The Conversation

Ecology & Evolutionary Biology

Faculty of Arts & Science

University Health Network

Even before COVID-19, Megan Frederickson had her hands full as the mother of a six-year-old boy and as a tenured professor managing a lab, grants and graduate students. Now, with kids out of school and daycare, things have become even more challenging – and Frederickson suspected she was not alone.

“The scientist in me wondered whether I could measure the pandemic's effect on the productivity of male and female researchers,” she writes in The Conversation.

Frederickson, an associate professor in ecology and evolutionary biology in the ��߲ݴ�ý's Faculty of Arts & Science, conducted a gender analysis of papers submitted to pre-print servers for researchers in STEM subjects shortly before and during the COVID-19 lockdown. She found that the number of male pre-print authors is currently growing faster than the number of female pre-print authors, suggesting women are not getting as much research done as men during the pandemic.

There are no easy solutions to fixing the gender imbalances in care-giving and domestic labour, Frederickson notes.

“I will remember to count my many blessings, because a few less papers is nothing compared to the lives and livelihoods lost because of COVID-19,” she writes. “But a part of me will always wonder what discoveries women scientists might have made were it not for this pandemic and the setback it is causing to the hard-won progress of women in STEM.”

Read the full op-ed at the Conversation

How medical experts are deciding which treatments should be used for COVID-19: U of T expert

Christopher.Sorensen — Fri, 01 May 2020 14:22:38 +0000

How medical experts are deciding which treatments should be used for COVID-19: U of T expert

Christopher.Sorensen Fri, 05/01/2020 - 10:22

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A nurse puts on personal protective equipment before entering a patient’s room in a COVID-19 intensive care unit (photo by Jonathan Hayward/Canadian Press)

Topic

Ontario doctors and scientists have formed two high-powered committees to sift through the mountain of often conflicting and even dangerous scientific studies on how best to treat patients with COVID-19.

The two committees – one charged with recommending the most effective drugs and the other with how best to manage critical illness – were formed to ensure treatment for patients hospitalized with the novel coronavirus in Ontario is based on the best science available.

Dr. Andrew Morris, an infectious disease specialist at the University Health Network and Mount Sinai Hospital in Toronto, as well as a professor in the ��߲ݴ�ý’s Faculty of Medicine, is the chair of the committee focused on providing drug guidance, called the Clinical Practice Guidelines for Antimicrobial and Immunomodulatory Therapy in Adult Patients with COVID-19.

This 20-member antimicrobial committee formed in March includes infectious disease specialists, pharmacists, ethicists and even a patient who has recovered from COVID-19. As Morris puts it, he and his colleagues felt, “There was a sense of impending doom and we needed to be prepared to have something to offer people.”

Weighing evidence against emotion

The deluge of recommendations for COVID-19 remedies – some from experts, others from amateurs – underlines the importance of the two committees’ work. For example, medications, such as the anti-malaria drug hydroxychloroquine, are being used and stockpiled worldwide despite dangerous side-effects and little evidence of effectiveness against COVID-19.

The anti-malaria drug hydroxychloroquine was hyped as a possible treatment for COVID-19 despite a lack of evidence (photo by John Locher/AP Photo)

As a veteran in the treatment of lethal infections, Morris says, “People, if given the chance, will over-treat based on emotion and not on cognition. They will choose emotion nine times out of 10.”

Morris says even the most evidence-based physicians have been swayed by the lure of hydroxychloroquine as a readily available treatment.

“It has turned out to be a total scam,” he says. “It was clear there was no peer review, and no hard data on the benefit.”

The antimicrobial committee recommended overwhelmingly in mid-April against prescribing hydroxychloroquine, even for the sickest patients.

They have tried to be cautious in their recommendations because, as Morris says, “None of the drugs available so far are designed specifically to treat COVID-19. The likelihood of a game-changing treatment at this point in time is incredibly small.”

Starting from scratch

There are no national or provincial guidelines for the treatment of most infectious diseases. So, the committee — all volunteers — has worked entirely from scratch to develop its recommendations and disseminate them to health-care providers.

Ontario Health has helped disseminate the committee’s recommendations for the use of antimicrobial drugs against COVID-19.

Transmission electron micrograph of SARS-CoV-2 virus particles. Image captured and colour-enhanced at the NIAID Integrated Research Facility (NIAID, CC BY)

The committee has so far not recommended any medications unless a patient is enrolled in an approved clinical trial. One reason, Morris says, is based on his infectious disease expertise and experience with COVID-19: “The human body and nature will actually do a decent job of fighting the infection. Unless we know what we are doing, the worst thing we can do is harm patients with COVID-19.”

Evidence-based critical care

For the sickest patients in intensive care units, a committee of critical care specialists formed the ��߲ݴ�ý Interdepartmental Division of Critical Care COVID Working Group to provide care guidance. It was formed in March, at the same time as the antimicrobial committee.

This group advises critical care providers in Ontario on the most up-to-date management of COVID-19 and how to prevent it spreading in hospitals.

Dr. Nava Maham, a critical care specialist at the University Health Network and a member of the committee says, “Our job is to apply evidence-based practice that we know works, provides a benefit to patients and does not harm them.”

Five critical care physicians from Toronto’s largest academic hospitals comprise the committee. These doctors care for Ontario’s sickest COVID-19 patients, even as they update the guidelines twice each week.

The committee advising on care for critically ill COVID-19 patients in intensive care units is made up of five critical care specialists (photo by Jonathan Hayward/Canadian Press)

Reflecting on her dual responsibilities, Maham says, “[COVID-19] is something we are all consumed by. There are no business hours during this pandemic. We are either taking care of patients with critical illness or desperately trying to keep up with the literature, and keep our guidelines as up-to-date and as helpful as possible.”

