How Are We Doing – Part II

Dr Dina News, Infectious Diseases

Foreword: The information in this article is what we know as of October 28, 2020 – the pandemic situation is quite fluid and information can change rapidly. I post daily updates on social media and publish a weekly newsletter – click here for all my links and to subscribe. Dr. Dina Kulik


Hello friends!

When I wrote out my personal thoughts last week and decided to package it as a newsletter, I wasn’t sure how it would be received. I am always mindful that my perspective is my own, clouded with my own unique life experiences and insights.

I only want to educate and empower parents.

Since the beginning of the pandemic, and far before, I have been invested in providing information and education to families so you can live the best, most healthy, and happy life possible. I am a mom of four myself, and I know how hard that gig is!

We all have stresses and anxieties, and I want to help you get through it with more ease. And a bit more information.

I am so thankful for my community, who continue to respond with such positivity and thoughtfulness.

I admit I was surprised by the droves of emails I received after you read last week’s newsletter. I am so pleased that I inspired and educated you and help make your journey just a little bit easier.

I’m back at it for more, and always welcome feedback.

If you have loved ones who would like to receive this as well, you are welcome to share, and they can join the email list if they’d like – simply go to my website and a subscribe popup will appear.

In the same fashion as last week, I will summarize my understanding of the bad news first, followed by the good news. I love ending on a positive note.

And then I can share my personal silver linings for this week.

The bad news

Europe is not doing ok.

The United States is not doing well.

Quite a few other areas of the world are not doing ok.

However, as we go into more later, Asia, Australia, New Zealand, and Africa are doing amazing. Go Team!

This will help explain the world situation far better than I can, in a simple picture.

The US, Spain, France, and several other European countries have many, many cases. Canada, Brazil, Peru, China, India, Russia, Turkey, and Iran are (sadly) notable for a lot of cases, but marginally better than the US, etc.

And look at Africa, Laos, Myanmar, Australia, New Zealand, Mexico, Saudi Arabia, Argentina, and several other countries.

It’s incredible that some of these countries have fared impressively well even when surrounded by countries with high COVID numbers. Hats off to you!

How are we doing in Canada?

Well… we aren’t doing as poorly as our neighbours to the South, but things are not looking so hot.

Our numbers are rising.

They may not seem to be rising so quickly, but what we know about outbreaks is that things seem ok and relatively well controlled for a while, people let their guard down, and then numbers can increase dramatically.

We saw that in wave 1. And it is forecasted by very smart (MUCH smarter than me) epidemiologists, public health and infectious disease specialists, that wave 2 will be FAR worse than wave 1. (Cue the loud piano ‘bad news is coming’ music.)

What is worse than the direction of cases going up, is the fact that we are testing FAR LESS frequently, so we actually have a very poor understanding of the numbers.

How do we know how to act based on faulty data? Well, considering many people were pretending nothing bad was happening even when the data was more accurate…

As a result, many smart people predict we will be heading towards the mess that is in Europe right now, in the next 2 months.

This is BAD NEWS, as this is when it is cold outside.

Who wants to be at risk of quarantine again during the Winter?

Do you like being cooped up in your house when it is cold outside? When we are meant to be celebrating the Holidays with family and friends? I sure don’t!

You can clearly see that the second wave is here. Scarily higher now than wave 1. (Cue more piano thumping music.)

So, we know the numbers are going up. Now what? Where does that leave us?

Dr. Trisha Greenhalgh created this incredibly useful graph. And the brilliant Dr. Andrew Morris made me aware of it. These two are awesome, super-smart researchers and clinicians who are worth following if you are looking for much more depth than I can provide.

This shows beautifully that being masked, with few people with lots of ventilation confers less risk of COVID transmission.

I have said it before and will say it again:

Masks are not dangerous (except in very rare circumstances such as being unconscious, less than 2 years of age or unable to remove due to developmental challenges, etc.).

Most people can and should wear a mask when around others. Period.

Sadly, singing increases the risk of transmission, and that sucks for those who frequent places of worship, choirs, or for those that make their living in the world of music (or love music as a hobby). Super sucks. I wish I could make that better.

Most of us will not do ok if we pretend to live in a bubble and avoid all activities and people.

We are social, active creatures, and we need exposure to people and places. We just do.

I don’t want you to be scared and avoid life.

That WILL NOT be good or healthy for you and your family.

If you are feeling anxious about being with others or out of your home, please, please, please chat with your doctor.

Isolation and fear are NOT GOOD FOR YOU.

We know the rates of anxiety and depression and agoraphobia (fear of leaving the home) have risen dramatically during COVID and I am worried about you.

For real, please don’t ignore these symptoms in yourself or your loved ones.

Let’s talk for a brief minute about the idea of herd immunity and just relaxing and letting people be ‘free’ again. I am asked all the time about countries that have been lax, and yet ”don’t have a lot of COVID cases”. Please show me these countries. I am intrigued.

There were a few countries such as Sweden that started out being lax and have since eaten their words.

I don’t want to go into this much, but essentially the, ”be free and merry and don’t worry about COVID” approach will lead to the inevitable loss of our most vulnerable community members.

Grandparents, those with underlying health concerns, BIPOC, and those with low socioeconomic status are most at risk. To turn our back on anyone in our community would be tragic and disgusting.

Not to mention that relaxing our COVID restrictions will ABSOLUTELY lead to overwhelming our health care system. A health care system that is vulnerable already.

