Canada’s culture of silence on airborne virus transmission leaves many confused on how to best avoid infection

It’s the dog days of the pandemic. We continue to follow public health guidance, which is getting less restrictive, as we wait for vaccines to end this crisis. We have learned so much over the last year about how to better protect ourselves, including critical information that COVID is likely transmitted predominantly via airborne spread. And yet, many of our infectious disease and public health specialists — including our chief medical officers of health — seem to be unable to say the word “airborne” or “aerosol” out loud, and instead continue to emphasize measures such as deep cleaning and plexiglass panels. All major medical journals have recently published breakthrough pieces on airborne transmission. The Lancet, BMJ, JAMA, Science, the NEJM, Nature and our own CMAJ adeptly summarize the growing body of evidence supporting airborne transmission and advocate for improved mitigation measures. Both the CDC and the WHO have recently acknowledged the importance of short- and long-range aerosol spread of COVID-19.The droplet/contact paradigm favoured by public health sees sneezes or coughs creating droplets that either travel directly to the nose and mouth, or that land on surfaces touched by fingers that transmit the droplets to your mucous membranes. In contrast to the airborne mode of transmission for COVID-19, the droplet/contact route has seen no similar tsunami of peer-reviewed evidence. Indeed, the CDC has gone so far as to say that contact transmission is extremely rare: “each contact with a contaminated surface has less than a 1 in 10,000 chance of causing an infection.” Canada’s top public health organization, the Public Health Agency of Canada (PHAC), has produced strong, unbiased summaries of the evidence for airborne transmission. There have been three, each one with stronger language supported by the evidence. The March 2021 version is 60 pages long and covers 84 different primary studies, the vast majority supporting airborne transmission.But these summaries are very hard to find. They are not posted publicly, and PHAC has specifically requested that the reviews not be shared. In order to receive a copy, you first have to discover its existence, find the title and email PHAC for a copy. Evidently, our public health leaders have also not seen these documents, as they consistently dismiss the evidence. As such, Canadians remain confused as to the best methods of avoiding transmission. The focus is still on the neverending cleaning of surfaces and putting up splash guards (which are ineffective against airborne particles), instead of using properly fitting masks, moving our interactions outdoors, and improving our indoor air through ventilation upgrades (including easy solutions like opening windows and doors) and air filtration.This is not just an esoteric academic debate. Although cases are dropping, there are still over a thousand new cases per day nationally, now predominantly in children — of whom only those 12 and older can receive vaccinations. In addition, increasingly transmissible variants are beginning to appear. Hospital outbreaks continue across the country. For example, last week saw nine health care workers in Calgary’s Foothills Medical Centre infected with the new Delta variant in a hospital system where better-fitting masks (N95s) were available but discouraged and not used.Responding effectively to a health crisis that impacts all Canadian citizens is not an easy task. Agencies such as PHAC consistently face immense pressure to devise the best plans of action during a rapidly changing emergency. While acknowledging these challenges, it is still crucial to ensure that public health leaders act swiftly when the scientific consensus shifts in an important new direction.Wider transparency on what we now know about the airborne spread of COVID-19 would have a far-reaching impact on keeping people healthy. Talking about it is the first step in ensuring that people, schools and businesses are empowered enough to protect themselves and re-open safely. The understanding of viral aerosolization will be seen as one of the most important scientific advances of the COVID-19 pandemic. But what is the purpose of knowledge if it is not translated into practice?If our public health leaders can accept the science, they can teach the public the fundamentals of COVID-19 transmission, and we can all make the right decisions to prevent more unnecessary illness, long COVID and deaths.Dr. Joe Vipond and Dr. Kashif Pirzada are emergency physicians and two of the co-founders of Masks4Canada. Danielle Cane is a master’s student studying infectious diseases and is a member of Masks4Canada.