Maham and her colleagues on the committee receive daily input from physicians across Ontario and from heavily hit areas, such as Italy.

“I feel that we know as much as anyone anywhere else in the world given the level of collaboration we are seeing,” she says.

The temptation of unproven treatments

Like Morris, Maham is wary of unproven therapies.

“There is a human desire to want to do something,” she says. “There is a feeling that if you are administering a drug, then it feels better than doing nothing.”

However, except for approved clinical trials, she cautions that health-care providers should resist the urge to test therapies on patients.

“Because we know these could come with significant and serious harm,” she says.

She is optimistic the two new committees will prevent harm to Ontario patients.

“People are working around the clock to ensure that we give every patient the best chance to recover, and they can feel comfortable knowing their care will be guided with the best available evidence.”

Catherine Varner is an emergency physician and an assistant professor in the department of family and community medicine at the Faculty of Medicine at the ��߲ݴ�ý.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Even during the coronavirus pandemic, public health workers' role is unrecognized: U of T's Vivek Goel

Christopher.Sorensen — Wed, 29 Apr 2020 19:54:46 +0000

Even during the coronavirus pandemic, public health workers' role is unrecognized: U of T's Vivek Goel

Christopher.Sorensen Wed, 04/29/2020 - 15:54

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Anthony Fauci, left, director of the National Institute of Allergy and Infectious Diseases, speaks with Robert Redfield, director of the Centers for Disease Control and Prevention, at a congressional hearing in March (photo by Patrick Semansky/AP Photo)

Vivek Goel

Topic

Our Community

Public Health

Ontario Institute for Studies in Education

Vivek Goel

The recent One World: Together at Home virtual concert brought together musical talent from around the world to thank front-line health workers and raised about US$128 million to support COVID-19 response efforts globally. Celebrities and politicians thanked those on the front lines of the response, including health-care workers and scientists working on COVID-19, those working in the food supply chain, as well as sanitation, delivery and mail workers.

However, nobody acknowledged all the people in public health agencies who have been working tirelessly during this crisis. This includes public health nurses and physicians, health inspectors and educators, laboratory technicians, epidemiologists and statisticians.

These are the people who work in the background to keep us healthy. They process the tests that identify who has the disease. They produce the statistics and models that track how the disease is progressing through our countries.

The lack of acknowledgement doesn’t surprise me. The work of public health is invisible, largely unrecognized by society. Despite increases to general spending on medical services, public health agencies are regularly subjected to budget cuts.

Fixation on front-line workers

I say this not just as a disgruntled public health specialist, upset to see my colleagues overlooked. There is something much more significant about our society’s fixation on front-line health care and medical approaches to disease management.

For the past century we have medicalized disease prevention and management for both infectious and chronic diseases. We focus on early detection and treatment (known as screening) and therapies (chemoprophylaxis) for disease prevention. Such medical models run counter to what is known as population health.

Lady Gaga was the driving force behind the One World: Together at Home virtual concert that paid tribute to front-line health-care workers (YouTube/Global One)

In a population health approach, we consider everyone and examine what keeps people healthy. Social and economic determinants of health are much more strongly related to health outcomes than biologic factors.

A population health approach promotes healthy living, healthy environments and healthy social policies balanced with appropriate medical interventions for those who need them. For example, risk of cardiovascular disease can be reduced through a focus on physical activity, good nutrition and smoking cessation. Population health approaches look at the environment in which people live and ensure they have the means and access to services to lead healthy lives.

In contrast, the medical model might focus on finding the people at highest risk for cardiovascular disease through screening tests and then prescribing them drugs. Research has consistently shown that a population health approach has greater impact on health status and is more equitable across society.

Losing sight of larger perspective

What does this mean for our responses to COVID-19? The narrative to date has been dominated by the medical model – testing and the search for treatments, ICU beds and ventilators.

Many people, like these residents of Toronto, pay tribute every night to front-line health-care workers. Those who work in public health away from the front lines should also be recognized. (photo by Frank Gunn/Canadian Press)

We absolutely do need to focus on these factors to ensure we can treat those who develop severe disease. But this fixation has come at the expense of the population health perspective.

And I mean this literally. Newscasts are dominated by clinicians on the front lines and those with a biomedical perspective. How often have we seen Anthony Fauci, the head of the U.S. National Institute of Allergy and Infectious Diseases, versus Robert Redfield, the head of the U.S. Centers for Disease Control and Prevention? Fauci has done an incredible job, but the perspective of Redfield is also important.

The medical model has focused on the immediate needs. To get us out of this, the medical model points to a vaccine – which could take years to roll out – as the solution.

A population health perspective to COVID-19 considers the impact on the entire population, not just those with disease. It applies an equity lens to ensure no one gets left behind. A population health perspective will consider whether the consequences of continuing our current restrictive measures will cause more harm than good in the long run.

Socio-economic status is the strongest determinant of health. Long-term economic harm may have greater health consequences than COVID-19. But the deaths from COVID-19 are visible and in the news. The deaths that might result from the economic consequences will only be seen in statistics – we won’t know who was directly affected. They will be invisible, just like public health.

We need to thank our public health workers. We also need to listen to them.

Vivek Goel is a professor at the Dalla Lana School of Public Health and vice-president of research and innovation, and strategic initiatives at the ��߲ݴ�ý.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID-19 discriminates against Black lives via surveillance, policing and lack of data: U of T experts

Christopher.Sorensen — Tue, 21 Apr 2020 13:31:37 +0000

COVID-19 discriminates against Black lives via surveillance, policing and lack of data: U of T experts

Christopher.Sorensen Tue, 04/21/2020 - 09:31

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A woman waits for a streetcar in Toronto on April 16, 2020. Many Black community members who work in essential jobs do not have the luxury of staying home during the pandemic (photo by Nathan Denette/Canadian Press)

Topic

Rubén Gaztambide-Fernández

U of T Mississauga

Women and Gender Studies

The claim that COVID-19 and its associated medical and social responses do not discriminate belies the history of how pandemics work and who is most impacted by them. States of emergency show that citizenship privileges some, is partial for others and disappears others.

