Toronto Mike'd: The Official Toronto Mike Podcast - Dr. Brian Goldman: Toronto Mike'd #653

Episode Date: May 26, 2020

Mike chats with Dr. Brian Goldman, host of White Coat, Black Art on CBC Radio, and the new podcast The Dose, about that and many COVID-19 questions from you and me.

Welcome to episode 653 of Toronto Mic'd, a weekly podcast about anything and everything. Proudly brought to you by Great Lakes Brewery, a fiercely independent craft brewery who believes in supporting communities, good times and brewing amazing beer. Palma Pasta. Enjoy the taste of fresh homemade Italian pasta and entrees from Palma Pasta in Mississauga and Oakville. Garbage Day. Weekly reminders for garbage, recycling, and yard waste pickup. Visit GarbageDay.com slash Toronto Mike to sign up now. StickerU.com. Create custom stickers, labels, tattoos, and decals for your home and your business. The Keitner Group. They love helping buyers find their dream home.

Text TORONTOMIKE to 59559. And our newest sponsor, CDN Technologies. Your IT and cybersecurity experts. I'm Mike from torontomike.com and joining me is emergency physician and host of White Coat Black Art on CBC Radio and the podcast The Dose, Dr. Brian Goldman. Now, Dr. Brian Goldman, you might be the first medical doctor I've ever had on Toronto Mike. So I need a little help here. Do I call you Doc, Brian or Dr. Goldman? Oh, my God, please call me call me Brian. And, you know, it's a weird thing that I should want to be called Brian because I remember the first time my friends of my daughter, Kaylee, she must have been maybe 10 at the time. So her contemporaries, her 10-year-old

contemporaries called me Brian. And I was totally taken aback. I thought, how dare you? But what were they going to call me? Mr. Goldman? I mean, that was weird. So I've actually gotten used to being called Brian. So please call me Brian. And then if you do get the Mr. Goldman, then it gets a bit of an Eddie Haskell flavor to it, right? Like it's a little strange. I know that's the way they rocked it back in the 50s or whatnot. But I don't know.

I'd rather my children's friends call me mike or i could say to you good morning mrs cleaver what a what a lovely sweater you're wearing uh and i'm totally dating myself by saying that but no no no it's a syndication so uh everyone my age watched it every day i think on ckvr and eddie haskell just died he died in the last few days so yeah ken osmond so uh we'll dedicate this episode to ken osmond who was who was great he got typecast he became a cop i think but uh yeah it was one of the more memorable sitcom characters i'd say eddie haskell yeah so thanks for uh brian since I can call you Brian, thanks for making the time. I can't imagine you have a lot of time right now. Uh, you're actually a practicing, you're a practicing medical doctor, right? which means I do shift work.

And since I've been on White Coat Blackguard, I've done a lot more of the evening and night shifts and weekend shifts to afford me more time to work Monday to Friday during the daytime when my mates at the CBC tend to work. And in fact, this evening, I will be on duty at 6 p.m. in the emergency department, and I'll be doing a night shift next week. So I'm still at it. Have you ever had a patient say, I know that voice? Yeah. In fact, I get a lot of patients who kind of stare me down and they have to look far down

to see me and they say, you sound a lot taller on the radio than you do in person. And of course, that hurts because I'm all of about five, six. So there you go. Now I really do wish these were non-COVID times because pre-COVID, I'd have all the guests visit me at my home studio and they would sit just a few feet to my left. And one of the trademarks of this home studio, which is in my basement

in like a hundred and something year old home is that the ceiling dips just above the uh just above the studio it dips significantly to a point where if you're five foot eight you've got a duck so uh i wish you were here because i wouldn't have to worry like i worried when leo rowdens visited i wouldn't have to worry about concussion or anything i know you'd be fine here and you know what uh I wish I could visit you so that I could get the famous driveway shot right which I have come to know and love and and unfortunately uh no can do because of physical distancing well here's a small world story before we get rocking here, which is that, do you know who is the very last what do I

call it? I guess front yard shot that I took with a Toronto Mike guest. Do you know who the last one was on March 13th, 2020? This is a trivia question. It's not actually docking, is it? No, it's a good guess. But actually, this is more a small world story.

