Interview with Dr. Jeff Kwong

📷 DLSPH, University of Toronto

Journalist: Haleema Ahmed

Haleema Ahmed: Hello everyone and welcome back to SciSection. I'm Haleema, your journalist for this week, and today we are delighted to have Dr. Jeff Kwong: an epidemiologist, public health and preventive medicine specialist, and a family physician. With all of these roles. Dr. Kwong serves as a professor at the University of Toronto and as a scientist at ICES and Public Health Ontario. Thank you so much for joining us today.

Dr. Jeff Kwong: Thanks for having me.

Haleema Ahmed: We don't often get to see the personal side of many frontline workers and researchers like yourself, especially during COVID-19. What are you most looking forward to post-pandemic?

Dr. Jeff Kwong: Traveling, seeing friends, and eating out at restaurants.

Haleema Ahmed: I would definitely agree as well. I miss going to restaurants. How did you get interested in medicine and how did that interest lead to public health?

Dr. Jeff Kwong: I've always had an interest in helping others and I was strong in the biological sciences so I gravitated towards a career in medicine. When I got into medical school, I realized that I like looking at bigger picture things. That's why I decided to go into public health as my specialty.

Haleema Ahmed: How has your work and research changed pre-pandemic to now?

Dr. Jeff Kwong: Before the pandemic, most of my research was on influenza, infectious diseases, and vaccines. Everyone had to pivot to doing COVID research. It was a relatively smooth transition for me because respiratory viruses have a lot of similarities.

Haleema Ahmed: As you mentioned, a lot of your research is focused on influenza studying everything from the association between influenza and heart attacks to influenza and vaccine effectiveness. Drawing some parallels to today, especially about vaccines and even heart attacks, how has your work in influenza translated to the ongoing pandemic?

Dr. Jeff Kwong: At ICES, we work with a lot of the large health administrative databases. We link databases together to do epidemiologic studies. And so for COVID, we've been doing a lot of the same processes where we bring lab data for COVID testing and do epidemiologic surveillance finding the percent positivity for COVID over time and at different levels of geography. Now with the COVID vaccine, I will be doing COVID vaccine surveillance such as how well the vaccines are working, are there any safety concerns, and what percent of the population are getting COVID vaccines.

Haleema Ahmed: This question has plagued a lot of scientists fighting misinformation about COVID since March and as an expert in influenza, how are COVID treatment, prevention, and vaccination different from the flu? Why is it much more threatful to society?

Dr. Jeff Kwong: There are similarities between influenza and COVID, but there are important differences. They are both transmitted by the same sorts of routes and they're both respiratory viruses. The methods to prevent those two infections are the same; wearing the masks, physically distancing, and hand-washing. That is why we haven't seen any influenza last year since we've been doing all this stuff against COVID. In terms of treatment, they are different. We use steroids and other treatments for COVID whereas for influenza there are antivirals. In terms of prevention, the public health measures are pretty much the same. The infection prevention and control measures will work for both viruses. Obviously, the vaccines are different because the vaccines are training our immune system to identify specific pathogens.

Haleema Ahmed: As you mentioned the various approved vaccines being rolled out in Ontario specifically, could you run us through exactly which ones have been approved? How exactly do they work? (highlighting their safety and importance so we can get as many people vaccinated to build that herd immunity and ultimately travel and see friends again.)

Dr. Jeff Kwong: First, I just want to emphasize that they are all very good vaccines. All of the ones that we have available prevent hospitalization and death which are the most important outcomes to prevent. The first two approved were the mRNA vaccines so the Pfitzer and Moderna. They are just a piece of the virus's messenger RNA that is enclosed in a lipid coding and then that's injected into your body. That piece of mRNA gets introduced into the cells of your body and then tells your cells to produce the virus's spike protein. When your body produces them, they train your immune cells to identify that virus. The AstraZeneca vaccine and the Johnson & Johnson vaccine are not yet available in Canada but they are similar in that they contain a piece of the virus's genetic material so they use slightly different technologies. At the end of the day, they train our body to develop antibodies against the Coronavirus. Hopefully, everyone, when their turn comes, gets vaccinated.

