Thanks for joining us at the Canadian Breakpoint, a Canadian infectious diseases podcast by
Canadian infectious diseases physicians.
I'm Summer Stewart, here with Dr. Rupina Pirwal, pediatric infectious diseases physician
in Saskatoon.
For this episode, we celebrate all things spooky for Halloween, and what's scarier
than another pandemic.
Today we welcome back Dr. Kinderchuck to discuss emerging viral diseases.
Are we prepared for the next pandemic?
Dr. Pirwal.
All right, welcome everyone to another episode of our podcast, the Canadian Breakpoint.
Today we have a very special guest with us, Dr. Kinderchuck, who is an associate professor
and Canada research chair in emerging virus pathogenesis in the Department of Medical
Microbiology and Infectious Diseases and cross appointed in the Department of Internal Medicine
and Manitoba Centre for Proteomics and Systems Biology, the University of Manitoba.
His work focuses on viruses that pose the greatest threat to global health, including
Ebola virus, orthophox viruses, coronaviruses and influenza viruses.
His research program centres on the circulation, transmission and pathogenesis of emerging
viruses.
Past and present findings from these investigations will help inform emerging virus therapeutic
treatment strategies, outbreak prediction and preparedness efforts with impacts on both
human and animal health.
Dr. Kinderchuck leads multiple nationally funded emerging infectious disease research
investigations, including One Health emerging zoonotic virus surveillance activities in
Canada and Africa.
These include as a director for the International EMPOC's Response Consortium, co-lead for
pillar two of the Coronavirus Variance Rapid Response Network and ongoing investigations
on the long-term impacts of Ebola virus infection in disease survivors in West Africa.
Today we'll be talking about more just a broader topic, what he's been doing in terms of his
work out in Africa in terms of emerging viral diseases.
And really that one question that many of us probably have or multiple questions that
we have about what are the actions that we're going to take to kind of prevent a pandemic
or what's the future like, what's the preparedness level at this time in terms of, in the realm
of being surrounded by emerging viral diseases.
So thanks Dr. Kinderchuck for coming back on today and it's always a pleasure to have
you.
Thanks for having me.
And now I've got to try and figure out if I'm going to be optimistic or pessimistic
with the questions.
We'll see.
And you know what, the one thing we always tell our listeners is that this is for informational
purposes only and it's always evolving.
So what we will talk about today may change and that's completely fine, but I think it's
up for discussion and there's always, in our profession, I think there's always things
that are evolving and we just have to take that into consideration.
Today's episode, what I kind of wanted to focus on was your workout in Africa because
you, I think have done a fantastic and commendable job in terms of the different areas that you've
been working out there.
And I think it was neat for me to hear it when we had our initial discussions and just
hear about all the work that you've been doing out there.
And I think it would be nice for some of our listeners who are actually interested in emerging
viral diseases and a lot of the prevention work that you're doing out there as well and
surveillance, to kind of hear about and maybe elaborate on the work that you are currently
involved in.
Sure.
I mean, a big part of it is I work with extremely talented people that often tend to be leaps
and bounds smarter than myself and keeping motivated in that.
And I say that very specifically to my African colleagues, that people are the best in the
business.
So the program has developed really since I started at the University of Manitoba seven
years ago.
It really had already kind of been in development prior to that when I was still down at NIH
in Bethesda.
The key point was kind of in 2014, I had the opportunity to spend some time in Liberia
during the West African Ebola virus disease epidemic, really providing diagnostic support
kind of as that outbreak started to kind of hit its peak in the country.
That really changed my perception of research.
It kind of went from being this very kind of pragmatic kind of molecular biology based
program, trying to understand why is one virus more violent than the other and try to understand
the mechanics of it to suddenly saying, oh wait, there's a lot of people that get sick
from these things and these diseases look awful when you see them upfront.
What do we do to try to reduce the impacts?
And that's a very simplistic way of saying it.
So since that time point, we've tried to get a number of things off the ground.
One of the big initiatives that we've been working on has been in regards to continual
work with Ebola virus.
So in Sierra Leone, one of the pieces that we've been able to get up there has been to
work with about a thousand Ebola virus disease survivors to look at long-term health complications,
as well as long-term stigma that's faced by survivors in the community.
And I think one of the pieces that kind of comes out of this that's important is when
we often think about outbreaks and this whole idea of outbreak response, there's almost
kind of this view of the movie outbreak where we come in, you get everything contained and
then everything goes back to normal and things are fine.
