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    COVID-19 Pandemic Response

    Articles published in response to the 2020 coronavirus pandemic.

    Shelagh Day
    May 21, 2020
    We need a new social and gender pact that addresses inequality
     

    Women are at the frontlines of the battle against COVID-19 in Canada
     
    AROUND THE WORLD, citizens are calling for change because COVID-19 has laid bare the dangers of inequality. For women, the risks are diverse and harsh. This is the moment for a new social and gender pact.
    Over the past several decades, the slashing of social programs and services in western democracies in the name of austerity and deficit-slaying has permitted social and economic inequality to thrive. COVID-19 has confronted us starkly with the result: the risk of death and disease falls unevenly across the population.
    The frail elderly, disabled persons, prisoners, the homeless in shelters and camps, and Indigenous people in northern and remote communities – those we have institutionalized, or left without homes, those we have impoverished and marginalized—are most at risk.
    COVID-19 has also made us recognize that increased risk for some is a threat to us all; we are more dependent on each other than we thought. 
    The good news in this time of pandemic is that governments have shown they can act when necessary. The best have done so quickly and effectively, addressing social inequalities to protect everyone’s health and safety. Canada’s willingness to spend billions of dollars to support its residents is crucial for social solidarity and well-being.
     But now what? Do we just go back to the “normal” of inequality and wait for the next crisis? Not a chance.
     A fundamental lesson of COVID-19 has been that social justice is a threshold requirement for a resilient and sustainable society. We cannot return to the status quo of inequality when its dangers for everyone are now so obvious. As we learned from the 2008 financial collapse, we also can’t leave the planning to those who favour the markets-before-people policies that created the problems in the first place.
    If we view moving beyond this health emergency as a narrow exercise in getting businesses open again, we will miss a transformative opportunity. This is not about patching up the largest holes in Canada’s tattered social safety net. What we need is a new economic and social model, one that works for everyone, placing human rights, social justice and gender equality at the centre. 
    Key to making an effective recovery is addressing the gender inequality that the COVID-19 crisis has thrown into stark relief. 
    Women have been disproportionately and harshly affected. They are the majority of the frontline essential workers in health care, social welfare and retail services; many of them are racialized or immigrant women. They are at risk at work, where they’re essential to maintaining the lives of others, and yet they’re among the lowest paid workers in our economy.
     Women are also most at risk of being out of work, as recent unemployment figures show, and they can’t return to work without adequate, affordable childcare. They’re also at risk from male violence in their homes, and on the streets, with their means of escaping violence reduced by isolation requirements and by lost income.
     To build a resilient society we need to deliver income security, provide adequate housing for everyone and make child care an essential service. We must eliminate discrimination in pay and conditions of work, increase the capacities of our health care and elder care systems, and make real progress on climate change.
     We must also address the systemic issue of male violence against women, treat the people whom we convict of crimes fairly and humanely, and start respecting the rights of Indigenous peoples to land, clean water, and healthy lives.
     The Secretary-General of the United Nations, António Gutteres, and the Inter-American Commission of Women have both issued reports recently recognizing the impact of COVID-19 on women around the world and urging states to ensure that recovery plans are feminist and that women are equal partners in decision-making.
     The response of the nay-sayers to these calls for government action to tackle inequality are predictable. They will cite the need for austerity, seed panic over deficit and debt levels, claim that government is the enemy and must be kept small. But Canadians now know otherwise: this is a time for public entrepreneurship and investment in people and services.  
     This is a time for governments to think big about a people-centre and women-centred economy and to engaged in a major assault on inequality and poverty.  There can be no going back to ‘normal.’
     Shelagh Day is the Chair of the Human Rights Committee of the Canadian Feminist Alliance for International Action, a human rights expert and a Member of the Order of Canada.

    Kumanan Wilson
    Resolving the COVID-19 pandemic could require digitally identifying who is immune and who isn't.
     
    IN THE 1800S, SMALLPOX RAVAGED THE WORLD. Fortunately, a vaccine had been developed that could protect individuals. This vaccine left a scar at the site of injection and identified the individuals as “immune.”
    As we look towards the future of the COVID-19 pandemic, unless the virus burns out or an effective therapeutic intervention becomes available, the only way out of our current situation will be immunity—either natural or induced by a vaccine. If so, we will need to create a digital proof of immunity, a digital version of the smallpox scar, to help society to return to normal.
     

    A smallpox vaccination scar identifies who is immune from infection by the variola virus
     
    Ideally, a safe and effective vaccine will be available in the New Year. If this is the case, we will need to have effective systems in place to identify those who are immunized. Our existing system of largely paper records will not be adequate. 
    Here is how such a system should work.
    Most provincial/territorial governments have repositories of immunization data. For the eventual COVID-19 vaccine, they will need to ensure that this data is accurate and that the individual identified did, indeed, receive the vaccine. The government could then issue a verified credential, an immunization badge, which contains an easily scannable barcode or QR code, through government portals. This can be consumable by third party apps or be downloaded similar to a boarding pass. 
    To enter into certain venues, such as sporting events or for international travel, the digital badge will have to be presented. The bar code will be scanned and matched to an individual’s ID card, just as we do for boarding passes. This will permit entry or travel. Exemptions will exist for medical reasons. 
    I expect our tolerance for philosophical exemptions will be much lower given the consequences on both health and the economy if outbreaks re-emerge.
    Ideally an international standard for this vaccination will be set under the International Health Regulations which already provide guidance for Yellow Fever vaccine certificates (Annex 7). This guidance needs to take into account the digitization of these certificates.
     More controversial is the issuance of digital badges for natural immunity confirmed by antibody testing. The science and ethics of this solution are not mature at present but that should not preclude us from considering this option. 
     As for immunization, antibody data from credentialed labs could be stored in immunity repositories and digital badges issued if a threshold of immunity is considered to be achieved. The most likely initial application of this solution will be front-line workers where, if we are confident natural immunity provides protection, we can create systems ensuring certain percentages of front-line workers are identified to be immune. This will create a form of “shield immunity” disrupting the transmission of the virus and protecting front-line workers and the people for whom they care.
     A digital solution will have security and privacy risks that a paper record won’t have. However, a digital solution will be agile and adaptable in a way paper records cannot be. For example, if scientific evidence emerges on waning immunity, digital badges can be revoked. Decentralized ledgers (think blockchain) can facilitate the movement of this information across borders and between institutions.
     As we enter into the next stage of this pandemic, we must start taking steps to ensure we have the right technology in place when science provide us with solutions. I have confidence that the combination of science and technology with ethical and legal oversight can accelerate our return to normal.
    Kumanan Wilson, MD, MSc, FRCPC, is a physician at The Ottawa Hospital and a member of the University of Ottawa Centre for Health Law, Policy and Ethics.  He has been a consultant to the World Health Organization on the IHR (2005).

    Marilyn McCrimmon
    PEPPER’S FOOD, a local family-owned business, has been a fixture in Cadboro Bay for 35 years. When General Manager Cory Davits was asked how the virus had affected business, he said, “In every way.”
    Once COVID-19 restrictions were announced in mid-March, Pepper’s quickly got busier. “People went on a buying spree, and then there were too many people in the store,” Davits says. He started asking the customers to line up outside, allowing only ten customers in the store at a time.
    Pepper’s has always offered online ordering either for customer pick-up or home delivery. Home delivery increased instantly, to the point that they now have three drivers driving all day to customers’ doors.
     

    Pepper’s Food General Manager Cory Davits
     
    Financially, Davits says business is similar, like other grocery stores and liquor stores right now, but the way they’re doing business, is dramatically different.
    For one thing, “We have shortages. First it was toilet paper, then it was pasta and rice, then it was flour. Our suppliers are keeping up, but we are out of these things at the end of the day.” They get resupplied each day.
    Staff safety and morale are big priorities. When restrictions were first announced, some staff were fearful enough of the virus that they opted to stay home for now. At the same time, the store was very busy, so they were short-handed.
    “Everyone wants their business to survive. One person gets sick and the whole business shuts down. It was scary,” Davits says.
    Davits says the community really stepped up. Pepper’s has a large loyal following of customers, and community members offered to work for free to help out. But while he gratefully said yes to the offer of help, he also said, no to the volunteering. “We will pay you.” And he notes that they are all still there. It’s a stressful time for all of the staff, he acknowledges, so Davits has since instituted “hero pay”—giving everybody $2 an hour more to work.
    The store got so busy that staff morale suffered, and Davits could see that everyone was on edge. About two weeks ago (early April), they made the decision to close the doors to the public, and instead, “We concierge shop the orders for them,” he says. Customers have three choices: “They can email the orders in and we phone them when it’s ready and put it in a cooler in front of the store and they pick it up. They can email the orders in and we have it delivered to them. We ring the doorbell and leave it on the porch. If they just come to the store, we take the list and shop for them.”
    He saw some differences immediately. “Staff morale is amazing. It is way more comfortable for them.”  Safety protocols are in place to keep the staff safe. They work six-feet apart, and Davits says all of them are wearing gloves, which they change frequently, and everyone sanitizes regularly. It was hard to find hand sanitizer until Davits managed to secure a supply from an up-island distillery.
    They ran out of plastic bags as people can’t bring their own bags anymore. Similarly, masks have been hard to come by. Davits ordered some on March 5, and they arrived seven weeks later. “We will have the staff masked when we reopen.” He also has a group making some bandanas for the staff. He anticipates requiring customers to wear their own masks as well once they reopen the front doors of the store.
    “Lots of things have changed, some for the better, some for the worse, but we are adapting.” Down the road Davits says, “I think you’ll see businesses with line-ups for some time to come.  It’s the only way to keep staff safe. It’s still scary, but we’re getting used to it.”
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.

    Irving Gold
    May 5, 2020
     

     
    OUR HEALTHCARE PROFESSIONALS in direct contact with patients who are infected, or presumed to be infected, with COVID-19, are making the selfless decision to put the lives of others ahead of their own. Now, more than ever, they need to be propped up, cheered on and profoundly thanked. 
    But more importantly, they need to be protected—all of them.
    The term “frontline worker” has become ubiquitous, a form of shorthand to refer only to doctors and nurses. Unfortunately, this shorthand is not limited to media coverage but has made its way into policies and procedures of healthcare institutions, regional health authorities and even provincial ministries of health. The consequences are potentially disastrous. 
    Medical Radiation Technologists (MRTs), respiratory therapists, custodial staff and others are working the frontlines but too often do not have access to adequate personal protective equipment (PPE) despite working regularly with COVID-19 patients. This puts them and their families at risk. 
    PPE should not be considered a “nice to have.” It is a must have.
    MRTs are the frontline professionals responsible for producing vital medical images (using x-ray, Computed Tomography, Nuclear Medicine, MRI, Mammography and more) and for performing life-saving radiation therapy treatments. In the performance of their essential activities during this pandemic, many MRTs are in direct contact with COVID-19 patients in emergency departments, ICUs, or in instances where COVID-19 patients are sent directly to medical imaging departments for their examinations. 
    Recent observations from the University of Washington, showed that from a sample of 5,000 COVID-19 patients, 4,700 chest imaging exams were performed. In these instances, MRTs are the professionals who assist patients to ready and position themselves for scans, educating them and offering them comfort throughout the process.
    All frontline professionals are equal, but some frontline professionals are more equal than others, it seems (appropriating George Orwell’s warning in Animal Farm).
    Following several emails and calls from our MRTs from across the country, we were compelled to send a survey to our membership at the Canadian Association of Medical Radiation Technologists asking them two questions: Did they feel they had adequate access to PPE? And, if not, was PPE being distributed inequitably among front like workers in their workplace?
    The responses should alarm all of us. 
    Of the roughly 3,000 responses received, nearly 40 per cent of MRTs felt they did not have adequate access to PPE. Of those, 60 per cent said that other frontline professionals were being given greater access to PPE. Variance in rates across provinces also reveals how MRTs are treated differently depending on where they work. 
    This is clearly unacceptable. The health and safety of MRTs and others on the front lines should not be protected less vigorously than any other frontline professionals. And those working in one province should not be protected less than those in another. 
    To leave any frontline workers with inadequate PPE is indefensible, even when it is in short supply. 
    The designation as a “frontline worker” must not depend on one’s professional title but their potential exposure to COVID-19. Risk should be determined by the procedure and the patient group being treated.
    Access to adequate PPE must be addressed now, without delay. 
    Professional associations throughout healthcare should work together to take on this issue. We are all rowing in the same direction and inter-professionalism has never been more important. 
    Provincial governments must work together to ensure that hospitals, regional health authorities, clinics and long-term care facilities have consistent and equitable PPE policies. If this cannot be accomplished, the federal government should intervene.
    Once we have reached the tail end of this first wave of the pandemic, we will need to address these gaps systematically in preparation for the next waves. Or the next pandemic. 
    This will not be the last time such choices will need to be made. We need to develop policies that are fair and consistent across the country -- and protect all our frontline workers. 
    Irving Gold is the Chief Executive Officer of the Canadian Association of Medical Radiation Technologists.

    Trudy Duivenvoorden Mitic
    May 5

    Plant a saved pea and it will remember what to do
     
    I’M BREATHING EASIER NOW that the vegetable seeds on my heating mat are coming to life. The tiny ones rising up to become crowd-feeding tomatoes and salad greens, the creamy teardrops morphing into squash, and all the rest—theirs is an inimitable feat powered only by nature, which should be humbling for us humans who are the proud, self-appointed, top-dog species roaming throughout the global savanna.
    At our house, the germination spectacle almost didn’t happen this year. Preparing for deep isolation more than six weeks ago, we stocked up on frozen, dried and pantry foods, the usual staples to see us through the next several weeks. It never occurred to me to put my seed order in early, and when I finally got to that line on my to-do list, seed packets were already flying off the shelves everywhere. Too late, I realized I’d been caught with my gardening pants down.
    After some frantic scrambling online, I managed to get what I needed from two trusted sources, although my orders are so backlogged by the landslide of sudden demand that, taking the positive view, my seed shopping’s all done for 2021.
    This rush on seeds and ensuing scarcity should not have hit me by surprise because, in reality, it’s been coming for years, waiting only for a trigger. Seeds have always been valuable currency, although, like so much of nature’s treasure trove, we’ve commodified, adulterated and exploited them to the point where their essentiality for life has become lost on so many. But that might be changing now, given the current upheaval and disquiet. Suddenly we’re spending a lot more time thinking about food, shopping for it, and hoping that the stocks and supply chains hold up.
    No surprise then, that all around us there’s a major gardening revolution going on. Tools everywhere are coming out of storage, and vegetable beds are being created or refreshed. Down on our knees and with reverence and contrition, we are opening the earth’s mantle to rediscover the lifeblood of soil. We are creating food plots on boulevards, balconies, community allotments and in our own yards. We are rushing to the garden centre for transplants; local greenhouses are selling millions of them and struggling to stay ahead of demand.
    Gardening is for everyone. If you’re new to this, support is almost everywhere you turn. The Victoria Master Gardeners are eager to answer your questions and get you started: Check out their friendly website. The City of Victoria is taking the unprecedented step of retooling some of its own flower-growing greenhouses for the production of up to 70,000 vegetable seedlings. These will be given free of charge to families at risk for food insecurity.
    The Food Eco District (FED), a local, urban gardening non-profit, is working with its business partners to supply food gardening kits to 500 families who’ve been disadvantaged by COVID-19. These kits will contain everything needed to start a garden, including seeds.
    Back at my house, the seed saga has ended well. Fortunately, I had older seeds that could still be coaxed to germinate, and also some seeds I saved from squashes we bought and ate a month ago. A friend gave me heirloom tomato seeds that came from her neighbour, and my astute daughter was kind enough to share seeds she had bought well before the crisis.
    We could say that we’re once again planting Victory gardens, as our ancestors did during the war years. This time the victory will be in better foods and food security. That alone will help make the world a better place.
    Trudy Duivenvoorden Mitic is a Saanich-based writer and Master Gardener. Her books include People in Transition and Ernie Coombs: Mr Dressup (both from Fitzhenry & Whiteside)
     

    Marilyn McCrimmon
    May 4, 2020
    SALON MODELLO on Cadboro Bay Road temporarily closed its doors on March 21. Co-owner/operator Moira Dick described it as, “A complete shutdown. A 100 percent loss of revenue.”
    She says, “It’s been really sad. I had to lay off all my employees.” Like many small business owners, Dick is grateful for the government CERB program for her employees. “I am eligible too as I’m not getting a wage. That goes into paying the rent of the building.” She noted that for most small businesses, the challenge is how to keep paying the rent on their buildings with no income coming in.
     

    Moira Dick
     
    Dick and her co-owner plan to look into the government interest-free loan of $40,000 next month, when they become eligible. “Like everybody, we just wait and see. If it goes beyond three months, it’s going to be scary. That’s where the loan comes in. I don’t want to go into debt, but if we have to, we have to.”
    She has a few ventures to generate some income. “We’ve joined up with Support Local which is selling gift certificates. That’s been helping. So far we’ve sold about $1000 worth of gift certificates.” Besides selling some product, she also sells some hair colour kits, “So we don’t have a lot of fix-up to do when we re-open.”
    Regular texts keep Dick in touch with her staff.  She knows they’re missing doing hair and seeing clients. Dick has also been calling her clients just as she would when reminding them of an appointment. “It’s like a big family and it feels strange not to be talking to them.” Like many in the profession, she has a lot of long-time clients who she is used to seeing regularly.
    Dick has also been anticipating what it will be like when they get the go-ahead to reopen. “As businesses start back up, our situation is unique. They haven’t addressed what it’s going to look like for us. Will my employees feel safe to return? That’s my worry. You have to be six feet away—that’s a challenge as hair stylists. We can’t maintain six feet.” There are a lot of unknowns.
    And then there’s the challenge of cutting hair and applying colour to someone wearing a face mask. Dick isn’t sure what that will look like.
    However, she expects that she and every other salon will be very busy when they do reopen. “There’s going to be a huge demand once government says we can open.” She says, “We are not an essential service,” she says, then adds, “but once we’re open, it’s going to be an essential service.”
    Some anxious clients have asked her what the stylist association is saying about opening, but she says, “We know as much as anyone else. We listen to Dr Bonnie Henry and we have to listen to what the law says.”
    Meanwhile, as someone who likes to stay busy, Dick is making the most of the temporary closure. “I have been painting the inside of the salon. We might as well take advantage of the time.” She knows she is not the only one as she can hear renovation work going on upstairs from her salon.
    And Dick is also enjoying spending time in her garden and going for regular hikes, but she worries about what is to come.  “It’s still so up in the air. I am trying to take one day at a time.”
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.
     

    Michael Wolfson
    May 4, 2020
    Sophisticated sampling strategy needed to adapt to evolving policies associated with gradual relaxation of physical distancing.
     
    THE FEDERAL GOVERNMENT recently announced it will fund at least one million blood tests to track the novel coronavirus over the next two years. This is a step in the right direction. But is it enough?  
    How do we know if we are testing the right number, and the right people, especially as the pressure to ease up on the lock down and isolation rules increases? The answer depends critically on why we need test results. 
    A sophisticated sampling strategy is the only path forward at present. There simply is not enough resources to test everyone or even perform a simple random sample.
     

