Dermod Travis, 1960-2020

 

There is much to be said about Dermod and the work he did, even while in hospital, close to the end. I will write more when I can type without tears but this is gutting, for many. It’s hard to comprehend not talking to him ever again ūüė•

My thoughts and love are with his family and close friends. A huge loss for British Columbians. Its unbelievably unfair.

An open letter to Prime Minister Justin Trudeau

Preface
*In recent weeks I, like all Canadians, have watched the ’emergency’ aid packages roll out. While I applaud the efforts to do so, I have wondered-as someone who advocated in my former column for a Universal Basic Income-why the government did not choose this route as an immediate option. Emergency aid is exactly that…it is needed immediately. Funds coming two months from now, don’t help those treading water and slipping below the surface right now. Delivering a Universal Basic Income would have saved on the myriad of administrative costs associated with multiple funding routes and could be delivered immediately to every Canadian,thereby leaving no one falling through the cracks. And there are still many who do. Those who survive in a gig economy, those on CPP, etc etc. I think government failed to recognize how a very large majority of Canadians are living right on the edge. Many leaders will be defined by their responses during this crisis and if you have never struggled in your life, it is often hard to develop policy that effectively represents the reality of those in poverty, or on the edge of it. We see that clearly now in the current crisis as every community is dealing with trying to feed people who, in some cases, have not eaten for days. Kim is a friend of mine. She has been a hard working Canadian and a fierce advocate in her life for others. She is one of many being left behind. She asked me to proof read this letter she intended to email, and upon reading it I knew it would be better served representing the voices of many in the public realm because I think there are many more like Kim out there, who may not have any voice at all.¬† If you too find yourself not fitting into any emergency aid categories, please share your story in the comments. We hope it will help officials in guiding their policy decisions during this time.And if we can help direct you to assistance in the community you live in, we will do so. Without any more delay, please read Kim’s letter below. *¬†
Dear Prime Minister,
I am a constituent of the Honourable Mr. Garrison, on Vancouver Island.
During this difficult time, I have watched different press conferences every day, from all levels of government, hoping that today will be the day I will no longer fall through the cracks.
Every day I am left feeling defeated, and disappointed.
I understand that you need to help suddenly unemployed Canadians. I applaud that you are trying to do that.
Today the province of BC pledged some real help for the poor, in supports for those on Income Assistance and PWD, and I applaud that as well. Many BC’ers are still falling through the cracks though, because it was required that we access CPP disability before any provincial disability…and that made us invisible to the province.
Personally, let me describe my situation.
My CPP Disability (I am not quite a senior) pays me $890 a month, my husband gets about $910. We have paid the rent. Most of the bills. But the last month we ran out of medications, so I rationed mine, and husband was out for 5 days. Blood pressure meds, in a highly stressful time, should not be rationed.
We had $100 left for food last month.
Friends brought me toilet paper. And food. This month I went to the pharmacy and they informed me it would take 3 days to fill my prescription and the were limited to a 30 day supply now. My medication went from $70 over three months to $40 for one month. I now have to pay more dispensing fees. The grocery store charged me $11 for 15 rolls of toilet paper. All of this comes directly out of our food budget.
It seems fairly obvious to me that many people are falling through these cracks. It seems fairly obvious to me that this is by design. Everyone knows you could immediately deliver a universal basic income. Even the Conservatives are calling for that. I can’t help but think you are terrified that once you unleash such a powerful tool, it will be demanded that it remain in place.
I want you to consider history for a minute, how Tommy Douglas managed to do a good thing for Canadians with Universal Health Care and how Canadians have voted him the Greatest Canadian for that. Mr. Trudeau,¬† please reach back and find that your father had the courage to trial this idea in Manitoba in the 1970’s.¬† Imagine the legacy such courage would leave you. Our grandchildren would learn about it, and celebrate your vision. This is what Canada needs right now, urgently so. An error doesn’t become a mistake, unless you fail to correct it.
Lacking the courage to act so boldly, at least, for the sake of the citizens of this country, who need it, raise the CPP. It’s not perfect, but it will help the poor people continually ignored.
I remain
in poverty,
Kim Poirier
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Lessons not learned from the SARS inquiry: The Precautionary Principle be expressly adopted as a guiding principle

A question of hindsight: Why did officials wait so long?