In our early analysis of national media coverage, those experts sharing the grim statistics of infections and deaths, those front-line workers seen as risking their lives and those who have lost loved ones are predominantly white. Black, Indigenous and racialized people, and many whose lives have been further imperilled by this pandemic, remain virtually disappeared from the Canadian landscape.

That makes collective care for members across our communities untenable. We take pause and reflect on how this will impact Black people across economy, health and policing, to name three areas of concern.

Black people tend to be employed in low-paying and highly feminized jobs: These include clerical jobs, janitorial staff, orderlies and nursing assistants who are now determined as essential services. Black people are also more likely to work in the grey and underground economy, which are forms of labour that might involve payments outside the regular labour force and taxation system, and not counted in GDP.

Effectively, anti-Black racism has already ensured that Black people and undocumented residents are less-than-citizens in late modern capitalist Canada. Yet, the people who are likely most at risk are the ones who are being asked to sacrifice their lives. Collectively, Black people in Canada find themselves among the most disadvantaged in all indicators of what is considered a “good life.”

Policing the pandemic

The attempt to interrupt the spread of the virus has brought together policing and public health. Since at least the post-emancipation period in the Americas – and this period includes Canada – public health and policing have been launched against Black communities. Both public health and policing depend on assessing Black people as wayward.

In the post-emancipation Americas, early public health campaigns sought to “train” Black women on child rearing, cleanliness of homes and food preparation. Indeed, as late as the 1960s, one of the justifications for the destruction of Africville, N.S., was the public health claim that the community was at a health risk as there was no sewage system. Instead of providing necessary services, the community was forcibly removed.

Public health has historically been an extension of policing for Black people that has positioned us as suspicious and nefarious in our actions and movements. In our current state of emergency, this union of policing and public health has led to more Black people being arrested, detained and physically restrained in the name of public health protection.

The current rules around movement put Black people at risk, more vulnerable to intensified policing (including carding and street checks) when in public and potentially exposed to the virus at work.

Disavowing the data

On CBC radio’s The Current, Simon Fraser University’s June Francis recapped a conversation she had with a senior federal official in which she raised concerns regarding Black people’s health. Instead of acknowledging this need for data, Francis said the senior federal official told her: “Canada is a colour-blind society and [she] shouldn’t expect that race-based data is necessary.”

On April 9, during a public conversation with the Preston Community COVID-19 Response team and African Nova Scotian communities, Nova Scotia’s chief medical officer, Robert Strang, said now was not the time to focus on how the social determinants of health and “longstanding issues” are impacting Black communities during this pandemic. He said: “We can focus on these issues later.”

On April 10, Ontario’s chief medical health officer, David Williams, said as the province fights to contain the coronavirus, disaggregated race-based data is not necessary.

We know differently. The HIV and AIDS responses in Canada show that public health and policing result in criminalization and incarceration for Black people. To ask us to suspend our understanding of these intimate links is to ask us to contend with the possibility of our own demise.

Pandemics do discriminate

Claims of colour-blind health care and approaches to the COVID-19 pandemic are concerning. The data from elsewhere, including the United States and the United Kingdom, sounds an alarm for Canada.

Emerging American data reveal that Black people are contracting the virus at higher rates and also are dying in higher numbers.

Dr. Chaand Nagpaul, head of the British Medical Association, called on the U.K. government to urgently investigate why Black, Asian and minority ethnic people are more vulnerable to COVID-19.

While some provincial public health officers in Canada claim to be concerned about all citizens and committed to everyone’s health, they simultaneously declare that now is not the time to address the social determinants of health or to begin the collection of disaggregated race-based data. In other words, they refuse to address how racial discrimination negatively impacts the health of Black people.

The absence of such plans, however, is indeed evidence of Black people’s partial citizenship and not-yet-quite citizenship.

In fact, our health officials must meet these demands for data. Accounting for how the virus impacts Black communities differently would actually demonstrate care.

Since the pandemic, we have heard of many Black women and their families in Toronto being evicted and made homeless. We have come to know that many are dealing with increased violence in the narrowly confined spaces they now live in, and are unable to access income support. Despite successful efforts to open health care to all, regardless of immigration status, the Toronto Star reported that some people in Toronto seeking emergency treatment had to pay $500 or risk not being treated.

Racism, poverty, incarceration, limited literacy, over-crowded living conditions, lack of social supports and limited access to health services are chronic conditions that must be considered during this pandemic.

Black lives are further in peril in a time of COVID-19. Subject to death on both the public health and policing fronts, we will not be silent. Even as state public officials choose to ignore our lives and livability by insisting that race and class do not matter, the historical and contemporary evidence in this country demonstrates more than otherwise.

Beverly Bain is a lecturer in the Women and Gender Studies program at ��߲ݴ�ý Mississauga. OmiSoore Dryden is an associate professor and the James R. Johnston Chair in Black Canadian Studies at Dalhousie University. Rinaldo Walcott is a professor at the Ontario Institute for Studies in Education and the director of Women and Gender Studies Institute at the ��߲ݴ�ý.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is solidarity? During coronavirus and always, it's more than 'we're all in this together': U of T expert

Christopher.Sorensen — Mon, 20 Apr 2020 13:28:47 +0000

What is solidarity? During coronavirus and always, it's more than 'we're all in this together': U of T expert

Christopher.Sorensen Mon, 04/20/2020 - 09:28

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A woman claps above a banner reading “everything will be all right,” in Rome. This phrase has appeared on social media and at balconies and windows across Italy as the country faces coronavirus (photo by Roberto Monaldo/LaPresse via AP)

Topic

Our Community

Ontario Institute for Studies in Education

Medical researchers around the world are involved in an unprecedented collaboration to test experimental treatments for COVID-19. When Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO), announced the initiative in mid-March, he called it the “solidarity trial.”

