Art theft: Churchill and Zelensky

Around December 2021 the famous Yousuf Karsh 1941 photograph of Winston Churchill was stolen from the Chateau Laurier in Ottawa and replaced by a forgery. The heist was about 2 months before Russia invaded Ukraine. The Russian invasion is not related to the photograph but also, very related.

The photograph is perhaps one of the most widely reproduced photos of all time. Prime Minister Churchill's belligerent expression exemplified the British resolve to win against Hitler, who many believed to be invincible.

Karsh at that time lived in the Chateau Laurier and was a friend of the Prime Minister of Canada - William Lyon Mackenzie King - and this is how he was able to take the photograph and why it was hanging in the Chateau Laurier.

The photograph is aptly titled ‘The Roaring Lion’. The roar behind the photograph has a story, some parts moving and some parts simply hilarious. Just prior to the photograph being taken, Prime Minister Churchill had given a rousing and defiant speech to the Parliament of Canada. In fact, if you look closely at the photograph you can see the speech peeking out of his pocket. It was a speech to an ally in Parliament but Churchill knew it was a speech that would be shared with the world. I picture him writing the speech by reaching deep within himself into places where hope and belligerence met.

After this speech, and probably carrying the mood of the speech with him, Churchill was brought into the Speaker’s Chamber. Here he found Karsh waiting, with his camera and lighting equipment. The Prime Minister of Canada, William Lyon Mackenzie King, hadn't told Churchill he was to be photographed so Churchill roared, "Why was I not told?” I suspect that the look captured on Churchill’s face was present at that moment. Churchill gave Karsh two minutes to take the photograph and this is how Karsh described the two minutes:

“Churchill’s cigar was ever present. I held out an ashtray, but he would not dispose of it. I went back to my camera and made sure that everything was all right technically. I waited; he continued to chomp vigorously at his cigar. I waited. Then I stepped toward him and, without premeditation, but ever so respectfully, I said, “Forgive me, sir,” and plucked the cigar out of his mouth. By the time I got back to my camera, he looked so belligerent he could have devoured me. It was at that instant that I took the photograph.”

The title of the photograph came, inadvertently, from Churchill himself, who told Karsh, “You can even make a roaring lion stand still to be photographed.” So Karsh named the photograph 'The Roaring Lion'.

This photograph, as much as Churchill’s speech, helped bolster the resolve to continue fighting during those difficult days.

Almost 80 years – perhaps even to the day – after Karsh took this photograph, it was stolen. Then two months later, Russia invaded Ukraine.

Russia believed it would win the war quickly because it was a much more powerful nation than Ukraine. It felt invincible, just like Hitler did. However, Russia faced two potent forces: history and Zelensky.

History taught Europe and North America that appeasement doesn’t work and the only thing to do when one country attacks a sovereign country is to fight. Churchill’s photograph embodies this fight.

After the 1938 Munich Conference, then British Prime Minister Neville Chamberlain declared his appeasement of Hitler had obtained “peace for our time.” When Chamberlain resigned in disgrace, Churchill - who had argued against appeasement - became the Prime Minister, outlined a bold plan of British resistance and declared Britain would “never surrender.”

When Russia invaded Ukraine, Ukrainian President Volodymyr Zelensky turned down an offer from the United States of evacuation from the capital city Kyiv, by famously stating, "The fight is here; I need ammunition, not a ride," and with that statement, Zelensky became a wartime leader and, his own ‘Roaring Lion’.

This is because human stories of history never stay in books about the past - they are relived by every generation.

Listening to Churchill’s 1941 speech in that Parliament of Canada and then, Zelensky’s 2022 speech to the Parliament of Canada - although they are very different - one can hear similar themes: both spoke to the courage of their people and the brutality of their opponent. Both were unbowed and pugnacious in their resolve. Leaders give speeches for their allies, for their enemies but, most of all, for their own people because of the personal costs of war. We see that now in videos of Ukraine. We know that more from stories of WWII. My mother-in-law told me half of the young boys she grew up with were killed in the war. I think of that incomprehensible loss when I see videos of the devastation in Ukraine. During wartime, leaders must be roaring lions to keep up the spirit of their people and play down the invincibility of their enemy.

Even though the original stolen photo, The Roaring Lion, has never been recovered, there are copies of this elsewhere, to remind us of a time back then and how easily back then becomes now. History never stays in books - as long as there are people, history is relived by each generation. Apparently, art continues to be stolen by each generation as well.

Justice delayed but not denied: Investigative genetic genealogy

It’s that time of year when people think about interesting presents to give and you might have hit on a unique idea: DNA testing. Perhaps you want family and friends to find out about health risks. Perhaps you saw an advertisement and thought this saves you from going into crowded malls or because someone you know is a history buff and this is what they want. Whatever the reason, by getting DNA tests on yourself or others, you’ve joined millions of people around the world who send off a swab of their cheek or a saliva sample and get information using their DNA.

With your DNA test you’ve done something that you probably never thought you’d do: help catch criminals by solving cold cases. 

In December 1983, Sean McCowan and his brother stayed overnight at the apartment of his sister, 22-year-old Erin Gilmour, "She … would do that frequently, we would sort of go over there and spend the night and just hang out with her and then we'd all climb into bed together and watch movies and eat popcorn," said Sean McCowan, who was 13 years old when his sister was killed. "It was five days before Christmas, and so … we all woke up the next morning. Erin drove my brother Kaelin back … to my mom's house. And I ... went out actually to do some Christmas shopping. And we said our goodbyes and that was the last time I saw her.” 

That evening, Erin was brutally raped and murdered in the same apartment where she and her brothers watched movies and ate popcorn the night before.

Four months earlier, in August of 1983, Susan Tice, 45, was also brutally raped and murdered in her Toronto home.

”My mom was supposed to have dinner with my aunt and uncle and when she didn't show up, he went to the house to find out where she was," said her daughter, Christian Tice, who was 16 at the time. "We had like the best family… we were very, very close… we did everything together. We were one of those houses where everybody else's friends were always over… And everyone called my mom Mrs. T or Ma.” 

In 2000, DNA technology showed that one person was responsible for both crimes but police were still unable to identify the man.

In November 2022, almost four decades later, Joseph George Sutherland was arrested and charged with these two brutal crimes. 

How were they able to identify and arrest Sutherland? 

“In 2019, police began using a technique called "investigative genetic genealogy” to identify the suspect's family group. The process involves cross-referencing DNA found at crime scenes with DNA samples voluntarily submitted to services like 23andMe or Ancestry.ca and then uploaded to open-source databases.”

Essentially, this arrest was made possible by the millions of people who got DNA tests for many reasons but none of them to finally jail a brutal rapist and murderer.

So, when you buy a DNA test for yourself or someone you care about, you’re not only finding out interesting things about health and family history. You are helping find criminals who would otherwise have walked free. 

Det.-Sgt. Steve Smith, lead investigator on the cold case, “called the investigation the "most complex" case he's worked in his 25 years on the force and credited the recent development to genetic genealogy. He said that Sutherland had never previously been a person of interest in the killings. "If we hadn't utilized this technology, we never would have came to his name.”

There have been many valid privacy concerns about the DNA databases of companies that provide these tests. However, the use of these data bases to catch criminals, in my opinion, is not merely fair but also just. Sutherland has walked freely among us for over four decades while those who loved his two victims have had justice denied to them. Using databases to finally arrest and try Sutherland is fair and just to his victims and their families.

The most powerful argument to support using these databases in this way, are the pictures of Sutherland’s victims. These photos are over 40 years old. Both Erin Gilmour and  Susan Tice should have had many more photos taken of them since 1983, when they became frozen in time because they were brutally murdered.

What happens in Gatineau doesn't stay in Gatineau

"By day he worked for the Canadian government as an IT specialist.

By night, he worked as a drug trafficker and becomes a federal government employee  hacker, extorting companies and others around the world as a part of a criminal ransomware gang, amassing millions of dollars in bitcoin by threatening to expose the private digital information of victims who didn't pay up.”

