How Bad Does It Have to Get??

I'm not sure what it will take to wake people up to the tragedy we're wading through right now enough to slap on a mask whenever they leave the house, but this 3 minute TikTok is from a front line nurse in Ajax, Ontario: 

"To see a big strong man drop to his knees to see his baby in that condition. . . . This baby died ON THE FLOOR of the emergency room. . . . We have moved well passed crisis mode at this point. . . . And you [Ford and Jones] are shameful. . . . Sleep well you two - in hell."

 

@nursewithsign416

♬ original sound - Nancy Halupa

When I post about children dying or parents having to drive kids to a hospital in another city because ours is full, I have people on Facebook who respond with laughing emojis. Do they think it's all fake?? Or are they excited for the depleted population?? So unnerving that this is where we are right now. 

For some reason, Hotel Rwanda keeps coming to mind today.

How Could Covid Cause Kids to Die of Strep A??

A great thread from @1goodtern explains this study providing evidence to help people understand why children are dying of Strep A. All the loud letters are theirs.: 

Here's how.

Covid infects kids. It infects their tonsils. What does it infect there? What does it do there?

Covid infects and kills dendritic cells and lymphoctyes (cells that are used in fighting infection) in the tonsils - where Strep A has attacked these children.

Those numbers are very important, because those are the numbers of infected cells of these types IN CHILDREN WHO HAD BEEN ASYMPTOMATIC AND WELL ENOUGH TO HAVE AN OPERATION DONE TO REMOVE THEIR ADENOIDS AND/OR TONSILS.

What I've Learned So Far: My First 2 Weeks as a Trustee

The boardroom is smaller than it looks on camera, and cozier and everyone's very nice and welcoming. It doesn't feel as formal as it looks, so I started out a little less formal than I should have been. It's hard to remember all the "through the chair" things to say. They gave us two books on procedure (Roberts Rules), and I haven't opened either one yet. Something I knew to expect and that was entirely reinforced by this experience, though, is that the corporate secretaries or managers, the ones you've never heard of, run the show and keep everything organized and are an incredible resource and remarkably accommodating. 

When I first considered campaigning, I asked how much a trustee gets paid, and I was always given a range from about $6,000 to $25,000. It's a honorarium based on student numbers, so it has no benefits or any extras attached to it, and it changes a bit each years. But I wasn't sure if that would be a yearly lump sum dumped in my bank account without notice or what. I started Nov. 14th, and got my first pay on Dec. 2. It's $541.64, so I assume that's paid bi-weekly, and I imagine for 26 pays, for a total of $14,082.64. I was just emailed that my gross pay is $16,185.31 per year, so that sounds about right. Funny that nobody will be upfront about that! It's very much a part-time job. If I work twenty hours/week, which is likely, then I'll be making minimum wage. For comparison, a trustee takes home $240/week and a crossing guard makes $170/week; as a teacher, I took home $1,270 a week, and the associate directors - we have two of them now - make over $4,000/week. But, on top of my pay, I also get a small allowance for phone use (not sure how much yet), and mileage if I drive to to meetings, and free subscriptions to The Record, The Star, and The Globe and Mail. I already pay for a Star subscription, and I'll just keep that one myself.

Will Steffan on What a Four Degrees Temperature Rise Looks Like in the Age of Ecological Disorder

For a trifecta of depressing posts for this Monday morning, I want to save this video here. It's Will Steffan, an American chemist who became the executive director of the Australian National University Climate Change Institute, explaining back in 2018 that we only have two years to make a solid plan we all stick to 100% in order to keep the global temperature to just 2°C above pre-industrial times. Whoops! 

He explains that without a plan incorporated everywhere NOW, as we watch Ford destroys the greenbelt, we'll be on track to see a 4°C rise by the end of this century. The real shocker for me, that he does a great job of explaining, is that the difference between mean global temperatures now and the mean global temperatures during the last ice age, is just FOUR DEGREES!! People survived during the ice age, but didn't thrive and innovate until the weather became optimal. We're in this very tiny optimal place, but it won't last long. And who knows what a 4° rise will look like, but Steffan predicts it won't be survivable without air conditioning, and that might not be possible if we lose too many engineers and skilled labourers, etc. to the inhabitable conditions. That's just our bodies trying to survive. He didn't get into what will happen to the entire agricultural system. I'd hazard to guess we'll go hungry before we burn up. 

