The Bridge with Peter Mansbridge - Was This Poem Really Written During The 1918 Flu Or Are Its Origins Much More Recent?

Episode Date: April 22, 2020

Is she the Poet Laureate of a 1869 cholera pandemic, the 1918 "Spanish flu" or Covid-19? That and thoughts About Returning To School. Plus what is it about "testing, testing, testing" that we still don't get?

And hello there, Peter Mansbridge here with the latest edition of The Bridge Daily. How many of those daily news briefings from whether they're political leaders or health officials do you listen to each day? Do you listen to any each day? Or do you only listen to maybe a couple? Some, the ones you find that are productive and informative and you actually get something out of? I'm only listening to a couple now a day. I don't listen to that circus in Washington at night. I think that's just crazy. I listen occasionally to the main Ottawa one with the Prime Minister,

sometimes to Premier Ford of Ontario, occasionally to the main Ottawa one with the Prime Minister. Sometimes to Premier Ford of Ontario because I live in Ontario. I listen to Quebec, BC, occasionally, not every day. I probably only listen to

on average one a day. Maybe two. The only American one I listen to, the only one I, aside from the Trump business at night, the only one that I think is available on a regular basis is the Andrew Cuomo one, the governor of New York. And I listened to 10 or 15 minutes of his today. He does go on a bit, but he's pretty good. Anyway, I listened to one thing because the issue about school came up again. And I know it's on the minds of a lot of you because you write about it to me. And obviously he's getting a lot of questions about it.

Will kids go back to school? And he was pretty good today because he explained the situation in some detail. And part of the detail on making the decision about school is whether you've made the decision about business. Because as the governor said, he can't send people who work in businesses back to work if there's nobody at home to look after the kids who still aren't going to school. So the two decisions are kind of together.

And he was giving the distinct impression that it's not going to happen before June. So in other words, it's not going to happen before the end of this school year. Might, he said, but not likely. But he also talked about the protocol that would have to be followed in terms of the schools themselves when you get around to making that decision, that all the schools would have to have big disinfectant teams go in there and clean the schools out, that there would have to be a form of social distancing,

physical distancing for the students in the schools once they go back. And nobody had quite figured out how that was going to work yet. And there would have to be personal protection equipment for people in the schools. So it's quite a long way to go. But I thought it was interesting the way he kind of decongened it, if you wish, walking through the process that would have to take place and the pitfalls in terms of parents

and whether they go back to work. And if they go back to work, who's going to look after the kids if the kids haven't gone back to school yet? So there are some tough decisions being made, and there was a lot of talk today on different levels about you know when when are things going to open up a little bit um i still think we're tending to get our head of ourselves here um and i think it's partly because the weather is starting in some places to look like it's supposed to at this time of year. Not here in Stratford, mind you. It was freezing again this morning.

A little bit of dusting of snow on the ground. And I was out doing my 4,000 steps. It was minus four. So that's not good. But anyway, as things start to warm up and it's supposed to be nice tomorrow, 10 degrees or something, in many parts of the country, it's really starting to look like spring.

And the more it starts to look like spring, the more the temptation to get out and hurry things up. Well, you can't hurry this up. Well, you can't hurry this up. And you certainly can't hurry it up when you hear the continuing numbers and the statistics and the horrifying situation inside long-term care homes. And this is not just happening in Ontario.

It's not just happening in Quebec. It's not just happening in Canada. It's not just happening in Quebec. It's not just happening in Canada. It's happening in different places around the world where the numbers of those who are dying in long-term care homes represent 40% to 50% of the total death number. It's happening in the states and parts of the states. It certainly happened in parts of New York. It's happening, you know, I saw in Scotland today.

They've done the numbers, and it's almost 50% of the deaths are in long-term care homes. So we clearly, universally, have a problem with how long-term care homes are protected. And I'm not apportioning blame here, because I don't know where the blame should lie. But clearly, there has to be some serious discussions about this when we finally move on from the situation we're in now. I fully expect, I don't know, but I fully expect that there will be government inquiries of an official nature, whether it's a royal commission looking into long-term care facilities or whether it's some kind of formal inquiry.

It sounds like it's needed, big time. And we can't, you know, we can't allow this to happen again where the most vulnerable in our society become those who are vulnerable to the point of dying in their long-term care facilities. Now, in a minute, I want to talk about testing. But first of all, I want to read a poem. Now, some of you may well have heard of this poem or read it yourself online because it's been bouncing around for a while and people think that it first came out during the 1918 Spanish flu. And then they went,

no, no, no. It was before that. It was in the cholera epidemic of 1869. It was first printed then. And so it's appeared with pictures from either the Spanish flu or various things from 1869. Well, it turns out, in fact, it was just written not that long ago by an American by the name of Kitty O'Meara, who's now being called a poet laureate of COVID-19. She has a blog, The Daily Round, it's called, and you can find it. Now, if you haven't heard this poem, I'm going to read it. You know, it's not that long, but it's an amazing poem.