Canada’s culture of silence on airborne virus transmission leaves many confused on how to best avoid infection

It’s the dog days of the pandemic. We continue to follow public health guidance, which is getting less restrictive, as we wait for vaccines to end this crisis. We have learned so much over the last year about how to better protect ourselves, including critical information that COVID is likely transmitted predominantly via airborne spread.

And yet, many of our infectious disease and public health specialists — including our chief medical officers of health — seem to be unable to say the word “airborne” or “aerosol” out loud, and instead continue to emphasize measures such as deep cleaning and plexiglass panels.

All major medical journals have recently published breakthrough pieces on airborne transmission. The Lancet, BMJ, JAMA, Science, the NEJM, Nature and our own CMAJ adeptly summarize the growing body of evidence supporting airborne transmission and advocate for improved mitigation measures. Both the CDC and the WHO have recently acknowledged the importance of short- and long-range aerosol spread of COVID-19.

The droplet/contact paradigm favoured by public health sees sneezes or coughs creating droplets that either travel directly to the nose and mouth, or that land on surfaces touched by fingers that transmit the droplets to your mucous membranes. In contrast to the airborne mode of transmission for COVID-19, the droplet/contact route has seen no similar tsunami of peer-reviewed evidence. Indeed, the CDC has gone so far as to say that contact transmission is extremely rare: “each contact with a contaminated surface has less than a 1 in 10,000 chance of causing an infection.”

Canada’s top public health organization, the Public Health Agency of Canada (PHAC), has produced strong, unbiased summaries of the evidence for airborne transmission. There have been three, each one with stronger language supported by the evidence. The March 2021 version is 60 pages long and covers 84 different primary studies, the vast majority supporting airborne transmission.

But these summaries are very hard to find. They are not posted publicly, and PHAC has specifically requested that the reviews not be shared. In order to receive a copy, you first have to discover its existence, find the title and email PHAC for a copy.

Evidently, our public health leaders have also not seen these documents, as they consistently dismiss the evidence. As such, Canadians remain confused as to the best methods of avoiding transmission. The focus is still on the neverending cleaning of surfaces and putting up splash guards (which are ineffective against airborne particles), instead of using properly fitting masks, moving our interactions outdoors, and improving our indoor air through ventilation upgrades (including easy solutions like opening windows and doors) and air filtration.

This is not just an esoteric academic debate. Although cases are dropping, there are still over a thousand new cases per day nationally, now predominantly in children — of whom only those 12 and older can receive vaccinations. In addition, increasingly transmissible variants are beginning to appear. Hospital outbreaks continue across the country. For example, last week saw nine health care workers in Calgary’s Foothills Medical Centre infected with the new Delta variant in a hospital system where better-fitting masks (N95s) were available but discouraged and not used.

Responding effectively to a health crisis that impacts all Canadian citizens is not an easy task. Agencies such as PHAC consistently face immense pressure to devise the best plans of action during a rapidly changing emergency. While acknowledging these challenges, it is still crucial to ensure that public health leaders act swiftly when the scientific consensus shifts in an important new direction.

Wider transparency on what we now know about the airborne spread of COVID-19 would have a far-reaching impact on keeping people healthy. Talking about it is the first step in ensuring that people, schools and businesses are empowered enough to protect themselves and re-open safely.

The understanding of viral aerosolization will be seen as one of the most important scientific advances of the COVID-19 pandemic. But what is the purpose of knowledge if it is not translated into practice?

If our public health leaders can accept the science, they can teach the public the fundamentals of COVID-19 transmission, and we can all make the right decisions to prevent more unnecessary illness, long COVID and deaths.

Dr. Joe Vipond and Dr. Kashif Pirzada are emergency physicians and two of the co-founders of Masks4Canada. Danielle Cane is a master’s student studying infectious diseases and is a member of Masks4Canada.

