Three years after COVID-19 was declared a pandemic, the World Health Organization has warned the next pandemic could be caused by even deadlier pathogens. Researchers are examining the virus’s ongoing impact on public health and society.
President Alan Shepard recently sat down with Professor Kate Choi, director, Centre for Research on Social Inequality and Professor Eric Arts, executive director, Imaging Pathogens for Knowledge Translation Facility, for a four-part video series that includes a wide-ranging discussion – from how the pandemic has re-oriented their research, to data collection in Canada; and from the nature of long COVID, to health-care inequities and vaccine skepticism.
Alan Shepard: How has your research changed in the course of the pandemic? What were you doing right before it hit?
Kate Choi: Before the pandemic, I was studying inequality across families, particularly racial and socio-economic inequalities and how that affects the health of children.
After the pandemic started, a lot of countries were seeing a pattern of racial and ethnic inequalities in COVID-19 rates. But because of the absence of race-based data on COVID-19, that information wasn’t available in Canada. Much of my work during the three years of the pandemic has focused on documenting patterns of racial and socio-economic inequality, looking at how neighbourhoods’ socio-demographic contexts affected the pace of spread of COVID-19.
Eric Arts: Prior to COVID-19, I was largely working on HIV and HIV pathogenesis, looking at treatment outcomes in patients, particularly in sub-Saharan Africa. Then the pandemic hit. As a virologist, basically, we were all called to action. That changed the whole dynamics of the way I was doing research. It refocused us to look at things important for public health and to understand how the virus was spreading and how we could develop better vaccines.
AS: Both of you are interested in the impact of disease on disadvantaged groups. What did we learn from the pandemic?
KC: In the very beginning COVID-19 was termed the great equalizer, affecting rich and poor alike. But later we discovered low-income individuals, racialized minorities and immigrants were disproportionately affected, in large part because they already had all the different axes of disadvantages that rendered them much more vulnerable to infection.
Three years on, we’re starting to see these inequalities have been exacerbated because of the economic lockdowns and strong public health measures that were very necessary to mitigate the spread of the virus.
AS: What are the differences in how COVID-19 is seen in Canada versus the U.S.?
EA: I was shocked and disappointed at how attitudes have changed in terms of prevention and vaccine uptake. Conspiracy theories have blossomed in Canada as well as in the U.S. At the beginning of the pandemic, I was doing a lot of town hall events, and just describing the vaccines, especially the mRNA vaccine, because it was new and people were concerned and worried.
With marginalized populations, there’s always this fear: Are you doing things to us that you would do to yourself? But at the same time, we have to have a way to control misinformation.
AS: People imagine science happens overnight, and that you don’t need to invest in basic science. But investments today may pay off in 25 years. It’s really critical to keep doing that.
EA: Many of us are concerned about this now. This is not the last pandemic. People have to realize that we’re, unfortunately, in for a lot of bad luck in the future. And if we stop working on these things now, we’re just going to come back to square one with the next pandemic.
Canada does a good job at monitoring overall patterns for the population. But there was a lack of high-quality individual level data on the social determinants of COVID-19.
KC: We would often hone in on a place like Toronto where there was neighborhood-level data. The absence of high-quality individual-level data on things like race and income made identifying the social determinants difficult.
AS: When I first arrived in Canada from the U.S. more than 20 years ago, I was struck by how little data we had at that university around the student population. In the U.S., you would know racial composition and other socio-economic determinants that would tell us who it is we’re teaching and how we can help them. The U.S. is far more obsessed with privacy than Canada is and yet Canada has much more stringent privacy controls around data and access to data.
KC: Also, in the U.S., people feel there must be diverse sources of individuals collecting data. So private enterprise collects data, the government collects data. And of course, individual researchers collect data.
I think, in Canada, there is a much heavier reliance on collection of data from the government. And people are much more comfortable with that. A lot of different social demographers come with the expectation that they will get rapid and ready access to the data. But it is often hard to get access to. And it’s often administrative data, not necessarily collected for research purposes.
AS: Coming back to Eric’s point about conspiracy theories, data scientists today are not respected. The opinion of a non-expert and an expert are thought to have the same value. This is a problem related to how people think of science, as well as their views on public policy. What can we do about that?
EA: I was shocked with how many people got their news and information only from sources like Facebook. People get their information wherever it’s readily available, and free.
Now with vaccines being readily available around the world, those in low- to middle-income settings are most resistant to getting vaccinated. And that appears to be mostly related to misinformation they’ve been fed.
AS: Looking ahead, what do you think about how we’re moving out of the pandemic? And what about the long-term cognitive implications?
EA: We could have taken better cues from what we saw, for example, in the 1918 flu pandemic. After that, in the 1930s and ‘40s, we had an incredible increase in the number of cases of neurodegenerative diseases like Alzheimer’s and Parkinson’s. What we don’t realize maybe is that flu had a much higher mortality rate. Fewer survivors meant fewer people facing long-term consequences.
For COVID-19, there seems to be some kind of yet unknown link between inflammation in the lungs and in the brain. Estimates are between 10 and 15 per cent of the population have had these symptoms, which we call long COVID. What we’re seeing already is this doubling of the number of Parkinson’s cases in just a couple of years; and increases in Alzheimer’s. It shouldn’t be happening this soon.
“With all of us being exhausted and just so tired of the pandemic, we don’t want to hear about this. Nobody wants to know that you might have some consequences in the future. And I feel that. Now is the time, though, to start looking at possibilities to really mitigate this. And we can.” – Eric Arts, executive director, Imaging Pathogens for Knowledge Translation Facility
AS: Kate, on the social demography side of this question, what do you think?
KC: We know cognitive skills decline at a much faster rate for racialized populations, low-income individuals and immigrants, particularly refugees. Marginalized populations are much more likely to have unmet healthcare needs. They’re less likely to receive treatment or have adequate high-quality treatment that allows them to mitigate the impact of Alzheimer’s or dementia for example. So, the impact of COVID-19-induced cognitive impairments and other long-term illnesses will be something that we will have to worry about significantly in the years to come. And it will occupy a heavy share of our healthcare budget.
AS: I’m assuming you’ll both say that mortality disproportionately impacted marginalized groups. What are some other health-care implications?
EA: I think, as the pandemic has continued, mortality rates have really decreased. Now, we have to look at this balance of providing adequate health care for many other conditions as compared to dealing with COVID-19. And we see that requirement for adequate health already with flu and RSV that had been circulating earlier this year.
Fortunately, these two viral diseases were in the same sort of area of prevention as COVID-19. But, you look at dealing with other major infectious diseases like HIV, which without treatment has 100 per cent mortality, which nobody ever realizes or thinks about. So, we have 37 million people at mortal risk if they do not receive their drugs every single day.
KC: Also, the question is if there will be these long-term impacts which are going to adversely affect the quality of life of individuals. We need to make sure there are research and resources within our healthcare system that will allow medical professionals to improve the quality of life of individuals, particularly marginalized individuals.
The conversation has been edited for clarity and length.