And when you consider the fact that it's the kind of history it's had in terms of how different people have come up with different ideas of where it came from and when it was written, that too is kind of interesting. Anyway, here it is. And people stayed at home and read books and listened, and they rested and did exercises and made art and played and learned new ways of being and stopped and listened more deeply. Someone meditated, someone prayed, someone met their shadow,

and people began to think differently, and people healed. And in the absence of people who lived in ignorant ways, dangerous, meaningless, and heartless, the earth also began to heal. And when the danger ended and people found themselves, they grieved for the dead and made new choices and dreamed of new visions and created new ways of living and completely healed the earth just as they were healed. that's it Kitty O'Meara

the poet laureate of COVID-19 I think it's especially relevant today today is Earth Day and how does she conclude that poem we created new ways of living And how does she conclude that poem? We created new ways of living and completely healed the earth just as we were healed. Well, can that be so?

Is that possible? I guess we're going to find out. All right. As I told you, I wanted to deal with the issue of testing because ever since we began, we've talked about testing. And I think it's time to go over some basic facts about testing and why it's important and what we should know about testing because we talk about it as if we all know about it. And you know what?

I don't think we do. So I reached out to David Fissman, who's a professor at the Dalla Lana School of Public Health in Toronto. I reached out to David Fissman, who's a professor at the Dalla Lana School of Public Health in Toronto. And David's a, well, he's a well-known figure and expert on issues of public health, and he's certainly closely monitoring this story. So I had a chat with him this morning, and here it is. Professor, I guess one of the most used phrases in covering this story and listening to the different officials is, we need more testing, testing, testing.

Why, after weeks, if not months, are we still hearing that phrase? You know, I think we have needed testing for different reasons at different times during this epidemic. We probably are never going to do as much testing as we might want to just in terms of organizational and resource constraints. But we still want to test a lot for this disease because lab tests are our eyes and ears during this process. It's trite that you can't fight an enemy that you can't see. And you can't see this epidemic process if you don't test a lot. So in order to be maximally effective, both at preventing disease and death, but also at allowing society to reopen and allowing people to get back to work and have a bit of a life outside their houses. Either or both of those require that we really understand what's going on from an epidemiology point of view, and that all comes down to testing.

Well, what exactly are we looking for when we say we need more testing? I think increasingly we want to use testing in kind of some targeted ways. We're already doing a lot of testing in hospitals on sick people. So you could regard that as diagnostic kind of testing. Other ways that you can use testing would be for infection control. That's preventing outbreaks like what we have in long-term care, like what we're seeing in some hospitals now, possibly in other settings like prisons. So there you might be testing people regardless of whether or not they feel sick. You might be testing staff regularly, for example, to prevent them transmitting infection to those in their care, be they long-term care residents or patients.

That becomes very similar to surveillance. And surveillance is the kind of testing that we probably want to do on a fairly wide scale now to have and maintain situational awareness so that we know how much disease activity is out there, especially as we climb down from physical distancing. Because if we understand what the disease is doing in the community when we relax physical distancing. Because if we understand what the disease is doing in the community when we relax physical distancing, we will know whether or not we need to strengthen measures or we can continue to have them looser and a lot more kind of economic and social activity. And that's probably the most challenging one. You know, there are a few different ways to think about how we

might use testing for surveillance. We might want to almost, you could almost think of it as testing random individuals in the population. It wouldn't be totally at random, but there's some ways to do that. You might want to do surveillance in an efficient way by looking at people coming into hospital as a good proxy for what's going on in the community. If I'm coming into hospital because I had a car accident or I'm coming in to give birth to a baby, that has nothing to do with me having respiratory illness. So testing those people both prevents them from transmitting infection in the hospital because you can use precautions to prevent that. But it also gives us a proxy for what's happening out in the wide world.

And we might also want to do targeted testing of specific populations like kids, where we have very little information because kids seldom get sick. It's maybe important transmitters of this infection. So those are all some different applications of testing that we might want to engage in. We might even want... Sorry, go ahead. The community I live in, there are requirements if you want to be tested. You have to have at least three of the symptoms, the commonly known symptoms of COVID-19. So that's clearly restricting who you can test. And what impact does that have? Well, you know, I think that's been the state of affairs in Ontario for, well, the last couple of months. I don't have a huge quarrel with that at this point, simply because if folks do have mild illness, and we're not doing a lot of, I don't really think it's realistic to control this with case identification and contact tracing, isolating cases and quarantining

their contacts. We're all effectively quarantined right now anyway. So if folks aren't that sick and public health officials are overwhelmed and can't really do anything with that information, I don't think there's a ton of reason to test people with mild illness in terms of managing their infection. There's nothing to do beyond stay home and stay away from others. If people get sick, it becomes another matter because you have to care for them. If we could be like South Korea, that would be wonderful. If we could crank through whatever they hit, 150,000 tests a week, that would be marvelous. But I think we've proven that we don't really have the capacity or the supplies to do that. So, you know, if there's

one area where I'd say, okay, well, we can't do it, you know, it's probably less of a priority. It's probably folks with mild symptoms who want to know whether or not they have COVID. That's probably the lowest priority for me. And the reason I'm kind of bearish on the idea of case identification, isolation, contact tracing, is there are a couple of things that make that a very difficult control strategy for this illness. One is, slowly as this goes along, we're realizing there are a lot of people who have this very mild illness, and so we're going to miss a lot of folks. The other component of it is that this disease can be very non-infectious, but it can also at the same time be very explosive. And so all you have to do is miss that mild case who then goes to a large gathering and transmits this to 20 or 40 people, which has happened, and you're sort of right back at square one.