The reality is very, very different, right?
What we've seen in the cohort of individuals that we've worked with, a lot of long-term
health complications, six to eight years post-recovery, a lot of general health complications,
these are all self-supported, but neurological sequelae, eye pain, ear pain, we see some
reproductive impacts, certainly menstrual impacts for women.
And then of course we see a lot of mental health impacts.
So a lot of very, very severe depression or chronic depression in survivors, and as well
a lot of perceived stigma from the community.
And we see it on the ground, right?
There's still kind of that piece of somebody that survived is not always welcomed back
into communities.
So we've really tried to establish a program to identify what those needs are, knowing
that we're working in a country and in an area of the world that doesn't have the support
for the needs that are there.
So we've really kind of used this as, first of all, a mechanism to be able to report what
this looks like, to be able to put a spotlight on to our Sierra Leone colleagues that have
been working on this for a number of years, but also to try and kind of impart the importance
of this to the Ministry of Health in the country, as well as to the broader public health community.
And I think it plays back into this idea that that outbreak was not an isolated incident.
We've seen really nearly annual outbreaks in the DRC every year kind of following 2016.
The outbreaks are not going away, and this probably doesn't just apply to Ebola, really
to any disease that has a high morbidity cost to it.
There are probably a lot of these long-term complications that we don't actually know
about because we're not investigating them, because the systems aren't present within
the community.
So that's a big piece of it.
The other piece of what we're doing in West Africa has been more about the idea of what
happened in 2014.
There's December 31st, 2013.
There's this case of a young child that starts showing symptoms, and the contact tracing
and the investigations go back to this idea that this child probably had a contact with
an infected bat.
We think bats are the likely reservoir host for Ebola virus.
The kind of in-between gets a little bit more complicated because there are other animal
species that can act as intermediate hosts between humans and bats, most notably non-human
primates.
And if we go back into the late 90s, early 2000s, some of the data that came out of Gabon
by their local researchers and folks from France was that there was actually a pretty
high impact of Ebola virus amongst great apes, so both mountain gorillas as well as in chimpanzees.
So we know that these animals are potential hosts for the virus, but we don't know much
about what it looks like in terms of circulation or how they play a role in ongoing circulation.
For us, when we think about Sierra Leone, the virus kind of came out of nowhere in 2014
for the first time, the end of 2013, and has really since disappeared outside of recrudescence
in Guinea in 2021.
These viruses often don't disappear.
So the likelihood is that Ebola virus is still circulating somewhere in the wild, but we
don't really know where.
So we were actually working with a chimpanzee sanctuary called Takugama in Sierra Leone.
The sanctuary serves to rehabilitate chimps that have been either orphaned or injured
in the wild, and they bring them in, they rehabilitate them, but also acclimate them
back towards non-human contact with chimpanzees that are at the facility.
We have been working in partnership with that group for a couple of years now.
They do annual health checks on the animals.
It's basically a top to bottom health check.
The animals are fully sedated.
They do everything from digital x-rays to looking for scarring and tissue abnormalities,
swabs, blood, urine, feces.
So we've been assisting with those, but also trying to collect sera so we can look for
exposures.
And really what we see this as an opportunity to do is to be able to better identify where
viruses are circulating in the wild.
So we have that big initiative in DRC.
We're actually looking at that, obviously it applies to M-Plox right now, but more broadly,
one of the things that we're focusing on is the idea of certainly the wild animal trade,
more so in terms of wild game.
So the trading and purchase of meat from local markets.
One of the things we don't really understand is the risk that there is to people in terms
of exposures to animal tissues, certainly from species that we know are potential hosts
for these different viruses.
There has not really been a thorough study of what do those risks look like?
What does testing of those tissues look like in terms of positivity for viruses or emerging
infectious diseases?
So we're working locally in South Kivu right now with basically acquiring samples from
local animal markets.
We want to be able to also move into dry blood spot analysis on folks that are involved in
hunting to be able to look at those exposures and be able to look at potential risks for
humans in terms of consumption or contact with those samples.
And then of course we do a multitude of other things on the One Health front, but those
two are the biggest initiatives that we're undertaking at the moment.
Okay.
That's fantastic.
Yeah.
So I think what we've learned from the pandemic and then also with even M-Pox in the situation,
really having these surveillance networks is important because that is key to kind of
mitigating the risks and disease spread and really finding out where there's high disease
areas so that we can focus our efforts there.
Yeah.
And it's important for us.
