Monday, January 30, 2023

What Went Wrong? Hubris.

Mario Possamai, senior advisor for the SARS commission, was interviewed in an hour-long video from ISPR Respiratory Protection back in July 2022. Here's a summary of his talk with some of his slides:

He started comparing reactions to SARS. Back in 2003, a single patient with SARS walked in to Vancouver General Hospital about the same time as a patient walked into Toronto General. But the effects of this were dramatically different. One was fully contained, the other started a spread that led to dozens of deaths.

What was the difference? Vancouver General Hospital worked together better and listened to patients and front-line staff more.  

Saturday, January 28, 2023

It's a Social Problem, not a Medical Problem

Carol Dumaine wrote about the Davos safety measures, and how the rest of us are playing Covid roulette. It's a solid read, but I got totally sidetracked by one of the links she provides: "Infection of Society," by Antoine Danchin, published in EMBO Reports back in April 2003 - almost exactly 20 years ago. 

He talks about a common psychological occurrence: we are affected by huge sudden events far more significantly than by regular daily events. We care more about lives lost in a tsunami than in traffic, for instance, even though car collision fatalities number much higher. We begin to tolerate a certain level of vehicular carnage because we get used to it. But then he gets into how diseases have evolved to exploit ever growing weakness in our defences, most recently, 

"a societal shift such that we value the individual more than the community, which creates the new weaknesses that bacteria and viruses can exploit. In fact, there is a strong connection between diseases and society, and if we do not recognize this link, we will forever have new and increasingly virulent disease to face. Since antibiotics were discovered just over half a century ago, we have suddenly, in the course of only one generation, forgotten the terrible burden that infectious diseases present--at least those of us who are lucky enough to live in the developed world. But this sense of security is an illusion."

We have another avian flu sweeping the world right now, and Danchin explains that,

"the only effective prevention--establishing a controlled slaughtering system, and prohibiting the sale of live chickens at the markets in Hong King--cannot be implemented, simply because people traditionally like to eat freshly killed chicken. This shows vividly that it is impossible to separate infectious disease from our lifestyle or from the structure of our societies, and above all, from venal considerations. Our infections mirror our primary interests, and our way of life." 

He laments the number of parents no longer vaccinating their children 20 years ago, and warns,

"The threat of an epidemic of a disease that would certainly affect their unvaccinated children seem to be too far removed from these well-meaning parents to be taken seriously. The question of what is a tolerable level of infection, alas, is improperly asked. It is not a medical problem, but a social one, and thus asks for political intervention--in its noble meaning--as a consequence."

His solution:

"We have to teach our societies to reconsider our values--it is not the purse that is important, it is lives. We need to trap our societies with their own defects: nothing will happen without financial or economic pressure. . . . The Black Death stopped being a scourge when, after the implementation of sanitary cordons, soldiers had orders to fire on 'rich' people trying to cross the cordon. Using corruption, the rich were able to cross these lines and propagated the disease much more efficiently than rats ever did. We have not learned since. . . . The general consequence of the inertia created by venal interests and the existing strata in society is that rules are badly needed for the collective good. If we do not react fast enough, if we are not able to recreate the much needed sense of fraternity--and we are all equal when it comes to disease and death--then the microbes that we thought we had controlled will haunt us again. Unfortunately, a large number of deaths will probably be the price we have to pay to understand, finally, that true democracy is not representing the freedom of the individual, but that of the City."

Such incredibly prescient words. Such a shame we didn't listen.

Elsewhere today an actuary responded to the question, When will we stop studying the Covid pandemic? He said,

"I remember reading a few years ago a paper published in 2006, and and that paper was called, "Is the 1918-19 Flu Pandemic Finally Over," and essentially what was being recognized and acknowledged and the theory that the author was putting forward is that the generation of people who were young adults when the 1918-19 flu pandemic hit, tragically, had a decades-long elevated risk from cardiovascular causes which stayed with them for the rest of their lives. So it's only now, nearly 100 years later, that that generation are all no longer with us, and we can say that the flu pandemic's behind us. I'm expecting actuaries to be worrying about the long-term impacts of Covid for many decades."

So, only 97 years left, then! Maybe we'll have recognized the vital importance of the collective by then.

What Does Compassion in Education Look LIke?

