COVID19: Some Quick Q&A Part VI

by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)

Sorry, folks, the time got away from me again. And instead of expending the effort on a comprehensive post, you get a summary of some of the comments I’ve been sending to journalists recently.


But First…

Before we start, I found a site referring to me as a “global well being epidemiologist”, while misquoting me in the best ways possible. Someone mocked up a t-shirt to commemorate the find:


Then there’s this still from a TV spot, in which I look like I’m free-basing the chyron:


I love this photo of me on the cover of the National Post, which makes it look like I’m the evil scientist threatening Canadians with mass death:



I have particular affection for this still from CBC’s The National, when I was on a panel with Dr Lynora Saxinger. I like it because I look high as fuck. (For the record, I’m not. That’s the official story and I’m sticking with it):

Oh, and I’d like there to be a record of the kinds of things people are now speculating about me. I’m a quiet old professor enjoying a generous, though not extraordinary, salary from my sole employer, the University of Ottawa. And yet apparently I’m also on the payroll of the Liberals and  the Conservatives, Dr Theresa Tam, the WHO, and Bill Gates himself! Here’s a taste:


But because I’m a positive guy who likes to feel good about himself, I also want to create a permanent record of this very nice comment sent to CBC host Robyn Bresnahan after my first appearance on her show:


But I’d be remiss if I did not also include this capture from pharmacist Lindsay Dixon, who was letting Youtube create the captions from one of my TV interviews, and inadvertently discovered the truth of my family origins:

Q&A With Journalists:

Question from a journalist: “The latest data we have from PHO and it shows that the age group of 20-49 has by far the highest percentage of COVID cases as of now and for the last several weeks. Basically what I’m trying to get across to lay readers is, what does this mean? Are younger people not following social distancing? Are they simply more likely to go out and eat at bars and restaurants? Are they higher risk takers? Or are they more likely to get tested and therefore they show up as having the virus more than others? Also, when we see this trend, what public health measures might our policy makers want to think about? How do we get this trend in this age group down?”

My response:

Two possibilities, one or both might be true. First is that older people are better protected now, so in comparison the younger people now account for a higher proportion of cases. Second is that younger people are being more social in unsafe ways.

It’s commonly felt that young people have a lower appreciation for risk (we see it in other public health behaviours, like speeding and drug use); particularly true for younger men. And the Ontario data do suggest that COVID is now mostly a young male thing.

As well, young people have a much higher need for social contact. We all understand this. The combination of a rampant infectious disease, low risk perception, and high desire to mingle is a recipe for greater transmission in this age group.

What we have to do is deploy more and better messaging. BC made a call to Ryan Reynolds and Seth Rogan to appeal to the youth. That’s a bit pandering. But I appreciate the desperation in their voice. I’m a fan of talking about the carrot and the stick. The stick is the scolding voice and even the heavy hand of the law. But the carrot is what the young people get out of staying away from mass gatherings. What do they get? They get a safer society, parents and grandparents who won’t die, and an open economy such that they don’t have to be locked inside anymore. As well, they get to be heroic in an easy way. And who doesn’t want to be heroic?

If you skip the party this weekend, you might think about it for a couple of weeks, but will forget about it in a month. If you bring home COVID to your grandmother and kill her, you will live with that horror the rest of your life. That message needs to be expressed.

I also see this as a societal level marshmallow test. You know, you offer a kid a marshmallow, then tell him if he waits an hour he can have two marshmallows; can he delay gratification for a larger reward? If we can as a society delay the gratification of mass socialization, we get the double marshmallows of an open society and functioning economy.

In terms of the 2nd graph you sent, it’s not surprising that overall it’s the middle aged people who have been most infected. They are the ones with jobs, who must go to the grocery store, who are called upon to interact with the world. The other age groups have the luxury of self-isolation and protection.

A clarification from an earlier interview: I said on the news that opening schools is “relatively safe” and I really regret that choice of words. Will be on CTV Toronto later tonight; probably getting into deeper trouble. Some important points:

(1) As Andre Picard says, the question isn’t whether schools should be open –schools will open, whether we like it or not. Rather, the question now is how to do it safely.

(2) The single best way to open schools safely is to keep the incidence of COVID in the community as low as possible. If it’s not in the community, then it can’t get into the schools.

(3) We cannot eliminate the risk, however much we try. The goal, then, must be to reduce the risk as much as possible.

(4) While there is some debate around the science, it is now clear that children do catch it, and can transmit it to others to a meaningful extent. So the risk is real and should not be trivialized.