When we think about certainly again, going back to West Africa with Ebola, the virus
emerged, had devastating consequences, not only in terms of human health, but also obviously
economically within the region, those impacts continue to be felt 10 years later.
There's really a need to be able to try and understand for the local communities where
kind of those greatest risks lie in terms of potential exposures.
While also kind of appreciating that we can't, certainly with One Health work, we can't go
into communities and say, listen, just don't hunt or don't have contact with animals.
That will reduce the risk because that's part of their traditional lifestyle and you're
not offering anything in terms of sustenance alternative.
So a big part of this is being able to try to understand what that exposure risk is,
but also to try and work with communities to look for areas to try and reduce the potential
for exposure.
So are there basic kind of IPC things that we can do and we can work with communities
on or be able to try to promote and engage people for self-reporting or trying to increase
diagnostic capacity in the area so we have earlier detection of when these events occur.
Yeah.
So it sounds like awareness is a key component of this, right?
And then, so if they are engaging in activities, which can increase disease activity, then
they know from the infection prevention control, handling, meat handling, those types of practices
so that they can kind of mitigate the risk of spread of the disease.
Yeah.
And still the caring of patients locally, right?
Whether it's within a household or within a local healthcare clinic, being able to try
and provide at least some recommendations to reduce risks where we can or where we can
provide information on.
Oh, that's fair.
Yeah, and what I've seen in our practice over the years, and even when we had local centers
preparing for any Ebola cases that were travel related, there was definitely infection prevention
control was the forefront of everything, right?
In that terms as well.
But I think the most important thing was just being aware that these are the high risk areas.
So if travel was coming from there and if anybody had really, I mean, fever was the
main, one of the main signs.
And if they had fever and they were coming and they traveled from this area, then the
protocols were initiated.
And I think that probably controlled most of the situation within most countries outside
of the endemic areas.
Yeah.
And I think coming through COVID, I mean, I was in, kind of living in front of Maryland
at the point where I was in Liberia, I came back into the US from my deployment, the day
that the first US case was announced, things changed.
And there was a lot of local concern about what that meant.
I think where we were then versus where we are now, we know a lot more about the importance
of infection prevention control, but also the importance, I think, for the public in
terms of self reporting.
I hope coming through COVID, that's one of the lessons we've learned is, if you're sick,
you have symptoms, you think you've had a contact, these are the measures you should
personally take to try and reduce potential transmission risks.
And then the importance of being able to get for testing.
We still need to keep promoting it.
Certainly, Implox has taught us that, but I think we're in a different place than we
were kind of pre 2020 as well.
I agree with you.
Yeah.
And then in terms of, I mean, obviously there will be other emerging viral diseases.
We currently are dealing with situations in Africa and the surveillance networks are well
in place in places where there is more endemic disease.
Is there something, is Canada doing something different now post pandemic from the COVID
pandemic to kind of ramp up surveillance so that we can pick up on some of these emerging
viral diseases as well?
Yeah.
I would say so.
I say that in a bias perspective, because I'm somebody who has been able to get grant
funding to do some of this work and also works with others who do as well.
I think it's kind of a two-sided coin because the one side is, yep, there's been greater
investment certainly in surveillance.
I think a greater appreciation that surveillance is actually a science and it belongs in terms
of funded research and science.
So that's the positive side.
The kind of more pessimistic side is much of that surveillance again is based off of
grant funding.
So, you know, your surveillance networks that you're creating, they're usually coming in
with like a two to a five year period where you know that you have sustained funding.
After that, it's, you know, you're either going back to try to reapply or hoping somebody
else is coming forward to be able to try and sustain the network.
I think that's one of the areas where we still need some work is what does sustained investment
look like and how do we sustain researchers or sustain groups to be able to do this type
of work on the ground and also ensure that we are doing this in a way that is building
capacity and not just kind of providing hands and saying, yeah, we'll do the work.
Please just let us have access to, you know, to your country and to all of your equipment
and let us have at it.
We need to be able to do this from a partnership perspective and ensure that we can move funds
to partners rapidly and also appreciate the expertise that those partners often have for
far greater amounts than what we do.
Yeah.
And always it goes down to funding, right?
And so the problem we have sometimes with research and even some of these surveillance
networks or programs that we're developing, it comes down to funding.
And like you mentioned that having that sustained funding is really important.
So there's a lot of discussion in literature in terms of the spillover.
So from zoonotic reservoir, we've seen a lot of environmental changes over the last decade,
I would say constantly like areas are flooding, we're dealing with global warming, areas that
never really had much tick activity.