For those who don’t know Gatineau, its a rather sleepy community in Quebec, so near the capital of Canada, Ottawa, that many federal civil servants live there because it’s lovely, nestled in nature, and much cheaper than Ottawa. Who would have thought that an international criminal in ransomware - masquerading as a 33-year-old simple bureaucrat - lived there? He has an addiction to making money and is very dangerous.

What is ransomware? It’s a form of malicious software that blocks access to a computer or computers until a ransom payment is made.  The ransomware criminals hold sensitive information on the locked computer and threaten to release the information publicly if the payment is not made. How much? Millions of dollars. In bitcoin that can’t be traced.

For those who aren’t familiar with the Fifth Estate, it’s an amazing CBC investigative journalism program. Here is the link: https://gem.cbc.ca/media/the-fifth-estate/s48e07

My summary:

The hacker, User ID 128, has a name: Vachon-Desjardins. He doesn’t live big, he lives in a small home in a sleepy community. He just wants more money. And then, even more.

He attacked universities and health institutions during COVID-19, their most vulnerable time, to extort millions. He threatened them with losing their valuable data and releasing personal information on patients. Why? For money. “He told me … he was having an addiction to money. He always wanted more and more and more. He [didn’t] know where to stop,”

Vachon was charged in Canada and, after the FBI got involved via the ransomware attacks in the United States, he was extradited and charged there too. “I think that a lot of individuals who commit these crimes don’t think that they’ll ever stand trial in the United States. I think that the 20-year sentence was a very good deterrence piece to prevent others who might consider committing this type of conduct, that maybe they should think twice.”

Vachon-Desjardins remains in Pinellas County Jail in Clearwater, Fla., as he awaits his next hearing set for January, when restitution for his victims will be decided. He will then be assigned to a federal prison.”

Does crime pay for those who need more and more money? At first, it sure looked like it, “When police raided Vachon-Desjardins’ Gatineau home and arrested him on Jan. 27, 2021, they seized $742,840 and 719 Bitcoin, valued at approximately $21,849,087 at the time and $14,463,993 as of today.”

Today, he’s in a federal prison in the United States, serving a 20 year sentence.

What happens in a small home, in a sleepy community like Gatineau Canada? A lot apparently. And what happens in Gatineau never stays in Gatineau. It isn’t Las Vegas. Thank goodness.

Threatening institutions in Canada and the United States during COVID-19 should have a price — 20 years seems hardly enough.

Medicine and Mysteries: Justice Served

Medicine and mystery novels have much in common and this pandemic has highlighted one commonality in a very tragic way.

Many doctors I know are mystery readers. Many mystery writers the world knows are doctors, from Arthur Conan Doyle to Josephine Bell, Daniel Kalla and Tess Gerritsen.

Readers of mysteries are often greeted with a person facing a serious situation, or a tragedy, often from the first page or shortly thereafter. The rest of the book is all about unraveling the complexities of this story – the pain, the fears and, often with many clues – finally finding out whodunnit.

In medicine a person comes carrying a serious story and through listening to the story, unraveling the complexities of their story, their pains, their fears, we often add some tests and hopefully lift the burden of their story with a treatment once we’ve identified the disease or - in mystery terms - whodunnit.

The focus on the story, the complexities of people and the determination to find whodunnit: this is what mystery readers (and writers) and doctors share.

There’s something else they have in common: a sense of moral beliefs and justice being satisfied – as much as they can be – is part of this commonality.

Physicians go into medicine to help people – to deliver just and fair care to patients. Oddly, one can look on medicine as a means (within limits of science) to rectify the wrongs of disease. It is an attempt to give back the patient the best life they can have for as long as they can have it.

Readers approach mystery novels with a sense of righting wrongs and a sense of of justice delivered.

Imagine a mystery book where everyone throws up their hands and claims that they will never find a murderer because they don’t care or can’t be bothered. Where not even a smidgen of justice is served and the smirking murderer goes free. Now, of  course this may make an interesting plot but, let’s face it, it’s not the normal fare served by a mystery novel. In fact, I would argue, that seeing evil get their comeuppance is part of the satisfaction of reading a good mystery. Yes, we must often tolerate suffering of the innocent but suffering of the many innocents while detectives shrug their shoulders is certainly not the norm and would leave readers disappointed.

Now, imagine being a doctor during the pandemic. At first, physicians were swamped with patents they could not help because COVID-19 was a new disease. Not only did we lack vaccines and treatments, but we were woefully short of the knowledge and supplies to use masks. Then, vaccines came in, and when one waned, we had more vaccines and the promise (now fulfilled) of better vaccines. We had good quality research to show that masks work to prevent infection and even ample supplies of good masks, not just to protect healthcare workers but also the public. We now have rapid antigen tests - although they aren’t perfect, they give an indication of who is infected, allowing them to isolate and prevent further infections.

All of this good stuff should make being a doctor better than it was at the beginning of the pandemic. So, why are many doctors burning out, quitting their jobs or suffering from various mental health problems, including depression?

Part of it stems from the behaviour of the public. Many are eschewing updating their vaccines – or refusing vaccines altogether – and refusing to wear masks. If they get infected and hospitalized – there are some treatments. However, putting a COVID19 patient in a hospital bed may mean that a cancer patient doesn’t get their surgery or a patent in pain doesn’t get a hip replacement. The doctors caring for cancer patients who can’t get a hospital bed, can’t offer them optimal treatment and watch the unnecessary deterioration of their patients. As we add more patients with COVID19 and LongCovid, and lose doctors, physicians at times cannot get their patients access to the help they need for specialist care. Some physicians have been subjected to abuse – verbal and physical – from increasingly frustrated patients. 

The Canadian Medical Association has identified moral injury as a serious and growing problem during the pandemic:

“In the context of health care, when physicians are unable to uphold the oath they took to deliver the best care and put the needs of their patients first, they can experience moral injury. Moral injury is not considered a mental illness; however, those who experience moral injuries often develop negative thoughts about themselves and others, and these symptoms can lead to the development of mental health conditions.”

Moral injury is not a new problem for physicians, but it has increased during this pandemic. A pre-pandemic paper described the dilemma accurately:

“Moral injury describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.”

To not be able to properly care for patients is like a lousy ending to a mystery novel – except it’s worse. Much worse. These are real people. With lives, loves and people who love them. To not be able to help a patient because medical science is not up to the task is always sad. However, to not be able to access the care we have and allowing patients to suffer is immoral and unjust.

Fingerprints: Not So Elementary

Can a character in a mystery and crime novel have no fingerprints or altered fingerprints? This would make for a fascinating plot twist.

Fingerprints are used to identify people because each one is unique. Formed during pregnancy, fingerprints remain the same throughout life.

Fingerprints are also usually a durable identifier. In one famous case, a gangster in the 1930s, John Dillinger, tried to destroy his fingerprints by burning his fingertips with fire and acid. In the end, his skin regrew and his fingerprints were still intact.

However, details on fingerprints can be temporally changed

Some jobs, such as bricklayers, dishwashers and those who work with chemicals such as calcium oxide, may lose some details in their fingerprints but the ridges grow back once these activities stop.

Some medical conditions can impact fingerprints temporarily. Skin diseases such as eczema or psoriasis may cause temporary changes to the fingerprints, but upon healing the fingerprints will return to their original pattern.

Other medical conditions can leave people with no fingerprints at all.

A genetic disorder, adermatoglyphia, causes a person to have no fingerprints. Scleroderma is a disease associated with changes in skin elasticity, hardness, and thickness and eventually make a patient with scleroderma a “fingerprintless person”.

Some people treated for breast or colon cancer with the chemotherapy drug capecitabine may have a side effect called “hand-foot syndrome,” which sometimes can lead to loss of fingerprints.

What about a criminal who wants to change their fingerprints? One interesting option is surgical, “using plastic surgery (changing the skin completely, causing change in pattern – portions of skin are removed from a finger and grafted back in different positions, like rotation or “Z” cuts, transplantations of an area from other parts of the body like other fingers, palms, toes, soles.”

