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How Are We Doing – Part III

Dr Dina News, Infectious Diseases

Foreword: The information in this article is what we know as of November 4, 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!

Welcome back for round three!

I have received so much positive feedback on my recent newsletters, so I am back for more.

As always, I try to share up to date and easy to understand information to empower you and help you feel more informed and confident.

You are welcome to share with friends and family who may benefit.

As before, let’s start with the bad news, and then we will head into the good news. I like to end on a high note.

The bad news

Sorry friends, but the world is not doing well with COVID-19.

We in Canada are not doing well with COVID-19, though a lot of people seem to be ignoring this. I am hearing a lot of, ‘Dr Dina, the numbers are stable right now, we still only have about 900 new cases a day in Ontario, that is good right?’

Well, not really.

I am thrilled we don’t have numbers > 1000 daily, BUT, we are seeing far fewer people getting tested, and a lot more conspiracy theory nonsense and COVID denial. I won’t get into this much, but, just like in the US, we are seeing a rise in anti-science, conspiracy, pseudoscience rhetoric, and I can’t even put my attention at that.

COVID is real. It is scary. It is killing people.

And it isn’t going away anytime soon.

Sorry, but we have to get with the program if we are going to stay safe and alive and get through this pandemic.

Here is the evidence

The spread is similar to before, with Quebec and Ontario leading the pack (this is NOT the type of game I want to win), with rising cases in Alberta and BC.

Good on the northern territories and the Eastern Provinces. High five to you!

There is some talk about relaxing measures and opening up restaurants and other businesses soon.

What do I think about this?

I am not an infectious disease specialist. I am not a public health official. I am FAR too simple for these jobs. But, in my humble opinion, I would strongly recommend against opening up, and do suggest remaining conservative.

Look, I am a mom of four. I am a business owner.

I know many businesses are struggling.

I know many families are struggling.

COVID SUCKS!

But if we don’t want to end up like the US, Brazil, India, much of Europe and so many other places in the world, we have got to be PATIENT.

That is my word for 2020 .. PATIENCE.

If we rush to go ‘back to normal’, we will have more cases. More people will get sick, and more people will die.

Overwhelming the health care system will cost far more money than that gained by opening up more businesses.

Not just during COVID, but perhaps for long afterward, as there will be delayed non-urgent care due to loss of capacity.

Perhaps we think of creative ways to funnel money to businesses to keep them from going under, while still keeping them closed or operational in a new way?

All I know is if we open up again as though nothing happened, we are screwed.

This isn’t a guess. It is based on TONS of data.

COVID has been around for almost a year. And though in some ways we know very little about the virus, there are some things we know well.

We can see exactly what happened in many countries and can see what went right and wrong.

New Zealand and Australia were swift and conservative. Lockdown was a serious thing. And guess what? They are doing amazing.

Other countries (you know them well by now) were more blasé, and some are STILL BLASÉ and have rising rates of illness and death.

Please look at the mess that is the US, Europe, and a bunch of South America.

I remain incredibly impressed by Oceania and Africa.

I was super concerned about Africa.

There is much poverty and poor access to health care in many areas.

COVID could cause significant damage where there is already fragile health infrastructure. It hasn’t yet, and I hope it does not.

I have a very special place in my heart for the continent, and perhaps I will get into the more in another newsletter.

There are several reasons why Africa is fairing so well so far.

The first case of COVID in Africa was confirmed in Egypt on February 14, 2020. African governments took quick and drastic measures to slow the spread of the virus due to concerns COVID could overwhelm the health systems.

Public health measures such as avoiding handshakes, wearing masks, frequent hand-washing, and social distancing were introduced very early.

Some countries like Lesotho closed schools and declared a state of emergency for three weeks, BEFORE A SINGLE CASE WAS REPORTED!

Intense yes, but it worked!

In addition, only 3% of the population in Africa is over 65 years of age. We know that older age is associated with more illness and more death from COVID. So, a young population may fair better.

Older adults in Africa also tend to live in rural areas, where maintaining social distance is easier than in urban areas.

Plus, people in Africa don’t tend to travel between and within countries as much as in many other areas of the world, so exposure is less.

Who is getting COVID now?

For or those of you who think, or are hearing from others, that COVID is an illness that affects only older adults, I’m going to show you this.

This is Canada specific, but similar numbers can be found elsewhere.

Which age group is testing positive for COVID the most?

Young adults.

Many of us likely fall in one of the two highest categories.

COVID is no longer a disease of the elderly.

We are at risk.

We are all at risk.

Most of these 20 and 30 somethings have no underlying health conditions. Most don’t have diabetes or high blood pressure or obesity. They are normal healthy adults.

I am not immune.

You are not immune.

Also, look at the % for kids (<19-year-olds).

This is pretty much the same % as for those 60-80 (2 categories).

Please read that again.

Kids are getting COVID as much as adults 60-80 years of age.

COVID affects every age group. It is no longer just the elderly.

How do we prevent infection?

I am asked often how to avoid infection.

Parents ask whether backyard playgroups are safe.

Yes, if you are maintaining the proper distance, ideally wearing masks if > 2 years, not hanging out with people who are sick or recently exposed, etc.).

Are garage playdates safe?

NO! consider a garage to be like your basement. Small space. Poor airflow and only one side is open.

It is NOT like a backyard and is likely more challenging to maintain distance). Please consider a garage to be ‘indoors’.

We were told this week that the majority of COVID outbreaks are NOT in restaurants and bars.

The data shows that the number of cases associated with schools, child-care centers, and long-term care facilities is higher.

