Note: Transcripts may contain errors. If you wish to re-use all, or part of, a transcript, please contact CBC for permission. Please check the corresponding audio before quoting in print. Copyright © CBC 2021

The Current Transcript for February 9, 2021

Host: Matt Galloway

STORIES FROM THIS EPISODE

[fclip]1857371203984[fclip]

Prologue

[Music: Theme]

MAN: It's clear that the existing vaccine, in the long run, won't be adequate for the South African variant. It'll give partial protection, some protection, but we're going to have to make two vaccines.

MATT GALLOWAY: The vaccines are coming, but will they be enough? As COVID variants take hold, it is unclear whether the jabs that we are all waiting for will actually keep this disease at bay? In 30 minutes, the view from South Africa, where a variant there has threatened to derail the immunization program. Also, this morning, did you make a New Year's resolution to work out more? How's that going? If your treadmill sits unloved in your basement, don't worry. It turns out humans didn't actually evolve to exercise.

MAN#2: You know, in the past, people had to be physically active to survive. They had to get food. They had to avoid being somebody else's food. And today, we've created this world where we no longer have to be physically active. And so we now have to choose it.

MATT GALLOWAY: In an hour, the commodification of activity and how to make exercise less of a chore. We begin, though, with cancer tests delayed and the lurking health consequences of this pandemic. Good morning, I'm Matt Galloway. This is "The Current".

[Music: Theme]

COVID-19’s impact on routine breast cancer screening

Guests: Anna Maria Perricone, Jean Seely, Aisha Lofters

MATT GALLOWAY: Almost a year into this pandemic, and fewer women are getting mammograms in Canada. Doctors are worried that that could have serious consequences, especially if it means a delayed cancer diagnosis. In the first few months of the pandemic, thousands of routine cancer screenings were put on hold. Anna Maria Perricone waited months for a mammogram and she joins me now. Anna Maria, good morning.

ANNA MARIA PERRICONE Good morning.

MATT GALLOWAY: I'm going to... and I apologize for this, I'm going to ask you questions that I guess are pretty personal, but it's important to hear from you. So I really appreciate you being willing to... to talk about this. When were you supposed to get a mammogram?

ANNA MARIA PERRICONE I was... well, I would have been back in March of 2020.

MATT GALLOWAY: And why didn't that happen?

ANNA MARIA PERRICONE Well, everything closed down because of COVID, and that... that was it, it was closed. And then I had to wait about six months to finally get in to get a mammogram.

MATT GALLOWAY: And was that a routine screening or was that something that... that you had been scheduled to get for a referral reason from a doctor?

ANNA MARIA PERRICONE No, it was a routine screening. You know, you do it every two years, every year. Yeah, no problem.

MATT GALLOWAY: What was that like waiting? I mean, again, it's sort of the unknown, but you're sort of in limbo.

ANNA MARIA PERRICONE Well, at the time, I didn't think much of it was, you know, there was no history of breast cancer in my family. So it's like, OK, I'll postpone. This is not a big deal.

MATT GALLOWAY: When did you get the mammogram?

ANNA MARIA PERRICONE End of August.

MATT GALLOWAY: And what happened?

ANNA MARIA PERRICONE Well, about a week later or four days later, I got the phone call that they found what call, you know, a spot on the imaging, and I had a small tumour in one of my breasts.

MATT GALLOWAY: What went through your mind when you got that call?

ANNA MARIA PERRICONE You know, it was it was kind of not much, [chuckling] I'll be honest. I guess it was a bit of a shock. It's a little bit surreal thinking, OK, OK, and what do we do now? That was basically it. I was... I was surprised, definitely surprised because I wasn't... you know, there's no history, you don't... you kind of figure you're OK.

MATT GALLOWAY: Yeah. And they found something on a lymph node as well?

ANNA MARIA PERRICONE They found a very tiny it's called a MEK, which is if you put your pen to a piece of paper and you get that tiny dot that was the size of it, it was very, very, very tiny on one of the lymph nodes. And because of that, I had to have I guess the routine is you take five... five lymph nodes are taken out to make sure that everything is clear.

MATT GALLOWAY: Besides that one lymph node, did your mind go back to those six months or so where you couldn't get the mammogram and wonder what was happening in that interim after the diagnosis?

ANNA MARIA PERRICONE Yeah, later on, it did. You know, you start thinking, well, if I had gone sooner, maybe that tiny dot on my lymph node, maybe it wouldn't have spread to that one lymph node. And maybe I didn't have to get that particular surgery done. It's, you know, I mean, they cut through, you know, it's, you know, they give you a nice four-inch cut, I guess. So and cut through the muscles and, you know, a little bit longer in recovery. So that's probably the only thing that kind of went through my mind. The size of the tumour, maybe there would have been a bit of a difference. It was very small, to begin with. So, you know, the stage of the cancer may not have changed. That's basically it. I'm glad that, you know, they finally opened. I was finally able to get in because obviously, the longer you wait --

MATT GALLOWAY: Yeah.

ANNA MARIA PERRICONE The more of a chance that the cancer would spread.

MATT GALLOWAY: And so you've had treatment now?

ANNA MARIA PERRICONE Yes, I went through the, obviously, the surgery and a round of radiation.

MATT GALLOWAY: And how are you doing now?

ANNA MARIA PERRICONE Actually, very good. You know, I do have a little bit of fatigue that comes as a side effect. But other than that, I'm doing very well.

MATT GALLOWAY: I was saying in the introduction that mammograms and screenings for cancer are down across the country because of this pandemic. And we're going to talk more about how that's happening across the country in a moment. But there are a lot of people who would find themselves in the position that you were in, where things were closed. You couldn't go in for screening. You couldn't get, you know, your routine physical, routine check-up or what have you. What advice would you have for people who find themselves in that situation, the situation that you find yourself in, you know, in waiting for that screening?

ANNA MARIA PERRICONE Waiting. Unfortunately, your hands are tied, right? The waiting part of it, it can, you know, in retrospect now, it could be frustrating, especially if you have a history of breast cancer in the family.

MATT GALLOWAY: Yeah.

ANNA MARIA PERRICONE Like I said, I didn't think much of it. But, you know, I was able to have gone back in March. Maybe there would have been a difference. I don't know?

MATT GALLOWAY: I'm glad you're doing OK now. I really appreciate talking to you, Anna Maria

ANNA MARIA PERRICONE Yes. Yes, I am doing very well.

MATT GALLOWAY: Excellent!

ANNA MARIA PERRICONE And everything seems to be going the way it's supposed to. So it's great.

MATT GALLOWAY: That's what we want to hear. [Anna Maria laughs] Thanks again. Good to talk to you.

ANNA MARIA PERRICONE Thank you.

MATT GALLOWAY: Anna Maria Perricone waited for a mammogram she was unable to get at the beginning of the pandemic. Subsequently, as you heard, diagnosed with a tumour, has undergone treatment. We reached her in Toronto. These delays are worrying for physicians, including my next guests. Dr. Jean Seely is a professor of radiology at the University of Ottawa, head of the breast imaging section at the Ottawa Hospital. Dr. Aisha Lofters is a physician with Women's College Hospital in Toronto. Good morning to you both.

BOTH: Good morning,.

MATT GALLOWAY: Dr. Seely, what do you make of what we just heard from Anna Maria there? Is her story a common story?

JEAN SEELY: It's very typical. So Anna Maria made a really good point, she had no history of breast cancer. And 75 per cent of women who get breast cancer have no family history or risk factors. So it's... It's important that we screen all women who get breast cancer in that starting age, so at 40 on. We had a marked decrease in screening. In fact, we stopped in March when the pandemic started. And we only started screening back up gradually resuming in June. So there's a three-month gap in the time period where we screened. And even now, we've not been able to resume normal screening volumes because we're using all the safe procedures for imaging. So our capacity is reduced by about 80... down to 80 per cent of what it was before COVID. So Anna Maria is very typical of many, many women in the province of Ontario and across Canada.

MATT GALLOWAY: I was going to say, is that your understanding of what's happening right across the country?

JEAN SEELY: Yes, I'm the president of the Canadian Society of Breast Imaging. And so I speak with physician colleagues and technologists across the country. And we're seeing this across the country. So it's very typical.

MATT GALLOWAY: What about for you, Dr. Lofters? You work in the Centre for Women's Cancers at your hospital. What are you seeing in your own practice?