Now we're seeing the spread of that.
So your work obviously out in Africa, you're working closely with seeing that zoonotic
transmission and we know that emerging viral diseases commonly kind of present that way.
And so in terms of kind of what the potential of this is and what are we doing, are there
other diseases that you're currently on the rise or you're looking at and what kind of
surveillance are you doing there?
Absolutely.
I mean, I think the easiest one that I think most people will kind of have top of mind
is H5N1 avian influenza, right?
So earlier this year, now I can't separate months and years anymore.
So I think it was early 2024.
We saw the introduction of H5N1 from wild birds into dairy cattle in the US.
We are continuing to see movement of the virus through dairy cattle.
We've seen some human infections that have accompanied that.
Those have been fairly mild in nature, which has been great.
The cattle, it's largely been a self-limiting disease, but we've seen also spillover from
those animals into other species like farm cats or I should say farm cats, the cats that
are found on farms.
We've seen high fatality rates in those animals.
We've seen certainly prior to that, the broad movement of H5N1 globally the last couple
of years and really moving and having really profound impacts on marine mammals all across
North America, moving into South America and now obviously moving into Antarctica.
And I think now every continent has had avian influenza introduction.
So those types of events are things we're following.
We pretty quickly, when it was established that you could start to look for fragments
of H5N1 virus in commercial milk, as FDA reported, we set up really an academic network across
Canada to start testing retail milk samples and really just to try and provide where we
could because Canada had not seen any case at that point.
We still haven't seen any introduction, but to be able to provide some additional surveillance
coverage.
So we've been very active there.
There's another piece of this, which of course, avian influenza, so we know that wild birds
are really the, you know, the kind of the reservoir host that we need to focus on.
There's a piece of this, which is still, what is that risk for people that are in close
contact to wild birds?
People that are doing bird handling, those that are hunting, those that are consuming
wild birds.
So we are working on getting some serosurveillance networks up and running right now to be able
to address some of that, to look at exposures over time, to also be able to provide confidence
for people that are taking in these activities and also to look at infection prevention control
mechanisms.
Those things continue to be top of mind.
For tick-borne diseases, you know, right now, you know, obviously, you know, wine continues
to be a big concern in Canada with kind of greater geographic spread.
Powassan virus is top of mind for, you know, the kind of, you know, northeasterly direction
we've seen coming out of the US and the movement into Canada.
But we're also watching other arthropod-borne viruses as well, including dengue and obviously,
you know, still focusing on Zika and chikungunya.
And then, you know, working in Crimean Congo in the background of all this, because of
the kind of more sustained transmission that we're starting to see, or at least, say, sustained
circulation we're seeing amongst ticks in Europe.
You know, we're kind of looking at that movement out of Africa now to, you know, to additional
continents.
So the unfortunate reality, I think, for us is I try to be very maneuverable.
I think all my collaborators are trying to be very maneuverable with what we work on.
We're pivoting all the time, though.
Either we're doing much better surveillance and we're much more cognizant of what's going
on around us, or we're seeing, you know, a greater emergence of these infectious diseases.
And I would suggest we're probably seeing the latter.
I think we continue to need to be prepared.
We continue to need to figure out where we need to do surveillance, what surveillance
looks like, and overall what exposure looks like for humans.
Again, we kind of tend to focus on mortality and morbidity for many of these diseases.
M-Plox is certainly, you know, kind of top of mind, but of course Ebola and avian influenza
and others.
But we tend to know about the cases that are presenting, right?
The piece that we don't understand yet is how many cases do we not know about and what
does that circulation look like?
So for us, a big part of this is trying to get those networks created and try to get
a better idea of what exposure and circulation looks like, more broadly for emerging infectious
diseases overall.
Yeah, and I think like even what I've learned, like being in infectious disease position,
right?
I was a staff like right at the peak of the pandemic, a new staff.
And so just kind of learning and also going through the whole pandemic and answering questions
and just, and really seeing this, even now, the strains evolve and the variants come through.
And I think that's always really challenging.
You know, you talked about like pivoting.
I think it also makes it very challenging because you see newer strains and newer variants
come from these strains that then makes your work so complicated.
Well, and it gets, I think the piece that gets probably the most complicated to, at
least in my mind, is communicating back to the public.
Like, you know, M-Plox, a perfect example, when we talk about clade 1B, trying to explain,
well, how does clade 1 and clade 2, how do they differ?
Then how do the subclades differ?