Source : Toronto Star More   

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One hundred years apart, they fought for Indigenous children. He lost. She keeps winning

OTTAWA—Last week, Cindy Blackstock stood beside the grave of a man who, more than a century ago, sounded the alarm about children dying in Canada’s residential schools. Dr. Peter Henderson Bryce, a non-Indigenous medical doctor and civil servant, warned the federal government in 1907 that poor ventilation and overcrowding was fuelling the spread of tuberculosis in residential schools across Western Canada, and that children were dying at alarming rates. His report demanded an “immediate remedy,” but the government did not act. Blackstock, a child welfare activist and McGill University professor, had come to his grave at a pivotal moment in her own battle. She was about to take on the federal government in court — again — over systemic discrimination against First Nations children.“I feel a kinship with him in many ways, even though we’re 100 years apart,” said Blackstock, executive director of the First Nations Child and Family Caring Society of Canada, and a member of the Gitxsan First Nation. “I always think he must have felt like he was screaming into silence. And sometimes I feel that way, too.” Bryce was sidelined for being a whistleblower and ultimately pushed out of public service. He died in 1932, when he was 80. His gravestone sits under a canopy of trees in Ottawa’s Beechwood Cemetery, a grand 160-acre resting place with winding roads, hiking trails, extravagant gardens and tombstones dating back to the 19th century. Bryce felt certain that the public, hearing his account of conditions in residential schools, would demand change from the government. That didn’t happen. The story faded from the headlines and the public consciousness.The question on Blackstock’s mind as she visited Bryce’s grave last week was: Are people finally ready to act?For 14 years, Blackstock has been fighting the federal government on behalf of First Nations children. The legal battle started in 2007 when she filed a human rights complaint alleging the government was discriminating against them by underfunding the child-welfare system. This week, Prime Minister Justin Trudeau’s government moved forward with a controversial legal challenge, seeking to overturn two Canadian Human Rights Tribunal rulings that found, among other things, the government had wilfully and recklessly discriminated against First Nations children by underfunding child welfare services, which incentivized removing them from their families.The government does not deny the discrimination, but considers the tribunal’s award of $40,000 for each victim or their family an “overreach of jurisdiction.”Blackstock, along with lawyers representing the First Nations Child and Family Caring Society of Canada, the Assembly of First Nations and other groups, made their arguments this week in Federal Court.Blackstock had hoped the government would back down from this fight amid calls from opposition leaders and the public to do so, especially after news in late May that the remains of 215 Indigenous children had been discovered on the grounds near the former Kamloops Indian Residential School — a stark reminder of historical injustices that persist today. Many of those children might have lived if Canada had heeded Bryce’s warnings, Blackstock said. And more may suffer, she added, if we fail to address problems that persist today. Bryce’s “greatest lament was that the work did not get done,” she said. “And so that’s the question for all of us: Are we going to get the work done this time?”Arriving at the cemetery days before she returned to court, Blackstock walked carefully down a steep grassy hill to reach Bryce’s grave. “Someone has been here since I came last time,” she said. There were new gifts placed on top of the headstone — tobacco pouches, dried flowers, small rocks carried from communities across the country. Blackstock had recently placed pinwheels around the grave, “to represent the joyousness of children,” she said. “And to let them know that this was a person who was looking out for them.” Blackstock first visited the grave in 2008, a year into her court battle with the federal government and the day before then-Prime Minister Stephen Harper made a formal apology to residential school victims. At that time, the only regular visitors were Bryce’s family members. Blackstock wanted to change that.She started by sprucing the place up. She brought a garden shovel and dug a few inches into the earth around the headstone to create a small flower bed, unaware that doing so was against cemetery rules. The garden stayed. Planted around it are red geraniums, a lavender bush, healing plants like echinacea. An orange plaque amongst the flowers bears the words “Every Child Matters,” a gift from a high school class.Blackstock developed a relationship with Bryce’s family and is now the caretaker of his grave. She shares his story widely and has turned the burial site into a place of learning and reflection. School groups make trips to learn about Bryce. “When they come,

One hundred years apart, they fought for Indigenous children. He lost. She keeps winning

OTTAWA—Last week, Cindy Blackstock stood beside the grave of a man who, more than a century ago, sounded the alarm about children dying in Canada’s residential schools.