It's 50 minutes long, but the most important bit is from 30-37 minutes.

ETA: Can't find the 50 min. long version - but here's the clip

 

ETA: This article: Climate change isn't the main cause of a loss of biodiversity - which is another urgent issue. That can be blamed on "habitat fragmentation and loss, overhunting, over-exploitation, agricultural expansion, pollution, and industrial development." The problem comes when things like massive solar fields directly harm habitats:  

"There is at present no plan, in any country, anywhere, on a global or national scale, to address extinctions, biodiversity crash, and habitat loss. The dismal reality is that with a green build-out, we will be saving not the complex web of life on Earth but the particular way of life of one privileged domineering species that depends for its success on a nature-ravaging network of technological marvels. Only once this truth is understood can honest decisions be made about what kind of world humanity wishes to inhabit in the age of ecological disorder." 

Time for palliative care?

What Going on With Kids Today? This is What "No Mitigations" Looks Like

 Dr. Jeff Gilchrist's thread on what's going on with kids today. He does biomedical research. (I didn't indent it because it's long, but this is entirely his words:)

"This virus season has been like no other with high hospitalization rates from RSV, Influenza and now more children are dying from Strep A bacterial infections. This looks at what might be going on.

So far in the UK, five children have died in England under age 10 within a week of diagnosis of invasive group A strep (a bacterial infection) and one 7 year old child in Wales. The rates of invasive Strep A in children age 1-4 is 4.6x higher and age 5-9 is 3.7x higher than pre-pandemic 2017-2019 seasons according to the UKHSA. A 9 year old Canadian girl also recently died from a bacterial infection. 

Normally most infections cause mild illnesses but this bacteria can also cause scarlet fever and in rare occasions infect the lungs and bloodstream which needs urgent treatment and can be life-threatening. The bacteria can easily spread between people. This kind of infection is typically treated successfully with antibiotics but currently many places, including in Canada, are facing antibiotics shortages, so the necessary treatment may not be easily available. The UKHSA is advising people to call 911/999 or go to Emergency if your child is having difficulty breathing, there are pauses when your child breathes, your child's skin, tongue, or lips are blue, your child is floppy and will not wake up or stay awake. Why are serious Strep A bacterial infections worse this year than before the pandemic? Dr. David Fisman points out that surges in viral respiratory infections can lead to downstream surges in invasive bacterial disease. His group has demonstrated this with influenza and pneumococcal disease and also a 4.3x increased risk after RSV and 2x increased risk after influenza activity for meningococcal disease. 

Those Darn Hibernating Viruses!

Many viruses stay in the body, all sneaky-like, for years after a first infection. Let's compare chicken pox, polio, HIV, and Covid.

Chicken pox, which spreads from contact with blisters or mucus, shows up with flu-like symptoms and characteristic spots. Then 30-70 years later, it can develop into shingles in about 10% of people, which is a painful skin condition. Luckily we have a vaccination for chicken pox AND a vaccination for shingles for anyone over 50 who had chicken pox in their life. It's two shots, and they're a couple hundred dollars each. They figured out the connection between chicken pox and shingles back in 1953, but didn't try to prevent chicken pox with a vaccine (or even warn parents to avoid it) until 2000, and the shingles vaccine wasn't developed until 2006.

Polio, which spreads from contact with bodily fluids (mucus or feces), first shows up with flu-like symptoms that most people make a full recovery from within a week or two, but less than 1% end up with paralysis of some type. Then 15-40 years later, people who just had mild symptoms can develop post-polio syndrome, characterized by progressive muscle weakness and atrophy, joint degeneration and pain, and skeletal deformities. Polio was around for centuries before Jonas Salk's vaccine in 1955. Luckily, vaccinations have almost completely eradicated polio here. So far.

