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  3. 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 70 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).
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  5. Today's numbers from around the globe, including Canada, BC and the Island Health Region. Stop at an image by using the pause button at the bottom April 6.m4v
  6. 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.
  7. 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 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
  8. 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.
  9. 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. A coronavirus testing laboratory in Leeds, UK (Credit: HM Treasury) 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.
  10. 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.
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  12. 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. <script type="text/javascript" src="https://pixel.propublica.org/pixel.js" async="true"></script>
  13. 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.
  14. 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.
  15. 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.
  16. 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).
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. Last updated 3:30pm April 4. This site seems to have the most frequently updated numbers for Canada: https://ici.radio-canada.ca/info/2020/coronavirus-covid-19-pandemie-cas-carte-maladie-symptomes-propagation/
  22. Updated 6:00pm April 4. You can also view the full world count here.
  23. Last updated 6pm April 4. • As of April 4, Italy has suffered the most deaths (15,362) from the disease of any country. The rate at which new cases are being reported appears to be slowing down. • The current rate of increase in confirmed cases in the USA is much higher than Italy's has ever been (the US has 5.5 times Italy's population). Confirmed cases in the USA are at 941 per million of population. Today, Canada is at 369 cases per million. • Focus updates this information twice daily. The data in our earlier update may show a flattening of the US and Canadian curves that disappears in the end-of-day data.
  24. Last updated 3:30pm April 4. For more information see https://www.islandhealth.ca/learn-about-health/diseases-conditions/novel-coronavirus-information
  25. Last updated 3:30pm April 4. For more information see http://www.bccdc.ca/about/news-stories/stories/2020/information-on-novel-coronavirus
  26. until
    We have cancelled our public calendar until further notice from public health authorities.
  27. Thanks for posting this. As usual your perspective helps with decision-making.
  28. Great article Trudy!! I always love the article on the last page of Focus. I feel a close affinity to you and grew up on a mixed farm in Saskatchewan. I've made the same journey to being mostly vegetarian, having one night a week no meat dinners and also wonder what we could have done with the $12 billion the Fed's have committed to Trans Mountsin?? Thanks and keep on being real and hard hitting in a subtle way😊
  29. March-April 2020 Focus.pdf
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