And how does this compare to what we've seen reported historically?
That piece of community engagement and knowledge translation is so important.
I think one of the things coming out of COVID that I hope we appreciated was ensuring that
that messaging, again, is not a one size fits all.
There are communities in Canada and Manitoba, Saskatchewan, certainly more broadly in the
global community that are disproportionately affected by these viruses or may also have
underlying concerns in regards to what their perceived risks are.
How do we ensure that information is getting to those communities and is being done in
a way that, or communicated in a way that's respectful and transparent based on kind of
local customs?
Like, that's a big piece for us.
We learned in 2020 on the fly.
I think now we really have to ensure that we integrate that piece into all the work
that we're doing.
Oh, yeah, that's fantastic.
Yeah.
I think definitely, I mean, all of the information that we've provided till now is factual, but
then there's always this component of, you know, you're working at the front line of
this.
You've seen the surveillance networks.
Do you feel like the evolution from 2020 till now, have we evolved as a society to kind
of fight the next pandemic?
And this is obviously an opinionated question.
So this is the pessimistic side of it.
So yes and no.
And I know that that's kind of an easy way for me to get out of this.
I'm more optimistic because of the fact that things like M-Plox right now, we're talking
about it.
It's on the global stage.
We're seeing, you know, kind of rash and very, I should say rash, but expedited movement
of vaccines and hopefully sustained funds into the areas of need.
The pessimistic side is, yeah, but it took until now to do that, right?
We had 20 months prior to this where we knew that this was kind of the trajectory.
So I weigh the optimism with some of that pessimism.
I think H5 is a perfect example where people immediately picked up on those cases.
We had broad testing networks.
There have been certainly limitations in the robustness of those networks and the reporting
and certainly the acquisition of human data that are related to those farms or those agricultural
centers.
But I think we're moving forward.
And I think the rapidity at which that was done is a good indication that we're in a
very different place kind of post 2020.
So I'm optimistic from that side.
Every time I see an Ebola or even a potential Ebola outbreak being announced, I'm more optimistic
because I know that that means vaccine deployment is going to be occurring quickly and the areas
where we've seen these emergency events in the past, their local capacity for testing
is much greater.
Certainly the folks in DRC, it's kind of like within hours they're testing, they've got
teams moving out.
It's a very, very good system.
Globally, I still worry about this idea of the division between the global north and
the global south.
Coming out of 2022 with M-Pox, we did very, very well with M-Pox containment, certainly
in Canada and more broadly amongst non-endemic countries.
Cases work or tailed quickly.
There's been local transmission underneath that, but that's been fairly well contained.
But we always knew where the source was.
And there's that period of saying, well, we still haven't gotten vaccines into Nigeria,
into DRC, into other endemic regions.
We haven't necessarily built up the surveillance networks or the sustained capacity for testing.
Where in DRC we have massive limitations for being able to test samples.
Can we do that without finding ourselves in a new emergency to kind of provoke us to then
do it?
So I think we're getting closer to that, but it's coordination and money.
And those are decisions that are made at much higher levels than me by much smarter people.
So I hope we're getting there.
I'm more confident than I was pre-2020, but we have work to do.
Yeah.
And I think that's fair.
And when we look at even cases when Ebola, for instance, back in 2013 and that time,
we've learned a lot since then as well.
But even at that point, I feel like we were able to contain the infection from becoming
a pandemic.
And I think some of it is familiarity, right?
So like we talked about the H5N1 response, probably some of our knowledge back from H1N1
outbreaks probably helped us at that time too.
And so we know way more information than we did previously.
And I think the real thing is the importance.
We know the importance of being aware that something like this is out there and that
we have surveillance networks in place so that if there is any case that is reported
outside of kind of that endemic area, it's picked up quickly.
And like you said, deployment is quicker.
So it does make you feel a little bit better that things are in the works.
And I think the other piece of this too is that all this is being done in a multidisciplinary
fashion, right?
I think one of the things that's come through during the pandemic is you have this old branch
that's been extended across between healthcare workers, physicians, physician researchers,
researchers, social scientists, people that are working in natural sciences.
Like everybody is kind of banding together to figure out how can we build teams to combat
this from a very kind of broad brush.
I think we're doing better in that realm.
And that's important.
That way at the very least that information is able to get across all these different
communities much faster and ensure that we're also not kind of missing areas within research
when we have the opportunities to do very focused investigations.
Yeah.
And you make a very valid point about the multidisciplinary approach.