Dr. Peter Henderson Bryce, a non-Indigenous medical doctor and civil servant, warned the federal government in 1907 that poor ventilation and overcrowding was fuelling the spread of tuberculosis in residential schools across Western Canada, and that children were dying at alarming rates. His report demanded an “immediate remedy,” but the government did not act.

Blackstock, a child welfare activist and McGill University professor, had come to his grave at a pivotal moment in her own battle. She was about to take on the federal government in court — again — over systemic discrimination against First Nations children.

“I feel a kinship with him in many ways, even though we’re 100 years apart,” said Blackstock, executive director of the First Nations Child and Family Caring Society of Canada, and a member of the Gitxsan First Nation. “I always think he must have felt like he was screaming into silence. And sometimes I feel that way, too.”

Bryce was sidelined for being a whistleblower and ultimately pushed out of public service. He died in 1932, when he was 80. His gravestone sits under a canopy of trees in Ottawa’s Beechwood Cemetery, a grand 160-acre resting place with winding roads, hiking trails, extravagant gardens and tombstones dating back to the 19th century.

Bryce felt certain that the public, hearing his account of conditions in residential schools, would demand change from the government. That didn’t happen. The story faded from the headlines and the public consciousness.

The question on Blackstock’s mind as she visited Bryce’s grave last week was: Are people finally ready to act?

For 14 years, Blackstock has been fighting the federal government on behalf of First Nations children. The legal battle started in 2007 when she filed a human rights complaint alleging the government was discriminating against them by underfunding the child-welfare system.

This week, Prime Minister Justin Trudeau’s government moved forward with a controversial legal challenge, seeking to overturn two Canadian Human Rights Tribunal rulings that found, among other things, the government had wilfully and recklessly discriminated against First Nations children by underfunding child welfare services, which incentivized removing them from their families.

The government does not deny the discrimination, but considers the tribunal’s award of $40,000 for each victim or their family an “overreach of jurisdiction.”

Blackstock, along with lawyers representing the First Nations Child and Family Caring Society of Canada, the Assembly of First Nations and other groups, made their arguments this week in Federal Court.

Blackstock had hoped the government would back down from this fight amid calls from opposition leaders and the public to do so, especially after news in late May that the remains of 215 Indigenous children had been discovered on the grounds near the former Kamloops Indian Residential School — a stark reminder of historical injustices that persist today.

Many of those children might have lived if Canada had heeded Bryce’s warnings, Blackstock said. And more may suffer, she added, if we fail to address problems that persist today.

Bryce’s “greatest lament was that the work did not get done,” she said. “And so that’s the question for all of us: Are we going to get the work done this time?”

Arriving at the cemetery days before she returned to court, Blackstock walked carefully down a steep grassy hill to reach Bryce’s grave. “Someone has been here since I came last time,” she said. There were new gifts placed on top of the headstone — tobacco pouches, dried flowers, small rocks carried from communities across the country. Blackstock had recently placed pinwheels around the grave, “to represent the joyousness of children,” she said. “And to let them know that this was a person who was looking out for them.”

Blackstock first visited the grave in 2008, a year into her court battle with the federal government and the day before then-Prime Minister Stephen Harper made a formal apology to residential school victims. At that time, the only regular visitors were Bryce’s family members. Blackstock wanted to change that.

She started by sprucing the place up. She brought a garden shovel and dug a few inches into the earth around the headstone to create a small flower bed, unaware that doing so was against cemetery rules. The garden stayed. Planted around it are red geraniums, a lavender bush, healing plants like echinacea. An orange plaque amongst the flowers bears the words “Every Child Matters,” a gift from a high school class.

Blackstock developed a relationship with Bryce’s family and is now the caretaker of his grave. She shares his story widely and has turned the burial site into a place of learning and reflection. School groups make trips to learn about Bryce. “When they come, we blow bubbles,” Blackstock said, removing a tube from her bag and waving the wand in the spring breeze to demonstrate. “Each bubble represents the dreams of a child.”