Across the globe, local expressions of solidarity appear to be spreading as individuals take it upon themselves to act on behalf of others in need.

From the WHO to government leaders and citizen actions, expressions of solidarity may appear to be a good and common-sense response to the crisis. Yet, as American author Barbara Ehrenreich suggests, fascists, religious zealots or nations at war also unite in solidarity to advance their agendas. Some groups can mobilize solidarity for destructive purposes.

While solidarity may be a fundamental human need, the meaning of solidarity and what it requires of us is elusive. In my work, I explore how realizing solidarity depends on education. Teaching for solidarity requires relationships, intentions and actions grounded in explicit ethical and political commitments. I am interested in how the values that underpin these commitments define the differences between “us” and “them.”

Whether we are confronting a pandemic, global warming, income inequality, racism or gender-based violence, solidarity depends on how we come together. It is defined by how we understand and enact our responsibilities to, and relationships with, each other.

People stand on their balconies for a physically distant show of social support amid the coronavirus outbreak, in Milan, Italy, in March 2020 (photo by Claudio Furlan/LaPresse via AP)

Equally responsible for a debt

The word solidarity has its roots in the Roman law of obligation that held a group of people bound together – in solidum – as equally responsible for a debt. The contemporary uses of the concept go back to the French Revolution and the ideal of human solidarity articulated by philosopher and “champion of socialism,” Pierre Leroux.

For Leroux, solidarity was necessary for human well-being and flourishing. But in their 1848 Communist Manifesto, Karl Marx and Friedrich Engels conceptualized solidarity as an expression of the shared experience and specific political needs of the working class.

Solidarity has also been a central concept in Catholic social teachings since the end of the 19th century. It figures prominently in liberation theology, in which solidarity and communion with the poor is a fundamental spiritual commitment.

This brief history illustrates that solidarity depends on some idea of what it means to be “us.” In my forthcoming book, I explore the educational challenges that arise when people invoke solidarity in colonial societies.

I examine what happens when solidarity is contingent on others being more like us, thinking more like us and believing what we believe.

Universalistic solidarity

German philosopher Kurt Bayertz points to four uses of the concept of solidarity.

The first, universalistic solidarity, suggests all human beings have a moral duty to work together for the benefit of all. This is implied whenever someone says “we’re all in this together.”

While compelling, this view of solidarity ignores differences and potential conflict between the needs and values of different groups. It overshadows how the impact of a crisis isn’t equal among different groups.

Civic solidarity

The essence of civic solidarity is that we don’t necessarily have a personal relationship with those on whose behalf we take action. Civic solidarity involves an indirect commitment through taxes or charity contributions. Practising physical distancing is also an act of civic solidarity.

Lacking a personal sense of connection to and reciprocity with those who benefit from civic solidarity can undermine solidarity efforts, which may lead to the need for legal enforcement.

Social solidarity

Bayertz’s third use, social solidarity, refers to how societies stick together, but also to how certain groups act together as a community to protect their interests.

Maclean’s magazine contributing editor Stephen Maher suggests that in the United States, Donald Trump supporters’ acceptance of the president’s early response to the virus, which downplayed its possible impact, reflected low levels of social solidarity.

But this is misleading. Trump’s right-wing conservative supporters don’t lack social solidarity. Rather, their sense of solidarity coheres around a commitment to ideals of freedom from restrictions and protecting their financial resources and investments as a way to ensure their own well-being.

Likewise, there is a strong sense of solidarity among conservative religious groups that rely on Christian faith over science to protect themselves.

A strong sense of social solidarity is crucial for advancing all kinds of political agendas and values.

People prepare places to sleep in a parking lot acting as a makeshift camp for homeless people on March 30, 2020, in Las Vegas. A shelter closed when a man tested positive for COVID-19 (photo by John Locher/AP Photo)

Political solidarity

Political solidarity revolves around issues of inequality related to class, racism, sexism and other forms of discrimination. Political solidarity usually involves one group acting in support of another, even though groups may not be affected equally by injustices.

Political solidarity raises questions about identification, privilege and reciprocity, as expressed, for example, through the hashtag #solidarityisforwhitewomen.

Yet the concept of political solidarity is crucial for addressing how pandemics exacerbate existing social inequalities. Ignoring this actually undermines other forms of solidarity.

Three critical aspects of solidarity

Whatever form we invoke, it’s helpful to remember three aspects of solidarity:

Solidarity is always about relationships. We cannot be in solidarity alone. Who are we in solidarity with and what defines that relationship?

Solidarity always requires us to be intentional about our commitments. What is the aim of our solidarity and where do those commitments come from?

Solidarity requires actions that also change us, perhaps even a sacrifice. What am I willing to do and give up in order to ensure the well-being of others, whether they are like or unlike me?

Toward creative forms of solidarity

Acknowledging the ethical and political commitments that we bring to solidarity is crucial. Otherwise, solidarity can “turn against us,” as Barbara Ehrenreich suggests.

For instance, some solutions, such as physical distancing, become impossible for communities that are already under-resourced, such as the homeless. Otherwise allied nations like Canada and the U.S. find themselves in conflict as both seek to ensure the supply of personal protective equipment for health-care workers.

