Showing posts with label corona virus. Show all posts
Showing posts with label corona virus. Show all posts

14 March 2021

COVID-19: Lessons learned and justice are not the same


The World Health Organization declared a pandemic on March 11, 2020 and by March 11, 2021, 2.6 million people have died from Covid-19.

On the news and social media on March 11th, 2021, passing the year mark of this pandemic was the subject of numerous discussions. There were many honouring those who died. Many pointed to the tsunami of grief, the bravery of our frontline healthcare workers, the generosity of neighbourhoods, friends and family.

As I was falling asleep that evening my thoughts went to crime and justice. 

When people die or are harmed by the actions of others, they want justice.

Elderly parents have died in Long Term Care Homes where families felt they were not cared for or protected. Doctors, nurses, personal support workers, paramedics and other have been infected because they did not have adequate personal protective equipment – some have died and others are still suffering from Post-Acute Covid Syndrome. Many others have been infected and died because they were told that they didn’t need masks to protect them from COVID-19, until they were finally told to wear masks. Many are now waiting for available Covid vaccines but some are getting infected and dying while they wait. 

Who is brought to justice when it is clear that deaths are clearly cause by the actions of others? 

There will be commissions on how we care for and protect the elderly. There will be analysis on why aerosol and asymptotic spread were not identified earlier. There will be some form of reckoning on the lack of PPE for healthcare workers who were forced to work without proper protections. These will all be filed under lessons learned to maybe influence how we move forward. And maybe is the operative word.

What I worry about most is whether those who lost loved ones, those who still remain ill from post-acute COVID will feel that justice is served? Lessons learned serve those who come after us, but what about those who bear the scars of this year? What do they need to move forward?

Here I came to my worst conclusion in this line of thought: those responsible for true harm, whether they be politicians, organizations that said they would care for our elderly or those who made decisions that killed our health care workers-will not be held to account. They will be responsible for a large number of deaths through their actions and nothing will come of it. There will be no justice.

Let’s roll back to the beginning: if someone harms another, we demand justice. How does it work if many people make decisions and take actions that harm hundreds if not thousands of people. Under the cover of group work, apparently nothing.

Crimes are punished in part as a deterrent for future crimes. I hope we don’t learn that mistakes that cost lives can be done with impunity if they are done by governments, organizations like Long Term Care Homes and those who are responsible for safely equipping healthcare workers. 

So, at the end of a painful year full of death and suffering, of course my mind turned to crime. The worst kind: those that are not punished. 

As I fell asleep, I thought about how, in a pandemic, we can discuss the bad things that happened. We cannot really get justice. No one is really responsible. We will simply have some large files on lessons learned that may simply be ignored anyway. 

Now, late night thoughts are sometimes morbid. I hope I’m wrong.

14 February 2021

The Pandemic: Babies and Stories


With so much time together with our lovers, many expected a pandemic baby boom, but it is looking more like a bust.

I get it.

My writing fantasy is to have stories - the ones that reveal the places we live and breathe, the dark places, the places of joy - and also the time to write them. 

I now have the time but the onslaught of stories is just too much. The edits on my book are not a boom but a bust. A total bust.

Normally, when I work I shut out the world. Ignore it. However, this is a time in history when absorbing what is going on in the world is needed.

When I sit down to write, my head swirls from the page outward. Perhaps my characters are talking on the phone - I think of all the people isolated by #COVID19 who can only talk to those they love by phone. When my characters sit for coffee, I think of all the lonely people unable to gather and the small coffee shops struggling to survive in this pandemic.

Then there are the elderly in long term care homes, isolated and at times suffering with dementia - how do they make sense of the long days when no familiar faces come? Do they forget them? Do they remember them in their dreams?

The children who once rushed up to playgrounds to do what we have forgotten to do - play with abandon with children they have just met. Now, they are masked and are asked to keep their distance. Will they play with abandon when the virus is gone or will they grow up too soon into the far more distanced adults that surround them? Hell, we are asking them to keep their distance so it would be a small wonder if they don’t.

The lovers, the ones that had planned romantic trips, weddings and parties - what happens when none of that is possible? Do they put that spontaneous side - the most romantic moments - on hold. Can they return?

And then there are those who don’t return at all.  Their families watch them disappear into the bowels of an ambulance or hospital and then can’t see them, hold them before they die. 

I’m bombarded by stories of my colleagues in the #COVID ICUs. They have so many tools to save people but now, their tools are often useless against Covid-19. Death after death. It's everything they've been trained to fight and yet they lose the battle constantly. They are tired and demoralized when one patient dies, the numerous deaths are just too much for them.