Five Questions for the Minister of Health

 Dr. Christopher Leighton, MD, FRCPC, wrote the following letter to the Minister of Health, and encourages other to do likewise in order to "document the gross negligence of our government. If they will not act, we should be doing more: Protesting, petitioning our local MPPs. Eventually there will be an Ontario Inquiry or Investigation." It's just five questions:

RE: The Failure of the Ontario Government to Respond to this Unprecedented Health Care Crisis

1. Why does this government fail to acknowledge the most serious healthcare crisis facing Ontario hospitals in 70 years?
2. Why hasn't this government formed an Emergency Response Team to formulate and implement immediate solutions to improve access to emergency service, pediatric critical care, cancer treatment and urgent surgical care (adult and paediatric)? 
3. Why has this government failed to adopt ANY public health measures that will reduce the spread of COVID19 and influenza especially? 
4. Why has this government removed the reporting of COVID19 infections by schools (contrary to the HPPA & the Education Act) when absentee rates are >= 30% in a number of schools & districts across the province? [PHO as of Nov. 21, 2022]: "Only 40% of children ages 5-11 have had a primary series (2 doses). Only 5% of children ages 6 months to 4 years have had a single dose of a mRNA vaccine." These numbers have barely changed over several months meanwhile, children are presenting to hospitals across Ontario "requiring critical care and [mechanical] ventilation." 
5. Has the Premier, yourself, or the Chief Medical Officer of Health, directed in writing or verbally, or otherwise discouraged Medical Officers of Health from using their independent authority with the Health Protection and Promotion Act (HPPA) to make Section 22 Orders..." "..to require masking in schools for example?" "I personally cannot understand why preserving the health & welfare of all Ontarians is no longer a priority for this government. Shouldn't this be the ethical duty of every elected provincial and territorial government in Canada?" "Is it that this government values the lives of those who are predominantly dying from COVID19 differently from the rest of the population i.e. the elderly and persons with disabilities? This inaction leaves one with so many uncomfortable questions." 

 "These comments are my own"

History of Mask Controversy

 The New Journal of Medicine just posted a video of the history of mask wearing. It's just 12 minutes:

Unfortunately, they conclude that masks have always been controversial, so will likely always be controversial, and it's even worse in more atomistic, partisan, polarized countries that focus on the individual over the community. 

You can see more about the history of the Spanish Flu, which killed one in five people, here. One in five, and they still fought against wearing a mask!! 

All Natural Misinformation

This thread is from Dr. Kay M. Dingwell on her experience shifting from natural is necessarily best to incorporating some scientific research into her decision-making:

I used to be vaccine hesitant. Had my kids on a modified schedule and felt I was VERY educated. Here are posts I made in 2010 about visiting public health with Charlie, two months at the time:

When pregnant with Charlie, I was pretty resentful of 'unnatural ' obstetric care and was convinced I could do things better. I had 'done my research' and wanted an unassisted home birth. 

On OCDSB's Mask Motion

The OCDSB motion to require masks in all schools but allow exemptions for anyone who finds masks to be a hardship was not passed tonight after a 6-6 tie. Both student trustees also opposed it, but their votes weren't counted in the official tally. Here are three arguments I heard from opposing voices, and my rebuttals: 

Telling people it's required but that they can avoid it by saying it's a hardship for them means it won't change anything. 

Although it was hard to watch concessions be made in the spirit of compromise and the original motion be whittled away bit by bit over two long evenings, it was worse to hear final arguments about it being too watered down to bother passing by the very people who chiseled away at it! Of course that was the plan. The idea of the exemptions was to take any enforcement off the plates of teachers and administrators, but people argued that it makes it no different than a strong recommendation. 

I believe it's not the case that everything will be the same if you require masks but allow people to remove them without penalty. We know that every little bit will help, and we can't let the perfect be the enemy of the good. Sure people who are anti-masks will still not wear them, but I'm hearing from many parents with kids who want to mask, but don't want to be feel weird. If it's stated that they're required unless there's a hardship, then it makes masking the default, and those kids who want to mask will put them back on. In my own classes, almost all my students kept their masks on after the mandates were lifted last April because I told them the risks and the current data, and I asked them to keep them on if possible. That's all it took to get compliance from 95% of them. When the message is, "Masking isn't mandatory, but please respect people's choice to continue masking if they want to," that messaging leaves NOT masking as the default, and then kids feel uncomfortable wearing a mask. The message makes a huge difference even if there's no penalty for non-compliance.

