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The Current Transcript for April 14, 2020

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

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VOICE: When they have tested certain fluids like amniotic fluid, cord blood, throat swabs from the babies and breast milk, they have not found signs that the virus is present there.

MATT GALLOWAY: Having a baby is stressful enough, having a baby in the midst of a pandemic is a whole other matter. In an hour, two moms, one with a new baby, one with a second on the way, discuss the questions they have about pregnancy and birth in the time of COVID-19 and how they're coping with a much smaller support system. Also this morning.

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VOICE: Now, this is not the end. It is not even the beginning of the end, but it is perhaps the end of the beginning.

MG: Promising sort of. As lockdowns roll into another week, a look at faint signs of optimism in one of the pandemic hotspots, New York City. And Adrienne Arsenault takes us inside a Canadian hospital for a look at life on the frontlines here. Plus, health writer Andre Picard on what this experience has revealed about the hard truths when it comes to long-term care in this country. Plus, Tom Power speaks with Margaret Atwood about the role of arts in the time of the pandemic. We begin though with the question we're all asking, how will we know when this is over and what happens then? Good morning. I'm Matt Galloway. This is an extended edition of The Current.

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Sacrificing privacy for freedom with contact tracing

Guests: Daniel Leung, Don Stewart, David Fisman

MG: When will it end? This is a question that almost everyone is asking these days and unfortunately there is no clear answer. There's no firm date for the end of physical distancing or for schools to open up or for businesses to get back to business. There are though, people who are working hard to get us back to, well, not normal exactly, but at least closer to what we're used to. Daniel Leung is the founder of the digital health company, LivNao. It's a company currently working on contact tracing. Daniel, good morning.

DANIEL LEUNG: Morning, Matt. How's it going?

MG: I'm well. Just briefly explain what contact tracing is.

DANIEL LEUNG: Yeah. So contact tracing has been used to fight all previous pandemics is to be active, basically talking to every single patient that you know for sure has that disease and figuring out who and where they've been in contact with for the past X number of days. In this case, 14 days, because that's how long you're contagious for. And I'm making a list of all those people that you may have had contact with and those places you've been and then trying to get in touch with every single one of those are people and then telling them to self isolate and keep an eye on them to see if they develop symptoms. So that's kind of what contact tracing is on the manual side.

MG: And so how would it work through the app that you're developing? What would that add to the process of contact tracing?

DANIEL LEUNG: Yes. So just to give you an idea of like our app works, it's built on the building blocks of our core product, which is a positive measurement of mental health using smartphone sensors. We do that to deliver just in time interventions for burnout prevention. But what's important here is the building block that we're using is our ability to create a digital twin of a person's interactions with their physical environment and their peers and these are one of the inputs that go into our mental health. So what this means is we basically take that whole traditional process of talking to each patient and asking them, making the list. And we make that a completely innocent process, because all we have to do is we look at identical twin that we've made of that person's interactions with their environment and their peers, and it automatically flags everyone that they've been in contact with. And then people will automatically notify all of those people that they may have had contact with coded so that they can get right to self isolation and tracking their symptoms. And they're provided with next steps after completing our assessment.

MG: When you say digital twin, you mean you're using location data plus something else to try and represent where we've been and what we've been doing?

DANIEL LEUNG: Yeah. So we used an automized Bluetooth, low energy data as well as location data.

MG: And that would tell you everywhere that I've been and again who I've been talking to or who I've been around?

DANIEL LEUNG: Yeah, exactly.

MG: If you have that and someone using the app tests positive for COVID, just what happens then?

DANIEL LEUNG: Yeah. So let's say you're a user of the app and you test or someone who you've had contact with test positive for COVID, then you'll get a notification telling you that's the case and you'll be provided with next steps. And the next steps are a risk assessment that you perform to basically check on your symptoms, see whether or not you need to go to the hospital. In most cases, you probably don't need to. And so we will ask you to self-quarantine for 14 days and then you can complete the symptom tracker every day just to track how your symptoms might be progressing and to get next steps every single day.

MG: How many people have to be using the app for it to be effective?

DANIEL LEUNG: So in our projections, in our modelling based on an Oxford study, we found that only around 5 percent of the population needs to use something like this for it to effectively double the doubling rate. So cutting the curb in half, basically.

MG: But if you want to have a true representation of what's going on and truly not just flatten the curve, but you know, eliminate the curve, you need to have a lot more than just 5 percent.

DANIEL LEUNG: Yeah, definitely. And in our modelling, 25 percent adoption is kind of where we start to see COVID potentially go away.

MG: Why do you think people would be willing to give up their privacy to have an app like this work? Because I'm giving up essentially all of my personal interactions. You know where I've been, you know who I've been talking to. Why would I want to do that?

DANIEL LEUNG: Yeah. Good question. So I wouldn't say people are fully giving up their privacy. What we do is like as a mental health company, we traditionally we'd normally deal with sensitive data and privacy is a priority at our company. And so that's why we designed our product to be built around privacy as a priority. And so what this means is what we do is we separate the data, personal data into two categories. One is their profile, which would contain anything that might be identifiable, such as a name or email address. And then the other is their raw data. So everything else and so everything the everything else category does get shared and sent to our servers and aggregated. But anything that's identifiable, their profile stays on their phone and that data does not leave their phone until after two steps have been met. So first off, you have to have been flagged as having had contact with a COVID positive case. And after that, you're notified. You go through the steps and then we'll ask you if you want to share your profile. At set steps, you don't have to share your profile, it's completely optional. But what you do get out of it if you do share your profile is we will share that with your local health agency. And if you do end up at the hospital, the physicians will be able to provide better care because they'll have access to your 14 day history on your symptoms. And so we, yeah go ahead.

MG: I was going to say just before I let you go, because we're just about out of time, but do you think that that bargain is worth it in terms of the, you know, the privacy exchange for people getting a bit more freedom back and seeing a bit of the restrictions that they've been living under eased?

DANIEL LEUNG: Yeah, I think everyone will have their opinion on this, but I personally feel that in the kind of effort of public health and getting back to normal life, I think it's a little bit of something to give up and I think it's worth it. But again, that's my opinion and everyone will have their own.

MG: Daniel, we'll leave it there. It's an interesting idea. Thank you.

DANIEL LEUNG: Yeah. Thanks a lot.

MG: Daniel Leung is the founder of LivNao. He is in Vancouver. That idea of contact tracing, perhaps, as he says, giving up some of your data and your privacy to get some of your freedom back is the only way to start getting life back to normal. There is something called immunity testing that could also be an important tool. Don Stewart is the CEO of a biopharmaceutical company PlantForm. Don, good morning to you.

DON STEWART: Good morning, Matt.

MG: What is immunity testing?

DON STEWART: So immunity testing is one for two types of tests that are done on patients who've been exposed to the virus. So the first type of test that I think most people know about is PCR testing, which is testing for the virus itself. Right. If you've been infected. But what's becoming more important now is the immunity testing. So what happens is when you're exposed to the virus, your body naturally starts trying to fight the virus and the immune system kicks in. And part of that is generating antibodies in your blood that fight the virus and protect you. So what we can do is we can identify and find those antibodies when someone has been infected, has become ill, but is recovering.

MG: There's not yet scientific consensus on whether people who've been infected with COVID-19, are immune from getting it again, but if you follow down the road that you're on and the path that you're on, what makes a test like this so important to you know, our basic point is to try and figure out when we can get back to some degree of normal life.

DON STEWART: Yeah, so that's an important question. And what happens was once you generate these antibodies, which doesn't happen immediately, but when it does, they will be present regardless of whether you had any other symptoms or not. And we can look for these antibodies probably from about five days after you're infected and up for a considerable time afterwards. It can be months or possibly even up to years. And by measuring the presence of these antibodies, we can let someone go back into the community, back to work immediately instead of having that 14 day quarantine period, because, you know, that person is is not going to be carrying the virus and then transmitting it to someone else.

MG: What's the timeline for something like this? We hear about a vaccine and people say a vaccine could be a year, 18 months away. What about for these antibody tests?

DON STEWART: Know, these antibody tests are different because what happens is you're taking a prick of blood off your finger. And so all the testing is done outside of your body. So these can be moved into approval by the regulatory authorities like Health Canada, much quicker than a vaccine which is injected into you. So it's important if we're having a vaccine or a therapeutic drug of some kind that we know it's safe and that it works, it's efficacious. But with these types of tests, it's done outside the body. So while it's very important, we know that the test actually works and has a low incidence of false positives, the timeline for development is much quicker because the testing that's required is simpler.

MG: What is much quicker? And we talking months?

DON STEWART: We're talking weeks.

MG: Weeks.

DON STEWART: Yeah.

MG: And what would that allow in terms of, again, you know, throwing the switch and allowing normal life to start to resume?

DON STEWART: I think it gives more assurance to the professionals in the field who are going to make these decisions that we will be able to look at large numbers of people, particularly focusing on hotspots, focusing on areas where this particular risk of transmission. And that gives one of the tools that adds to what we already have in helping the professionals make that decision should we go back to work. So it's a science based tool that adds value to a number of things that are part of that consideration.

MG: Don, good to speak with you about this. Thank you.

DON STEWART: Thank you so much, Matt.

MG: Don Stewart is the CEO of PlantForm. Those are just a couple of tools, the idea of contact tracing and then immunity testing that could help open society back up again. We aren't there yet though for those tools to be put into place. Dr. David Fisman is an infectious disease physician, professor of epidemiology at the University of Toronto's Dalai Lama School of Public Health. He's been listening in. Doctor, good morning to you.

DAVID FISMAN: Good morning, Matt.

MG: Where are we at in terms of being able to use tools like contact tracing and immunity testing to open society back up again?

DAVID FISMAN: So both of those are interesting ideas that are getting a lot of play right now. I'm very excited about immunity and serological testing. I think that really is the doorway out of our current situation to a certain extent. I'm not excited about contact tracing apps. I think there's sort of a shiny theme right now that it's getting a lot of play. And I think you already. Prest, your first interviewee on some of the reasons why that might not be such a good idea, that we're probably going to give up a lot and get very little in return if we go down the route of contact tracing apps.

MG: And yet people are desperate to get life back to normal, whether it's getting businesses open, getting back to school, being able to go and see their friends. If you take a look at the arc of where we're at, where are we right now in this pendant?

DAVID FISMAN: So, yeah, no, it's interesting. I'll focus on Ontario because that's where where you and I live and that's where most of my mental focus has been in recent recent days. I would almost say that we've had an epidemic that split off into two epidemics. Social distancing turns out to be incredibly potent as a way to shut down COVID transmission in the community. And I think we're seeing that our intensive care units have not overflowed. Our hospitals are not overloaded. So that's all good. Our forecasting suggests that the Ontario epidemic is actually at peak right around now. So we should be going down the other side shortly. What we have though, is in congregate settings, this is in long term care facilities, in prisons and jails, in shelters and to a certain extent, in hospitals. We now have a different epidemic that's taking off. And it's particularly notable in long term care facilities where because of who lives there, there's incredibly high case fatality. And I think we're crossing over now in Ontario, where we're starting to see the majority of deaths that occur in Ontario being in long term care settings. So it's a good news, bad news setting. And it also speaks to the fact that, you know, in terms of contact tracing upswell, we can shut this down nicely with with physical distancing, social distance, contact tracing up student nothing to put out the fire that's raging in long term care facilities, which is where the action is right now.

MG: You talked about immunity tracing and the possibility and a promise of immunity testing. What is so intriguing to you about that?

DAVID FISMAN: Well, immunity is how communicable disease epidemics die as that populations become immune. So we think about epidemics is really being a matter of it's almost like growing a garden. It's the seed and the soil. The seed is COVID, the SARS-COVID2 virus that we've never had in our population before. And that's been planted in the garden. The garden is our population. And because we're all susceptible at baseline to this virus, it's very fertile soil and that garden can bloom. And that's the epidemic that we experience. The way the epidemic ends is we take away the soil that that epidemic needs to bloom and we take away way the soil by becoming immune and developing herd immunity over time. That's why pandemics are such a big deal, is because pandemics play out and totally susceptible populations. So you have high attack rates and you have frail, vulnerable people at usually the higher, higher ages who in a typical epidemic are somewhat protected by a lifetime of immune experience. Those people are protected at all. And that's why you see this devastating older people. So if we we will eventually reach a point where where we'd call it an endemic equilibrium, where this is a disease that our our population is sort of accustomed to and we have a degree of immunity to it, it will probably become something like flu. I don't think we know exactly where this is going to land, something like that eventually. What what immunity testing gets us in the short term, which is exciting, is a couple of different things. One is it gives us a clear picture of where we're even at in this epidemic. We know in Ontario that we've had a lot of issues with with testing, PCR testing and so we really don't know how many cases have occurred in serologic testing. Blood testing will tell us that. And we'll also be able to sort of recalibrate that and say, well, how many cases have we missed? We'll get that information. We'll be able to recalibrate how severe we think this disease is. Get a true infection fatality ratio rather than case fatality ratio. And that'll be helpful for planning. And then the last thing that it will do is will actually be able to certify people as in the short term being safe to work. We don't know how durable this immunity is, but if we start to identify cohorts, say, of intensive care unit nurses and doctors who are antibody positive, those may be people who kind of become superheroes in the healthcare context because they're now invincible to this virus, at least for the short term.

MG: When you say certifiable, does that mean that they would actually have a certificate that says, I am immune and I'm able to go back to work?

DAVID FISMAN: Yeah, I think details follow, but there's certainly people working on that. You know, whether this is again, an app, the ubiquitous apps in our current way of living or whether this is something that lives on your smartphone or whether this is a little card you carry in your wallet. I don't know, but there's certainly I'm not involved in that. But I know folks are giving a lot of thought to that. And clearly there's a whole ethical can of worms there. Perhaps not at the same level as contact tracing apps. But, you know, are we going to have a stratified society where the folks who have, you know, the I am immune and safe to work cards get to go to concerts and sports events. And if you don't have the card, you have to stay home. And I'm sure you'll start to see a brisk trade in counterfeit immunity cards and so forth. So, you know, it's a little bit of uncharted territory. But but just to keep it like really simple and short term, it is exciting because, you know, right now. Look, I'm a healthcare worker. I was working on our first cases of COBA, came into my my hospital. I took a week off because I developed a weird cough illness. My PCR test was negative. I still wonder whether I shouldn't have covered. And I'd really like to know if I have antibodies because it would it would give me peace of mind moving forward. And it would also, you know, be an index that, well, this is a guy who can probably work with patients and not worry about infecting the patients.

MG: In the last minute and a half or so that we have, the question that so many people are asking is when will we know when this is over? What do you have a sense as to when we'll know?