    Health worker performs a coronavirus throat swab test
     
    Perhaps half of those infected do not show more than very mild symptoms, if any. These individuals have greatly complicated efforts at epidemic control. If everyone infected with COVID-19 had symptoms, we could simply require them to self-isolate. Instead, we have to keep two meters from everyone and wear masks, because we cannot tell if they are infected but not showing it.  
    Public health agencies clearly need to continue and expand testing for high risk populations, including front-line health care workers, personal support workers (PSWs) working in nursing homes, retirement residences and in home care, as well as the public health workers doing contact tracing.
    But we need to do better, with reliable real-time data on how many people in the population are, or have been, infected and where they are.  Tests of current infections, with a lag of a few weeks, signal impending hospitalizations. That’s no longer good enough. 
    It is essential to detect and isolate infected individuals quickly, and as many of their contacts as can be traced, if we want to relax the restrictions as quickly as possible.  
    Blood tests as the government has just announced, can tell us how many people have been infected (though the amount of resulting immunity remains unknown). But these will likely be far below those needed for herd immunity, so low that significant relaxation of physical distancing would result in a surge of new infections—straining health care resources, causing more deaths, and requiring the reintroduction of draconian controls. 
    To monitor adequately, the tests cannot cover only symptomatic individuals since this will miss the large asymptomatic or pre-symptomatic portion of the infected population. 
    It matters who is tested. If it’s mainly individuals who live alone and are careful about physically isolating, most tests will be negative.  For PSWs or meat processing plant workers, though, the same number of tests could find much higher rates of infection.
    To provide valid and useful results, testing needs to be based on sophisticated sampling, simple random samples will not work. A highly controversial Santa Clara study of how many residents have been infected shows the perils of poor sampling. 
    For example, nursing homes need their own samples; indeed, every resident should be tested periodically for the time being. For the general population, though, a multi-pronged effort is needed, starting with new clusters of infection, including key groups such as front-line workers in shops that are re-opening.  
    We also need to distinguish geographic regions within provinces, for example, different cities. Even though most of the public discussion has been about policies at the provincial level (and state level in the US), proper sampling, and relaxation policies, will need to target very real differences within provinces. 
    In sum, we need a sophisticated sampling strategy for testing, and one that can adapt to evolving circumstances, not least as physical distancing and related policies are reduced.
    These data need to be accessible for statistical analysis not only locally, not only provincially, but also nationally, and of course they need to be securely handled and protected. 
    Testing results, based on proper and extensive sampling, are fundamental to improving the model results shown on TV and used by governments to inform the relaxation of restrictions. This would allow us to return to a new normal—more quickly, and with lower risks of serious mistakes. 
    Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

    Judith Lavoie
    May 3, 2020
     
    ANXIETY IS RIPPLING THROUGH Victoria’s Burnside-Gorge neighbourhood as residents hear through the unofficial grapevine that about 80 percent of the more than 350 of those living in tents in Topaz Park and Pandora Avenue will be coming to hotels in their community.
    The area, which is home to many families with children, already has two shelters and several supportive housing complexes. Residents have, as a result, experienced fallout from mental health and addiction problems in the past. Recent incidents around Topaz Park, where crime spiked after the camp was set up, have added to their concerns.
     

    Rock Bay Landing, located in the Burnside-Gorge neighbourhood
     
    It’s a delicate balance for both residents and those who have been living in tents since shelter space was reduced because of COVID-19.
    While there is widespread support for dismantling the camps, providing adequate housing, and helping those struggling with mental health and addictions, questions are being raised about what help is available to the receiving community.
    Residents in the Burnside-Gorge area neighbourhood recently discovered that four out of five sites for hotel relocations are in their area—although, according to Michelle Peterson, no one has reached out to the community to offer specific information or security help.
    Peterson, a long-time Burnside-Gorge resident, told Focus, “Every single one of the people I have talked to, no question, agree that these people need to be housed. That is not an issue. It is more the impact and the lack of support for the communities.”
    At a virtual meeting that included Island Health representatives, Peterson was told that many of the campers are feeling anxious and uncertain about the move, so will be helped by psychiatrists and mental health experts.
    “I told them I am hearing very similar feelings from residents in my community and there’s no supports for them. What are they going to do to support the neighbours?” she asked. Island Health has agreed to take the concerns to their executive, Peterson said.
    “This is a crisis and I think everyone understands that, but what people are worried about is what is the plan to help mitigate any negative impact, because we know that there is a percentage of that population who can be quite dangerous. They’re the ones who have active, significant mental health issues or active substance abuse issues or they’re violent to themselves or others,” she said.
    Given the crime spike in the Topaz neighbourhood, residents are asking for increased security, possibly additional policing, and assurances that 24/7 supervision will amount to more than someone sitting at a reception desk, Peterson said.
    BC Housing is not confirming which hotels in Victoria are providing the 324 rooms, but emphasized that people will be assessed and then connected to wrap-around care including doctors, outreach workers and psychosocial supports. Harm reduction supplies will be provided to people with substance use disorders.
    “BC Housing is engaged in active and ongoing conversations with neighbourhood and community associations in Victoria to raise awareness and provide information about our response to the pandemic and how we are assisting those who are vulnerable,” said a Ministry of Municipal Affairs and Housing spokeswoman in an emailed response to questions from Focus.
    “While we typically connect with neighbours and the public prior to new services opening in the community for those who are vulnerable, we recognize the need to act quickly in the current context. The hotels are temporary and will be vital to mitigating the spread of this virus, protecting those who are vulnerable and the broader community.”
    Peterson said a BC Housing representative is planning to meet with residents, but, so far, no one has come up with a mitigation plan and the lack of information is creating suspicion and polarization.
    “I understand why they don’t want to disclose the location, but, when they don’t provide information to the community and they stay silent and don’t reach out, it creates a significant lack of trust,” she said. “Then what happens is it creates more of a divide, more hostility, more conflict between the neighbourhood and the homeless population which is not what we want,” she said.
    By April 30, 51 people had been moved out of camps and into hotel rooms, with the Province paying the tab. The final cost will depend on the length of time the hotels are used, according to the ministry.
    The contracts with hotels are below the market rental rate, but are providing income for hotel owners at a time when COVID-19 has brought the tourism industry to a grinding halt.
    “We have not forced hotels to accept people. To date, all hotel spaces that BC Housing has secured have been freely negotiated with hotel owners without the use of orders,” wrote the spokeswoman. “These contracts are producing positive outcomes for everyone, including hotel owners, who are getting a fair deal, and their employees, some of whom are being contracted to help operate hotels.” BC Housing has committed to “professional and rigorous cleaning” of all the buildings once the contracts end and will cover the cost of any damages.
    However, for Peterson and other Burnside-Gorge residents, the remaining question is how much help the neighbourhood will be receiving.
    “There needs to be a plan on how to mitigate the impact in the short term, because we know there are going to be impacts,” she said.
    Judith Lavoie is an award-winning journalist specializing in the environment, First Nations, and social issues. Twitter @LavoieJudith

    Scott Lear
    May 2, 2020
    While many of us are focused on the short-term concerns about COVID-19 infection, it is also important to focus on long-term health.
     
    WITH GOVERNMENTAL DIRECTIONS TO STAY AT HOME, it may be tempting to sit on the couch, binge watch TV and eat junk food until everything blows over. That might be okay for a couple of days, but restrictions will probably last for several weeks to months. 
    It may seem like things such as nutrition and exercise are trivial during the crisis, but they aren’t.
     

    A bad case of couch potato
     
    Over time, people neglecting their heart and brain health are increasing their chances of obesity, diabetes, stroke and heart disease. And these are some of the top underlying conditions associated with increased severity of COVID-19. People’s mental well-being is also suffering as two-thirds of Canadians have reported increased stress, fear and anxiety. 
    For both short-term and long-term physical and mental well-being, maintaining a healthy lifestyle is as important now as it ever was. This includes getting sufficient quality sleep, eating healthy, getting regular physical activity and staying connected. 
    Even at the best of times, nearly 50 per cent of Canadians have trouble with sleep. And with information on the pandemic bombarding us throughout the day, getting a good night’s sleep can be tough. But not getting enough sleep can heighten anxiety and increase risk of heart disease and stroke.  
    Adults should get seven to nine hours of sleep per night. Our bodies have their own internal clock, so consistent sleep and wake times are also important. 
    To help with sleep, set up a wind down routine—things to do each night for the half hour before bed. This could be silent reading, listening to music or meditating; avoid screen time as the blue light suppresses the sleep hormone melatonin.
    With daily news stories of empty grocery stores and people hoarding food, it may seem hard to get fresh healthy foods. Especially when trips to the grocery store should be limited. But try to resist the urge to stock up on processed convenience foods. These ultra-processed foods increase chances of getting heart disease and stroke. 
    Instead, use the extra time at home to learn new recipes. Fresh fruits, vegetables, meats and dairy can all be easily frozen. Previously frozen fruits and vegetables are also just as nutritious as fresh. 
    If freezer space is a problem, try canned fruits and vegetables, along with canned fish such as sardines, salmon and tuna. And as grocery stores remain open and frequently stocked, take only what is needed, otherwise it can deprive others from getting food they need. 
    Getting regular activity may be equally challenging, especially if you live in a small apartment with no backyard. But it can raise one’s mood and improve the immune system. Simple things such as skipping rope in the parking lot or calisthenics at home are great. For weights, look around your kitchen. Soup cans and milk jugs can replace dumbbells. For guided exercise programs, there are many videos on YouTube. 
    If feasible, getting out for a walk or bike ride is great. Even short two minute walks around the house can break up sitting and improve blood sugar.
    Lastly, don’t forget about staying connected with others. We’ve all been told to social distance, but that really means physical distancing. Being connected is good for us, while being alone is associated with poor physical and mental health. And with technology, distance isn’t a problem. Just hearing a familiar voice is comforting and sharing a smile on a video call can increase happiness and reduce stress.
    If you’re one of the 2.5 million people in Canada with heart disease or one of the 62,000 people who have a stroke each year it is crucial to keep up with personal self-care. 
    Many clinics as well as cardiac and stroke rehabilitation programs have closed but some are providing virtual sessions and others may be available to support by phone. 
    If you have a medical appointment, call ahead before heading out. A lot of doctors are consulting patients by telephone or video conference. If possible, opt for that choice to keep you home. 
    Ensure you continue to take your medications and have at least a month’s supply. For additional resources, the Heart and Stroke Foundation has moderated Facebook groups and plenty of information to help you take care of your heart health at heartandstroke.ca
    Dr. Scott Lear is a professor in the Faculty of Health Sciences at Simon Fraser University and the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital.

    Maleea Acker
    Pollinator gardens on Victoria’s Lang Street help native plants and bees
     
    MY NEIGHBOUR CUT DOWN HIS HERITAGE APPLE this spring (which used to support the bees every spring and feed us every fall). At our shared fence, I tried to convince him otherwise: food security; habitat for wildlife; the tree was a perch for the Anna’s hummingbird that nests in my yard; wildness; beauty.
    “It’s ugly. I don’t want to look at it,” he responded. He replaced it with cedar hedging, one of the thirstiest plants in the region. You can spot them by looking for the brittle brown skeletons edging people’s yards each summer; they are dying in droves.
    The problems we had before COVID-19 hit us—increasing drought, falling pollinator numbers, decreased biodiversity, rampant development in natural areas—are still with us. The skies might look clearer, but I saw only two bees pollinating my pear tree this April. Empty seed displays at stores attest to the increasing numbers of people growing food this summer. But gardens are appearing and disappearing this summer thanks to COVID-19.
    Mike Large (who I last wrote about regarding Haultain Corners’ boulevard gardens) had a couple of ambitious summer projects before the pandemic hit. One was to work with the Oaklands Community Association (OCA) on a five-day kids gardening camp this August. But, along with all of OCA’s summer programs, it has been cancelled because of the virus. The camp would have seen construction of a garden on OCA lands, as well as some boulevard plots especially reserved for children’s plantings.
    Large also had plans to establish a new community boulevard garden in Victoria. Community gardens are notoriously overstretched; many have waiting lists that number in the hundreds, and one of the primary roadblocks to new community garden spaces is finding a location. Vacant land in cities would seem the obvious choice, but it’s harder to proceed with a new development if an established garden is present, so landowners are often reluctant. Many parks have open grassy areas, but these areas are often viewed as essential recreation spaces (even if they’re not often used).
    Why not convert a boulevard instead? Large is working with adjacent property owners, organizers and potential gardeners. But COVID-19 has thrown a wrench into the process. “I’m optimistic that a window of opportunity will open over the summer,” he tells me by email, but for now, this project is “on pause,” another of many community action casualties during the pandemic.
    But there is a project that’s ongoing despite the current emergency. A couple of years ago, Tamara Batory began organizing with nine of her neighbours because she wanted to do something to make her street “more sociable.” Lang Street runs between Cook and Cedar Hill just south of Finlayson in Saanich. It has remnant Garry oak meadow patches along its residential length. Batory and her neighbours read about the All Ireland Pollinator Plan (pollinators.ie), which is striving to create habitat for pollinating insects across that country. They were inspired.
    Around 70 percent of our food crops require or benefit from pollinators. Honey bee populations have seen drastic losses in the last decade, and 1 in 4 native bee species is at risk of extinction in North America. Native flowering plants depend on pollinators such as bees, birds and bats to reproduce. Their beneficial effects cascade through ecosystems.
     

    A native Painted Lady butterfly sipping nectar from a non-native Buddleia (Photo by David Broadland)
     
    Batory and her neighbours applied for and received two grants from the Victoria Foundation and the Native Plant Study Group to purchase native plant seedlings. They spent the winter of 2019 sheet mulching small patches of each of their boulevards, adjacent to the sidewalk, to prepare for planting. Sheet mulching adds layers of cardboard, leaves, compost and manure over existing grass in order to create a new bed. In summer 2019, they added a variety of native plants and this spring they’re enlarging the plots with the money left from the grants.
    A physically-distanced walk along Lang Street with Batory revealed Nootka rose, red-flowering currant, woolly sunflower, camas, blue-eyed Mary, nodding onion and many other native shrubs, flowers, and bunch grasses.
    As the city densifies, these pollinator corridors—which provide food and habitat for birds, insects and reptiles—will become more and more integral to biodiversity. “We would like to start sharing seed in the future,” Batory tells me. She’s also hoping to install signage that can communicate the WASANEC and Lekwungen names for plants.
    There’s no payment required for neighbours on Lang to join the pollinator gardens, and Batory hopes the movement will spread. She muses, “Maybe people will think of what they can do to help!”
    In this time of great uncertainty and sadness, stop before you cut anything down. Wait a moment, as the poet Kenneth Koch wrote, “to see what is already there.” Then add food plants or native species, don’t subtract.
    Maleea Acker is the author of Gardens Aflame: Garry Oak Meadows of BC’s South Coast, which just entered its second printing. She is still a PhD student. She’s also a lecturer in Geography, Canadian Studies, and Literature, at UVic and Camosun.

    Kate Cino
    A TINY VIRUS WE CAN'T SEE has stopped the world in its tracks. We are now afraid to go out and mingle and worried about our future. Enter the Gage Gallery Arts Collective with an innovative project to keep us busy during stressful times. The Gage Gallery in Oak Bay delights in engaging community. The 18-member ever-evolving collective promotes art and culture through a variety of innovative programming. As well as regular exhibitions, the spacious gallery hosts art talks, poetry readings, musical events and demonstrations
    The Gage Gallery COVID-19 Community Project aims to “Challenge Crisis with Creativity.” While the world deals with self-isolation and social distancing, this project aims to connect us through artistic expression. Community members, including those who don’t consider themselves “artists,” are invited to join in. All ages and abilities are invited to draw, paint, sculpt, write or photograph their personal experiences of the global pandemic. Each week “Challenge Crisis with Creativity” offers a new theme.
    The themes offer focus, and photos of the artworks are placed on the Gage website. Themes so far include: Social Distancing; Can’t Stop the Spring; and Thankful for…
     

    Untitled,  by Margret Fincke
     

    "I feel like I'm just waiting" by Beverly Jean Hancock
     

    "Musical Paintings" by Calla Cowan
     

    "Bacon Family Heart" by Sarah, Michael, Eli, Nate and Josh Bacon
     

    "I am thankful for my neighbour's four-legged friends who are keeping me company" by Elizabeth Carefoot
     

    "Connecting while Physically Distanced" by Diane MacDonald
     
    The genesis of this great idea came from three artists: Deborah Leigh, Tanya Bub and Gabriela Hirt. Their group show called Inside Out, originally scheduled for April 2020, was to encourage community members to share their inner workings on paper.
    The concept morphed into the COVID-19 Community Project when Inside Out was postponed due to the pandemic. Response has been strong, and Gage Gallery hopes to publish a book and have a post-COVID exhibition of selected submissions.
    The book and exhibition are curated by Ashley Riddett, who receives and posts the weekly submissions. Riddett is a graduate student in the Art History and Visual Studies program at the University of Victoria. “We’ve received many interesting and heartfelt artworks,” she says.  After the initial shock wore off, Riddett saw people reflecting and responding with great clarity. As a researcher, the grad student appreciates the archival merit of the project. “These submissions are an important record of unprecedented times,” she says.
    Artist Gabriela Hirt, who has a background in journalism, also sees a wealth of information in these visual stories. “Once the gallery reopens,” she says, “we can share our experiences during the initial weeks.”
    Meanwhile, the collective is financially able to pay the rent while staying busy at home. Plans for the future percolate within this energetic group of idea-people. The gallery is doing rotating “window shows” and recently launched an on-line store on their website. Being active on social media helps spread the news and keep people interested. “We know this is a tough time for people,” Hirt says, “but we have each other and keep on track by sharing ideas and staying positive.”
    Visit the online gallery to see what people have submitted so far.
    Kate Cino has run www.artopenings.ca for over 10 years, and has written about the arts in Victoria for even longer.

    Marilyn McCrimmon
    FRONTRUNNERS FOOTWEAR is a locally owned and operated business co-owned by Nick Walker and Rob Reid. Reid opened the first Frontrunners store in Victoria in 1988; Walker and a partner opened Frontrunners in Langford in 2005; and then seven years ago, Walker became a full co-owner with Reid when all five shops (Frontrunners Victoria, Frontrunners Shelbourne, Frontrunners Langford, and New Balance stores in both Victoria and Nanaimo) were amalgamated into one company.
    Frontrunners closed their doors to the public mid-March to protect the safety of customers and staff, and pivoted to online only. Business is now “substantially different” from normal, reports Walker. Local customers have a choice of curbside pickup or free delivery six days a week. Frontrunners will ship to their customers up island and on the Gulf Islands.
     