There’s an interesting case proving this actually works. A woman used this surgical method, “skin from her thumbs and index fingers were reportedly removed and then grafted on to the ends of fingers on the opposite hand. As a result, Rong's identity was not detected when she re-entered Japan illegally.”

Maybe we are entering a whole new era where we now have the knowledge that fingerprints aren’t as reliable as they once were, can even be changed and we now could have new plots twists.

Crime and no punishment: Public Health

When Leigh kindly invited me to write crime/mystery articles from a medical viewpoint, he certainly wasn’t expecting me to colour wildly, and enthusiastically, outside the lines of my mandate. Both he and Rob have been infinitely patient with me and I owe them an apology, because here I go again.

In my defence, crime can be seen through many lens: breaking the law, injustice and even awful things that happen.

I’ve been thinking a lot about awful things that are happening. They’re not a crimes in the sense of breaking a law. They do, however, result in death and, from a certain point of view, can be seen as murder. Mass murder.

What are these awful things?

Lousy Public Health decisions.

Public health is defined as the organized effort to keep people healthy and prevent injury, illness and premature death. This field was once relegated to textbooks, articles and conferences enthusiastically attended by nerds in the field.

What is this Public Health thing that most of us happily ignored for so long and why is it messing with our lives?

The reality is that Public Health has always messed with our lives. From the 1800s, the sanitary reform movement, spurred on by new understanding of disease transmission, helped create sewage treatment infrastructure alongside water filtration systems to provide clean drinking water. This sounds very technical, but imagine drinking water filled with feces and urine— it’s a great way to spread disease and, seriously, totally gross as well.

From food safety standards to policies for disease mitigation, from mass vaccination to public education, Public Health has been there for us. Before mass vaccination programs, diseases like smallpox, polio and diphtheria were rampant. Before changes in hygiene standards, your surgeon would operate with bare, unwashed hands and your food was prepared and served without hand washing too. Again – gross.

What seems self-evident now, was not always so. In fact, when the Canadian Public Health Association was created in 1910, the early founders were determined to bring about change, “come hell or high water.”

Sounds like fighting words to me and suggest that, even then, the pushback they faced was serious.

Fast forward to 2022 and we see many Public Health decisions move from the ‘hell or high water’ fight to a ‘paddling in leaky canoe and ignoring the tidal waves’ approach.

Harsh?

Hardly.

In my home province of Ontario, we have a surge in the new omicron variant, BA.5 and yet, public health has removed masks mandates, even for hospitals, allowing our most vulnerable patients to get infected. We have vaccines but anyone under 60 is being denied their fourth dose, despite the fact that third doses have long since waned for most people. Allowing BA.5 to infect our citizens by refusing to institute even the minimum of mask mandates or updating much needed vaccines is harsh and unethical. People will die. My statements are mild in comparison.

During COVID-19, decisions that endanger and kill people are being made not just in my backyard - they are being made all over the world.

Some will ask, “Isn’t this politics?” Yes. Of course it is. But here’s the rub: all of these decisions are presented to us by a M.D. who is the Chief Medical Officer. His M.D. gives him credibility – imagine how many would listen to him if he had a botany degree? So, these are Public Health decisions presented by a M.D. and this makes all the difference. If a doctor makes a decision knowing this will endanger or kill a patient, they can and should lose their licence. If a doctor makes a decision that endangers or kills many - give them a title of ‘medical officer of health’ and they have impunity.

Even a non-MD who makes a decision knowing others can be harmed or killed is held accountable - think of a driver who is drunk, drives a car and hits a pedestrian. We hold them accountable for the harm and death they cause. Crimes that can be legally prosecuted apparently are very different than awful things that happen to people. Mass harm and mass murder are O.K. if they are a ‘policy’ decision.

In 2020, I was concerned but optimistic. In 2021, I was worn out and somewhat discouraged. Now, I’ve reached the level of being sad and furious.

Awful things knowingly dumped upon us by Public Health should be crimes.

They are not.

And that is a crime.

COVID-19 Mystery: Based on a True Story

The mystery: ten friends gathered for a weekend pre-wedding party. After spending the weekend together, only five of them got COVID-19.

Why did only half of the people get infected?

?

It is highly likely they were infected with the omicron variant – the dominant variant at this time – which is very contagious.

“The Omicron coronavirus variant was likely the fastest-spreading virus in human history. One person with the measles virus – a standout among infectious microbes – might infect 15 others within twelve days. But when Omicron suddenly arrived this past winter, it jumped from person to person so quickly that a single case could give rise to six cases after four days, 36 cases after eight days, and 216 cases after twelve days.”

So asked another way, how did five party goers avoid getting omicron?

Let’s set the stage with what we know of protections against omicron

First, all those at the party had three doses of the COVID-19 vaccine – so there was no difference in vaccinations between those who got infected wth COVID-19 and those who didn’t. However, they were all about 5 months past their third dose of vaccine and vaccines wane, making them vulnerable to be infected at this point in time. 

None were eligible for their fourth doses because they were all in their twenties – too young for fourth dose eligibility.  

However, they took a very important precaution: understanding they were vulnerable to infection they all did rapid antigen tests on Friday morning before meeting on Friday afternoon. All of them tested negative.

Did the rapid antigen tests miss an infection? How reliable are rapid antigen tests? Research suggests they aren't entirely accurate, “Medical experts continue to warn that a negative result on a rapid test doesn't necessarily mean you don't have COVID-19." New Swiss research, which is yet to be peer-reviewed, suggests some rapid tests have "significantly lower sensitivity" to Omicron than to the Delta variant.

So, could this have been a problem with one or more people being infected with COVID-19 but not testing positive on the rapid antigen test? Unlikely, because they all spent a weekend together, not wearing masks and doing what young people do – hugging, laughing, occasionally bursting into song and sharing bedrooms. Is it possible that half the people avoided infection given all this?

COVID19 is airborne, so a person gets infected “when infectious particles that pass through the air are inhaled at short range”, a process otherwise known as “short-range aerosol or short-range airborne transmission”… transmission can [also] occur through “long-range airborne transmission” in poorly ventilated or crowded indoor settings “because aerosols can remain suspended in the air or travel farther than conversational distance.”

If 10 young people share space with one or more infected persons, sharing the same air for an entire weekend, wouldn’t it be likely that more than half get infected? 

To answer this mystery, it’s helpful to fast forward to the end of the weekend. As all ten people were leaving, there were unmasked hugs, chats and laugher. Then 5 of the people piled into one car and 5 into the other. This is where the mystery becomes less baffling: all the people in one car got infected and none in the other car got infected.

Again – the question is why? What was in one car but not the other? What was in one car but not present all weekend long that infected everyone in the car only?

There are two important concepts to break down: the duration of safety with rapid antigen tests and the incubation period of omicron.

Rapid antigen tests, even if they accurately detect infections, are only useful for that moment in time. So, one can be accurately negative today and accurately positive tomorrow.

How?

Here we need to look at the incubation period of omicron. An incubation period – for this mystery – is best seen as the time from the moment a person is infected to the time they are infectious. That time varies from three to five days.

So lets’s backtrack to the week before the get together. Someone got infected with omicron that previous week. They were asymptomatic when the weekend began and – very importantly – it was too early in the infection for the rapid antigen test to detect this early infection. As the weekend wore on, this person still remained infected but not infectious.

However, on the 2 hour long car ride home, this person went from infected to infectious and – with COVID19 being airborne and no one wearing masks – everyone in that car became infected.

We often say in medicine, timing is everything. It turns out, with rapid antigen tests and COVID-19, this still remains true.

The Fog

The light of the sun is barely penetrating the early morning fog. Some trees are visible, some are hidden. It should be a warm spring day but instead it’s cold and there are still patches of dirty snow on the ground.

This is the weather.

This is my mood.

The pandemic is still raging on despite those who try to hide the infected and dead behind the fog of words.

The war in Ukraine is raging on and those who declare it is just another war are trying to obscure what is at stake.

Even if we can see through the fog created by today’s chatter, none of us can see how the pandemic or the Ukraine war will end.