DAVID FISMAN: Do you know what? I'm I'm going to sort of sort of dodge and waffle on that because because I think it's appropriate to dodge. I think what this is telling us, we do need to know. We need situational awareness. And what that means is we need to build really strong surveillance systems. We need to know what this disease is doing in our population. And we do that. It's kind of like the three blind men and the elephant, you know, the one hugs the leg and says it's tree trunk. One pulls the tail and says it's a rope and so forth. When you have multiple sources of information, you can say, aha, this is an elephant. So we need to be doing great surveillance in terms of health care, long term care testing. We need to be testing for this in places where we don't think it is and don't suspect it is. And that's why we need to be doing wide, wide scale testing in hospitals and long term care. Right now, we need to find a mechanism to do testing out in the community. We need to do testing in kids before we start to think about, you know, going back to normal school, because we really have no idea. We have so many blind spots in for us to make good decisions. We need more information about what this information's doing in our population. So so I think we're getting there based on the information we have. This looks like it's on the wane. We probably don't have time to discuss all the ideas about how a society reopens, but we're getting there. But the most important thing is for us to be situationally aware and we get there through excellent public health surveillance, which we need to build.

MG: We will have you back to talk about how we start to reopen things, because I think that's the next question. But in the meantime, David, it's great to talk to you about this. Thank you.

DAVID FISMAN: Always great to talk to you. Thank you so much.

MG: Dr. David Fisman is a physician and professor of epidemiology at the University of Toronto. As I say, we will speak more about how we go to the next level of that coming up in days and weeks ahead. The CBC News is next. And then two CBC correspondents take us to the frontlines of this pandemic. Adrienne Arsenault inside a Toronto hospital. Susan Ormiston in New York City will tell you more about what's going on in those venues, coming up. I'm Matt Galloway. This is The Current. We're back in six minutes. Stay with us.

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A look into Toronto and New York City during COVID

Guests: Adrienne Arsenault, Susan Ormiston

MG: Good morning, I'm Matt Galloway. You're listening to The Current.

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MG: Still to come, giving birth in a time of coronavirus. But first, two CBC correspondents on the frontline realities of COVID-19 in Toronto and in New York City.

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[Sounds at hospital during preperation]

MG: It is a vital daily ritual. The sound of doctors and nurses getting ready for their shift in the ongoing battle against COVID-19, where Canada's hospitals are the frontline. The National's co-host Adrienne Arsenault got a look inside the toll that the fight is taking on patients and health care workers at a hospital in Toronto. And she joins me now. Adrienne, good morning.

ADRIENNE ARSENAULT: Good morning, Matt.

MG: You went to the Humber River Hospital. Tell me what is unique about that hospital?

ADRIENNE ARSENAULT: Wellis, actually, it's huge, but it's more importantly, it was a place that was built from the ground up after SARS. And so it was built with the prospect of yet, you know, another viral epidemic in mind. So you have things like ambulance bays are really designed to handle maskin contamination. The hospital is filled with negative pressure rooms, which really basically just means that fresh air flows in, but contaminated air does not flow out. And so effectively, when you know, when you're talking to an infectious disease, this is among the most prepared hospitals in North America.

MG: As I mentioned, these hospitals are on the frontlines of this fight. You go to one of those hospitals and go inside. What sort of safety precautions did you and your crew need to take in telling the story?

ADRIENNE ARSENAULT: Well, it can be a bit of a lengthy process. I mean, you don't just show up. So we had several conversations with various staff of the hospital first and obviously when we were there. So a couple of things we did, it was just limited inside to Jared Thomas, who's our camera operator, and editor and myself really paired down gear. It was very clear always from the from the beginning that hospitals are short of PPE. So the last thing they want to do and the last thing we should be doing is taking any of that from them. So sometimes, you know, Matt, we are occasionally assigned like an N95, for example, for certain hazardous shoots. If you head out, you know, you don't know what you're about to be breathing in. So I have one in my kit. Jared has one in his kit. So we said to them, can we bring this in? Is it okay if we wear this? Is anyone gonna be mad that we wear this? You know, what are the rules? We we had those and we had goggles and then gloves. And that was it. And, you know, I know some people were like, wow, you didn't have a gown and you hairnet, you know, your hair wasn't in a net. And they were very clear with us every step of the way. This is all you need. You are fine. And so then we did what people have come to accept. You know, you see, you don't stand that close to someone. You have a microphone on a pole. We're not using in this setup. Mike, SoCs, you know, those those fluffy things you put on mikes because you can't really clean them very well after. So everything we have, we clean before we go in and we clean after we come out. And then, of course, it's it's baby steps all the way. You know, I wear a knapsack on a shoe like this because I'm not putting anything down. All our gear is in that knapsack and then it's permissions every step of the way. Are we OK here? Is this patient OK with us being there? Can we get clearance from the patient and or the patient's family or both? Preferably. So it's a baby steps kind of process.

MG: We heard in that little clip a little bit of what it's like for the doctors and nurses as they're getting ready for their shift. Just describe what you saw when you got to the hospital.

ADRIENNE ARSENAULT: Well, that is really the first thing you see is that when they come through the door, you know, it's not. Hey, good morning. How are you? From the security officers, it's. Do you have any symptoms? Have you been in contact with anyone who has any symptoms? There's a grilling right at the front door and then hand-washing right at the front door. And then the process of getting the PPE, which is interesting because on the walls of the E.R., there are these big grey boxes that are empty. But very recently they were filled with PPE. You need an then ninety five mask. You take it off. Take it from the shelf or a gown or whatever. Now they're locked up like like narcotics and they are signed out and and they are counted and they are allocated and they are rationed. So you see the fear in people when they realise that's happening. And the fear is in part, you know, do they have what they need? Because in a way, the testing has been so low in Ontario, they have no idea who's coming in. So they almost have to presume that every one of us, you know, of of presenting in a certain way probably has it. So on goes all the PPE. So they are burning through it in part because they're just they're just. Light sometimes in terms of what's coming in and so that you know, that that makes them very afraid. And what struck me the most is that every person they spoke to at some point we had a quiet word and they were very, very emotional. And I'm not sure I quite expected that.

MG: Emotional because of the scale of what's happening and also the stakes that are at play. And you see, that's not just in speaking with the doctors and nurses that are there, but you also spoke with some of the people who are being treated at that hospital. Tell us what they said.

ADRIENNE ARSENAULT: To a person, we spoke with, a man named Frank, for example, who who turned very quickly. And is there on oxygen. And he said he's really lonely. And this is what you hear. I poked my head in the room of another lady just to say hello. She wasn't in the story that I said, hey, how are you doing? And she said, I'm really lonely. I kept hearing that word again and again. And that is part of what is behind the emotion of the health care workers, because, you know, the connection with the family in some of these healing is really important. And to be in the hospital, to be terrified and then to see people who not only are strangers, but they're covered head to toe in PPE, and you can't really hear them very well and you can't connect with your eyes very well. This is devastating as a patient, but it's really devastating as a health care worker, too, because they know that they don't just have to take care of the body of that person. They have to be a substitute, you know, kindred spirit and family member for that person and and help them make phone calls and sometimes use the tech and arrange to do a face to face call and it's really, really getting to them. It's really getting to them that, you know, the people who love these patients the most can't be there with them. And I think that's behind a lot of the emotion you see you see in that hospital right now.

MG: You mentioned Frank, who's one of the patients that you spoke with. Let's have a listen to a bit of your conversation with him.

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VOICE: I'm coughing up blood, mainly blood clots. My chest really hurts. I'm really, really weak. Even if I try to stand up, I'm dizzy and I fall. Pain through my whole body. It's not a good experience. I'll tell you that much. I'd do anything for this to go away. My family cannot be here. My son, my wife, anybody. My brothers. Anybody. Nobody can come and visit. I don't think they can even bring me stuff.

MG: And he's there on his own?

ADRIENNE ARSENAULT: He is there on his own. And, you know, we we called Frank's wife from the room and she was, you know, graciously spoke to us. And she said, I asked her how she was managing without him. And she said, she's crying. You know, she's crying all night and all day. And I I get he, of course, is now worried. And he said to her, you know, everybody's my son. OK, do you have symptoms? Anybody else in the family of symptoms? So the anxiety for everybody is is pretty high. Frank says he turned really fast. And and I. That is something else we hear for the health care workers that they are shocked at. How quickly people turn and why that matters is that there's you know, there's a man in ICU met who came in not that long ago with, you know, he'd been recovering at home. He didn't have a test. But his family doctor probably said to him, it sounds like you have COVID-19. You should self isolate and and know, keep an eye on symptoms. So he did that and then he finds himself in the hospital. And then the doctor he followed followed. Dr. Taslim Nimjee, an amazing ER physician told us that it was really less than an hour, maybe half an hour or so before she realised this man needs to be into B-Mor. So the consequence of that is he has half an hour to connect with his family and and tell them whatever he needs to tell them and ask whatever he needs to, because then he's going to be sedated and then he's on an intubator and then you don't know what's going to happen. So this is really short circuiting a process, an emotional process and a medical one and it's really hard.

MG: And as you mentioned, it has a toll on the health care workers as well. Let's have a listen to some of those health care workers.

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VOICE: Everybody is a bit worried. I have two young children, and that's all I think about. So part of the most painful thing for me through this has been having to separate from them, having to move into the basement. I can't hug my own children. They're brave and courageous little guys, but it's hard. Right? And so, yeah, you question every tickle in your throat, but you keep your distance from your loved ones to keep them safe.

MG: What sort of toll is this taking on on those doctors, on those nurses, on those health care workers and their personal lives, Adrienne?

ADRIENNE ARSENAULT: Well, that is Dr. Taslima Nimjee who I mentioned before. So you hear one, which is that they have to isolate themselves from the people. Look to I asked them all. How are you sleeping? And to a person they all said, you know, not that well. And now we are docs and nurses are pretty special group. You know, they they go through a lot every day and they are at, you know, in their lives that they've learned how to manage and still go to sleep. But this one is bugging them. And Dr. Nimjee says, you know, she'll wake up sometimes and, you know, stare at the ceiling. I think like everybody is doing right now. And for her, those are dreams of of being an intubation, being in an intubation again or other. An anaesthesiologists said to us that he's replaying I take off the PPE properly. Did I make a mistake somewhere that's going to cost me my life or one of my colleagues their lives? These are tbig decisions. And it's the not knowing and not seeing the threat that makes it so insidious and realizing how cruel and callous COVID is. You know, it doesn't, it attacks all sorts of people that that you don't necessarily think. Like there are young people who are really getting blasted with this. And it's terrifying.

MG: Are they, just a couple of things before I let you go, one is those doctors and nurses, as you mentioned, they're working long shifts. There's a lot of stress. And yet every night in my neighbourhood, 7:00, 7:30 last night, people out banging pots and pans and drums and the vuvuzela and all the noise that you can make on the street. Are they aware of that?

ADRIENNE ARSENAULT: Oh, 100 percent. So 7:30 is you know, is sort of I think it was chosen because it's around a shift change. The idea that, you know, that that people will hear it if they're not hearing it in person, they are seeing it on social media. And I know it matters in part because, you know, it was once we left the hospital was a long day where they're super early. And so we left in early evening. And I got an email with a video from somebody works at a hospital saying, look, look what was outside the hospital just after you left. It was a ring of fire trucks sounding their sirens and their lights. And they were and the health care workers who were there who were standing out and watching it. I know it means something to them. I think all the support that they're hearing means something doesn't make them safer. Does that give them the PPE they need? No. But they do know people are trying and they know that that people all over this country are doing what they can to to raise the PPE and to get it in front of them and I know that means the world.

MG: Just the other thing briefly, does this have echoes to you of the story that you covered a few years ago in looking at the Ebola outbreak?

ADRIENNE ARSENAULT: Yeah, it does and I've been thinking about Ebola non-stop. That was 2014. We were in Liberia covering it. And it was the most striking thing I'd ever seen in my life. You know, people who who love to touch and hug each other couldn't. People having to bury their family members without the rituals that matter so much without each other, the fact that this is a virus that that attacked people who loved you. So if you love someone enough to wipe the sweat from their brow when they were vomiting with Ebola, then you're probably going to get it. And so the cruelty and callousness of that virus is something I'd never seen. And to see it, shades of it here is really cuts deep. And and it's not just shades of the way the virus reacts. It's it's shades of the way humans react. So when we returned from covering Ebola, we were told to self isolate for then 21 days. It wasn't an airborne virus. So, you know, we knew we had not come in contact, but the public fear was so cute that we hid basically for 21 days. And still there was stigma around even being near people who had had Ebola. Still, there was a there still there was disinformation. And I kind of hoped that that wouldn't happen now. And so just to see the stigma and the fear I get the fear the stigma breaks my heart and and the misinformation makes me white hot with rage. And I just I find it a little I'm having a little bit of a hard time. I'm I'm finding it a bit haunting that the echoes of Ebola, because this is and this is a country that has so much and that is a country that had so little. And to see echoes of the same things that people not touching, that the shortage of gear, the misinformation, people afraid to touch each other and help somebody. It's, yeah, it's pretty crushing.

MG: Great storytelling. And it's a rare look inside the lives of those who are right on that front line, as you say, fighting this fight. Adrienne, thank you.

ADRIENNE ARSENAULT: Thank you, Matt.

MG: Adrienne Arsenault, co-host of The National. You can find her full story at cbc.ca/thenational. The CBC has also been reporting from the American epicentre of this pandemic in New York. More than 5000 people in that state have died from the virus in the past week alone. And yet the governor of New York, Andrew Cuomo, expressed some little bit of hope yesterday.

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VOICE: We are controlling the spread. You look at those numbers. You know what it says. We're controlling the spread. Feel good about that.

MG: Susan Ormiston is a CBC senior correspondent based in Washington. She's just back from New York City. Susan, good morning to you.

SUSAN ORMISTON: Good morning, Matt.

ADRIENNE ARSENAULT: Broadly, what is the mood in New York City right now?

SUSAN ORMISTON: Well, as you can imagine, at one end, people are petrified and at the other end, they're cautious. I'd say by my count, about two thirds of people are wearing masks. New Yorkers have taken this super seriously. I mean, the attack rate in that city was one in a thousand, meaning that that virus had been circulating there a long time before we were even starting to count it. So they're staying inside, but it's a massive city. So you see people out on the streets getting on buses, shopping at outdoor grocery markets. I saw one worker there. He had a surgical mask on, covered up by a helmet with a plastic shield like you'd see in the ICU. He was absolutely petrified that he was going to catch it and was very angry that he saw so many people still congregating on the streets. So it's serious.

MG: And yet you hear and the governor, Andrew Cuomo, saying that you should feel good about the slowing of the spread. Is there, are there signs that the virus could be slowing itself down in New York City?

SUSAN ORMISTON: There are good signs with a big caveat. And we've talked about peaks and plateaus and flattening. So new cases have started to drop. So have hospitalizations. Those are the glimmers of hope that Governor Cuomo is talking about. New deaths are also easing. But here's the caveat, Matt. We're talking about a plateau, and the plateau is at a incredibly high level. I mean, for many days last week, more people died in New York state than the total deaths overall in Canada. So we're talking between 700, 800 people a day dying in New York state. And that is still continuing. So, you know, when you put it into context, they're saying we're plateauing a crisis. It's still a crisis.

MG: People hear the governor say that you should feel good about this. And then they start to think about life coming back to normal. You spoke with Mark Levine. He's a city councillor in northern Manhattan. Let's have a listen to what he said about loosening restrictions too early.

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VOICE: It is way too soon to declare victory and I'm actually worried that reports that this might be slowing would lead New Yorkers to let their guard down. Would lead them to come out of their houses more. Would lead them to take their mask off. To socialize more. And we have seen other parts of the world have come to regret that. And that the virus has come roaring back. We need to keep our guard up until we are well, well past the most intense period of this. And that I'm sorry to say, it's certainly weeks and probably months away.