(5) Since risk will not be zero, we should not be surprised when school-based cases occur. What is crucial is to make sure that we have procedures in place to prevent those cases from becoming outbreaks that shut down schools and trigger epidemic waves: i.e., contact tracing and isolation.

(6) Ontario school boards have done much to prepare, but IMHO they could do more. Smaller class sizes, mandatory masks and face shields, improved HVAC, and plexiglass barriers between desks are just a few suggestions. Other countries have shown us that screening programs and community buy-in (like using hotels as additional space for in-class distancing, or reserving park space for children only during school hours) are also useful, as are staggered hours, encouraging older kids to study from home, and supporting those parents willing and able to home-school.

(7) IMHO it’s unfair to ask parents to choose their kids’ learning modality now in mid-August, when the situation in early September might be different. As part of community buy-in, we should empower parents with the opportunity to move their children online or in-class midstream, as the situation evolves. I realize this presents some pedagogical and administrative challenges, but those are surmountable.

(8) In terms of public health, it’s important to be clear about that the plan is for when someone in the school tests positive. What triggers a cohort quarantine? What triggers a school shut down? At what point will parents be informed?

(9) Employers must be partners in this process. If a child is symptomatic and must stay home, then employers must not disincentive parents from taking days off, as well.

(10) As per #2, #6 and #9, this is a community-level effort that requires the whole society to be on-side. Our ability to keep schools open safely also allows the economy to stay open.

Question from journalist (paraphrased): “Here in New Brunswick, there isn’t much clarity on what happens if someone in a school tests positive. Also, public health has commented that if someone does test positive, other parents in the school will not be informed. Can you comment?

My response:

My understanding is that in NB, high school kids will be in a blended (online and at-home) environment; whereas up to grade 8, classes will be kept separated into individual cells.

If someone in a cell tests positive, then that entire cell should be sent home for two weeks while saturation testing is applied to all members of that cell, plus first order contacts of the infected individuals.

Keep in mind that it takes a couple of days for sufficient virus to be replicated before the tests can pick up an infection, so we must be wary of false negatives. So I recommend waiting 2-3 days after quarantine to saturation test all members of the cell; then repeat that test in 24 hours to minimize the probability of a false negative.

This is contingent on there being sufficient testing capacity. But if the prevalence is low (as it is in NB), then positive cases should be rare; and therefore there should be sufficient testing capacity to allow for saturation testing, repeated.

In terms of who gets informed, I see both sides of the argument. Remember that we are writing the public health communications textbook in real time in the wake of this pandemic, so I’m forgiving of officials who don’t get it right the first or second time. We don’t want parents in the school to panic if they hear of a single case, and rush to pull their kids out of the school when they have not actually been exposed.

Remember that achieving zero risk is impossible. The goal here is risk reduction and minimization, not elimination (though that would be nice). We should expec a handful of positive cases as schools open. We should prepare ourselves for that. While we should expect that, we should also epect that public health will descend upon those cases and prevent them from becoming outbreaks. That should be the second half of the news. So to that extent, normalizing the occurrence of a handful of cases –followed by effective public health responses– means not having to alert all the parents all the time.

On the other hand, we’re in new territory here, where information and misinformation spread instantaneously. So for that reason, I would err on the side of complete transparency. That means that I would advise that all parents be informed if a case pops up in a school. This helps build trust. And maybe when it is seen that those cases can be handled and suppressed quickly, the need to report them will be obviated in time.

On the other hand, we’re in new territory here, where information and misinformation spread instantaneously. So for that reason, I would err on the side of complete transparency. That means that I would advise that all parents be informed if a case pops up in a school. This helps build trust. And maybe when it is seen that those cases can be handled and suppressed quickly, the need to report them will be obviated in time.

Question from a journalist: “I’m wondering if you have some advice to parents about whether kids should go trick-or-treating this year.”

My response:

(1) it depends ENTIRELY on what the situation is, come October. If the case load is higher than it is now, then it’s probably not a great idea. If it’s the same as now, or lesser, than we can probably manage some semblance of trick-or-treat.

(2) If we do do it, then it can be done at a distance, with candy left outside or no-contact sharing. If weather is good, participants can be outdoors (including home owners). In any case, it would probably warrant a dramatic change to how things have traditionally been done.

But we have to ask ourselves what the point of the tradition is. I think it’s a case of kids getting to dress up and wander around their neighbourhood, ring doorbells, and get candy. All of that can happen; it’s just the receipt of candy would have to be modified a little.”

Got more questions from a journalist about Hallowe’en. Again, here are my responses:

>1) Would you have concerns around homeowners leaving out bowls of candy for kids to take from? Does that create a surface-touching problem? Or can that be addressed with hand sanitizer, wiping down candy at home?