When the pandemic first hit, I was naively convinced that we could manage it well by following advice by scientific and medical experts and that vaccines would come rather quickly.

The vaccines did come quickly but their durability is still problematic. I’m certain we’ll get the better, more durable vaccines. However, the hit to science, to medical expertise, I worry may also be more durable.

The Omicron variant was first detected in Canada in late November, a few months ago. Since then, we have had 53% of deaths in people 19 or younger and 20% of all deaths from COVID-19. Long covid - a disease that impacts the brain, heart and many organs - will be worsened by the increasing infections we are seeing with omicron and its new variants. Yet the narrative that this variant is ‘mild’ reigns, so people are removing their masks, interacting in unsafe ways because they are convinced that the danger of COVID-19 is over.

How can the ‘mild’ narrative be so persuasive when the facts prove it wrong? One of the main reasons is that the anti-science, anti-expert movement has gained great strength during this pandemic by feeding on its favourite food: fear. When people are frightened, science, with its nuanced and new emerging facts, is less enticing than the strong, definitive anti-science narrative where answers are clear and unalterable because they aren’t true. It’s easy to make up a narrative when it’s immutable in the face of facts, and it is the very rigidity of the narrative that appears to make it strong and a haven for the frightened - fear is reassured by strength, even if it is false strength.

Now that some people have been convinced that science and experts are the enemy - we can only hope that the numbers of people convinced are fewer than those who recognize that the truth - even with facts that change as new evidence emerges - is a better alternative than lies.

The future of how this will play out is unclear: the fog is thick.

The war in Ukraine appears to be a very different animal than the pandemic but they rub shoulders in a very important way.

Right wing, authoritarian ideology has been nipping at the heels of many European countries. The pandemic seems to have worsened this, particularly in countries where restrictions limited the number of infections, they were “sceptical about their governments’ intentions behind lockdowns, and are most likely to accuse them of using COVID-19 as an excuse to control the public”

The pandemic has, “eroded young Europeans’ trust in the political system could have long-term consequences for the future of democracy. Research by the Centre for the Future of Democracy at Cambridge University shows that – even before the crisis – today’s young people are the generation most dissatisfied with the performance of democratic governments. Members of this generation are more skeptical of the merits of democracy compared not only with the older generation now but also with young people polled in earlier eras.”

This merging of the distrust in science with a distrust in democratic governments is the birthplace of autocracy.

The war in Ukraine is a war waged by an authoritarian government against a democratic country. The suffering of Ukrainians has moved the world and also divided it. As Ursela Gertrud von der Leyen - the German politician, physician and President of the European Commission summarized during a visit to Ukraine:

“It is indeed a decisive moment … Will autocracy be dominant or will democracy be the long term dominant winner or will the right of might be the rule or will it be the rule of law. This is what is at stake in this war…it is these big questions that will be decided in this war.”

The rule of might is decisive and clear - a haven for those who crave certainty. The rule of law, like science, is nuanced and cumbersome, as evidence is weighed and considered. Justice, like science, is messy business but it is a crucial pillar of democracy. 

None of us can see how the war in Ukraine will end or what Europe will look like when it does. Nor can we see what the end of the pandemic will look like and what we will have become in response to it.

The fog.

It’s the weather.

It’s a whole mood.

The Power of Ukraine

On February 24^th, Russia invaded Ukraine. Russia expected to win the war in a matter of days since they are so much larger and better equipped than the Ukraine. What Russia did not expect was having Ukraine rally the world to help defend them.

Apart from the geopolitical importance of this invasion, one question is why are so many ordinary people gripped by the story of Ukraine? Because we are indeed gripped, watching the news constantly and protesting in the streets around the world. Something about this war has moved us all. It has moved countries to impose economic sanctions against Russia and send much needed military equipment to Ukraine.

One reason is that Ukraine’s plight is the universal story of the underdog fighting valiantly, like David fought Goliath, and humans are built to be moved by stories.

“The human mind is addicted to stories,” says Jonathan Gottschall, author of The Storytelling Animal (how stories make us human)

“As you cross cultures and move around in history, you find the same basic concerns and the same basic story structure. The technology of story changes—from oral tales, to clay tablets, to medieval codices, to printed books, to movie screens, iPads, and Kindles. But the stories themselves don’t ever change. They have the same old obsessions. And that won’t change until human nature changes.”

This story - the underdog fighting valiantly - has been articulated by many Ukrainians but first and foremost by President Zelensky.

When Russia invaded, President Zelensky turned down an offer to evacuated from Kyiv. Zelensky’s now famous response was, "The fight is here; I need ammunition, not a ride.”

This is truly the story of David entering battle with Goliath, because David did not have to fight but he felt it was his duty to defeat Goliath and, in doing so, save his people from becoming slaves. Certainly, if Russia defeats Ukraine in this war, Ukrainians become owned and subjugated by Russia.

Malcom Gladwell in his book, David and Goliath: Underdogs, Misfits, and the Art of Battling Giants, dissects the battle in a unique way. Gladwell explains that Goliath is huge and frightening but David has the upper hand because he didn’t have the cumbersome armour of Goliath and could be nimble. Most importantly, David had a sling that can kill a target from two hundred yards away.

David wins the battle by doing the unexpected – he runs towards Goliath, who is immobilized by a hundred pounds of heavy armour, and kills him by hitting him in the head with a stone with a  velocity of thirty-four meters per second. (122kmph or 76mph)

Gladwell’s perspective is that underdogs win by fighting in unexpected ways that make their opponent’s strengths useless. Goliath’s size, armour and weapons were no match for David’s nimbleness with his lack of armour and heavy weapons, nor was his bare forehead a match for David’s lethal stone sent at high velocity by a sling.

Just like David, Zelensky fought Russia from the start in very unexpected ways. He didn’t flee. More importantly, despite the famed strength of Russia’s information warfare, Zelensky won the information war from the day he refused to flee. He did this by not speaking like a politician. He spoke with the emotion of a man who loves his country and his people. Rather than speaking of strategy, he appealed to the emotion we all feel towards our own countries, our homes and families. He used the most unusual and unexpected tactic of all when fighting a large military power: he asked the world to see themselves in the plight of Ukraine.

Ukraine is smaller, poorer and ill-equipped compared to Russia. To fight a behemoth like Russia seemed impossible but President Zelensky fought by making us all feel like every missile, every tank and every soldier in Ukraine was like a missile, tank and soldier in our country. This sent people into the street to protest the war and moved countries to sanction Russia. How do you fight a rich country? By making it poorer with economic sanctions. How do you fight a better equipped army? By moving the world to send you military equipment.

We are two weeks into a war that Russia expected to win in days and now some are suggesting that Russia might lose.

I know nothing about military strategy, but I do know the power of stories. From ancient times they have shaped our values and the way we act. The story of Ukraine is one of the reasons that the world values Ukraine and wants to act to protect it. They are the underdog, our modern day David, and we too are Ukraine, the underdog, the victim of Russia’s aggression. Every hospital that is bombed, every child that is killed, feels like ours and we all suffer with Ukraine. As we watch David running towards Goliath, fighting a battle in unexpected ways, we suffer and we hope because that’s the power of stories.

Ottawa Protest: It's not what it seems.

Canada’s capital, Ottawa, finds itself in the midst of a protest and, like Alice in Wonderland, in a situation that gets curiouser and curiouser.


During my decades of living in Ottawa, protests have come and gone. Never has any protest disrupted the city and terrorized its occupants. There is something very different about this. 

There are presently about 400+ trucks in Ottawa and a group of people that varies from hundreds to a few thousand who claim they are protesting vaccine mandates for truckers who cross the border.

For perspective, Canada has 38 million citizens, and at least 85% have had one dose of their COVID-19 vaccine and over 80% are fully vaccinated. In Ottawa, 91% of residents have their first dose of the COVID-19 vaccine and 88% are fully vaccinated. Further, I can walk into any grocery store or pharmacy in Ottawa and find everyone masked and happily shopping. As one of the most vaccinated countries in the world, Canada has also enjoyed one the most peaceful acceptance of mask mandates in world. 