MG: It's a very different message than we've been hearing from the U.S. president, Donald Trump.

SUSAN ORMISTON: Indeed. And it's going to be extremely difficult to navigate that line of opening up the epicentre of the United States. You know, millions of people trying to bust out in New York, but they've been ravaged so bad that they're cautious. You know, they have followed social distancing primarily. That's why we're seeing some of those glimmers of hope. But this is the financial capital. People want to travel to New York. People are, you know, in the boroughs, hunkered down in their homes. There is going to be some kind of graduated opening up. But figuring out that balance map is going to be extremely difficult, particularly in New York. It's easier, you know, in a state which has a few hundred cases. But in New York, with thousands and thousands of cases, it's really hard to see how they're going to limit that enough in order to open up wide swaths of the community.

MG: We were hearing from Adrienne about people on the frontlines here in Canada. You spoke with a paramedic about what life has been like on the job. What did he tell you?

SUSAN ORMISTON: Yeah, you know, we hear a lot from inside the hospitals. Those doctors and nurses, but these guys are at the pointy end of the spear and they've really been under stress. They've had more calls by several thousand a day in New York than they had during 9/11 and that has been continuing day after day after day. So I talkeded to Anthony A. He's a lieutenant paramedic with the Battalion 80 in Brooklyn, a great guy. Here's how he described his day.

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VOICE: I've been on the job going on 17 years. I've been around for some of the big events in New York City. You know, as a paramedic, you learn to deal with death. You know, you're not going to save everybody. You know, you get to save some of them. You get to save the people that are almost dead. The bad asmathics and stuff, you know, that's what keeps you going cause you're able to do those and alright I didn't save this one, but I go to the next one. But we've never seen death like this. This is astronomical. We've never seen this many cardiac arrests.

SUSAN ORMISTON: Is that related to COVID?

VOICE: So of the twelve patients I had the other day, ten of them, families told me they had fever, cough, the symptoms.

MG: What a difficult situation to be put in. You were talking broadly about New York City and New York State. You went to a specific neighbourhood. Tell us about the neighbourhood.

SUSAN ORMISTON: Yeah. Well, you won't believe it. It's called Corona and it's a neighbourhood in the borough of Queens. And it had the highest rate of infection in all of New York store state. Late in March, 77 percent of the people who were tested had the virus. So we went there. It's working class, large population of Hispanics. People lined up for fish on Good Friday. The fishmonger told me simply, people are petrified. Masks of all kind. And there was a woman waiting in line to get her fish who told us a little bit about what was happening in her life.

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VOICE: This is scary, but you know that's what, you have to do. Like any help they can get from us, I will do it. But it is scary. You get there, you see your co-workers. You want to say hi, how's everything? They're just waiting for like someone to call you saying I'm positive or like something happened to my family. So it's really, really scary.

SUSAN ORMISTON: So, Matt, she worked in a hospital and she was on a three day bereavement leave when I spoke to her, because her father in law has just died and she told me there was a waiting list at the funeral home. They wouldn't be able to get a slot for the funeral for two weeks. It's hard to imagine the emotional toll on communities like that. People were hunkered down. There was a real feeling of sorrow and fear. I frankly didn't see it anywhere else to that degree in in New York.

MG: Do you see that resilience just finally in the last minute or so that we have, do you see that resilience the New York is so well known for as well?

SUSAN ORMISTON: Oh, absolutely. I mean, the naked cowboy was still out there strumming his guitar coronavirus 2020 in Times Square. You know, I saw all kinds of people scurrying along the streets, a guy in his surgical swabs on a bike with his plastic crocs, obviously riding to work. That's it. No coat. Nothing. And at seven o'clock, as Adrienne described, you also heard the 7 o'clock symphony. I was in my hotel room one night, opened the window, and there was a young boy who opened his window across in another skyscraper and was banging a pot as fast as he could. And you hear that. The other soundtrack though is the sirens over and over. You can't escape it. So, you know, New York is vacillating between hope and real despair there. Matt, and it's gonna be a while before they find their way out of it.

MG: Susan, thank you.

SUSAN ORMISTON: You're welcome.

MG: Susan Ormiston, senior correspondent for CBC Television, CBC Radio and CBC Online in New York talking about what she has seen in that city. Coming up in about 90 seconds time, we're going to talk about the pandemic and pregnancy. I'll speak with expectant mothers about hope and fears in the midst of this trying time. I'm Matt Galloway. You're listening to The Current. We're back in a minute and a half. Stay with us.

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I'm afraid of getting COVID-19, and what it would mean for my baby, says expectant mother

Guests: Amanda Jacques, Maria Power, Catherine Lebel, Dustin Costescu

MG: Hi, I'm Matt Galloway. You're listening to The Current. Pregnancy and giving birth are tough under normal circumstances. It can come with a lot of anxiety. It's exhausting, perhaps confusing. You're figuring out a whole new lifestyle. These, however, are hardly normal circumstances. People expecting a baby or have just given birth are navigating all of that while also figuring out how to live in the midst of a pandemic. Amanda Jacques is 35 weeks pregnant, has a toddler at home. She's in Calgary. Maria Power gave birth to her first child in mid-March. She is in Toronto. Good morning to you both.

MARIA POWER: Hi, Matt.

AMANDA JACQUES: Good morning.

MG: Maria, congratulations on the baby.

MARIA POWER: Thank you so much.

MG: How are you guys doing?

MARIA POWER: We're doing well. Yeah, we are. It's actually one month today.

MG: Amazing.

MARIA POWER: Yeah. It's gone by fast.

MG: What is, if you take a look at, I mean, it's a bewildering experience in terms of what you go through and suddenly the new world that you're in and all of this, as I said, is hardly a normal circumstance. How does that abnormal life that we are in the midst of right now intrude into what you're in the midst of?

MARIA POWER: It was, it's been, it's been weird. It's been crazy. But but we're doing well. It's funny. I was I was trying to think back and, you know, a month ago in this kind of in these times just feels like a lifetime ago, things things were so different. Even a month ago. So, I mean, certainly leading up leading up to the birth, you know, I think I think we delivered on the day Doug Ford declared a state of emergency in Ontario. So and I remember there was sort of rumours about borders shutting. You know, everything was kind of felt like every day there, there was some sort of new big news item about what was shutting down or what was changing. So things things are kind of. I feel like they've sort of stabilized a bit. I'm I'm sort of I've adjusted to kind of, OK, this is the new normal. But certainly that week delivering it was it was very I was very anxious. There was a lot of unknowns. We certainly had to change our plans quickly as far as caregivers and follow up appointments and whatnot. But but now we're we're home and now we're kind of hunkered down and we're doing well.

MG: Fantastic. Amanda, what about for you? Your pregnancy is nearing its end. How are you feeling right now?

AMANDA JACQUES: Yeah. I guess I'm a little bit nervous about what's to come because there's still a lot of uncertainty for how it's going to go for us. But yeah, just adjusting and trying to take it day by day and see how things go.

MG: What are you most concerned about in this time in given how unusual, as I say, life is right now?

AMANDA JACQUES: Definitely that I could get sick either right before the birth or right after and what that could mean for the baby. That's probably the biggest concern.

MG: You also work in health care?

AMANDA JACQUES: Yes. Yeah, I'm a radiation therapist. I work with cancer patients. And that's been a big change is that I actually decided to stop going to work as an essential health care worker. It was a difficult decision, but, you know, there was a lot of mixed messaging about whether or not I should be a work and if it was the best thing for the family. And so that's definitely been a big change for me. It's just staying home for now.

MG: What are the questions that you've been asking in the last couple of weeks? To Maria's point to me, a month ago seems like a lifetime ago. The last couple of weeks as things continue for you, what are the questions that you've been asking, Amanda?

AMANDA JACQUES: Definitely what it's going to look like in the hospital, you know. Could my partner still come to the birth because that's something that seems to be changing with who is allowed into the hospital and when that might change. Just like how things are going to look afterwards. There's a lot of, you know, medical appointments that follow after having a baby and what it is going to look like. Are they going to be tellhouse. Are they going to be in person? Are they going to be at high risk? My due date is actually at the projected peak for Alberta for COVID. So it does put a little bit of worry into my mind about what that's going to look like for us.

MG: And what have you, I want to bring Maria back in in a moment, but what have you been told about as you said, who could come in with you for the birth? Amanda.

AMANDA JACQUES: Oh, sorry. So far, one person is allowed, one support person, and that would be my husband. Unless anything changes.

MG: And for you, Maria, you talked about changing plans. What were the plans that had to change even a month ago as this really started to take hold?

MARIA POWER: Yeah, well, I think the biggest question mark my, so my immediate family all lives in Vancouver. And my mum was going to fly out to come one to hand for for a month or so. So she had flights book, we had AirBNBs lined up. So we were closely sort of watching what was going on with with travel and flights. We ultimately made the decision that it just wasn't, you know, technically you can travel domestically, but we just decided it wasn't worth the risk of having her come. So. So that was probably the biggest and hardest decision. And then yeah, I think that the day we delivered it was sort of the hospital had implemented new sort of screening procedures. So that that was something we weren't expecting. But, you know, when one visitor who was my husband had to get screened and I know they've tightened things up even further, just I think there's no sort of in and out privileges. I think there's restrictions on what sort of supplies you can bring in to the room. So there was a lot of a lot of last minute juggling with things like that. And then also just a follow up appointments Amanda mentioned. You know, I had a lactation consultant booked. I had a ton of, you know, pediatrician follow ups to do. And suddenly, you know, my pediatrician was self isolating and wasn't available and lactation consultant. Luckily, I got I got one in-person appointment. And before she was unable to, you know, she had to go completely telehealth as well. So just a lot of confusion around, you know, what what was gonna be available, who who I could see in person, who who was gonna be online. Yeah. With with a newborn freshly born. Yeah. Not a lot of sleep. So it was a hectic week or two for sure.

MG: What does that mean in terms of the anxiety that you might be feeling even leading up in the best case scenario to a moment like this?

MARIA POWER: Me, Maria?

MG: Yeah.

MARIA POWER: I was anxious. You know, I think, you know, moms, you you want to try and prepare as much as possible and you know, you've been waiting, you know, nine months or so and really just thinking about this moment and trying to do everything you can to make it make it the experience that you want it to be. And then just even even little things, just just sort of made me super anxious. I was noticing, you know, just basic supplies, like newborn diapers were were sold out or, you know, baby like wet wipes, like just little things like that would sort of I would I would see. OK, I can't get that. And that would send me into a bit of a bit of a panic leading up leading up to the birth, which was sounds kind of silly, but it was just just these little things we take for granted that we're sort of beginning to really stress me out. And and yeah, I it really it really was just sort of a big distraction I have to say.

MG: Amanda, does that sound familiar, Amanda? That a big distraction, not something else that you need piled on your plate in the middle of a moment like this?

AMANDA JACQUES: Absolutely. I do feel fortunate. This is my second child, so I do feel like some of the uncertainty and the worry and what's coming and how to prepare. You know, I've already gone through that. And I feel for any of the moms that, you know, haven't bought a crib and haven't bought a stroller and, you know, can actually go physically touch anything. I feel for those people because that was a big part of preparing for a baby was just sort of figuring out what did you need and what did you want and what would suit you. And I'm grateful that I have a lot of these things. And, you know, we have diapers and we have bottles and we kind of know what the lay of the land is going to hopefully look like for us.

MG: What about the support network, Amanda? The things that Maria was talking about just in terms of family, you know, some friends as well. And in a moment like this, people will pitch in. They'll offer to help out. And these are very different times. What is the support network going to look like for you, Amanda?

AMANDA JACQUES: Yes, we are fortunate. We have a lot of very close friends, neighbours and family within our city. There's the layer of the self-isolation and social distancing that makes it difficult because clearly we're going to rely on some people, especially when the baby come. But we are fortunate that there are lots of people just waiting to be asked to step in and help out wherever we need them.

MG: It's tricky though, because as he said, you have to be distanced.

AMANDA JACQUES: Yes. And grandparents are always vulnerable.

MG: You mentioned Maria family trying to figure out how to get them to visit from the West Coast and that they can't come in. That must have been a really difficult conversation.

MARIA POWER: It was. Yeah, it was. And then we played with a, you know, a ton of different scenarios. We were, you know, maybe maybe we could sort of self isolate for a few weeks and then have my mum come out. And I don't know, we we were just playing with, you know, how could we make this work? But ultimately, I think we definitely made the right decision and the baby will certainly be be here and ready for lots of visits when this is all over.

MG: Have you been introducing the baby through, I mean, FaceTime or, you know, waves through the window or from the front porch or from, you know, the side of the street or something to family and friends?

MARIA POWER: Yeah. I mean, we've definitely we've been doing a lot of Zoom with friends and family. And that's pretty much it. Yeah. I haven't had a ton of people. I mean, I've had people come and drop groceries often and meals, which is lovely, but yeah, he's pretty much mostly on Zoom I would say.

MG: What are you doing to take care of yourself? I mean, this is, as I said, a stressful time at the best of times and taking care of physical health and the baby's health is one thing. Taking care of your mental health is something else. What are you doing to take care of yourself, Maria?

MARIA POWER: I would say I mean, definitely keeping in touch with friends and family has been key for me. I'm also lucky enough that my my partner is is working from home now, which has actually been a huge, I would say, silver lining of all this. So she's he's really stepped up. And now that, you know, he's not sort of commuting and getting ready for work. We can we can put those hours towards him kind of helping out with the baby and giving me a break. So so I'm able to get enough sleep. Friends and family. For me, it's really just been about getting enough sleep and eating properly. So friends and family have dropped off, you know, healthy meals and helped with groceries, which has been great. And then and then, yeah, the husband is helping turn to trying to get me enough sleep and really just talking. Yeah. Talking to friends and family, you know, expressing when I'm stressed out or when I'm having a good day, just laughing less seeing their faces. That all goes a long way for sure.

MG: Amanda, what about you?

AMANDA JACQUES: Yes. Very, very similar. I'm spending a lot of time talking to people, just catching up with friends, taking the opportunity that I have extra time. And I'm trying to limit how much information I actually take in about the situation that's going on. You know, just maybe checking in in the morning and in the evening. I've been spending a lot of time with my daughter. She's quite entertaining. She's about two and a half right now. So that's been great. I also am trying to get a lot of rest and then just trying to get outside. Unfortunately, we're getting a lot of snow still here in Alberta, but, you know, getting some sunshine and just some time in the yard is nice.

MG: Good luck with the weeks to come. Everything will go well, I'm sure, but it is an interesting time to be in the situation that you're in, Amanda. Thank you for joining us.

AMANDA JACQUES: Thank you.

MG: And Maria, thanks so much and good luck to you.

MARIA POWER: Thank you very much.

MG: Maria Power gave birth to her first baby in mid-March in Toronto. Amanda Jacques is expecting her second child in about a month's time in Calgary. The concerns that they raised are all too common right across this country. There is research that's coming out. It's early research, but it is getting some attention. It comes from the University of Calgary. It indicates that more than half of pregnant women are worried about giving birth in this very stressful and strange time. Catherine Lebel is a professor of radiology at the University of Calgary. She's leading a study on the mental health of expectant parents during COVID-19. Dr. Dustin Costescu is an OBGYN and a professor of obstetrics and gynaecology at McMaster University. He's trying to help his patients navigate all their anxieties and have healthy deliveries. Good morning to you both.