Fomite (surface) transmission is not as big of a COVID deal as we had first suspected earlier in the pandemic. In fact, as far as I know, there have been no conclusive and confirmed instances of anyone in the community getting it from touching a surface; we only have suspicions. So I think the risk of this particular disease being transmitted from candies is vanishingly small. Even so, the regular precautions should be taken, because other health factors might be in play, and you should always be careful of strange things going into your child’s mouth. So check for tampering, and wipe down packaging just to be safe.

>2) What could no-contact sharing look like?

One model would be leaving bowls of candy 6 feet from the front door, and standing by the door to wave at trick-or-treaters as they come by. Or maybe start a new tradition wherein kids chant “trick or treat” at closed doors, instead of ringing the doorbell, before grabbing the candy that’s been left out. Of course, there are some logistical issues, like how to ensure one kid doesn’t take ALL the candies, but I’m sure we can figure out some solutions.

Or, more simply, ring the bell, say your piece, stand back, then have the home owner throw candy into your bag from afar. 🙂

I don’t know. I’m sure there are ways we can make this fun.

>3) Do you imagine that local health officials will impose restrictions or even bans on trick-or-treating if case numbers get high by then?

Yes, I suspect new guidance would be forthcoming on this issue. An outright ban might be cruel. But we can be creative enough to recommend alternatives.

>4) What will you consider when it comes time to make a decision for your kids? (if they are of trick-or-treating age)

Luckily, my son is still an infant. But if he were not, I feel that the value of Hallowe’en is in the costumes, being out in the neighbourhood after dark, seeing other kids in costumes, and eating candy. The first three can be done quite safely, just by walking around while dressed up. The last, we can do back at home with our own candy. It’s not the same, I know. But for this year alone, I would make that one modification so the spirit of the tradition is sustained. (Spirit… heh heh. Pun unintened.)

A journalist asked a series of quick questions about what we can learn from other countries regarding school openings. I was very pressed for time, so sent quick bullet points instead:

> How have other countries done with back to school?

  • Denmark – opened on April 15, no increased cases
  • South Korea – some cases caused school closures
  • Israel – several school outbreaks leading to closures
  • Germany – multiple outbreaks within days of opening

> Is anyone getting it right? What are they doing right?

Denmark. Here is what they did right:

South Korea also did things right:

  • phased re-opening
  • mandatory masks
  • temperature checks at home and at school
  • a lot of sitting alone, even at lunch


  • mandatory masks


>Who is getting it wrong? Why?


  • masks only mandatory in hallways, not classrooms


  • during heatwave, masks were waived
  • limitations on class sizes lifted


  • most places have large classes
  • no masks
  • no additional hygiene measures
  • no new surveillance


> Can we learn anything from camps/daycares that have been open all along and apply that to the public school system, or are the factors too different.

We learned that kids CAN get it and CAN transmit it to a meaningful extent. While not surprising, it is useful information.


I had some additional comments on school openings that I shared openly:

There’s a lot being discussed around safe school openings right now. To simplify it, I think parents should remember that it’s really about five things: Community, Distancing, Barriers, HVAC, and Bubbles.

(1) Community: The single best way to keep schools safe is to drive the incidence rate in the community as low as possible. If it’s not in the community, then it can’t get into schools. This means that even if you don’t have a child or work in a school, you have a role to play in keeping schools (and thus the economy) open: wear your mask, physically distance, and avoid gatherings.

(2) Distancing: The next best way to keep schools safe is to enforce physical distancing for students and staff. This means small class sizes and large classrooms. It also means using as many doors as possible, and staggering hours or even days.

(3) Barriers: Placing barriers between people to prevent droplet transmission. This means masks, face shields, and plexiglass barriers between desks.

(4) HVAC: For that small fraction of transmission caused by aerosol transmission, an improved HVAC system, or open windows, or outdoor classes, will help.

(5) Bubbles: Limit exposures. The reason for consistent classes, separated cohorts, learning bubbles, etc, is to reduce the number of people to whom a given child is exposed. We can’t control what happens outside of school. But inside, having fewer exposures means (i) a lesser chance of being exposed to an infected person, (ii) an easier job of contact tracing if an infection does occur, and (iii) a lower likelihood of needing to shut down an entire school if an outbreak occurs.