So it's David Ryder from the Toronto Star. Oh! I should have known that. That really is a small world. Right. It wasn't a true trivia question. It was more like a Brian question here. But why don't we just disclose this to the listeners?

Just tell the listeners, why is that a fun fact for you, that David Ryder of the Toronto Star was my last in-person guest? Well, David Ryder just happens to be partnered with Donna Dingwall, who just happens to be my show producer at White Coat Black Art. Has been for six or seven years right now. And David, Donna really rocks as a show producer. She really knows her stuff. She watches my back she watches the shows back and uh and is creative and smart and you are very lucky to have her as a partner in

life just as i have her as a partner at work wow and here i'll bang it home with another fun fact which that donna's brother-in-law painted this uh the studio i'm talking to you in right now oh chris brown so shout out to chrisbrownpainting.com uh so it's all comes together here brian so you're practicing medical doctor and you also host white coat black art which i i think is a fantastic show it's on cbc radio one uh us, before we dive into the COVID stuff, because I got a few questions, as you can imagine, how did you get the white coat black art gig on CBC Radio? Well, this is a true story. You know, first of all, I've been, you know, I've been a freelance writer, dabbling in matters medical for a long time, about as long as I've been an emergency

physician. You know, the fact that you work shifts in the emergency department means you have a lot of free time. And, you know, I developed an interest in feature writing, you know, on ethical stuff, medical, legal stuff, emerging diseases. And I had pitched a book. Now, let me back up. I made my way from magazines and newspaper writing to radio documentary writing in the late 80s, early 90s. I did some stories for Sunday Morning, which was, you know, now they call it the Sunday edition. Back then it was called Sunday Morning. Did some shows for ideas. Then drifted into television for six years.

I was one of the medical reporters on a show called The Health Show, which was a current affairs show about health. That took me to about 1999. I worked at Alliance Atlantis when they were launching their 24-hour health channel, which is now called the Oprah Winfrey Network. I was there for a year and drifted away from that. I went back to the emergency department doing more or less full-time there and thinking about what I might do next in the media. I had an idea for a book and the book was basically about the things that doctors say to one another when they think patients aren't listening and how that compares to what they

actually say to patients. Right. And I, I, you know, I thought it was a cool idea. I got a cool title. I called it medical BS. And, uh, you haven't read a book called Medical BS because it was never published. My agent loved it. Unfortunately, about 30 publishers didn't. But this is now, this is 2005. And I was still doing a weekly radio column as the house doctor for CBC Radio 1 for afternoon and morning stations across the country. And they were starting to develop a kind of a rigorous program development process where they would gather producers from the CBC right across the country and they would hear pitches for radio shows. And so what I did was I took that medical BS book proposal and I turned it into a radio proposal. And the long story short is that that's what became White Coat Black Art.

How many years has it been running now? It's been running since the summer of 2007. So 13 years and counting. And I remember the first time, after the first 10 episodes, I was asked, so you think you want it, can you do any more episodes? And I'd been writing about for for a long time up to

that point in time and i knew that there was an infinite number of potential stories and i don't think i've been proven wrong no no no and again i encourage anybody it's it's just i i think it's just a well-produced well-crafted show and you you really kind of are the you're the straw that stirs the drink you're you're a great host. You, you know, your stuff and you got, you know, you got the degree to back it up here. So, but Mike, but let me say one, one, one plug for the team, you know, for, for, for Donna, senior producer, Jeff Goods, Jada Berry, Arianne Robinson, and, and the many,

many other producers who've contributed to the show. It's a team game and, and, and without the team, we are nothing. And, and I'm, I'm never more thrilled than when, you know, producers like Jeff goods and, and Rika Walsh won, won a Gabriel, a sorry, a Gracie award this year, we got second in a, in a Gabriel. So we're winning a fistful of awards and that's really a testament to the talent of the producers I work with. Well, congratulations. That's a, these are physical awards. You I work with. Well, congratulations.