DUSTIN COSTESCU: Good morning, Matt.

CATHERINE LEBEL: Good morning.

MG: Doctor, as you listen to those two women, Maria and Amanda, talk about what they are in the midst of, how familiar does that sound to you?

DUSTIN COSTESCU: I would say that's a very common experience. Most of the time in our obstetrical clinics right now, the bulk of the conversation is really around trying to prepare for the variables that are just not known and that the pace of change is just so rapid. It's hard for me to get through a single clinic without at least one email of a policy change. And so it's hard for us because we can only give so much information about what the current state is. But for someone, for instance, who's 35 weeks pregnant, we know that we'll be different by the time they come in for labour and delivery. And so we're doing our best to provide general information to two to patients and their families. But also just to get them thinking about how to be adaptable to some of these changes and to be thinking about what parts of their birth experience are going to be important for them to hold on to and what parts of them they might be able to like go of her or reframe.

MG: Catherine, you're researching this right now. Is what you're hearing, you know, in line with with the research that you've been gathering across the country?

CATHERINE LEBEL: Yes. We're seeing higher rates of anxiety and pregnancy related anxiety than we would normally see in pregnant women. And I think a lot of that has to do with the uncertainty about their situation, about what's going to happen when they deliver what their postpartum extreme's is going to look like.

MG: Specifically, what are the most common concerns that you've seen?

CATHERINE LEBEL: We haven't looked at really detailed concerns, but we're definitely seeing elevated rates of generalized anxiety as well as anxiety specifically related to the birth and baby.

MG: Do we know doctor, much about the issue of getting infected when it comes to how perhaps babies might be exposed to the coronavirus?

DUSTIN COSTESCU: Yeah. So we're really, if there is a silver lining, lucky that pregnancy itself is not considered a high risk condition for for coronavirus. Pregnant women seem to be doing as well as their non-pregnant peers of the same age and overall health. So that's really good in comparison to influenza. For instance, where we know pregnant women do a little bit worse and we also know that most babies they get infective have done extremely well and most are detected through surveillance. So there's already a family member that's that's infected. And so, you know, for those new parents who are worried about it, even just being worried about coming to the hospital to give birth and then going home to their families or their their big little ones at home, at this point, we really don't think there's much risk to them and so that's very reassuring to us.

MG: How this plays out in some ways depends on where you happen to be in this country and who you happen to be. We're learning more and more about this when it comes to the coronavirus, that it is not affecting us all in the same way. Aimee Carbonneau is a midwife at K'tigaaning Midwives on the Nipissing First Nation Reserve outside of North Bay, Ontario. Have a listen to what she's worried about in terms of the care that she's offering her patients.

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VOICE: Our practise serves the indigenous community and I think particularly from that community, we know that indigenous people have the worst health outcomes of everyone in Canada. So I think there is quite a lot of concern around that. We think if you think about co-morbidities, diabetes, high blood pressure, things that disproportionately affect our community, those are things that we know give you worse outcomes from this virus. So we also saw the Amish community there taking this very seriously. I think all of our communities have their own concerns, but specifically, the indigenous community, I think has sort of more at stake in terms of if people from our community get it, we know that that our odds of having a good outcome are lower.

MG: Catherine Lebel. Are you noticing differences in your data yet between people who might be in larger centres and people who may be living in more remote communities?

CATHERINE LEBEL: We haven't looked at that data yet. So we do have respondents from across Canada right now, which is great. We're still looking for more participants. And I think particularly we need some more data from rural areas to be able to properly compare that.

MG: Dustin, is this a concern for you in terms of where people happen to be?

DUSTIN COSTESCU: Yeah, I'm lucky to work in an academic hospital where I have access to every specialist that can help me. I think just down the road we have a relatively affluent indigenous reserve, but we know urban indigenous people might not have access to their communities as well as supports regionally. And what we see in the smaller hospitals where we know they may have less resources to deal with sicker patients is that they're they're having to make it more difficult decisions about the appropriateness of care. And and the thing that's hard for coronavirus is if this becomes a high risk condition, then patients might have to travel further or travel further away from their communities for giving birth. And we we already know that doesn't set people up for success. And so that's not an ideal outcome for anybody.

MG: You talked about the variables and we heard from Maria saying, again, you know, what happened a month ago seems like a lifetime ago. What is it like for you delivering babies right now in the midst of a pandemic?

DUSTIN COSTESCU: Well, I just was on the Labour floor last night. So, I mean, I can tell you, you know, 3000 deliveries later, it never stops getting old. It always brings a smile on your face to see a baby take its first breath. There is something aethereal with each birth lately that just you realise these babies are being born in this uncertain time. But in some ways, that connects us to our past because, you know, people who live around the world in periods of sorcerous upstair conflict live through this all the time. People in history have lived through through these things. You know, we still see that spark of joy in parents eyes as they meet their new little one for the first time. We see that that joy. And and I know that the patients that are being seen are being very well cared for here at the hospital. And that's probably the most important thing I try to reiterate to patients is that you're still being cared for here. We might be wearing masks. We might look a little different, but we care about you. More importantly, we want to see you. And we still think this is a really important part of your life as well. But it's a bit surreal to just do it when you think about it in the big picture.

MG: I mean, two things. One, that joy that you see and experience every time you're involved in that work is something that a lot of us could use right now in the midst of a grim time. But practically, what's different? I mean, the other things that you have to do differently are the things that unfold, I mean, the unpredictability, you talked about the variables. What does that mean?

DUSTIN COSTESCU: Well, we're a team on labour and delivery. We have midwives, extremely skilled nurses, physicians. I have trainees, residents with us. We have to distance ourselves so we don't have that same family and team that's working together. It feels a bit more isolated when we're doing the work. We currently mask every time we're in the hospital taking it off to eat and then putting it back on. So we're losing those visual cues that we use to to reassure patients. There's there's certainly is fear amongst health care providers, a little bit of fear of patients and who might be the asymptomatic spread and, you know, whether we talk about it or not, it is creating this us versus them dynamic, which is really the last place we want to be, especially in maternity care. And, you know, our clinics look different. Many places are shutting down. There's checkpoints to come to the hospital. So, you know, every day you come to work, you just get reminded as soon as you enter that you're kind of entering the battlefield. And I know that analogy is dangerous, but it's an important one, too.

MG: You talked about changing plans. I want to hear another little bit from Aimee Carbonneau, the midwife in North Bay that we heard from earlier. In many provinces, including Ontario, midwives can deliver babies at home. Here's what she said about whether people are opting for that option more given the reality that we're in right now.

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VOICE: So right now, we have a lot of interest in homebirth, but in our particular situation, because we have a clinic birthing suite that tends to actually be people's number one choice right now. And certainly a lot a lot of people have switched from planning hospital births to planning clinic births. So I would say almost all of our clients are currently planning a clinic births. And then if they can't have a clinic births, a lot of them home is their second choice.

MG: Catherine, what are you hearing about people changing their birth plans?

CATHERINE LEBEL: Yeah, we've had a lot of changes in birth plans from people, most notably that their support people have changed whether they were going to bring more and they can only bring one or not, that uncertainty about who they're going to bring. We've also heard a lot about changes in prenatal care. So cancelled appointments or appointments being delivered in other ways.

MG: Dustin, what do you say to people who wonder that people who want to go to the hospital the best of times, especially now. What do you say to people who wonder whether it's safe to give birth at a hospital right now?

DUSTIN COSTESCU: The hospital is a safe place to be. It's as safe as it ever has been. One of the reasons we're limiting the number of people in the hospital is to keep it safe for those people who need to be there. And that does include, you know, partners or the most important person in a in a pregnant person's life. You know, I think the homebirth thing is also it's important to remember that homebirth in many provinces, most provinces is actually safe when done with a skilled birth attendant. And midwives in Canada are trained to do it. But I think the fear of a hospital may not be the right motivation to have a homebirth, because I think it is about preparation and planning and really trying to do what you think is right for you. So no one should make that decision lightly.

MG: What about we heard from Maria and from Amanda. They both used the word anxiety and talked about stress that they're feeling. And you can imagine that again at the best of times. How is COVID-19 going to affect this, the general anxiety that people might be feeling, but also if you take a look specifically at something like postpartum depression, Dustin?

DUSTIN COSTESCU: Yeah. That's actually probably my my biggest fear about this. And I think that the wave of postnatal depression and mood disorder is going to be very significant. We know that in Canada, childbirth is very safe. But mental illness and even suicide risk in pregnant and postpartum patients is actually a major contributor to maternal mortality. And in fact, when we think about what we're doing, wait for the babies. Postpartum depression is associated with poor attachment. Poor attachment has long lasting effects for for kids. And I say this not to put pressure on people, to not be anxious, because obviously telling people not to be anxious is the least important thing, but we do want to make sure we're addressing this. And I think as we we look at virtual delivery of care. One thing that has to continue and if it continues virtual is certainly better than nothing is, is our importance of of of mental health help, but also of communities rallying behind new parents to make sure that they're getting support in whatever whatever that looks like in the moment that they need it.

MG: Catherine, you were hinting at this earlier. What are you seeing from your research and what are you concerned about?

CATHERINE LEBEL: Yeah. So first of all, we know that prenatal anxiety and depression and these sort of mental health difficulties can contribute, like Dustin said, to long term outcomes in the kids. And so I think it's a real it's a real concern not just now, but also longer in these children's lives. But we are seeing that there are some things that that seem to help. And you heard some of this from Maria and Amanda. So, for example, they were talking about social support, reaching out to friends and family. They're talking about their partners contributing and how that's sort of helping them cope and deal with it.

MG: Dustin, what advice are you giving your patients now about how to get through this?

DUSTIN COSTESCU: I think about childbirth as another major life event in your life for those who are married. You know, it's their wedding. You pick two or three things that are really important to you and really stick to those things. And good parenting advice, they say this is a pair myself is to learn to let go of some of the things that you can't have him take every opportunity at a prenatal visit to go over questions and worries. Because I think that although there are these scary-looking policies, talking about it and understanding where they're coming from is, I think, the most important way to reassure people.

MG: But the pace of change, as you said, what might be a policy now may not be a policy that applies in a week?

DUSTIN COSTESCU: Yes. And and so we're certainly trying to give patients a heads up in a way that isn't alarming. I think we're seeing worst case scenarios in certain cities where there have been, you know, complete bans on partners, for instance. I think people know what the worst case looks like. And so we're trying to reassure them that we're not thre yet and it's not our intention to get there and we'll deal with it as it comes.

MG: It's great to speak with you both about this. This is a familiar experience, I think, to many people across the country. Thank you.

DUSTIN COSTESCU: Thank you so much.

CATHERINE LEBEL: Thank you.

MG: Dr. Dustin Costescu is an OBGYN and professor of obstetrics and gynaecology at McMaster University. Catherine Lebel is a professor of radiology and the lead researcher of a study on mental health and pregnancy during COVID-19 from the University of Calgary. That study is ongoing. You can find out more at pregnancydurinthe pandemic.com. That's all one word. The CBC News is next. And then, we're back. Tom Power will be here with a chat with Margaret Atwood. That and more to come. I'm Matt Galloway. This is The Current. Stay with us.

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Unlocking Bryson’s Brain

Guests: Keith McArthur

MG: Good morning, I'm Matt Galloway. You're listening to an extended edition of The Current.

[Music: Theme]

MG: Still to come.

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VOICE: If you've been in an ice storm and all the lights had gone out and if you've been through extreme conditions of one kind or another, you've already kind of had this experience. And if you grew up at a time when there were a lot of diseases that didn't have vaccines, you were, you're hist to quarantines.

MG: Margaret Atwood on the familiarity of isolation and writing in the time of COVID-19. But first, a father's quest for a cure.

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[Clip from CBC podcast "Unlocking Bryson's Brain"]

MG: It's that sweet moment when a little boy meets his baby brother for the first time. It's from a new CBC podcast called Unlocking Bryson's Brain. It's a beautiful, perfect moment and it's long before the family realizes that Bryson has a rare genetic condition. The host of the podcast and Bryson's father is Keith McArthur. Keith, good morning.

KEITH MCARTHUR: Good morning.

MG: What's it like for you to listen to that?

KEITH MCARTHUR: You know, it's I still love hearing that that tape of Connor as a little kid, but at the same time, it reminds me of that point where we kind of imagined that we had this quote unquote, perfect family and sort of preceded this period of mourning where we realised that, you know, the second child that we thought we were going to have ended up being much different from the one we do have today.

MG: Tell me about when that shifted for you.

KEITH MCARTHUR: Well, it actually happened when Bryson was about five weeks old. This is when it started. We went to do those baby pictures at Sears and back when there were Sears. And you know how the photographer tries to get kids to prop up their heads with their fists. When he tried to do that with price and for that classic photo prescence had kept falling over. And so was the first clue that something wasn't developing typically with Bryson. And a few weeks later, doctors confirmed, yeah, that he wasn't developing typically. But that kind of set off a 10 year, nearly 10 year search to actually find out what was going on with Bryce and why he wasn't developing typically either physically or cognitively.

MG: What did doctors initially think was going on?

KEITH MCARTHUR: You know, they really didn't know the initial diagnosis was hypertonic or low muscle tone because of the fact that he just couldn't support himself. But over the next few months, it became clear he was missing all of his early milestones and they realised that the delays were cognitive as well. And so they Kyra, I said, as you know, developmental delay and intellectual disability, we had so many different kinds of blood tests and MRI eyes and muscle biopsies to try to find out what was going on. But it had, as I said, took nearly a decade to find a diagnosis.

MG: And what have you been able to figure out about Bryson's condition?

KEITH MCARTHUR: Well, Bryson has something called Brynn disorder. So essentially, we all have 6.4 billion genes in our DNA. And one of Brice's gene, there's a spelling error. So I want to start one of the 6.4 Billion letters, there are 6.4 billion letters in our DNA. One of those letters has a spelling mistake for Bryson. And that single letter change fundamentally changes who he is. So he's, you know, a sweet, loving, caring little boy, but his brain is blocked at the developmental level of a twelve month old.

MG: And what does that mean for the life that he leads?

KEITH MCARTHUR: Well, it means, you know, he has a very different kind of life. So he goes to a special needs school, or at least he did before, you know, the shutdown. And he loves it there. He is most excited. We see him every day as when he sees the bus arrive out front and he's excited to go to school. So, you know, being locked at home was a bit concerning for us. We didn't know how we would react. But he's actually doing, he's actually doing OK.

MG: You described it when we just started talking. You talked about a period of mourning that your family went through. Why did you use that phrase?

KEITH MCARTHUR: Because it really is a kind of period of mourning, you know, it you spend nine months, at least during the pregnancy, where you're imagining what your family is going to be like. And then it hits you pretty hard to realise that that child that you had is not the one that you expected. And, you know, we're lucky that we've come to a point in time where we've realised that the child that we have is actually a great gift. We're able now to both mourn the child that we thought we were going to get, but also just cherish this one we have. But at the same time, his life is hard. He has these violent seizure like episodes. He can't express his wants and desires. You know, he has a lot of challenges. And so that's why I've decided to focus and do whatever I can on trying to find therapies and or cures that can help Bryson to live an easier life.

