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Infectious Disease Specialist: Dr. Ayukekbong

30th April 2020

Dr. Ayukekbong is an infectious disease specialist on Vancouver Island.  He kindly took some time out of his schedule, and his birthday, earlier this week to chat about the COVID-19 pandemic.

His company Epitech Consulting  is based out of Nanaimo B.C. and Carbon Safety Solutions was able to spend some time with Dr. Ayukekbong reviewing his take on the COVID-19 pandemic, his book, use of home made masks, and whether a second wave of COVID-19 is something to be concerned about.

You have a PhD in molecular epidemiology, how long have you been studying and working with infectious diseases? 

I was a clinical microbiologist between 2003-2006 working in a microbiology laboratory prior to beginning my studies in infectious disease control and epidemiology that culminated to my PHD in 2013.

I was interested in epidemiology because I felt clinical microbiology was more reactive, and epidemiology seemed to be a more proactive approach to understand the pattern of transmission of infectious diseases through surveillance.

When did you start tracking, or monitoring COVID-19? 

I really started tracking what was happening in China when I was hearing about it on the news during a flight to Africa on Dec 29th and I have been monitoring it since that point from the epidemic, to the current pandemic stage.  My most recent paper summarizes some of my observations and recommendations over this period of time while comparing COVID-19 to other Coronavirus diseases.

My concern from the start as I mentioned on my Facebook and Linked In pages, was that this had the potential to be a serious world wide health issue.

I was surprised at how naïve the WHO was in their initial assessments of the disease. They appeared to be slow in recognizing that this was going to be a global health problem and not just a Chinese public health problem.

The delay in action has caused enormous harm to the entire world.  If the WHO had warned early enough, most countries would have instituted mechanisms to mitigate the risk of transmission. For example, travel bans and flight restriction from impacted regions.

Were you surprised to see how quickly this virus spread within China, and throughout the world?

No, I was not surprised.  The outbreak coincided with the Chinese New Year. Because this is the largest and most important holiday of the year in China, millions of domestic and international trips are made by residents and visitors in often crowded planes, trains, buses, and local transit systems. If travel restrictions should have been applied more quickly, the spread of the disease beyond international borders would have been reduced.

It’s interesting to see that only some sections of China seemed to be infected.  Why do you think that is?

Difficult to say, there is limited data to accurately track and identify how the virus spread, and impacted different areas within China.

At what point were you concerned that it was a significant threat to human health?

Once the outbreak was declared in early 2020  I started thinking about the SARS in 2002 and the MERS in 2012.  I felt this could culminate to an epidemic or pandemic because we have seen a pattern of coronaviruses emerging every 8-10 year within the last 2 decades.

I didn’t initially anticipate that it would be this intense, but as I watched it grow, I could deduce by the rate at which it was spreading, it was reasonable to anticipate a pandemic.

You wrote a book “Infection Prevention And Control Guide For Health Care Professionals” last year which was published a few months prior to the outbreak.  How’s your book doing with the current outbreak?

It’s going well, and readership has spiked for sure with sales globally.  I certainly didn’t anticipate a pandemic when I was writing it!  So the book is hopefully helping a number of people.

There is a section on public health emergencies, I’m amazed, and happy that this section was included.  Hopefully it is providing relevant guidelines and interventions to prevent the spread of this pandemic.

You live in B.C. but are currently in Ontario?  How long have you been there, and what are you doing there?

I am in Northern Ontario, helping a hospital and long term care facility in the  Sudbury area in their infection prevention and control initiatives.   They are both doing well, and so far we haven’t had any outbreak, although there have been some cases in the community.

I arrived Ontario on the 3rd of February, so I’ve been stuck here for a while.  I really don’t know when I’ll be able to travel back home to my family.

How do you think Canada is doing in general? 

Canada is doing well, we’re around 50,000 cases, and 2700 fatalities as of today April 28 and all the national strategies such as the social distancing, restricting business operations, travel bans, and other measures have been good choices and are clearly effective, especially considering  our proximity to the U.S. which is one of the most impacted countries in the world.

Living in B.C. what are your thoughts on B.C.’s management of the virus?

Quebec and Ontario are the most impacted provinces in Canada, when you look at the difference in the number of cases and deaths between those two provinces and B.C., B.C. is doing incredibly well.

The restrictions are similar in B.C. to the rest of the country, but perhaps B.C.’s communities and population are contributing significantly to the results.

The outbreak of a pandemic isn’t the sole responsibility of the government, it is down to the population of each country to adhere to public health measures and contribute to breaking the chain of transmission.

This is a really key aspect to control of infectious diseases, it’s up to us as individuals to use the appropriate measures to reduce transmission.

Using the key principles of hand washing, social distancing, and regular cleaning of surfaces are key to managing the spread of COVID-19, but with many parts of Canada looking to start sections of the economy up again, is that enough for schools, daycares, and workplaces to start to resume activities?

It’s still very early to be considering lifting restrictions, but if it’s gradual, it would make sense, depending on data and the number of new cases still occurring.

By gradual I mean we need to consider how we can get businesses to operate, but with restrictions such as maintaining social distancing, or reducing the numbers of clients, or employees in close proximity.   For example a plane with capacity to carry 200 people, the airline may be able to resume flights, but not at full capacity.

Limiting the capacity of the flight to half or maybe one third may give way for physical distancing to be maintained within the aircraft. Also, ensuring the use of masks, hand washing, and disinfecting surfaces may significantly mitigate risk. To compensate or balance for the low capacity, flight fares might be increased, and taxes to be paid by the airlines reduced.