AISHA LOFTERS: Yeah, thanks, Matt. So, I'm a... I'm a family physician, so I see things from that perspective. And I also work at the Peter Gilgan Centre for Women's Cancers. And this is something that the clinicians, the educators, the researchers there are seeing and concerned about. And, you know, there's a very logical fear that people have about coming in because of, you know, [chuckling] we've been in this global pandemic. But we're worrying because we're seeing women who are scared to come in for screening, they're scared to come in when they have a breast lump, when they have another worrisome symptom, because they're worried about coming in and catching COVID. So, you know, there's a real worry in the system, just about like what are the long-term effects going to be if there are delays in cancer diagnosis, including for breast cancer?

MATT GALLOWAY: Hindsight is 2020. I mean, Dr. Seely talked about just stopping the screenings in March. And we heard that for Anna Maria as well. Was that, I mean, Dr. Lofters, do you think in hindsight, was that the right decision? Obviously, we're in the midst of a pandemic, and everything changed very, very quickly in those days in March. But was stopping the screenings the right decision?

AISHA LOFTERS: You know, I think it's even too early to be talking about hindsight. [chuckling].

MATT GALLOWAY: Yeah.

AISHA LOFTERS: I think we're going to look back at a lot of decisions that have been made during COVID and after, reflect if they were at the right or the wrong decision? I think it was the decision... best decision to make at the time based on what we knew. But I think now we need to focus on a gradual resumption, a safe and gradual resumption of screening.

MATT GALLOWAY: Dr. Seely, are you seeing nationally a change in when women would come in for screening? There's routine screening, but then there might be screening based on something they discovered in a self-examination or a referral.

JEAN SEELY: So because when a woman has a lump, a symptom of a palpable finding or a change in the breast, that no longer is screening. It's called diagnostic. And across the country, we are seeing more women presenting with palpable lumps. And their cancers are being detected at a later stage. We're seeing more advanced cancers now than we were before the pandemic hit. And I... I... I want to emphasise what Dr. Lofters said, you know, hindsight is... is something I think we did the right decision at the time to stop screening. But what the problem is now is women don't know that screening is open. We will not stop it again. We've learnt and we've adopted these these guidelines. And so we're seeing more women delaying their screening and waiting until they have a lump. And this is a significant problem because, by the time they have a palpable lump, it's more likely, like with Amna Maria, to have spread to the lymph nodes and to have spread to the rest of the body. So picking it up before symptoms happen is much, much better. And we know that it correlates with a more than 90 per cent survival if it's picked up with screening, as compared with a palpable lump where it might have a chance of survival that's reduced to 80 per cent five-year survival or even lower if it spread to the rest of the body.

MATT GALLOWAY: Tell me more about that. I mean, in the six months that this pandemic would have perhaps derailed or slowed down or stopped screening, what would be the change in that in terms of, you know, where cancer might be, but also, as you say, survival rates?

JEAN SEELY: Well, it's too early for us to know. And we're starting a study to look at this because we believe that this is a factor that's happening across the country. There was a modelling study done by the group at Sunnybrook, and they used a mathematical model called OncoSim, where they estimated that a six-month delay in screening would lead to 670 more advanced breast cancers in Canada and 250 more breast cancer deaths in the next 10 years. And delaying that even more than six months, which may happen with people stopping or naturally not referring themselves, would lead to an even higher number of deaths. So we are seeing this across the country.

MATT GALLOWAY: Are you seeing that in your own practice, Dr Lofters?

AISHA LOFTERS: Yeah, yeah, I mean, we're definitely seeing people who are delaying their screening, postponing, you know, their... their routine mammograms. Our Ontario breast screening program site actually does have capacity. So, you know, they are able to take people, but we are seeing that hesitation for people to come in, or thinking, well, you know what? [chuckling] I've already put it off for this long. I'll just keep putting it off until the pandemic is, quote/unquote, over. And, you know, I would encourage all listeners to, you know, if... if you're due, call your local breast screening program site, ask them what their protocols are, make sure that you feel safe and comfortable, which I feel confident that people will, and go in and have that mammogram done.

MATT GALLOWAY: One of your areas of research, Dr. Lofters, is on marginalized populations. And we know this pandemic has not hit people equally, that... that there are different communities that are being disproportionately impacted by what's happened over the last year or so. Do we know what sort of impact that might have on, this drop-in screening, might have on those communities?

AISHA LOFTERS: We... we don't. There's not a lot of strong evidence. There's not a lot of data that we have available in Canada to really tell us that. Certainly, you know, there's always the concern that when there are pre-existing disparities or inequalities in screening, that something that hits the whole system can have a disproportionate effect and actually increase those screening inequalities. That's always a worry. We don't have the data to show that. But if definitely something that's on... on the minds of all of us who work in the area of screening inequalities.

MATT GALLOWAY: So tell me more, just briefly, about that screening inequalities because not everyone is... is able to or is taking advantage of the screening that might be available?

AISHA LOFTERS: Yeah. So basically, like we... we have, you know, the Ontario Breast screening program. And for women who are aged 50 to 74, they're able to get mammograms once every two years, in some cases, once every year. But not every woman is part of the breast screening program. Not everybody gets mammograms done regularly. And we know that particularly... particular women are at high risk of not being screened and because of things that shouldn't matter. So things like their income level, things like how long they've been in Canada, those are factors that shouldn't play a role in a universal screening program, but they do. And that's what we talk about... that's what we're speaking about when we talk about screening disparities.

MATT GALLOWAY: Dr. Seely, we had a conversation last week on this program about the backlog, if I can put it that way, in surgeries. And these were elective surgeries. But what is elective and what is nonurgent, you know, is a bit of a moving target for... for a number of different people. And we're seeing this across the country coming out of this pandemic that health consequences are being exacerbated because people aren't being.... aren't able to get the treatment that they need. What needs to happen to clear this backlog caused by the pandemic and ensure that people are actually getting the screenings that they need in a timely fashion?

JEAN SEELY: Well, if... Dr. Lofters mentioned the discrepancies. And one of the big areas is that our Canadian task force guidelines only recommend screening women 50 to 74 years of age. This is a very outdated recommendation because we know that Black, Asian women in the US, for example, their peak breast cancer incidence occurs in the 40s. And white women, which the guidelines are based on, peak breast cancer in the early 60s. So we need to have more inclusive guidelines. And we need to recommend and communicate to physicians across the country about the importance of screening women when breast cancer starts to peak in their incidence. We... we really need a national strategy to encourage women to screen, particularly in the COVID situation. And as you mentioned, these discrepancies that we're seeing with COVID are being exacerbated. So I think that this is something that requires a national strategy and not just dependant on each province.

MATT GALLOWAY: What would that look like, a national strategy?

JEAN SEELY: I think we need to get people who.... who understand the the issues, who are experts in this, aware of the discrepancies. And... and ways to reach all the provinces to communicate this better because I don't think this is going to happen just with small groups. I think this really requires a coordinated effort. So I would like to see us taking a lead on this in Canada.

MATT GALLOWAY: Dr. Lofters, what are you worried about when we get to the other side of this? People have used the phrase, you know, that there could be a tsunami of cancers because... and it's not just breast cancer, colorectal cancer, other forms of cancers that may not be screened in a timely fashion because of all of the reasons that we've laid out, that people would be reluctant to come into a hospital, go to a doctor's office, or the capacity may not just be there. When we get through this, what are you concerned about in terms of what we might be facing?

AISHA LOFTERS: I'm concerned about exactly that, Matt. So we be screen for breast cancer, cervical cancer, colorectal cancer, some parts of the province have lung cancer screening. And I'm concerned that for all of those cancers where we've made these great advances and are able to catch cancers very early or even when they're pre-cancers, that we're going to lose some of that benefit. And we're going to have, just like you said, a tsunami of cancers, you know, people diagnosed at a later stage than they would have been. And, you know, thinking about all of the effects that follows down from that. I think we've all been, rightly so, very, very focussed on COVID over the last year. But all those other health issues that affect us are still an issue. And I think that once we step out of this COVID world, that we're going to have to really be reckoning with that.

MATT GALLOWAY: I'm going to say, once you step out of the COVID world, you're already in a health care system that is, I mean, we're seeing it right now. It's stretched to the limit, perhaps beyond the limit. Physicians, nurses, people who work in that system are already at their breaking point. So what has to happen to ensure that you can catch up in some ways and deal with that backlog?