MG: And what are some of those therapies and cures that might be out there?

KEITH MCARTHUR: We don't know what the therapies and cures are yet. But a big part of the podcast is kind of speaking with scientists and researchers around the world to try to put together some of the tests and that can help us to get there. So, for example, CRISPR is, you know, an amazing new gene editing technology that has a potential down the road for actually curing rare diseases like the one Bryson has. But over the short term, CRISPR was also used to be able to make lab mouse with Bryson's exact genetic condition. And so scientists can do tests on that mouse to try to find out more about what's going on in Bryson's brain and to trial different drugs and therapies.

MG: Has all of that work been put on pause now because of the pandemic?

KEITH MCARTHUR: It has. Yeah, I mean, pretty much every kind of work, every kind of research that's not related to COVID-19, is now on pause. And, you know, one of the big fears that we have is some labs are having to consider to keep these animals alive. You know, there's obviously bats that have to be there. And so there's an important trade-off during this social distancing period, whether you keep sending the bats in or whether you have to euthanize that animal colony. And so far, Bryson's mouse is OK, but that's another piece of fear that we have.

MG: You talked about the school and he loves the interaction of school and loves the routine. So much of our our lives have been disrupted and the routines that we relied on are now on hold like this research. How's he doing now with everything that's going down through this pandemic?

KEITH MCARTHUR: He's doing OK. So, you know, it's a challenge for us because when he goes to school, that's where he gets his physical therapy and his speech therapy and so many other things that, you know, a lot of special needs families just don't have access to right now. But we do, fortunately, have a caregiver that comes in typically after Bryson goes to school. Right now, we're driving two hours each day so we can go and pick her up. She social distancing in her house where social distancing in ours, but we want to make sure that she's not taking public transit or taxis. We're picking her up and making sure that she stays safe. And Bryson is happy with her. She's almost become like a third parent. She's been with him for over 10 years.

MG: This is a very personal story. Why did you want to share it through podcast?

KEITH MCARTHUR: Well, a few different reasons. One, really, you know, we felt so vulnerable as I talked about that point of mourning first got our diagnosis. And so I hope that this podcast can give hope to other people when they're first getting that diagnosis and see that there are a lot of challenges with special needs kid with with a rare disorder. But there's a lot of happiness and joy as well. And we're also at this amazing point in medical history where I really believe that a lot of diseases that we thought of as incurable are going to find cures in the next 10 or 20 years.

MG: Just finally, would you have imagined that you would have made it to this point in terms of who you are and how your family is when you were in the midst of that period of mourning way back when?

KEITH MCARTHUR: I know I could never have imagined. And one of the things actually that that happens during a podcast is I talk to a family that just first got their diagnosis. And it really shocked me and reminded me of how vulnerable we had been at that period years earlier because it can't be difficult. And that was sort of just a reminder to me of how far we had come and how amazing that journey is to go from, you know, being scared and feeling sorry for yourself to being grateful for this special child that you have in your life.

MG: It's a great story, Keith. We'll send people to the podcast to find out more. Thank you.

KEITH MCARTHUR: Thank you.

MG: Keith McArthur is the host of a new CBC podcast. It's called Unlocking Bryson's Brain. You can find it at cbc.ca/podcasts.

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Tom Power in conversation with Margaret Atwood

Guests: Tom Power, Margaret Atwood

MG: This is The Current on CBC Radio One. My name's Matt Galloway. Extended edition of the program, which means we welcome virtually into the studio once again, Mr. Tom Power, the host of Q. Hello, Tom.

TOM POWER: Matt, how was your weekend?

MG: Well, you know, it was good and I tried to not pay attention to the news and I failed miserably. But that was alright. Yourself?

TOM POWER: You know, not too bad. I tried also not to pay attention to the news, also failed miserably, but did so while watching The Sopranos again, which is kind of OK.

MG: Oh, this is not the first time you've seen it? You're rewatching The Sopranos?

TOM POWER: Yeah, I think it's possibly my second or third time watching it. Nothing calms me down during a global pandemic, like good old fashioned gratuitous violence.

MG: It's a great show.

TOM POWER: It is.

MG: It's a great show. You've been speaking of culture. You have been not, in addition to watching television, speaking with authors, including one of the best.

TOM POWER: The great Margaret Atwood. You're familiar with her, Matt?

MG: I've heard of her name. Yeah.

TOM POWER: She's an up and comer. She's doing great. If you follow Margaret Atwood on Twitter, you know that she's been posting frequently throughout this whole quarantine with thoughts on everything from new books to check out to making soup with dried mushrooms from the back of her pantry. I got to talk to her at her home. I mean, I mean, where else would I talk to her? Where she filled me in on how she's been occupying her time. She shared some thoughts on the role of arts during our lives, during the pandemic. Here's a little of my conversation with Margaret Atwood.

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TOM POWER: Margaret, I hear you've been sewing masks with your sister, Ruth. How's that going?

MARGARET ATWOOD: Well, that's fine. I made the cookies and she did the sewing, in point of fact. But she is, she's cut one out for me, which she fondly believes I'm going to sew and maybe I will.

TOM POWER: Is there anything you're enjoying about being stuck at home?

MARGARET ATWOOD: Oh, I don't think of it as stuck Tom. You discover things about your house that you've been neglecting for a while. Your house and garden and there's suddenly of more interest than they were. Don't you think?

TOM POWER: I think so. I don't have a garden, but I sure wish I did.

MARGARET ATWOOD: You can get some nice potted plants to have inside and you can put them on windowsills.

TOM POWER: I only have plastic ones, Margaret.

MARGARET ATWOOD: Tom, you can up your game. It's time. It's time for the real ones.

TOM POWER: It's time to grow up, put away childish things. How are you holding up? Are you doing good?

MARGARET ATWOOD: I'm doing well. Yes. But of course, writers are isolated most of the time anyway. So it's not that much of a change.

TOM POWER: Are you writing?

MARGARET ATWOOD: I'm writing so much. You could hardly believe it because everybody wants you to write about this thing that's going on. So in different way, it's in many ways in different angles. And I'm writing a lot right now.

TOM POWER: I wonder if growing up the way you did where I live for months and months at a time, you and your family would just take off to the woods in northern Quebec and live far apart from everywhere, everybody else. Like, I wonder if you're uniquely prepared for self-isolation?

MARGARET ATWOOD: Well, I wouldn't say it's a unique time because people of my age in that generation, a lot of people did that. So more in the now, probably. But if he had been in an ice storm and all the lights gone out, and and if you've been through extreme conditions of one kind or another, you've already kind of had this experience. And if you grew up in a at a time when there were a lot of diseases that didn't have vaccines. You're used to quaranties. Like you remember this, you've been there. You remember the scarlet fever, the polio, the TB and the measles. What else? Typhoid. Diphtheria. Those killed people. So it's not that unfamiliar, but for younger people who have never experienced this, it must seem like the end of the world or something.

TOM POWER: I mean, yeah, this is the first bit of experience I've ever had with this. I'm in my early 30s now. I've never had anything like this before. It feels like I'm living in one of your books.

MARGARET ATWOOD: Well, you're lucky you're not because things are worse in my books, Tom. So anybody who's in a house, isn't ill, has enough food, has enough money to see them through, is able to either grocery shop at old people time or have their relatives go and get them food. They're pretty lucky. You know, they're not dying of COVID-19 and they have lots to amuse them, if you think of it compared to what people used to have. I expect Netflix is doing a pretty booming business and radio shows and TV shows and podcasts and books. Books, you can order from your local bookstore. They will deliver. Some of them have curbside delivery. So you have a lot of access that people once upon a time would not have had.

TOM POWER: What do you find interesting about the way that Canadians are responding to this?

MARGARET ATWOOD: That's quite a wide range of people. But I think on the whole, they're responding quite well there. They're donating masks. They're donating to online things that are raising money for medical supplies. They're sewing their own masks. I think they're doing biometric hand sanitizing. They're not having toilet paper riots the way some countries, too. And so all in all, I think they're being quite aware. And the West Coast particularly seems to flatten the curve. Well, that's good. But you also have to you will notice a great rise in the appreciation for health care workers. They are they're very much on the frontlines. And I think we we tended to just take it for granted or our health care system. But I don't think we're taking it for granted anymore.

TOM POWER: I wasn't really joking when I said, I feel like I'm living in one of your books right now. Like I want even though, yes, it would be far worse, but I think about someone like you who is known for writing speculative fiction. I wonder if you have a unique perspective on what's going on right now or whether it gives you something different than the rest of us.

MARGARET ATWOOD: I don't think it's unique, Tom. It's probably just about the same as everybody else's. I don't think writers have some kind of special unique thing that that only they have. I think it's living through possible scenarios in which which we all do a lot in our heads anyway. So. So, yes, but I'm not the first person on the face of the planet who has thought about pandemic plagues and pandemic plagues go way, way, way, way back in history there, some of them in the Bible, just for instance. And if you read ancient Greek history, there were numerous ones. Roman as well. And in many times, of course, you had the well-known great mortality or are Black Death, which killed half of the people in Europe. Not to mention they wipe out of indigenous communities. That happened when European diseases came over with Columbus and those involved. They had no immunity. So what we're looking at right now is a new thing to which nobody has any immunity. It's not really. It's not the rate of death isn't as high as it was true or, for instance, smallpox or the black deaths, but it can kill you.

TOM POWER: What I find interesting about that is I think one of the mistakes people make when they talk to you about The Handmaid's Tale is they say to you, how did you come up with this? How did you imagine that these things were gonna happen? And you almost always respond in a similar way, which is that I'm really only ever writing about things that have happened and could happen again. And that comes to mind, because to me, it seems like this thing is unimaginable to be happening in such a time of modern technology. I mean, for God's sake, it's 20/20. This couldn't possibly happen. But what you're saying is, is that these things tend to repeat.

MARGARET ATWOOD: Why is that with pandemic plagues? Because viruses and microbes can evolve way faster than you can, so. And human beings, by the way, are not the only species to suffer from such things. Frogs are having a pretty bad time right now until our bats because of these very infectious diseases that they can catch. So we're not alone on the planet and having such things. And they've happened before. Quite a lot because something comes along. It's different from anything we've had before us and we have no immunity to it either. Acquired immunity, which you get by having had it and and having survived or inherited immunity, which you get from having it wipe out every issue that is very susceptible to it. And those are by us on their their survival genes to their offspring, which is what happened. Black death over centuries. So we don't have either kind of immunity. And scientists are working very, very, very hard. But it takes time because first of all, you have to figure out what it is, how it works, and then you have to figure out how to foil it, how to make it so that it's trick for getting into your cells is blocked.

TOM POWER: Did your parents ever talk to you about the Spanish flu, what it was like to live through that?

MARGARET ATWOOD: Oh, yes. My mum's entire family had it in 1919. Her dad was a country doctor in Nova Scotia. And she said the whole family had it. Five kids, two parents. And I said, well, who took care of you and she said, our father dead, even though he had it himself. So they all survived, but a lot of it is luck, Tom, you know. Who survives and who gets it even. A lot of it is just dumb luck. Yeah, so it was pretty bad, but it was particularly bad because it was just after the war. So a lot of people's immune systems were down. So many people are susceptible because their bodies didn't have the wherewithal to fight the disease.

TOM POWER: How do you think we're going to be changed after this?

MARGARET ATWOOD: Well, there's been a lot of speculation about that Tom and the optimistic view is that people will rethink a number of things about how we've been living and doing stuff. So is it really a good idea to have essential supplies made in another country. For instance, we've certainly experienced that when the medical masks were almost cut off from this country by another country who we shall not name. And do we have enough basics, you know? Do we have enough essential food? How long can we hold out? So this, again, is pretty familiar to people who went through World War 2 because there was there was rationing and there was a way of distributing goods so that people couldn't hoard and everybody got at least some. So is that coming down the pike towards us? No. Yeah, I wouldn't I wouldn't think. But just remember, it has been done. It can be done. And the other thing that seen a big uptick right now is in some scenes, people are planting vegetable gardens that haven't done that for a while. So baking vegetable gardens is a great shortage of yeast. Recently, I happened to have got my hands on some, but people couldn't find it in the stores.

TOM POWER: I got some too. I learned to bake bread.

MARGARET ATWOOD: You learned to bake bread? How did it come out?

TOM POWER: I wouldn't eat it, but it was pretty good.

MARGARET ATWOOD: You wouldn't eat it? Why?

TOM POWER: It was a little bit raw in the middle.

MARGARET ATWOOD: OK. So here's here's the trick, Tom, which your Granny should have taught you. You take a straw from a broom, you stick it in the middle of the bread and pull it out. And if there's goo on it, the bread isn't done. And the other thing is, if you turn out the loaf upside down and tap it, it has a particular sort of a hollow sound that you learn to identify. Tap, tap, tap. But I think for you, the straw is the best idea.

TOM POWER: I'll keep that in mind. Margaret, thanks so much for talking to us today.

MARGARET ATWOOD: Oh, that's it? You don't want to hear more about bread?

TOM POWER: I want to hear everything you could ever tell me about bread and bagels.

MARGARET ATWOOD: Tell me how your next batch comes out, Tom.

TOM POWER: I will. I'll send you a picture.

MARGARET ATWOOD: Don't give up. You can do it.

TOM POWER: Well stay safe. If you need any toilet paper, let me know.

MARGARET ATWOOD: I'm good, Tom.

TOM POWER: Or bread.

MARGARET ATWOOD: Yeah, bread. Well, I'll wait for your fifth batch. I'm sure it'll be perfect.

TOM POWER: See you later. Take care. Hey, stay safe.

MARGARET ATWOOD: Bye bye.

TOM POWER: Bye bye.

MG: Baking tips from Margaret Atwood. Tom Power speaking with the author, Margaret Atwood. Tom will be back a little bit later on in the program. She's right. Turn your bread over. There's a little hollow sound that you tap on the bottom. If it's done, that's what you'll hear. Coming up in about 90 seconds time, Tom and Margaret, we're talking about imagining something like this ever happening. You'll hear about the past as prologue. Former CBC health reporter Pauline Dakin will join us to talk about how previous pandemics could serve as teaching tools for what we are living through today. That's on its way in a minute and a half. I'm Matt Galloway. This is an extended edition of The Current. We'll be right back.

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A century ago, physical distancing helped slow the Spanish flu. Here's what we can learn from that pandemic

Guests: Pauline Dakin, Andre Picard

MG: Hello, I'm Matt Galloway. You're listening to The Current. That word "unprecedented" has been used again and again when describing the nature of this pandemic and undoubtedly in most people's living history it is. We do know, though, that there have been previous outbreaks like the Spanish flu pandemic of 1918. And for years, infectious disease experts have drawn on that experience to project what would happen the next time. Well, here we are in the next time. 15 years ago, the current brought you a story about what a serious pandemic could look like. Thoughts on where it would come from and how prepared Canada would be. Pauline Dakin told us that story. She was the national health reporter on CBC Radio for many years. She's now a professor in the School of Journalism at the University of King's College in Halifax. Pauline, good morning.