    Frontrunners’ co-owner Nick Walker
     
    Financially, Walker says, “We are only doing a fraction of our usual business.” After laying off the entire staff, he said, “with the wage subsidy program, we brought back eight full-time staff.” That, unfortunately, still left 80 percent laid off. He added, “Hopefully we can bring back the whole staff when it’s over.”
    Frontrunners has had to quickly adapt from their preferred “sit and fit” model, to virtual fittings. “Our main focus is our service. We are not just selling a product,” explains Walker. Customers email photos of their feet and of their current shoes in order to show wear patterns. “These are all things we would normally do in the store,” says Nick, but now they assess photos rather than the real thing. Occasionally, they have done fittings through the door. “We want people to get the right product so they can stay active and injury-free.”
    The 400 participants in Frontrunners’ popular run clinics are currently staying “connected but apart,” thanks to Facebook groups and a new online training model.
    With more people out running due to the closure of gyms and rec centres, Frontrunners is planning to publish an easy walk/run program to promote injury-free running which they will post on Facebook and Instagram, says Walker.
    The move from a 9 to 5 store-opening model, to an online shopping open-ended model has brought some unexpected challenges.
    People who shop online imagine a big company with staff available 24/7, says Walker. But in the case of small businesses that have temporarily moved to this model to survive, “It’s your neighbour down the road answering the phone,” he says. “If someone wants to order something at 10 at night and you don’t respond right away, you’ll lose them.”
    While he says that he tries to shut his brain off from work when he’s at home, the reality is that, “right now, every sale counts.”
    Frontrunners is grateful to their customers for their support. “Our current customers are our best advertisers. They spread the word with friends and neighbours and family members,” says Walker. In the long run, how they fare will depend on how long this current state goes on. Walker notes that, “rent still needs to be paid, but we have a good line of credit at the bank.”
    A talented competitive runner, Walker runs regularly when he is not at work, but it’s taken on a new urgency. “It’s a stress reliever and a form of therapy and meditation. I feel better after a run.” He emphasizes that it’s important to “keep physical health for mental health.” Good advice for all of us navigating these uncertain times.
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.
     
     
     

    Stephen Hume
    AFTER ARCHAEOLOGISTS WORKING NEAR THE MOUTH OF THE PITT RIVER in the Fraser Valley uncovered hundreds of fire-charred body ornaments that weren’t supposed to be there, another team excavating a construction site at Port Angeles about 15 years ago made a horrifying discovery.
    The remains of children, dozens of them, all of them 12 years or under, were buried in mass graves amid burned house planks. Valuable tools were scattered where they had been dropped and there was evidence of unusual rituals not before seen in the material culture of the region.
    Radiocarbon samples—it’s an archaeological dating method based upon the measurable rate at which the radioactive isotope carbon 14 decays—pegged the burials to between 1780 and 1800.
    That coincided with evidence 150 kilometres to the northeast.
    The finds provided corroboration in the physical record of accounts recorded in the oral traditions of First Nations occupying the Georgia Basin, as well as naval records from Captain George Vancouver’s expedition in the summer of 1792.
     

    Artist John David Kelly's 1900-ish painting commemorating Captain George Vancouver's 1792 exploration of BC's coast
     
    Vancouver’s log records his arrival off Neah Bay on April 29. He coasted along the south shore of the Strait of Juan de Fuca, dazzled by the snowy Olympic Mountains and noting the stunning beauty of the pastoral landscape.
    He’d observed signs or human habitation at what we now know were Clallam village sites at Pysht, Elwha, Yinnis and Tsewhitzen. Then, towed by his jollyboats in an absence of wind, he turned into what’s now Discovery Bay near Port Townsend, and, on May 2, dropped anchor in 34 fathoms and send ashore a landing party.
    As the world grapples with the social and economic upheaval from the current pandemic there’s much discussion of how the events of our time have the potential to reconfigure conceptions of governance, economies, how we practice business and the relative merits of values we not so long ago considered unassailable.
    Pandemics have a way of bringing down our collective certainties like so many houses of cards. They shake faith in our institutions from the spiritual to the secular, remind us that for all our technological prowess, our hold on life is tenuous and far from guaranteed by wealth, status or power—although these things provide indisputable advantage.
    The events of 240 years ago are worth contemplating in the context of current events because they offer a poignant and compelling reminder that we are nothing special in our collective angst and suffering.
    It’s all happened before, right here, and to an extent that makes our current upheaval look like a passing irritation, and it’s happened more than once.
    Vancouver’s landing parties brought back chilling reports of very large abandoned villages. Skulls and human bones were scattered among the weed-infested ruins, skeletal remains were strewn down the beaches behind which the villages were built.
    There were so many bones that Vancouver assumed he had come upon a burial ground and ordered his crews to offer no indignities to the remains. But as the exploration progressed, subordinates reported baskets with bones in them, canoes full of bones, mass cremations where houses full of bodies had been burned, holes into which bodies had been tumbled and barely covered and evidence that many, many bodies had simply been left where they fell.
    As in New York and Milan, the accelerating speed of mortalities had overwhelmed the societies' most basic ability—to care for the sick and dispose of the dead.
    Vancouver was convinced that he was witness to the aftermath of some cataclysmic disaster that had befallen a once populous nation, leaving it suddenly impoverished and in an economically ruinous state.
    James Colnett reached a similar conclusion landing even farther north at Kildidt Sound, midway between Vancouver Island and Haida Gwaii in 1788. Spanish explorers reported blind survivors in 1792. Peter Puget, one of Vancouver’s lieutenants, reported a large fortified but abandoned village in Desolation Sound where an intolerable stench and a vast infestation of insect vermin literally drove his party off.
    The ever observant Vancouver suspected smallpox based on his knowledge of the disease and the fact that among the few survivors he met, many were blind in one eye, something the Spanish had noted, at Nanaimo.
    Science would later prove him right. The Clallam and their relatives the Lekwungen in what’s now Victoria, Nitinat and Ditidaht, the Straits Salish peoples of Saanich and the Gulf Islands, the Cowichans, the Lummi, the Sto;lo tribes of the Lower Fraser and on up the coast all had their world shattered and brutally reconfigured in an instant.
    Stephen Hume has spent half a century as a journalist writing about Western Canada, the Far North, BC and the Island.

    Leslie Campbell
    A pre-COVID-19 class at Iyengar Yoga Centre of Victoria
     
    THE NON-PROFIT Iyengar Centre of Victoria has been a remarkable success story. Since its inception in 1976, it has grown to offer over 40 classes weekly to 450 people. For the last 20 years, it has done so from beautiful, large studios on upper Fort Street. Based on the teachings of Yoga Master B.K.S Iyengar, the Centre takes great pride in its rigorously trained teachers and offering one of the most comprehensive programs of Iyengar Yoga in North America.
    Of course, that has all changed, at least for a while. On March 16, the centre shut down in response to the pandemic and needed public health actions.
    General Manager Wendy Boyer tells me that the closure meant an immediate loss of revenue of $49,000. “March is a big month for us. We had to cancel classes plus the annual five-day workshop with Jawahar, our teacher from Mumbai, who attracts about 70 students.”
     

    Iyengar Yoga Centre’s General Manager Wendy Boyer
     
    Boyer, who has taught since 1996, tells me they sent out an “appeal letter” after closing, reminding students that as a registered charity, their class fees could be donated for a tax receipt. “We received overwhelming support,” says Boyer. Within hours of the appeal, about 50 had responded and so far, people have donated about $10,000.
    Still the closure meant that Iyengar’s 21 teachers, all contractors, along with four part-time staff, were out of work. Right now only Boyer and office manager Britta Poisson are still working (remotely).
    They have been very busy. Says Boyer, “Britta and I are still working on admin—mostly refunding to the students because of cancellations. Also connecting through our online channels: e-bulletins, website blog, Facebook and Instagram.”
    And, like so many businesses, the Iyengar team has been figuring out how to host classes on line. They will launch the first couple of classes, live-streaming from the teachers’ homes, at the beginning of May. Fortunately, Boyer enjoys learning new technology so is excited. But she recognizes that experimenting with technology is a big step for others. “It takes time to transition to the virtual world.” So they will start slow and evolve from there. Boyer feels that even when the studio opens, some may choose to continue with online classes, so it’s a good investment of their time.
    Boyer tells me the online classes will be very affordable, adding, “We just basically want to help people keep up their yoga practice, to communicate the Iyengar method and philosophy, and help them get set up at home.” The teachers will show students what props they can use at home—for instance, books for blocks— “the way we used to do it,” notes Boyer, before things got so professionalized. “That said the Centre is eager to open our studio as soon as it is deemed safe to do so.”
    Boyer says they are looking into the federal government’s wage subsidy; they are also hoping to see some relief on the rent front, but so far have only been offered “deferral” by their landlord.
    Because of the likely need for some degree of physical distancing into future months, Boyer is thinking through ways they could accomplish that—such as having smaller class sizes, asking people to bring their own props and gear, and avoiding use of the change rooms.
    The first online classes will be Tuesday and Friday from 10 -11:30am with Ann Kilbertus and Ty Chandler.  Check the website for how to register.
    Leslie Campbell is Focus’ editor.

    Judith Lavoie
    Guy Felicella, right, an advocate for a safe drug supply (Photo courtesy guyfelicella.com)
     
    THE ALREADY-TOXIC STREET DRUG SUPPLY in BC is becoming increasingly poisonous and expensive as borders close and supplies from China and the US shrink.
    But, for most people suffering from addiction, quitting is not an immediate option and, although a growing amount of basement concoctions are being sold on the street, the urge to avoid withdrawal overrides all else.
    “You will have to go out, no matter what, and do what you have to do to get that substance,” said Guy Felicella, who spent decades as a heroin addict living in Vancouver’s Downtown Eastside and is now clean, an advocate for a safe drug supply and a peer clinical adviser for BC Centre on Substance Use.
    As COVID-19 physical distancing rules clear the streets, it is more difficult to make money from panhandling, bottle collecting or the sex trade. Advocates worry that people with addictions are struggling to find alternate ways to finance their habits.
    There is also concern that those searching for drugs are at risk of both contracting and spreading COVID-19.
    So it is to everyone’s advantage that new guidelines will give prescribers and pharmacists flexibility to prescribe and distribute drugs such as hydromorphone, stimulants, benzodiazepines, and substances to manage alcohol and nicotine withdrawal, according to Felicella and other advocates.
    Federal relaxation of the Controlled Drugs and Substances Act was followed last month by innovative provincial guidelines designed to address two overlapping public health emergencies—the opioid crisis, fuelled by fentanyl, which has killed more than 5,000 British Columbians since January 2016 and, now, COVID-19.
    The new rules allow physicians and nurse practitioners to prescribe the drugs to people at risk of contracting COVID-19, those with a history of ongoing substance use, people at high risk of withdrawal or overdose and youth under the age of 19 who provide informed consent, provided there is additional education. Costs are covered by provincial PharmaCare.
    Rapid access addiction clinics can also provide assessments, and phone visits to prescribers and pharmacists are encouraged. The guidelines allow home delivery by pharmacy employees, pharmacists can extend, renew and transfer prescriptions and, in some cases, people will be allowed up to three weeks supply instead of having to go to the pharmacy daily.
    “We want people not to have to go into pharmacies every day, which puts themselves and other people at risk when they should be self-isolating,” said Judy Darcy, Minister of Mental health and Addiction. “We are trying to flatten the curve at the same time as stopping overdoses and these really unprecedented measures are meant to do both of those things,” she said.
    The guidelines were put in place as fast as possible and a massive effort is now underway to get the word out to all health professionals, Darcy said.
    However, implementation is slow as some physicians and pharmacists are not yet fully informed about the changes.
    It is frustrating, said Leslie McBain, co-founder of Moms Stop The Harm. “What you had was rollout of a good policy that I hope will continue to progress and evolve, but the infrastructure was not out there,” McBain said.
    She added, “If I was a person searching for safe drugs because I didn’t want to go out and buy them on the street, there was no way to figure out that pathway.”
    Bernie Pauly, University of Victoria School of Nursing professor and a scientist with the Canadian Institute for Substance Use research, said it is essential prescribers familiarize themselves with the changes. “[They] need to not only know and understand the guidelines, they need to do it really quickly because people’s lives are at stake,” she said.
    Pauly and other advocates are anxious to ensure the changes stay in place after federal exemptions reach their sunset clause at the end of September.
    “I would hope we are able to show the benefits of this,” said Pauly, who also wants to see decriminalization of personal possession—something recommended last year by provincial health officer Dr Bonnie Henry.
    Felicella wants to see a further step with pharmaceutical grade heroin, fentanyl and cocaine made available without prescription.
    “What we have today is a medical version and it’s a great start and will help many people, but it is not where we want to stay,” he said.
     
    Judith Lavoie is an award-winning journalist specializing in the environment, First Nations, and social issues. Twitter @LavoieJudith

    Carole Estabrooks
    Unsung heroes: Care home care aides
     
    Co-authored by Carole A. Estabrooks and Janice Keefe
    THERE WILL BE MANY HEROES in the coming days, some already rising to the challenge of COVID-19, including nurses, doctors, paramedics and hospital cleaners, as well as delivery drivers, grocery store workers and warehouse staff.
     But there’s one critical occupation that is routinely forgotten when we champion the heroes: nursing home care aides who stayed when even their own lives and the lives of their families were put in danger.  
     When they are remembered at all, they are mentioned in passing, as a homogenous block, without giving much thought to the real people they are, the work they do and the challenges and dangers they face—both before the crisis and now, during the pandemic. 
     Care aides suffer along with families and residents when these older adults die, separated from family under difficult and sometimes unpleasant circumstances. 
     Who are care aides and what do they do?
     Care aides, also known as nurses’ aides, personal support workers or continuing care assistants, are the largest work force in long-term care homes in Canada, providing upwards of 90 per cent of direct care. Their role is central to the quality of care and quality of life of individuals living in long-term care homes.
     Now, their work is central to the survival of our most vulnerable population. Over 80 per cent of residents in Canadian nursing homes are now living with some kind of cognitive impairment (dementia).
     Many families often take on tasks like feeding, helping with mobility and engaging socially in the care homes, but because they can no longer visit, this puts even more onus on care aides to safeguard them. 
     By nature, the work of care aides is intimate—it involves bathing, feeding and toileting residents. They can’t practice the advised "social distancing." And yet, we also aren’t consistently giving them the personal protective equipment (PPE) they need to keep themselves safe.  
     COVID-19 has hit nursing homes across the country hard with more than 600 nursing homes reporting COVID-19 cases and many reported COVID-19 related deaths – and these numbers rising daily.
     We’ve put care aides in a state of triple vulnerability: their work is more important than ever, yet they are working in understaffed conditions, and they are underpaid and under-equipped to do it adequately—while also putting their own safety and that of their families at risk.
     The long-term care system is particularly susceptible to being overwhelmed right now because, as over a decade of Translating Research in Elder Care research has shown us, it was running on zero margins before the COVID-19 crisis.
     Who’s holding it all together? 
     TREC data collected across more than 90 long-term care homes in BC, Alberta, Saskatchewan and Manitoba, some of it collected for more than a decade, reveals that the majority of care aides are women (90 per cent), over 40 years of age (67 per cent) and almost two-thirds (61 per cent) speak English as a second language.  
     Thirty per cent of care aides work at more than one long-term care home simultaneously, in order to gain full time hours or earn a living wage. Most have worked 10 years on average as a care aide, about half of that time on the same unit.
     Care aides consistently report higher levels of burnout and lower levels of mental health than the general population. They are regularly—before the pandemic—under work duress.
     Our recent study documented the frequency with which care aides in Canada skipped or rushed essential care tasks on their last shift because they had insufficient time.  Essential care tasks include things like taking residents for a walk, talking with residents, performing mouth care, toileting, bathing, feeding, dressing and preparing residents for sleep.
     More than 65 per cent of care aides reported rushing at least one essential care task and over 57 per cent of care aides reported missing at least one essential care task altogether on their last shift.  
     COVID-19 is only revealing fault lines that already existed in long-term care. Now we must do everything we can to make sure we don’t put either our vulnerable seniors or our care aides at unnecessary risk.
     We need to protect our long-term care heroes now.  
     We need to do everything in our power to immediately raise staffing levels in nursing homes to safe levels, no matter what it takes.
     We need to prioritize essential PPE to all care aides.  
     Governments should also consider providing, as Quebec and BC have already done, "top up" or "danger pay" for care aides, recognizing the risks that they are incurring and ensuring they do not need to, as many do currently, work in more than one care home or one job at once.
     We need to immediately begin planning for the mental health support that these essential workers will require in the aftermath of the pandemic’s first wave.
     We need to look at these short-term solutions carefully and ensure we do not have negative unintended long-term consequences for example, from the one workplace policy.
     If we do not intervene immediately to better support the front line in nursing homes, the outcomes will be far worse than they need to be—among both residents and this essential workforce.
     
    Dr. Carole A. Estabrooks is Scientific Director of the pan-Canadian Translating Research in Elder Care (TREC) program and Professor & Canada Research Chair, Faculty of Nursing at the University of Alberta.
     Dr. Janice Keefe is Professor of Family Studies & Gerontology, the Lena Isabel Jodrey Chair in Gerontology and Director of the NS Centre on Aging at Mount Saint Vincent University. She is also a Senior member of the TREC research program.

    Marilyn McCrimmon
    Pagliacci’s co-owner Solomon Siegel
     
    POPULAR BROAD STREET EATERY Pagliacci’s has none of its usual lineups these days. “There is no table service, the core of our entire business,” states Solomon Siegel, general manager and co-owner of the long-time family-owned restaurant. “We have pivoted to delivery and pick-up only.”
    Siegel has had to lay off the majority of the staff, keeping only management and a few cooks to facilitate the take-out business. He’s very grateful for the impending government assistance for the laid-off staff. “It made the layoffs more palatable to me. I haven’t abandoned them,” he says. The jobs will be waiting for them when this time is over.
    Siegel has adjusted the menu, offering only the dishes that transport well, at the same time keeping food waste to a minimum. He’s also offering cocktail kits for sale in the restaurant for customers who want to stock their own home bars
    Financially, the difference is “night and day,” he says. At the end of February, Siegel was feeling very positive about the projections for the restaurant. “Some new items on the menu were being positively received. We have a good balance between locals and tourists. We were getting ready for when the locals recommend the restaurant to tourists.” And now, “If it wasn’t for the wage subsidy, we’d be operating at a loss.”
    Siegel lists off the measures he has taken to keep staff and customers safe, measures which are all too familiar these days: “One front-of-house person, who has nothing to do with food prep, and the food prep staff have nothing to do with the public. Increased hand washing, which is always important with food prep, anyhow. I keep the front door open so you [customers and delivery drivers] don’t have to touch anything to enter. Hand sanitizing stations are at the door and at the till. Contactless credit card, and we sanitize the units each time with a food-safe sanitizer. Social distancing.”
    Pagliacci’s has been a fixture in Victoria for 40 years, and Siegel is keenly aware of their loyal customers. By moving to take-out rather than shutting the doors for the duration, he says, “Regulars are happy that they can get the food they love. It’s a big positive for a lot of people. And for people who aren’t able to cook every night.”
    With no immediate end of social distancing in sight, Siegel is working on a plan to offer family-style meals for four. He says, “We’re lucky. Our style of food works well for pickup and delivery, we had a delivery system in place already, and we have a loyal guest base who love our food and still want it.”
    He fears that lots of small restaurants will be forced to close, but Pag’s won’t be one of them. Besides the 75 percent subsidy for employees, Siegel will apply for the business loan being offered by the Federal Government. Then, “if the current volume continues and if we get those programs, we won’t make money, but we won’t go into debt. My goal is to employ some staff, provide food, open again and not be in horrible debt.”
    Sounds like a realistic plan for these unprecedented times.
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.
     