And, perhaps a few blocks from these ICUs, people are gathering without masks, perhaps in homes, to have a drink, laugh and spread this damn virus around another room.

Will all the pandemic stories raging around demanding attention finally settle when the worst of this pandemic is over? Will we have time to write them when life returns to normal?

My hope is that these stories will be written and we will take the time to pay tribute to each person we can. There have never in my lifetime been so many stories crying out to be told. There are also so many people who are now no longer with us to tell their story and we need to honour them by telling it.

I have practiced medicine. I have written. Both involve a similar process.

In medicine, the key to a diagnosis is always the story - the more fulsome the story, the more likely the diagnosis will be accurate. And after diagnosis, following the story allows us to assess the treatment and, more importantly, how the patient is doing. 

With writing, the key is always the story and the more fulsome, the more accurate. 

With the pandemic stories that will be written, I hope that that they will be about how we recover, or don’t, from this terrible time in our history. Like a medical story, we need to follow this up. 

At this point in time I have no idea how the story ends for us all.

Oh, and babies. We need to see more babies please. We need a new generation to whom we pass on our stories, because this has been a time of such important stories. But until we pass on our stories, we need the joy of a new beginning.

08 November 2020

Protect your eyes from COVID19 infection.


There’s a saying: if you’re the smartest person in the room, you’re in the wrong room. I recently found myself in the right room—a masked, backyard get-together with close friends.

My husband mentioned he’d added a face shield to his mask in indoor public places, to protect his eyes during the second wave of COVID-19. One of our friends, Brian Foody, said that using a face shield with a mask wouldn’t protect eyes from airborne COVID-19 but goggles would.

This statement was very surprising. Public health experts have been clear, given the airborne transmission of COVID-19, that face shields and goggles protect the eyes equally.

For the public, Dr. Anthony Fauci said in an interview, “. . . you should protect all of the mucosal surfaces, so if you have goggles or an eye shield, you should use it.”

In healthcare settings, face shields are irreplaceable to protect against splatter during procedures, but face shields and goggles are recommended by public health as interchangeable eye protection.

For protection during aerosol-generating medical procedures, Canadian Public Health recommends, “eye, nose and mouth protection (mask and eye protection, or mask and face shield, or mask with attached shield) that fully covers the eyes, nose and mouth and ensures that no part of the face is exposed.”

The CDC states, “The PPE recommended when caring for a patient with suspected or confirmed COVID-19 includes the following . . . Put on eye protection (i.e., goggles or a face shield that covers the front and sides of the face) upon entry to the patient room or care area.”

If face shields don’t protect the eyes from airborne COVID-19, the definition of “adequate PPE” changes and this may save lives. A large study of healthcare workers showed that they accounted for 10% to 20% of COVID-19 infections and, even more worryingly, “even among frontline healthcare workers reporting adequate PPE, the risk for COVID-19 was increased . . ..”

Given the importance of this issue for the public and for healthcare workers, I interviewed Brian Foody, president and chief executive officer of Iogen Corporation and an MIT-educated mechanical engineer, who specializes in fluid motion.

The movement of COVID-19 infected air is at the heart of this issue.

“Imagine two people wearing face masks, one has on a face shield and the other is wearing goggles, walking into a closed room where the ambient air contains COVID-19 infected aerosols,” Foody explained. “Whose eyes are better protected? For our wearer of the face shield, with every breath, the clean air behind her face shield is ventilated and exchanged with the contaminated ambient air. Because of this ventilation, the air behind the face shield will have the same concentration of aerosols as the rest of the room within a matter of minutes. On the other hand, for our goggle wearer, the clean air behind her goggles is sealed off from the ambient air.”

The mixing of air behind a face shield is based on the basic scientific principles of fluid dynamics: if there are COVID-19 particles, they’ll be drawn into the face shield and up to the eyes.

This behaviour of aerosols is supported by a 2014 study. “Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled,” it noted.

A review of the literature in March, 2020 stated that, “There is a lack of research on the effectiveness of different forms of eye protection.”

And yet, certainly the public health recommendations consider goggles and face shields as equivalent.

I am reminded of the early days when many of us recognized the pattern of airborne transmission of COVID-19 infections and advocated for masks, contradicting public health recommendations. Now the widespread use of masks is recognized as an important tool to limit COVID-19. This information on face shields is just as important: face shields protect from splatter but do not offer eye protection and public health recommendations for the public and healthcare workers must change.

Then Brian asked a crucial question: “What are the chances of getting infected through your eyes?”

To begin to find my way through this issue, I had to enter the right room, so I unabashedly called my friend, Dr. Sherif El-Defrawy, at his cottage on Thanksgiving.