AISHA LOFTERS: Yeah, so I think as funny as it might sound, I think one thing we need to do to address the issue we're talking about about, you know, cancer is to help us get out of this COVID world. So we need to get people vaccinated. We need to have public health measures in place so that we can get the numbers down for COVID so that people do feel safe coming in. I think we need to have conversations like this one where people hear that it is, you know, breast screening program sites, your physicians' offices are doing the best that they can with PPE, keeping people safe, spacing them out. So, you know, do call your physician's office, do a check into your breast screening program site and see if they have capacity to take... to take you in. As Dr. Seely said, the system is not shutting down again, and we have to gradually resume all of these preventive measures that we were doing before.

MATT GALLOWAY: And so what do you say, just finally, to your patients? I mean, if they are concerned about coming in, we're all being told to stay home, and we're nervous about going anywhere.

AISHA LOFTERS: So I think we as physicians and, you know, I certainly take the time to explain to people that it is safe. At our Gilgan Centre website, we actually put up a video kind of walking people through what's the experience like, you know? So that people know when you come in, this is what's going to happen. You're not going to be sitting in a crowded waiting room like what you're used to before. And, you know, we are doing everything that we can. So it's really, I think, A responsibility for us in the health care system to let people know that it is safe to come in.

MATT GALLOWAY: And Dr. Seely, in that final minute or so that we have, is that message, do you think, enough to get people to feel comfortable?

JEAN SEELY: Well, I think it's great that you're doing this segment. I think it's really important to remind people that you don't have to have a family history of breast cancer to get breast cancer. And it's safe. Your technologist, your physician will be wearing a mask. You will wear a mask. But you are not going to get COVID by getting your breast screening appointment. And, you know, as I said, cancer doesn't stop with COVID. We we really want to impact the negative cost of delaying diagnosis. It's going to impact the health care system. You're going to be doing everybody a favour by getting an early diagnosis. So I really want to encourage people to... to get their screening. And that includes all women, not just OBFP, but all women who should be screened.

MATT GALLOWAY: Important to hear from you both on this. I appreciate you taking some time to speak with us this morning. Thank you.

AISHA LOFTERS: Thank you.

JEAN SEELY: Thank you very much.

MATT GALLOWAY: Dr. Aisha Loftus is a physician with Women's College Hospital, and an associate professor of family and community medicine with the University of Toronto. Dr Jean Seely is a professor of medicine in the Department of Radiology at the University of Ottawa, and the head of the breast imaging section at Ottawa Hospital. Your CBC News is next. And then,.

TEDROS ADHANOM GHEBREYESUS: We know we have to be ready to adapt vaccines so they remain effective.

MATT GALLOWAY: The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus. And his message is particularly relevant right now. In South Africa, the vaccine that was being administered isn't doing the job. We'll speak with the doctor on the front lines there about why the shots are on hold and what is next in that country and ours. I'm Matt Galloway. You're listening to "The Current" on CBC Radio One. Stay with us.

Vaccine concerns in South Africa

Guests: Rinesh Chetty, Gerald Evans

MATT GALLOWAY: Good morning, I'm Matt Galloway. And you're listening to "The Current".

[Music: Theme]

MATT GALLOWAY: Still to come, exercise and that daily conversation you have with yourself, should I go for a run now or maybe later, maybe much, much later? Like, next week. [chuckling] Author Daniel Lieberman will be here to talk about why exercise isn't always about hopping on the treadmill. But first, how new COVID variants could change what vaccines are needed where?

SALIM ABDOOL KARIM: We are unclear and uncertain about the efficacy of the vaccine in preventing hospitalization and severe disease. We are just not confident about its efficacy against the 501Y.V2 variant.

MATT GALLOWAY: That is Salim Abdool Karim, co-chair of South Africa's Advisory Committee on COVID-19. That country is facing another hurdle in its fight against the pandemic. A new study suggests the Oxford AstraZeneca vaccine is largely ineffective against the variant. The country's now dominant strain. Health officials have halted the vaccine's rollout for now. Dr. Rinesh Chetty is working on the front lines of the pandemic in Durban, South Africa. Doctor, hello.

RINESH CHETTY: Hi. How are you doing, Matt?

MATT GALLOWAY: I'm OK, thanks. What was your reaction to the findings of this study suggesting that the vaccine is, as I said, perhaps largely ineffective against this... this variant?

RINESH CHETTY: You know, it was a feeling of proper disappointment and frustration and anger, as well as a feeling of inevitability because, you know, it was a gut feeling that most doctors on the front line probably had... had a suspicion that the COVID variant, the vaccine that we had brought in, wasn't going to be that effective. It wasn't a surprise, per se, because we knew that this variant was slightly different to the coronavirus. And we knew that there was a chance that this vaccine was going to end up showing us that it was in effective. We didn't realize it was going to be that ineffective to a point where there's like no significant protection if we do take the vaccine. So the anger and the frustration was eventually just replaced by disappointment.

MATT GALLOWAY: I want to talk about this variant, just for a moment. How prevalent is it in COVID cases in South Africa?

RINESH CHETTY: Look, of the positive cases that we are getting at the moment, it's nine... it's 95 per cent. The majority of the cases are the COVID variant itself. So even if we did have a small percentage, if we gave the vaccine out and we had a good protection against the original coronavirus strain, it wouldn't make much of a difference here. That's the significant inability to give us protection because the majority of the infections in South Africa is the.. the so-called South African variant.

MATT GALLOWAY: And there are questions about the study itself. I mean, it was a small study. It hasn't been peer-reviewed. And it looked at mild to moderate cases of the illness, particularly in young people. Given those qualifications, is it too soon to pull this vaccine from wide distribution?

RINESH CHETTY: It's not too soon to pull it out. There's still a bit more needs to be done with regards to its protection on whether it actually covers us from sever COVID? That's... that's... that's the main thing that we need this vaccine to protect us some from. Not so much the mild to moderate, because, at the end of the day, mild to moderate, as we know, quite a majority of people do recover. It's the protection against hospitalization, the protection against severe COVID that we really need so that we have less amount of patients requiring intensive care. So that study still needs to be done. But the time needs to be taken. The point made is that although it's not peer-reviewed, the study is done by quite a reputable university, so we're quite happy to understand why we want to delay it. Putting it off or delaying the administration of the vaccine is a viable option right now. It's not something that the doctors are arguing or sort of angry against. It's more just the fact we wished that there was some form of protection that could offer us for the up and coming third wave.

MATT GALLOWAY: I guess, I mean, given that up and coming third wave, but also what you're talking about, the question that some people are raising... and it's coming from even the folks at Oxford who helped create this is whether it's some degree of protection is better than no protection at all?

RINESH CHETTY: Yeah. But that's why we need to we need a bit more time to see whether it does cover for the... for the severe Corona virus. If it does, then it is a viable option. But, you know, at the moment, the fact that it doesn't come for mild to moderate, you can extrapolate the evidence further. But that's the... that's the reason for us not to give the vaccine yet. Because we do have the Johnson and Johnson one coming in. And the problem is, is that if you give the AstraZeneca vaccine, then it might run into issues trying to get us... give us the other vaccine that is coming in. So the government has said that they are going to be getting in the Johnson and Johnson vaccine, probably around the same timeline as the AstraZeneca. So they're going to be keeping AstraZeneca on the side to... to finish off those studies and, hopefully, start with the Johnson and Johnson.

MATT GALLOWAY: How much of this is also about confidence in the vaccine? That you need to to be able to show to the public that the vaccine works if you're going to convince people to actually get the vaccine and fight against what people call vaccine hesitancy?

RINESH CHETTY: Now, that's 100 per cent. I mean, look, you know, quite a few people are worried about the timeline. Quite a few people are worried about the fact that they think that we've cut corners. As a global medical community, I think there's very few doctors that are worried about that because we know that there was a lot of money pumped in. There was everybody was working as a unified force. Every virologist, epidemiologists, research laboratory, had put... had put their lives on hold and their research on hold purely just to work on the coronavirus. So, you know, there's... there's multiple factors to why we actually didn't cut corners. And the fact that the politicians were willing to work with doctors is one of the reasons why we cut through a lot of the red tape. So the confidence in the vaccine itself needs to be high and is high currently amongst the medical professionals and people in South Africa and probably in the world. The main thing is try to get rid of all the fake news, try to get rid of all the conspiracy theories and try and just get people educated and... and confident in the public that the vaccines are working. And 99 per cent of doctors and health care professionals in South Africa are ready to take the vaccine.

MATT GALLOWAY: You said at the beginning of our conversation that you're frustrated and you're angry. You're a year almost into this pandemic. And I'm just wondering how... how health care workers like yourself are holding up in the midst of all of this?