Many may not know that following the deadly SARS outbreak in Canada in the early 2000’s, an inquiry was held to determine what went wrong ( and quite a bit did ), how to fix it, and to learn from those mistakes in order to ” give a legacy of betterment to those who died, those who fell ill, those who suffered so much and those who fought it with such courage.” 13 essential questions were asked. http://www.archives.gov.on.ca/en/e_records/sars/report/v1-pdf/Vol1Chp2.pdf ¬†While the report focused primarily on events in Ontario, the lessons learned were critical for the reform, preparation and decision making¬† of all officials across Canada.

Because of past and ongoing concerns and criticisms voiced by ER docs, nurses, infectious disease specialists, journalists and people like myself, I wanted to go back and see exactly what happened and what was learned during SARS, to see if the recommendations and learned experiences have been applied by government officials, both elected and appointed.¬† In the middle of a global pandemic, it makes for¬† both compelling reading, and it provides a critical lens with which to view the current timeline of decisions made in handling Covid-19…and there is much to be critical about.

One of the best and ongoing timelines of the unfolding crisis management at the federal level has been given in this piece in the Edmonton Journal. https://edmontonjournal.com/news/national/the-road-to-canadas-covid-19-outbreak-timeline-of-federal-government-failure-at-border-to-slow-the-virus/

This timeline is a stunning read, made even more so because of how provincial counterparts parroted the federal messaging, telling citizens the risk to Canadians/ British Columbians etc, was low… until very quickly they all had to do an about face. (I posted a very small timeline of key moments here in BC, in this post https://lailayuile.com/2020/03/17/covid-19dont-let-hindsight-be-the-most-astute-advisor-measures-we-need-to-keep-our-communities-safe-and-operational/)

 

Risk Management 101: The Precautionary Principle

Why the Precautionary Principle has been ignored repeatedly by officials who hesitated to close borders, hesitated to order the public to stay home, hesitate still in closing down work camps and constructions sites, is surely going to be a matter considered by another inquiry down the road.

From page 3 of the Executive Summary of the Sars Commission report:

“Precautionary Principle

In The Commission of Inquiry on the Blood System in Canada, Mr. Justice Krever said:
‘Where there is reasonable evidence of an impending threat to public
health, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat.’
The importance of the precautionary principle that reasonable efforts to reduce risk
need not await scientific proof was demonstrated over and over during SARS. The
need to apply it better is noted throughout this report.
One example was the debate during SARS over whether SARS was transmitted by
large droplets or through airborne particles. The point is not who was right and who
was wrong in this debate. When it comes to worker safety in hospitals, we should not
be driven by the scientific dogma of yesterday or even the scientific dogma of today.
We should be driven by the precautionary principle that reasonable steps to reduce
risk should not await scientific certainty.”

Despite being in a state of emergency in BC, and requests for citizens to stay home and limit excursions from our homes, we have heard repeated assertions and mention of the economy as a reason why places where people work and live in close quarters have not been shut down.

From Page 4 of the same summary:

“The Commission therefore recommends:
‚ÄĘ That the precautionary principle, which states that action to reduce
risk need not await scientific certainty, be expressly adopted as a guiding principle throughout Ontario’s health, public health and worker
safety systems by way of policy statement, by explicit reference in all
relevant operational standards and directions, and by way of inclusion,
through preamble, statement of principle, or otherwise, in the
Occupational Health and Safety Act, the Health Protection and Promotion
Act, and all relevant health statutes and regulations.
‚ÄĘ That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of procedures, guidelines, processes and systems for the early detection and
treatment of possible cases.
‚ÄĘ That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of worker
safety procedures, guidelines, processes and systems.”