Earlier today, the Prime Minister announced $2 billion in total funding to help schools prepare for re-opening. I offered my thoughts on how the money should be allocated:

My potentially unpopular opinions on how to spend new federal $$ on safe school openings:

(1) 100% goes to public schools; let private schools fund themselves
(2) deep cleaning is hygiene theatre; should not be a priority for a lot of new money
(3) distribute money based on size of school-age child population, not geographically or based on overall population size
(4) money spent on HVAC improvement is an infrastructure investment that will pay dividends for decades to come; don’t skimp
(5) bulk of money should be spent on reducing class sizes…
(6) …this means much spent on new hires, well paid to disincentivize working in more than one school
(7) …also means retaining and paying cohort of supply teachers who will have minimal exposures
(8) …also means $$ for admin support to manage staggered hours and cohorts
(9) spend some $$ on plexiglass barriers between desks
(10) spend lots of $$ on HR. People are needed to teach smaller classes, oversee movement of children in hallways, cafeterias, play spaces, and through doors, to drive more school buses
(11) money spent on HR is an investment in the population and will ultimately reduce other drains on our coffers.
(12) set aside some $$ for in-school disease surveillance and dedicated public health communications staff to transparently manage parent and community relations when the inevitable cases arise.


To date, I’ve had three appearances on CBC’s The National. They usually send some questions that will define the on-air live conversation. Here are the notes I sent to the producers before each appearance. But first, I got to see CBC’s pronunciation guide for my name. I’m impressed:

July 20, 2020:

>Give me a sober assessment of how Canada and the US compare. How successful they’ve been in controlling the outbreak, so far?

We like to think of our two countries as very similar –demographics, language, tastes. But they very different.

Pandemics have a way of revealing the truth of a nation, both its strengths and its weaknesses. In the USA, this one has revealed weak leadership, distrust of authority, a pathwork of plans and responses, and incredible social inequity.

In Canada, it’s revealed mostly a unified mindset, common public health goals, trust of expertise, and largely a willingness to sacrifice for the common good.

Those differences, in my mind, are writ large in these national incidence data. Canada is ending its first wave, with the disease simmering where it still persists. In the USA, it has exploded into exponential growth, with a first wave that shows no signs of peaking in many parts of the country.

>Is the pandemic in the United States clearly and measurably worse than in Canada?

There is a danger in aggregating regional data. States are very heterogeneous. So… Yes and yes.

USA: 143K deaths (15x), 3.9 million cases, national R=1.01
Canada: <9K deaths, 111K cases, national R= 0.9

More importantly, the number of cases per day in the USA is increasing rapidly and might hit 100K in a single day soon.

>If the US border reopens what is the risk to Canadians and our healthcare system?

The goal right now is to find a way to open schools safely in the Fall. That should be 100% of our public health focus. The best way to do that is to keep the number of cases in the community as low as possible.

With distancing and mask-wearing in place, the major threat of new outbreaks is new seeding events. Travel from a hotzone region represents a real threat of multiple new seeding events. Every seed is point source for an explosive outbreak. Every incoming American traveller is therefore a potential public health hazard.

If the borders were open, we would have to expend extraordinary public health resources to keep that threat at bay, and we would still probably fail. The threat is palpable and unnecessary, and puts a Fall school opening in jeopardy.

>What would you like to see in place before the border reopens (in terms of new infection levels?)…what’s the bar?

We look at 3 metrics at least: the number of new cases per day, the reproduction number, and the percent of tests that come back positive. There is no magic threshhold for any of these. But personally, I would like to see the first in double or single digits, the second well below one, and the third less than 1%.

>When the border does open, what protocols would you like to see put in place, in terms of quarantine and testing?

Ideally, any incoming traveler should quarantine for 2 weeks *before* coming, then quarantine again after arriving, for an unspecified time. If we had rapid onsite testing capacity, then anyone crossing the border should be tested, as well. And yes, even if they test negative, I want them quarantined. Obvious measures like temperature checks and symptom checking done; but that’s largely performative. Of course, detailed contact tracing procedures should be put into place, should they test positive at a later date, so that we can corral any exposed individuals.

Aug 5, 2020:

> How significant is the news that Canada is securing doses of the Moderna and Pfizer vaccines?

  • pfizer will sell at profit; Moderna might not have the manufacturing capacity
  • CureVac and Sanofi also producing mRNA vaccines
  • It’s really important to secure vaccines now so that Canadians are assured of that early access


> What has to happen before we get the vaccine into our hands?

  • frst, phase 3 data must be compelling
  • the vaccine must meet Canadian licensing standards before it can be considered for approval by Health Canada. (The Biologics and Genetic Therapies Directorate (BGTD))
  • The BGTD approves a vaccine for use only if it has been thoroughly proven to be safe and effective, and only if the benefits of the vaccine greatly outweigh any risks associated with it.
  • Canada has a unique program called IMPACT (Immunization Monitoring Program ACTive) to detect adverse events related to immunization and to monitor vaccine-preventable diseases.
  • There’s a vaccine task force that looks at, presumably, how the vaccine will be unrolled, but it’s not transparent
  • Distribution is an issue

>What are the priority groups to receive the vaccine first?