These are physical awards? Do you get an actual trophy? When Jeff Goods doesn't break them. Some of these awards are made out of glass, and he has an uncanny ability to kind of knee the shelf, the trophy shelf, and knock a few of them down. But yeah, they are. Most of them are physical trophies, although unfortunately, sad to say,

because of COVID-19, we can't pick them up in person these days oh yeah just just yet another uh sacrifice we're all making here we're gonna dive into that but i need to ask the obvious question which is okay so cbc radio one broadcasts white coat black art uh by the way what is the time like what is the time slot for the show if somebody wanted to actually dial in an old terrestrial radio and hear it on good old terrestrial radio so basically in the toronto area we're on saturday white coat black arts on saturdays at 1 p.m right after the news and on sunday same show um at 6 30 p.m right after the world this weekend, which runs from 6 to 6.30. So it's all after cross-country checkup. Right, and of course, this is a digital universe we live in here,

so most people are probably going to listen on demand, but it's all available at cbc.ca, I see. And of course, you're talking about White Coat Blackheart, our new baby, our proud... Well, please, yes, I was about to say, tell us what the dose is. The dose, so first of all, White Coat Blackguard, just to give you the distinction, White Coat Blackguard is, is tell stories, heartbeat stories about the experience of patients and their families in the culture of modern medicine. So how they're treated,

how they're mistreated sometimes their hopes and dreams, the hopes and dreams of people who work behind the sliding doors or inside the sliding doors. That's White Coat Blackheart. It is not about information that you can use to immediately change your health. And that was the gap. Although that's what made White Coat Blackheart successful. We knew there was a gap. And there really isn't a good, until the dose, there wasn't a solid regular podcast that gives you information that answers questions like, should I care about my body mass index, my BMI? And these are questions that very often are the people, our subscribers send to us.

It's also questions that are around the water cooler. And so it's a weekly episode. It's intended to be shorter than White Coat Blackheart. So we try for 20 minutes. Sometimes we don't hit that mark, 20, 22 minutes. And we answer practical questions. And not surprisingly, since the pandemic was declared, we've pivoted almost exclusively to COVID-19, you know, answering questions that people have, like, you know, what's flattening the curve about when's there going to be a vaccine? What's this thing about testing? Why should we care about testing? You know, what's the formula for reopening the economy and getting people to get back to work without increasing the rate of

COVID-19? And, you know, we have, you know, there are infinite numbers of questions that people have. People have insatiable curiosity about it. Yeah. So that's what the dose has been about. And we expect that sometime, you know, in the near future, we'll be pivoting back to non-COVID topics.

Like my kid has migraine headaches. What can we do for them without taking drugs? Right. That kind of stuff. Okay. This is excellent. So the dose, it sounds like the dose is a true podcast. So this is not made for radio. This is actually a true podcast. So people, you're now fishing wisely, Brian, you're now fishing where the fish are. So if anyone's hearing our voice right now, they're already comfortable with podcasts and they can essentially pause this and subscribe

to the dose. And this is almost like your your this episode will be sort of a gateway drug to the dose because i'm going to be peppering you of some uh questions i have and i consider myself a pretty uh i don't know i i'm not an alarmist in any way i'm fairly here i'm bragging about being so pragmatic and practical and i follow follow the news, but I'm confused on a number of things. So I've taken my questions, and I've taken some questions from listeners, and I'm going to chat with you about it over the next bit. And then if people like the way you answer questions, and why wouldn't they, then they're already sold on the Dose, right?

Because this is sort of like a gateway to the Dose. Yeah, well, we hope that people get addicted to the dose so uh so uh fire away is the theme song uh curtis mayfield's i'm your pusher is that the theme song you're pushing oh it's some no-name theme song uh when we get to be way more successful we'll we'll have one carefully crafted and composed for us are you a composer do you want to compose one for us i'll'll get my buddy Illvibe to do it. He composed my theme song. But, you know, soon you'll discover this crazy thing about podcasts

where you can't legally license a piece of music like Curtis Mayfield's I'm Your Pressure. Yeah. We kind of know that because I used to love putting pop culture references into white coat black art. And when we had to turn it into a podcast, they all had to be stripped out. So it was kind of like a make work effort. And because you're with the CBC on this one, you have to abide by these rules.

If you were a little more rogue like yours truly, you might just be a rebel and say, come at me. But you can't do that at the CBC. All right, Brian. No comment. No comment here. That's smart. That's smart. So you're the ideal guest, in my opinion, for this time here.