So, what has changed? Is it just the rebellious 9-15% taking a stand against vaccine mandates for truckers? Maybe. But it’s doubtful. In fact they may not even be truckers, “90 percent of Canadian truckers are vaccinated and the Canadian Trucking Alliance, which represents the industry in the country and does not support the convoy, has said most of the people in and around the protests “do not have a connection to the trucking industry.” 

It’s also important to note that the United States has its own mandate about vaccination - so getting rid of Canada’s mandates wouldn’t allow these truckers to cross the border anyway, but I digress. 

To understand what’s going on in Ottawa - a situation that has inflamed the world and resulted in copycat protests - you need to dissect it, look on the ground and look at how it evolved. 

When these protesters first came into Ottawa, it looked like any other protest. People with an opinion that differed from the federal government. They appeared to have a lot of support online and financially - this was to be proven incorrect. 

Our first sense of real trouble came from reports from Centretown - the area in close proximity to this protest, where 50,000 residents live. The protesters swarmed in on our largest mall, defying the mask mandates for indoor spaces, with large groups of them shouting at minimum wage store clerks to take off their masks and be ‘free’. What a store-clerk removing her or his mask has to do with vaccine mandates for truckers to cross the border is perplexing, but here we were. The mall shut down and remained closed to protect their employees. 

These protesters, angry about being shut out of restaurants with mask mandates, went to our most vulnerable and demanded food from soup kitchens. The frightened volunteers, unequipped to refuse, fed them. 

Reports started to flood in about gangs of protesters yelling at residents to remove they masks and join the protests. People started to hide in their homes rather than venture out. Many complained about the inability to sleep because of the incessant honking all night and those with pets told us about their animals cowering under beds, shaking from the noise. 

This is when Ottawa - a friendly and calm city - became angry. 

Soon reports came in from investigative journalists that the immense 10 million in financial support from Gofundme was not Canadian support, but largely foreign, “Donations from abroad are quite a common part of any large crowdfunding campaign,” Ciaran O’Connor, an expert on online extremism at the Institute for Strategic Dialogue, told Politico. “But the scale of this one is unprecedented.” 

The Gofundme money was stopped - refunded I believe - and yet we saw the protesters go from stealing food from soup kitchens to setting up barbecues for everyone, beside bouncy castles for the children to enjoy. Yes, children, “Almost 25 per cent of the 418 trucks have children living in them — children who could be at risk during a police operation,” 

As well, the apparent online support was largely from troll farms: “groups that weaponize social media to spread misinformation, promote division and influence public opinion.”

As the normally sanguine city of Ottawa got angry, Twitter became full of many who denounced all COVID-19 mandates and others who decried the Ottawa protesters.

As a physician, I’m puzzled what a world without any COVID-19 mandates would look like. Do we have unvaccinated, unmasked healthcare workers looking after children with cancer? 

Even those who are against the protesters goals are at times worrisome - they are generating attacks on our mayor, our police and various levels of government for not being strong enough. It’s a distrust of the very institutions of our democracy at a level that’s new. 

Canada, being a robust democracy, does not allow politicians to direct the police. Thank goodness because this could be abused. So, what about the police? Again, in a democracy, the police have limited powers (again, thank goodness) and are constrained by the budgets elected officials give them, limiting their numbers. 

A democracy has certain tools and one of them is declaring a state of emergency. This allows the police more powers (not to be taken lightly) and also an increase in their numbers by drawing from other police forces. This is one thing that should have been done much earlier since the Ottawa police chief has been clear: he doesn’t have enough police to enforce even the laws he has at his disposal. We have never seen this large a group of protesters and Ottawa simply doesn't have the police numbers to manage to remove them. Rather than distrust the police, we should be giving them the help they have asked for repeatedly. 

Luckily, we now have a declared state of emergency in our city and province, to give the police more powers. And hopefully Ottawa will get more policing help. 

Michael Kempa - a professor of criminology at University of Ottawa - has helped to make a very curious situation much more understandable. 

He identifies two distinct groups involved in the Ottawa protest. The first group are the ones we have been seeing on the news, alternating between yelling at the citizens and the media, to grilling burgers and setting up bouncy castles. They are the public face of this protest. A diverse group - only a few actually concerned about vaccine mandates for truckers at the border, some concerned with any mandates from vaccines to masks, some bringing their own issues like the need to fly a Nazi flag. 

The group that worries Michael Kempa more are the ones we don’t see in the command centres of the protest. They are hard-core, long time anti-democratic organizers who fund, fuel and strategize for the protest in Ottawa and elsewhere. They don’t care about vaccines and mandates because they have been planning this trucker convoy since before COVID-19. Their goal is to damage our democracy by damaging our citizens trust in its institutions and to replace it with a far right, more authoritarian system.

With the new powers given to police under the declaration of a state of emergency both in Ottawa and in the province, Kempa is heartened that “Canada is starting to demonstrate that the institutions of democracy are strong, and capable of dealing the with the radicalized political threat…we cannot give the organizers the image that Canada’s institutions are too weak to handle their challenge of misinformation and mobilizing people to fight their battles for them at the front line of protest.” 

This explains why a protest about truckers and vaccines has gone so out of control and why it has spread so quickly. For the organizers this was never about vaccine mandates and they have been planning this attack on our democracy for a long time.

To regain trust in our institutions, police need new powers but they also need larger numbers. After years of police cuts, it’s time to put enough police in play to protect against this new threat and fulfil the promise of the Canadian Constitution: Peace, order and good government. 

Writing Mysteries in the Age of COVID-19

As always, I’m curious on how to plot a murder mystery and have been peeking at how death investigations have changed.

Since COVID-19, mystery writers attempting to hide a murder have a different landscape to deal with. If a person is COVID-19 positive, even if they wouldn’t die from the disease - this is far more possible with the Omicron variant - a murder via poison at home would be easier to conceal.

Recently, our jurisdiction changed the rules stating, “Autopsies will no longer be performed on someone who is suspected to have died from COVID-19 unless there is another factor of great significance, such as a homicide.”

So, without evidence of blunt force trauma or anything obviously untoward, a murder via poison in a COVID-19 positive person can be more easily hidden.

Is this true in other jurisdictions?

“During the pandemic, many sick people have stayed at home and died there rather than seeking help at hospitals overwhelmed with coronavirus patients.

“In April in New York City, for example, a reported 200 residents died at home each day, compared with 20 such deaths before the pandemic…If family or friends say the person had symptoms consistent with COVID-19, the coroner's office will typically do a nasal swab to test for the virus, he says. If the test is positive and the office can determine the cause of death without an autopsy, one will generally not be performed.”

A review of the literature shows, “The literature is dominated by appeals for more autopsies to be performed…The main reason for the great reluctance worldwide to perform autopsies seems to be concerns about infectivity emanating from deceased persons.”

In the United States, there’s the added problem of cost, availability of specialists and the vast number COVID-19 deaths.

“Hospitals are not required to provide autopsy services, and in those that do perform them, the procedure’s costs are not directly covered by most private insurance or by Medicare…Added into the mix: The number of experts who can actually perform autopsies is critically low. Estimates suggest the U.S. has only a few hundred forensic pathologists but could use several thousand — and less than one in 100 graduating medical school students enters the profession each year.”

Add to this the fact that there are almost 860k COVID-19 deaths to date, the volume of detailed death investigations, let alone autopsies, of those who die out of hospital would overwhelm the system. So they are not done.

In hospital deaths are also not autopsied but with COVID-19 restrictions on visitors it would be hard to write a plausible mystery involving a murder in hospital.

So if autopsies aren’t done for most COVID-19 deaths, is toxicology conducted?

“How are forensic toxicology tests done? At the time of the autopsy, collection of blood, urine, and tissue samples is done in preparation for the toxicology tests, says Barbarajean Magnani, PhD, MD, chairwoman of the Toxicology Resource committee for the College of American Pathologists.”