RINESH CHETTY: You know, the mental fatigue, and the fact that we know this third wave coming, and the fact that we were really decimated by the second wave, and seeing our colleagues die, seeing our friends and loved ones and the guys working the offices' empty desks, it's really... it really is affecting us quite badly. And I think that's... that's the anger and frustration. And the biggest issue is that I think a lot of the frustration is vented out because we know that there is a way that we can protect ourselves. And if anybody in the public and everybody, health care workers are willing to take the precautions, that's the reason why there's such an outcry from the health care workers that we need everybody, the public and everybody, to... to follow the precautions, whear masks, sanitise, social-distance so they can help us by cutting down the numbers and in essence, cutting down the risk. So that's the anger and frustration that we feel.

MATT GALLOWAY: There's also a really lively conversation here in this country and elsewhere about what's known as vaccine equity and making sure that there are vaccines for the whole world, not just for the wealthiest nations in the world. Are you concerned about that?

RINESH CHETTY: Yeah, look, besides the financial and the fact that, you know, the issue behind equality, I think the most important principle everybody needs to understand is that our first shot at vaccination needs to be our best and most extensive shot because it's pointless having a country that's vaccinated against a single variant of COVID, of the coronavirus. And then there's another country that's... that's already developing resistance to... to the original strain, and there's a new variant that's... that's... that's sort of sweeping through because that inactivates the protection of the country that's completely vaccinated. So besides the equity policy behind it, there's a scientific reason why there needs to be a global sustained, immediate and extensive effort across the board. And, you know, it plays into the term that everybody, not just single borders, the coronavirus doesn't respect borders, it doesn't respect economies, it doesn't respect people that have a lot of money versus people that are of a low socioeconomic. And that should be the same principle that our main defence is. Don't respect the borders, and everybody needs to be treated equally across the board.

MATT GALLOWAY: So with the vaccination program on pause, just finally, I mean, how are you preparing for that third wave? You've mentioned it a few different times, saying that you... you anticipated coming? How are you preparing for that?

RINESH CHETTY: [deep sigh] Look, the health care workers are preparing mentally, physically, and, you know, logistically as well. We are trying to reeducate the public. We're trying to make sure that everybody understands that they need to mask up, they need to socially-distance. And we need to... we need to cut down the amount of numbers coming into the hospitals. So we need to identify, track and trace specific outbreaks of the virus and control them right at the origin. And I think the main thing is that... is that the public's behaviour. We're trying to make sure that we warn the public that there is third wave due. And if we can control public behaviour and public opinion and make sure that they follow the unified protection mechanism, such as masking up, sanitizing and avoiding high-risk social gatherings, we should be able to calm the wave down and control it. The problem was the second wave was done during school holidays in December, which is summer here, everybody was out, everybody dropped the ball, and everybody was affected. So we're hoping to keep the ball in and make sure that we play the game properly.

MATT GALLOWAY: Doctor, good to speak with you, and I wish you the best of luck. Thank you.

RINESH CHETTY: Thank you very much, sir.

MATT GALLOWAY: Dr. Rinesh Chetty is in Durban, South Africa. Variants first found in South Africa, the U.K., and Brazil are now showing up in Canada. What exactly does that mean for this country's vaccination efforts? To find out. I'm joined by Dr. Gerald Evans, an infectious disease specialist at Queen's University and Kingston Health Sciences Centre. Doctor, good morning to you.

GERALD EVANS: Good morning, Matt.

MATT GALLOWAY: Do you understand the deflation there that Dr. Chetty feels? They're on the verge of a third wave, and their vaccination program has been put on pause.

GERALD EVANS: Absolutely, I think that's a kind of a prevalent view and emotion that a lot of health care workers are feeling. I've been very fortunate where I live that we have not had large numbers of cases. We've been taking some cases from other parts of the province of Ontario that have had larger numbers. But I think, you know, I would reflect very strongly on his words that everyone needs to do what they can because everybody in health care is really working hard to make sure that we reduce the impact of this pandemic in terms of its toll on human lives.

MATT GALLOWAY: How are you interpreting the data about vaccine effectiveness on the variant first found in South Africa?

GERALD EVANS: Well, it's interesting because, you know, we... we have lots of studies that are looking at how effective current vaccinated individuals' antibodies are against these variants. And some of those are very encouraging to suggest that although there's a somewhat reduced efficacy, particularly for the variants that have arisen in South Africa and Brazil, there still seem to be effective at... at a protective immunity of individuals. And I think it's really important that people understand there's two kinds of immunity that a vaccine can induce. One is a sterilizing immunity, meaning it prevents you from ever getting the infection. But the other one that's probably more important, and I think is relevant to the discussion about the decision in South Africa to withdraw AstraZeneca, is protective immunity. Protective immunity means it doesn't prevent you from getting infected, but it prevents you from becoming severely ill, for instance, and getting hospitalized and dying. And what we've seen with the Johnson and Johnson vaccine, which is a very similar technology to the AstraZeneca one, is their very large study, which included a population in South Africa that had variants, actually showed that it was protective. There were no deaths, and it prevented severe illness. So the decision to withdraw AstraZeneca based on the fact that there may still be people who are getting mild to moderate infection and really underscores the issue that they don't have enough numbers in that study to show that there's actually probably protective immunity from AstraZeneca. So that protective immunity is really the super important one because that's the one that really is going to have the most profound effect on reducing mortality, reducing hospitalizations. And I think if if and when they continue to study, enrol more individuals so that they can actually assess that, I think they'll see that it probably has somewhat similar results to what was seen with a similar vaccine, which was the Johnson and Johnson vaccine.

MATT GALLOWAY: I mentioned in the introduction variants that had been seen in South Africa, in the U.K., and Brazil. How many variants are there out there? Do we know?

GERALD EVANS: Oh, [chuckling] we're just getting a handle on that, I think, right at the moment. And that's because suddenly, there is an explosion of interest in doing whole-genome sequencing, which allows us to kind of look at these variants and see where the mutations are. There are others. There's one now in California that arose in the States, obviously. There's a Midwestern variant that's now being described in the United States as well. There are variants arising all around the world because viral replication has been ongoing in millions of people around the... around the planet now for months. And when this virus replicates, it creates random mutations. And what we've seen is something called positive convergence. In other words, there's a kind of common commonality to some of the mutations that pop up. And almost all the ones that we're talking about this morning have a specific mutation which goes by the name of N501Y, and that's a very favourable mutation for the virus to have. It increases transmissibility. And that's what we're seeing with the emergence of the U.K. variant, as well as these other variants, in that the numbers are beginning to rise. It's beginning to dominate over what we would call the wild-type SARS-coV-2. So variants are emerging all the time. And that's why it's absolutely pivotal at the moment to get numbers of cases down as low as possible.

MATT GALLOWAY: Right.

GERALD EVANS: And, of course, to roll out vaccine so that we prevent further a emergence of more strains because vaccinated individuals probably do get some form of sterilizing immunity, meaning they may not actually get infected with the virus.

MATT GALLOWAY: Let me ask you about that, because, I mean, obviously, the vaccine rollout program is going a bit slower than people had hoped for. We're told that that will pick up in the weeks ahead. But in the meantime, given the fact that there are these new variants that are around, does that require us changing our vaccination strategy?

GERALD EVANS: Well, certainly, one of the probably the most pre-eminent strategies we're seeing now is that trying to get at least single shots into as many people as possible because there is some protection provided by single doses, particularly of the mRNA vaccines. So those are the two ones that are approved here in Canada from Pfizer-BioNTech and Moderna. And so what we've seen with our modelling is that if we can get one shot and get that, you know, protective immunity, perhaps sterilizing immunity of about anywhere between 70 and 85 per cent, then that actually reduces the number of cases. We still have to concentrate to some degree on getting second shots into highly-susceptible individuals who may have a somewhat lower response to the vaccine and those are basically elderly people, but that's probably the big strategy is with the limitation on procurement and getting vaccine in, it's getting first doses into everybody, as many people as possible, versus making sure that we have two doses in everyone at this point at least.

MATT GALLOWAY: Will we need another vaccine, do you think, to deal with or other vaccines to deal with these variants? Or would there be... there's been the suggestion that perhaps we need a booster shot or something like that. Will they have to develop entirely new, you know, fleets of vaccines?