     
     
     

    Thara Kumar
    Nurses, doctors, respiratory therapists and support staff at Vancouver General Hospital's emergency department (Photo courtesy of Lara Gurney, RN)
     
    Co-authored with Melanie Bechard
     
    WHILE GOVERNMENTS, health care workers and the Canadian public are uniting to take on the COVID-19 pandemic, some critics have seen this as an opportunity to capitalize on public fear and promote a profit-driven health care system over Canadian medicare.
    Would Canada—as some claim—really have been better prepared for a pandemic in a health system where care would be delivered to those who can afford to pay for it, rather than based on need?
    Let’s look at the evidence.
    No country could have been fully prepared for a crisis of this scale—indeed, no country has been. No country in the world has an “on demand” health care system with limitless capacity. That would mean building empty “rainy day” hospital beds and stockpiling unused ventilators and personal protective equipment (PPE) for decades, in the event they would be needed some day.  
    But Canada’s single-payer health system has allowed us to impressively ramp up our “surge capacity” to expand in a time of crisis—while still ensuring universal access.
    In a matter of just weeks, Canadian hospitals have increased staffing for critically ill patients, reduced inpatient loads by 30-40 per cent to make room for a surge of COVID-19 admissions, and bolstered our supply of PPE and ventilators. 
    These measures were taken so that every patient who requires hospital care for COVID-19, or for any other medical emergency, can continue to access the highest quality of care possible, no matter who they are or what they earn.
    Our health care system is not traded on the stock exchange. 
    Fans of the American health system praise it for having lower average hospital occupancies of 64 per cent, leaving lots of room for surge capacity in a crisis. But what they fail to recognize is that these half-empty hospitals are a result of the most expensive profit-driven health care system in the world, in which hospitals are all competing to attract “customers,” over-selling tests and treatments just to keep themselves in business.  
    Tragically, those empty hospital beds are of no use to the roughly 30 million uninsured Americans with no access to care, or the millions of under-insured Americans who risk financial ruin if they seek care or choosing between paying crippling hospital bills or having a roof over their heads.  
    This is even more concerning in a viral pandemic where those with no access to medical care can put the rest of the community at risk.  
    Health care profiteers persistently and intentionally conflate health care “delivery” with health care “financing.” Canada does not outlaw private for-profit delivery of health care. There is no monopoly on health care delivery.
    What Canada does not allow is private payment—whether out-of-pocket or through private insurance—for care already covered by our provincial plans. Physicians can’t bill the government for publicly insured medical services and charge patients extra money on top of that. 
    Having just one payer in each province means we don’t waste money on paying overhead to private insurers, like in the U.S. model.  
    COVID-19 should not be exploited to make the case for a private pay health care system. In fact, the reverse should ring true. Now is a good time to think about expanding our universal health system.
    As hundreds of thousands of Canadians face job loss as a result of this crisis, it highlights the need for more publicly funded health care to keep our citizens safe and healthy. Many Canadians will face financial struggles through this crisis and may also lose their job-linked extended health benefits. 
    They will not lose their access to physician and hospital care, but a loss of work-related health benefits will have a huge impact on their ability to access prescription medications and dental care.
    Of course, our health system is not perfectly prepared for a pandemic.  
    When this COVID-19 crisis ends, we will have an opportunity to reflect on the challenges our health care system faced and take steps to adapt for the future. Creative solutions that have come out of this pandemic, such as the widespread use of telemedicine and novel triage systems, might be continued to improve access to care.  
    But one thing that should not change is our commitment to equitable access to health care for everyone in Canada. 
    This is no time for greedy profiteers to be distracting us from saving lives. As front-line health care workers, we will continue to show up every day, throughout this pandemic and beyond, to protect our human right to health care. We are counting on everyone to do the same.
    Dr. Thara Kumar is an Emergency Room physician based in Red Deer, Alberta. 
    Dr. Melanie Bechard is a fellow in Pediatric Emergency Medicine at the University of Ottawa. Both are members of the Board of Directors at Canadian Doctors for Medicare.

    Stephen Hume
    A  pandemic on the coast around 1750 is suggested by examination and carbon-dating of material found in archaeological excavations near Port Coquitlam
     
    VALERIE PATENAUDE was a newly-minted 26-year-old archaeologist in 1978 and in charge of an important excavation at Duke Point in Nanaimo where the provincial government was planning a new ferry terminal.
    But she was sent to supervise a high priority rescue dig in Port Coquitlam where the Province planned a new highway bypass at Mary Hill near the mouth of the Pitt River.
    What Patenaude uncovered was what stalks the dreams of every archaeologist, evidence of a lost civilization.
    At first the archaeologist noticed many shallow depressions which, on more detailed examination, proved the remnants of a large food-processing complex. Locally abundant deer berries were cooked down to extract juice which was used, it’s thought, as a preservative for fish and game meat.
    As she explored further, Patenaude found that the food-processing factory supported a concentration of residential structures. A huge site, it sprawled well over a kilometre along the banks of the Pitt River. Radiocarbon dating identified two extended periods of occupation reaching back almost 5,000 years from the present. It proved, in fact, only one of a series of such sites which extended all the way to Pitt Lake, 20 kilometres to the North.
    How many people lived there is a matter of scholarly conjecture, but it was a large number.
    The site, in the territory of the Katzie First Nation, was exciting, not least because it opened a window into the ancient past of peoples who first settled the rich Fraser Valley floodplain.
    Yet it also brought a darker inkling. The site was abruptly abandoned sometime around 1750 and never reoccupied. Whatever happened there had ended the world as they had known it for 160 generations.
    Now, as media abounds with prognostications about a world turned upside down by the fallout from the current Covid-19 pandemic—whatever equilibrium we find in its aftermath, economists, social psychologists and politicians warn, our old conceptions of normal have been forever swept away—Patenaude’s discoveries from more than 40 years ago remind us that the world has been irrevocably changed more than once in British Columbia’s past.
    As the young archaeologist’s dig expanded, it began revealing something strange. In the level bags were all kind of artifacts that weren’t supposed to be there.
    There were scores of labrets, a kind of lip ornament worn by women that were seldom found in grave sites because they were bequeathed within families from one generation to the next, from mother to daughter to granddaughter to great-granddaughter.
    Labrets might be made from wood, bone, stone or shell and were sometimes decorated with inserts. Grant Keddie, curator of archaeology at the Royal BC Museum, says that labrets appear to have been crucial signifiers of social relationships, particularly with respect to marriage ties.
    “But at the Pitt River site we found hundreds of labrets,” Patenaude told me when I talked to her about it while researching a book on the first European contact with peoples on the Lower Fraser River.
    There was something else about the ornaments. They were all blackened by fire. For some reason, the ancient cycle of maternal inheritance had been disrupted. The women who wore the labrets had, instead of passing them to their daughters, been burned in massive funeral pyres, probably in the big wooden houses in which they lived.
    Who were the forgotten people of this lost world? Patenaude said that, too, was conjecture.
    “It was probably a smallpox epidemic,” she told me. “Yet neither the Katzie nor the Coquitlams claimed descent from those people. It’s a strong possibility that site was used by people from South Vancouver Island who just never came back after the catastrophe.”
    Next time, a look at the pandemic which reconfigured the West Coast before Europeans came to stay and, in fact, shaped the settler attitudes which bedevil us all today.
    Stephen Hume has spent half a century as a journalist writing about Western Canada, the Far North, BC and the Island.

    Marilyn McCrimmon
    Before the pandemic (left) and now
     
    MAUREEN GARDIN AND MIKE GARNETT are the owners of the independent coffee shop, Bean Around the World. The popular Fisgard Street café ordinarily opens at seven in the morning and welcomes customers for the next eleven hours.
    Now, they open for half an hour a week in order to greet a small group of customers who come to pick up whole beans. “In these weird times, it’s such a pleasure to see people,” says Gardin, then adds, “We are almost completely closed. It’s a giant difference.” And of course, it comes nowhere close to meeting the bills.
    Bean Around the World continues to roast beans once a week for a small group of private customers, because they didn’t want to leave them in the lurch. “We haven’t encouraged more whole bean customers as our space is limited. We don’t have a warehouse to store the green beans,” explains Gardin.
    Like all popular coffee shops, the main focus of their business is serving good coffee along with soups, sandwiches and baked goods. “We have a great staff, great customers.” But, they had to lay off all of their staff.  “It was a tough decision, but it’s what you have to do,” said Gardin.
    Some of the staff were university students who went home when the university closed, but some of their staff are in their 30s and they are trying to make a go in Victoria. Gardin acknowledges that, “Victoria is a very expensive city to live in and rent.”  A couple of the girls miss it and want to volunteer.
    She and Garnett are pleased that the government has set up a program to help the unexpectedly unemployed, such as their staff. As for the customers, Gardin says, “We have so many loyal regulars. It really feels like a community.”
    Financially, this month has been a shock. Bills are still rolling in from last month’s expenses, and of course there is very little income. In their 24 years in business in Victoria, the couple have seen many businesses come and go. Gardin wonders how many businesses will not be able to reopen after the pandemic passes, but she is confident their coffee shop will be among those that survive.
    Bean Around the World is a well-established business. “We own the property—that makes a big difference.” She talked about the mortgage relief that is available, and BC Hydro’s plan to postpone billing. They plan to look into the Federal assistance that will be made available for small businesses. And going forward, “We may open for takeout only, initially. We won’t have 20 staff ready to go.”
    Meanwhile, she and Garnett miss the interaction with their staff and their customers. Like many small businesses, staff is more like family. “I love my lifestyle,” says Gardin. “We are not intent on empire building. We make enough money to get by.” She describes a typical day for herself. “I get up, go down to the store, have a coffee, drive the staff nuts, kibbutz with the customers, come home—I love it.” She adds, “Hopefully we’ll get back to it sooner rather than later.”
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.
     
     
     

    Michael Wolfson
    It took the federal government until April 9 to publish projections of morbidity for COVID-19 in Canada 
     
    CANADIANS ARE FINALLY BEGINNING TO SEE projections of COVID-19 cases, deaths and needs for intensive-care units from various provinces and the federal government. We are also starting to see simulations that look beyond the next month or two when, hopefully, epidemic curves are clearly flattening.
    Canada’s national data-collection capacity will be critical for the next stage of the pandemic, when relaxing of the stringent physical-distancing measures can begin. Yet our data-collection infrastructure is proving woefully inadequate.
    To be effective, an extraordinary and co-ordinated national effort is required, with much more extensive testing and real-time standardized reporting of results, from local to provincial to federal agencies. These data on the tests will be much more powerful for managing the pandemic if they also include pre-existing diseases and risk factors such as smoking.
    These kinds of data flows are obviously feasible with current computing and communication technologies. Indeed, they were feasible 20 years ago when the federal government created the Canada Health Infoway corporation and provided it with billions of dollars. One of its missions was to work with the provinces to develop interoperable real-time “outbreak detection” systems.
    Had these systems been in place even as late as last year, Canada would not have wasted critical weeks and months in reacting to COVID-19. And if these systems were in place now, we could manage relaxing the current lockdown phase with “smart quarantine” and reap the major benefits of returning the economy to normalcy at a faster rate.
    So why do we still not have this real-time standardized data-reporting capacity?
    One blockage is the constitutional conflict over jurisdiction; the provinces claim almost exclusive jurisdiction over health care. The federal government also plays a substantial role, spending billions on health research and fiscal transfers to the provinces and regulating drugs and devices – on top of the billions given to Infoway – but it has been too timid to use all its powers much beyond ineffectual cajoling.
    Another blockage is fear of transparency. It has taken strong public pressure for governments to begin providing even limited epidemic-curve projections on which their policies are based.
    Of course, we need to ensure patients’ sensitive health data remain confidential except as needed in their circle of care. However, as the Council of Canadian Academies noted in its 2015 report, data custodians too often use privacy concerns to block access, stymieing major benefits of health research and, in the current emergency, support for both smart quarantine and much better modelling and projections.
    What can we do about these completely unacceptable blockages? There are several places to start.
    The Canadian Medical Association can offer strong leadership by supporting real-time interoperable data not only for their own interests and individual patient care, but also for broader health-system uses, not least for epidemic detection and management.
    The private-sector vendors of electronic medical-record systems can immediately cease their profit-capturing data blockages and allow their software to interoperate in real-time with those of other vendors and government systems.
    Provincial governments can agree quickly on more in-depth and uniform data standards for hospitals, labs and physicians so that, along with the federal government, they can quickly and unambiguously assemble these data, especially virus-testing results.
    Privacy commissioners need to alleviate the excessive concerns over privacy around health data, to rise above responding only to complaints, and to make it clear that – especially in this emergency situation – they support essential data flows, provided that basic privacy protections are in place.
    The Public Health Agency of Canada and the provinces can open up their data beyond a few pages to the energy and creativity of Canada’s excellent university-based health researchers and modellers and support the CIHR-funded pan-Canadian network.
    In turn, Statistics Canada can expedite a virtual form of its Research Data Centres so that bona fide health researchers can access much higher-quality data with appropriate privacy protections.
    The federal government must assert its leadership and authority, using its constitutional powers, to set critical national standards and enforce the collection, sharing and use of public-health data – and finally bring Canada into the 21st century of critical data infrastructure.
    Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.
     

    Amy Reiswig
    I COULDN’T WATCH OR READ ANY MORE NEWS. The world had passed the million-case mark in the COVID-19 pandemic, and what, I asked myself, was there for me to do? What I always do: Take a book and go outside. Sitting on a round paving stone below the front steps of my home—now my self-isolation chamber—on Mayne Island, like my garden plants I turned my face to the sun. A fat bee fumbled its way across a floppy crocus, and the eagles nesting down the road sent down a shower of staccato chatter.
    Feeling small and absorbed in the life going about its business around me was the perfect time for also turning to John Gould’s new book The End of Me (Freehand Books, May 2020), as it explores not just death and mortality but by extension life, the edges of our connection and that invisible force suffusing everything—mystery.
    In this collection of 56 very short stories, Gould returns to the genre of flash (or sometimes called sudden) fiction, for which he was a Giller Prize finalist with Kilter: 55 Fictions. He describes the form as a hybrid of short story and haiku.
    It is also a blend of trampoline, time machine, x-ray, astral projection and lover’s whisper, as the shifting perspectives, penetrating vision and imaginative agility allow the author to take you anywhere, inside and out, in endlessly unexpected directions.
    Gould takes us back in time to a young man dating one of Lot’s daughters in the city of Sodom; up into a spaceship’s decaying orbit; and into the early 1900’s lab of a scientist trying to weigh and discover the exit point of the human soul. We read a dating profile, a performance art grant proposal, customer’s book review, and obit for a professional obit writer. We’re led into the beautiful but sombre intimacy of dreaming extinct species, and the terrible intimacy of suicide. All with control, play, tenderness, curiosity and a willingness to end in question.
    Death is a tricky subject. One of the most covered themes in literature, it’s still something of a Gorgon most avoid looking directly into. While it’s a universal—100 percent of us will go through it—Gould reminds us that it’s also illimitably individual in terms of how we experience it, where we encounter it, how we see it and how it makes us see ourselves.
    “That multiplicity of perspectives suits my temperament,” Gould tells me by phone, as we each do as we’re told and stay home for safety’s sake. He says he inherited his mathematician father’s love of precision and concision and his journalist mother’s love of story, so “The form feels natural for me.”
    After stretching out inside a novel (Seven Good Reasons not to be Good—see the Focus review here), Gould was missing the short form, not only because it feels natural but because the ability to inhabit so many kinds of people across time and place, to put on the lens of wildly divergent predicaments, “gives me access to so many different ways of thinking.” It was, he says, “persistently exciting to write.”
    In this time of uncertainty around a global health crisis, Gould’s book—with serendipitous timing—invites us to remember that uncertainty is often the unnoticed norm. Several of the stories end outright on a question, and we’re shown that no matter how smart or prepared or rational we think we are, the unexpected can cut us off mid-stream, mid-steam and, in the case of one story, mid-sentence.
    But uncertainty is not all bad. While it can be unsettling, that space of not knowing allows us to confront the limits of our understanding, the edge of what we think we know.
    Gould does this partly as a philosopher, delighting in paradox. For instance, at a funeral home, two sisters experience the classic presence of absence—“two true things that couldn’t both be”—of a deceased sibling; and a dead woman trapped in an “exhausting afterlife” reflects on regrets but realizes you can’t distinguish between the things you did and the things you didn’t do. “Saying yes was saying no, and vice versa. Yes and no were indistinguishable, because you were always saying both.”
    These stories play with the edges of the metaphysical and the physical, and even mundane practical problems become more than they seem. Consider the poor guy on a first date trying to decide whether (and how) to mercifully kill an injured raccoon: “There was no way to be certain he’d be doing the creature a favour…What if the Babylonians were right, or maybe it was the Mesopotamians, what if we’re all going to spend the rest of forever in the dark eating dust?”
    And before arriving at the funeral home, those two sisters had gone shopping for an urn for their brother’s cremains, “lugging with them a bag of orzo to stand in…Research had helped them estimate him at twelve cups.” As the artist’s deadly grant proposal more explicitly yet cryptically reminds us: “your body isn’t what you think it is.”
    Then who and what are we? Where exactly is the end—or the beginning—of me? What do we coalesce out of and what do we dissolve into? When I watched my mother die of pneumonia last February, I kept thinking that simple and forever unanswerable question: “Where did she go?” How could a single exhalation be the difference between my mother and mother’s body? What was she now? What was I now?
    The connections we have with others can be powerful—enough to bend the boundaries of our selves.
    In several stories, Gould more tangentially shows us that the same power lies in our relationship with the world around us. Before COVID, we were already living in a time of global threat, that of ecocide, and Gould touches on that loss as well and the delicate edge of where we begin and end as creatures of nature.
    “Nature was my first real sanctuary,” Gould says, “but that sanctuary is such a loaded experience now. Now the tranquility brings the heartbreak with it. We’re having to acknowledge our role in the loss and contemplate the future of the living planet.”
    As I sit in my sunny outdoor refuge from pandemic news, almost on my mother’s birthday, I deeply feel the truth that one of Gould’s characters explains so simply: “There’s a great deal for which to brace oneself.” But The End of Me, in its collection of controlled surprises, delivers the equally important message that even when life is uncertain, “things can still be beautiful.”
    In these isolated times, The End of Me can be ordered directly from Freehand, and many local independent booksellers are either shipping for a flat fee, allowing customers to order and pick up at the door or arrange for delivery.
    Writer and musician Amy Reiswig works by day (and sometimes into the night—and now remotely) as an editor for the provincial government. Besides Focus, her writing has appeared in Quill & Quire, This Magazine, The Malahat Review and The Walrus.