In Toronto for example, restaurants, bars, and clubs accounted for 14% of outbreaks between August 1 and October 24, 2020, and gyms and sports accounted for 3%.

This is compared to long-term care homes at 18% and schools and daycares at 22%.

This looks worrisome, right?

Well, hold on.

In Toronto, 65% of cases have NOT BEEN TRACED back to a concrete source.

Can we rely on this data to confirm that schools are not safe, but restaurants are safe?

No way!

We have incomplete data.

Our contact tracing sucks at the moment, except in schools and daycares.

Schools and child-care centers meticulously watching each and every positive case. Students that become sick have a clear contact linkage.

What does this mean?

They get accurately accounted for on the graph.

Patrons in a restaurant or gym-goers?

How do they find out they were exposed to someone days ago?

Unless both people were using the COVID app… they likely won’t.

So that source of infection falls into ‘unknown source’; versus restaurant or gym.

Make sense.

We have an incomplete picture so conclusions cannot be properly drawn.

We also have an inability at this time to understand the true risk of infection from asymptomatic carriers.

Long story short – keep your distance, minimize time indoors with people except those in your (small) bubble, wear a mask, and wash your hands.

Same as always. It sucks, but it works .. Legit!

How then do we prevent further spread of COVID so we can get back to normal?

A huge piece is to decrease our current rate of contacts by 25%.

If we don’t change how many people we interact with, or if we increase our rate of contacts we are screwed.

This wave looks SCARY to me.

Ok, one more thing, promise.

I shared this link this week on Instagram. I think it explains some of the details about COVID transmission well, and the graphics are lovely.

https://english.elpais.com/society/2020-10-28/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air.html

These videos have gone ‘viral’ (haha, pun intended), but I want to clarify something important.

The graphics lead you to believe that the most important mode of transmission is through aerosols, and though we know we can be infected via aerosols, it likely isn’t as scary as depicted here.

If aerosols were the major source of transmission, many infected people would have no close contact with a case.

There would likely be far more and far faster spread of COVID.

Like measles.

Many people don’t know how incredibly contagious measles is.

Measles particles can linger in the air for hours after a contact leaves the room.

Luckily, we have a very effective vaccine to prevent illness.

https://www.canada.ca/en/public-health/services/diseases/measles/health-professionals-measles.html

The CDC and WHO say that aerosol transmission of COVID-19 can occur, but the main route of transmission is via droplets – in other words, through close contact.

The model demonstrates the importance of masking and ventilation.

Awesome.

I am in agreement here.

Here is the important point, and why I am even mentioning this.

The model does not mention the importance of social distancing, and this is KEY!

COVID spreads through droplets shared between people in close contact.

Being around more people, particularly indoors, particularly when unmasked, increases the risk of becoming infected with COVID-19. But physical distance matters greatly.

Minimize the number of people you are with.

Be outdoors when you can.

Increase ventilation indoors if you can. Wear a mask. Wash your hands.

And KEEP YOUR DISTANCE.

That brings me to the good news…

The best news I can bring you today is that we know more.

We know how COVID is spread.

We know what increases our risk, and what decreases our risk.

And that means we have more control.

Knowledge is power.

We see which countries are faring well and staying ahead of the pandemic.

We can model this. We can continue to protect ourselves, our families, and our communities.

Yes, it sucks.

We want to hang with our friends again.

I would really love to have drinks in a restaurant with friends or my husband again.

I would love to have our huge annual Kidcrew holiday party again.

In my home, packed to the brim with our families and friends and kids running around.

But we can’t.

I believe this is a marathon.

I believe we can and will get to the finish line.

But it is not a sprint.

But I believe it will take patience and time.

And we suck at waiting.

We want it over now, just as we want 1-hour Amazon delivery and we don’t want to wait a millisecond for a webpage to load. And we want an entire season of This Is Us to be available at our fingertips to binge in one night.

We are an impatient society and are being FORCED TO SLOW DOWN.

That brings me to my silver linings.

Each week I share what I am thankful for right now.

We have a family tradition in my home.

Each night at dinner we go around the table and each kid and adult share their favorite part of the day and what they are most thankful for.

And then they nominate another brother or parent. Every night. It never gets old for me.

Here are my silver linings for today:

1. A forced, slower life
I am a go-go-go type of person. You know this about me. I am always busy working on something (actually a bunch of things), and I get bored easily. It is midnight on Sunday AM while I write this, and I will likely be up a few more hours.

COVID however has slowed me down. I spend a lot more time with my kids. I spend A LOT more time at home. I am no longer out at meetings or out with friends 3-4 nights a week. I loved that. But I also love this forced restful time.

2. Less laundry
Tthis isn’t everyone’s experience, as I know some people are washing clothing more often for fear of spreading COVID, but for us, we aren’t changing as often for after school, or weekend activities. On weekends we often chill in our PJs. And this suits me perfectly.

3. Decreasing clutter
There is something about being at home all the time, that makes you realize you have a lot of stuff. And the stuff is on top of stuff. And the space feels small because of all that stuff. I have been streamlining for months. I think it calms my anxiety as well. Something to control, I guess. Donations, tidying, vacuum-bagging, and storing has allowed us to use more floor space and feel less overwhelmed and calmer.

4. The Holidays are coming
Sure, they won’t be filled with travel and big family gatherings. But they will be cozy and surrounded by your bubble – your closest and most cherished loved ones. You will be together and healthy and valued. No vacation or party is more important than that for me. Please continue to keep yourself safe, your family safe, and our communities safe and healthy.

Have an incredible week!

Love,

Dr. Dina Kulik

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