A 12 Step Solution to Fix Healthcare

This thread is from Dr. Raghu Venugopal, an emergency physician in Toronto explaining how to fix healthcare in Ontario:

1. Declare a crisis

2. Scrap bill 124.

3. Give nursing and allied staff a raise.

4. School masking to reduce spread (plus cleaning hands and ventilation).

5. Get provincial health ministers to agree to federal data request to get available federal funding.

6. Spend surplus on health staff and structures, not highways, car sticker rebates, and waste.

7. Robustly invest in family health teams.

8. Supercharge hospital bed capacity (including ICU), which we hugely lack.

9. Bipartisan flu vaccine promotion now.

10. Fair paid sick days.

I could go on. But the Ford administration is going to do none of this, I am sorry to say, except I do note they promise to build hospital beds.

Lastly, it's about publicly funded health care:

11. Yes to non-profit surgical facilities.

12. Scrap for-profit nursing homes with increased mortality. Most hospitals are general, so children fight with elderly for beds. Healthier seniors means more pediatric beds.

So simple, and so not going to happen!! 

A trustee in OCDSB (Ottawa/Carleton) last night, where they discussed a mask mandate at an intense meeting that required police intervention to keep the crowd at bay, asked, "Why, if the situation is so dire, have neither Moore nor Ottawa's Medical Officer of Health, Dr. Vera Etches, imposed mask mandates?" And many people are saying - Wow, great point!! 

Science of Mask Efficiency

A thread from Dr. Leo Lam, who has a Ph.D. in Electrical Engineering, worked for over twenty years as a science advocate, and was co-founder of medical imaging software.

I'm tired of hearing the contrarians talking about how masks don't work as protective devices against respiratory diseases as our nation's pediatric hospitals are full of children sick with RSV/Flu and COVID continues to be the 3rd leading cause of death. The contrarians are WRONG. Some of them are already making attempts to take apart the excellent study done at the Boston School District with minor technicalities while ignoring a fundamental fact: the study is only a proxy. 

These contrarian physicians mistakenly believe that RCTs [randomized control trials] or observation of the secondary effects somehow make the gold standard for scientific evidence. It is NOT. Why? Because masks are mechanical devices that are physically measurable. And we have physical data. RCTs, by definition, are examining efficacy by proxy because the effect of drugs (and some medical devices) is not directly observable. You can't directly see how the chemicals interact with our cells/molecules or organs until we have nanobots with viewing capabilities. With masks, we can directly test and measure their efficacy via controlled particulate generators and sensors. This is the same for other physical objects, like seat belts, parachutes, and helmets. It would be absurd to run RCTs on them. Unethical, too. 

Where Does the Buck Stop on Mandates??

So Dr. Kieran Moore, CMOH, claimed he doesn't have the authority to institute mandatory masking in schools, and that boards can "consult with their local medical officer of health." It was later clarified that the CMOH can order masking in schools, or local health units, and it's not up to individual school boards. The Ottawa Citizen reported, 

Several medical officers of health have said they would prefer the province bring in mandates. Although they have the power to do so themselves under provincial public health legislation, they say it is difficult to enforce and makes for uneven rules across the province. Ottawa's Medical Officer of Health, Dr. Vera Etches, has said she would support local businesses and organizations that bring in mask mandates--something the Ottawa-Carleton District School Board did earlier this year after provincial mandates were dropped. It is again set to debate the issue. . . . On Wednesday, OPH (Ottawa Public Health) posted a message on Twitter saying it would "fully support any business/organization that chooses to implement a mask wearing policy." That leaves schools and post-secondary institutions to make their own decisions.

But BOY is it tricky to find out where responsibility lies on this!

Moore on Masks: It's All on Families to Get Back to ALL of the Basics

I watched it so you don't have to! I've transcribed most of it, but left out repetitive information in places. I also added timestamps to some of the more pertinent bits. And I've added in my own responses here and there. Many reporters did an amazing job with persistent questioning, except that one guy in the front, who didn't write anything down and just lobbed softballs. 

TLDR - The reason kids are getting sick is because of their parent, siblings, and grandparents, who really need to do better. We're doing something really new and different today by urging people to wear masks specifically when they're around children four and under. And if we need mandates in daycare to save the children, we'll absolutely think about it.