    Marilyn McCrimmon
    Munro’s Books has temporarily become an online bookstore.
     
    MANAGING PARTNER JESSICA WALKER describes the day she had to phone the part-time employees, as well as some full-time employees, to let them know they were laid off, as one of the worst days of her life. “There is just not enough work for everyone.” Nor revenue.
    In early March they learned that the cruise ships were cancelled, prompting Walker and the remaining full-time staff to start preparing for a new reality. The store closed to the public on March 15.
     

     Jessica Walker
     
    “The first week, the numbers were scary, but more and more people are getting comfortable with online buying,” says Walker. Staff got used to their new jobs as the store switched to a warehouse model, taking orders on the phone and on the web, and reduced hours.
    “It’s not just about getting through the next six weeks,” Walker cautions, “it’s getting through the summer.” With the move online, their social media presence has become more important. Munro’s is active on Facebook, Instagram and Twitter, and the store always had a good website, but it didn’t feature all of their stock. That is changing. 
    “We are putting lists on the website. We’re trying to recreate the store experience,” explains Walker. Besides ever-popular lists of staff picks, they’ve posted a list of titles of the first books in an author’s series, to introduce readers to new authors. Jigsaw puzzles, children’s books, and books on baking, especially books on bread-making, are currently popular as people seek ways to keep themselves and their kids busy at home.
    Financially, it’s too early to say precisely how badly the store will be affected, but Walker says it is a dramatic change. She acknowledges that Munro’s losses will be “pretty significant,” and going into the summer, the losses will increase. “Five thousand cruise ship passengers a day are not coming this summer.” Anyone who has visited the crowded store in the summertime will know that Munro’s is a favoured destination for Victoria’s cruise ship tourists. Walker reiterates, “It is going to be a long-term significant impact.” Munro’s will apply for Federal Government assistance once applications are available. 
    Asked about expenses beyond staff, including rent, Walker responds: “We’ve certainly been looking at every expense, big and small. We are very fortunate that the Munro family own the building and are willing to work with us to make sure we get through these difficult times.
    Safety protocols are being maintained within the store, but Walker is keeping an eye on the staff. “It is stressful. The job is more labour intensive. People are learning new jobs.” She laughed when she said some staff are loving being able to play whatever music they want while they work. 
    Munro’s staff is grateful to their customers who have been offering amazing support. “Victoria is such a great book town,” acknowledges Walker. 
    Customers can have books mailed to them or contactless pick-up is available during the store’s open hours. Once you knock on the door and give your name, your order will be placed on a stool outside the door. 
    When asked if she had ever experienced anything like this in her life, Walker says, “No, never. Nothing like this.” Then she compared it to a natural disaster, “a hurricane without the weather—the roof is still on.” A perfect metaphor for these times. 
    Marilyn McCrimmon is a native Victorian and freelance writer. She has written for Focus since its inception in 1988.
     
     

    Mollie Kaye
    “Lorna Crozier—poetess” oil on canvas, 28 x 22 inches
     
    Portraits of Victoria women raise funds for Our Place
    AS I COLLECTED MY PICK-UP ORDER of groceries last week at the new Save-on Foods at Pandora Avenue, I was amazed to see what looked like over 100 tents, erected for many blocks along the boulevard, centred around Our Place. To adhere to provincial social distancing requirements, all homeless shelters are currently operating at a fraction of their initial, pre-pandemic capacity. Hence, the immediate support and protection of this vulnerable population has become a grave concern, according to Steven Seltzer, events and fundraising coordinator for Our Place.
    “The need is greater; people are trying to survive through this without the normal supports,” he says. “We’ve tried to adapt as best we can; instead of people coming in to get the help at Our Place…we’re feeding them outside, the paramedics are out and about. We’re lacking some of the ordinary funding we normally get—businesses would come in, serve a meal and sponsor, but that’s not happening, so obviously we’re looking for alternate ways to raise funds to run four shelters.”
    To contribute to this need (though she began well before the pandemic), portrait artist Elfrida Schragen has created a series of paintings capturing the spirit and achievements of 40 of Victoria’s most accomplished and influential women as a fundraiser for Our Place. An “online gallery” at www.hibid.ca/events/admired must now stand in for the physical exhibition originally envisioned at the Bay Centre. The official show begins April 9 and runs through June 30. All donated funds will go directly to Our Place, and donors will receive charitable receipts.
    “I love to do portraits,” Schragen says. “People don’t commission portraits of themselves very often; it’s seen as self-centred. So I thought maybe I could do this for a reason, and people would feel more comfortable.” Subjects include Focus’ own Leslie Campbell, dance maven Lynda Raino, Victoria Mayor Lisa Helps, choral conductor Shivon Robinsong, and Victoria Councillor Charlayne Thornton-Joe, among others.
     

    “Bernice Kamano—support for homeless Indigenous” oil on panel, 28 x 22 inches
     

    “Carole Sabiston—textile artist” oil on canvas, 28 x 24 inches
     
    “Everyone is in need of money right now,” Schragen acknowledges. “People are trying to be generous.” While the portraits can be purchased outright for $1000 by either the subject or a group, donations in the name of each portrait subject are being collected online as a way to honour the diverse contributions of these female community leaders—while directing funds where they’re needed most during the COVID-19 crisis. “It’s not an auction, it’s more like, 'I want to donate to Our Place, let’s put it as a donation toward this particular painting;’ it’s like a support system.”
    All of the paintings are either 22 by 28 inches, or 24 inches square. “I took the photographs and then put in the background they each wanted, composing as I went,” Schragen says of the deft, impressionist images. “I wanted them to okay the portrait before I made it public in any way. We had lots of fun.”
    To view the exhibit see www.hibid.ca/donate/admired
    You can view Elfrida Schragen’s website at www.elfridasart.com
     
    Mollie Kaye writes and performs parodies of ’40s and ’50s songs. She also is the vintage-clad performer behind “Turned-out Tuesdays” (see www.theyearofdressup.com)—now with a home-made mask.

    Briony Penn
    Do the construction of future pipelines, mining, logging, fish farms and other resource industries qualify as essential services? Are enough precautions against virus transmission being employed?
     
    WHILE JUST ABOUT EVERYONE but grocery and health care workers are staying home and practicing social distancing to the point of losing jobs or businesses, there is one sector that seems to be immune to any national effort to contain the virus. The resource sector is still being mandated to work by their companies on a directive from government that they are essential services. 
    According to the Council of Canadians, “Across BC and Alberta, over 100 energy megaproject work camps are continuing to operate, including Site C and the Trans Mountain and Coastal GasLink pipelines. Each of these camps houses hundreds of workers in close proximity…At least one worker has already tested positive for COVID-19 at LNG Canada, the destination of the Coastal GasLink pipeline. Site C, which has over 1,000 workers on site, recently isolated 16 workers who exhibited flu-like symptoms.” (April 4, 2020)
     

    Site C's 1600-room Two Rivers worker accommodation facility. It experienced at least one virus outbreak in 2017.
     
    Just how does the construction of future pipelines, mining, logging, fish farms and other resource industries qualify as essential services? 
    These industries have been handed guidelines that provide, at best, minimum measures: restricting only foreign travel; mandating self-isolation for returned travellers; social distancing; increased cleaning and sanitization in workplaces; and instructing employees who work remotely to reduce interpersonal contact. 
    But even these measures, according to workers, are impossible to meet with the existing conditions and no attempt is being made by their employers or regulators to bring them into line with what the rest of the population are doing. For many, the fact that resource companies are asking for bailouts for their “hardworking families” while putting those same families at risk and the rest of us, doesn’t sit well. 
    In Victoria, BC Tradeswomen Society Board member, Robyn Hacking, has sent a letter to Premier Horgan about the conditions of her work and the failure of her employer, general contractor and Worksafe BC to ensure even minimum measures. “On a busy construction site with multiple trades working in enclosed spaces together, social distancing is very difficult to maintain and almost every surface gets touched by multiple people hundreds of times a day. (Consider access tools like ladders and scaffolding). Hand washing is impossible when workers don’t have access to soap and clean water, which is certainly the case on most new construction sites, even though it has been a WorkSafeBC requirement since 2005…The reality is the last time I personally had access to hand washing facilities on the job was over three years ago…The workforce is calling on you, our government, to remedy poor working conditions that have been accepted standards on construction sites for far too long.” 
    Hacking’s concerns are evident just about anywhere you look. A fish farm worker on Vancouver Island, who has asked to remain anonymous says: “social distancing requirements in the boats and fish farms are impossible to meet. We share small kitchens, small bathrooms, eating and sleeping areas; we can’t practice social distancing, yet we are being told we must go to work.” 
    He went on to describe how crews regularly use planes to fly in and out for work returning to their homes between shifts. These shifts are typically less than two weeks—shorter than the required period of self-isolation should symptoms appear. 
    Grand Chief Stewart Phillip of the BC Union of Indian Chiefs has sent an open letter asking governments to halt pipeline projects to protect remote communities with limited services and elders increasingly at risk from workers returning home. 
    A quick review of different company websites doesn’t provide a lot of confidence. For example, in the camps of LNG Canada, which number in the hundreds, “juice machines are cleaned every 15 minutes” and “hand sanitizer usage remains mandatory prior to entering the dining halls.” LNG did not respond to Focus on how they were social distancing in the workplace nor how self-isolation is managed with shift workers. Canfor simply reports they will reduce operating hours. 
    Prime Minister Trudeau, when questioned about concerns that workers and communities might have for the spread of the virus through this sector, said companies are to be trusted in implementing these measures.
    Grand Chief Phillip states: “Corporate exceptionalism cannot become a pandemic response strategy for the Governments of BC and Canada.” 
    Concerns from the communities into which workers travel or return have led to self-quarantining in places like Haida Gwaii and Bella Bella. 
    The fish farm worker noted that before the Heiltsuk took their own initiative to shut down the airport to anything but real essential services like food and medical supplies, his crew members had flown into the community and could potentially have exposed villagers to the virus. “Why is everyone else being asked to stay home and I’m not? Am I really an essential service? Are exported industrial foods that put local food supplies at risk essential?” 
    He challenged Transport Canada about why he is an essential service and hasn’t received a reply. Dr. Bonnie Henry, who has deflected questions from the media about the “essentialness” of the resource sector, also didn’t respond to Focus. 
    Calgary airport, the hub through which potentially thousands of workers pass on their way back and forth to northeast camps and Vancouver Island, doesn’t appear to be taking any special measures to monitor or advise passengers, according to a Vancouver Islander coming back through Calgary on March 31. She reported that the only recommendation for 14-day self-quarantine came from “a table of volunteers.” Sixty-one percent of Alberta’s COVID infections are in Calgary, and one in six Albertans polled believe the crisis is overinflated in the media.
    The legal definition of essential services under the government’s own Public Service Labour Relations Act, is “any service facility or activity that will be necessary for the safety or security of the public or a segment of the public.” Corporate exceptionalism now appears to be corporate essentialism in this time of crisis.

    Briony Penn has been living near and writing about the Salish Sea pretty much all of her life. She is the award-winning author of non-fiction books including The Real Thing: The Natural History of Ian McTaggart Cowan, A Year on the Wild Side, and, most recently, Following the Good River: the Life and Times of Wa’xaid, a biography of Cecil Paul (Rocky Mountain Books).

    Maleea Acker
    Vegetables and flowers in a City of Victoria boulevard (Photo courtesy City of Victoria)

     
    THE COVID-19 pandemic has seen a surge of press about victory gardens recently. The New York Times, the Chicago Tribune and Australia’s Broadcasting Corporation are all talking about the vegetable gardens planted during the First and Second World Wars, when governments encouraged residents to grow food as a way of freeing up national production and shipping capacity, raising local food production and increasing food security. 
    As COVID-19 tracks a course around the world, many are asking questions about food security on Vancouver Island, the available stock in grocery stores and individual self-sufficiency that haven’t been asked since the conformities of the 1950s, when victory vegetable gardens were swept away by Kentucky bluegrass lawns. 
    One benefit of this pandemic could be the return of local food systems, grown in neighbourhoods near you. In support of community resilience, on April 2, Victoria councillors Ben Isitt and Jeremy Loveday announced a City project to grow food seedlings in the Beacon Hill municipal nursery. Between 50,000 and 75,000 plants will be distributed along with soil and educational resources this growing season in response to Covid-19.
    If you want an example of successful boulevard gardens, take a physically-distanced walk to the corner of Haultain and Asquith Streets, where lawyer and boulevard gardener Mike Large and local neighbours have created street-side gardens that could easily (and do) feed more than a few families through the year.
     

    Mike Large
     
    The Haultain Corners—where a coffee shop, a grocery and a few other stores anchor the community—supports three boulevard gardens. Self-seeded arugula pokes through the grass; raspberry canes hug a bus shelter. Miner’s lettuce and chard nestle around berry bushes and well-trimmed fig trees. During my walk with Large, we each pick a bag of greens as he describes the gardens and their neighbours, the current and former owners who have stewarded these parcels.
     

    Boulevard garden near Haultain Corners Village
     
    When Large first came upon a couple tending vegetables on a boulevard on Fernwood’s Haultain Street, about a decade ago, he admits to me, “I didn’t even know how to plant a potato.” 
    Large graduated with enormous debt and a law degree in 1998; he went to work for private companies and government in Ontario, but it wasn’t his calling. He returned to Victoria to complete a Master’s in Law in 2008. The boulevard garden, planted by his friends Margot Johnston and Rainey Hopewell, struck him as an exciting opportunity to get directly involved in bottom-up change in his city. What else is there other than the state, he wondered. What tools can we use to enact positive change in our communities?
    A lot has changed since that first meeting. 
    Large met Ben Isitt in 2014. Isitt thought he could get votes on council for support of new boulevard garden guidelines. Victoria had just passed a new Official Community Plan that seemed to support innovative urban food production. Gardens were already common in many areas of Victoria but no official support for them existed. 
    By 2016, Large had worked with council and 12 local community groups to draft and pass an interim, then an official guideline: “Growing in the City.” You don’t need the City’s permission anymore to dig up that grass. 
    At Haultain Corners, “there’s never a raspberry to be found, in summer,” he laughs. People graze while they wait for the bus. The verdant, chaotic, early-spring greens muscle their way out of the earth. Mike picks up a pair of secateurs he knows must belong to a woman who tends the edges of the largest garden and returns them to her shed. “I’m optimistic,” he says. “It’s slowly dawning on people how fragile a system we’ve built.”
    Now that we are increasingly confined to our own neighbourhoods, it may be time to put away the lawn mower and start sowing carrot seeds. “Everyone should be able to feed themselves,” argues Large. Gardening also presents an ideal opportunity to stay social while physically distancing. Get your beds ready; Victoria’s nursery seedlings will be ready to hand out to residents soon.
    Still, there are logistical challenges with matching gardeners with land. Many live in rentals or apartments and don’t have the space to garden. Next week, I’ll look at Large’s new project, which he hopes will link the community garden model with boulevards perfect for gardening. 
     
    Maleea Acker is the author of Gardens Aflame: Garry Oak Meadows of BC’s South Coast (New Star, 2012). She is currently completing a PhD in Human Geography, focusing on the intersections between the social sciences and poetry.

     

    Russ Francis
    It didn't take long for the novel corona virus to spread from humans to BC’s liquefied natural gas (LNG) projects.
     
    ON APRIL 2, LNG Canada chief executive officer Peter Zebedee announced that in response to the COVID-19 pandemic, the foreign consortium had cut its 1,800-strong Kitimat workforce by 65 percent, continuing with only “essential” work. (Wonder what those 1,200 non-essential workers were doing.)
     

    LNG Canada CEO Peter Zebedee says 65 percent of workers have been sent home
     
    Despite this, LNG Canada is persisting with its GHG-laden future. Zebedee said in his letter that “we have every intention to deliver.” Zebedee is a former vice-president of Shell, which, as the largest partner, owns 40 percent of the project.
    However, I can’t help but ask whether Zebedee has spoken recently to his own head office. 
    For on March 23, the multinational fossil fuel giant announced it is slashing spending world-wide. Without revealing details, Shell said it is cutting annual operating costs by $3 - $4 billion US, and capital spending by $5 billion US this year. A week later, on March 30 Shell said it is pulling out of the Lake Charles LNG project, a partnership with Texas-based Energy Transfer to convert the existing Louisiana LNG import facility to one that would export 16.45 million tonnes per annum (MPTA) of LNG. This compares with LNG Canada’s 14 MPTA for its first phase.
    Why did Shell withdraw? To “preserve cash and reinforce the resilience of our business,” said Shell’s Maarten Wetselaar, adding that “the time is not right for Shell to invest.”
    Where have we heard that sort of language before? Last fall, Kitimat LNG partner Woodside Energy said it wanted to reduce its 50 percent share of the project, joined in December by the other partner, Chevron, which wants to exit completely. Both companies said the reasons were risk and cost. The virus is also affecting other Woodside projects. In March, Woodside cut its spending in half, and delayed decisions on three planned LNG projects in its native Australia. It blamed COVID-19,as well as the oversupply of crude oil and LNG.
    A much smaller BC LNG project has also been infected by the virus. Woodfibre LNG, which planned to produce 2.1 MPTA on the shores of Howe Sound, said in March it was delaying its start date from summer 2020 to the end of 2021, in part because of the virus. Like LNG Canada, Woodfibre LNG—owned by Asia-based Pacific Oil & Gas—is building much of its plant in Chinese fabrication yards.
     

    Woodfibre LNG delays Howe Sound project in part due to COVID-19
     
    Texas-based Fluor is building the LNG Canada facility in partnership with Japan’s JGC. Asked about the project during a February 18 analyst conference call, Fluor chief Carlos Hernandez said “at this point, we don’t see any delays, but obviously we’ll wait and see when we wrap up completely.”
    Marc Lee, senior economist with the Canadian Centre for Policy Alternatives, said in an interview the fact that much of the LNG Canada plant’s construction work is being done at the Chinese fabrication yard may be a hiccup for the project: “The supply chain may be severely disrupted.”
     

    Economist Marc Lee: LNG Canada’s Chinese-built modules may be delayed due to supply-chain disruption.
     
    At a time of severe financial stress on BC’s economy, the growing possibility that LNG Canada may not proceed cannot be good news for Premier John Horgan, who has claimed that the $40 billion project would bring the government $23 billion in new revenue. 
    Then there is LNG Canada’s contribution to increasing GHG emissions, at a time when the entire planet is supposed to be drastically cutting them. According to BC government data, the first phase of the project will add 3.45 MPTA of GHG emissions, though the figures have been widely criticized as considerably under-estimating fugitive emissions (those released before the fracked gas arrives at the facility.) If fully built, LNG Canada would result in 6.9 MTPA in emissions—more than one-third of the 18.9 MTPA in GHG reductions under specific programs of BC’s CleanBC plan.
    Green MP Elizabeth May is confident that neither LNG Canada nor Woodfibre LNG will go ahead. “The whole notion that they’re going to proceed with any of these is fanciful,” May said in an interview. “The economics of these projects are absolutely not on.”
    The Green Party has proposed a detailed plan to reassign fossil fuel workers to cleaning up orphan wells, while transforming to renewable energy.
    Neither Shell nor LNG Canada had responded to Focus requests for comment by the time of publication.

