Coming Soon to a Hospital Near You

The Minden ER closed June 1, 2023. A recent article in the Minden Paper explains why this should worry all of us.

Jeff Nicholls said,

"After we analyzed the decision-making processes before, during, and after the closure of Minden ER, our team audited teh audited financial statements of every hospital in Ontario. . . . For FY22, 25% of Ontario hospitals posted a deficit . . . For FY23, 75% of Ontario Hospitals posted a deficit. . . . Their average deficit was $5.9 million. . . . One healthcare system -- Mackenzie Health [in Richmond Hill] -- posted a $93 million surplus. . . . 

On Psychosomatic Illness

I don't know anything about Fibromyalgia, yet I wince when someone says it's psychosomatic. I wonder about almost any conditioned considered psychosomatic now.

I realize I'm using the term in the vernacular to mean "it's all in your head". That's how it is largely understood even though, technically, psychosomatic illness can refer to anything without a medical explanation. People communicating with the public have to understand the common usage of the term as it's being heard.

Jane Brody wrote about the concern with this label almost a decade ago (in full at the very bottom):

"When I was given a diagnosis of breast cancer in February 1999, many friends and readers wondered: 'Why did you get breast cancer? You take such good care of yourself!' . . . It seems that many people believe that if you do everything 'right', bad things won't happen. But bad things can and do happen. And they happen to the 'best' and the 'worst' of us. . . . If you're blessed with good health, you can say, 'I did it.' But if you lose your health, you know that external forces beyond your control can get in your way. Healthy people tend to act as if beneath every sick person is a healthy person trying to come out. . . . 

Wasn't it Susan Sontag who pointed out that whenever the cause of an illness is mysterious, it's assumed to come from psychological problems or a moral weakness? And once science finally figures out the medical root of the illness, that assumption disappears. Will we one day have a better -- that is, more scientific -- understanding of ailments like chronic fatigue syndrome, fibromyalgia, Gulf War syndrome, multiple chemical sensitivities or any of the other current 'wastebasket' diagnoses that many medical and lay people consider psychosomatic? 

Canada's Healthcare Crisis

A major backbone of Canada is falling apart, and much of it is from poor policy decisions that has led to a serious doctor shortage. 

Mary Fernando, MD, wrote about it. 

"A personal post in two parts: 1. Someone I love needs a specialist but wait times are dangerously long because of our specialist shortage. 2. As a doctor who resisted large money offers from the US to stay in Canada, I've lost something more important than money: my family's safety. 

The Enshittification of Health Care

Last week David Moscrop wrote an excellent piece in The Walrus about Loblaw. 

He wrote, 

"If you live in Canada, you're probably part of the Loblaw ecosystem, whether you like it or not. . . . It accounts for nearly a third of Canada's grocery market. . . . Loblaw's sensational fourth-quarter results--$14.53 billion in revenue and $541 million in profit--suggest the mission is going well. . . . President Galen Weston Jr. was hauled before a parliamentary committee, which grilled him over soaring food prices. . . . Grocers in Canada have recently enjoyed not just higher profits but higher profit margins--a practice one might call profiteering. Retailers keep charging more, in other words, not just because of increased industry costs but because there isn't enough competition to stop them. . . . Another wave of outrage from customers and experts forced health insurer Manulife to walk back a deal to cover certain prescription drugs exclusively at Loblaw-owned pharmacies--an arrangement that would have deepened Loblaw's reach into Canadian lives, a presence already bordering on the imperial. . . . As Shoppers Drug Mart expanded into health services, critics warned it might be pressured into putting profits first and care second by cutting corners, rushing patients, and pushing unnecessary treatments. And right on target, Shoppers was recently accused of unethical billing practices in its MedsCheck consultation program.

Erosion of Public Health

You would think that after dealing with Covid for over FOUR years that Public Health would be amazing at stopping Measles in its tracks, unless maybe they've been directed otherwise.

From Henry Madison:

Why persist with Covid questions? Because our greatest achievement in history was the invention of public health. Nothing else comes close. We went to war on infections, and suddenly people lived twice as long. Living with infections is a betrayal of our own history.

Avoiding Pathogens Benefits Babies

My mom was right after all: We really should do everything we can to keep babies from getting sick.  

When I was close to the due date of my first child, my mom warned me not to pass around the baby to people or let lots of people into the house no matter how much they beg to see the baby. Everyone's going to want to see the baby, but the baby shouldn't be in contact with anyone who could be sick. And you can't always tell if someone's sick.  

