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).

Drugs, rugs, and dogs

I’m now suspicious of my carpets.

First, I should explain that I’m a huge fan of Persian carpets. When I was a poor student, I bought one at a flea market and got hooked. No pun intended.

When I had a bit more money, I bought some more from a lovely local store and became even more enamoured with them. I even gifted them to my children when they moved out.

I was wandering the internet late at night - we are on lockdown, so my late night amusements are limited these days - and I found out that some rugs have drugs.

“Sniffer dogs at the Manchester Airport aroused suspicions for a large import of beautiful carpets, and upon further examination the security personnel found the drugs “hidden inside thread-like sheathes that look like carpet yarn to the naked eye”.

These smugglers literally managed to create little malleable ‘tunnel containers’ for heroin that look like rope, then wove them into the fabric of gorgeous, completely inconspicuous carpets of commercial quality. 46 of these hand-made knotted carpets were in this particular shipment, and they found around 50 kilograms of heroin hidden in them so far.

The sheer size and sophistication of this operation is just mind-blowing. This particular shipment would be worth several millions of dollars, and while this one was miraculously sniffed out by highly trained dogs, there could have been dozens more that went completely unnoticed.”

It’s a marvel, really, that someone would be able to think of, let alone implement, a process where heroine was hidden in carpet strands and then woven into a rug.

Apart from admiring the technical brilliance of the plan, I was worried. When I read that I looked at my sleeping bouvier, Kai. Surely, if our rugs had drugs, Kai would have found them. I came to my senses and realized that Kai is not a trained sniffer dog and unless a rug smelled like meat or cheese, she would ignore it completely.

I then went down the rabbit hole of drugs in rugs. I wondered if rugs with drugs have been found near where I lived?

Apparently so.

“The joint investigation between provincial and Toronto police as well as the Canada Border Services Agency began in June 2010, when border services agents at Pearson airport found 15 kilograms of heroin hidden inside 27 carpets that arrived from Pakistan.

The drug had been put into the main support strands and the carpets were woven around them, likely by people who were paid almost nothing for their labour, police said.”

Who doesn’t love the totally Canadian statement about the poor pay of those who made the heroin laced rugs?

However, I must admit this alarmed me. Did I buy a rug around that time? I might have.

Then I realized that a heroin laden rug would be promptly picked up by whoever organized it and it was unlikely to end up on my floor.

In case you’re wondering - because of course you are - I did ask Kai to sniff our rugs. In the middle of the night.

Kai is a very reasonable dog. She is also inordinately fond of me for no reason I can ascertain, and generally puts up with my odd request. I can be a handful.

After a curious look at the carpet, she simply lay down and promptly went to sleep. She may live with a crazy woman who goes down crime rabbit holes late at night, but she needs her beauty sleep.

I also found out that they have made dinner sets out of compressed cocaine. Is it out of line for me to ask Kai to smell my dishes?

Did I mention we’re in lockdown?

Anti-Asian hate crimes

If I told you that there’s a crime spree going on and you can stop it, would you? 

The rise of anti-Asian hate crimes in Canada - yes, Canada, the land of the multiculturally smug – are crimes we can all stop. The first step is always understanding it.

Many have blamed the former U.S. President Trump for the rise of anti-Asian racism because of his racist rhetoric, but he was simply repeating a long historic tradition of targeting Asians. Kim Yi Dionne, a professor of political science at the University of California-Riverside, explained that “America has a long history of immigrant exclusion on the basis of disease.”

Trump was feeding into the biases that some people already had and doing it to restrict immigration certainly, but also to deflect blame for any illness or death of Americans. As those deaths increased, so did his rhetoric.

Canada also has a long history of restricting Asian immigration and using anti-Asian rhetoric to do it.

In 1885, Canada imposed a head tax on Chinese migrants before admission into Canada, the purpose of which was to discourage more Chinese coming to Canada. The anti-Asian sentiment was in full force in the 1902 Royal Commission on Chinese and Japanese Immigration that stated that the Asians were "unfit for full citizenship … obnoxious to a free community and dangerous to the state.”

Despite the drop in Chinese and other Asians entering Canada, there were many violent anti-Asian riots on several occasions to protest Asians in Canada.

During the 1918 pandemic, Asian Canadians were once again targeted as disease ridden and were even excluded from treatment at “white” hospitals.

During World War II, the federal government put Japanese Canadians in internment camps and sold all their property.

It was only in the 1960s that Canadian immigration legislation and regulations were changed to allow Asians to immigrate to Canada on equal footing with whites.

This history explains why anti-Asian racism has risen so rapidly: the narratives and attitudes fed into prejudices some people already had and, although Canadian politicians have largely avoided xenophobic blaming of Asian Canadians, we are not immune to these narratives. The pandemic has given rise to all sorts of conspiracy theories and the internet knows no borders. Canadians so inclined have been drinking in anti-Asian rhetoric and spewing it out against Asian Canadians.

Of the 1,150 instances of anti-Asian racism reported between March 10, 2020, and Feb. 28, 2021, it was, “found that elderly people, young people and those in low-income jobs or who did not speak English were more vulnerable to attacks. According to the data, most incidents occurred in public spaces such as parks, streets or sidewalks. Restaurants, grocery stores and other food-sector locations were the site of nearly one-fifth of the incidents. Nearly ten per cent of the reported cases took place on public transit.”