Dr. Sherif El-Defrawy is an ophthalmologist who’s chair of the Department of Ophthalmology at the University of Toronto, before which he held a similar position at Queen’s University. He’s also president of the Canadian Ophthalmological Society and of the Association of Canadian University Professors of Ophthalmology.

In short, Dr. El-Defrawy knows eyes.

“If COVID-19 infects the conjunctiva of the eye, it could travel to the nose via the nasolacrimal duct and colonize the nose or throat,” he explained. “However, we would expect to see conjunctivitis. I find it highly unlikely that there would be enough COVID-19 to cause illness without seeing conjunctivitis.”

He explained that the number of COVID-19 infected patients with conjunctivitis wasn’t that large but it was unclear how many patients were checked for this. Finally, he expressed surprise that goggles were not universally recommended in healthcare settings along with face shields.

So, first things first, I’m not a fan of primate studies but there was one that answered many questions about COVID-19 infection via the eyes, so with great regret I present it here.

Three rhesus macaques were infected with COVID, two via their conjunctiva and one via intratracheal route. The conjunctival swabs were positive for the first day only, “indicating that the inoculated virus may transfer from conjunctiva to respiratory tract and other tissues . . . specific IgG antibodies against SARS-CoV-2 were detected in the rhesus macaques, indicating that the animal was indeed infected with SARS-CoV-2 [showing] that conjunctiva is a route of SARS-CoV-2 transmission.”

A literature review concluded, “The overall prevalence of ocular symptoms in patients with COVID-19 was 11.2%, which is not a common finding. Nevertheless, this reported prevalence might be an underestimation because patients with COVID-19 present with life-threatening clinical scenarios, which may preclude a detailed ocular examination or relevant history.”

Speaking of ophthalmologists, we should acknowledge with deep gratitude that it was the ophthalmologist, Li Wenliang, who was one of the first people who warned the world about the new disease we now call COVID-19. He later succumbed to the disease after contracting the virus seemingly from an asymptomatic glaucoma patient in his clinic.

So, how does eye protection play out on the ground in healthcare settings? Here I turned to information from Dr. Rick MacDonald, a community paediatrician on staff at Halton Healthcare hospitals where he takes call seeing paediatric patients and works in the NICU.

When many other physicians’ offices were largely doing virtual visits, “we decided early on that if we were going to be a useful resource for our paediatric population. . . .We needed to see patients [and] to provide this service, PPE is the most important first step without which it could not be done.”

Dr. MacDonald spent hours sourcing PPE for his office, opting for an N95 and a face shield but now also wears goggles as well. “To [keep our office open] we need full protection. No skimping, no cheating, full attention to detail. . . . Overkill is better and no government official or cloistered ID staff will convince me otherwise.”

He’s correct: protection, including eye protection, is crucial. Doctors are often in closed examining rooms, crowded emergency departments or intensive care units, with potentially large volumes of COVID-19 aerosols. So are nurses, paramedics, respiratory therapists and many others.

Certainly, we could benefit from research on the fluid dynamics of COVID19 aerosols with people wearing face shields and masks. However, we are in the second wave of this pandemic and there are a frightening number of infections in the public and healthcare workers.

I’m asking public health, in light of the basic science of fluid dynamics of aerosols, to change their recommendations:

The public should wear eye protection if they are indoors with others.

Healthcare workers working with patients that are potentially COVID-19 positive, should use face shields for splatter alone. Goggles are the only safe eye protection for aerosols.

13 September 2020

Wearing Masks During COVID19: How Neuroscience Can Help Us.


Never have lives depended so much on getting a buy in from the public to wear masks. The evidence that masks protect us from COVID-19 is clear and unequivocal. In terms of scientific evidence, that is. Where it all falls apart is when emotional arguments are made against wearing masks.

Many argue that we should avoid the emotional aspect of COVID and simply concentrate on the rational arguments for mask use. 

However, this argument falls apart too, because all decisions involve emotions and we can’t keep people safe without appealing to them. Why? Because that’s how our brain works.



In the 1990s, the neuroscientist and physician Antonio Damasio wrote a groundbreaking book, Descartes’ Error: Emotion Reason and the Human Brain. Through studying people with brain lesions he demonstrated how decision making necessitates emotional input: decisions cannot be made without emotional input. 



Much research has supported these findings and this has been taken into the political arena by authors like Westen and Lakoff. The basic conversation in both these books is how all political decisions involve emotional input. 



Some may feel that decision-making that necessitates emotional input is not a good thing. They will side with Descartes and claim that purely rational decision-making exists. Like everything in the human body, from kidney to heart function, one doesn’t get to chose how organs work. The vast amount of evidence from lesion studies proves this to be the way the brain works.