So, given the concerns about infection from COVID-19 would collection of samples occur? I have not found evidence to suggest it is done.

While this certainly makes for intriguing options for writing mysteries, it’s a huge loss to science. Fulsome and numerous autopsies are the one crucial way to obtain information about a disease. For scientific purposes, more rather than fewer autopsies should be conducted. However, the limitations of time, personnel, well-ventilated facilities and PPE have limited autopsies and we have lost a great deal of data. Because of this, there’s been a pushback from many to perform more autopsies.

“The results from the analyzed studies show that autopsies are essential in the COVID-19 pandemic. They enable a more differentiated assessment of mortality. More important than the determination of the cause of death, however, is the fact that only the autopsy (including histological and virological examinations) opens up the possibility of investigating the spread of the virus in the body, the involvement of various organ systems, but also the late effects of the disease…

There are few valid reasons not to perform autopsies in COVID-19 deceased if the technical equipment meets certain minimum standards. It is easy to protect oneself against infection during the autopsy. Both clinical and forensic pathologists – preferably in cooperation – play an important role in gaining knowledge about the new disease as a basis for therapeutic measures and global pandemic control.”

I do wonder how mysteries written in the age of COVID-19 will be different because of the new landscape of death investigations.

The Perplexing Patterns of Antisemitism

My daughter and I were discussing the rise of antisemitism during the pandemic. She asked, “Why? What they’re saying makes no sense at all. And there are so few Jews, so why them?”

So, this is an article for my daughter and everyone who is simply perplexed about what antisemites are saying - because it has a history and that’s why it makes no sense, continues to exist and is dangerous. 


During the plague outbreak in 1712, Hamburg forbade Jews from the city in an attempt to stop the plague and the cholera outbreak of the 19th century in Germany was also blamed on the Jews. 

To discourage smallpox vaccines, anti-Semitic propaganda leaflets were distributed blaming them for the vaccine. 

So, there’s a long history of both blaming Jews for diseases and blaming them for measures to stop diseases. We shouldn’t focus on the obvious lack of logic: it is the hatred evoked that matters.

Dr. Gavin Yamey has written poignantly on this issue, both in articles and on twitter. He has often outlined the perplexing mix of Jews both being blamed for the pandemic and for the vaccines and lockdowns.

In Australia, IKEA was, “defaced with the hateful words, “NO JEW JAB FOR OZ”  while other “antisemitic posts are flourishing on many Australian anti-vaccine networks, including outright finger-pointing at Jews for creating and unleashing the virus.” 

Like many students of psychology, I’ve studied the antisemitism of WW II, and there is a great deal of evidence tying authoritarian parenting and societies to antisemitism. However, this pandemic teaches us a crucial fact: the history of antisemitism, in all its lack of logic, is passed down in families and to others, so these patterns evoke emotions and make sense only to a twisted mind of an antisemite. 

Which brings me to my daughter’s point, “There are so few Jews.” 

Indeed there are.

In Canada, a country that prides itself on tolerance and lack of bigotry, “Jewish Canadians are the most targeted religious group for hate crimes…those numbers are particularly troubling since the Jewish community accounts for only 1% of the population and yet are the targets of 17% of police-reported hate crime.” 

"As of 2021, the world's "core" Jewish population (those identifying as Jews above all else) was estimated at 15.2 million, or 0.19% of the 7.89 billion worldwide population.” 

So why have so few shouldered so much hatred? The answer is complicated and certainly I would be remiss if I didn’t point out that there are excellent resources on the subject that discuss family and societal factors that we should all know. 

However, these strange patterns - such as being blamed for making a disease worse and also for any measures to make it better - are history being repeated, literally. They make no sense.  However, we should all learn these patterns so we can watch for them, know them and help in any way we can. We should also explain to our children the inexplicable: how the twisted minds of antisemites have passed these patterns down through centuries to place an immense burden of hate on such a small group. 

For us, these incoherent statements merely perplex us, while to the antisemite they evoke hatred. And that hatred often translates into action. 

An annual report by Tel Aviv University's researchers on anti-Semitism shows that online antisemitism has risen, as have desecrations of Jewish cemeteries, memorials and synagogues. They also warn that, while in person hate crimes have decreased as a result of the lockdowns, there is every indication that they will increase when lockdowns are reduced. 

For children who haven’t learned these patterns and have no hatred to muster against Jews, leaving them perplexed by incoherent and strange statements by antisemites isn’t enough. We should explain the history of these patterns and that, when they reemerge, it harkens a dangerous time for Jews. Our children need to know that and do everything they can to help, because when we are long gone, that will be their job.

Fear and Silence

A little while ago, I was asked by a reporter to speak about the escalating threats against doctors on Twitter. Since then, that conversation has been meandering, and at times galloping, through my mind. It’s kept me awake at night.

I have written previously about attacks against others and myself on Twitter while advocating for simple things like wearing masks and getting vaccines. However, attacks and threats are very different things. It’s far more worrisome when people tell me they will find me and ‘make me pay’ because that makes me look at our wall of windows overlooking our backyard and wonder who is in the woods looking in. What I said to the reporter is just that: ordinary people have no security so threats are worrisome. There are escalating threats against doctors but the real problem is far worse. Nurses, professors, psychologists and journalists have all had threats made against them, including death threats for speaking factually about COVID-19 and measures to help save lives.

From what I’ve observed, it’s often journalists who get the largest number of threats. Writing factual information on the pandemic isn’t the only thing that engenders threats, but it certainly begins large pile ons from the anti-science groups. Imagine having death threats or threats of violence against you but also having your face well-known, because it’s published with your articles or seen in TV appearances. Then imagine taking said face downtown, into stores, out walking with your dog or, worse, walking with your children.

While people are asking why people are becoming more violent, one very important piece of information needs to be brought to the table. Canada’s intelligence service, CSIS, has warned that foreign actors are using COVID-19 to sow discord in Canada:

“It is important to note that disinformation, originating from anywhere in the world, can have serious consequences including threats to the safety and security of Canadians, erosion of trust in our democratic institutions, and confusion about government policies and notices including information on the COVID-19 pandemic.”

Anything that sows discord in a democratic country weakens that democracy. The free press, as a cornerstone of our democracy and threatened in authoritarian countries, would certainly be a target. As would doctors, nurses and scientists who can speak in our country unlike in others, and stand as a testament to the freedoms we enjoy in a democratic nation. This is not to suggest that foreign bots are the only ones attacking journalists or others, but we must remember that their purpose is to inspire domestic threats with the volume and character of their attacks.

Regardless of who begins or escalates these threats, the consequence remains the same: fear, possible physical harm and silencing.

The avenues of help when you’re threatened are somewhat convoluted. A successful report to Twitter results in a thank you. Not sure what that means.

Wandering through the internet looking for help led me to Cybercrime that helpfully suggests “To report abusive behaviour, such as harassment, cyberbullying, threats, and impersonation, or other incidents that occur on social media, contact the social media provider directly through their help centre.”

Tried that.

Then there’s the labyrinth that take you to a report to your local police - but can they do anything from threats coming outside your local region?

One of my late night thoughts: could there be an avenue to create new methods of reporting threats made on social media, that allow quick reporting and maximum impact, like immediate and permanent bans from Twitter and quick attempts to find and prosecute these people?

The reason I’m bringing this up as a solution is that those who threaten are emboldened because they rarely pay a price for their actions. Some are actually dangerous, some are not, however, their threats have an impact of silencing or frightening people. What if they knew that people are quickly banned, quickly found and prosecuted? That would send a chilling message to them.

It would also reduce the sense of helplessness we all feel in the face of these threats.

Mind you, these are the late night thoughts of someone who never studied law and law enforcement. They are also the simple thoughts of someone who sees a new and large problem emerging that urgently needs new solutions.

Certainly, what we have now is not sufficient, because those threatened are increasingly frightened and those who threaten are increasingly emboldened. Why not do something to turn that pattern around?

If we don’t find innovative solutions to nip this growing problem in the bud, we’ll have a larger problem. If scientists, doctors, journalists, nurses and others fear speaking out factually on this pandemic, their increasing silence will just make our society much more dangerous by yielding the information space to those who will not keep us safe in a pandemic.