     
    Russ Francis is not sad about some effects of COVID-19: the suspension of Hockey Fight in Canada, the estimated 5 percent drop in 2020 GHG emissions, and the expected cancellation of the Calgary Stampede.

    Trudy Duivenvoorden Mitic
    Moss Street Market customers practice physical distancing—and supported local produce growers. (Photo by Ross Crockford)
     
    I’M THINKING OF MY MOTHER on this Sunday morning, while carving the blemishes out of last year’s beets nearing the end of their remarkable storability. The sun is streaming in, early spring flowers drift through the garden, and Michael Enright on the radio is helping me stay calm. Freshly brewed coffee helps too, and so far the expired cream is holding up nicely.
    I’m thinking of my mother who grew up in the Netherlands during WWII, when much of the country’s food was forcibly syphoned away by the Nazis. One hundred thousand civilians starved to death during those hardscrabble years, but Mom and her family were not among them. They lived on a farm and stealthily managed to grow enough food to keep themselves and their community alive. 
    There’s a warm security in rescuing these beets, along with the carrots beginning to sport root hairs, and the shrinking mushrooms and peppers. It’s earthy work that connects me to nature, the wellspring of all life. I’m grateful for the food we have, especially the daily bread of overwintered kale near the back door. 
    So much has happened in the past month and now we wait anxiously in isolation, blinking in near disbelief. Wasn’t it just a few weeks ago that we were noshing gaily in trendy restaurants and shopping sprightly for the best eats and treats from all over the world? For decades we have been normalizing this—an almost full-scale snub of simple food in favour of highly processed concoctions, of local food for far-away ambrosia hauled to our tables in refrigerated trucks. 
    Those systems are all being tested now, and the myth of our food security is coming to light. As I write this, grocers are still managing to keep shelves somewhat stocked, but a trip to the store has morphed into a risky exercise even for those who are young and robust. In truth, food has become a precious commodity.
    My beets are ready for the oven. Cooking is becoming a thing again, maybe even the slow kind because we’re working with staples and there’s no point in rushing. We’re probably wasting less food now too, just as we seem to be driving more carefully and living more cautiously. It’s all part of the new uncertainty.
    On the radio Michael Enright is asking British security and peace expert Paul Rogers if he thinks the world will ever be the same again. Rogers’ reply is quick: “It should never be the same again because we have to learn from this.”
    We are learning right now, in our own kitchens, where the complex implications of this protracted situation slowly sink in. We are re-thinking food security and loyalty for local food providers, the protection and preservation of farmland and waterways, and the sprouting of more backyard gardens and gardeners. Vancouver Island has a food-rich history. Self-sufficiency was once a thing here, and could be again if we want it to be.
    As for my mother, now 80 years later, she is again safely ensconced on a farm, this time with my sister in Newfoundland. 
    From grower to table is still a good system. It’s one of the few that we don’t have to change. 
     
    Trudy Duivenvoorden Mitic is a Saanich-based writer, mother and Master Gardener. Her books include People in Transition and Ernie Coombs: Mr Dressup (both from Fitzhenry & Whiteside).

     

     

    Leslie Campbell
    This is the first in a series of interviews with Victoria businesses and non-profits about how they are weathering the pandemic.

     
    DESPITE STEPHEN WHITE’S WELL-ROUNDED, long-time experience working in arts organizations, he’s never experienced anything quite like the shake-up caused by COVID-19. 
    For 20 years, White has headed up Dance Victoria, a dynamic non-profit which brings world-renowned dance companies to Victoria. The organization also supports the development of dance through commissioning new works, puts on a 10-day dance festival offering free dance classes, and rents out dance studios.
     

    Dance Victoria’s Executive Producer Stephen White
     
    The five-member management team at Dance Victoria has been holding daily morning meetings, online of course, for the past couple of weeks. To begin with, White tells me, the focus was primarily to make sure everyone in the organization was safe through the end of June. “Our General Manager Bernard Sauvé has been building the budget so we can retain all core staff.”
    While the last performance of the season, Ballet BC’s Romeo & Juliet in mid-March, was cancelled, virtually all those who had bought tickets donated the value back to the company, for which White and crew feel incredibly grateful.
    His greatest anxiety is around Victoria’s small business community. “We’ve been really fortunate to have a lot of sponsorship from the small business community—they’re having the biggest struggle now so our sponsorship campaign is up in the air,” says White. “We’ve never really been successful at getting large corporations as sponsors, so we’ve always been really happy to have so many small businesses as cash sponsors.”
    Small business sponsorships have also helped grow DV’s audience. Tickets provided to sponsors have enabled business owners to invite clients and friends. “Once people have been introduced to live dance performance, they’re likely to return—so it’s been an effective audience development tool,” says White.
    DV also relies on donations. With the volatility in the market, White can’t help but wonder if those who rely on investment income will as readily donate to Dance Victoria in the future.
    Such individual patrons and small business sponsorship together normally constitute about 25-30 percent of DV’s revenues. About 50 percent comes from ticket sales; 15 percent from government; and another 10 percent from studio rentals—which have gone to zero since the “stay home” orders.
    “But when one’s back is against the wall,” notes White, “it’s time to innovate…it’s causing all of us to rethink our business models,” which he feels is a good exercise.
    White admits to concern over a possible “residual reluctance for people to gather in large groups, even after we get a green light and restrictions are lifted.” Yet he still feels the work DV has done to build an audience for dance in Victoria will work in their favour.
    “I am feeling really grateful for the strength of that community, how engaged they are with dance,” says White, noting that visiting dance companies regularly express how impressed they are with the engagement of the local audience.
    White and crew are now focusing on their next season, feeling some relief that it doesn’t start till November (with Compagnie Hervé Koubi). However, one of DV’s major fundraisers, Cherish: A Glamorous Evening of Fashion and Philanthropy, happens in October. Last year it provided $80,000 in revenues shared equally with Victoria Women’s Transition Centre. Because it relied on scores of cash donations from small businesses, plus silent auction contributions, the team is re-thinking options. Says White, “We are wondering how we can return the loyalty of the small business community.”
     
    Leslie Campbell is the founding editor of Focus—a 32-year-old small business and media outlet in Victoria. She, too, has never experienced anything like this pandemic.

    Judith Lavoie
    With an estimated 1,500 homeless people in Victoria, increasingly worried officials are trying to find enough facilities to house them in a way that allows physical distancing.
     
    THERE IS INCREASING URGENCY to move the jumble of tents on Pandora Avenue into the safer environments of Topaz Park and Royal Athletic Park, as health professionals and advocates watch anxiously for signs of COVID-19 spreading to Victoria’s homeless population.
    So far, no members of the group, many of whom have compromised immune systems, have tested positive, but the risk is obvious. With parks regarded as a temporary solution, the overriding question is whether the virus will hold off long enough to allow indoor accommodation—where greater physical distancing is possible—to be found for hundreds of people.
    Tents sprung up along the 900-block of Pandora Avenue, outside Our Place, after drop-ins closed and shelter spaces were reduced because of the need for physical distancing.
     

    Tents on Pandora Avenue. (Photo by Ross Crockford)
     
    Many of those camping on Pandora are using Our Place services such as washrooms, paramedic services, and meals—which are handed out at the gate in disposable containers.
    The City, BC Housing, Island Health, Greater Victoria Coalition to End Homelessness and the Dandelion Society are working together to move people initially into the specified parks, which have washrooms and running water and will allow for physical distancing.
    The plan to use parks as temporary campsites has brought objections from some neighbours who worry about drug use and increased crime.
    But the possibility of infection in the current crowded environments should concern everyone, not just the unhoused population, said Reverend Al Tysick, founder of the Victoria Dandelion Society. “This doesn’t just affect [this group]…We are all in this together. This epidemic does not distinguish between the rich and the poor, the drug addict and the woman in the nursing home,” Tysick said.
    “Once it hits our [homeless] community it’s going to spread like wildfire. People are already sick when they move into the community. This is serious stuff. Much more serious than we have ever seen before,” he said.
    It has not been possible to persuade Pandora campers of the importance of staying at a safe distance from each other, said Our Place communications director Grant McKenzie. It is difficult to explain social distancing to a group living in precarious circumstances, who are already dealing with losses from the opioid crisis, McKenzie said.
    “Many people here are suffering from addiction or using opioids, so they are really just looking at their day-to-day survival. Where is my next meal coming from? Where am I sleeping tonight? They don’t have the luxury of worrying about COVID-19, which is why social distancing is very difficult,” he said.
     
     

    Tents on Pandora 720p.mov  
    Tents along Pandora Avenue (20-second video by Ross Crockford)
     
    Royal Athletic Park [see update in Comments] will be set up for 80 people with addictions or mental health problems, who are likely to need a higher level of service, but one delay is finding available front-line staff. “We are working as hard and as fast as we can,” said Mayor Lisa Helps at one of her daily briefings. “In a public health emergency, no one should be living outside. Period,” she said.
    “COVID-19 will hit the unsheltered population at some time,” Helps said, echoing the concerns of Chief Medical Officer Richard Stanwick who has emphasized that homeless people must have the opportunity to meet social distancing requirements and that, if they are displaying symptoms, they must be able to isolate themselves. 
    A federal grant of more than $1.3-million will be added to programs to address homelessness; and a search is on to find indoor alternatives to parks. 
    As of April 3, 102 homeless, who are healthy and do not require a high level of support, had been moved into motel rooms. Others, who were previously camping in Topaz Park, will remain there until indoor accommodation can be found.
    Ideally, that search should include premises in neighbouring municipalities as the downtown core attracts people from all over the region and several of Victoria’s facilities have already been rejected as unsuitable, said Helps. She acknowledged that 80 spaces at Royal Athletic Park will not be sufficient to meet the needs.
    Meanwhile, there seem to be more tents on Pandora than ever. And the numbers of facilities in motels and parks so far arranged do not add up to anywhere near the 1,525 homeless people found in the 2018 count in Greater Victoria.

    Judith Lavoie is an award-winning journalist specializing in the environment, First Nations, and social issues. Twitter @LavoieJudith

    Stephen Hume
    This virus is another evolutionary opportunist, not so different from we humans. 
     
    THE MORNING the United States became the world’s epicentre in the coronavirus pandemic, I woke to more ancient news. A spring rain drumming on my skylights and a raucous perturbation among nesting waterfowl.
    The rain dwindled to a drizzle, then a sniffle, then wraiths of mist. The birds subsided into grumbling. I took a hike. I seldom meet anyone on the back trails, less frequently now that we’re social distancing.
    Above, the sky was steel grey but for a band of intense blue at the eastern horizon. Mt. Baker glittered behind the San Juan Islands in Washington, an epicentre within the epicentre.
    Yet, a silver lining. Those snowfields are brighter than most of us have ever seen as entire cities discover they can do what many claimed impossible—just shut down—and the air pollution from 6.5 million vehicles, most from Victoria through Seattle to Vancouver, disappears.
     

    Mount Baker as seen recently from Sidney, BC. Cleaner air is one consequence of the pandemic. 
     
    By April, this virus had killed about 40,000 people, mostly elders over 70. Air pollution kills about 73,000 elders over 70 each year—and another 4,000 infants under five.
    Tourists who normally throng Victoria’s waterfront and Downtown shopping districts have vanished as abruptly as the Purple Martins in the fall.
    So have Americans enjoying an inexpensive day trip to Sidney from Anacortes. They normally swarm Sidney Bakery for cream puffs and perch in rows sipping their London Fogs or eating ice cream at the two flanking cafes.
    The Colwood Crawl and the Pat Bay Pandemonium are gone.
    As the pandemic spreads, war metaphors abound.
    Yet, despite harrowing stories from hospitals in Milan and New York, what we’re experiencing is not war. It’s a natural biological event.
    This virus is another evolutionary opportunist, not so different from we humans. It’s killed 40,000 of us so far. We, on the other hand, continue to kill ourselves at a much faster rate—about 500 suicides a year in BC, about 5,000 by self-administered drugs since 2015, 35,000 drug homicides in Mexico, maybe 500,000 dead in Syria’s civil war. Since January we’ve killed more than 13 billion sentient animals in slaughter factories.
    We inhabit a vast sea of viruses. This one surged into an ecological niche—us—exploiting vectors that we created with our technologies, our complacent social habits and our political and economic hubris. 
    Is it scary? Yes. Can it have tragic consequences. Yes. Do we have an obligation to respond to it appropriately? Yes. Does the war analogy help? No. The term mischaracterizes that with which we must deal.
    Unlike war, which rages unabated in Africa and the Middle East and which, as we see from our response to coronavirus, could be ended tomorrow if parties to the conflicts agreed to end them, we are dealing with a force of nature—not malevolent, just ambivalent.
    Around us, everywhere, life is resurgent. As our urban lives contract, the natural world reasserts itself. Wild boar forage in Barcelona’s streets, deer investigate empty train stations in Asia, mountain lions pad the squares of South American cities, wild turkeys strut San Francisco and red foxes return to Paris.
    Here, on my deserted trail, spring unfolds on schedule. Red currants bloom, Indian plum dresses drab thickets with creamy lace, green moss velvets dead stumps and countless buds uncurl their tiny, defiant fists into the growing light, a reminder that these gloomy days, too, shall pass one day from memory.
    Stephen Hume spent half a century as a journalist writing about Western Canada, the Far North, BC and the Island.

    Ross Crockford
    A coronavirus testing laboratory in Leeds, UK (Credit: HM Treasury)
    Some doctors say we must test widely to find all carriers of the coronavirus. British Columbia isn’t doing that.

    ON MARCH 16, as many countries rapidly expanded their social-distancing measures to combat spread of the SARS-CoV-2 coronavirus and the associated disease COVID-19, the director-general of the World Health Organization told them that they needed to do more. 
    “The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate,” said Dr. Tedros Adhanom Ghebreyesus. “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected. We have a simple message for all countries: test, test, test. Test every suspected case.”
    Canada generally, and British Columbia in particular, claims to be following that advice. B.C. health minister Adrian Dix says the province conducts around 3,500 tests for COVID-19 every day. According to the B.C. Centre for Disease Control, by March 31 the province had conducted 43,229 tests — 8,458 per million residents, a testing rate better than the 8,152 per million conducted by South Korea, considered a model country for managing the crisis.
    But some say that’s still not enough if we want accurate data about the prevalence of the virus, and hope to identify and isolate carriers who are only experiencing mild symptoms, or no symptoms at all.
     Estimates of the number of such asymptomatic carriers varies greatly. One study of the notorious Diamond Princess cruise ship found that half of its passengers who tested positive for COVID-19 showed no symptoms. A recent study of transmission of the virus in China said that 86% of the infections there went undocumented — meaning that for every one person who tested positive, another six carried the virus but weren’t identified. “This high proportion of undocumented infections, many of whom were likely not severely symptomatic, appears to have facilitated the rapid spread of the virus throughout China,” the researchers said.
    Consequently, some argue that the only way to catch those asymptomatic carriers is to test healthy as well as sick people, like Iceland has done. As of April 1, Iceland had conducted 19,516 tests of its 364,000 citizens, or 5.3% of its population, the highest testing rate in the world. “The virus had a much, much wider spread in the community than we would have assumed, based on the screening of high-risk people,” said Kári Stefánsson, a neurologist and head of the Reykjavik-based biopharmaceutical company deCode genetics. Iceland has identified 63 positive cases for every 1,000 tests, a rate of 6.3%. British Columbia, on the other hand, has only turned up 23 positives for every 1,000 tests.
    Dr. Bonnie Henry, B.C.’s provincial health officer, told FOCUS at a March 28 press conference that the province is testing some asymptomatic people — if it’s tracking the source of an outbreak, for example — but otherwise it’s concentrating tests on workers in the health-care system and long-term care homes, and people being admitted to hospital, to ensure that COVID-19 sufferers are separated from other patients. “A broad testing of well people in our community right now is not what we are going to be doing,” she said. “That is the strategy we will be looking at if and when we come to the downside of our curve, when we’re looking again at introductions coming into B.C. from other places. That’s part of the strategy that would be at that phase of the epidemic. But certainly not right now.”
    What’s more troubling is the fact that B.C.’s testing regime is also bypassing people who are showing symptoms of COVID-19. On March 23, the CBC reported that at least 11 attendees at a memorial service in Vancouver were experiencing symptoms, and though some were told by doctors that they likely had the virus, they still didn't qualify for testing. 
    On March 28, Dr. Sean Wormsbecker, an emergency-room physician at New Westminster’s Royal Columbia hospital, posted a video (embedded below) expressing his frustration that “based on our current resources, we are very much undertesting the population.” He said he saw several ill patients that day who likely had COVID-19, but because they displayed stable lung function, he followed the Ministry of Health’s protocol and sent them home without testing. “And that scares me,” Wormsbecker said, concerned that such patients wouldn’t self-isolate because they didn’t know that they had the virus. He also said failure to test those patients means B.C. is “low-balling” its numbers, and that we’re not copying the nations that have identified carriers to flatten their rates of infection. “We can’t use those countries like Singapore or [South] Korea as a benchmark for what we can expect to come.”
     
     

    “I actually don’t agree with that,” Henry said on March 30, when asked about Wormsbecker’s comments. “Having been on the front lines with my colleagues in public health who are actually talking to these people, who are at home and who are self-isolating, most people are absolutely doing what we need them to do.” As she explained, the province’s testing strategy has been to concentrate on the people most likely to have the disease, and those most likely to need hospital care. “And we are still maintaining the contact tracing, we’re talking with people who have this, who have mild enough illness that they’re able to stay at home. For the most part, that is working.”
    Strategy aside, the province is also likely limiting tests to conserve its supplies for the peak of the crisis. (FOCUS asked the Ministry of Health what’s holding up wider-scale testing, but the Ministry hasn’t replied.) Governments around the world are in a rush — and sometimes bidding wars — for the nasal swabs and chemical reagents used in test kits, and for PPE (personal protective equipment) such as gowns and masks, which if used for testing would take them away from hospital wards. It’s true that some countries like South Korea and the United Arab Emirates have been able to conduct large-scale testing, but that’s because they’ve been stockpiling equipment and chemicals ever since the MERS coronavirus hit them in 2015.
    Instead, it seems that locating those who actually have the virus in B.C. will be left up to a variety of ad-hoc projects. The City of Langford, for example, has created its own COVID-19 response team, asking all of its residents to take an online screening test, even if they don’t have symptoms, to “help us understand the COVID-19 health status of our community.” Langford mayor Stew Young told CFAX that the team has already sent doctors to the residences of 16 people for in-home testing, using a small number of test kits provided by the province. “What's going to win the war is test kits and home testing at the front line and keeping our hospitals for the severe cases,” Young said. “That is the way to do this.” (Dr. Henry doesn’t agree: when asked about Langford’s project on March 31, she said “it’s not a good use of resources to test people who are at low risk.”)
    Online projects are also springing up to assess local COVID-19 risks, such as FLATTEN, which asks Canadians to answer an anonymous online survey about their symptoms and contacts with COVID-19 patients, generating a “heat map” of the country organized by postal code. By March 31, 281 people had answered surveys in the V8V postal code, which covers James Bay and Fairfield — and 24 of them exhibited enough symptoms and/or connections to be considered “potential cases,” suggesting the spread of the illness could be wider than officially declared, even in Victoria.
    We won’t know without tests. New ones should be coming quickly: on March 27 the US government approved a new test that can provide results in minutes, unlike current tests which take days, and the manufacturer plans to start cranking out 50,000 of them daily.
    In the meantime, British Columbia, like the rest of North America, is about to head into the mouth of the COVID-19 storm. Very soon, we will know whether or not the province’s testing strategy has worked.
     