PAULINE DAKIN: Good morning, Matt.

MG: At the time of that story, 15 years ago, millions of chickens were being slaughtered in Asia because of fears of a new virus that experts thought could be the next pandemic. Remind us about that. What was going on then?

PAULINE DAKIN: Yeah, a new virus, but at that time, it wasn't a coronavirus that was the threat. It was a bird flu. But what they were saying then now seems eerily relevant today. Have a listen to some of the voices that were sounding the alarm at that time.

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VOICE 1: We saw with SARS, one single exposure resulted in transmission to five different countries in two different continents on one single day. We will shut borders because of the hope that that will slow the spread of this virus.

VOICE 2: People will stop going to work. They will stop going to concerts. They don't go to restaurants.

VOICE 3: We're looking at an influenza pandemic at a economic event that would dwarf the oil crises of the 1970s and 80s.

VOICE 3: And so what they do is restrict their activities. And when you do that, our complex society stops working.

VOICE 4: When you start adding it all up, it really is, in a sense the ultimate perfect storm for not only an infectious disease problem, but for really bringing the world to its knees, something that terrorism, something that war hasn't done to date. And we fear this greatly.

VOICE 5: The pandemic clock is ticking, we just don't know what time it is.

MG: We have a pretty good idea of what time it is now.

PAULINE DAKIN: We do. Yes. It is striking, though, Matt, isn't it, that the experts knew something like this was coming and it was just a matter of when. Yeah. So the voices you heard there were medical historian and professor emeritus Dr. Jock Murray from Dalhousie University School of Medicine here in Halifax, and Dr. Michael Osterholm, a pandemic expert and director of the Centre for Infectious Disease Research and Policy at the University of Minnesota.

MG: And it's fascinating when you listen to them, so much of what they described to you in 2005 has come to pass with this pandemic.

PAULINE DAKIN: Yes. As I listened back to their 2005 interviews, I was just amazed. And it's chilling, but not completely surprising. They weren't just guessing how a pandemic like COVID-19 might affect us. They were basing a lot of what they said on experiences from the 1918 Spanish flu and other pandemics and outbreaks. And much of what we're coping with now was completely predictable.

MG: I want to talk about that in a moment, but give us a bit of background, rewind a little bit to those previous pandemics.

PAULINE DAKIN: Well, in the last 100 years, this is the fourth declared pandemic. There were two that were relatively mild, both the Asian flu in 1957 and the Hong Kong flu in 1968. Still, they are estimated to have each killed between 1 and 4 million people globally. And then, of course, swine flu or H1N1 in 2009. The W.H.O. says it killed between 100,000 and 400,000 people around the world in the first year after it emerged. And it's still around, but it's now considered just part of the regular slate of seasonal flu viruses and there was a vaccine developed for it quite quickly.

MG: And, of course, the 1918 pandemic, the Spanish flu, that was the big one.

PAULINE DAKIN: Yeah, it's estimated to have killed at least 50 million people during the two years or more that it was circulating, which it did in three waves. In Canada, overall, it killed 55,000 people. In the U.S., 675,000 died. It's thought to have infected about half a billion people.

MG: Those are enormous numbers.

PAULINE DAKIN: Absolutely. And that's like a third of the world's population at the time. And it took a particular toll on young people. Mortality was high in small children and 20 to 40 year olds as well as in people over 65. And by the time it was all over, one in six Canadians had contracted it, one in four Americans. And then of those, about 20 per cent developed serious pneumonia and about half of them died.

MG: And all of that was in an era before the age of air travel. It's not like now where you can go anywhere in the world and bring whatever you have with you somewhere else. How did it get such a foothold in 1918?

PAULINE DAKIN: Well, it was the late winter or spring. It's not clear but some scientists believe it started in Asia. Early reports, though, were among troops during the Great War, the First World War. It also spread along trade and shipping routes. And at the end of the war, soldiers carried the virus home and large armistice parades and parties made that infection rate explode. So that was the second wave in the late fall of 1918. And then the third wave lasted through the winter and spring of 1919, and then it subsided by 1920, at least in the northern hemisphere, a little bit longer in the southern hemisphere.

MG: There would be very few people, if any, I would imagine that would have any real memory of that time.

PAULINE DAKIN: No, but in 2005, I was able to speak to some people about their childhood memories of what it was like to live through the Spanish flu. And I found an old interview with one of them. Bernice Manning was from St. John, New Brunswick. She died some time ago. But this recording offers a unique point of view.

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VOICE: We had eleven in the family. But I only actually knew four of my brothers and two of my sisters because mum lost four children during the last epidemic. My brother was coming back from the first Great War, and they had this flu going very violently at that time. And even the doctors when in the house. And they have what they call a soup kitchen for everybody in those days, and they would bring me food or soup or whatever and put it at the door. And if you're lucky enough to have someone on their feet in the house, they would come, of course, and get the soup and tried to feed the rest. Now, I can truthfully say that I can attribute my life to my sister because she and my brother Earl were the only two that could walk and go to the door.

MG: It's amazing. Her crediting her siblings with her survival. What sort of medicine was there to offer those who were in the grips of this?

PAULINE DAKIN: Not much. Bernice talked about how her sister would make poultices from goose grease and onions to put on her chest. Some were recommending gargling or rinsing the sinuses with chlorinated soda or even a weak solution of carbolic acid — carbolic acid being a poisonous derivative of benzene.

MG: That's not a probably a good idea.

PAULINE DAKIN: Probably not. Yeah. And there were the usual snake oil salesmen peddling miraculous cures. Cloth masks became common for doctors and nurses and were even mandated for the public, in some places. It's really not clear whether they were helpful. There was a study in Asia and Australia in 2014 that showed cloth masks aren't just useless, they might actually increase the risk of infection, you know, largely because when people wear a mask, they touch their face more or they're their breath can sort of saturate the mask. You know, this is something that's being debated once again now that Canada's public health agency in the U.S. Centres for Disease Control are recommending mass.

MG: Was there anything that did work in 1918?

PAULINE DAKIN: Well, that's the question I put to medical historian Dr. Jock Murray. You heard him in the opening montage talking about the social restraints during a pandemic. And he says that kind of isolating was important. He says the best advice then and now is not the sexiest advice, but it's effective. Here's Dr. Murray, professor emeritus at Dalhousie University.

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VOICE: Everybody always wants a magic bullet. So they'd like a medicine — or they're talking now about chloroquine and vaccines and whatever. The answer is one that people don't find very exciting: wash your hands and keep away from people. And that was the public health measure at the time. Be isolated, stay in your homes, don't go out — don't go to bars, don't go to pool rooms, don't go to church, even though the minister said you can't close our churches. And the theatre owners didn't want to close either, they closed them all. So there was resistance again to these kinds of things, which is another important point. Once you enact the restrictions, then you have to stick to them until it's quite clear that it's safe to begin to de-escalate. That actually happened in Halifax. There was a lot of pressure from the media and from the public to loosen the restrictions and when they did, within a matter of days, the cases started to spike.

MG: Now we've seen that already in the United States polling with the president suggesting it was time to relax restrictions, save the economy. He's since dialled that back, but that's a lively conversation.

PAULINE DAKIN: And it's hard to imagine how long we might have to continue with isolation policies. 1918 was the first time isolation was applied as a mass approach, but it was unevenly applied, which in hindsight gives us an opportunity to see the impact. There have been studies that compared the spread of Spanish flu in different American cities, and they found the death rates were 50 percent lower in cities that closed schools and churches and theatres and banned public gatherings. They also found that cities that relaxed those measures too quickly saw a resurgence in cases. Just as Dr. Murray said, those that kept them in place avoided larger numbers of deaths associated with the second wave of that pandemic.

MG: Is it possible that that's what we're seeing now and the difference between how quickly Canada and the United States enacted and legislated these sort of isolation policies?

PAULINE DAKIN: It could be because at least at this point, we have far fewer infections and deaths per capita.

MG: But if we take those examples to heart, we might be talking about isolation for a long time to come.

PAULINE DAKIN: Yeah. And I should tell you that not everyone thinks that isolation is the answer, though, unless we're willing to do it for the foreseeable future. Dr. Michael Osterholm is a pandemic expert and the director of the Centre for Infectious Disease Research and Policy at the University of Minnesota. He says what really stopped the 1918 flu was the larger percentage of the population that was infected. Remember, one in six Canadians, one in four Americans, and those that survive became immune. And then you get into that herd immunity thing. He says if we're going to rely on isolation this time, we better be prepared to do it until there's a vaccine for the COVID-19 virus.

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VOICE: Everyone is trying to call the game after one inning when there's eight innings left to go. And as we're learning that when we take our foot off the pedal, and we're not accelerating into this distancing kind of activity, the virus is going to come back. You saw that with SARS in 2003. We in Toronto saw it in April, May, that they had solved the problem and that they had basically squelched the SARS virus in Toronto, only to have a major return of the virus because it hadn't been completely extinguished in Toronto. And the second wave was worse than the first. And so I think we're in the same boat here. Keep remembering, why did 1918 go away? It went away because enough people got infected, and they were like rods in a reaction. The virus couldn't transmit if these immune rods are in there. So that's an important point that people don't often understand.

MG: We're only in the first inning? That's unsettling. The other part of that is that, I mean, the big fear that health officials have is avoiding those huge numbers of sick all at once, so you don't overwhelm the hospitals.

PAULINE DAKIN: Yes, that's right. We also heard earlier what Michael Osterholm told me back in 2005 about how we would have to shut borders in a pandemic and halt trade. So it's interesting that when I spoke with him again the other day, he had more to add about the wider impact on our community.

MG: Like what?

PAULINE DAKIN: Well, he spoke to about some of what we're seeing around supply chains and the shortages that we've been hearing about. He says so much of the manufacturing of things we rely on — so medicines and technologies — is now done in China. And there's no backup, which is complicating how we deal with the virus. He and others have warned about this for years when I spoke with him the other day. I could really hear his frustration.

SOUNDCLIP

VOICE: Why is the world surprised? Clearly, every segment of the world, whether it be the public health community, the medical community, the business community, governments, civic leaders and the public all seem very surprised by this. And if you go back, there has been a track record of more than 15 years of detailing what a pandemic would look like in its earliest, middle and late stages. But it amazes me how those who should have been in the know weren't. The second thing is around the world, we have basically reduced health care capacity, meaning there's just not the extra beds or elasticity within the system to choose to take on these surge events like this. We don't have the manpower, we don't have the equipment, we don't have the beds. And that surely did aid in bringing down some health care costs because we didn't have to pay for that redundancy. So now we're paying a huge price for not having it. We're paying a huge price for not having the protective equipment.

PAULINE DAKIN: So, Matt, obviously some frustration that governments didn't do some of the things that would have helped us be more prepared for a pandemic. So stockpiling the ventilators and the masks. And that goes to something Dr. Murray talks about. He says the history of public health, here and elsewhere, waxes and wanes and that can have critical consequences.

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VOICE: When you have a challenge, then the interest and the importance of public health is in everybody's mind. As soon as it's over, you get the attitude that Trump has. He said I don't want these people sitting around doing nothing, and then he fired them. You know, the whole epidemic preparedness team, when you don't have an emergency, people say, well, you know, do we really need to spend all this money on the concept of public health? And then there'll be a tragedy. And when that happens, we'll see a sudden escalation of interest and all the things related to public health.

PAULINE DAKIN: So, Matt, for example, there was a SARS vaccine in development in 2003, but it was pretty much abandoned after the outbreak was over and the virus disappeared. So maybe a missed opportunity for COVID-19. But pandemics and epidemics do change history and this one will, too. For example, after the Spanish flu, the Canadian government founded a Department of Health.

MG: Really? I had no idea that that's why the Department of Health was founded.

PAULINE DAKIN: And it was after SARS that the government created the Public Health Agency of Canada, which has worked with the provinces, to develop frameworks that we're relying on very heavily right now for testing, vaccine development and the whole communication to the public about COVID-19. Here's Michael Osterholm again.

SOUNDCLIP

VOICE: We have to be open and prepared to continue to learn the lessons every day and then not get through it and kind of breathe a sigh of relief and say, 'Well, now that's all done with,' because what's now done with is going to happen again and again and again. And how many more times do we have to be surprised? And so I think, if nothing else, I hope this pandemic doesn't scare us out of our wits, but scares us into our wits, to understand what we can do to make sure that we are much better prepared in the future.

MG: Scared us into our wits? That's really interesting. The sweep of history is as fascinating and people often say, and you be careful what you do so you don't repeat history. Pauline, thank you.

PAULINE DAKIN: You're very welcome.

MG: Pauline Dakin is a former health reporter for CBC Radio and she teaches journalism at the University of King's College in Halifax.

MG: This is The Current on CBC Radio One. My name is Matt Galloway. Yesterday, health officials reported Canada's number of confirmed COVID-19 cases has reached 25,000. Many of those cases are in long term care facilities, housing Canada's seniors, particularly in Ontario and Quebec. Yet the spread of the virus further west seems to be slowing down. Andre Picard is a health columnist for The Globe and Mail, one of this country's leading public health voices. We have checked in with him regularly over the course of this pandemic. He's back. Andre, good morning.

ANDRE PICARD: Hi.

MG: 25,000 confirmed cases, where does that place us, do you think, in this pandemic?

ANDRE PICARD: Well, we're waiting to see if we're going to hit the peak soon. So we're still among, if you look at all the countries in the world, Canada's about number 14, 15 in the world. So we're batting well above our weight to we're about the 40th most populous country in the world. So we still have a lot of cases proportionally in the world and this is far from over.

MG: You and I have talked about testing before. We saw in the last couple of days Health Canada approving the first rapid COVID-19 testing kits. How do you think that will help in us assessing what's actually going on when it comes to the coronavirus?

ANDRE PICARD: It's going to be helpful to get a sense of who in the population is infected. So we're gonna have to figure out how to use these properly, get some idea of, you know, just what's going on in the population in general. But it's not a panacea. It has limitations. This testing, we're certainly not going to you know, you hear cries. We have to test everyone. We're not going to do that. We just have to get little snapshots of what's going on, that that will give us a sense of if there's immunity in the community, if there are harder hit areas, et cetera.

MG: There are questions as to whether Health Canada is moving fast enough on some fronts. Yesterday, the premier of Alberta, Jason Kenney, was speaking on power and politics and said that his province would not be waiting for Health Canada to approve certain tests or treatments. Said that we as a province are not going to wait for Health Canada, play catch up with the European Union or the United States, and then raise some questions about Theresa Tam, the Chief Public Health Officer for this country, saying this is the same Doctor Tam, who's telling us we shouldn't close our borders to Canada's with two countries with high levels of infection, who in January was repeating talking points out of the People's Republic of China about there being no evidence of human to human transmission. hYou've written on Twitter about Teresa Tam and the criticism around her. Do you think that that criticism of her and of Health Canada is fair?