Then suddenly, for just the past four years or so, the general populace seemed (seems?) to think that children should get as many infections as possible when they're young - and many think they also shouldn't get the inert version of infections offered by vaccines. Funny that. 

But now the old ways - the pre-2020 ways - have even further evidence. 

Infection Control Measures Work

A Lancet study found that there's little Covid transmission in schools WHEN infection control measures were in place. 

Since we stopped all mitigation efforts, hospitalizations for Covid in Ontario have increased year-round. We don't need lockdowns for Covid, but we do still need N95s until we can clean the air. 

From CP24:

"The review found that masking, vaccinations and test-to-stay policies were the best methods to reduce Covid-19's spread in schools and daycares. The effectiveness of strategies like mandatory quarantining, cohorting, and hybrid learning is uncertain and may have made 'little to no difference in transmission.'"

N95s Reduce the Risk

There are more studies coming out that show that N95s and fresh air help in schools, and we're still not going to act on them! 

A pre-print just came out yesterday that studied university classrooms and the way students interacted, and concluded, 

"Due to high-population density, frequent close contact, possible poor ventilation, university classrooms are vulnerable for transmission of respiratory infectious diseases. . . . When all students are wearing N95 respirators, the infection risk could be reduced by 96%." 

They also found that increased fresh air can decrease exposure by 81% and that cutting occupancy rate in half and spreading seating out can decrease exposure by 62%. 

Yet universities still demand in-person attendance without any useful mitigations in place.  

Peak Advancement

Measles cases are on the rise because of lower vaccination rates. It's one of the most contagious diseases out there, but that's still not going to budge policy.

An article in yesterday's Guardian explains that we're actually less prepared to cope with any viral activity now than we were in 2019. We've lost capacity to work with viruses! The guy in charge of the UK's vaccine taskforce, Dr. Clive Dix, said there's been a "'complete demise' of work to ensure the UK was better equipped with vaccines." He told the government his recommendations and was more than ignored:

"There were activities already going on that were stopped. . . . The UK also drove vaccine manufacturers away by treating them so poorly. . . . What we've seen is a whole list of incompetent decisions."

He also talks about concern with reliance on mRNA vaccines which need to chase after each specific strain, and are always behind the curve. We have better options, but McKinsey's in bed with Pfizer and Moderna here, so we might not ever get a chance to access them.

It's almost as if we refuse to advance any further. Have we peaked as a species?? Did we get so clever that we're witnessing the downward trend in the willingness to implement care for the public? I often think about the chimp wars the way some men apparently think of the Roman Empire. The chiimps seemed to hit a specific population density or just had too many alpha males, and they turned on each other, taking their own numbers down by half within four years. Maybe that's us right now, willing to let people die by more passive means that protects everyone from ever taking responsibility for anything.

Covid Won't Go Away On Its Own

I'm feeling a bit frantic today (even more than usual) as it's two days before school opens again, and wastewater indications show we're really in the thick of it in my part of the world:

Across Ontario, we've hit the third highest number of daily hospital admissions since this pandemic started, and it's still rising. 

And schools are doing nothing to prevent the spread. Absolutely nothing beyond the bare minimum of mechanical ventilation. Washing hands and coughing into your elbow does fuck all to stop an airborne virus. We've got, "zero mitigations in the middle of a well documented mass disabling event" (from Themme Fatale below). No encouragement of masks in class, no CR boxes allowed, no windows opened because kids can't learn if they're cold, and not even any education on what Covid does to the body, how additional cases accumulate and make it so much more likely they'll get Long Covid, except in rooms with rare teachers willing to ignore the rules that increase the likelihood of harm to children. If you've got kids in school, please do what you can to try to get them to be that kid who wears a mask. Maybe your little one can be a trendsetter!!

McKinsey's Effect on Public Health

Almost two years ago, the Canadian government published a Covid response plan that's largely vague and useless. Who benefits from that?

Canadian Public Health Response Plan

The 3rd edition of the guide was published in March 2022, and it appears to be the most recent edition. They outline the "worst case scenario," and it's pretty much what we're living through right this minute: a large wave with a peak of prolonged duration, concurrent with other respiratory pathogens, with a new variant of concern that has immune escape properties that reduce vaccine effectiveness at a time where people are reluctant to get vaccinated, and a shortage of health care providers. Check, check, and check! 

So when do public health measure kick in??

Can We Get Some Leadership Here?