    Ross Crockford agrees with Dorothy: there's no place like home.
     

    Colleen Flood
    March 31
     
    THE PRIME MINISTER is called upon almost daily to explain why the federal government has not invoked the Emergencies Act. Canadians perceive the COVID-19 pandemic to be an emergency and rightly so. The problem is that the Act can only be employed when an emergency rises above the ability of any one province to cope with the situation and there is, as a consequence, a risk to other provinces. 
    The mere fact that there are different approaches to the pandemic across the country is not by itself sufficient to trigger the Act.
    As the pandemic unfolds it has been clear that our provinces are not able to ensure sufficient testing for COVID-19. Without this, there is no hope of notifying all those who have been exposed and, in turn, testing and—crucially—isolating them too, if positive. 
    Other countries, such as Taiwan and South Korea, have had success with taming COVID-19 this way. It is only through this method that we can hope to eradicate nests of infection. Otherwise, lock-down and social isolation measures will stalk us for months to come, wreaking unsustainable havoc on the economy and social and cultural life.
    The provinces’ inability to achieve high levels of testing and tracing collectively from coast to coast arguably is a sufficient ground for the federal government to trigger the Emergencies Act.
    The World Health Organization has urged countries to “isolate, test, treat & trace.” The powers that the federal government has under the Act include the “establishment of emergency shelters and hospitals.” This would allow Canada to act swiftly to establish additional testing sites to support hospitals, deploying military and other public servants, as well as medical and nursing students, and possibly volunteers to supplement the already overtaxed health care workforce. The government could further establish testing sites in rural remote and northern areas. 
    Once a person tests positive and has been assigned appropriate care, the next step will be to trace and follow up with everyone the person has come in contact with. Trying to do this the old-school way of calling folks up and talking to them about where, when and who has already proven too slow for the fast-moving virus. 
    In contrast, South Korea accessed people’s cell phone data to track their whereabouts in the days before they tested positive. Then, tracers used the data on their phones to send messages to individuals whose phone data revealed they had been in the same spaces. The messages said: “You need to be tested, immediately, to save lives.”
    Under the Act, the federal government could use the power to require, use or dispose of “property” to access data held by telecommunications companies. In Canada, not everybody has a cell phone, but close to 90 per cent do, and this approach could complement traditional tracing methods.
    The next hurdle would be the federal privacy legislation, Personal Information Protection and Electronic Documents Act (PIPEDA), which prohibits companies from disclosing personal data without consent. It would be necessary to pass a new law—temporarily and only for the purpose of fighting COVID-19—to permit this. This law would, in turn, have to comply with the Charter of Rights and Freedoms. 
    To succeed here, the federal government would need to show strong evidence of the need to ramp up testing and contact tracing. The Chief Public Health Officer would have to consider the imperative for testing and tracing but also consider whether the disease is so wide-spread that wide-spread contact tracing, which works well with discrete chains of infection, may not have the desired effect. 
    The federal government would also need to show it had implemented the strongest privacy protections they could in the circumstances, including limiting collection of data to COVID-19-related purposes, for a specific period, providing safeguards for the use and disposal of the data, and ensuring consultation and possible oversight by the Privacy Commissioner. 
    It is better for the federal government to do this well and do it right for all Canadians rather than to permit differences across provinces, particularly as tracing those who may have been infected may involve crossing provincial boundaries. Whatever the federal government does in this space would require significant interactions and synergies between provincial governments and local public health units across the country.

    Colleen M. Flood is Director of the Centre for Health Law, Policy and Ethics and University Research Chair at the University of Ottawa. 
    Teresa Scassa is Canada Research Chair in Information Law and Policy at the University of Ottawa.

    Lizzie Presser, ProPublica
    AS OF FRIDAY, Louisiana was reporting 479 confirmed cases of COVID-19, one of the highest numbers in the country. Ten people had died. The majority of cases are in New Orleans, which now has one confirmed case for every 1,000 residents. New Orleans had held Mardi Gras celebrations just two weeks before its first patient, with more than a million revelers on its streets.
    I spoke to a respiratory therapist there, whose job is to ensure that patients are breathing well. He works in a medium-sized city hospital’s intensive care unit. (We are withholding his name and employer, as he fears retaliation.) Before the virus came to New Orleans, his days were pretty relaxed, nebulizing patients with asthma, adjusting oxygen tubes that run through the nose or, in the most severe cases, setting up and managing ventilators. His patients were usually older, with chronic health conditions and bad lungs.
    Since last week, he’s been running ventilators for the sickest COVID-19 patients. Many are relatively young, in their 40s and 50s, and have minimal, if any, preexisting conditions in their charts. He is overwhelmed, stunned by the manifestation of the infection, both its speed and intensity. The ICU where he works has essentially become a coronavirus unit. He estimates that his hospital has admitted dozens of confirmed or presumptive coronavirus patients. About a third have ended up on ventilators.
    His hospital had not prepared for this volume before the virus first appeared. One physician had tried to raise alarms, asking about negative pressure rooms and ventilators. Most staff concluded that he was overreacting. “They thought the media was overhyping it,” the respiratory therapist told me. “In retrospect, he was right to be concerned.”
    He spoke to me by phone on Thursday about why, exactly, he has been so alarmed. His account has been condensed and edited for clarity.
    “Reading about it in the news, I knew it was going to be bad, but we deal with the flu every year so I was thinking: Well, it’s probably not that much worse than the flu. But seeing patients with COVID-19 completely changed my perspective, and it’s a lot more frightening.”
    “I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.”
    “We have an observation unit in the hospital, and we have been admitting patients that had tested positive or are presumptive positive — these are patients that had been in contact with people who were positive. We go and check vitals on patients every four hours, and some are on a continuous cardiac monitor, so we see that their heart rate has a sudden increase or decrease, or someone goes in and sees that the patient is struggling to breathe or is unresponsive. That seems to be what happens to a lot of these patients: They suddenly become unresponsive or go into respiratory failure.”
    “It’s called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. And it’s notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%. The way to manage it is to put a patient on a ventilator. The additional pressure helps the oxygen go into the bloodstream.
    “Normally, ARDS is something that happens over time as the lungs get more and more inflamed. But with this virus, it seems like it happens overnight. When you’re healthy, your lung is made up of little balloons. Like a tree is made out of a bunch of little leaves, the lung is made of little air sacs that are called the alveoli. When you breathe in, all of those little air sacs inflate, and they have capillaries in the walls, little blood vessels. The oxygen gets from the air in the lung into the blood so it can be carried around the body.
    “Typically with ARDS, the lungs become inflamed. It’s like inflammation anywhere: If you have a burn on your arm, the skin around it turns red from additional blood flow. The body is sending it additional nutrients to heal. The problem is, when that happens in your lungs, fluid and extra blood starts going to the lungs. Viruses can injure cells in the walls of the alveoli, so the fluid leaks into the alveoli. A telltale sign of ARDS in an X-ray is what’s called ‘ground glass opacity,’ like an old-fashioned ground glass privacy window in a shower. And lungs look that way because fluid is white on an X-ray, so the lung looks like white ground glass, or sometimes pure white, because the lung is filled with so much fluid, displacing where the air would normally be.”
    “With our coronavirus patients, once they’re on ventilators, most need about the highest settings that we can do. About 90% oxygen, and 16 of PEEP, positive end-expiratory pressure, which keeps the lung inflated. This is nearly as high as I’ve ever seen. The level we’re at means we are running out of options.
    “In my experience, this severity of ARDS is usually more typical of someone who has a near drowning experience — they have a bunch of dirty water in their lungs — or people who inhale caustic gas. Especially for it to have such an acute onset like that. I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly. That was what really shocked me.”
    “It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning.
    “When someone has an infection, I’m used to seeing the normal colors you’d associate with it: greens and yellows. The coronavirus patients with ARDS have been having a lot of secretions that are actually pink because they’re filled with blood cells that are leaking into their airways. They are essentially drowning in their own blood and fluids because their lungs are so full. So we’re constantly having to suction out the secretions every time we go into their rooms.”
    “Before this, we were all joking. It’s grim humor. If you are exposed to the virus and test positive and go on quarantine, you get paid. We were all joking: I want to get the coronavirus because then I get a paid vacation from work. And once I saw these patients with it, I was like, Holy shit, I do not want to catch this and I don’t want anyone I know to catch this.
    “I worked a long stretch of days last week, and I watched it go from this novelty to a serious issue. We had one or two patients at our hospital, and then five to 10 patients, and then 20 patients. Every day, the intensity kept ratcheting up. More patients, and the patients themselves are starting to get sicker and sicker. When it first started, we all had tons of equipment, tons of supplies, and as we started getting more patients, we started to run out. They had to ration supplies. At first we were trying to use one mask per patient. Then it was just: You get one mask for positive patients, another mask for everyone else. And now it’s just: You get one mask.
    “I work 12-hour shifts. Right now, we are running about four times the number of ventilators than we normally have going. We have such a large volume of patients, but it’s really hard to find enough people to fill all the shifts. The caregiver-to-patient ratio has gone down, and you can’t spend as much time with each patient, you can’t adjust the vent settings as aggressively because you’re not going into the room as often. And we’re also trying to avoid going into the room as much as possible to reduce infection risk of staff and to conserve personal protective equipment.”
    “But we are trying to wean down the settings on the ventilator as much as possible, because you don’t want someone to be on the ventilator longer than they need to be. Your risk of mortality increases every day that you spend on a ventilator. The high pressures from high vent settings is pushing air into the lung and can overinflate those little balloons. They can pop. It can destroy the alveoli. Even if you survive ARDS, although some damage can heal, it can also do long-lasting damage to the lungs. They can get filled up with scar tissue. ARDS can lead to cognitive decline. Some people’s muscles waste away, and it takes them a long time to recover once they come off the ventilator.
    “There is a very real possibility that we might run out of ICU beds and at that point I don’t know what happens if patients get sick and need to be intubated and put on a ventilator. Is that person going to die because we don’t have the equipment to keep them alive? What if it goes on for months and dozens of people die because we don’t have the ventilators?
    “Hopefully we don’t get there, but if you only have one ventilator, and you have two patients, you’re going to have to go with the one who has a higher likelihood of surviving. And I’m afraid we’ll get to that point. I’ve heard that’s happening in Italy.”
    Lizzie Presser covers health, inequality, and how policy is experienced for ProPublica.
    This story was originally published by ProPublica.
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    David Broadland
    When the going gets tough, the tough keep their chin up and write a poem
     
    BETWEEN JANUARY 1918 and December 1920, the “Spanish flu” infected 500 million people worldwide. Between 17 and 50 million died. Spread of the H1N1 influenza virus around the globe has been attributed to military troop movements as World War I came to an end.
    On November 3, 1918, Victoria’s Daily Colonist published a poem written by Mrs. A. Wilson of 549 Connaught Road in Victoria West. Mrs. Wilson was fed up with the disease and the many ways in which it had impacted her community. She poetically shook her fist in the face of the flu and “skidooed” it away.
    Mrs. Wilson's poem from 102 years ago shows us that our ancestors met fear and adversity with courage and creativity. And we will too.
     

    The 2nd Canadian Mounted Rifles Battalion marches up Yates Street as the troops returned to Victoria in April 1919. (Photo Courtesy of the City of Victoria Archives)
     
    The Spanish Flu
    Oh, the grippe; this terrible grip.
    Thro’ country and town it is taking a trip;
    Bringing to all a most fearful attack
    Of billiousness, headache and pains in the back.
    Its victims are many, its ravages grave;
    Its “grip” is like iron, we lie and we rave,
    Groaning and moaning with exquisite pain,
    And praying we never may have it again.

    Where does it come from, this wonderful grip,
    So powerful that no one can give it the slip?
    It comes and it brings with it doses of chills,
    And then you must take for it doses of pills.
    You shiver and sneeze and your head’s like a tap,
    For you’ve got the grip and the grip’s got you, nap;
    But it’s got a new name, ’tis the “Spanish Flu.”

    But one thing I’ve noticed that this “Spanish Flu”
    Is not a respector of persons—have you?
    It visits the homes of the humble and great,
    And travels at will over country and state.
    Brave men fall before it, proud women as well,
    And children have also been smitten and fell.
    For one who has come, saw, and conquered all through,
    We take off our hats to you, “Conquering Flu.”

    But we don’t bid you welcome; Oh, you Mighty Flu,
    There’s nobody wants you, so kindly skidoo.
    At your word of command we have closed every door,
    Of theatres, movies and places galore.
    You’ve shut down our meetings and even our schools,
    You’ve treated us just like a parcel of fools.
    And even our churches and Sunday schools, too,
    You have closed with a bang, oh, you wonderful Flu!

    Still, altho’ you have made us obey every whim,
    We rise up in defiance, your chance is now slim.
    We’ll chase you before us, grim spectre, away!
    We’ll fear you no longer, we’ll rout you today.
    You’ve stalked through our midst like a fiend seeking prey.
    ’Till you quite overpowered our brightest and gay.
    But your day is near over, you’ve had us, ’tis true,
    And we are the conquerers, oh, Great Spanish Flu.
    —Mrs. A. Wilson
    549 Connaught Road, Victoria W.

    Michael Wolfson
    March 25, 2020
    IT'S TAKEN TOO LONG for many governments, including Canada’s, to recognize the seriousness of the Corona virus pandemic when even days of delay can have large effects on the ultimate death toll.  It is only now that our governments are recognizing that successfully flattening the epidemic curve means that we could be self-isolating for more than just a month or two.  
    It is not too soon to start planning for the phase after, when it is time to begin relaxing the social distancing measures.
    If this relaxation is not done very carefully, the epidemic will simply resume. During the 1918 Spanish flu epidemic, which killed tens of millions world-wide, some cities like St. Louis quickly instituted rigorous social distancing while others, like Philadelphia, did not.  Both had resumptions of the epidemic after their social distancing and quarantine efforts were relaxed.
    At present, a major issue is that we do not even know, in Canada and in most other countries, how many individuals are infected. We know how many cases have been reported, but these tend to be individuals with more than very mild symptoms. Various studies have estimated that for every reported case, there could be anywhere from 10 to 100 unreported cases.
    It is possible to successfully limit the spread of the virus, as we can see in Wuhan, Singapore, Taiwan and South Korea, and to avoid the catastrophe unfolding in parts of Italy, where doctors are now having to decide who among their gravely ill patients can have their life saved with a ventilator.  
    But how will we know when and how to begin relaxing the very stringent social distancing measures now being implemented, and allow Canadians to safely resume their daily lives without fear of getting sick, and without the risk of infecting anyone else?  
    For evidence informed public health policy, we need accurate information.   
    There is an international movement to develop smart phone apps that, with big data analytics, could provide critically needed real-time information to help track the pandemic. But serious options quickly run into questions of protecting personal privacy, especially with the public’s growing concerns about the behaviours of high-tech firms like Google, Facebook, Amazon and Twitter.
    So, is there a way, in Canada, for us to be both sensitive to very real concerns about personal privacy and be able to use the obvious potential of social media-type apps? 
    In principle, individuals with immunity, could be issued a “green card” authorizing them to resume fully all their social activities. On the other hand, those who are infected would have a “red card,” while those who are still susceptible would be in a “yellow” state. In fact, China is implementing a system like this using a smart phone app already.  If your phone shows red, your freedom is highly restricted.  
    Obviously in Canada, surveillance measures would have to be compliant with protections guaranteed under the Canadian Charter of Rights & Freedoms and relevant federal and provincial privacy laws. But there would be major benefits to developing this kind of data infrastructure to manage both the current and subsequent phases of the pandemic.  
    Public health policy and implementation need smart ways to manage the relaxation of COVID-19 containment measures. This includes being able quickly, in real time, to identify clusters of new infections and isolate them; and to monitor people arriving from outside the country in case they become infectious.  
    It will also be necessary to monitor the movements of any already infected individuals in order to enforce their isolation as the large pool of Canadians who would still be susceptible to infection return to more normal social life. Canada’s current infectious disease surveillance data flows are simply not up to the standards of countries like Taiwan.
    Still, there are very serious trade-offs here. The more detailed the data collected, the more sophisticated the evidence that can be produced to inform smart public health policy. But at the same time, more detailed data collection will be more invasive of individual privacy.  
    Being able to deploy this kind of real-time geographically detailed infectious disease surveillance requires serious planning by Canadian governments and key researchers now.
    It is not too soon to begin discussing where to strike the right balance.
    Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

     

    Samantha Vanderslott
    March 25, 2020
     
    THE PROLIFERATION OF FAKE NEWS about the COVID-19 pandemic has been labelled a dangerous “infodemic.” Fake news spreads faster and more easily today through the internet, social media and instant messaging. These messages may contain useless, incorrect or even harmful information and advice, which can hamper the public health response and add to social disorder and division. 
    Confusingly some fake news also contains a mixture of correct information, which makes it difficult to spot what is true and accurate. Fake news may also be shared by trusted friends and family, including those who are doctors and nurses. They might not have read the full story before sharing or just glanced over it. Before you decide to share, make sure to read stories properly and follow some checks to determine the accuracy.
    If the story appears to claim a much higher level of certainty in its advice and arguments than other stories, this is questionable. People will be seeking certainty in a time of high uncertainty, anxiety and panic. So it is only natural to more readily accept information that resolves, reassures and provides easy solutions – unfortunately, often in a false way.
    Similarly, if a story is more surprising or upsetting than other stories it is worth double-checking, as fake news will try to grab your attention by being more exaggerated than real stories.
    What to look out for
    Source. Question the source. References have been made to “Taiwanese experts” or “Japanese doctors” or “Stanford University” during the outbreak. Check on official websites if stories are repeated there. If a source is “a friend of a friend”, this is a rumour unless you also know the person directly.
    Logo: Check whether any organisation’s logo used in the message looks the same as on the official website.
    Bad English: Credible journalists and organisations are less likely to make repeated spelling and grammar mistakes. Also, anything written entirely in capital letters or containing a lot of exclamation marks should raise your suspicions. 
    Pretend social media accounts: Some fake accounts mimic the real thing. For example, the unofficial Twitter handle @BBCNewsTonight, which was made to look like the legitimate @BBCNews account, shared a fake story about the actor Daniel Radcliffe testing positive for coronavirus. Media platforms try to remove or flag fake accounts and stories as well as verify real ones. Look out for what their policies are to try to do this.
    Over-encouragement to share: Be wary if the message presses you to share – this is how viral messaging works.
    Use fact-checking websites: Websites such as APFactCheck and Full Fact highlight common fake news stories. You can also use a search engine to look up the title of the article to see if it has been identified as fake news by the mainstream media.
    Who to trust
    The best sources to go to for health information about COVID-19 are your government health websites and the World Health Organization website. Primary sources are generally better than news articles.
    Even government messaging and the mainstream media can get things wrong, but they are more trustworthy than unverified sources on social media and viral messaging.
    Charlatans have been promoting false preventions and cures for people to spend their money on. For example, the New York attorney general has had to send cease and desist notices for claims that toothpaste, dietary supplements and creams will prevent and cure COVID-19.
    The effects can also be more serious than losing some cash. Iran has reported at least 44 people died from alcohol poisoning after drinking bootleg alcohol in a misguided attempt to cure COVID-19.
    Unfortunately, the most basic and correct advice given so far does not offer a miracle or special insight. Wash your hands often (use hand sanitisers if you cannot), avoid touching your face, and sneeze or cough into the crook of your elbow or a tissue (and throw it away in a bag-lined bin). Avoid crowds and public places, keep a sensible distance from people, and do not travel unless absolutely necessary. Now many governments are introducing measures including travel bans and quarantines that need to be followed to protect the health of everyone, especially the most vulnerable.
    We can all get caught out. Think twice about the messages currently circulating and help guide your family and friends to decide what to trust.
    Samantha Vanderslott is a postdoctoral researcher in Social Sciences at the University of Oxford.