If these recommendations should be applied to health care and disease control within health systems, is it not prudent to assume they be applied to actions taken in all venues where disease transmission may occur rapidly?

How is it that the risk is great enough to consider releasing some non violent offenders from prison early, yet men who live, eat and work in close quarters in work camps, are not in the same category of risk? 

Where isn’t the precautionary principle applied¬† there? A serious question for the powers that be, particularly since we are now all defined as essential and non essential workers, to try and keep everyone who isn’t essential at home to break the chains of transmission.

There are photos circulating online of workers being taken to and from the Kinder Morgan work camp in buses. There are photos of men all working shoulder to shoulder on construction sites in downtown Vancouver. We know men were in isolation with flu like symptoms at the site C work camp. Mayor Lori Ackerman declared a local state of emergency over the concerns of what might happen, and was quickly reined in when Farnsworth then declared a provincial state of emergency which nullified her actions. The site C camp remains open as do others, yet one builder said the guidelines were too little, too late and shut down his sites, urging others to do the same. https://www.nanaimobulletin.com/news/construction-company-shuts-down-all-job-sites-says-new-b-c-guidelines-are-too-little-too-late/

How much did we actually learn from the SARS Commission? 

Which brings me to a key recommendation from the SARS Commission:

“1. Medical Independence and Leadership
Public confidence requires that the fight against infectious disease be driven by
medical expertise, free from bureaucratic or political pressure. The Commission, in its
first interim report, recommended more independence for the Chief Medical Officer
of Health. The government has made significant progress in that direction, by
amending the Health Protection and Promotion Act to give the Chief Medical Officer
of Health a greater measure of independence.”

When I hear appointed¬† health officials talk about keeping the economy going, mentioning the economy repeatedly, I’m not hearing a doctors concern, I’m hearing a politicians. It doesn’t matter if its a provincial official or a federal one, the economy is a politicians concern and that concern should not drive public health policy or decisions in a time of crisis, where it has been shown time and time again that early and aggressive intervention and restrictions work. We are not under draconian restrictions. We need essential services only during this time.

Should we be worried about the economy? Of course. But breaking chains of transmissions takes precedent above all. Or it should. Jacinda Arden had it right and continues to have strong support for her early and strong actions. Justin Trudeau might want to spend some of his alone time to take notes. https://www.straitstimes.com/asia/australianz/new-zealand-pm-ardern-declares-national-emergency-as-country-reports-47-new 

This is where I veer off into another issue: differing and contradicting experiences and opinions between medical professionals. Having read the full SARS Commission reports, I understand better perhaps, her rationale of testing on health care professionals and care homes and contacts.

As detailed in the SARS reports, their concerns were often ignored and negated during the SARS outbreaks and many became ill because proper precautions were not taken early on in the outbreak with regards to PPE, )personal protection equipment).

Instead of assuming the worst and taking the biggest protections early on, nurses and doctors only increased the protections as the risks became better known and bigger. This resulted in transmissions that should have been avoidable. This is directly mentioned within the report, as was the recommendation to require whistleblower protection for health professionals who come forward and speak out.¬† But Covid 19 isn’t SARS, and the infectious viral shedding periods are reportedly different.

Different professional opinions: Don’t kill the messenger and listen to the front lines.

In my last post, I brought the message from Dr. David Forrest, a calm but powerful message of caution and warning to practice physical distancing and self isolation and why. Many said he was over dramatic.

Last weekend Royal Columbian ER doctor Sean Wormsbecker posted a video to youtube, sharing his concerns that he was not allowed to test people who were sent home to self isolate. He said the province was lowballing numbers of postives by not testing people with symptoms who are in self isolation, and expressed concerns those people didnt take it seriously.

Dr. Bonnie Henry disagreed publicly yesterday in her daily update, saying she and her colleagues on the front lines were talking to people who self isolated. And maybe the people she has spoken to are, but many people are not being followed up on who have symptoms at home.