Hopefully more people will start paying attention to the dangers of Covid and wear a simple N95 to protect themselves and others now that JN.1 seems to be in the news more. But leadership would help.

The concern with JN.1 is that the "variant appears to have an increased affinity for lung tissue, potentially leading to more severe cases of pneumonia compared to earlier strains. . . . Monitoring symptoms such as persistent cough, difficulty breathing, and fever is crucial, as timely intervention can help prevent the progression to severe pneumonia." But the article just advocates for more vaccinations, without mentioning prevention through respirators beyond "wear masks in crowded places or when required." That type of message is almost worse than just not mentioning masks at all, as it convinces people they're safe in a room with just a few people, when it can only takes one person across the room who appears perfectly healthy to exhale in order to get this variant if you're in there without a mask on. Or you could be the person spreading it. 

But definitely get vaccinated. Gregory Travis graphed disease fatalities in school-aged children against vaccination status to find an inverse correlation: "In other words, The more you vaccinate your children, the fewer of them that die."

On top of the continued pandemic with an even more transmissible variant, Ontario is suffering a critical nursing shortage, delaying surgeries, with many patients waiting in hallways to be seen, and many emergency departments being closed. "As the health care crisis rages unabated across the country, it is nurses who are holding our health systems together through grit, determination and a shocking amount of overtime. . . . Research shows that fatigue has effects similar to alcohol intoxication. . . . Alarmingly, there are no regulatory limits to the hours a nurse can work continuously. "

Yikes!

David Christopher posted, 

"I try to stay measured when talking about SARS-CoV-2. However, after what I've seen in one of the busiest hospitals on the planet and personally experienced the last four years I am extremely worried about our future. This virus can infect us 2, 3, 4, 5 × a year and it is airborne. It can persist, replicate and mutate for months, perhaps even years in our organs, brain and bone marrow. It is constantly mutating and staying ahead of current vaccines, our therapeutics are very limited and both do very little if nothing to prevent long covid. The damage done by convincing most of the general public that this virus is mild or harmless for all but the most vulnerable among us is irreversible. How many mild or asymptomatic infections are causing silent or unnoticed damage that will show up months or years from now? 

I've seen what this virus does both in the acute phase and for months after when looking at thousands upon thousands of laboratory test results the last four years. It attacks every organ, including the brain and circulatory system. Oncology patients are becoming more fragile. Diabetics are struggling to keep their A1C levels down. The number of cardiac patients has exploded. More and more patients in renal failure are going on dialysis. Abnormal hepatic function test numbers are skyrocketing. Lymphopenia, thrombocytopenia and abnormal coags are ⏫. In summary, this virus has become a Trojan horse that most of society ignores. Even most of our medical institutions want to normalize it like influenza where a yearly vaccine is all you need. The push to go back to 2019 has largely succeeded at the expense of our future." 

In 1918, people didn't just wait for the flu to run its course; they fought hard against continued waves of the Spanish Flu despite having no vaccination. A big component of that success was ventilation, which included running classrooms outside all winter long. In my board, opening a window a crack was a concern because, according to my admin, "Kids can't learn when they're cold." We've chosen immediate comfort over long term survival. In my current university, there is nothing in place for people who want to avoid getting Covid. Nothing was done except to pretend it ended. Classes start Monday with full knowledge that we are in one of the worst peaks of the pandemic, and nothing is happening in schools except minimizing. Teachers still can't bring in their own CR boxes. Most people aren't masked. The comms has been a nightmare leading to many many preventable deaths. The death rate further increased for kids 5-19 in 2023. Vaccinations help reduce severity, but too few are being vaccinated (only 15%).

We need a big move, right now, to get more people wearing N95s in all public places, especially places people have to be: schools, healthcare, public transportation, grocery stores. At the very least we should make it possible for anyone to buy a loaf of bread without contracting a fatal disease! I've been in arguments with people who are all or nothing about this -- that allowing unmasked dining or bars means it will still spread, and that's true. (And yes, some people are even more extreme than I am about all this!!) But legislating masks everywhere again will be met with far too much vitriol and rage. At least legislate them in public buildings and transportation that can't be avoided. Let the few up in arms off the hook with a note, and everyone else in masks will protect them from illness. N95s work, but they work much better if more people wear them. I'm not hopeful that things will change voluntarily despite 7 million deaths and an unknowable amount of disability from it all. 

***

COVID BASICS: (1-3 from Dr. Joe Vipond):

"1. Covid is predominantly airborne. [It can cross a room in minutes and linger for hours.]