GERALD EVANS: Yeah, well, I think what the exciting part about the development of vaccines for COVID-19 is these very new platforms. So the vaccines we're talking about, one is the mRNA vaccine, which has never been used in infectious disease vaccine up until COVID-19. And the cool thing about that is that you can change that messenger RNA template very quickly. We're told by the companies that they can turn around a change in that in six to eight weeks. And so you can produce a vaccine that's now effective against the changes that have been seen in the variants. The same thing can be done actually with both the AstraZeneca and the Johnson Johnson vaccine because they use a adenovirus vector. And again, you can change the little piece of DNA that you insert into those viruses. That takes a little bit longer, but there's lots of opportunity to very quickly change the characteristics of these vaccines so that they're now effective against these variants. And that's the exciting part of what's really happened with vaccine development with COVID-19.

MATT GALLOWAY: Would you have to do entirely new approvals to get those vaccines back out? Once you do those changes, are they minor enough that you know that the approval process such as it is right now, would be... would be sufficient?

GERALD EVANS: Well, I guess my opinion is they wouldn't need to be reapproved because most of the issues around approval relate to the safety of the vaccine. And you're not changing any of the other components other than the small piece of RNA, which codes for the altered spike protein that's seen in the variants. So my thought is, is that if it required approval, it would be expedited, simply because the construction of the vaccine is essentially all the same other than this template that's put into it. But it's a good question. It would be a question to throw at the regulators, and I'm assuming that they may agree with me, but I'm just an infectious disease doctor.

MATT GALLOWAY: [both laughing] With some some information behind you, not just an infectious disease doctor. I mean, one of the things that we're seeing now is there are jurisdictions across this country that are beginning to loosen restrictions, to ease up, to begin the process of reopening. Given the fact that these variants are starting to appear in this country, and people believe that they may take hold and become, you know, the dominant strain of COVID within the next several weeks, perhaps, how should that affect our pandemic planning in this country?

GERALD EVANS: Well, I think the view when you look at how the modelling shows up is this is not the time to really begin pulling back on restrictions. Or if you do, it has to be done unbelievably carefully and minimally. And that's because the upswing of the introduction of B1.1.7, that's the U.K. variant, into Canada has been well established. And our expectation when we look at the experience of other countries that have had that variant introduced is that we're going to see a rise up in numbers. And so you don't want to complicate that by now suddenly rolling back restrictions, which is just going to help facilitate the increased transmission of a new variant, which is already increasingly more transmissible than the wild-type. So I think the view should be, be very careful about pulling back restrictions. If I ruled the planet, [both chuckling] I would keep restrictions in place for four weeks. But again, I'm just an infectious disease doctor. I don't run the planet.

MATT GALLOWAY: The chief medical officer of health in Toronto GOT a lot of attention across this country when yesterday, she said that that city is transitioning into, in some ways, a new pandemic. People thought, what, we're still in this pandemic? What do you mean a new pandemic? Is that what you see?

GERALD EVANS: Well, it's changed the flavour of the pandemic, and it's not something that we didn't expect. We knew that viruses mutate. We knew variants were going to arise, and we knew that that carried with it the risk that what we were seeing with the first and second waves, with the wild-type virus might convert into a different kind of wave. And I think what Dr. de Villa was describing is essentially the idea that the increased transmissibility of the variant that we're seeing will, you know, really kind of introduce a sort of new pandemic. And I think a lot of it was also really messaging how important and how incredibly potentially dangerous it is to see these variants emerge at this time, because people are beginning to kind of be relaxed about, wow, the numbers are coming down, cases are coming down across the country, and we're going to see this resurgence.

MATT GALLOWAY: Just two final things before I let you go. Is your expectation once we get through this initial round of vaccinations that this is going to be a bit like, you know, the seasonal flu, that we would need to get a shot every year to keep whatever variants exist at bay?

GERALD EVANS: Yeah, it's quite possible, but there's some very interesting information we know about coronaviruses, right? So this is a big family of viruses. If we look at the human coronaviruses that circulated before this SARS-coV-2 did, what we know is that the sterilizing immunity, the prevention of infection, only lasts for a couple of years before you're susceptible to getting re-infected. But protective immunity, that... that prevents you from getting more severe forms of the infection or the disease actually lasts for a long, long time, for decades. So part of what we're going to see in the next little while is being able to sort does the vaccine give us protective immunity that lasts for a long period, in which case we may only need a booster if it's necessary to adapt to some of the antigenic drift that's seen in this particular virus every five years. However, if there's a big change, it may mean something like an annual flu shot. So that part, I think we're still going to have to try and tease out. But it's very likely that a vaccine for this disease is going to be repeated again in the future.

MATT GALLOWAY: Just in the last few seconds that we have, is there light at the end of the tunnel? People here, you know, new pandemic and third wave, and you can imagine, you know, the gloom starts to hang over their heads. Is there light at the end of the tunnel?

GERALD EVANS: Yeah, I think there is. I think the problem is, is that the light that we're going towards along the track is not following a straight line. It's kind of zigging and zagging its way there. But I'm still very optimistic that a good use of the vaccine is going to help us, along with the continuation of the public health measures that were outlined by Dr. Chetty in his discussion with you.

MATT GALLOWAY: This has been really helpful, dr. Evans. Thank you very much.

GERALD EVANS: Thank you.

MATT GALLOWAY: Dr. Gerald Evans, infectious diseases specialist at Queen's University in Kingston Health Sciences Centre. This is "The Current" on CBC Radio One. I'm Matt Galloway living through a plague is something I think a lot of us can relate to right about now. It's interesting to go back in history, though, and see how others have coped with epidemics, like Italy in the early 17th century, where cities were locked down, travel was restricted and governments implemented programs to help the poor. Later this week, I'll be speaking with John Henderson about this. He's a professor of Italian Renaissance history, and has written a book about how people in Florence survived the plague. And some of that may sound familiar.

JOHN HENDERSON: Something that's not often reflected in the period of the time, a sort of the ideas of loneliness, as we've all experienced over the last year. There's an example of a lady called Lucrezia DeFrancesco BIanche who had moved to a friend's house despite having been told she had to stay in her own one. So she went off to visit this woman, a friend of hers, Maria. And when she'd been arrested for leaving her locked up house, she said, quote, that she didn't want to remain alone at house. I went to stay in this house in the Miller's friend, who's my friend, thinking I'd not done anything wrong. And I found myself in the house of good people. There are also examples of sociability which... which do break the law much more significantly. So people, for example, going to taverns, people playing cards. And obviously this was, you know, a serious time during lockdown. So this was discouraged. There are even cases of people walking along the top of roofs, along terraced houses in order to visit friends and have a party and play guitar and so on.

MATT GALLOWAY: My full conversation with Professor John Henderson about surviving the plague coming up later this week on "The Current". Coming up after your regional update, planning to go for a run today, maybe there's a workout video cued up for a mid-morning break? We'll talk exercise and why our automated lifestyles are making it more difficult for us to get moving. Don't go anywhere for the next 90 seconds. I'm Matt Galloway, you're listening to "The Current" on CBC Radio One.

[Music: Theme]

Why humans may not be designed for exercise on a treadmill

Guest: Daniel Lieberman

MATT GALLOWAY: Hello, I'm Matt Galloway, you're listening to "The Current". Did you make a New Year's resolution this year to exercise more? How's that working out for you? By now, [chuckling] you may have succumbed to that little voice in your head telling you to stay on the couch and take it easy. Turns out that may be in your human nature. A new book says we may not be designed for exercise, on a treadmill, at least. Daniel Lieberman is the author of Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding". He's a professor of human evolutionary biology at Harvard University. Daniel, good morning.

DANIEL LIEBERMAN: Good morning. Thanks for having me.

MATT GALLOWAY: Thanks for being here. Explain this to us. How could humans not have evolved to exercise?

DANIEL LIEBERMAN: [laughing] Well, that seems to be a head-turner for a lot of folks. It's a... it's a basic distinction between physical activity and exercise. So physical activity is just moving, right? It's just getting up and doing stuff. Like, I just shoveled the driveway this morning. That's physical activity. But exercise is a special kind of physical activity. It's... it's discretionary. It's voluntary. It's when we when we do physical activity for the sake of health and fitness. And so when I go for a run today, that's exercise. So it's a special kind of physical activity. You know, in the past, people had to be very physically active, right? They had to be physically active to survive. They had to get food. They had to avoid being somebody else's food. And today, we've created this world where we no longer have to be physically active. And so we now have to choose it. We have to choose to do exercise. And yet, when it used to be sort of required, spending extra energy doing physical activity was a bad idea. You'd use up energy, you know, going for a needless five-mile run in the morning, and then you wouldn't have that energy to spend on taking care of your body or your children or all the other important things we do with limited calories.