It is unequivocally a public safety issue.

1977

“The hangman asked if Turpin or Lucas had any last words. "Nothing," they answered… The hangman yanked on a lever and the trapdoor fell open with a crash that echoed through the jail…On their way down, the men made no sound.”

These events took place on` December 10, 1962, the last time a Canadian would die from capital punishment.

“The death penalty was abolished July 26, 1976, with the passage of a bill barring its use introduced by the government of Pierre Trudeau.” 

A short year later, a gruesome rape and murder would test the resolve of Canadians to support this ban on capital punishment. 

On July 28, 1977, Emmanuel was shining shoes at Yonge and Dundas streets in Toronto. His family had immigrated to Canada from Portugal three years earlier and, the family all worked to support the family, including 12 year old Emmanuel. 

He was lured away from his shoe stand with an offer of $35 to help move some equipment. This money was important to Emmanuel because it would allow him to buy dog food for a puppy he wanted.

Instead, for “12 tortuous hours, he was held captive and raped by the men in the third-floor apartment,” and finally murdered.

“The biggest thing that happened was a protest … on Aug. 8, where members of the Portuguese community came out and called for … bringing back the death penalty and they called for the eradication of homosexuality.” 

The protest was accompanied by angry articles and letters concerning the death penalty, but  capital punishment remained banned in Canada despite this pressure.

Unfortunately, this also fuelled a rise in homophobia and that had many consequences.

In June 1969, Parliament had passed the Criminal Law Amendment Act, 1968–69, which decriminalized sexual activity between men, but, “The murder of Emanuel Jaques put this idea into people’s minds that homosexuality was somehow associated with pedophilia … This sort of association that homosexuals were dangerous, perverted and somehow a threat to children.”

This attitude towards the LGTBQ community was echoed in the press, by the public, by police, and eventually resulted in the bathhouse raids of 1981, where four bathhouses frequented by the LGBTQ community were raided and the occupants were treated viciously. These raids resulted in “growing politicization and support of the gay community [and] fueled civil rights activism, made homophobia less acceptable, and have led to Pride becoming one of Toronto’s largest annual public celebrations.”

Ultimately, the LGBTQ community and their supporters prevailed. Their rights are stronger now with “anti-discrimination, anti-harassment, gay marriage, homoparentality, blood donations, transgender rights and outlawry of conversion therapies.”

In 2020, police chiefs of Canada issued a formal apology for oppressing and opposing LGBT rights.

This one grotesque and horrible murder of a child and the resulting protests, media coverage and anger threatened to topple decades of human rights progress. Eventually progress took its rightful place in pushing these rights further. 

They say history teaches important lessons. These are the days where the fabric of our rights, our scientific progress and our basic humanity feel threatened - nay, moving backwards. I find myself looking back often to turbulent times. Looking for hope. Looking for lessons.




Chasing Healthcare Workers Off Twitter: Who are these people?

Those of us advocating for vaccines and masks on Twitter during this pandemic have had some rather interesting replies.

Here is one:

As you can imagine, many of my colleagues are asking- who are these people?

Certainly not the kind people you would meet at a dinner party - for those of us old enough to remember these much loved pre-pandemic events.

CSIS, the Canadian organization responsible for protecting us against security threats, has given one answer about who some of these people might be and by whom they may be influenced.

CSIS has accused “Russia, China and Iran of spreading COVID-19 disinformation to promote their strategic ambitions…COVID-19 misinformation has flourished since the start of the pandemic, fuelling what has been called an “infodemic” of conspiracy theories and falsehoods amid efforts to contain the coronavirus.

“Declassified documents obtained by Global News under the Access to Information Act show that CSIS has been monitoring the national security implications of the phenomenon.

“Threat actors have used the pandemic as an opportunity to spread disinformation online,” CSIS spokesman John Townsend said, “It is important to note that disinformation, originating from anywhere in the world, can have serious consequences including threats to the safety and security of Canadians, erosion of trust in our democratic institutions, and confusion about government policies and notices including information on the COVID-19 pandemic.”

It makes sense that undermining democratic institutions during a deadly pandemic includes undermining any health department both provincially and federally and their attempts to administer vaccines and make mask mandates. To be clear, this is about diminishing our government and nothing diminishes a government like portraying them as responsible for worsening deaths, providing inadequate solutions and flat out lying to the public. 

It would be wise to assume some of the social media misinformation comes from these foreign actors. It would also be wise to assume that discrediting healthcare professionals is one of their aims.

Some accounts on Twitter are influenced by this misinformation - created by foreign actors or concocted by people from our own country who genuinely believe it.

On Twitter, I have watched colleagues deal with anti-vaccine and anti-mask accounts, most of them anonymous. Some appear benign at first. An anonymous account will start with simple questions or tweet things that are incorrect but relatively innocuous. When you respond, it starts a long back and forth and at the end they accuse you of vile things - like killing patients.  This experience is like following a little bunny and getting your foot caught in a trap. 


Personally, I like to answer them with sassiness and I also block these accounts quickly now. Blocking is an important weapon against misinformation - these accounts can’t appear on your tweets and don’t have access to your followers. If more people blocked them, we would diminish their reach substantially. There have been days where even my sassiness fails me and I’m not amused at all. These unpleasant experiences have exhausted and chased many healthcare professionals off Twitter. There is only so much abuse one can take.

There are accounts that are also dangerous in many ways. I worry about my colleagues because of them. Some people behind these accounts spend a great deal of time reporting doctors, nurses and other professionals to their licensing bodies and filling rating sites pretending to be disgruntled patients. Also, some colleagues have had threats against them and their families.

There is nothing that enhances the spread of misinformation like chasing healthcare professionals with accurate information off Twitter, by bothering them, damaging their professional reputations and forcing them to defend themselves to their colleges.

Perhaps we should return to why this is happening. It’s simply healthcare professionals asking people to get vaccinated and wear a mask. If these healthcare professionals get chased off Twitter, who remains to educate and help? During a pandemic the most precious commodity is scientific information - this is what keeps people safe. Distributing false information endangers people’s health and may even kill them.

Everyone tries to figure out, for themselves, how to keep advocating during this pandemic. Personally, my Twitter account - you guessed it - is largely about stories. Not just stories about the pandemic, but stories about many aspects of peoples' lives - I try to highlight the stories others tell and, occasionally, tell my own. 

For the pandemic advocacy that I do, I try to keep my sense of humour, lift up colleagues by highlighting their work, and use my block button. Who knows if any of us individually makes a difference, but I do know that chasing reasonable, science based voices off Twitter is a bad thing during a pandemic.

Dr. Kona Williams on Investigating Residential School Gravesites: It's Complicated.

Residential schools in Canada were set up in the 19th century, funded by the government and often run by the Church. Indigenous children were forcibly removed from their homes and taken to over 130 schools with the, “primary aim of assimilating Indigenous children” 

Stories of abuse at these schools have been told for decades. After another 751 unmarked graves were discovered at the Marieval Indian Residential School site in Saskatchewan, Canada, the Native Women’s Association of Canada (NWAC) demanded that charges be laid over the deaths of Indigenous children at residential schools. 

The NWAC asked that, “sites of former Indian residential schools be declared crime scenes and that an investigation into how each child buried there died — as well as into who is responsible for their deaths — be conducted…In Canada, we live under the rule of law. The law does not allow those who are responsible for the deaths of children to walk free with impunity.” This principle of investigating these deaths and charging anyone responsible has been widely discussed among  Canadians.

To address this issue, I had the honour of speaking with Dr. Kona Williams, the only Indigenous Forensic Pathologist in Canada. 

Forensic pathologists are medical doctors who are trained to autopsy bodies and come as close to the truth about the cause of death as is possible.

I asked, naively, why aren’t we investigating to charge people for the murder of these children? 

Dr. Williams explained that she has had many talks with the Indigenous leadership and her colleagues in the forensic world about how to proceed as more gravesites are found. While acknowledging the anger and grief these gravesites are engendering, she explained that it is very complicated. 