Blackstock visits the grave often. She trudged through snow after the Canadian Human Rights Tribunal victory in January 2016 and read excerpts from that 226-page ruling to Bryce. With a smile, she added: “Then I went over the hill and read it to Duncan Campbell Scott.”

Buried at Beechwood are some of Canada’s most notorious historical figures, including Scott, a poet and public servant who oversaw the residential school system and whose professional goal was to “get rid of the Indian problem.”

Scott, deputy superintendent of the Department of Indian Affairs, was Bryce’s nemesis. He thwarted Bryce’s efforts to improve health conditions in residential schools and halted funding for his annual reports, said the historian John Milloy.

“Bryce went up against a disinterested public and a very determined civil servant,” Milloy said. “He wasn’t the only one that Duncan Campbell Scott chopped off at the knees.”

Milloy, with Blackstock and others, worked with Beechwood a few years ago to update Scott’s graveside plaque with a more complete account of his life’s work. The historical profile now acknowledges his leadership role in the “assimilationist” Indian residential school system and cites the 2015 Truth and Reconciliation Committee report, which found that the institutions “amounted to cultural genocide.”

In 1907, as medical inspector to the Department of the Interior and Indian Affairs, Bryce visited 35 residential schools in Manitoba, Saskatchewan and Alberta. What he found shocked him: defective sanitary conditions, poor ventilation, inadequate air quality. Administrators had limited understanding of how disease spreads and minimized the “ever-present danger of infection,” he wrote in a report.

Surveys collected from some of the schools showed that 25 per cent of Indigenous students had died of tuberculosis, while at one school 69 per cent of former pupils were dead.

His report, which came at a time before bureaucratic jargon, makes a blunt case for immediate remedy: “We have created a situation so dangerous to health that I was often surprised that the results were not even worse than they have been shown statistically to be.”

Bryce faced career repercussions for speaking out. The government suspended funding for his research, prevented him from speaking at academic conferences and blocked him from positions within the federal civil service. Forced into retirement in the early 1920s, he wrote a tell-all book lamenting that “this trail of disease and death has gone on almost unchecked.”

In a letter from that time, Bryce wrote that people like Duncan Campbell Scott were “counting upon the ignorance and indifference of the public to the fate of the Indians.” Bryce believed there would be an “awakening of the health conscience of the people” — that the public would ultimately hold the government accountable.

There was no such awakening. The story faded from headlines. The public moved on. The government did little to change. Blackstock has seen that pattern repeat throughout history. Decade after decade, Indigenous children have been taken from their families, through residential schools, the Sixties Scoop, the child-welfare system. The public outrage comes in waves, but fades before there is real change.

That is why the story of Bryce is so important to Blackstock. “He puts a red-hot poker stick into the myth that people back then didn’t know any better,” she said.

“We have this way of erasing these people who were of that period who were speaking up against this inhumanity.” Focusing on the past, she said, allows us to avoid the major issue: “We are the people of this period. We know better. And the question is whether we’re going to do better.”

Will change come? Blackstock believes so. The younger generation gives her hope.

When she began her court battle with the federal government in 2007, there was little interest in the hearings. In 2009, a high school class showed up. That group went back and told others about it. More students came. By 2012, “the courtroom was so full we’d book them in in shifts,” she said.

Blackstock believes we are moving further away from the “ignorance and indifference” Scott counted on and closer to the “awakening” Bryce hoped for. “If we educate children, then they grow up knowing these injustices and not making excuses for them,” Blackstock said.

Over five days in court this week, lawyers representing the federal government and First Nations children made their arguments. Days or weeks from now, when the decision comes in, Blackstock will once again walk down the grassy hill to Bryce’s grave to share the news of what she is convinced will be a win for children.

Amy Dempsey is a Star reporter and feature writer based in Ottawa. Follow her on Twitter: @amydempsey

Source : Toronto Star More   

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