So I think the control measures have to focus more on figuring out what kinds of, how large the gatherings are going to be that we're going to allow as we lose some restrictions, and also focusing more on distancing us from each other as the mainstay, because the case identification, contact tracing, quarantine, and so forth doesn't really seem to be on the table as a highly effective control strategy this time around. It worked very well during SARS. Let me just ask one last question. And it's one of the things that we've noticed watching the testing issue is that, A, there are a number of different ways to test,

number of different kits, and there also seem to be a number of different outcomes, and some of them are not accurate. So how does that all play into the testing issue, that there are different kits, they're not all accurate, and there can be false results because of that. Yes, well, I think that's absolutely right. And just to step back, there are really two main kinds of tests we're talking about here. One is throat swabs mostly, or not throat swabs, nasopharyngeal swabs more correctly. As I've explained to people, your nasopharynx is your body part that the milk goes through. If someone makes you laugh while you're drinking milk, that's your nasopharynx.

And to try to sample this, what you need is a trained person to actually put a swab back there, right at the back where your nose meets your throat, apply a little bit of pressure, and twist that thing around, twist that swab around, because what they're trying to get are actual cells from the back of your throat, because the virus lives inside those cells. So that's what you have to sample to test. So a big limitation on test sensitivity, that's the probability that you're going to get a positive test if someone is infected. A big limitation on that is the person who's sampling the back of your nasopharynx needs to know what they're doing and needs to be good at it. And we think that the

sensitivity of these tests probably sits around 75%, which means that you likely miss about a quarter of the people who have this infection. Even if you test them properly, you test the back of their nasopharynx, you miss a quarter of them. So that's the key limitation with the swab testing. There's a second kind of testing, which is antibody testing, which we're not doing yet in Canada, but I think it's on the horizon. And there what people try to find is the immune footprint of your body having fought off this infection. And that's done through a blood test. And those kinds of tests also have limitations with their sensitivity and also their specificity.

So you can get false and positive tests. And that's why the kind of kit is very important. But those tests are going to be very important as we move forward because they tell us both how many infections occurred that we recognized, but they also tell us how many infections occurred that we missed. And there's a lot more of that kind of testing going on in Europe right now. And it looks like we missed about 19 out of 20 infections that way. When we compare the swab tests to the blood tests, we see that we probably miss about 95% of these infections. Those tests will become very important for two reasons. One is they allow us to really understand how far into this epidemic we are, because there's sort

of a historic record of what people's bodies have been through and fought off. The other really important thing about the antibody testing is it may show that a person is immune to infection and won't be transmitting this to other people and can also work safely, for example, in hospitals or as an essential worker. So I think that's going to be increasingly important over the coming months that people start to document immunity to this. Just as, you know, for me as a healthcare worker, you have to document that you got your vaccines, and if you can't remember or you don't have a record

of having gotten your measles vaccine, they can test your blood for measles antibodies, and if you have the antibody, they say, okay, well, you're okay, you're immune to that. You're probably going to see that emerging for COVID. So there are a couple of different kinds of tests. Any test has limitations with sensitivity and specificity, so they need to be done by labs that know what they're doing and are competent to do it.

All right. Listen, thanks so much for this. It gives us, certainly gives me a clearer picture of the whole testing issue. So thank you. Oh, it's a pleasure. It's nice to talk to you. So there you go. David Fissman from the Dalla Lana School of Public Health. A professor, David Fissman. And that'll give you some more to think about. I mean, there's lots more about testing, and there are different issues to dig down on in terms of the testing issue and how it has played out through this crisis

and how it continues to play out. So if you have thoughts or questions or comments about testing, send them along. Love to hear them. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. The Mansbridge Podcast at gmail.com. Now, a number of you have written to me over the past couple of weeks saying you love it when we bring on guests for a few minutes to talk,

usually kind of in the five to ten minute range, on different topics that relate to this crisis. And so I've got, you know, listen, I've got lots of people who want to come on and are willing to come on. And so I will keep bringing them into the conversation to help all of us understand the different issues that are at play. And I should have another guest tomorrow,

but we're heading towards, it's Wednesday of this week, we're heading towards Friday. You know what Friday is, it's mailbag day. So if you want your letter considered for one of the most popular editions of the week, then make sure you drop me a line at themansbridgepodcast at gmail.com. themansbridgepodcast at gmail.com. themansbridgepodcast at gmail.com. That's it for now.

Another episode of The Bridge Daily is complete. I'm Peter Mansbridge. Thanks for listening. We'll talk to you again in 24 hours. Thank you.