Since the pandemic started, educators have been asked to use a "trauma-informed" approach to their teaching, i.e. pay attention to the psychological safety of their students. Some of the literature on this looks pretty good: build connections through empathy, be consistent and predictable in the classroom, be flexible to accommodate different needs, delight in students by finding the best in them, and co-regulate by sharing your calmness with others. But, in practice, it fell apart a bit.

In my own experience, I was made to be flexible at the expense of consistency and predictability in a way that overrode our guiding documents. And, I'd argue, in a way that wasn't compassionate. 

I practiced a trauma-informed approach long before it was called that, providing clear expectations but with many alternatives for people to choose. Before my classes start, I'd email a survey of questions to students asking if they'd have any concerns with general rules and deadlines, and where they'd prefer to sit in the room, what would make them most comfortable, what they like to be called, etc., so that when they walked into the room on the first day, they knew exactly what to expect and they had already had some say in what the room looked like. These are grade 12s, many over 18. With Covid, I added more questions about what would make them feel safe, and I asked if having windows open 1/2" would be okay to add some ventilation to the room. 

Then, once in the room, I again asked if people were comfortable where they were sitting and if it wasn't too cold. Everyone was fine. Except somebody wasn't, but they likely didn't want to be the odd one out in the class, so texted dad, who called admin, who marched down to my class immediately to tell me, "Kids can't learn if they're cold!" And the students learned a valuable lesson that day: Get dad to call admin, and you can make anything happen right before your eyes! 

We talked about what to do if you have a conflict with a person, that it's always best to start with to the offending person directly, and then go higher up if you feel like you're not being heard or not being treated fairly. "Resolving" a conflict doesn't always mean getting what you want, though. We have to measure out what we want, what others want, and if anyone needs something to happen differently to figure out what's fair. I asked them, What will you do in a few months, if you have a concern about a class in university? 

Get my dad to call the university. 

I shocked them by letting them know that university profs and administrators won't talk to their parents. 

Friday, January 27, 2023

OPSBA Conference in the Time of Covid

I'm missing my first trustee conference this weekend because there are no Covid mitigations in effect. I called to ask about it, and they're following the Ontario protocol, which is basically nothing. It's a full weekend at a hotel eating together, and I suspect that very few will be masked. Meeting people of a similar bent, being able to discuss the benefits and pitfalls of taking on this role, and being recharged by one another is something I normally relish. But it's not safe enough for me. They also decided not to livestream because it would be too costly, so I'll just hear about it second-hand. But Dr. Nili Kaplan-Myrth went and responded to a speaker with this concern about Covid. (I have no idea what the general topic was or what was said just prior to elicit this, and this is tidied up a bit from the recording at the link): 

Wednesday, January 25, 2023

On Argumentation and Straddling the Middle

At the school board meeting Monday night (video here, starting at 1:23:50 for over an hour), an open letter the board recently sent out was discussed. I said nothing because everything had already been said by everyone, and I didn't think it necessary to just be one more to add my thanks. The letter is well-written, clear, and well-supported with links to all necessary documentation. Last night, our director, associate director, and many trustees gave beautiful speeches about inclusivity, and I was happy that the board took such a strong and decisive stance on the issue. 

Thursday, January 19, 2023

Leading by Example or What's Good for the Goose...

This is about the Davos World Economic Forum, ending tomorrow. Social media is all atwitter with the incredible precautions they pulled off. Check out their rules here. It's three pages (!!!) of Covid rules and mitigations. Some highlights here:

"To create a safe environment at the Annual Meeting 2023, the Forum is working with the world's leading health experts and virologists. . . . The Forum strongly recommends that participants are vaccinated with the latest available vaccines and take a COVID-19 test before travelling to Davos. Participants are required to get tested in one of the Forum testing centres after arriving . . . with a PCR test. . . . If you fail to conduct a test, your badge will automatically be deactivated. . . . . Masks and disinfectants will be available throughout. . . . State-of-the-art ventilation systems have been installed"

And their masks are FFP2, similar to our N95s. They're not fooling around! On top of the PCR test, "Rapid antigen tests will be available free of charge . . . If you do not feel well, please take a self-tests."

Saturday, January 14, 2023

Unmasked People, Unmasked in Their Own Way

I think masks separate us like the families in Tolstoy's famous opening line of Anna Karenina. You know the one: "Happy families are all alike; every unhappy family is unhappy in its own way." Everyone I've met who wears a mask does it for more or less the same reasons: to protect themselves and others from a virus. But there appears to be a wide variety of reasons people won't wear a mask. 