Artist Jeff Saint works on a mural of a crying eye with images symbolizing the historic coastal whaling city, New Bedford, Mass., reflected in its pupil, surrounded by coronavirus spores. He and fellow artist Ryan McFee hope to eventually replace the spores with flowers as the virus is defeated (photo by Peter Pereira/The Standard-Times via AP)

Being explicit about ethical and political commitments will become increasingly important as governments ask us to compromise our personal freedoms and civil liberties to contain the spread of the virus.

Such compromises and the global character of the current crisis demand that we also think of solidarity as creative.

As the “crisis blows open the sense of what is possible,” in the words of journalist Naomi Klein, we are forced to imagine new ways of being with one another. We also have the opportunity to rethink our values and intentions, and to re-narrate the stories we tell about who we are, where we belong and with and to whom we share a debt.

Rubén Gaztambide-Fernández is professor of curriculum and pedagogy at the Ontario Institute for Studies in Education at the ��߲ݴ�ý.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus: U of T expert on the risks to essential workers with hidden health conditions

Christopher.Sorensen — Thu, 16 Apr 2020 13:17:18 +0000

Coronavirus: U of T expert on the risks to essential workers with hidden health conditions

Christopher.Sorensen Thu, 04/16/2020 - 09:17

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Plexiglass installed as a barrier to protect a cashier is seen at a grocery store in Airdrie, Alta. (photo by Jeff McIntosh/Canadian Press)

Arif Jetha

Topic

Our Community

The COVID-19 pandemic has left many in Canada’s workforce worried about their health and finances. Those worries are even greater for workers living with an underlying and invisible chronic health condition.

In the planning of health and safety responses to COVID-19 and the ultimate reopening of workplaces, employers should be aware of the unique needs of this potentially vulnerable group of workers.

Data show that some of the most commonly reported chronic health conditions experienced by Canada’s working population have no visible signs or symptoms and may go unnoticed by employers.

According to the 2019 Sanofi Canada Healthcare Survey on workplace benefit plans, 54 per cent of workers reported having such a condition, with high blood pressure, arthritis and diabetes among the top five. In the same survey, employers estimated that only 29 per cent of their staff had a chronic condition, pointing to a gap in awareness within workplaces.

Arthritis is one of the most chronic – and hidden – health conditions among many Canadian workers (photo via Pixabay)

Our growing understanding of COVID-19 illustrates that the virus poses a particular threat to workers with underlying health conditions.

A review of 46,000 people with COVID-19 in China found that the odds of having severe symptoms were two or more times higher for people with an underlying health condition. Although the data are limited, a recent analysis conducted by the U.S. Centers for Disease Control and Prevention also shows that 38 per cent of COVID-19 cases in the United States had an underlying health condition including diabetes, cardiovascular disease, chronic lung disease and immmunocompromised conditions.

Essential workers are on the job

Going to work, therefore, could mean being exposed to a virus that disproportionately targets those with underlying health conditions. Of course, staying at home would be the best solution for workers with chronic health conditions. But even after the provinces ordered the closure of businesses, people in a large cross-section of essential services found themselves having to continue to show up for work.

These include people who work in health care, grocery stores, drug stores, warehouses, gas stations, fast-food chains and other restaurants, hotels, long-term care homes, among many others.

A grocery store clerk brings groceries to a waiting vehicle in Calgary, Alta., on April 9, 2020. Workers with chronic, hidden health conditions are particularly vulnerable to COVID-19 (photo by Jeff McIntosh/Canadian Press)

Despite the provinces encouraging workers who feel unwell to stay home and the availability of emergency relief for compensation, workers with chronic health conditions may not want to sacrifice a paycheque during a period of economic uncertainty. They may decide to accept the risk of going to work.

This is a predicament that many community groups are highlighting. As Siân Bevan, chief science officer at the Arthritis Society, puts it: “Some people in these essential roles may be fearful for their employment if their condition makes them unable to work – and fearful to let their employer know about their health concerns for fear of losing their jobs. Many immunosuppressed people with rheumatic conditions are afraid to go to work, but afraid to tell their employer why.”

Commendably, some employers are offering “hero pay” to compensate for the added risk that workers face. Yet the extra wages could also have the unintended effect of encouraging people with chronic health conditions who face income insecurity to go to work.

Some conditions fluctuate

Growing research conducted by the Toronto-based Institute for Work & Health highlights the challenges that workers with chronic health conditions face when asking for accommodations that will allow them to continue working productively while maintaining their health. This is especially the case for those living with invisible health conditions that may fluctuate in severity, young workers, those new to their jobs and other vulnerable groups.

In the current health and economic crisis brought about by COVID-19, the inability of these individuals to ask for protective accommodation poses a potentially serious risk to the health and safety, and the long-term employment, of people with chronic health conditions in the workforce.

These are trying times, and from many accounts, employers are doing their best to keep essential services running while safeguarding the health and safety of workers. As they continue to navigate the way forward and develop back-to-work plans, employers should acknowledge that they may have workers with a chronic health condition who could be reluctant to ask for support.

Employers must keep the lines of communication open (photo by Siavash Ghanbari via Unsplash)

Employers should also be encouraged to open up the lines of communication with all workers so that those with underlying conditions feel supported in bringing forward their concerns. While workers are not obligated to talk about their health, more than ever, supportive workplace environments are needed to encourage people to communicate what assistance they need to stay healthy while working productively.

Laurie Proulx, vice-president of the Canadian Arthritis Patient Alliance, sums it up well. She sees the COVID-19 pandemic as: “… an opportunity for employers to build credibility with their employees by listening and finding ways for workers with underlying health conditions to still make important contributions and not put themselves and their families at risk.”