  • health care workers
  • residents of long term care centres
  • other medically high risk groups and possibly teachers
  • USA is looking at vulnerable sub-populationss (certain ethnicities and neighbourhoods, for example)


>How can we convince Canadians to get the vaccine?

  • That is the trillion dollar question!
  • an educational campaign
  • focus on safety
  • handle the matter with some delicacy

> Can we have a COVID vaccine as part of our regular lives in the near future?

  • yes we can, if many things go well. I anticipate in a couple of years, we will have the regular flu/COVID vaccine every year

Aug 10, 2020:

>Should we do better at NORMALIZING the idea of getting tested? (eg. today I’m going to buy groceries, fill up the car, pick up the kids, get tested, then make dinner?)

If we assume that the vaccine will not be in our hands for a very long time to come, then testing is our path back to normalcy. In the movie “Ad Astra”, Brad Pitt had to pass a psych test every few days before he’s allowed to continue on his space mission. One path forward is to require something similar for many people in general society, with respect to COVID testing.

For some aspects of our daily lives, yes, regular testing should become normalized. Ideally, regular testing of everyone in schools should happen; or regular testing for anyone interacting with the elderly. It’s probably not necessary for all parts of society —like getting gas. But, given sufficient capacity, testing can be deployed strategically in those nodes in the social network that are most likely to affect the most people.

>What is the sweet spot — for how often the average person should be getting tested? (there are obvious diminishing returns to testing too often)

I think of myself —I work from home, get all my stuff via Amazon, and only ever see my immediate family. So for someone like me, there probably isn’t ever a need to get tested unless I’m going to be interacting with other, new people.

But for people who will have to pick up their kid from daycare, a rapid on-site test should be conducted before going to the centre. The current nasal test, less frequently.

But for those who work in a grocery store or drive an uber, given sufficient capacity, testing several times a week is not untoward.

>What IS the bottleneck now? Is it capacity? Or is it access to testing sites? Or is it convincing people to go?

It’s different in different parts of the country. In more remote areas, the actual test kits are lacking, as is the expertise to give and interpret the test. In some urban areas, there is a lag in getting test results. And in others, there’s a line-up to get the actual test, which could be gated by poor hours or not enough human resources. And yes, in some cases, it’s people unwilling to go get the test, or unsure if they qualify for the test.

>And for those who’ve never gotten tested — what ARE the main tests people will encounter, and what’s different about them?

In Canada, really there is one test that most people will get: the nasopharyngeal swab. You either get it at a COVID testing centre, your local clinic, a mobile testing unit, or a drive-through facility.

A nurse technician sticks a swab way down your nose to scrape the back of your nasopharynx, and you’re done. Shouldn’t take more than a few minutes.

>Would it ever make sense to make tests MANDATORY?

Yes, for some people. For workers in LTCs, for example. If we have rapid on-site tests, or an easy saliva test, then it makes sense to do mandatory testing of everyone in a school, regularly.

We already have mandatory breath testing for drivers, and mandatory drug testing for pilots. This is similar. When other people’s lives are at stake, civl liberties are massaged.

I’m in favour of repeated saturation testing of students and teachers —assuming we have the capacity and the test is tolerable to kids. Yes, there is heightened chance of false positives as we drive the prevalence lower. But that’s okay. I’d rather we have the ability to investigate false positives than miss some, which go on to produce outbreaks.

>On going back to school — Alberta’s Chief Medical Officer recently said this: “it’s important before school to take [kids] for a BASELINE test to ensure they have at least one negative result.” She was talking particularly about kids who often HAVE COVID symptoms — but that are actually just seasonal allergies, or some other chronic condition. Can you explain that?

There are several things going on there. First is that a lot of kids have cold or allergy symptoms. They might be mistaken for COVID symptoms. So test them now when they have those symptoms, and if they test negative, then parents can get a sense of how symptomatic their kids are even when they are not infected by COVID. That way when additional symptoms arise, they will know to seek testing then.

Second, since kids have cold symptoms all the time, we don’t want kids with colds or allergies to be stigmatized by their friends who might suspect them of being COVID positive.

Saturation testing of all incoming students would obviate the need to just focus on the symptomatic ones, though. Building the capaity for repeated saturation testing would be useful.


That’s all, folks. See you next time. And remember…