I mean, even coming from during COVID and having kind of vaccine programs and vaccine
development was a key thing at that time.
And we saw that approach happen over several months, within like six months, I would say,
that where we were able to have researchers come together, have companies help with production
and deployment of these vaccines.
So it does make you feel-
And all these things, like it's fantastic.
Yeah.
And then coming from like, I think not only surveillance, but then lab testing, because
that's huge too, right?
So-
Absolutely.
Yeah.
And has there been a lot of kind of in the microbiology world, because I'm away from
that, although I work very closely with my colleagues in micro, are there advancements
in terms of...
I mean, I think like gene expert was something that has obviously revolutionized.
PCR has obviously changed our world, and then there's the quicker diagnostics, but is there
anything that's emerged since the pandemic that you would say is going to be helpful
in the future?
You know, I think one of the things that we learned coming through the pandemic game,
you know, kind of, I'm just a virologist, right?
So just kind of my naive viewpoint, but just thinking of the idea of like rapid antigen
testing.
That was something that, you know, for years people have talked about, we had seen some
amount of deployment of it, then 2020 hits, and we have massive global deployment of rapid
antigen tests.
The ability to be able to do that type of testing on the spot, change things, I think,
insurmountably, because this was also a technology that didn't require a constant power source
and, you know, it could be done really in very, very resource-limited areas.
So I think there's a move towards that, you know, our current situation with M-Pox, you
know, we're still trying to figure out how we can do rapid testing.
PCR is limited.
We have to appreciate many of the areas that are hotspots for emerging infectious diseases,
you know, largely are very resource-limited settings and tend to be very remote settings
or rural settings.
So it's often difficult to be able to kind of deploy infrastructure that requires constant
power sources.
But things like rapid antigen tests, if we can get those deployed and if we can identify
those cases faster, these are technologies that can be used by individuals that don't
have medical training or don't require diagnostic training outside of being able to understand,
you know, what the lines mean and what, you know, the potential confounding variables
might be.
That faster ability to be able to identify a suspected case to then do for what testing,
I think will really revolutionize things.
I agree with you.
I mean, I see that even currently with COVID too, that we still have these antigen tests
that general public can use and can really identify, okay, I shouldn't go to work or
I shouldn't be around people if this is positive, which then, you know, takes you to the next
step, which is then goes into prevention because we have less circulating strain.
And can reduce the stigma associated with having to go somewhere for testing, right?
I mean, I think that's a big piece of me, especially like M-Pox with what we're seeing
in Congo with the link back to sex worker, to those that identify as GBM SAM.
So they have a stigma attached with that.
So you know, being able to have testing that can be done in the home that then pushes somebody
to go to a local healthcare clinic or gives them the impetus to do that, I think is good.
You know, being able, we still need to figure out the whole idea of how we can take kind
of self testing to be able to then be integrated into like national databases or at least to
be recorded data of just positives or negatives.
That's a bigger question, but I think we're moving towards something that is easier for
the user.
Yeah, I agree.
I think you're doing a fantastic job out there.
It's commendable to see that you have a huge team and your team is, you know, looking at
such great work like surveillance and the long-term effects as well, because I think
that's really important to kind of evaluate.
And so I think your workout in Africa, but then also the work that you're doing locally
as well, I think it's super helpful.
And folks like yourself are the ones that are, you know, the reasons why we're optimistic
that we are getting closer and closer to being more prepared.
And obviously there's holes in every system and it takes time to learn how to fill some
of those holes.
So, but after having this conversation with you, I definitely feel my answer would be
that we are definitely more prepared than we were back in 2020.
I appreciate that.
It's humbling.
I'll use it in my next annual performance review.
But I say the feeling is absolutely equal on my side for our healthcare workers.
You know, you all have been taking it on the chin with COVID and M-Plox and everything
in between the work that all of you have been doing and as well the work on community engagement,
public engagement, the stuff that you're doing with podcasts like this for the public.
It makes a massive difference for us as well.
So very, very much appreciate it.
Again, it's working together, right?
And so I think we learned that from the pandemic and that's what's going to help.
And yeah, it's great to see all of your work.
And I honestly, it was a pleasure to have you on the podcast today.
We had a fantastic previous episode on M-Plox.
Everybody will tune into that, I'm sure.
And then we might see you again on the podcast.
Or hopefully there won't be another outbreak and everything's fine.
Nice chatting.
Thanks so much.
Take care.
Thank you, Dr. Kinderchuck, for joining us again.
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