    Kumanan Wilson
    MARCH 23, 2020
    IT WASN'T SUPPOSED TO PLAY OUT THIS WAY.  The world had entered into a grand bargain in 2005 with the approval of the revised International Health Regulations (IHR). Countries had essentially ceded some sovereignty to the World Health Organization (WHO) in order to best protect each other from global public health emergencies, and to preserve international travel and trade when these emergencies occurred.  
    Countries also agreed to implement measures to detect, report and respond to potential international threats that emerge within their borders. The WHO would decide when an event had met the level of a public health emergency of international concern. If it did, the WHO would decide what measures were necessary to prevent the spread of the threat, while at the same time, avoiding unnecessary interference with international travel and trade.
    How did this unfold with COVID-19?
    On Jan. 20, 2020, using its authority under the International Health Regulations, the WHO declared COVID-19 a public health emergency of international concern. Currently the WHO has stated there is no role for travel bans to prevent the spread of the disease, except at the earliest stages of the disease entering a country to give the country time to develop preparedness measures.
    However, from the beginning of this crisis, countries and non-state actors, such as airlines, have exceeded the WHO recommendations. The United States announced a ban of all non-essential travel to mainland Europe. Canada has asked all non-essential travel to be cancelled and has closed its borders to non-Canadian travelers.  European nations are rapidly closing borders. The WHO’s statement on travel restrictions remains unchanged.
    What went wrong?
    The international agreement was always a bit of a long shot. While unanimously approved by World Health Assembly (WHA) member states, there was no enforcement mechanism for the IHR. It was largely based on trust in the WHO, and a trust in global governance.
    And that is what has changed. The International Health Regulations were approved in a world which believed in global approaches to combating these and other threats. We don’t live in that world anymore.
    We live in a world which is increasingly distrustful of global elites, one characterized by increasing populist sentiment.
    In this world, it’s not surprising that countries would disregard WHO guidance. Did President Trump even know (or care) what this guidance was? Is Boris Johnson going to “take orders” from Geneva? Is Modi? Putin? Bolsonaro?
    No. In the current world, increasingly, countries are acting solely in their own best interest. But it’s not just the populist nations that are taking this action as the pandemics toll increases. Now we are all looking to protect our own citizens first.  
    Diseases are harder to control when countries act independently. Travel and trade are unnecessarily impacted. The loss of global wealth attributed to COVID-19 is in the trillions. And when we eventually come out of this crisis, we are all going to have to agree on rules to reopen our borders – it is apparent the WHO is not currently a trusted source to make this decision.
    So, what needs to happen?  
    Countries need to trust the WHO—and the WHO needs to earn this trust.
    Trust was dissipating after a series of questions in recent years surrounding WHO leadership in addressing emergencies, most notably its response to the 2014 Ebola outbreak.
    It is incumbent upon the WHO to ensure that it acts in a way that is transparent and accountable to rebuild this trust.  It is very concerning that there is such a discordance between WHO advice and nation’s actions.  Either the WHO advice was incorrect and contributed to the spread of the virus, or countries are over-reacting and causing unnecessary harm to international trade and travel.  
    The WHO also needs to be financially supported and, in turn, needs to financially support low- and middle-income countries so that they can invest in surveillance and response capacity.  
    A comparatively small investment in local public health could lead to the early detection and containment of future COVID-19-type outbreaks. A compensation program also needs to be created to offset the economic consequences of early reporting of potential threats—particularly by low- and middle-income countries.  
    Importantly, the views of local populations affected by outbreaks and travel advisories—which can be devastating to local industries—need to be considered, and these local populations need to be supported. It is the perception that their needs are secondary to global goals that has, perhaps more than any other factor, fueled populist sentiment.  
    The world needs the International Health Regulations, even in spite of the fact that nations are not following all of their guidance, as we're currently seeing with COVID-19. The good news is if we can learn from this outbreak and make this system work, local populations will be better supported. 
    Investments in local public health by the global community will have tangible results.  And this will increase confidence in global efforts to prevent disease spread as well as other efforts to work as a global community.
    Kumanan Wilson, MD, MSc, FRCPC, is a physician at The Ottawa Hospital and a member of the University of Ottawa Centre for Health Law, Policy and Ethics.  He has been a consultant to the World Health Organization on the IHR (2005).
     

    Jamie Liew
    MARCH 21, 2020
    CANADA ANNOUNCED unprecedented measures this week to restrict the movement of people across our borders as a response to the COVID-19 pandemic. Starting on Wednesday, most foreign nationals — people who are not Canadian citizens or permanent residents — will no longer be allowed into the country.
    Affected by this ban are many foreign nationals who live in Canada but had temporarily left the country including international students. This ban also covers anyone who wants to make a refugee claim. Initially, this ban also included foreign workers but that appears to have since been rolled back.
    Are these measures justified? We think not.
    Canada has a legal obligation under the International Health Regulations to adopt public health measures that do not unduly interfere with international traffic.
    The World Health Organization has not recommended travel restrictions for the purpose of curbing the spread of COVID-19. Rather, it advises countries to take appropriate screening measures at ports of entry and exit, and it urges the public to follow good hygiene practices and to maintain social distancing. Many of these actions are already in place in Canada.
    Even if travel restrictions are deemed necessary, a more individualized assessment of who can enter the country based on people’s actual health status would arguably achieve the same public health objective as banning nearly all foreign nationals.
    By going beyond these less restrictive but scientifically proven courses of action, Canada’s border closure contravenes the International Health Regulations.
    Canada’s border policies must also be in line with international humanitarian and human rights law. We are extremely concerned by the government’s recent announcement that asylum seekers crossing into Canada irregularly at the Canada-U.S. border would be returned to the U.S. 
    Many lawyers and advocates have long identified problems with the asylum system in the U.S. that put refugee claimants at risk of being returned to countries where they face persecution or torture. Some of the many problems include the inability to make gender-based refugee claims and the indefinite detention of migrants, including children.
    It is now also unclear what Canada would do with respect to asylum seekers arriving by ways other than irregular land-crossing. 
    If any of these individuals are returned to a country where they face persecution or torture, Canada may be violating its legal obligations under the Refugee Convention and the Convention Against Torture.
    The border closure also impacts international students and other foreign nationals who are resident in Canada but had temporarily left. Some of them are now separated from their families who remain in Canada.
    This not only puts Canada at odds with the right to family life guaranteed under the International Covenant on Civil and Political Rights, but it also raises practical questions of what Canada should do with people who depend on their foreign-national family members for support.
    There are emerging international legal norms recognizing that people with temporary immigration status should enjoy no less favourable treatment than nationals of a state. Given that we have already approved their entry into Canada, and given their contributions to our society and economy, the exclusion of these foreign nationals with clear ties to Canada seems arbitrary.
    In fact, recognizing the importance of migrant workers to many industries, the government walked back on its initial ban against these foreign nationals. Although details on this reversal remain scarce at this time, this is a step in the right direction. We hope it applies to all foreign workers. 
    We also urge the government to reconsider the entry ban on international students.
    Legality aside, Canada’s border closure in response to COVID-19 reinforces the stereotype that foreign nationals are a vector of disease. It feeds into the narrative that COVID-19 is a “foreign illness,” despite the fact that everyone is equally at risk of contracting this virus and anyone can spread it. This division between Canadians and foreign nationals, us and them, risks stoking racism and xenophobia, which has been frequently reported in the wake of the outbreak.
    A pursuit of public health that neglects scientific evidence and human rights will do more harm than good. And unfortunately, the brunt of these harms will be borne by people who are already marginalized in our society.
    Y.Y. Brandon Chen and Jamie Liew are law professors and members of the University of Ottawa Centre for Health Law, Policy and Ethics.
     

    John Muscedere
    March 20, 2020
    AS THE PRIME MINISTER addressed the nation, from his quarantined residence in Ottawa, he echoed what public health officials have been saying: Listen to your health care providers, practise social distancing and get prepared. 
    The World Health Organization (WHO) has officially declared the novel coronavirus (COVID-19) a global pandemic, and public health officials, together with credible media sources, have shared important information and data regarding who may be more likely to contract the virus from the current ‘hot spots’ – China, South Korea, Iran and Italy.
    Media reports rightly reassure us that most individuals will not become seriously ill with the virus. However, the 15 to 20 per cent who may become ill enough to require hospitalization will seriously impact and possibly overwhelm our hospitals and intensive care unit (ICU) system which is already at—or over—capacity. 
    Our failure to address the long-known crisis in elder care across the country has made us unprepared for an additional demand on hospital services on the level of COVID-19. Too many of Canada’s frail seniors are currently living in hospitals, awaiting placement in long-term care facilities or waiting for an alternative level of care elsewhere. This is why health authorities are striving now to implement policies that will slow the progression of the virus and “flatten the curve” of demand—so there is no sudden spike, but instead a slower increase in the number of those infected that would be more manageable. 
    Canada’s older adults, particularly those with underlying health issues, those with chronic health conditions and those living with frailty, are already at increased risk for severe, adverse health outcomes from even minor illnesses and injury. They will be the hardest hit by the COIVD-19 virus. 
    Currently around 16 per cent of the Canadian population is over the age of 65. The most vulnerable of these older adults are those living with frailty, which includes one in every four older adults over the age of 65.  For those over age 80, the frailty rate jumps to 50 per cent. 
    We need to make sure we recognize the vulnerability of seniors living with frailty.  They are the main reason the current containment efforts for this virus are so important.
    This also means making sure that measures to prevent the spread of COVID-19 don’t negatively affect our seniors.  Public health authorities have advised Canadians to engage in “social distancing”—staying away from crowded public spaces and avoiding unnecessary close contact with others.  But it is important to remember that social isolation is also dangerous to the health and well-being of older adults. Loneliness is associated with potentially life-shortening health issues, such as higher blood pressure, heart disease, obesity and depression. 
    Now is the time to check in on older, possibly frail or socially isolated neighbours, family and friends—but take precautions. This means washing your hands, making sure you’ve had your flu vaccination and avoiding in-person visits if you have been in contact with someone with an illness or have signs of illness yourself. 
    Now is also the time to help your older loved ones prepare for the long-term consequences of a COVID-19 outbreak, which may mean helping them stock up on provisions, medicines and other essentials. 
    We should also speak up when we hear, “Oh well, it’s only old people who are dying.” Ageism has no place in Canada and our seniors are not expendable but rather valuable members of our communities.  
    It’s times like this, a viral COVID-19 pandemic, that we are reminded of how interdependent we are as individuals. It is up to everyone to stay informed and work together as a community to mitigate the spread of the virus, which includes taking care of our vulnerable older Canadians.
    Dr. John Muscedere is an the Scientific Director of the Canadian Frailty Network, an intensivist in the Intensive Care Unit at Kingston Health Sciences Centre – KGH Site, and a Professor of Critical Care Medicine at Queen’s University.
    The Canadian Frailty Network works to improve care for older adults living with frailty and to support their families and caregivers by increasing recognition and assessment of frailty, increasing research based evidence for decision making, advancing evidence-based changes to care, educating the next generation of care providers and by engaging with older adults and caregivers.
     
     

    Katherine Lippel
    March 18, 2020
    ON THE HEELS OF the COVID-19 crisis, the federal government has now improved access to Employment Insurance, and some provinces, but not all, have discouraged employers from requiring sick notes. Banks have offered a six month payment deferral for mortgages and organizations responsible for workers’ compensation and occupational health and safety in some provinces have produced timely guidance material. 
    Much more needs to be done.
    Little if any action has been taken to relieve the needs of tenants who can’t meet their rental payments.  No one in Canada, including the precariously employed, should be left homeless or destitute because of COVID-19 and the consequences it will have for both the health of our people and our economy. We must ensure that workers have the ability to stop working if they are ill, in their own interest, and in the interest of public health.
    Statistics Canada estimates that between 27 per cent and 45 per cent of all Canadian workers do not have full-time stable jobs.  This does not include low wage earners with full time stable jobs who still live from paycheck to paycheck.  The precariously employed include: the solo self-employed including those working in the gig economy; those on temporary contracts, working on call or for temporary employment agencies; and part-time workers, including the involuntary part-time. 
    In many provinces, full time low-wage earners are also in situations of employment precarity where employers may lay them off at will or where non-unionized workers can be fired for being absent for more than three days, even if they are absent because of illness.  Labour legislation does not discourage employers from requiring sicknotes to justify absences. 
    Bill 148 in Ontario had curtailed employers’ right to require sicknotes, but that provision was repealed by the Ford Government’s Making Ontario Open for Business Bill 47. Now we’ve heard promises that legislation is in the works that will ensure employers no longer require sickness notes in Ontario for those in quarantine, although the legislation has yet to be tabled.
    Anyone can be at risk of contracting COVID-19 at work, but workers in certain sectors, such as health care, and also those working with the public, are particularly at risk.  Occupational Health and Safety legislation requires that employers protect workers from hazards, and workers have the right to refuse work that endangers their health. 
    Health and safety regulators and public health officials are mandated to proactively provide guidance to workers on the front lines to protect their health and safety and that of others. 
    If workers do become ill out of and in the course of their employment, workers’ compensation should normally be provided. Compensation boards need to adapt their requirements of all injured workers in light of current challenges to the health care system.
    Lots of workers will be falling through the cracks of a very uneven social safety net in Canada, primarily provincially regulated with regard to labour legislation, and federally regulated, with regard to Employment Insurance. 
    In other words, it is highly likely that some workers will not be able to pay their rent or feed their families if the current crisis is to go on for weeks or even months. Our governments need to take more action.
    Legislation improving Labour Standards and Workers’ Compensation coverage is required to ensure that all workers who are absent because of illness or in quarantine should be guaranteed economic support while they are away, regardless of their contractual status. They should not be required to produce sick notes by their employers and they should be protected from reprisals if they are absent for health reasons. 
    New measures should be introduced to protect the jobs of workers who are unable to work because of COVID-19.  Provinces should enact temporary prohibition of evictions for non-payment of rent.
    It sometimes takes a crisis to reveal all the fault lines in our flawed social safety nets.  We can weather the difficulties arising from COVID-19, but only if we face it together, and make sure to leave no one in Canada behind.
    Katherine Lippel is the Distinguished Research Chair in Occupational Health and Safety Law and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.
     

    Linda Silas
    March 2, 2020
    OUTSIDE ASIA, Canada was the country hardest hit by the SARS coronavirus. By the end of the 2003 global epidemic, there were 438 cases of SARS in Canada, resulting in 44 deaths. Most cases were concentrated in Toronto, as were all fatalities. More than 100 health care workers became ill and three died, including two nurses.
    Ontario’s independent commission to investigate the introduction and spread of SARS identified a key lesson: in the absence of scientific certainty about how an infectious illness is transmitted, reasonable precautions must be taken. 
    Justice Campbell, who served as the commission’s chair, explained that this precautionary principle places the emphasis on safety, rather than science. In other words, if we don’t know exactly how a virus spreads, we shouldn’t wait for the science to be settled to protect health care workers. 
    Despite this important lesson from the SARS epidemic, the Canadian government now seems content to wait for conclusive evidence on how the 2019 novel coronavirus (COVID-19) is transmitted before taking the necessary steps to protect front line health care workers. 
    As provinces brace for a potential outbreak of COVID-19, nurses’ unions are speaking out about the threat to health care workers. Notably, the Public Health Agency of Canada is failing to properly prepare frontline workers in acute care settings and overlooking the clear lessons learned from our previous experience with pandemics.
    The federal agency was created in the wake of the SARS epidemic to provide national leadership and clarity during public health crises. However, it has never embraced this mandate. During the 2003 pandemic, frontline workers received conflicting messages and were often confused about how best to protect themselves and their patients. 
    History may repeat itself if the Public Health Agency of Canada continues to provide weak leadership.  In particular, it’s disappointing that the Public Health Agency of Canada has failed to advise acute care facilities to adopt the precautionary principle –the key lesson from SARS. 
    Meanwhile, national public health agencies in the United States, the European Union and the United Kingdom have called for contact, droplet and airborne precautions to protect health care workers, deeming the illness of one health care worker to be one too many. 
    In response to COVID-19, these agencies are recommending an N-95 respirator, which is custom-fitted to a health care worker’s face to prevent any leakage. The province of Ontario, which experienced the worst of SARS, is also choosing to mandate the N-95 respirator for health care workers, in light of the current scientific uncertainty about how the virus is transmitted.

    In contrast, the Public Health Agency of Canada is recommending surgical masks for health care workers – a device designed to protect the patient from the wearer’s respiratory issues, not the reverse.
    Canada can and should do better. The agency’s position is quite simply an abdication of leadership. Unprotected, health care workers can easily transmit viruses throughout acute care facilities. Recent evidence published in the Lancet, a peer-reviewed medical journal, recommends “aggressive” protection for health care workers caring for presumed and confirmed cases of COVID-19. The study noted that even a non-symptomatic person can spread COVID-19 “with high efficiency”; face masks and other conventional forms of protection, according to the article, “provide insufficient protection.” 
    As nurses, we know that patient safety starts with worker safety. If our health care workers are safe, then our patients are safe. 
    The Canadian Federation of Nurses Unions has asked the Public Health Agency of Canada and the Health Minister of Canada to act out of an abundance of caution and carefully consider the lessons learned from the SARS epidemic. Canada should follow the precautions being taken in the United States, the European Union and the United Kingdom, as well in the province of Ontario. 
    We can and should do our best to protect our health care workers, and by extension, our vulnerable patient populations.
    Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions, representing nearly 200,000 nurses and student nurses across the country.
     



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