Sure, you may not get COVID.

You may not be in the group of vulnerable populations.

But what if you fall and break your arm?

What if you have an acute appendicitis?

What if you have been waiting 2 years for hernia repair?

Or have a chronic condition that requires frequent follow-up?

We don’t have endless doctors and nurses and clinicians (and dollars?!) to ensure that all continues to run smoothly.

While we are talking about vulnerable populations, I want to mention some interesting, and concerning data from this week in “The annals of Internal Medicine” (a super prestigious journal)

The researchers found that in the UK, people with Down Syndrome had a 25x higher chance of dying from COVID. Even if you corrected for other factors like diabetes, kidney disease, body mass, and dementia, people with Down Syndrome were 10x more likely to die from COVID.

This is a serious and scary stat and needs our significant attention.

The elderly, particularly those over age 70, especially in the setting of risk factors such as diabetes, high blood pressure, obesity, and smoking, have a significantly increased risk of death from COVID.

Especially if they live in a long-term care home.

Likely many of you have loved ones in this category. I want them alive and healthy and, in my life, and my kids’ lives.

By the way, did you know that 2.2 MILLION people live in multi-generational homes in Canada?

If community spread rises, and kids are in school (which I hope can be the case as long as possible), how many kids are coming home to their loving grandparents, or other older family members?

I have patients who live in homes with their parents, grandparents, and great grandparents. What an incredible blessing for that whole family!

We want all of our valued community members to remain well and healthy.

As mentioned last week, there continues to be clear evidence for the significant and upsetting vulnerability based on race and ethnicity. These are US graphics, but the same patterns can be seen around the world.

I believe we need a clear and concise plan for not only how to protect all Canadians (and the whole world), but also how to protect our most vulnerable populations. This cannot be ignored or swept under the rug.

Ok… that was long. Hope it was interesting and educational.

For the good news
(cue the ‘giggling baby’ music to elevate the mood )

By the way, my favourite sound in the whole world is the sound of my kids giggling.

There are quite a few vaccine candidates, and some are not far away from being assessed for effectiveness and safety.

Don’t get too excited yet though – we are not going to see a safe and effective vaccine being provided to everyone anytime soon (sorry, I know I am in the ‘good news’ section).

We will be masking for a while (but don’t stress, our kids don’t mind, see below the ‘silver linings’).

I hear from my infectious disease/public health colleagues that there is a good chance a COVID vaccine will be available in Canada in 2021.

I am cautiously optimistic.

There are around 50 vaccines in human trials at the moment, 11 are in the FINAL PHASE of testing (phase 3).

In these trials, people are given the vaccine or placebo and then access for any side effects.

This, by the way, is how most drugs and vaccines, and other medicinals are tested for efficacy and safety. Some of these 11 are nearing the end of safety testing, which is awesome. Though we don’t yet know how well they work or for how long.

You may have heard that some trials were paused due to unforeseen adverse events.

This is common in drug/vaccine safety trials. We want to see what the risks are before we give to people. It is good to catch these issues to make vaccines safer.

Of course, even if we find a safe, effective, and long(ish) lasting vaccine, we have to literally immunize the entire world.

Don’t get too excited that billions of people will have instant access to the vaccine.

We have to be patient.

Wear your mask, wash your hands, and limit group sizes – this is going to be a while.

More good-ish news – Halloween can still be fun this year.

Ok, I know that some areas are not safe for trick-or-treating.

Ontario’s Chief Medical Officer of Heath advised that kids in Peel, York, Toronto, and Ottawa could not trick or treat this year.

Bummer, I know. BUT, you can still have fun. I created a list of fun activities for you and your kids that are safe to do to enjoy some Halloween cheer.

Last week I shared some silver linings.

I fall back on these when I am feeling down.

Life is hard right now.

I want my kids to play with their friends again.

I want them to be mask-free at school.

I want to hug my parents.

I want to celebrate with my friends in a restaurant, sipping wine sans mask.

Alas, we cannot.

I am happy to focus on some incredible positives that I would not have had pre-COVID.

This provides me some comfort.

1. We are spending SO. MUCH. TIME with our kids.
There is no way we would have hung out with them as much without COVID.

2. So many parents are home with their kids every day.
This can be tiring, and overwhelming, and stressful, yes. But it is a complete blessing. Watching them grow up, and not be out in the world without us so much is a huge silver lining for me.

3. This gives us a chance to see how incredibly resilient and flexible kids are.
All-day, I see kids wearing masks, not fussed about it at all, telling me that they are loving school despite the many restrictions. Kids roll with the punches and are so much stronger than we give them credit for. We can learn from this.

4. So much less forced travel.
Did you or your loved ones have to travel all the time for work? Though many of us long to get away, there are tons of people who have not had to travel for work as much, and that is awesome.

5. Slower pace of life.
The pandemic has really allowed me to slow down and notice the incredible blessings in my life. I have my health and safety and am surrounded by people I love and who love me.

I am lucky.

You are lucky.

I hope you stay healthy and safe and loved.

Have an incredible week!

Dr. Dina Kulik

Dr. Dina Kulik, MD, FRCPC, PEM

Written By: Dr. Dina Kulik, MD, FRCPC, PEM

Dina is a wife, mother of 4, and adrenaline junky. She loves to share children’s health information from her professional and personal experience. More About Dr Dina.

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