ANDRE PICARD: Listen, there's no question we could have done better in a lot of areas retrospectively. You know, hindsight is always 20/20. But to Dr. Tam has become this lightning rod for criticism and I think quite unfair criticism. Mr Kenney's comments yesterday, for example, blaming her for, you know, we don't have enough test kits. That's not really something she's responsible for in any way. She's the public health officer. This notion that I keep reading on Twitter and this is kind of a Trump like accusation that she's an agent of China because she repeats the what the W.H.O. says. You know, what we have is Canada's top public health official taking advice from the top public health agency in the world. That doesn't strike me as outrageous. Were they a little slow? Are they a little too diplomatic? Perhaps, but, you know, you can't take the diplomacy out of public health, specially when she's in that position, which is largely I don't see symbolic, but she doesn't have any control over all the provinces. So it has to be a very diplomatic job. So short answer to your question, I think she's getting way too much blame for the power she has.

MG: She has said that one of the issues that we will look back on in the wake of this pandemic is the issue of long-term care. You've been talking about this as well. Police and health officials in Quebec have launched an investigation. 31 people died of a seniors residence, at least five of them from COVID-19. The premier said that it looked like gross negligence. And we talked about the situation at the long-term care home in Bobcaygeon, now a situation unfolding in Etobicoke, it's part of Toronto. You've said that this pandemic has exposed a crisis of neglect for our elders. What do you mean by that?

ANDRE PICARD: Well, we've neglected elders for a long time, especially in long-term care. And this is just showing how bad things are once you get a virus in there. It exposes all the other problems, the understaffing, poorly paid staff, lack of training people. You know, in this day and age, we still have many homes with two people are four people in a room. That's just a recipe for disaster when you have people who are very susceptible to infectious diseases. And that's what we're seeing. All these homes have a list of dozens of homes with more than 20 deaths. All of these were not all preventable, but they were largely preventable. We had a warning. The very first warnings were who's going to be hardest hit by this? While people in facilities who are frail and who have underlying conditions and this has come true and we we didn't really do a lot to prevent it.

MG: You said that this is also a larger societal issue and you talked about the language that will use a word like elderly. What happens when we use that word?

ANDRE PICARD: Well, what does elderly mean? It's sort of a a code word for disposable are well, they're ready to die anyhow. They've been around a long time. Some people are we've seen some people articulate this in pretty crude terms, saying, listen, these people are going to die anyhow. Let them just die of COVID, right?

MG: One of those people was a Conservative MP, Mark Dalton, who said on Twitter and he later deleted this tweet, "Most deaths are in care homes where the average life expectancy is two years and 65 percent usually pass in the first year. Is it time to start moving Canada back to work?"

ANDRE PICARD: Right, and that's this argument we've seen also out of the U.S. that let's just sort of call the elderly, right, let's they're going to die anyhow, so it might not kill them off sooner. Get back to work. It's a pretty awful way of thinking. And I don't think people think that when they put it in terms of their own grandmother or their own mother in that situation, and that's how we have to treat people as we would treat our own loved ones. And that's certainly not the way people are being cared for in homes.

MG: So once this pandemic passes, what needs to change when it comes to seniors homes and how seniors homes operate?

ANDRE PICARD: Well, we need to do what, you know, countless inquiries have been telling us for 30 or 40 years. Get proper staffing. A lot you don't don't have single rooms, don't have people bunched into rooms like it's a prison. Get people properly trained, invest properly in these homes. The government really a lot of these institutions are government funded. They're grossly underfunded. We've had staff shortages for at least a decade in all of the country. Nothing has ever been done to do that, to deal with that. We've had an inquiry after this mass murder by a nurse in Ontario that outlined all these problems. She was allowed to kill people with impunity, would have never been caught had she had not confessed. That tells me a lot about the state of these homes and how we just neglect people and don't oversee them properly. And they mean all that was district attorney. Yeah. So there are good homes or I don't want to paint tar everyone with the same brush. There's excellent care out there and we should learn from those homes. And we should make this universal, not the exception.

MG: Do you expect other provinces to pick up on what Quebec is doing and expert inspecting all private long-term care facilities and public ones in that province?

ANDRE PICARD: Well, I think Quebec is doing this. It's overdue. In other jurisdictions should do it, but I was shocked to hear yesterday Ontario said, no, we're not going to test everyone in long-term care. It's a waste of tests. And it strikes me as, and think about that policy. Quebec is going to test everyone in the homes and they should, because we're going to find a lot of infected people.

MG: People have talked a lot about what we will be like and who we will be when we come out at the other side of this. Is this one of the reckonings, do you think, in terms of how we care for our elders?

ANDRE PICARD: I think this is going to be one of the big reckonings if we're going to have to rethink about the place of older people in society. Do we want to institutionalize them in the numbers that we do? We have 400,000 older people in institutional care in Canada. Do we want a different approach? Do we want to have smaller, more intimate homes like they do in European countries like Denmark? Do we want to pay people a decent living wage so that they don't have to move from one institution to the next? In Quebec, people were getting paid as little as $13 an hour to do this really, really hard work, physically, mentally demanding work. That just it seems unthinkable.

MG: Andre, it's great to speak with you, as always. Lots to mull over. Thank you.

ANDRE PICARD: Thank you.

MG: Andre Picard is the Global Mail's health columnist. We'll check in with him regularly in the weeks ahead. In the meantime, that idea of a reckoning when it comes to how we as a society treat our elders is something we'll be talking about. We'd love your thoughts on it as well. You can reach us through the website at cbc.ca/thecurrent. Click on the Contact link. You can send us an email thecurrent@cbc.ca or send us a tweet @TheCurrentCBC. The CBC News is next and then we'll talk about the economy. It's in a tailspin. Two economists will weigh in on what to watch for and how you start the economy back up. I'm Matt Galloway. This is The Current. We're back in six minutes. Stay with us.

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Economists weigh in to how government responded to pandemic

Guests: Armine Yalnizyan, Frances Donald

MG: Good morning. I'm Matt Galloway. You're listening to The Current.

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MG: Still to come, are you, like me, wondering when and how life will return to some semblance of normal? Well, the answers may involve contact tracing and immunity testing. We'll hear more about that coming up. Also, Q's Tom Power in conversation with Catherine Reitman on the hurly burly of being a working mum during this pandemic. But first, the economic fallout of COVID-19.

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MG: From a $73 billion wage subsidy program for Canadian businesses to a global agreement to slash oil output by nearly 10 million barrels a day, Canada is witnessing economic measures of historic proportions, all intended to bring us back from the brink of pandemic induced disaster. Our economic panellists are here to talk about those measures and more. Armine Yalnizyan is in is the Atkinson Fellow on the Future of Workers. She is in Ottawa. Frances Donald is global chief economist at Manulife Investment Management. She's in Toronto. Good morning to you both.

ARMINE YALNIZYAN: Good morning, Matt.

FRANCES DONALD: Morning.

MG: Armine, we'll start with you. This wage subsidy program helping businesses pay their employees comes after another massive federal initiative. The candidate emergency response benefit money is going out the door at a staggering pace to try and help those who have been impacted by this pandemic. How well do you think the federal government is doing in getting this relief actually in to the pockets of Canadians?

ARMINE YALNIZYAN: I think it is done. The federal government has done a remarkable job of staging the type of help that is required. And just this morning that we learned from the IMF that they are forecasting an economic hit that rivals that of the Great Depression. And we in the Great Depression in Canada, we saw 30 percent of the labour force out of work and a fifth of our population in Canada dependent on government assistance. It looks like we're more than rivalling that right now because of the type of measures that were put into place very quickly through the Canada Emergency Response Benefit. And the wage subsidy has yet to kick in. And the hope is there that this thing doesn't go on so long that relationships between employers and employees are broken, but who knows where we're going?

MG: Am I correct in saying that you put the emphasis on the federal government there?

ARMINE YALNIZYAN: Yes. Because the federal government is responsible for income supports, certainly at this scale. And we are likely to see the federal government coming in as it did in the Great Depression, helping out jurisdictions that are also hugely financially strapped. I reference Newfoundland and Labrador that is on the brink of bankruptcy and Vancouver says the same thing.

MG: We'll talk about what other levels of government are or aren't doing. Frances, for you, how do you think the government is doing? Is it getting it right? It's sort of making these decisions on the fly in many ways.

FRANCES DONALD: Well, as we noted, the whole goal here is to build a bridge from pre-coronavirus to the other side with the intention that if we can limit the amount of people that are laid off, we don't have to worry as much about rehiring them, which is a much longer process. Typically five times as long to recoup the damage of a recession than to actually create a recession. My concern is we have a pretty strong bridge here, but I'm not sure it's long enough. My concern is that this economy is not going to bounce back as quickly as we hope it is. Pressing go and opening shops is one thing, but there's a sizable confident shock at play here. I'm worried the bridge is not long enough. And my hope is that we continue to add to it as we see this crisis prolong several more months than I think it's currently expected.

MG: I'll use your metaphor. Is the bridge strong enough? To Armine's point, you have a wage subsidy that has been announced and approved, but is yet to actually pay off for people. Will those businesses be around to experience the switching back on the economy whenever that happens to be, Frances?

FRANCES DONALD: Matt, you're highlighting one of the biggest challenges in analysing the Canadian economy right now, which is that we know, for example, there are over 8 million people that applied for both EI and the CERB, double counting how many of those people are going to be rehired from the wage subsidy. We hope many, but it really complicates our ability to get a sense of how deep these job losses will be. To Armine's means earlier point as well, we need to make sure that relationships are sustained between employers and employees. I hope to see that the retroactive element of wage subsidies going back to the middle of March will mean rehiring activity. We've seen some large companies say they'll engage in it. But what I'm really concerned. Are the small coffee shops, the small businesses that need to bring people back online. We're going to find out in the next couple of weeks and whether we see that rehiring activity is going to be a major determinants of how how weak this recession is and how quickly we can bounce back.

MG: Armine, how long can those small businesses last? It's not just rehiring people. It's also rent. We're halfway through the month of April and many of those businesses, restaurants, barbershops, salons, what have you, have no idea how they're going to pay the May rent. How long can this last?

ARMINE YALNIZYAN: Excellent point, Matt. And we don't know, as we have said the last time we visited with you, part of it depends on how we behave and how much we can truncate the contagion. And, you know, do we need to do a stop start twice? Everybody is saying that the COVID virus appears to be a multiple wave thing. So who knows what the answer is to your question, but even before COVID struck, we were looking at an escalation in in corporate insolvencies. And I fear that going through this period, we may be looking at a tsunami of bankruptcies that are both consumer and corporate driven. And we are going to have to come up with a very different take on how we deal with debt. On the other side of this, this is we have gone through the looking glass on everything that we know about how economics works. And there's nothing, you know, normal about the recovery to this thing on the other side and we still don't know how long it could last.

MG: The emergency response benefit has been praised by many people. There are some criticism by some in particular for who falls through the cracks. If you are a freelance worker, a gig worker, if you are somebody who is perhaps trying to keep to Frances's point some of those connections that you might have with work and you pick up a little bit of freelance work, $100 here, $200 there, you could lose your $2000 a month emergency response benefit. Is that necessary? Is it necessary Armine, for the government to try and figure out how to close that gap, to make sure that people aren't being cut off because they're trying to keep some ties with work.

ARMINE YALNIZYAN: I assure you that there are hundreds of people working on broadening and strengthening the social safety net. What the federal government did with the CERB was get it out to the people that got sick or lost their jobs first. Then they introduced the wage subsidy to maintain relationships. Now they're looking at, OK, who's left out, who has no shelter from the economic storm and they will be expanding the reach of the CERB. They've said that repeatedly, including on Saturday when the parliament was recalled in an emergency way. What is really is important for us to understand is that just cutting a cheque for everybody is not the right moment. This isn't what the moment calls for. And the reason is because the majority of the 19 million people that were employed in Canada before COVID struck are still working. The majority of them have not lost work and there is a huge portion of them that are deemed essential workers that we need to not stay home, but actually safely go to work and do the things we all need. So this isn't a one size fits all universal approach by any stretch.

MG: Frances, there have been calls for that. Just say, you know, cut a cheque, get a thousand dollars or two thousand dollars into the bank accounts of everyone and then we'll deal with the fallout from that later. Is to Armine's point, is that not the right approach or do you have some sympathy for people, politicians or activists or other economists who are saying that this is the right way forward?

FRANCES DONALD: This is an iterative process, and as much as economists like Arlene and I are analysing the data every day, so too are the policy makers. The most important thing at this juncture is to realise that we are going to see not just some of the largest job losses that we have seen in modern economic history, but we will see them happening more quickly than we have ever seen. Job losses occur. So what will we would typically expect to occur in a matter of nine, 12 months? We're witnessing in a matter of weeks. And for me, that means we have to get money into the pockets as quickly as possible. And for that, I do think our policies need to be commended. I also believe, however, that we need to be looking at commercial rents. We need to make sure that we aren't just subsidizing wages, but making sure that people are going to actually pay their small business rent each month. Those are the two components that go into the small business outlook. And if we support the small businesses who hire the workers, then we're more likely to see ourselves helping the workers on the other side.

MG: Armine, you mentioned Vancouver. The city of Vancouver has warned it might declare bankruptcy. Cities, municipalities, big and small are losing millions of dollars every single day because of the shutdown to the national economy. How do we go about shoring up our cities, cities that that can't run a deficit because they need to come up with balanced budgets?

ARMINE YALNIZYAN: Yes. Here we're looking at some very, very serious maths. And it's not all cities that are in this position, but in many cities, the two largest, Toronto and Vancouver, failed to raise development fees and taxation at a time when the cities were exploding with development activities and consequently have been raiding their reserves, too, and basically running out of room for a rainy day. So here we are. The rainy day has arrived. In fact, it's a flood. And as in the past, because this is not the first time in history this has happened. It is very likely that we are going to have to come up with something very creative that relies on the federal government to provide supports. And as I mentioned earlier, and it's inland in Labrador, we're already in this position. There was faint hope for its ability to be able to ever balance books based on what is happening to the price of oil and its dependence on oil. I don't think that's the same for Alberta, which never had a sales tax, but this is not a time to be raising taxes. So we are going to be looking at some very different roles for the federal government, which since the mid 1990s has been paring back its contribution to the economy on purpose by design to sanitize its bottom bottom line. And now we have the space for it to step back in in stepping back and it is doing.

MG: Frances, where does that leave a province like Alberta, Saskatchewan as well, where the energy sector has been hit already? You now have a double, triple whammy where the economy seems to be being bashed from all different sides. What's the role of the federal government there in providing assistance? We've been hearing that it's coming, that it hasn't arrived yet.

FRANCES DONALD: You're highlighting one of the biggest challenges for Canada, which is every major province, is suffering from a different additional problem on top of COVID-19. For example, Vancouver in Toronto, which we've just mentioned, are now facing the popping, in my view, of their housing market bubbles that are going to see additional stresses from those sectors. And of course, Calgary in Alberta dealing with this tremendous drop in oil prices. I mean, we have western Canada select trading at less than $3 for a barrel of oil. This is unprecedented. It will change the industry. In 2014, 33 percent of business investment in this country was going towards the energy sector. Today, it's 16 percent and continues to decline. This is a structural shift that will hit this province and require it requires structural changes, not just to support direct workers, but all of the export energy related industries around it.

MG: Just in the short remaining time that we have, I'm going to ask you both the same question, which is when is it time to start thinking about how you turn the economy back on? A lot of this is about keeping whatever it is afloat, but when do you start to think about plugging it back in? Frances?