“We know that there are stories of children being injured and who died from these injuries, as well as children who died from malnutrition or not receiving medical care.”

“We know that some of these graves may be older than 50 years so we don’t have the legislation for those over 50 years on how to deal with these deaths.” 

Deaths over 50 years ago are considered not ‘forensically relevant’ in Ontario because prosecuting deaths over 50 years ago is - in most circumstances - unlikely to yield convictions. 

Dr. Williams then went on further explain how complicated the process of any investigation would be. “It’s going to be hard for families and communities to decide what to do. Some will want to let them rest, some will want it investigated… It’s up to the families and communities.

“These are difficult discussions. This can’t be forced. it has to be driven by what the communities want. 

“We might not be able to find all the children, or identify all of them or even maybe not even find the cause of death. What do you want us to do then? 

“The investigation is more complicated if we only have bones. If they died of pneumonia - bones aren’t a lot to go on. If it’s malnutrition or blunt trauma, that’s easier. 

“It’s going to be hard for families and communities to decide what to do. Some will want to let them rest, some will want it investigated.

“Also, with my work, generally we have records that we compare to the body, for example, dental records. Here we only have bones so we could get DNA but we would have to go to the community and ask if they would provide DNA samples to compare…the ethics around this are huge. How do we ensure that the information is kept securely and not used for anything else?” 

When I asked how would they even know which body to exhume if some families and communities don’t want an investigation and some do? 


“We need to ask the communities about how to proceed. I’m happy to provide the expertise, but I’m not going to do it without the permission of the people involved” 




When I asked if there were about 150,000 children in these schools, Dr. Williams said, “That’s an estimation, because we really don’t know. The records kept by the government and church aren’t always clear. The Catholic church has never provided the records that they have…do we have the authority by law to get these records? I asked [someone recently] do we have the authority to subpoena the Catholic church?”



Then Dr. Williams added, “There is something I’ve been chewing on. There is a ‘death in custody’ if the person is being held against their will, they may be some responsibility on the part of the people whose care they’re in…legally this is an interesting question. The custodians and institutions can be held responsible…Can this be put under “death in custody”? 

Would this allow these people to be charged past the 50 years?

Dr. Williams replied, “Potentially. The legislation doesn’t exist - it might still be limited by ‘forensically relevant’.

“My colleagues and I have been discussing how to investigate these sites. People will get traumatized and re-traumatized, digging up bones is traumatic, and the proper ceremony, protocol must be followed. 



“Some people have been asking about the cost - how can we put a price on this? We don’t know how many children there are, and we don’t know the cost. When people ask how much is this going to cost to dig up these kids, I say - I don’t know, how much would it cost to dig up yours if they were your kids? Would you not want everything done? Would you not want to know what happened and would you not want someone to pay for this? The last school closed in 1996 - it’s not ancient history.” 

How to proceed, whether to proceed in some cases, in investigating the gravesites at residential schools is indeed complicated. I thank Dr. Williams for giving us a glimpse into the difficulties and how to proceed respecting the Indigenous community because surely, the utmost respect must be given to these children, their families and communities. 




Dr. Josh Trebach and his Tox Murder Mysteries

I usually interview people and write articles, but not today.

First, let me introduce you to Dr. Josh Trebach, an emergency physician and toxicology fellow at NYC. You can follow him @jtrebach on twitter and following him is a treat for anyone interested in the lovely combination of medicine and mystery.

Second, let me explain why I didn’t interview Dr. Trebach. He writes murder mystery threads. They are so perfectly written, that I asked him for permission to put them, largely unedited, in an article.

So, here’s how he introduces his mysteries: Buckle up - it’s tox murder mystery thread.

Without further ado, here are two of his mysteries. 

Tox murder mystery #1.

A 45 year old man is found dead in the orthopedic room of an emergency department. He has no signs of trauma and no past medical history.

What do you think happened?

Clues

1. The man was hired by the hospital to clean drain pipes blocked by plaster washed down the sink by silly residents. (Stop washing your plaster down the sink! I see you!! STOP DOING IT! It's nasty and gross)
2. The material used to make the splints was Plaster of Paris. This product is still used today.
3. The man was using sulfuric acid to clean the drain and dissolve the clogged up Plaster of Paris. I'm a toxicology fellow, not a drain declogging expert, what do you want from me? I don't know why they used that.
4. What happens to Plaster of Paris when its gunked up in the pipes?  It gets chewed up by bacteria. Under anaerobic conditions, the bacteria can make a nasty, thick (thicc?) calcium sulfide sludge.
5. Sulfuric acid + Calcium Sulfide = ??? UGHHHHH chemistry.

Yet, the answer is in here. These two combine in the following chemical reaction, giving us our answer.

  CaS + H₂SO₄ → CaSO₄ + H₂S  

The culprit: Hydrogen Sulfide gas was formed by the chemical reaction above and it caused the man to die pretty quickly. Perhaps the only thing abnormal on the patient's skin exam was his silver wedding ring that had tarnished after reacting with the gas.

Hydrogen sulfide is a colorless gas that classically smells like rotten eggs . It gets inhaled into the body and interferes with oxidative phosphorylation and causes cellular hypoxia. What does this translate into? Rapid unconsciousness and cardiopulmonary arrest.

Hydrogen sulfide is scary. People will die in groups because whenever someone (not wearing PPE) goes to rescue the victim, they become exposed to the gas and then pass out/die… and the cycle continues.In fact, at ~1000ppm, breathing will STOP after just 1-2 breaths.

Treatment: Moving the victim to fresh air and giving oxygen, in addition to good supportive care and respiratory/ventilatory support, is key. Antidotes such as sodium nitrite work by inducing methemoglobinemia which scavenges the hydrogen sulfide.

Tox murder mystery #2.

A 33 year old woman is found dead in a bank vault. She has no signs of trauma and no past medical history.

What do you think happened?

Clues

1. The woman was a bank employee doing normal bank employee things. Unfortunately, when she went into the bank vault, it locked behind her. Whoopsies.
2. She waved at the camera. She banged on the doors. She pulled the fire alarm (but nothing happened?). She tried her phone but had no service and couldn't even tweet. Imagine the horror.
3. She figured she would wait an hour or so until someone else opened the vault… yet, over the course of 30 minutes, the woman slowly dropped to the ground and suffocated to death. What happened? Why did she die so quickly? Let’s learn about asphyxiants!
4. Asphyxiants cause harm by suffocation. There are two categories of asphyxiants– chemical and simple. Chemical asphyxiants (like hydrogen sulfide) interrupt the body's ability to deliver or utilize oxygen.
5. Simple asphyxiants displace the oxygen in the air, making it so there's less oxygen around for you and your body. Thus, when you take a deep breath, you get a mouthful of NOT OXYGEN. Your body/mitochondria are like "ew seriously?"… and then you suffocate.
6. But what does any of this have to do with our case? Well, ask yourself--why is there a fire alarm in a bank vault? Most times when you pull a fire alarm, you trigger a water sprinkler system...but then that would cause the money to get nasty and wet. Gross.
7. So the fire alarm doesn't trigger the release of water. But how else can you put out a fire? By using a CARBON DIOXIDE-BASED FIRE EXTINGUISHER SYSTEM! By releasing carbon dioxide and displacing the oxygen, the combustion reaction cannot occur and fire is put out!

Unfortunately, this woman sealed her fate the moment the fire alarm was pulled. Carbon dioxide filled the bank vault and she suffocated from this simple asphyxiant. Education about the risks with these extinguishers is key– these are preventable deaths.

Simple asphyxiants are everywhere. Virtually every gas (except oxygen) can act as a simple asphyxiant– the dose makes the poison. There are even cases of people dying after being in a room with a bunch of dry ice (sublimation reaction leads to lots of carbon dioxide).

Treatment: Get away from the simple asphyxiant. Get to oxygen. This seems remarkably simple, but unfortunately, can be very challenging in some situations (like when you are trapped in a bank vault).