2. Over 50% of transmission is from asymptomatic people. [They feel perfectly healthy!!]

3. Long Covid is real and impacts a substantial number of people." And...

4. Vaccines help reduce severity of cases, but can't eliminate transmission and wane in effectiveness within months because Covid mutates so fast (because of all the spread!).

5.  N95s trap Covid using inertial impaction, diffusion, interception, and electrostatic attraction. They really work!!

6. Covid's the #3 killer in Canada, and we don't know how many people it has disabled. Avoid being one of them. There is no treatment, only prevention. Be wise with N95s! 

Long Covid Tag

Mentioning Long Covid symptoms to people can set off a series of other stories from people with similar symptoms. It's out there, but we're wary of talking about it.

This is from Nikki S's thread, a founding member of Long Covid Support in the UK:

"I was at a get-together at a friend’s house. Someone asked how my LongCovid was and others started listening. Someone else then said their husband has it. Then another said their sister-in-law hadn’t been right since having Covid, but they’d only just linked it. Then another said their relative had a stroke after having Covid and has never really recovered. 

Someone else’s daughter never recovered from Covid and when I last saw them six months ago she had had no healthcare, so I gave them some general information. She since developed typical symptoms of PoTS. GP referred her to a Long Covid clinic who spoke to her three weeks ago. She is waiting for a TTT, appointment is in three months’ time. BUT she was given no advice by her GP or LC clinic to try to help her symptoms whilst she waits. So I sat with her Dad, directed him to various resources and talked in general about Long Covid. They were so grateful as their daughter had been given no advice by her GP or LC Clinic. The question is why the hell not?! 

You Had One Job! On IPACs Refusal to Prevent or Control Infection

The Infection Prevention and Control (IPAC) of Canada is a registered charity making some questionable decisions recently.

They promote themselves as, "Focussing on infection prevention and control in the community and in healthcare facilities." Their mission is "to advance infection prevention and control by advocating for our members and providing access to evidence-based resources, education and networking opportunities," and their vision is "a world without preventable infections." Their goal is, "Not one preventable infection. Ever." In their promotional video they say, "IPAC Canada members are dedicated to supporting efforts in eliminating preventable infections."

Dr. Lisa Iannattone noted the power they have:

Newsflash: Covid Should Be Avoided

Studies make it very clear that Covid is really bad for us, yet we're going to do nothing to prevent the spread.

In case you didn't know, if you have almost $20,000 to spend each year, per kid, on a private school, that many of them have excellent pandemic plans still in place. People with money are able to keep their children very safe from the pandemic. One school still recognizes that, 

"There is no such thing as a harmless single case of Covid that someone with 'a healthy immune system' can overcome." So, all staff, students, and any visitors, "will wear masks whenever we are indoors, and any time we are close to one another outdoors. . . . The only options for masks indoors are KF94s, KN95s, or N95s (or higher filtration masks or respirators), and they must completely cover both the nose and the mouth and be snug against the sides of the face." 

What a dream it would be if all schools cared so much for our kids!

A recent National Geographic article explains how Covid triggers cardiovascular problems by directly infecting the arteries of the heart. The study they discuss was published in Nature in September. The big news is that they figured out that, "the virus can survive and grow inside the cells that form plaque. . . . If the plaque breaks, it can block blood flow and cause a heart attack or stroke. The SARS-CoV-2 infection makes the situation worse by inflaming the plaque and increasing the chance that it breaks free."

The Big Lie of Covid Herd Immunity

Why do some healthcare professionals still insist that herd immunity will work despite visual evidence to the contrary? 

A nicely explainer came out in Journal of Infectious Diseases March 2022: 

"As commonly understood, herd immunity thresholds are reached when a sufficient proportion of the population is vaccinated or has recovered from natural infection with a pathogen such that its community circulation is reduced below the level of significant public health threat. For example, this threshold has been met with polio and measles circulation in the United States. However, SARS-CoV-2, the virus that causes Covid-19, is so different from polio and measles that classical herd immunity may not readily apply to it. Important differences include the phenotypic stability [tendency for the virus to remain the same] of polio and measles viruses, and their ability to elicit long-term protective immunity, compared to SARS-CoV-2."