I understand the concern with the idea that decisions are emotionally based - I grew up with scientists who felt emotions should never enter decisions. Emotions were seen as out of control and in need of control. 



Perhaps it would be reassuring to look at the areas of the brain that are involved in emotions - there is a complex, interconnected system that is utterly beautiful. A glance at some of the players may inspire you: these areas respond directly and indirectly to bodily and sensory inputs and coordinate, like a symphony: orbitofrontal cortex, dorsolateral prefrontal cortex, anterior temporal lobe, ventrolateral prefrontal cortex, dorsomedial prefrontal cortex, anterior mid-cingulate cortex , amygdala, anterior insula, anterior cingulate cortex, dorsomedial/dorsolateral prefrontal cortex, medial temporal lobe, retrosplenial cortex/posterior cingulate cortex and periaqueductal gray.

So, although emotions are often viewed as the basest form of human reaction, they involve complex cascades of brain activity that are crucial for synthesizing social, empathetic and protective aspects of a decision.

This impacts mask wearing because different countries have different emotional narratives to which they generally respond.

All governments are using narratives to explain the spread of COVID-19. In Canada, the narratives of the federal and provincial governments are largely in line with each other and all appeal to a sense of helping others. This narrative has high emotional salience in Canada, where helping others, working together as a country to help each other is the basis of everything from our universal healthcare system to our investment in schooling. It is a core value. Not for everyone, of course, because no country has a homogenous set of values. However, most countries do have some values that are widely shared. 

Even some of the anti-maskers in Canada protest under the banner of “Hugs not masks”. Appealing to a sense of community well-being while spreading the virus may be odd, but it encapsulates the emotional weight of community in Canada. 



South of our border, COVID-19 infections and deaths are mounting, and masks would help limit the spread of this virus. There are many factors involved in this but one factor is the conflicting messaging coming from the federal government and the states. Another factor may well be the emotional weight given to the idea of individual decisions - much of the messaging has actually been against the community well-being by arguing that individuals can’t be forced to do things by others, particularly governments. We have some of that in Canada, but not in such large numbers because the narrative in Canada is that taking care of others is valuable and putting yourself above the health of others is generally frowned upon.

I have thought long and hard about how to encourage people to wear masks south of the border. Many of my colleagues in the United States spend their days and nights caring for COVID patients and then spend their free time on twitter encouraging people to wear masks. 


When I think of appeals that have been made to Americans, this comes to mind:




Or this as a mantra for today:





So many fine and civic minded Americans have called upon Americans to follow their better angels. These appeals are emotional - heck, I’m Canadian and they move me to the core.

Some of my American friends have argued that the population of America has changed and that appealing to better angels will not work because many are driven by anger and fear. The division of people into those who are angry and scared verses those who are rationally following public health measures is a fallacy. We are all scared and we are all angry. These are difficult times and we would be completely detached from reality if our responses to this drastic situation were not intense: remember our emotional systems are nuanced, coordinated and work with reality because they are dependent on input from our senses.

Directing our fear towards its source - this virus - drives many of us to wear masks, wash our hands, keep our distance from people and allows us to stay safe. Anger? That's a great energizer for fear and enables us to fight paralysis by driving us to action. We are seeing governments and others trying to direct anger when infections increase towards those who are infected and, these days, this is often young people who are painted with the narrative that they are selfish and irresponsible. When we direct anger towards our own, it's rarely productive and always divisive. When young people have heard inaccurate information that they are largely unaffected by this virus, we should look to the source of their behaviour and perhaps correct the information they were given, using that anger to drive us, energetically, to educate them and appeal to the values of community and empathy that we have raised them with. 

History has taught us that citizens who have been complicit in terrible things can and have turned things around - think postwar Germany. Surely, we can give our young and our fellow citizens the benefit of the doubt and appeal to their better angels - to their more noble emotions such as empathy. 

One of the bright spots - maybe - is the response Canadians have seen to mask mandates and this might help in America. “An overwhelming 95 per cent of the survey respondents say they now wear a mask on public transit. In mid-July, those numbers were as low as 45 per cent.”  In cities all over Canada, we are seeing similar response to mask mandates. Not certain if this would work with our southern neighbours given the violence that has accompanied masks refusal and the lives that have been lost. But maybe this provides some hope. Along with an emotional appeal to civic duty grounded in empathy. 

I don’t know if this will work. I’m just hoping that we can all turn the rising infections around by standing on the shoulders of scientists, who explained how we make all decisions, including whether to wear masks or not: facts without emotional appeals will simply not work to help people make the right public health decisions. 