FRANCES DONALD: When people are safe, and that's why this is so challenging. Our economic outlook has to depend on our medical outlook that puts it in the hands of our medical community kids and tell us what has to be the number one priority.

MG: Armine, for you, when do you start to think about what's on the other side of this?

ARMINE YALNIZYAN: What she said.

MG: I love that you agree. Would you care to elaborate on that?

ARMINE YALNIZYAN: Well, there is no elaboration. This is a public health crisis. It is a pandemic. We have to stop the contagion that is job one. We don't know when that's going to be over. So talking about how we recover is completely premature in my mind, because as the pandemic goes through, we are blitzkrieg ing the economy. We don't know what the landscape is going to look like on the other side. How much of the economic landscape that exists today will have been blown up and not something that we can rebuild. So I just can't even imagine talking about recovery yet.

MG: We'll talk to you both again. In the meantime, thank you. It's great to to speak with you.

ARMINE YALNIZYAN: Thank you very much.

FRANCES DONALD: Thanks for having us.

MG: Armine Yalnizyan is the Atkinson Fellow on the Future of Workers. She was in Ottawa. Frances Donald is global chief economist at Manulife Investment Management. She was in Toronto.

[Music]

Tom Power in conversation with Catherine Reitman and Tamara Levitt

Guests: Tom Power, Catherine Reitman, Tamara Levitt

MG: This is The Current on CBC Radio One, my name is Matt Galloway, Tom Power is the host of Q. Hello, Tom.

TOM POWER: Matt, how are you?

MG: Well, I'm okay. Have you started cutting your own Heriot?

TOM POWER: I have not. I've decided since I'm now on the television as well, I want to make it like a grand experiment to see how long I can get by the end of it. I want to see if I can look like Brett 'The Hitman' Hart in about eight weeks.

MG: Must see TV.

TOM POWER: Yeah, only in here alone, not in physique. I want to make that perfectly clear.

MG: Duly noted. You wanted to talk about other TV?

TOM POWER: Yeah. Do you ever watch that Working Moms show on CBC?

MG: It is a great show.

TOM POWER: It's pretty great, isn't it? Yeah, I was talking to Catherine Reitman. She's this creator, executive producer, the star. And she, like so many people, is trying to juggle work and childcare during a quarantine. She's a real life working mum and she's right now she's at home with, check this out, two pets, two kids, husband and her aging parents, one of whom is the director, Ivan Reitman.

MG: That's a full house.

TOM POWER: Oh my God, is it ever. I feel like Danny Tanner should be there. I caught up with Catherine about the madness and, yes, the hilarity that is a life of a working mom during COVID-19. Take a listen.

SOUNDCLIP

TOM POWER: How are you holding up?

CATHERINE REITMAN: I'm doing OK. I don't think I have, I do not feel right complaining. That is for sure. You know, it's I'm struggling with the home schooling. I don't think I'm very good at it. And it's, you know, I'm I'm still working. So that that's been very complicated.

TOM POWER: What kind of homeschooling are you doing?

CATHERINE REITMAN: The kind where I hand them iPads and run. No, I'm trying. Like I taught, I just recently taught my six year old, like, I opened up the like, we have these workbooks. And thank God there's like a Zoom school for them to attend, but there's hours where I'm supposed to like review it with him. And he had, he has to learn, he's at the phase of learning how to tell time. Remember that when you had to look at a clock and like learn what the big hand and the little hand meant? And I'm realizing I'm like, oh, my God, this is pretty complicated. I've really been taking my phone for granted. But yes, I'm teaching him, I think I taught him how to read a clock. Time will tell. That's a nice pun for you. That's a pun for your viewers.

TOM POWER: Pretty good. Pretty good. You're living with your kids and your folks?

CATHERINE REITMAN: I am, I am, and it's been kind of stressful, I mean, both my parents are in their 70s. Both have medical issues. And it I think I mean, everyone's already so stressed out. But the fact that additionally I have to make sure that we don't go like nothing can come every time I order something from Amazon or like I don't think we ever even order takeout food very rarely, because I'm just so paranoid that, you know, my parents are kind of the target demographic for this thing. It's stressful.

TOM POWER: But you're getting along.

CATHERINE REITMAN: We're for the most part, getting along. We're watching movies together and they've, they're like my dad, my dad, who went to McMaster's, what what, shout out to McMaster's. I'm sure there's some fun. I don't know what the mascot is, but anyway.

TOM POWER: I think it's a book.

CATHERINE REITMAN: He's a music major. Is it? Is it actually? Or is that just an awesome joke.

TOM POWER: Yeah, it's a big book with glasses?

CATHERINE REITMAN: Yeah it's just the Harry Potter owl. Yeah. He was a music major, and so he was in a capella group called The Twin Tone Four. And so there's been some singing and some jamming. Not Tom Power level jamming. I would never, but we're having some fun. We're having some fun.

TOM POWER: I love the idea of your dad, like Ivan Reitman is like a legend in film, singing in an acapella group.

CATHERINE REITMAN: Oh, my God. I can't sing happy birthday to someone without him hitting three harmonies. The man understands the music scale. He's very musically talented.

TOM POWER: How about you? Are you taking this time to like learn how to do something that you couldn't do before?

CATHERINE REITMAN: I hope you're not asking everyone this question. I'm so annoyed at this and here is why. Like, there's a lot going on. Fair? And I feel like there's so much pressure on us right now to like learn how to play an instrument or write the next great novel or discover a vaccine by accidentally combining bleach and toothpaste and not only am I not capable of all those things, but it's a really stressful climate right now. I don't find it creatively stimulating. I don't find it to be like when people are like, I'm bored, I feel like doing something playful, I'm like.I was talking to a friend the other day who's like, you know, who I'm sick of listening to right now? People without children. People are like oh I made another bread or here's a yoga pose. I'm like, where are you finding the? I feel like I'm working full time with kids at home and trying to teach them how to read a clock. No, I haven't learned to play an instrument, Tom.

TOM POWER: I don't have children and I was just about to tell you that I learned how to make bread.

CATHERINE REITMAN: Of course you did. You making sourdoughs? You making a wicked walnut cherry loaf? What are you making over there?

TOM POWER: I just got so much free time, I don't know what to do with it. Well, let's talk about Working Moms for a second. I think we have a clip. Take a listen to this.

[Clip from Working Moms]

TOM POWER: So that's Kate taking her son to work after he misses the bus. Do you think that working moms land's different during this pandemic?

CATHERINE REITMAN: I think that there is a want for escape right now. And our show, which drops on Netflix, season 4, May 6, and of course, you can find it on CBC Gem, is that. I mean, it's a great escape. It is like literally the image of women leaving the house and going and acquiring their dreams in and fabulous blazers. So I think it's pretty fun to watch right now. But I also know that it's. It's a different world right now. I feel like it's a very delicate time, like I feel like I'm watching things being like, huh? Will we ever be able to shake hands again? That high five that those two best friends did? Is that a thing of the past? Are we going to enter buildings without getting our temperature taken? It's just it's a you know, as we're as I'm looking into the future potentially of the show, I'm definitely considering, does this affect it? Is it a new world?

TOM POWER: It's hard to say. I really do think that, like more than ever and I'm not just saying that because I have a stake in this, but like more than ever, it's proven that like shows that can take our minds off of it have a deep, deep value, you know?

CATHERINE REITMAN: Oh, my God, yes. And also shows that can make you feel something, right. I mean, I was watching Mike Nichols working girl with Melanie Griffin and I haven't seen it in ages. And I found myself, like, crying. I found myself fully moved. And I was like, God, I need to feel this right now. I need to feel things other than the anxiety of, are my parents going to get through this? Are my kids going to catch it? Am I going to fail my children? Are they going to be held back a level next year? Can my husband and I survive all this with all this pressure? You know, it's it's it's nice to be here. Just click on something and laugh at really small problems.

TOM POWER: What's your advice to parents right now who are home with their kids?

CATHERINE REITMAN: Find a closet. Lock the door and find. My advice to parents is to be easy on yourself. It's really stressful right now. And I think that people who are handing out advice or pushing you to learn new instruments are they mean well, but they're dangerous. I think you should do. You listen to yourself and take it easy and take the pressure down a notch. You're doing great. And if you it. My hope is that come fall, when all of our children knock on wood, re-enter schools, there'll be a gradual let's put our toe in the water approach to where are all of we academically that we're you know, we're not expected to all of a sudden become professors, that we can all be a little easy on ourselves coming out of this.

TOM POWER: Well, listen, if you want to know how to bake bread or make a watch out of aluminium foil, I'm here.

CATHERINE REITMAN: I would love to learn how to make a watch out of aluminium foil. I can see no problems with that. That's going to work out perfectly.

MG: That's Tom Power speaking with Catherine Reitman, actor, creator and executive producer of CBC TV's hit show, Working Moms. For listeners in Newfoundland and Labrador, Cross-talk is up next. Thank you for listening to us. We'll see you tomorrow hopefully. For everyone else, stick around. We're back in 90 seconds with a look at our roadmap out of this pandemic life. How will we know when this is over? And when we get there, how are we going to know how to stay safe? Some ideas on that coming up. I'm Matt Galloway. You're listening to an extended edition of The Current. Stick around.

[Music]

MG: This is The Current on CBC Radio One. My name is Matt Galloway. Tom Power, host of Q is back and you bring something calming for us?

TOM POWER: Matt, you and I were texting over the weekend, weren't we, about running?

MG: We do. We both run. Yes.

TOM POWER: Yeah. Well I'm a new runner, as you as you might remember. I was texting you embarrassed, sending you embarrassing texts about my distance running, which for you I think is called a light stroll.

MG: Congratulations, you're doing great. It's fantastic.

TOM POWER: For me, it was like the Olympics. But I was struck by something you said to me one time. This is sort of the reason I started, is you find it a bit meditative, right?

MG: I do. Yeah. It's a mobile meditation for me. And I mean, I sit and meditate as well, but I find that running is something that keeps me present and allows me to think about things I can control and things I can't control.

TOM POWER: A lot of Canadians are looking to meditation at a time right now, especially member, when we're all sort of stuck inside and were maybe a little bit stressed and you could use a break from our brains. And a lot of people are using the app calm. It provides guided meditation, guided mindfulness, you know, hoping to ease your stress a little bit. And what's interesting is that, you know, this thing is being used all around the world. The voice behind Calm is in Toronto. It's a Canadian, Tamara Levitt. So I spoke to her about how she's getting through this, how creativity could be to the calm right now. So I think even just by listening to this interview, it's sort of a form of meditation, Matt.

SOUNDCLIP

TOM POWER: Tamara, how are you holding up?

TAMARA LEVITT: I'm doing well, thank you. It's really great to be here.

TOM POWER: I'm glad you're here. I have so many questions for you. But first, you know, I know you sort of look after the mindfulness of a whole section in the mindfulness program of Calm, in addition to guiding the meditations yourself. Have more people been using your app and the mindfulness part of your app during this time?

TAMARA LEVITT: Yeah, we've definitely seen an increase. People are looking for tools to help them navigate this chaotic, stressful time. And people have been coming to our app and we've also been offering free resource page for people. So we're offering meditations and sleep stories and master classes and music and all kinds of calming things to help people cope. And I think within the first week and a half, we've had like 1.6 million people view the page. It's been pretty amazing and very meaningful to be able to support people in this way.

TOM POWER: Mindfulness is something that I think a lot of people associate with a very busy life. Like if you're travelling, if you're working a lot, if you're always coming and going, you take a moment, you you sit with yourself, you get in touch with yourself for a couple of minutes. How does mindfulness fit into this time that we're in where so many people are inside?

TAMARA LEVITT: Yeah. So mindfulness is really applicable anywhere at anytime for anyone. It's a practice that allows us to develop more awareness and insight into what we're experiencing in any moment. And it helps us respond to what we're experiencing in a more self away. So for this instant, I mean, we're all going through this collective trauma and our lives are in our people for many of us. Every aspect of our lives have been changed. And so we're dealing with a lot of uncertainty and a lot of stress and anxiety and turning towards meditation and and mindfulness allows us to find some space in it all. I mean, meditation is a technique that can help us sue their nervous system and come ourselves in times of anxiety and help us develop equanimity, which is really the ability to learn to be okay with this uncertainty.

TOM POWER: You know, it's ia duel will be happening because one side of things we're being encouraged to write the great Canadian novel. You know, we're constantly being reminded that like Shakespeare wrote these pieces during times of duress. We're also getting encouragement to like just live in yourself and be happy with who you are and how you're dealing with it. But I am curious, you know, what can being creative give us during a time like this?

TAMARA LEVITT: So, you know, the connection between mindfulness and creativity is pretty clear. Both things bring us into the present moment. And so when we're in the present moment, it pulls us away from anxious and worried thoughts, which are what is causing so much stress for us right now. So, you know, when we're when we're writing music or when we're dancing or when we're creating art, we're fully invested in and engaged in that activity. And there's this really beautiful stillness. I mean, any musician will be able to relate to the feeling of flow. You know, that beautiful feeling where it's like creation is coming through you. You're not making it happen. It's coming through you. Right. Mindfulness is similar and it's that we can still our minds and create the space. It's a really rare activity that we can only really do in the present moment.

TOM POWER: Tamara, before we go, can you show me like and show Canadians just a little thing that we can do, a little practice we can do to be mindful?

TAMARA LEVITT: I'll offer a practice that can be done at any time and I actually used this when I went to the grocery store about a week and a half ago and I got very anxious seeing the bare shelves and, you know, seeing just the anxiety that you experience in a grocery store right now. So once I left, I felt my heart was racing. I felt some anxiety in my belly. And so I knew that I needed to calm myself down. And so what I did was this practice where I I focussed on my breath. I closed my eyes. I focused on my breath. I inhaled for a counted of four. I paused for a count of four and I exhaled for a count of eight. So elongating the breath actually it triggers the parasympathetic nervous system and it calms us down. So the way it would work.

TOM POWER: Can we try it?

TAMARA LEVITT: Yeah. Do you want me to guide you in trying it?

TOM POWER: Yeah, please?

TAMARA LEVITT: So we inhale. Two, three, four. Hold. Two, three, four. And exhale. Two, three, four, five, six, seven, eight. Inhale. Two, three, four. Hold. Two, three, four. Exhale. Two, three, four, five, six, seven, eight. Inhale. Two, three, four. Hold. Two, three, four. Exhale. Two, three, four, five, six, seven, eight. And so you can.

TOM POWER: It really kind of worked.

TAMARA LEVITT: Did it? Good.

TOM POWER: I can at least tell you that I felt different when I opened my eyes than when I closed them.

TAMARA LEVITT: Oh, good then. Good, good. I'm glad.

TOM POWER: Thank you so much for your time today and thanks for everything you're doing to keep Canadian sort of sane during this time.

TAMARA LEVITT: You're so welcome.

MG: That's Tom Power speaking with Tamara Levitt. She's the voice of the app, Calm. Maybe you're using that to calm yourself down in these tricky times. That is it for The Current for today. My name's Matt Galloway. Thanks for listening. We'll be back tomorrow. Take care of yourself.

[Music: Theme]

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Apr. 14, 2020 episode transcript

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