NOTE: When I say masks, I mean NIOSH certified N95s or better - aka respirators. They do signficantly stop the spread of viruses.

I posted on twitter that I was starting to understand some concerns some people have raised about masks and that I think we need a new approach to get more people on board, and I was hit with an onslaught of comments along the line of, "They're playing you," and "I just can't bring myself to care at all about anti-maskers." I think this view is propagated because people against masks who are loudest on social media tend to be of a similar ilk: It's the pro-freedom, anti-everything group that bombards our posts, so they might colour the way mask advocates see anyone unmasked. But I've discovered there are others out there that don't fit the mold. And, if we want to get everyone in masks, then we have to care about anti-maskers enough to try to understand their position and bridge the divide. Instead, people got mad that I could have some compassion for them. 

It doesn't help anyone to lump them all together as sneaky and uncaring. I've argued before that anyone who is able to mask but won't is either misunderstanding the science and doesn't know they present a risk to others (which is totally on public health and our inept/corrupt premier), or they don't care they present a risk (sometimes, in part, because they don't know how serious the risk is, which is again on public health and our inept/corrupt premier). I still think those two different groups exist, but now, after getting tons of emails on masks as a trustee, I recognize there is huge diversity within each category. 

And I think I missed a category.

Thursday, January 5, 2023

We Need to Talk about Kraken (XBB.1.5)

I watched this livestream tonight:  an interview and Q&A with Dr. Eric Feigl-Ding (EFD), an U.S. epidemiologist who broke the news that the CDC knew XBB.1.5. was a variant of concern but didn't tell us and Dr. David Berger (DB), an emergency physician in Australia. Here are the main points as I heard them, a bit summarized to take out repetitive bits, and somewhere between quoted and loosely paraphrased. I bolded the bits I liked. Dr. Berger gives particularly good soundbites. You can watch the whole thing here
EFD: XBB is from Singapore, but XBB.1.5 is lightyears apart. It started in October in New England, Connecticut, New Jersey, Massachusetts, and New York. They are the same areas hit at the very beginning. This is a U.S. variant, from the northeast part of the U.S. I wasn't the first to track it, but posted and disclosed the unreported memo from the CDC. They are supposed to report if a new variant reaches over 1%. This blew up in October with BQ not being reported fast enough. XBB.1.5 was unreported until it hit 40%, so the CDC knew for weeks prior. This is unprecedented except for the original Omicron. There are lots of variants out there, but this one is highly immune evasive and and highly invasive in human cells. 

DB: XBB.1.5 has a high affinity for (likes to stick to) ACE2 receptors found on cells throughout the body. It's used to get into the cell, so it's easy to transmit it, and it may cause greater severity through dramatic growth in the cells. There could be very significant breakthroughs. Most important is that if we weren't discussing this one, we'd be discussing another in a few months the same way. We've encouraged unrestrained replication of this virus in a partially immune population - the ideal way to create mutants that will escape immunity, and here we are.  

Tuesday, January 3, 2023

Debunking Sheer's Carbon Tax "Myth"

 Max Fawcett, columnist for the National Observer, wrote a thread debunking Andrew Scheer's 6 minute video on the "myth" of the carbon tax. 

First, a few caveats/concessions. He complains about the Liberal government insisting the carbon tax isn't a tax and promising not to raise it before then raising it. Those are fair criticisms. They don't make the carbon tax a "myth", but they're fair game. Now, onto the rest.

Scheer says that “the Liberals have missed every single one of the targets they set for themselves for greenhouse gas emissions”. But they weren’t in power when the Kyoto targets were missed. They weren’t in government when the Copenhagen targets were set. And while they've missed interim Paris targets, the real ones lie in 2030 -- well into the future. But guess where most of Canada's emissions growth is coming from? Yup, Alberta's oil and gas sector. 

The lack of emissions reductions brings Scheer around to a familiar talking point: “Emissions are going up. The tax is going up along with it. It’s not working.” This is, as they say, "a bunch of bollocks". Here's a good explainer of why. What Conservatives like Scheer are unintentionally saying is "the carbon tax needs to be higher". Which, guess what: it will be! I know this stuff is complicated, which is why this argument has lasted as long as it has. But it won't last much longer. 