19 July 2020

Florida… Oh No, Not Again!


Florida postcard
Florida’s bizarre politicians overshadow our usual weird news. But let’s take a stab at the strange.

Gator Cater

West Palm Beach, Florida.  No, I am NOT the guy who reads and sings to calm alligators not receiving their share of tourists. Everyone knows I can’t sing.

Marathon, Florida.  I also deny knowledge of the iguana that wrestled a guy and his bicycle to the ground. A spokesman for the bicycle said…

Tampa, Florida.  Nor do I have anything to do with neighbors preventing access to a landlocked bird sanctuary. (I have sympathy in this case. Orange County politicians turned over a county road to a private cattle company, preventing property owners access to their land.)

Head Honcho

St. Petersburg, Florida.  A jogger found a human head on a grassy knoll. Police confirm it is not that of Governor DeSantis, who is known for having lost his mind but not his head. Yet.

Softball Questioning

Jacksonville, Florida.  A hard-hitting woman batted eyelashes at her police detective boyfriend, who gave her a pass during a murder investigation. They made it beyond third base but not quite home when they were called out.

The Mother of All Gifts

Clearwater, Florida.  We missed reporting on Mother’s Day that a spitting, angry Pinellas County wife beat her husband for remembering and giving her flowers. Uh wait. I’m guessing she didn’t want flowers.

Clearwater, Florida.  Another woman attacked her man with a candy cane. And a brick. And a pen. Somehow after a brick and a yard-size candy cane, a pen doesn’t seem all that much.

Micanopy, Florida.  So her boyfriend, see, well, she was on her phone, actually, and her boyfriend, just sorta, kinda, tripped on air and fell on a knife, twisted it in maybe, and writhed and stabbed himself umpteen times or not and raccoons attacked… No flowers for her Mother’s Day.

Sanford, Florida.  Lest ye think it only women who’ve gone corona-mad, there’s the crazed man who stabbed a roommate then turned on police, screaming something about Satan and worms and… You see? Some normal Florida things still happen.

Deltona, Florida.  We mustn’t forget another man who attacked a roommate who’d kindly made him breakfast. Oh wait. The breakfast chef woke him at 5am. That’s like the middle of the night. Last time someone woke me at 5am, police found me sharpening my teeth.

coronavirus
Another Reason to Close the Bars

Indialantic, Florida.  She just spread the love or a message or coronavirus. Just because she kissed strangers without a mask, was that any reason to stop a sunny welcome?

Try as I might, I can’t seem to get away from COVID-19 stories.

Taking the Cure


Bradenton, Florida.  The Genesis II Church of Health and Healing continued selling their Miracle COVID Cure after a judge ordered them to stop selling industrial bleach for human consumption. This is the same chemical their leader wrote about to President Trump who subsequently claimed this wonderful detox would knock out the coronavirus in one minute. Side effects include heartburn, death…

Fort Myers, Florida.  That guy in Costco, you know, the dude who felt threatened by a 60-some year old lady who asked him to wear a mask… from Florida, of course. He’s a star insurance salesman; you’d think he’d want everyone to masque up.

Holly Hill, Florida.  The Costco guy wasn’t as nasty as the woman who spit into Walmart’s fruit and vegetable bins ruining $350 or so of foods. Because of the corona hoax, of course.

Homestead, Florida.  A couple wanted soooo bad to visit the Florida Keys, but those stupid Keys officials didn’t want to spread that hoaxy COVID and like all illegally tyrant-like keep non-residents out, which is soooo Naziish. Anyway, this freedom-loving couple took a teenager prisoner and forced her to drive through the checkpoint. They struck such a blow for freedom, not the terrified girl’s, of course, but theirs. Except they’re locked up.

Cadillac atop cars
Hernando, Florida.  Local drivers might not be as bad as Boston’s, but how do you drive backwards and park atop other cars? And we don’t even get snow?

Reedy Creek Control District, Florida.  One guy decided to self-quarantine in Walt Disney World. He shacked up on Discovery Island, Disney’s former zoo of sorts before Animal Kingdom.

Gainesville, Florida.  If you live in Florida and someone removes your testicles, you might be a politician. Or an adopted kitten. Who knew a stuffed dragon might not protect you?

Full Blown Politics

Tallahassee, Florida.  At the same time the White House blames poor coronavirus response on the media for too much coronavirus reporting, Florida’s governor blasts the media for too little reporting. Indeed, Governor DeSantis says the press reported nothing about COVID-19 until April, so he assumed all was okay. Which is weird, because like a kidnap hostage, I can hold up copies of the Orlando Sentinel and Miami Herald dated back in January. Doesn’t he know the Keys have been off limits to visitors since 22 March?