Arif Jetha is a scientist at the Institute of Work and Health and an assistant professor at the ��߲ݴ�ý’ s Dalla Lana School of Public Health.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why it's not OK to take small social risks during the COVID-19 pandemic: U of T experts

Christopher.Sorensen — Thu, 09 Apr 2020 12:53:11 +0000

Why it's not OK to take small social risks during the COVID-19 pandemic: U of T experts

Christopher.Sorensen Thu, 04/09/2020 - 08:53

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Two women practise social distancing while talking during the coronavirus outbreak in Boston (photo by Michael Dwyer/AP Photo)

Topic

Graduate Students

We’ve all heard the advice from public health officials: stay at home, wash your hands and don’t touch your face! We’ve cancelled sporting events, concerts and other mass gatherings; closed schools, libraries and playgrounds; and asked people to work from home wherever possible.

But as we enter into this extended period of social distancing (also called physical distancing), many might be wondering whether giving up in-person recreational time with friends and family is worth the potential harms to our social and emotional well-being.

Some may be asking: “Can I keep seeing my friends and family, but in a safer way?” But taking a risk-reduction approach to social distancing for COVID-19 won’t work.

Risk reduction (or harm reduction) refers to public health strategies that minimize the risks and related harms of certain behaviours, without expecting people to stop engaging in those behaviours. Examples include using condoms during sex or wearing a helmet while bike riding; people still practise these behaviours, but they do them less often or in a safer way.

When it comes to COVID-19, those considering a risk-reduction approach to social distancing may be thinking: “Is it OK to take small risks, such as visiting my parents for the Easter holiday if we’re all symptom-free? Or meeting up with my running group if we stay two metres apart? Or seeing my elderly grandmother in a nursing home if I’ve been physically isolating for 14 days?”

The short answer, sadly, is no.

Understanding the risks

First, COVID-19 is primarily transmitted by respiratory droplets produced when someone coughs or sneezes, and the virus can live on surfaces for several hours or even days. Even people who are practising social distancing can be exposed to COVID-19 when doing essential activities like getting groceries or exercising outdoors.

This means that even if you are staying at home and practising social distancing, it’s still possible to have been exposed to the virus and not even know it. Because people infected with COVID-19 can be contagious before they start showing symptoms, every close contact with someone else – even if they are asymptomatic – risks transmitting the virus. So, no, you can’t go visit your grandmother even if you have no symptoms and you’ve been physically isolating for 14 days.

Second, social distancing will only “flatten the curve” if everyone who is able to remain physically separated does so. This will keep the number of active cases below the health-care system’s capacity and increases the likelihood that those who need care will be able to get it.

Flattening the curve distributes transmission over a longer period and keeps it below the capacity of the health-care system (Image by Esther Kim & Carl T. Bergstrom, CC BY)

You may perceive your individual risk to be low, but the reality is that everyone is vulnerable to COVID-19. Social distancing protects not only you, but those in your community who are at higher risk for severe disease, such as older adults. Even seemingly less risky social encounters with friends or family can prolong our time under social distancing measures.

Third, Canada is now seeing more cases of COVID-19 that were acquired in the community, where the source of infection cannot be linked to a known case or other risk factors, such as international travel.

This is why the public health response has transitioned to broad population-wide approaches like social distancing, which aims to slow the spread of the virus and prevent our health-care system from being overwhelmed.

Finally, no specific treatment for COVID-19 currently exists. Unlike seasonal influenza, where we have vaccines that provide some protection and antiviral drugs that might reduce symptoms, effective therapies for COVID-19 will take months or even years to develop.

About one to two per cent of people infected with COVID-19 will die of their infection (versus about 0.1 per cent for seasonal influenza), and it only takes about three to four days for the number of cases to double. Given these characteristics, loosening social distancing measures, despite how safe it might seem, can increase the number of people who will require admission to hospital or tragically die from this infection.

Redefining social interactions

What would a risk-reduction approach for COVID-19 look like for our more recreational social interactions? The risks of COVID-19 are not going to stop people from being social, any more than the risks of sexually transmitted infections or head injuries stop people from having sex or riding a bike.

During the COVID-19 pandemic, the metaphorical equivalent of using condoms and wearing a helmet is not to have less frequent social encounters with friends and family. Rather, we must redefine what those social interactions look like.

According to public health experts, this could include virtual meet-ups with friends or colleagues, calling or texting a friend you haven’t seen for a while, hosting an online book club or movie night or spending family time with your household members.

These types of interactions are important for everyone, but especially those members of our society who live alone, or the one in five Canadians who experience mental health problems. We should still strive to stay socially connected, albeit in a different, more virtual way.

Until the virus is brought under control, practising strict social distancing, combined with other public health measures like widespread testing and vaccine development, will be critical in controlling the spread of COVID-19.

Catharine Chambers and Daniel Harris are PhD candidates in the division of epidemiology at ��߲ݴ�ý’s Dalla Lana School of Public Health.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus is not the 'great equalizer' – race matters: U of T expert

Christopher.Sorensen — Wed, 08 Apr 2020 13:29:51 +0000

Coronavirus is not the 'great equalizer' – race matters: U of T expert

Christopher.Sorensen Wed, 04/08/2020 - 09:29

Cutline

Wisconsin state representative David Bowen contracted COVID-19. As of March 27, about half of the state’s deaths and total cases were in Milwaukee and all eight people who died were Black (photo by Angela Peterson/Milwaukee Journal-Sentinel/AP Photo)

Topic

Global

Indigenous

Faculty of Kinesiology & Physical Education

One of the first stories to use race-based data to talk about the risk that Black communities face because of COVID-19 came on March 30 from the Charlotte Observer. The article said Black residents in Mecklenburg County, in Charlotte, N.C., accounted for 43.9 per cent of the 303 confirmed COVID-19 cases locally, but Black residents make up only 32.9 per cent of the county’s population.

More recently, the non-profit investigative journalism site ProPublica published a story on April 3 based on early data that shows “African Americans have contracted and died of coronavirus at an alarming rate.”