MATT GALLOWAY: There are people in the book that you refer to as "exercists". [both chuckling] who are the excercists amongst us?

DANIEL LIEBERMAN: Yeah, so we all know exercists. They're that kind of annoying people who nag and brag about exercise, you know, tell you how many pounds they lifted to the gym. You know, they just kind of make us feel bad about whatever it is that we do.

MATT GALLOWAY: What is wrong with those people and what is wrong — in terms of what they do — with how then we end up thinking about exercise?

DANIEL LIEBERMAN: That's the reason I entitled the book "Exercised", is that we get exercised about exercise, right? We get anxious and confused and sort of nervous. The biggest reason that people get nervous is that they're made to feel that they're lazy, that somehow there's something wrong with them if they don't run marathons or they don't go to the gym and lift huge numbers of weights or whatever. And and... actually, they're being totally normal, right? The example I love to use is in a mall or an airport or something like that, and there's an escalator next to a stairway, right? And we all know this, right, there's that little voice in your head which says, take the escalator, right? And even though there were no escalators in the Stone Age, obviously, it's still a basic, fundamental and sensible instinct to avoid unnecessary physical activity. And yet, we're made to feel bad for that little voice. And it may be good to overcome it, but... but we shouldn't feel like there's anything wrong with this or that we're somehow abnormal for for wanting to avoid unnecessary exertion. That's the most natural thing in the world.

MATT GALLOWAY: How did we get to this point then? I mean, and this is the question as a professor of human evolutionary biology, but how do we get to the point where we now believe that we need to do those things, lift weights, go for a run when we're not being chased by anything, [Daniel laughs] to somehow stay alive and stay in decent shape?

DANIEL LIEBERMAN: Well, it's because we invented all these wonderful machines that obviate the need to do labour anymore. I mean, you can get up and spend your entire day without ever having to elevate your heart rate. You know, you can sit in chairs all day long, and just press buttons and food magically appears. And we go to the supermarket, and we have shopping carts instead of having to carry the food, and the list goes on, right? So we now live in a world where we no longer have to exert ourselves at all. And yet, exertion, you know, doing physical activity turns out to be incredibly important for our health, because when you carry something a long distance, when you go for a long walk, when you go for a run, when you go swimming, whatever you like to do, right? Whenever you do any kind of physical activity, you're stressing your body and kind of normal ways. And then, the body then responds to those stresses by turning on an incredible array of repair and maintenance mechanisms. But now, because we don't do that, naturally, right, because we don't have to do that anymore, if we don't find alternative ways to be physically active, we never turn on those repair and maintenance mechanisms. And the end result is that you're much more vulnerable to heart disease, to cancers, to diabetes, to osteoporosis, to arthritis, to a wide range of diseases that used to be rare or absent.

MATT GALLOWAY: There's been a lot of research done on exercise. What is it that concerns you about how that research in past has been conducted, particularly when it comes to physical activity and what we need from physical activity?

DANIEL LIEBERMAN: It's not so much the research that concerns me. I think it's the way that we've packaged it and conveyed it. You know, we pick up the newspaper or click on a website, and you read an article about, you know, you should wear this kind of shoe. Two days later, you read a completely opposite article about you should wear a different kind of shoe. Or you read that you should do this amount of weight training. Or then you read that running is bad for your heart, and you read that running is good for your heart. We get this information, these little sound bites, that are often contradictory because of the kind of the small particulate way in which we get the information. So we get whiplash. And then the other thing is that we also we've kind of medicalized and commercialized how we think about physical activity. You know, the proof is in the pudding. I don't know the data in Canada, but in the United States, only about 20 per cent of Americans get the minimum level of physical activity that's recommended by every major health organization on the planet, which is 150 minutes of moderate to vigorous physical activity a week. And it's not like people don't know that exercise is good for them, everybody knows that [laughing] you don't need.... you don't need a Harvard professor to tell you that, right? It's that the medicalization and commercialization and commodification of physical activity, of exercise, has clearly not worked. And I think that an evolutionary approach and an anthropological approach can help us do a lot better in a more compassionate way.

MATT GALLOWAY: There's an anecdote at the beginning of the book in which I believe you're lugging a treadmill through [both laughing] to a remote area where perhaps people would raise their eyebrows at the existence of the treadmill and the place of the treadmill in our popular culture. Can you tell that story?

DANIEL LIEBERMAN: To me, the treadmill is the apotheosis of exercise, right? It's I mean, I don't know many people who enjoy, you know, using a treadmill. It's a bizarre, strange contraption that makes you work really hard to get where you are. And by the way, they were invented to torture Victorian prisoners.

MATT GALLOWAY: Sorry, they were invented as a torture device? I mean, there are a lot people who think it's a torture device, but they were actually invented as a torture device?

DANIEL LIEBERMAN: Yeah, yeah. It was invented by a guy named William Cubitt to torture people in Victorian prisons. And so if you... [laughing] if you think of treadmills as torture, you're in good company. [Matt laughs] But anyway, so... so we... we've been working for years and years, over a decade, in this community in Kenya, where people carry a lot of stuff, especially women. Like, they carry water every day because there's no plumbing. They carry firewood up enormous hills. And... and so we were interested in the biomechanics of how they carry a lot without spending a lot of energy. And so we thought the best way to do this experiment, let's get a treadmill. So we bought this treadmill, and we schlepped it up to this area. It's really hard to get there. The roads are awful, and the closest place we could plug it in was about two hours away from this community. So we plugged the treadmill in, and then we brought participants from the community back to where the treadmill was plugged in. And we put oxygen masks on them so we could measure how much oxygen they're using, and turn the treadmill on, and it was a total disaster [chuckling] because if you're, like, you know, a mid-40s person, and the first time in your life you walked on a treadmill with some weird guy like me putting all kinds of devices on you, you're not going to walk very normally. They actually thought it was really funny because what a strange machine, right? We're all having a good time. But we realized that we couldn't use the treadmill for the experiment because people weren't walking the way they normally do. And we had to abandon the treadmill after all the expense and bother of getting it up there and do the experiment in the different way. And it just to me, epitomized just how strange treadmills are.

MATT GALLOWAY: What have you learned in that research about physical activity that perhaps we could learn here, just in part around the idea of what you were hinting at earlier, that we've evolved in some ways to be as inactive as possible, and that when we push ourselves beyond that inactivity, there's something different that's going on.

DANIEL LIEBERMAN: I mean, look, there's several ways to... to answer your question, which is a really good one. So one is that we have the sense that, you know, our ancestors used to be active all the time, right? That are our ancestors were incredible athletes who could just get up in the morning and run marathons and, you know, worked tirelessly all day long. And the answer is, sure, they worked harder than your average American or Canadian, [chuckling] but they didn't work that hard. So your typical hunter-gatherers spent about two-and-a-quarter hours every day doing moderate to vigorous physical activity. That's... that's not a huge amount. The farmers we worked with in Kenya work harder, actually, but they also get more food as a result of the hard work. But when they're not working, they do just what you and I do. They hang out, you know, at home, and they sit on the ground or on stools or benches, they don't have fancy cushioned chairs like you and I do, but they rest. In fact, your typical hunter-gatherer sits as much as a typical American, about 10 hours a day. So we've kind of got this kind of bizarre notion about sort of physical inactivity. We think that, you know, we rush out and buy standing desks and kind of think that's like exercise, which isn't, right? And we demonize chairs. We say they're out to kill us, you know, and sitting is the new smoking. On the other hand, we also have these lives where we were so physically inactive. The average American in their 20s or 30s is active only about twenty-something minutes a day. And by the time people are in their 50s or 60s, they're active about 12 minutes a day. That's way, way lower than what's evolutionarily normal, right? Which is, you know, several hours a day. And and we're paying a price for it.

MATT GALLOWAY: And yet, one of the chapters, I mean, there are a number of myths that you kind of tackle head-on in the book. One of the chapters is titled "The Importance of Being Lazy". Why is it important to be lazy?

DANIEL LIEBERMAN: From an evolutionary perspective, yeah, until recently, energy was limited. People struggled to get enough calories to get through the day and pay for themselves and their children's bodies, right? And when... when energy is limited, every time you spend energy on one thing, you're not spending on something else. You have to engage in trade-offs, right? You know, yesterday, I went for about a five-mile run, and that meant I spent about 500 calories. Now, if I were energy-limited, those would be calories that I couldn't spend on taking care of my body, or... or if I was a nursing mother, energy that I would use to to synthesize milk, which is really expensive. Nursing is really calorically-expensive. Taking it easy when you didn't have to exert yourself was an adaptation. It's useful. It's good. But now, of course, we have this very strange modern world where we no longer have to be active at all. And now we have to do the reverse, we have to choose to be active, and we never evolved to do that.