Grim Reaper on Florida beach
© Tampa Bay Times and Shorty Awards
Florida is famous for costumed characters and since February, the Grim Reaper has patrolled Florida’s beaches warning visitors about the virus. In March, that Grim Reaper, revealed as Daniel Uhfelder, Esq, sued the Governor’s office to require face masks. So apparently our Governor doesn’t check the news, he also pays no attention to lawsuits.

Earlier this month when I wrote about Florida landing the sad position of NÂș 1 and setting new pandemic records every day, I hadn’t expected the Sunshine State to continue setting new records. As one observer put it, if Florida was a separate nation, it would rank among the worst countries on the planet for infections.

Governor DeSantis calls that ‘a blip’. Because, you know, the Black Plague was ‘a bump’ and reporters ‘a bleep’. Such ingrates! Florida has done soooo much to keep the numbers down. Like firing our heroine, Rebekah Jones, the state’s database administrator who revealed Florida’s government was grossly under-reporting cases. And sheriff offices complain that as infection hotspots soared, the state cut off critical information to police agencies including addresses of known outbreaks. And the state ordered medical examiners not to release autopsy data. Because no info, no problems.

Milledgeville, Georgia.  Above our border, Georgia’s Brian “Screw ’em” Kemp is posing a challenge to Florida’s Ron ‘Who Me?’ DeSantis for dumbest governor, but I’m afraid Georgia will have to settle for Miss Uncongeniality. Kemp is suing cities that require masks in public. Because no masks, no problems.

Oh God, the clowns! We’re all gonna die! But keep shaking your head and laughing.

10 May 2020

COVID19 in America versus Canada


Anger is the biggest difference between America and Canada’s response to the coronavirus pandemic.

Many people have been discussing the difference between the response to the coronavirus pandemic by the United States and Canada. “When you look at per capita cases and deaths across the course of the entire outbreak, the comparison looks even worse: the United States has over two times as many confirmed coronavirus cases as Canada and roughly twice as many deaths.”

The factors impacting coronavirus infections and deaths in the two countries are complicated and will, I’m certain, be analyzed for years.

What I find impossibly sad is the level of anger in the United States that is not directed at this virus – because we should all be furious at this virus - but at each other.

While both countries are grappling with how to open up the country and help the economy recover, the stories in the two countries couldn’t be more different. As they say, a picture is worth a thousand words. 



In America: 



In Canada:



One obvious difference is that in Canada, we are not allowed to openly carry guns. However, aside from the guns, the differences are crucial and it is in the level of anger and intimidation in the United States.

In Ontario, my home province, the Premier responded to the protests by saying: “Ontario Premier Doug Ford says he’s furious at the “bunch of yahoos” who decided to flout physical distancing measures and emergency laws to protest outside Queen’s Park Saturday afternoon, calling them “irresponsible, reckless and selfish.”

For those who don’t speak Canadian, this is a very, very angry statement by a Canadian Premier. Also - he suggested consequences: “He said he hoped Toronto police would ticket them.
Not keeping at least two metres apart from someone not in your own household currently carries a fine of $880 in Toronto.”

In the end however: “A spokesperson for the Toronto police said no arrests were made and no tickets were issued following the protest, saying the crowd was compliant and exercised good social distancing.”

In other words, fairly polite and compliant protesters. 

It is more than not carrying guns. 

The politeness of Canadians has long been a joke among Americans. Although generalizations are never universally true, there may be something to this. However, there is one picture that explains a great deal:



In the United States, people are out of work and losing their healthcare and the financial assistance given appears to be piecemeal -both federal and state assistance- and many appear to be falling through the cracks.

In Canada, our universal healthcare system means that everyone remains covered for healthcare regardless of their employment status.

The federal government has delivered a strong set of financial protections for employees, self-employed, seniors and students. For example, if you are self-employed and have lost your job, you receive $2,000 per month for 4 months. These financial safety nets during COVID19, allow people to put food on the table. The provinces have all stepped up with other financial supports for citizens. 

In short: it is far easier to be less angry about the financial impacts of COVID in Canada than in the United States. 


There is more though. In Canada, there has been coordination between all levels of government in another area: information.

Our press conferences have been focused on Medical Officers of Health (federal and provincial) giving updates on infections, looking at models and doing the crucial work of informing the public about the new knowledge of this virus. This serves to increase scientific literacy in general. For example, prior to this pandemic, some Canadians did not understand that a virus cannot live outside of a cell for long and that is the reason for physical distancing.