Masks will also be a key control measure in preventing asymptomatic people from coughing or spreading droplets. With COVID-19 the number of asymptomatic or mild infections is greater than other Coronaviruses.  This facilitates the spread of the infection. There are pro’s and con’s to asymptomatic and mild symptoms.

What About Masks at Work?

Obviously being asymptomatic or having mild symptoms is great if you’re infected, however these individuals can spread the infection to others who are vulnerable.  So, masks are going to be key in controlling the spread from individuals that are asymptomatic or showing mild symptoms.

There are key members of the population who are at a higher risk, and must stay home as much as possible.  These include the elderly, those with chronic disease conditions like diabetes, cancer, heart or lung disease. Other controls are also obviously required.  Employees should be encouraged to work from home if feasible and there should be a baseline screening program for employees prior to return to the workplace.

The number of employees at work should be kept at minimum so that at least 2m physical distancing can be maintained and all staff must wear a mask in the work place. Additionally, all employees should get education on cough etiquette, hand hygiene, high-touch surface disinfection and environmental hygiene.

There are a lot of people who aren’t sure whether a homemade mask, or painters masks are beneficial.  What are your thoughts?

Homemade masks (and other non-medical or non-filtered masks) do not provide the same protection as a (medical) procedure mask,N-95, or other filtered masks but they are better than no mask when it comes to preventing transmission of droplets via coughing or sneezing from asymptomatic persons.

Procedure, N95 or other filtered masks prevent the acquisition of infection from infected persons.

In terms of risk threshold:

  • Someone wearing a procedure or N-95 mask has low or no risk
  • Someone with a homemade mask has medium risk
  • Someone with no mask has high risk of exposure

I prefer people to use any form of mask to mitigate their risk. Healthcare providers should routinely use procedure masks and N-95 when performing aerosol generating medical procedures.

There’s a lot of talk that the summer might be less contagious, but that the fall may see an increase in transmission, is there any evidence or data to support these suggestions?

Good question, this is a little controversial.  We know that some respiratory viruses like the flu, don’t do well in hot and humid weather, but with COVID-19 we don’t know yet.  We are seeing COVID-19 transmission in warm countries like Singapore, Bangladesh, and African countries.

So it it’s really difficult to say if hot summer months in Canada will reduce transmission of the virus.  Based on what we’re seeing in warm weather countries, and because it’s a new virus, we can’t be certain, and we should continue to adhere to public health measures even as we approach the warmer weather.

Are there countries right now that are seeing a second wave of infections, and if so, is that something that B.C. and Canada as a whole should be braced for?

Second waves are not uncommon during epidemics or pandemics.  A second wave is where there is a secondary outbreak after a period with limited or no cases.  The second wave wouldn’t be considered a wave until the 1st wave has had a reasonable amount of time to abate.

A second wave is likely with infections like COVID-19 and we should expect that we may have one if public health measures are weakened.  Unfortunately, secondary waves often have more severe consequences, and there is a real chance we may have one and it could be more severe than the first.

This is something to consider as the province considers lifting restrictions.

Are second waves due to viral mutation?

Second waves aren’t due to viral mutations, the pathogen can’t generally mutate that quickly.  Usually the second waves tend to occur due to gaps in infection prevention and control.

So if we see a second wave, it will likely be because we have relaxed or weakened the interventions and controls and created a favorable environment for transmission.

In Closing

My paper has some interesting interventions, but the key for us to break the chain of transmission is population commitment.

We all need to take our individual responsibilities seriously.  Everyone has a responsibility to mitigate the transmission of the virus to protect our loved ones and each other.

Using all the identified interventions is key to reducing the spread of COVID-19:

  • Staying home (if you can)
  • Wearing a mask if you go out
  • Washing your hands with soap and water
  • Practicing good cough etiquette
  • Avoiding touching your face
  • Regular cleaning and disinfecting

These interventions are key to breaking the chain of transmission and getting our economy and our lives back to normal as quickly as possible.  This is how we protect our loved ones, and each other.

As we see the rate of new cases, and infection start to plateau and drop in some parts of Canada, including B.C. there are some key areas to consider as mentioned by Dr. Ayukekbong.

Let’s not get carried away with returning to work, and warmer weather.  Let’s keep following the measures to prevent a potential second wave, and let’s accept that we can’t go back to the way things were prior to the virus, that’s just not an option.

Please continue giving some thought to how you’re going to have to adjust over the next few months to keep risk of infection low, but also how you need to manage physical, mental, and financial health in your household.

This is a long game, and we’re still only just getting started, so keep thinking ahead, stay home, stay safe, stay sane!

Dr. Jim Ayukekbong

Dr. Ayukekbong Dr. Ayukekbong is an infectious disease specialist and his most recent paper ‘Coronavirus Disease 19 (COVID-19) Compared to other Epidemic Coronavirus Diseases’ has recently been accepted for publication in the World Journal of Clinical Infectious Diseases and should be published within a few weeks.

Dr. Ayukekbong holds a dual Masters’ degree in molecular biology and biomedicine. He received his PhD in molecular epidemiology from the university of Gothenburg, Sweden and a certificate in project management from Acuity Institute, Denver, USA. He is a CBIC board certified infection preventionist (CIC) and has extensive experience in public health disease control and capacity building in resource limited settings.

Dr. Ayukekbong’s book “Infection Prevention and Control  Guide For Health Care Professionals” is available on Amazon.

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