MATT GALLOWAY: And we're burning calories while we're still sitting around on the couch, perhaps not ingesting, you know, potato chips or something like that. But when... when we are inactive, energy's burned just by sitting around?

DANIEL LIEBERMAN: Oh, yeah. About two-thirds of a normal human being's energy levels are spent on just basal metabolism. That's just running your body, paying for your brain, and, you know, all the cells in your body that are doing everything, right? So just living is expensive. Just spending the day in a hospital bed is expensive. But on top of that, normally, we spend about another third of our... of our energy budget just doing stuff, you know, pottering around the house, going to work, gathering food, you know, and of course, today, because of... of modern technology, that number has dwindled. And the result is that we just don't turn on all kinds of mechanisms that are really important for our health.

MATT GALLOWAY: You mentioned the standing desk. We keep hearing that, you know, sitting is the new smoking. Is sitting the new smoking?

DANIEL LIEBERMAN: [bright laughter] Look, I think it's very well-intentioned. You know, people who make that... that statement mean well, right? And they're trying to promote physical activity. But I think everybody knows you do not need to be a doctor to know that, you know, sitting in a chair is not the same thing as smoking a cigarette. And I think we do ourselves a disservice when we demonize completely normal natural behaviours. I mean, it's a better way of saying it is sitting too much is unhealthy. Why can't we just say the truth, right? And let's not pretend that sitting is abnormal. As I said before, you know, our ancestors sat as much as we do, but it turns out that they sat differently. And... and that's where the really interesting information is. It's turns out that people who get up more frequently, so if they get up every 10 to 12 minutes are, much healthier. They have much better health outcomes than people who sit for 30 minutes or more spans. So just getting up every once in a while and turning on your muscles turns out to be really, really beneficial. The same thing is true of more active sitting. So if you're squatting or sitting on the ground or sitting on a chair that doesn't have a back, you're using some muscles, and those muscles are using up sugar in your bloodstream and using up fats in your bloodstream. And that's also beneficial. So what we really should tell people is, look, if you're going to sit at work all day, make sure you don't sit in the evening. People know that already. And also, when you sit, try to sit actively, you know, get up every once in a while, maybe consider a chair that doesn't have so much back support or sit more towards the front of your chair so that you... you know, you have to use some of your back muscles to hold your back up or something like that. We don't have to demonize sitting.

MATT GALLOWAY: There is, as the cliche goes, a German word for that. What does sitzfleisch mean?

DANIEL LIEBERMAN: [laughing] Well, sitzfleisch is this idea that if you... if you have the ability to sit still for a long period of time, you can, like, be brilliant. You know, you can do these amazing things. It's like it's stamina. It's like the stamina to sit in one place and solve a math problem or read a tough passage in a book or something. You know, I kind of use sitzfleisch as a way of thinking about this idea that there are trade-offs. Yes, there can be benefits to sitting in your chair for a long time and solving a puzzle, but that's not necessarily great for your health. And so there are better ways to sit, and there are worse ways to sit. And if we can have the best of both worlds, that's where we should be aiming our... our efforts rather than simply scaring people about something as natural and normal as sitting.

MATT GALLOWAY: What about scaring people about not getting enough sleep? This is something.... and when you talk about the commodification of things, one is sitting. We'll talk about walking and running in a minute. But sleep is this thing where... and I say this is somebody who wakes up early in the morning to come to work. We are terrified by health media and others that we're not getting enough sleep. And if we don't get enough sleep, I mean, it's like smoking and sitting and all those things kind of combined into one thing. [laughing] Are we getting enough sleep, and how do we quantify what enough sleep actually is?

DANIEL LIEBERMAN: Yeah, you said it as perfectly, which is that we're... we're exercised about sleep. [Matt chauckles] You know, the reason I wrote that chapter about sleep was that when I was working on sitting, and thinking about sitting, I just suddenly my brain asked the question, you know, if we're told to sit less, how come we're told to sleep more? You know, and that was actually how I got into that question. And I started looking at the literature. And I was surprised because I grew up thinking that you need eight hours of sleep and that, you know, Edison has robbed us of sleep. And that before television and... and light bulbs and iPhones and all these wonderful devices that we have, people used to sleep more. [chuckling] And the evidence is that's just not true. That's completely false. If you look at data from people who don't have electricity, some of the populations where I work, people don't sleep any more than Americans or Canadians. And, in fact, you know, hunter-gatherers have been measured in multiple continents, right.? They sleep like, you know, six hours a night and they seem to do just fine. And so we've just been fed this idea that eight hours just to be normal. But there's absolutely no evidence to support that. And then the other thing is that we've also been fed this notion that somehow eight hours is optimal. And I was really surprised, I started looking in the literature that, you know, there's been a lot of studies where they look at how much sleep you get on the on the horizontal axis and your health outcome on the... on the vertical axis. And the curve is U-shaped curve. And the bottom of that curve, i.e. the optimal amount of sleep that most people should get, turns out to be seven. And, of course, now there's a lot of variation, right? Everybody's different. So let's not... let's not oversimplify. And I don't oversimplify. But the fact of the matter is that plenty of people get six or seven hours of night and it's just fine for them. And there's no evidence that they would do better if they slept eight. In fact, if they're an average person, they'd probably do less well. So, again, I think we just we make people exercised about some many aspects of physical activity, but also physical inactivity. And then the result is we make them stressed, right? So, look, if you're getting three or four hours of sleep a night, that's probably too little, and you really probably should get some more sleep and work on that. But if you're getting six or seven hours of sleep a night and you're feeling fine, don't get stressed, because if you do get stressed about it, you elevate your levels of cortisol, which is the arousal hormone. And guess what cortisol does? It prevents you from sleeping. And then you just get this vicious circle where you get really nervous about sleeping, and that makes you less able to sleep. And then we end up, you know, buying drugs that are really bad for us. You know, hypnotics that are, really, the evidence of their effects are just scary. Or we spend ridiculous amounts of money on super special mattresses that, you know, actually don't really work, and special blinds that cut out all light, you know? But our ancestors in the past could sleep in conditions that bordered on bedlam. You know, a lot of the conditions that we like for sleep are really culturally-determined, which means I could learn to sleep in all kinds of other environments. It's just a question of what I get used to.

MATT GALLOWAY: What about walking? We're doing a lot of walking these days in the pandemic, when we can get out, you know, if we're not locked down, you might go in and walk around your neighbourhood and explore your neighbourhood. You talk in the book about why it is that humans are efficient walkers.

DANIEL LIEBERMAN: If there's any one physical activity that we evolved to do, it's walking. We are champion walkers, right? And your average hunter-gatherer walks, you know, between five to nine miles a day, which is extraordinary. That's like walking from Los Angeles to Washington, DC every year. It's... that's just normal. That's what we evolved to do. And we have all kinds of beautiful, elegant adaptations in our body that make us really good at it. You know, walking is... is remarkably unexpensive. And that's actually one of the reasons why it's hard to lose a lot of weight through walking because you just don't spend that much energy walking. A typical person walking a mile burns about 50 extra calories, which is not a lot. So you have to walk a lot of miles to burn a lot of calories. So it's not the best way to lose weight, although you can lose weight slowly through walking. But walking just turns on so many aspects of our cellular biology that... that have all kinds of incredible benefits in terms of our immune systems, our cardiovascular systems, our every... every system of your body. And it's one of the reasons why walking is so unbelievably healthy.

MATT GALLOWAY: What about running? Were we born to run, as the phrase says?

DANIEL LIEBERMAN: Well, that's... that's my work. I've done a lot of research --

MATT GALLOWAY: You sure have, yeah.

DANIEL LIEBERMAN: On if we should be running? And I believe that running, you know, didn't replace walking, it's in addition to walking. And that starting around two million years ago or so, our ancestors started running as well, you know, not all the time. But occasionally, in order to get meat for scavenging and for hunting. And it explains all kinds of adaptations that our bodies, the arches in our feet, the big muscles that we have that make our rear ends so attractive, the tendons in our legs. It's a long list of features that make us really good at running. Even if we evolved to run, we didn't have to run the way we kind of run today, right? So we didn't evolve to run marathons, you know, as fast as you can from one line to another line 26 miles away. We didn't we didn't evolve to run every day of the week. And we also get ourselves into trouble by running in kind of weird ways.