The news in the United States has covered the politics of this pandemic and the disagreements between levels of government and within government. This type of coverage in Canada would be rather short - because there is general agreement about the need for physical distancing and to stay at home to defeat this virus.

So the difference in the two countries could not be more striking. In the United States the coronavirus has been a magnet for political anger. In Canada there is some of that certainly, as evidenced by the protests, but they have been small because, largely, our politicians are not fuelling them.

A virus has no politics, knows no party affiliation. It simply infects and kills. The wartime analogy has been used to describe the fight against this virus but this appears to be a strange war in the US, where there is little agreement if the enemy is dangerous, how to fight it or whether to bother fighting at all.

So, while Americans are dying, they appear to be very angry with each other. I wish they would get angrier at the virus.

12 April 2020

Surviving COVID19


COVID19 is a dangerous adversary and everyone is discussing how stressful they are finding living in the age of COVID19.

There have been many excellent recommendations on how to reduce stress. Many of these recommendations have focused on stress reduction strategies like exercise.

Given my area is mental health, I would like to add to the conversations on stress by presenting a different lens.

First, let’s talk about what stress is and is not, because to tackle something one must always know what one is getting into the ring with. 

In 1936, biologist Hans Selye described a common physiological response in rats subjected to harmful factors and he named this the stress response. “The main features of the syndrome were suppression of the immune system, ulceration of the lining of the stomach and small intestine, and activation of the two … stress-response systems.”

Over the last 80 years, there has been extensive documentation of the widespread damage of stress on our body and brain.

So stress doesn’t just feel bad - it is really bad for you. Reducing stress can save your life and a sense of control is the one way cortisol and other factors provoked by stress can be reduced and the health impacts minimized.

What is crucial is that stress is not just bad things happening to you – it is bad things happening with a sense of having no control over these things.


You might be thinking: if control is crucial to managing stress, how on earth can you control a global outbreak of a virus? How can we control not only the illnesses and deaths but also the economic consequences on such a large scale. Control? It seems like a rather ludicrous word in the face of all this.

All true points. Thank you for making them.

My answer is to introduce some people whom I have known that belong to “The Greatest Generation”- those who lived through World War II. They earned their name because of their tenacity and 'can do' attitude. They did not enter the war with these attitudes but, rather, they were forged by the hardships they faced.

My father-in-law, Bill, and his twin brother were pilots in World War II. Bill’s brother died when his plane went down in Europe and he was never able to speak of him again – it was as if the grief of his loss had torn out his heart. Bill went on to get an engineering degree, marry, have children and live a life of laughter and love.

My mother-in-law, Verna, stayed home and helped in many ways the war effort. She told me stories of how they would try to get butter to make her beloved pastries, how they would save things so they could send packages to those who were fighting along with letters. The volume of letters diminished over time because many of the young men she grew up with died.


Neither of them had any ability to stop the war or save those they loved. Both were irreparably broken by the losses they sustained. Both walked into life after the war with a strong stride. They survived the war by small acts and large ones that were all acts of resistance. Bill was a man who embraced competence – taking care of his family and being the one who got things done – and Verna was loving, taking everyone under her wing. Perhaps those characteristics were their tribute to those they lost and a way to ensure that they would keep those around them safe.

Let me introduce you to Lili. She was Jewish and was sent away from her parents as a small child into hiding. She lost her parents and everyone in her family. I learned later that she had anxiety and many difficulties all her life in response to this, but what I remember about her was that she was one of the kindest people I have ever known. If the world robs you of so much through cruelty, kindness is the ultimate act of defiance.

None of them had control over global events that ended up at their door. What they did was to take control during and after in small and large ways. Ultimately, their characters are a testament to how they became known as the greatest generation, because it was not what they endured but how they endured it that defined them.

Back to COVID19. We have no control over when we will have a vaccine and this nightmare will end. However, the reality is that we have never had control over large global events and this is no different. What we do have control over is our small corner of this planet and that is where we fight. 

Much has been discussed about the courage and tenacity of my colleagues during COVID19. When I speak with them, they talk about doing what they have always done; medicine with the patient in front of them. They read voraciously about this virus, they consult others for more information, they organize their homes to have decontamination zones to keep their family safe and do many other things to manage their corner of the planet.

Many of my non-medical friends are reading and watching the news to educate themselves, they are designing new ways to get groceries safely and clean them down. They are reaching out to friends and family to inform them, check up on them and laugh with them.

When we talk about the new normal – it is the ability of each of us to have small and large acts of defiance and resistance to keep those we love safe.

We will not recover without scars. We can only hope to minimize the number we lose and comfort those who have lost people. There will be anguish: times when we wake up in the middle of the night drenched in fear. When we emerge from this - we can do so with a character forged by how we responded to COVID and how we controlled our corner of the world.

