People & Places

“It’s very disheartening” — Epidemiologist Dr. Manisha Kulkarni on the latest COVID-19 outbreak

As Ottawa, and the rest of the world, braces for a second wave of COVID-19, we talked to Dr. Manisha Kulkarni, an epidemiologist at the University of Ottawa who has spent her career studying — and trying to control the spread of — infectious disease. While much of her work has been focused on malaria prevention and treatment in East Africa, the pandemic is an international problem and parallels are clear. So we went to her with questions, and she offered reflection, insight, and hope.

Ottawa has seen a relatively large increase in COVID-19 cases in the past week, and public health officials have linked many cases to young people gathering indoors. As an epidemiologist who has spent decades studying the spread of infectious diseases, does this development surprise you?

No, I don’t think it’s surprising that as things start to reopen and the weather gets warmer that people want to gather, especially young people who place a lot of importance on those social contacts. It’s unfortunate, though, that the messaging isn’t sinking in, or maybe isn’t understood by certain groups of people. 

Ottawa Public Health  officials called this a wake up call. In your experience, do these spikes have the power to affect peoples behaviour?

I think they should. I think what we’re seeing right now is very early days of what could evolve into what we’re seeing in other countries — countries that had their epidemic numbers under control. It’s being detected early, it’s being monitored closely, for now our public health capacity is such that we can trace contact and isolate people who might have been exposed. But if the numbers grow, we can outstrip that capacity and we can have growth like we did back in March that could overwhelm the health system. If that happens, we risk having to roll back our opening plans, and jeopardize any plans that are in place for the fall. The short term gains that people get in socializing, in having some summer fun, are really increasing the long term consequences, which are actually quite severe. 

Dr. Kulkarni holding a CDC light trap and battery, used to collect malaria mosquitoes from local houses, in Misungwi, Tanzania. Photo by Charles Thickstun

Canada’s chief public health officer Theresa Tam said we’re experiencing ‘Covid fatigue’. How do we combat it? 

That’s really the magic question. Everyone wants this to end; the reality is, it’s going to be with us for a while. This isn’t a normal summer, it’s not going to be a normal fall — it’s probably not going to be a normal winter. Until we have a treatment that’s effective, or a vaccine, we need to find new ways of doing things. That means sticking to smaller groups, doing more socializing outdoors, and avoiding the dance floor. Those indoor spaces, crowded environments where people are shouting and jumping; those are the perfect conditions to spread the virus. So avoid those types of environments and encourage responsibity among everyone, not just young people. Right now, with the trends we’re seeing, young people have a lot of power to make change and to dictate the course the pandemic takes. So the messaging around social circles and social distancing has to be understood — I think there’s been some confusion about that. So by clarifying the messaging, targeting the messaging, and just having a realization that we need to do things differently, and for a long time. It’s the only way we’re going to get things under control again. 

What has worked for you when it comes to containing disease?

My experience is mainly with vector-borne diseases, where the pathogen can be in an insect or a tick. With COVID-19, we know the reservoir is people and the transmission is human-to-human. We have all the tools, and our approach worked very effectively to curb transmission. Until we have that treatment or that vaccine, it’s going to be a constant dance to tamp down new outbreaks. And the way that we can do that is with distancing and hygiene, wearing a mask… all of these tools we already have.

Dr. Kulkarni near Misungwi, Tanzania, where she’s working on a large-scale malaria intervention trial in collaboration with the Pan-African Malaria Vector Research Consortium (PAMVERC), with researchers Dr Jacklin Mosha (left) and Robert Kaaya (right). Photo by Charles Thickstun

With any kind of disease control initiative it takes multiple avenues of action. These include proactive testing and protecting those that we know are more vulnerable — people in older age groups, people with underlying conditions, people in marginalized populations in socio-economic groups who don’t have the option of working from home and who may live in housing conditions that are more crowded or in areas that are more densely populated. All of these things are considered when we think of disease control, so when we see outbreaks that are avoidable it’s really disheartening from a public health standpoint. It’s taking resources away from protecting the more vulnerable people. And all ages can have severe outcomes. The risk may be lower for younger people but it’s not zero. There are people in hospital who are in their 20s. There have been deaths in Ontario of people in their 20s that are related to COVID-19.

Do you worry that the focus on COVID-19 will stall or reverse progress made on other diseases? 

The longer this drags on, the more inadvertent deaths were going to see as well. For example, a lot of my work is in malaria; we have projections that show if control is disrupted we could have hundreds of thousands of additional cases in East Africa. So it’s not just the pandemic and it’s direct impacts but also the indirect impacts for people who have had to avoid seeking care.

In Ottawa, we have a lot of work looking at Lyme disease. The risk is still out there. People are perhaps enjoying the outdoors given that we can’t do things indoors. So it’s important to keep up the precautions. Lyme isn’t going anywhere; the ticks are out and it’s important for people to be on the lookout. And the symptoms are similar; we used to call Lyme disease “the summertime flu” because of the flu-like symptoms — but those, of course, overlap with COVID-19.

What is the latest on the suggestion that anti malaria medication can help COVID-19. Certainly that brought the two diseases into the headlines. What were you thinking when that hit the news earlier this year?

At the beginning, everyone was looking to existing drugs to see if there was a potential effect on COVID-19. So it wasn’t a totally off-the-wall hypothesis but the early trials showed it wasn’t having the impact so the emphasis has been placed elsewhere. And I’ve never seen science move at this pace. It’s been phenomenal. The international cooperation and the speed of progress has been amazing. 

Having insights into what’s been happening on the science front gives me a lot of hope that this will come to a conclusion one day. I just can’t say when. This “Covid fatigue” is a sense of hopelessness that people have that things aren’t going to end. But this isn’t going to last forever. Everything does pass. A solution will come out, we just need to keep the hard work. Little blips are bound to occur, we just want to make sure they don’t turn into a raging wildfire.

Theses blips demonstrate that the virus is still circulating, it hasn’t gone away and it can get out of hand very quickly. And this pandemic has really exposed health inequities. It’s been troubling to see how hard it has hit certain population groups, and neighbourhoods with a high percent of people with a lower socioeconomic status. People are taking notice, which I suppose you could say is a good outcome of the pandemic.