This is crucial: these incidents occur in public spaces. In plain sight.

The worst message we can send is that verbal or physical harassment of Asian Canadians is OK. This is why the Government of Canada “offers bystander intervention training on their website, with safe and positive options to prevent harm when there is a risk of violence.

The goal of this training is to send a message that hate, including racism and xenophobia, is unacceptable in all of its forms.”


Since this problem started with the Government of Canada and the citizens of Canada condoning and augmenting anti-Asian rhetoric, it is fitting that together we end it.

It is also fitting that the internet – used to promote anti-Asian rhetoric – can also be used to fight it. The same principle applies, don’t let Asians be harassed. If this happens, report the account and say something too.

Ultimately, like hate against any group, the only way to stop it is to learn about the history, understand what to do if we see it and support organizations that are helping.

Canada should not be a country in which Asian Canadians feel unsafe and unwelcome. Multiculturalism requires the actions of each generation to protect it.

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.

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.

B2020 and A2020: How 2020 has influenced what we want to read and what we will write.

As we are bombarded with news of COVID-19 deaths, the rising unemployment and the latest attack on Capital Hill - many of us wonder how this can happen and why do some people not care?

More and more we are hearing stories from the frontline, from the unemployment line, from lines at food-banks and, from homes where seniors live. We are hearing about policies that thoughtlessly harm others and we ask - didn’t they even think about these people’s lives?

After living through 2020 – and face it, 2020 might just be a prologue to the book  “The Horrors of 2021” - we will never be the same and I suspect that what we want to read is forever changed. 

Literature changes because readers change. 

When I was a child, I would often rummage through my father’s extensive library. I remember some old books, where the room would be meticulously described, from the sun dappled curtains to the chair with slightly worn arms. These descriptions would often be a page long. I remember wondering if I was simply less observant than most people or if these descriptions were simply overdone. Being a curious child, I watched my friends and family carefully. I decided that none of them spent enough time observing to be able to write a page of details and that the people in these books had a different life, were different people or the author just made up stuff. I would still read some of those books but with a stern skim over the sun dappled this, the intricate patterns of that and any other such useless info. 

There are many takes on the immense suffering we have seen in 2020, but I suspect many readers will be drawn to different writers. Just as none of us have patience for a page long descriptions as characters enter a room, I believe we will have less patience for characters who wander the world doing things, noticing things but failing to empathize with people. Let’s face it, Sherlock Holmes was delightful, but who is going to write a book today where the characters notice the hair, that came from a rare species of cat, owned by only two families in the city, coupled with a smudge of brown dust from a particular type of stone, found in the statues of lions that sit by the doorway of one of those families? Yep. No one. Most of us read it, but we don’t write like that anymore. 

I think that many readers who have lived through this year - and the worse year that is coming - will demand characters with empathy. Not sympathy, but empathy. 

The definition of empathy is: the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.

This stands in contrast to sympathy defined as: sympathy implies sharing (or having the capacity to share) the feelings of another, while empathy tends to be used to mean imagining, or having the capacity to imagine, feelings that one does not actually have.

If 2020 has made many of us yearn for anything, it is for people who have empathy and can imagine and feel what someone else is feeling - without having to be explicitly told and without having to have felt it themselves. Why? Because we are not all 90-year-old women, living alone in a care home, unable to see anyone. We are not all a single mother, with children to feed but with no money to feed them after we lost our job. We are not all ICU doctors, struggling to cope with losing patient after patient nor are we those who have to transport body after body to refrigerated trucks. We are not any of these people but we want someone, any one, to care about these people and tell us about them. 

What about sympathy – understanding the feelings that we actually have? This feels a little self-centred and, these days more than ever, the self-centred are at best unpopular and at worst, the villains of 2020: from anti-maskers to those who care only about staying in power.

I suspect many of us, who read voraciously,  and who have lived through this time , will want books with more characters who understand and feel what others are feeling and put us in their shoes. Detective novels highlighting not merely action but also empathy might become much more popular. I suspect this is true for all types of writing, from news stories to medical writing. I suspect we might have had our fill of self-centred characters, and I also suspect that they will often be cast as villains because, goodness knows, it feels ugly now. I have found that news stories, articles and - one could argue - political choices seem to already incorporate empathy more than before this dreadful year.

One could argue that good writing has always put us in the shoes of others, immersing us in their worlds. Somewhat true - but it is about the weight one gives to certain things. Do we devote pages to describe a room when a character enters it? Not anymore. So writing may have many elements in common but weight given differs. Weighting empathy heavily would change what we read. 

This may just be my new perspective but I doubt it. However, from a personal point of view, I am eager to read the new types of articles, books and characters born from 2020. I also look forward to new ways of telling the news, writing medical articles - any type of writing that tries to reach people who have lived this terrible year and await, with some trepidation, the unveiling of 2021. 

Whatever happens with various forms of writing, I believe that there will be fundamental changes in what writers write and readers read because we will never be the same after 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.