With measles and polio, once you get it, you won't soon get it again because, as they figured out in 1876, they "elicited long-term protective immunity that reduced or prevented epidemics, until cumulative births resulted in sufficiently large cohorts of susceptible children to support new waves of transmission." So vaccinating everyone as infants was enough to stop the virus in its tracks! With Covid, as we really really know, for sure, you CAN get it again over and over, right away. Some people have had it six and seven times. Some people have had two infections within 30 days. 

The article further explains why herd immunity doesn't always work:

Courage to Admit our Mistakes

Translation from Maarten De Cock

"Many people know, from unfortunate experience, and doctors recognize that most contagious diseases are communicated by breathing the air that comes out of the chest of individuals already suffering from these kinds of illnesses. ~ M. Rouland, 1784."

We've known about airborne pathogens for literally hundreds of years, yet the CDC and WHO have a bizarre aversion to acknowledging it. Surely they've all seen that Wired article by now, right?!?

Some suggest that it might be significantly more difficult for people in healthcare to start wearing a mask again:

"Imagine being a doctor and realizing your medical training overlooked the most important and basic fundamentals of patient safety, and that you were taught outright pseudoscience by charlatans, and that you repeated these lies confidently to patients who trusted you. Shit. We dug the hole too deep. The only way out now is to keep pretending. It can't be true."

It's hard to realize you've made a huge mistake, but people have to get over it.

As a teacher who focuses on teaching good science from junk and good media from biased unsubstantiated bullshit, I once told a class that some coaches were taking balls out of soccer games to make it so kids weren't humiliated by losing. I heard just a piece of what sounded like a news report on CBC while getting a lift, and I didn't look for any corroborating evidence or even the name of the show to check that it was the news! 

My students rightly pointed out it was a satirization of current events. Of course it was!! How incredibly embarrassing!! I used it as an example of how easy it is to get sucked in. A really humiliating example. I could have said I was just testing them, but I didn't. I owned it. 

You just have to eat it and go on. 

I get that it's a different kettle of fish with lives on the line -- nobody died thinking that some schools don't allow balls on the field or realizing that their teachers can make giant whoppers of mistakes -- but the longer they wait to fess up, the more lives will be harmed by this travesty. 

Jump in with both feet: strap on an N95 and goggles when you leave the house TODAY! People will ask you about it, and now's your chance to admit that you had been duped all this time and want to rectify that, to fix things as much as you can, and to teach others how airborne viruses work -- that they can worry far less about what they touch and far more about what they inhale. It'll be a difficult first day, but it will get easier. Soon it will be second nature. 

So brave!!  

(Tip: N95s are actually more comfortable and breathable than a surgical mask; they don't move on your face and slip around or fold into your mouth when you talk, and you can stick your tongue out at people without them knowing. If you really hate masks, you might just be wearing the wrong kind.)

On Teaching Public Health

Organizations have done such a bad job of explaining Covid to the public over the last almost four years, that it will be difficult to ever get mitigations back in place. 

Research director with a PhD in education, Dr. Sean Mullen said incredulously, 

"They said herd immunity would work. Then hybrid immunity. What's next? They should just come out and say it: Hocus-Pocus, Hail Mary Hypothetical Immunity. Seems we've been banking on magical thinking, prayers, and theories rather than results. Hallucination immunity. Might as well be dreaming."

When asked why health care professionals aren't masking he explained why he thinks people in general stopped:

Staying Healthy Takes Work

If social media is any barometer of this, anti-mask abuse appears to be skyrocketing.

Fixed it for ya!

There are tons of comments by the Covid cautious about about being accosted at stores and in the street, followed by others suggesting that's just not happening. 

I wrote about being harassed on the street over a year ago, and a few people (men) commented that it never happens to them, so I added in: 

"If right now you're thinking, 'Nobody ever hassles me about my mask,' it could be because you're male or a more imposing female or neurotypical or you don't travel around alone on foot or by bike all the time, or you don't live a few blocks away from a site home to regular anti-mask rallies!"

I've actually found the level of harassment directed towards me has decreased in my area -- knock wood -- which could be because I travel similar route, and see the same people over and over, and people have grown weary of hassling me and having no effect.

Children Risk More Illnesses after Covid

What every pediatrician in the world needs to read - from tern: 

Correct me if I'm wrong, but this is a really bad thing, isn't it?

I wonder what the percentage is after the 2nd, 5th, 8th, and 12th infection?

Here's a really really interesting point in the study: Only a tiny proportion of the kids have a constellation of problems.  The new issues are spread out across all the body's systems: 

"Only 2% of children had two disorders at the same time."

Do you understand the significance of that?