Indigenous communities globally have also been speaking about how the new virus may have more devastating impacts on their communities.

The fear and mistrust of health systems expressed by many in Black, Indigenous and racialized communities stem from historical eugenic practices of both governments and individual doctors. These communities have experienced systemic racist violence for generations. They have recently experienced xenophobic responses to COVID-19 and historically, other health crises.

Racialized people may have a fear or mistrust of health care professionals because of historical patterns of abuse (photo by Yogendra Singh via Unsplash)

I have worked for over 25 years in community health and as a health scholar. I have worked with survivors of trauma who have experienced colonial violence. I am concerned how anti-Black racism, anti-Indigenous racism and other forms of intersectional violence will impact the health of our communities during this crisis.

Based on my research, I believe that the actions and omissions of world leaders in charge of fighting the COVID-19 pandemic will reveal historical and current impacts of colonial violence and continued health inequities among African, Indigenous, racialized and marginalized folks.

Recently, I have had discussions about COVID-19 with family, friends and colleagues globally about the impacts of the coronavirus on the health of these groups.

The question often asked is: How will we navigate health systems that continuously violate us? We are talking about those who, like us, live with intersectional social locations, such as race, Indigeneity, age, (dis)ability, gender/gender identity, sexual orientation, refugee status, class and religion. Will these social factors play an implicit role in health-care workers’ decisions?

Racism impacts your health

Canadian Prime Minister Justin Trudeau has said: “Our government is going to make sure that no matter where you live, what you do or who you are, you get the support you need during this time.” This sounds good in a speech, but how will it be practised in a system that does not provide adequate services for racialized and marginalized communities?

African and Indigenous folks encounter racist health systems that impact their physical, mental, financial and spiritual well-being. To add to this, low-income communities’ ability to protect themselves from COVID-19 is severely restricted, as money is needed to support social distancing, pay bills, buy food supplies and hand sanitizer.

History tells us these disparities increase during stressful times.

Ignored warnings

Many government leaders ignored the warning signs emitting from China at first, including U.S. President Donald Trump and British Prime Minister Boris Johnson. Did racism impact the way some leaders initially responded to the virus – both in their response to China and to the African leader of the World Health Organization (WHO)?

On Feb. 11, Tedros Adhanom Ghebreyesus, the director-general of WHO, warned the world that COVID-19 is “public enemy No. 1.” He advised countries to take action immediately or have detrimental consequences. Instead, many national leaders and media outlets continued to focus on the Chinese government in Wuhan.

Did world leaders, like Britain’s Prime Minister Boris Johnson, ignore early COVID-19 warnings? Here Johnson shakes hands with boxer Anthony Joshua after attending service at Westminster Abbey in London on March 9 (photo by Ben Stansall/Pool)

On March 11, Tedros told nations to prepare for the onslaught of a global health crisis. Although those in medical communities understood his warnings, many leaders of nations did not initially heed that advice. Tedros said he was concerned by “alarming levels of inaction.”

China’s global warnings and loss of lives were not heeded by many governments until countries in Europe and then the U.S. were being devastated.

The focus on China’s “inadequate responses,” instead of their warnings and losses, mirrors similar world crises where racialized folks deaths are not taken seriously by western nations and media.

One example is the world’s lack of action on Ebola. The lack of support to Venezuela and Iran during this COVID-19 outbreak is a recent example.

How we see disease

Race plays a part in how we see diseases. How will the local and global responses to COVID-19 impact African/Black, Indigenous, racialized and marginalized communities?

The blatant acts of continued racist violence against Asian communities globally have been heightened by Trump’s consistent labelling of COVID-19 as the “China virus.” These reactions evoke memories of Ebola and HIV. Those diseases were initially seen as exclusively African and Black in nature.

Other infections like Zika, chikungunya and malaria are seen as “tropical” or a “disease of the south.”

In response to anti-Asian racism in the current pandemic, Asian, Latin-American and Black U.S. leaders came together to condemn all forms of racism and scapegoating.

Racialized front-line workers

Medical personnel like nurses and doctors are on the front lines of this health tsunami, along with paramedics, cleaners, personal support workers, child-care workers and other health aides. But health care in the West comes with distinct racialized hierarchies.

African and Indigenous workers in health care are not often found in roles of power or decision-making roles. In fact, Black and Indigenous workers experience increased levels of employment disparity and violence in their workplaces.

African and Indigenous workers in health care are not often found in roles of power (photo by Francisco Venancio via Unsplash)

As a result of colonial violence, African, Indigenous and racialized folks are disproportionately undocumented, under-housed, unemployed, working migrants, food-insecure, mental health-challenged and imprisoned.

As well, others are dealing with health violence because they are also addiction-involved, (dis)abled, sexually and gender-diverse or survivors of chronic health conditions such as people living with HIV.

Myth of immunity

There is an online rumour that Black people are less susceptible to COVID-19. This comes directly from earlier pandemics. During the Spanish flu pandemic of 1918, Black people in the U.S. had lower rates of infection.

Meanwhile, Black folks’ health in the U.S. and globally continue to be inflicted by the impact of enslavement, poverty, incarceration and other colonial realities. The local and global impacts of racism and health violence are insidious. We are all at risk.

If we are to truly survive this global pandemic as a global community, we must drastically de-colonize and change our health ideologies and practices.

Roberta K. Timothy is an assistant professor, teaching stream, of social and behavioural health science at the ��߲ݴ�ý’s Dalla Lana School of Public Health.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cities lead the charge on the coronavirus front lines: U of T expert

Christopher.Sorensen — Fri, 03 Apr 2020 14:42:56 +0000

Cities lead the charge on the coronavirus front lines: U of T expert

Christopher.Sorensen Fri, 04/03/2020 - 10:42

Cutline

A crew works on building a 68-bed emergency field hospital specially equipped with a respiratory unit in New York’s Central Park (photo by Mary Altaffer/AP Photo)

Topic

How many times have we heard over the past few weeks that we have entered an unprecedented era?

