP. People wonder if they’re in a place right now BA.5 is circulating and their kids are getting vaccinated with the original version, is that a problem? It’s certainly not dangerous and it’ll give them a good base to add to that natural infection immunity, and then hopefully we’ll have more vaccines that are bivalent for kids soon.
Kerri wants to know, are you less likely to develop long COVID if you are fully vaccinated?
Oh, lots of studies going on. And basically the take-home message is it does seem that at least two doses of vaccine probably lower your risk of getting the symptoms that we call long COVID. We’re not really sure what that means as an entity, as a disease yet, but it does seem to reduce your risk. How much is not clear, and in particular, the reason we’re not sure is that we’re not sure yet if Omicron and BA.4 or 5 Omicron, actually induces as much long COVID as previous versions of the virus.
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We were looking at what people were researching on Google to find about COVID, and a lot of the searches are people trying to figure out if they have COVID or if it’s a cold or flu or allergies or something else. So when you get sick, is there any way to tell if it’s one of these other things versus COVID?
Oh, boy. I wish there was an easy way to tell that, because then we wouldn’t be spending as much money as we are on rapid tests and PCR [tests]. There’s really not a great way to rule in or rule out without a test.
Let’s talk about what to do when you do have COVID. Stephanie Rempel said, public-health rules are all over the place. What isolation advice should I follow?
This comes back to my whole hope that Canadians are coming to a respiratory virus season culture. And you’re right, it’s all over the map. I think basically most human beings want to stay in isolation until they feel well, because a) it’s no fun hanging out when you’re feeling terrible with other people and being out in public or trying to work and b), it is somewhat risky to other people around you. Probably even if you’re vaccinated and the people around you are vaccinated, you may be a risk to others for up to seven days. Some places have gone with five, some said seven. And if you do need to be around others either family members, public workmates or vulnerable people, two strategies to consider: One, make sure you’re wearing a well-fitted mask for that period of time after when you may still be somewhat infectious. Two, if you have access, although we don’t know that it’s perfectly correlated, some people have decided to buy their own tests, rapid tests and test their way out of isolation. If they’re negative, they know that it’s highly unlikely they’re infectious to someone else. And at the same time, I think it’s really important to note that some people who are immunocompromised or who are older may shed virus for a longer period of time.
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I think many of us have heard about people who have symptoms and or they’ve been directly exposed to COVID and they still don’t test positive on rapid tests. Do rapid tests work with Omicron?
The protein itself that is detected by the rapid tests is almost identical in Omicron as it is to the other viruses, and therefore with lab strains at the same doses, the virus gets detected. What might be different, though, in these situations? Everyone in the house has Omicron and this one person has symptoms and keeps testing negative on a rapid test. You may not be getting that little swab where it needs to go. If you’re vaccinated, you may actually have the virus, but it’s at such a low level because of your vaccines that it’s very difficult to detect with the test. Or you may just have a different virus, even though everyone else around you has Omicron.
Looking forward to our future with COVID. Lacy wanted to know, are there any new variants of concern? What comes after Omicron? Do we know?
There are several that are on the list. And people think it’s a bit of a pain to do all this testing and then all the travel and airport testing that was voluntary; I can tell you it’s given us a really, really good look at the virus and how it moves early. Unfortunately, we’re going to lose a lot of that now, but there are several variants of concern that are out there. They look to have different transmission or look like they might escape immune responses that we’ve already built up. As of now, none of those have become fast-moving viruses. But the question asked is a great one, because if we don’t keep track, we’re going to lose track and be behind the ball again. Our vaccines can switch very quickly; it was June when the FDA told the manufacturer that they wanted an updated vaccine and they had it and are rolling it out in the millions in September. If we don’t have surveillance and we don’t keep testing and keep watching those variants of concern, we’re always going to be behind.
This conversation has been edited and condensed.