I don’t doubt that Dr. Henry is correct in her opinion. But I also don’t doubt that an ER doctor on the very front lines is correct in his either. Both have very different perspectives and experiences inherent to their positions right now. And its not hard to find news reports of doctors being threatened or fired in other jurisdictions for speaking out. It is prudent to point out that whistleblower protection was also a key recommendation in the SARS report to ensure those who speak up do not suffer employment loss or reprisals.

We are in a period right now with Covid-19 research, in which many different studies are already out and will continue to come out. It’s very common for different doctors and scientists to hold different views even in the face of scientific evidence. An example of this is the appearance by Dr. Patrician Daly on CBC yesterday, which is causing a lot of concern online today, because of what she said in a segment with respect to self isolation of foreign travellers, and with respect to transmission of the virus.

You can listen at this link, select the March 30th segment, and fast forward to the 54 minute mark: https://www.cbc.ca/listen/live-radio/1-4-bc-today

In her response  to the senior calling in to report a couple who refused to self quarantine after travelling, in a building of seniors, she says:

  1.  that returned travellers in mandatory quarantine are allowed to go out to do their essential services ( whats the point of quarantine if they go out into public ?)
  2.  travellers  that are supposed to be in self isolation with no symptoms pose no risk to others
  3.  repeats that if they have no symptoms they pose no risk
  4. Vancouver coastal health is not going out to enforce orders and relying on good will, or following up on federal quarantine orders.
  5. repeats again that people who have no symptoms pose no risk to the caller

Then we get to another caller Randall at the 1:01 mark,  who also asks about asymptomatic people spreading virus. She says:

  1.  We do not believe people who are asymptomatic spread the virus before they have symptoms or if they have no symptoms, again, there is no evidence asymptomatic people spread the virus.

This is showing to be inaccurate and gives mixed messaging to public who had many questions below a facebo

The CDC in the US is now saying the opposite, and in fact stating asymptomatic people are spreading it. That up to 25% may be capable of doing so.

More on this here:

https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us

And again,  If we learned anything from the SARS Commisions, it is that the precautionary principle dictates we do not wait for science to prove it, we must treat everyone as though they may have it, except those in our family bubbles who have not been out or about. This is a key guiding principle that must be followed in health and in dealing with the economic consequences of this pandemic.

Dr. Patricia Daly creates confusion when she says not to be concerned. This is why we wash our hands, it’s not just symptomatic people who can spray droplets. An asymptomatic person with virus can sneeze too, or touch their mouth or nose and then transfer that onto a doorknob. Seriously.

I’ve gone on too long, but this is important. This needs to be said. We are not seeing spikes yet but we are not through the next incubation period yet. We already know its spreading through our communities by community transmission now. We see the idiots having parties and gathering to pass a joint around between friends. And the order that gatherings of 50 people or less is ok, is still causing confusion. The messages must be simple numbered orders front page of every paper.

It’s incredibly important to stay home and stay safe. More than ever, anything that’s not essential shouldn’t be happening. In the end, it will be better to have looked like we went too far, rather than not far enough.Especially if it saves one of your friends or family.¬†

Until next post, here is the link to the full SARS reports. A compelling read right now.

 

http://www.archives.gov.on.ca/en/e_records/sars/report/v1.html

 

A message from Dr. David Forrest on Covid-19

Dr. David Forrest is an infectious disease specialist at NRGH and in the mid-island.

He has a history of being a strong patient and medical advocate for care and process, and has a strong powerful message to share. I strongly support our medical professionals in the best of times, but we have to come together as citizens to make sure as few people as possible get this virus. And Dr. Forrest explains in no uncertain terms why.

This is the clear, simple and powerful message every British Columbian needs to hear.

* source: https://m.facebook.com/story.php?story_fbid=10156542363696895&id=714446894

Please share.

 

Full appreciation for this messaging. Because as I said yesterday, you don’t get to put others at risk https://lailayuile.com/2020/03/22/you-do-not-get-to-put-others-at-risk/