08 March 2020

Coronavirus COVID-19: The Heroes and the Culprits


Dr Mary Fernando
Mary Fernando, MD
Every time a patient goes to a doctor with a new illness, the story of chasing down the diagnosis is like a mystery novel with one difference: everyone works hard to make the story short with as little excitement as possible.

In medicine, no one wants a long, twisted plot line and the best stories are the boring ones where the culprit is found quickly.

This desire for a short, boring story line has done what nothing else has been able to: it has united the world because citizens of every country want the story of the new coronavirus, #COVID-19, to end before they get a starring role in the tale of a new epidemic.



On December 30, 2019, Dr Li, a 34-year-old ophthalmologist in Wuhan, posted on Weibo that he had seen 7 cases of a SARS-like virus and warned fellow doctors to wear protective clothing to avoid infection. This sensible and medically appropriate suggestion resulted in Dr Li being summoned to the Public Security Bureau four days later and he was made to sign a letter confirming he had made false statements. Before his death from Coronavirus on Feb 7, 2020, Dr. Li explained why he warned people initially despite the fact that he knew he might be punished for it: “I think a healthy society should not only have one kind of voice.”


Like the Chinese government who tried to put a lid on information about COVID-19, we have had many others who have tried to do the same for political and financial reasons. There’s nothing wrong with trying to protect businesses, however, there is a great deal wrong with stifling information. The only thing that protects people and saves lives is the truth: if certain activities or places are unsafe, people should know this.

Through the evolution of this disease, there have been many kinds of voices speaking out and, just like in any mystery novel, each new crises reveals a great deal about the character of those involved.

There are some people who want everyone to stay calm – as if one smidgeon of worry will muck up their world. They came out in force at the beginning of this epidemic grabbing every straw they could to dampen down concern. I’m a huge fan of calmness but not when it is coupled with misinformation such as: this is only spread by animals, only spread by people who are symptomatic, the virus doesn’t live on surfaces for days and it is no more lethal than the flu.

Not one of those statements is true and people cannot protect themselves if they don’t know the truth. 


While some grasp at anything to calm people down, others have done the opposite and developed theories to fan all sorts of flames and even to start fires on their own. One theory floated around that this new virus was developed in a lab to destabilize the world. Right on the heels of this is another, very malignant theory that this is a virus that largely infects people of Chinese origin and that they are responsible for the spread of this. This has resulted in racist attacks on people around the globe.

There is another set of characters that have been emerging and speaking loudly: those who take a great deal of reassurance if they know things and even more reassurance if they know everything. Now this person who knows everything is a purely fictional character who has never existed but this doesn’t stop some people from emulating them. If this person who believes they have all the information has a large pulpit, they can spread information that is inaccurate and possibly dangerous.


Who is the biggest, baddest, scariest culprit in the saga of #COVID-19?
 Misinformation, spread by people whose need for calm, chaos or personal brilliance blinds them to the new facts emerging about this virus daily.

Some of those new facts are reassuring, some are worrisome and not one of us knows them all because it is an evolving story. For example, there has been some evidence that gastrointestinal symptoms such as nausea and diarrhea may precede respiratory symptoms during infection with this new coronavirus– this is crucial information that could lead people to seek medical attention earlier and therefore limit spread of the disease. Since we know that people without symptoms can spread the disease – unlike with SARS – we can’t assume we haven’t been exposed because no one around us was ill. 


Just like in any mystery novel, we should remain suspicious of all the characters - any one of them could spread misinformation – often not from malice but because their character compels them to engage in certain behaviours that increase misinformation. Bottom line – the only thing that will keep you and those you care about safe is information on how to avoid getting infected with coronavirus.

The heroes of this story? The first hero was Dr. Li  because he had a simple mission: to inform those around him with whatever information he had to keep them safe.

Inspired by the heroes in this coronavirus story, I recently told my children who were traveling with me that – given the fact that this disease can be spread by people who have no symptoms and the virus can live on surfaces for days – they could stay safer if they assume their hands are infected and not touch their face and food without disinfecting them first. This simple set of instructions was the best way I could summarize this disease to the people I care about the most in this world. I also keep telling them that we are in the midst of learning about this disease so I’ll keep them updated. My children must have confidence in me because they grin every time I say this.

As of the 7th of March, 2020, the World Health Organization reported that the number of confirmed cases of COVID19 has surpassed 100K. The doubling time of this disease appears to be around 7 days but the numbers, just like this disease, are fast moving. A peek at that study along with with data used gives an idea of why we need to take a deep breath and keep learning.