Haleema Ahmed: As these vaccine efforts are gradually rolling out, what issues do you think we will face in terms of reaching marginalized communities, logistical concerns as we've seen, and vaccine hesitancy?

Dr. Jeff Kwong: In terms of accessibility, it's important to make it as accessible as possible. So having lots of different places where people get vaccinated; mass vaccination clinics, pharmacies, family doctor clinics. Doing outreach such as setting up mobile pop-up clinics, speaking to long-term care homes, shelters, and other mass-inhabited places like that. In terms of hesitancy, that is a growing concern. We are seeing that certain communities seem to lack confidence or trust in the vaccines. These are often the same communities most hit by COVID too. We need to engage community leaders to encourage these communities to go get the vaccine highlighting their safety and importance.

Haleema Ahmed: Why do you think that the communities most hard hit with COVID are also the ones most hesitant to its solution?

Dr. Jeff Kwong: I'm not entirely sure. I suspect that there could be language barriers, mistrust in government, or certain authorities. This is something that needs a further study so that we can understand and address this as best as possible.

Haleema Ahmed: As you work directly in the field of infectious disease, politics has been very influential in the last year. Many public health experts are often battling between the public's outward interest of returning to normal life versus the health fallback of doing that so rapidly. How have you experienced tackled this?

Dr. Jeff Kwong: It has been a huge challenge. As for the public health physicians, it's the population that is their patient. They have to look at the overall good of the population. It's a balancing act between trying to save lives and reduce illness through measures such as lockdowns but also looking at the collateral damage from these measures such as the effects on mental health, education, and people's economic livelihoods. If they have to close all the businesses, then people lose their source of income and that's an important determinant of health as well. All of these factors play into the decision-making and although I'm trained as a public health physician, I don't practice as a public health physician. All of my colleagues who have been in public health physician roles like the Medical Officers of Health have had to make a lot of difficult decisions over this past year and they're trying to best their best to get it right. But sometimes, striking that balance can be very hard so we'll just have to see how things go in this next wave.

Haleema Ahmed: I think it's an incredibly difficult job because there are politics and constant opinions being thrown. I think now looking forward to the future, how do you think our society will be different post-pandemic? Do you think we'll be more health-conscious from this medical risk perspective?

Dr. Jeff Kwong: Hopefully, we'll keep up some of the behaviors such as hand washing and staying home when sick. These are things that we should but don't often do. We don't want to be wearing masks for the rest of our lives but, we do know that when we do wear a mask, then we can prevent infections. This year there was no influenza season. There have been fewer cases of asthma exacerbations because of fewer respiratory viruses present. When there are no respiratory virus infections, then people's asthma can be better controlled. I don't think we should continue physical distancing and masking post-pandemic but, there are some benefits from having those. It's about striking the balance moving forward on what things would be acceptable to do like hand washing and staying home if you're sick. Maybe working from home will be more prevalent and that will be better for the environment too with fewer people commuting in the future.

Haleema Ahmed: Lastly, there is a lot of conversation about COVID-19 in general and the likelihood of viruses like COVID-19 being recurring. Do you think there is anything we can do to prevent this? Is it likely to happen that viruses and coronaviruses are going to be more common to be dealt with in the future?

Dr. Jeff Kwong: I think that's a really good question. Humans are encroaching into places that we didn't go to before. In recent decades, there have been more zoonotic infections. So those are infectious agents that are normally in animals and have been jumping into humans. Combined with global travel and overpopulation, there are all kinds of factors that can increase the risk of pandemics like what we're currently experiencing. The last huge pandemic that we had was 100 years ago, the Spanish flu, and since then, we have had several influenza pandemics and other novel infectious agents that have been controlled such as SARS and MERS. It's hard to predict the future but, hopefully, we have the mechanisms to prevent another global pandemic like this in the future.

Haleema Ahmed: And on that note, thank you so much Dr. Kwong for joining us today and speaking to us about all things pandemic and public health. It was a pleasure having you and thank you for all the amazing work that you do on the front lines and researching for COVID-19.