Monday, January 2, 2023

A Buddhist Perspective on Addiction: Nothing is Vital.

Now that the hangover from New Year's Eve is abating for many, and we might be freshly open to some self-improvement, consider a Buddhist view of using meditation to tackle addictions. I don't just mean for substance abuse, but also for that incessant drive to check social media just once more before starting our day or before we finally lull ourselves to sleep by the light of our devices, or the drive to buy the store out of chocolates at boxing day sales. Not that there's anything wrong with that on its own; it's a sale after all, but when actions are compulsive instead of intentional, then this can be a different way of approaching the problem from the typical route. I'm not a mental health professional, but this is something I've finally tried with earnest and found helpful, but it took a very different understanding of it all to get just this far (which is still pretty far from where I'd like to be). 

Meditation is not about escaping the world but sharpening our awareness of it. Addiction comes from the Latin dicere, related to the root of the word dictator. It's like having an internal dictator usurping our agency. And Buddhist mindfulness meditation can help to notice that voice and then turn the volume down on it so we can get our lives back.   

In many ways the Buddhist perception is closer to Stoicism than to Freudian tactics, but don't toss the baby out with the bathwater. Many people benefit from the psychoanalytical method of finding themselves before they can work on losing themselves. This is particularly true with traumatic experiences that might need to be worked through enough before allowing the mind to wander into dark recesses unrestrained. 

Some research has found Buddhism to be as effective at treating addiction as typical methods, which is never anywhere near 100% because addiction is brutally difficult to overcome. One study of 500 opioid addicts had half use a detox program with counselling and the other half study in a Buddhist monastery with a focus on meditation and virtuous living. The abstinence rates were the same. The monastery used meditation to help clients (clients?) recognize the path they're on, then contemplating virtuous living to find their way back to a preferred path that's less frazzled and chaotic. Before researching the role of Buddhism in addiction treatment, it hadn't occurred to me that mindfulness meditation had anything to do with the Buddhist Noble Eightfold Path of virtuous living. All these years of dipping into meditation here and there, I had just been arguing with myself to stop my thoughts from racing, craving the perfection of enlightenment, and missing the most important aspects in the process. Like Stoicism, Buddhism has us check our thoughts and actions to intentionally get on the right path. 

Sunday, January 1, 2023

The Kraken Wakes: We Need to Stop Hosting Monsters!!

I don't read much fiction, but I loved John Wyndham as a teen, and I realize I didn't love English class because there was almost never any sci-fi on offer - except The Chrysalids in grade 9 was enough to get the binge started. The Kraken Wakes is about an alien invasion, and check out this plot description from Wikipedia:

"The novel describes escalating phases of an invasion of Earth by aliens, as told through the eyes of Mike Watson, who works for the English Broadcasting Company (EBC) with his wife and co-reporter Phyllis. A major role is also played by Professor Alastair Bocker – more clear-minded and far-sighted about the developing crisis than everybody else but often alienating people by telling brutally unvarnished and unwanted truths. Mike and Phyllis are witness to several events of the invasion, which proceeds in drawn-out phases; it takes years before the bulk of humanity even realises that the world has been invaded."

The aliens can only survive in the ocean, where it's pressurized, so you'd think they'd be easy to kill off. You'd think. But they're a far sight more clever than the people. Some characters in the book argue we can just live with the aliens, but others try to destroy them. By the time the aliens move onto land, it feels like it's too late. Spoiler: Japanese scientists save the day, but the population has been decimated by then, with about 80% dead, and most of the world is flooded. Aside: Some mark the first time people worried that fossil fuels will cause icebergs to melt with a Time article in 1956, but ice-caps melting is a major problem in this prescient book published in 1953. 

Films of 2022: Quick Single Line Comments

Some quick one-liners (synopsis and/or reviews) on the films and shows memorable enough to remember seeing this year. These are in no particular order, and I'm missing many of them:

Good Luck to You Leo Grande - It's Sex, Lies, and Videotape 40 years later. It was okay.

Tar - it's has the feel of Whiplash but starting from the suicide - more psychological thriller than drama

The Banshees of Inisherin - lovely and touching and so unfortunate and lonely and beautiful

The Fabelmans  - lovely film of Spielberg's childhood, mainly about his mom; love is heartbreaking

The Outfit - fun organized crime flick - love this kind of thing!