 

The Polycrisis and Planetary Palliative Care

Dr. Thomas Homer-Dixon and Johan Rockström wrote about the "Cascade of Crises" we're experiencing right now. They discuss global hunger, people forced to moved, political authoritarianism, violations of human rights, violent demonstrations, ongoing conflict. They point to three things: the magnitude of consumption, vastly greater connectivity among our economic and social systems, and risk synchronization. Since everyone is specialized, we don't have experts that can analyze all the connections. They advocate for creating a consortium for this. But can we do it fast enough?  

The two biggest issues right now, climate change and covid, are revealing an ongoing inability for our society to make wise decisions in the face of calamity, which may be leading us to a collapse of this civilization. But acknowledging that possibility doesn't mean giving up or hiding out. Perhaps if we accept (or just believe) that we're nearing the end, we can shift our priorities enough to usher in a more peaceful and equitable denouement.

Some recent climate change articles are painting a frighteningly bleak picture. At the Paris Agreement in 2015, countries around the world signed on to reduce greenhouse gases (GHGs) in order to cap warming at 1.5°C above pre-industrial levels by 2030. It's become clear that we won't be able to make it. 

Current pledges for action by 2030, if delivered in full, would mean a rise in global heating of about 2.5°C and catastrophic extreme weather around the world. . . . Global emissions must fall by almost 50% by that date to keep the 1.5°C target alive. . . . We had our chance to make incremental changes, but that time is over. 

The climate crisis has been a test of our ability to put long term collective needs over individual desires, and we failed miserably. It's no wonder we're not sufficiently mitigating SARS-CoV-2. Despite all our knowledge and technology and ability, we just don't want to be inconvenienced. 

Viral about that Virus

I posted a mini thread yesterday that exploded about the Delphi Consensus:

It hit a million impressions in just 24 hours, and it's still going strong. I'm so glad I turned off comments early on after I got slaughtered by trolls on a different post yesterday - almost 500 random comments mainly from people with fewer than 10 followers and almost entirely American based, lots of gun-lovers. It's the wild west on Twitter since Musk fired most of the staff. 

Our Duty to Others IS Love

In my class recently, we were asked to get into groups to get a reading down to one key word. The passage was on Confucius, and it was about human-heartedness, taming unruly impulses, filial piety, benevolence, and justice. 

In my little group, I suggested it's all about love. My group disagreed. I pointed out that the word is mentioned several times in the reading because they were quite sure it wasn't mentioned at all. They countered that it's all about duty, order and control. It's trying to control us by making us do things for other people. They said that like it's a bad thing. One kept bring up the idea of that we can only control people by shaming them and making them feel horrible, so it's in essence a horrible theory. I kept rereading the passage to see where they were getting this idea. I thought I must have missed something crucial in the text. Then, when we went around the room to share ideas, I was heartened that many other groups came up with terms like love and virtue and service, so I wasn't losing my mind. The reading was full of love.

It reminded me of two things: First, it's a similar reaction to class discussions on Kant's deontological (duty-based) ethics. Any thought of a duty or obligation to others gets the shackles up on many teenagers who are in survival mode competing with one another for university slots. But, if I come at it from the other end, focusing on what would make for the most benevolent society, or even what would be the best way to solve a conundrum with a group of people you really care about, they tend to come up with the notion of doing for others even if it's not in our best interest. They will start to argue that we can't expect to get our own way all the time, and that we have to look at the bigger picture and do what's right even when it's not what's easy or what most benefits ourselves. If we want to have a good home life or a good society, we have to consider the effects of our actions. And then we can get into the nitty gritty of how to decide that. It sometimes takes a full class of thinking to get them on board with "duty" being useful to keep the peace because first you have to get them outside of their selves, outside of their personal striving against each other. 

We Need Mask Mandates Now!

Here's Dr. Joe Vipond on mask mandates:

Hey Canada, it's time we talked about mask mandates: What they do, why they're important, and what we've learned from the past.

A mask mandate simply means a law that requires universal mask use in a certain situation (schools, work, public spaces, etc.). It's usually coupled with some kind of penalty, the simplest being lack of entry, but could be fines or other penalty. The intent of a mandate is to increase the number of people wearing a mask. It essentially sets the social benchmark for what is deemed acceptable behaviour. We go from mask wearers being the exceptional citizens to non-mask wearers being the exceptional citizens. We saw this in Calgary. On August 1, 2020, the percentage of mask wearers went from around 15% to 85% overnight.