MATT GALLOWAY: Is running going to destroy my knees?

DANIEL LIEBERMAN: No. [laughing]

MATT GALLOWAY: Thank you!

DANIEL LIEBERMAN: There's this idea that running causes wear and tear, right? And this is another myth, right? It's true that runners do often get knee injuries, but wearing away your knees, that's not what happens. In fact, there are plenty of studies which show that runners are not more prone to getting osteoarthritis. And furthermore, I think that a lot of the knee injuries that runners get are because a lot of folks don't know how to run properly. I think running is a skill, just like swimming and climbing and playing tennis or whatever, and that there are better and worse ways to run and that we should pay more attention to running form and help people learn to run better.

MATT GALLOWAY: What does that mean? I mean, just briefly, what does running better? I mean.

DANIEL LIEBERMAN: Well, I mean, I think this problem that people have when they run today is that they overstride. They stick their foot way out in front of them, and they land really hard on their heel. And they put huge forces around their around their knees and, you know, good runners run lightly and gently, right? And that's one of the reasons I think barefoot running is interesting because it forces you to be and gentle. Whether you wear shoes or not, I think it's a barefoot-style that tends to be a good running for. And so good runners land with their their ankles below their knees, so they're not sticking their their leg out in front, and that forces them to land kind of flat, and that forces them to to get their knees up when they're running and to run lightly and gently. The book describes a bunch of elements which I think are important for just basic running form. They're not that complicated. It's just that we don't pay that much attention to them.

MATT GALLOWAY: You've written a book about the runner's high, but beyond that, when we exercise, what happens? Like, what do we get out of that? That... that... that is something that we can't get elsewhere?

DANIEL LIEBERMAN: That's a great question, because, and it's an important question, because running and walking and swimming, all those kinds of physical activities change every aspect of our body, including our brains. So that turns on production of serotonin and dopamine. And if you run for long enough, you produce endocannabinoids, which are the same thing that make people high and you produce opioids, you know, for your body. And so all those wonderful mood improvements that we all experience after physical activity, those are kind of nature's reward to keep us doing it again. Dopamine is the molecule of more, right? That it's the dopamine that gets elevated for physical activity, which says, yeah, that was good, do it again, right. But the problem is that those mood-enhancing neurotransmitters and hormones aren't produced before you exercise. [chuckling] They're produced when you exercise. So they they give us a reward for having done it, but they don't get us out the door in the first place because we never evolved to have to choose these things, right? We evolved to need to do it whether we like to or not. And so today, in this strange modern world we live in, we have to find ways to help each other get out the door, and then so that we get the rewards. I'm no exception. I mean, you know, I often, I like to run, but I often really hate, especially in the winter, you know, putting on all these clothes and mittens and hats and whatever and getting out the door. And the way I do it is by running with friends and trying to make it social. And usually, I grumble about it. But I'm always glad that I did it afterwards because I feel good.

MATT GALLOWAY: Should we create the architecture so that it becomes — even if we didn't evolve to do it — that exercise becomes mandatory in some ways? I mean, you say that education is... is a model and in some ways we could treat exercise like education. What would that look like?

DANIEL LIEBERMAN: Yeah, exactly. So, yeah, you know, I mean, we never evolved to to read, right? Reading as a completely modern behaviour, too. Until a few thousand years ago, nobody on the planet read and nobody planet went to school, right? These are all modern things. And yet, the way we do that is we make them necessary and rewarding. And the 'and' is the important thing, right? So school is fun, right? You know, you learn stuff in school. It's not always easy, but you learn stuff. But also, we make it social and you see your friends there. And we have, in addition to the classes, there's, you know, art and dance and, you know, sports and all these good things that... that make school enjoyable. Let's do the same thing for physical activity. Instead of trudging on treadmills in dark basements with fluorescent lights, you know, listening to podcasts, try to make it tolerable, which, you know, if that works for you, that's fine. But let's make it social. Meet friends for a walk or a run or a game of tennis or dancing. I mean, dancing is the most wonderful forms of physical activity. It's social, it's fun. It's rewarding every culture in the world, does it. There's a ton of things that we could do as a society to make exercise, in particular, more necessary and rewarding.

MATT GALLOWAY: What is at stake if we don't do that?

DANIEL LIEBERMAN: Well, we already know what's happening, right? I mean, rates of diabetes and heart disease and cancer has been rising around the world. What's at stake is that we end up living more of our life with chronic, debilitating diseases, right? And physical activity, it's not a magic bullet, it's not going to prevent you completely from getting any of these diseases, but it reduces your chances. Alzheimer's, for example, physical activity reduces typical person's chances of getting Alzheimer's by at least 30 per cent. Even respiratory tract infection, if you get out and physically active, you... you activate your immune system to produce more of the cells that actually help you fight viruses and you actually deploy themselves more to your respiratory tract. So they're there and ready and waiting for... for when you breathe them in. And if you're going to get a vaccine soon, hopefully some of your listeners will be getting them already, there's plenty of evidence that a bout of moderate physical activity actually improves the body's response to the vaccine. And your antibody production is enhanced. And the list is so long, it's hard to even know where to where to stop.

MATT GALLOWAY: That should motivate people. But let me just ask you a couple of quick things before I let you go. One is, to your point, sometimes, you know, the couch is there and it's very inviting. And you could go for that run or the walk or the swim, but there's the couch and you could lie down. How do you convince yourself to exercise on days you really don't want to?

DANIEL LIEBERMAN: I try to plan for the fact that I know I'm going to be intrinsically unwilling to do that. I know that the inertia will set in. So, for example, here's how I do it, right? So everybody has to find their own solutions. But I have running friends, right? So I have a a colleague of mine who I meet often in the morning. And the night before, we agree that we're going to meet at like 6:00 a.m. at the corner between our two houses. And I can guarantee you that at 6:00 a.m. on most mornings, I do not want to do there. [both laughing] You know, I'd much rather be in bed, but, you know, I know he's going to be out there at 6:00 a.m. waiting for me. He'll be really irritated if I don't show up and vice versa. And so we meet, and you're often, like, very grumpy for the first few minutes. And then we kind of gradually warm up and then we have a fun conversation, and I'm always glad I did at the end. So that's one way I do it. Or I sign up for races. I mean, I don't really love running races that much, but signing up for race kind of is like an incentive for me to to train. So because I know I have a race coming up, and I better get the miles in or, you know, I come up all kinds of ways to force myself to do it. But I do my best, and I try not to beat myself up for my instincts, for my inclinations. And so I try to think about them and overcome them rationally.

MATT GALLOWAY: I mean, the book ends with a kind of mantra, which could be applied to any number of situations or taught to what have you. It's make exercise necessary and fun, do mostly cardio, but also some weights. Some is better than none. And then perhaps more importantly, keep it up as you age. Is that, not how you live your life, but the kind of thing that you try to remind yourself of?

DANIEL LIEBERMAN: Yeah, I mean, you know, it's not so complicated. We've made a really, really simple things super, super complicated. I managed to write a whole book about it. [Matt chuckles] But... but everybody basically knows the answer, right? You know, if you're... if you're physically inactive and you're struggling to get off the couch, don't worry. You don't have to run a marathon. Just a little bit will do you some benefit. You don't need to go crazy. Just anything is better than nothing, right? And it's good to mix it up. And as you said, you know, as you get older, weights keep you from being feeble. And as we get older, staying active is more important, not less important, I think it really is a fantastic way to fight the ageing process and and stay vigorous and healthy as we age. But everybody knows that. It's just useful sometimes to remind ourselves of that. And, hopefully, the book explains why that's the case, why that ancient wisdom really is true.

MATT GALLOWAY: Daniel, thank you very much.

DANIEL LIEBERMAN: It's my pleasure. Thank you.

MATT GALLOWAY: Daniel Lieberman is the author of "Exercised: Why Something We Never Evolved to Do is Healthy and Rewarding". He's also a professor at Harvard University. That's "The Current" for today. Coming up next on CBC Radio One, it's "Q". I'm not sure how many calories you burn off by reading, but it is a great thing to do. And with that in mind, you can hear Canada Reads panellist Rosey edeh talking about the book that she will be championing in Canada Reads. That's coming up in a few moments on CBC Radio One. I'm Matt Galloway. Thanks for listening to "The Current". Take good care. We'll talk to you tomorrow.

[Theme]

February 9, 2021 Episode Transcript

Social Sharing

More from this episode