The rapid spread of COVID-19 has upended lives and livelihoods. In cities around the world, the repercussions of scaling back as a result of physical distancing measures have had exceptionally damaging impacts.

And at the same time, observers marvel at the ways in which urban life continues.

Cities appear to be on the front lines of coronavirus outbreaks and hot spots. In fact, researchers from the University of Chicago show that larger cities are susceptible to relatively larger outbreaks of COVID-19.

More contacts, more spread

This is due to the increased number of contacts that individuals residing in larger centres tend to have. One of the key responses to containing the pandemic – stringent physical distancing measures – acts to disconnect social interactions.

Some scholars and pundits are pointing to COVID-19 pandemic as evidence that cities should no longer be sites of concentration for jobs, culture and people.

But the history of declaring the death of cities is well-documented – and also widely disproven.

With workplaces and social spaces largely shuttered, and messages from public health agencies to stay home, the economic and social impacts of recommendations to physically isolate are difficult to bear. In city after city, as public health experts call on citizens to isolate and stay at home, images display the shutdown of urban life.

A city police officer walks by the deserted Trevi fountain, in Rome, on March 14, 2020 (photo by Karl Ritter/AP Photo)

Empty office buildings, closed shops, vacant restaurants, transit without passengers, streets without cars and squares without people.

And yet despite the radical, though temporary, disconnection of physical proximity, cities and citizens have found ways to support resilience, to prop up the value of urban living without the customary interactions of city life.

The role of government

The coronavirus pandemic has made it clear that governments are more important than ever. The ability of national governments to enforce public health rulings, commit to massive stimulus packages, close borders and lend expertise to international efforts is unparalleled.

City governments are less powerful, and are subject to being overridden by more senior levels of government. However, a common refrain about city governments is that they are the level of government that is closest to the people.

In this regard, it should come as no surprise that municipal government leaders continue to be the first to act in response to the spread of the coronavirus.

On March 6, the mayor of San Jose, Calif., Sam Liccardo, proposed a measure to temporarily prevent evictions for renters whose incomes declined as a result of coronavirus shutdowns.

The San Jose moratorium went into effect on March 11. By the end of the month, a range of cities across the state, including San Francisco and Los Angeles, had also enacted eviction moratoriums.

Newsom discusses California’s response to the coronavirus on March 24 in Rancho Cordova, Calif (Photo by Rich Pedroncelli/AP Photo)

On March 27, California Gov. Gavin Newsom announced a statewide moratorium on evictions for renters.

Similarly, in Toronto, Mayor John Tory announced a series of tax relief measures to assist Torontonians. On March 16, the city introduced a 30-day grace period for businesses on property tax, water and solid waste bills.

The grace period was extended to 60 days, and expanded to cover businesses and residents later that week.

Presumably, municipal-led measures will continue to evolve as the reality of the pandemic, and timelines for getting back to some version of normal, remain uncertain.

Streets and public life

Admonitions for people to stay home have translated into rapid and significant declines in vehicle traffic on city streets around the world. Streets comprise, on average, about 30 per cent of land in cities and represent about 80 per cent of a city’s total public space.

In Chinese cities, images of streets and highways empty of vehicles depicted the initial, stark results of lockdowns. Vehicle traffic declined sharply.

In this Jan. 28, 2020 photo, people wearing face masks walk down a deserted street in Wuhan in central China (photo by Arek Rataj/AP Photo)

As efforts to physically distance take shape, residents in cities like New York have taken to cycling at the expense of public transit use.

The coronavirus has also led cities to reconsider street spaces dedicated to vehicles. Both New York and Bogotá have added temporary bike lanes to safely accommodate increases in cycling traffic.

Cyclists ride past a deactivated employee turnstile at Boeing Co.‘s manufacturing facility in Renton, Wash. on the first day of a shutdown due to the spread of the new coronavirus (photo by Ted S. Warren/AP Photo)

Cities are also experiencing increased pedestrian activity as people cooped up indoors head outside for a walk. Calls for cities to create pedestrian-only streets, where people can get fresh air, exercise and maintain physical distance, have ensued.

Calgary and Philadelphia are examples of urban centres that have temporarily opened some streets to pedestrians, while similar discussions are underway in numerous other cities.

In Italian cities, videos depicting neighbourhood balcony concerts give hope to residents, while entertaining viewers around the world.

Balcony concerts in Italy.

In Mallorca, Spain, police well-being checks have also presented opportunities for streetside music.

And, nightly at 7 p.m. in Vancouver, residents emerge to bang their pots and pans in support of health-care workers.

The impacts of the coronavirus on cities are extraordinarily difficult. There is tremendous uncertainty as to how long the virus and its impacts will endure, and how devastating it will be. Yet around the world, cities are responding rapidly and decisively to the crisis and its implications for urban life.

Shauna Brail, an associate professor, is the director of the urban studies program at Innis College and associate director, partnerships and outreach at the School of Cities at the ��߲ݴ�ý.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How the rescheduled Tokyo Olympics could heal a post-coronavirus world: U of T's Bruce Kidd

Christopher.Sorensen — Fri, 27 Mar 2020 13:14:18 +0000

How the rescheduled Tokyo Olympics could heal a post-coronavirus world: U of T's Bruce Kidd

Christopher.Sorensen Fri, 03/27/2020 - 09:14

Cutline

A student lights the Olympic flame during a ‘Flame of Recovery’ ceremony in Japan held the day after the decision was made to postpone the Tokyo Olympics because of the coronavirus pandemic (photo by Eugene Hoshiko/AP Photo)

Topic

Olympics