We now see a similar trajectory towards a mask mandate in Canada, with Ottawa leading the way. Baseline mask use has probably (by my eye) been about 5%. We hope this will increase with increasing exhortations to wear a mask. So we'll go from "now you need to wear a mask," "no, really it's quite important," "goddamn it we're drowning here, will you for god sakes wear a mask," and maybe we'll boost the mask use to 20, 30, or even 45%. It simply won't be enough to bend the curve. If we know (and we know) that we'll eventually end up with a mask mandate (because exhortations don't work well enough), the earlier we do it in the curve, the better. So why not skip the "pretty please" steps and go right to what's worked in the past??

If We Know What's Right, Will We Do What's Right?

The Toronto Star just quoted Kieran Moore,

I’m very loath, after 1,000 days of a pandemic, to put in a mandate. We know what works, and we can trust Ontarians to do the right things. 

Nope. If we could trust people to KNOW what's right with all the misinformation out there, and then to DO the right thing (i.e. wear an N95 completely covering mouth and nose at all times in all public places), then we wouldn't have kids being shipped to hospitals across the province because of overflow. It's even worse now that we have 112 Paediatric ICU beds in Ontario, and 122 patients in need of a bed. 

In Ontario, 19 children have died of Covid so far. How much worse does it have to be for people to understand the need to wear an N95 around others? Like many communicable diseases, Covid spreads through carriers - a third of cases have no symptoms, so we need to mask even when we feel perfectly healthy. We can't know we have it, and can't know if someone nearby will die or be permanently disabled from catching it from us. Vaccines help prevent severity, but don't significantly stop transmission. N95s are a painless and effective way to stop the spread. If public health had pushed masks over hand washing in the last few years, then I might trust Ontarians to "do the right thing," but PH comms has been a disaster. 

From a Socratic perspective -- he argued that if we know right, we'll do right -- the problem is that most people don't know in their hearts that walking around publicly without a mask is wrong. We often avoid doing wrong because we'll get in trouble, but when we really know wrong -- like if you were asked to kill an innocent child -- it doesn't matter whether or not you'd get in trouble because you wouldn't be able to betray your conscience to that extent. The problem with masks is that many people don't know it intellectually either. They don't get how Covid is transmitted and don't know what to believe about the effectiveness of masks, and they don't get the difference between an N95 that seals to the face and a flimsy bit of cloth or surgical mask. And then, once they get the right information, they have to make the connection between walking around the grocery store without a mask on and killing an innocent child, the one in the cart next to yours in the check-out line, or the one that the cashier has waiting at home for mum, in order to really know know that it's wrong. Only then can we trust them to do the right thing.

Please wear an N95 or better in public places, especially schools, healthcare facilities, transportation, grocery stores, and anywhere people NEED to be. If you think we need a mandate in order to save the lives of our children, let Ford know at 416-325-1941. 

Medical Officers of Health - Can't They Save the Day??

 The Peterborough Medical Officer of Health, Dr. Thomas Piggott, wrote, 

I would agree and add my voice to the numerous health system leaders who are concerned with capacity of the health system in the face of COVID and other respiratory viruses and have been calling for a return of masking in recent days. If we have not reached the threshold from a health system capacity impact to reinstate required masking in key indoor locations, we need to understand when exactly that would be. I have said before and I'll say again, a multi-layer approach is needed (especially we need to see improved COVID/influenza vaccination rates, and improvements in in indoor air quality/ventilation) but masking in indoor locations is a key effective strategy with no associated health harms. It should be the first preventive measure to be returned and the last to leave as we continue to learn to live with COVID, keep kids in school, keep businesses open, and prevent health system collapse. 

What we are seeing affecting paediatric hospitals and children is the sentinel event for more broad community transmission. We usually see transmission in younger first. In coming weeks, I anticipate other populations, including older adults, to be more severely affected as well. There is a broad, not localized crisis facing our health system. It should have a coordinated provincial, not local, response. This is needed for clarity of message and coordination/feasibility of implementing. I believe it will soon come, but I sincerely hope the decision on return of required masking comes before the worst period to prevent it, not when we've already reached that point.