And we're going to have a frank convo here. I'm going to start by asking you, Brian, how are we doing here specifically? I know you're national. You're national on the CBC. But here, we're going to speak Toronto centric here. How are we doing in Toronto, Ontario, Canada? With regards to COVID-19, I think that, you know, we have among the worst outbreaks in the province. And, and, you know, we've had, we've had a pretty awful time. If you have, if you live in a long-term care facility, if you have a loved one who lives in

long-term care or retirement home, you know, that, that there have been far too many people who have died, who've gotten COVID, there've been outbreaks of COVID in long-term care and there, and far too many people have died. I don't think anybody can be proud of that record. And, you know, that's why there's going to be a commission of inquiry to look into what we did right, what we did wrong. And I think we're going to find that there'll be lots of lessons to learn. The only question I have is, are we going to actually learn those lessons? Because, you know, if you look at SARS, you know, we had the SARS outbreak and I was on duty in the emergency department during SARS and I'm on duty now. And I said early in COVID-19

that we've learned those lessons and things are going to be better this time. And I'm not so sure. I'm not so sure at all. I think that it's fair to say that toronto and ontario were not prepared for the coronavirus and and there's you know we could we could talk about pointing fingers but before we start pointing fingers at people we can say that we didn't we haven't done enough testing we haven't done enough tracing of people who test positive you You know, I have relatives who went to COVID-19 assessment centers with symptoms of COVID, turned out to have COVID, and were told by a nurse there, sorry, we can't test you. Wow. We're not going to test you.

We didn't test everybody, and so we didn't trace contacts and we didn't, you know, we thought we would just tell people to stay home for two weeks and that would be enough. And which is fine for the first two weeks. But of course, you know, even if you tested negative today, you might get it next week or the week after or the week after that. And, you know, we're starting to see now they shut down the economy and it was the right thing to do. And now people don't know, you know, are we OK? Have we you know, have have we beat this first wave? I don't think so, because, you know, if you look at at at, you know, what happened at Trinity Bellwoods Park, where you had thousands of people showing up and kind of doing what the medical officer of health for the city of Toronto

said you shouldn't do. And, you know, the mixed messaging around that. And, you know, we're starting to see at this date, you know, towards the end of May, we're seeing rising rates of COVID-19 in the province. And why is that happening? Well, they think it's Mother's Day. We think that on Mother's Day, people started to congregate once again, which meant that's about three weeks ago, which is enough time for the numbers to start creeping up again.

So that's where we're at right now. Wow, there's a lot to unpack there. So I guess firstly, I want to ask about the long-term care facilities. Is it almost like, I think it might have been the premier of Quebec who made a comment about these two solitudes or whatever. There's two realities. So that we have the long-term care facility where there has been,

which is a crisis and horrific and what's happened there. But then you have everyone else. If we take the long, and this sounds a little callous only because of course these are human lives and we care about them. And you're right, there needs to be, we need to look into this. But if you take the long-term care and push it aside somehow and look at everything else, is it as bad as it sounds? Can you do that and look at things if you put long-term cares aside? Well, you know, I guess in a highly kind of theoretical hypothetical way, you could, you

could do that except for this, Mike. Yeah. Long-term care facilities, they aren't hospitals, but they aren't completely lay person, non medical places. They are places where people know about infection control. They know about washing hands. They know about personal protective equipment, and yet it happened there. So I think what you should be thinking of instead of the way you formulated it is that if it can happen there, it can happen in any place where there are vulnerable

people. And we've seen it happen. You know, this movie we have seen that you've talked about in long-term care, we've seen it in homeless shelters. We've seen it in prisons. We've seen it in meatpacking plants. We've seen it in churches where people have congregated together. And we've even seen it occasionally in hospitals, not so much in

Toronto or Ontario, but elsewhere, where one patient was able to infect a whole bunch of people in an ER, including staff. So the lessons that we should be learning from long-term care is that if we don't learn those lessons, we're going to pay the price everywhere. Yesterday, I spoke with Shirley McQueen, and she's in Edmonton, Alberta. And then prior week, I spoke to Brother Bill and Brother Jake, and they're both, they're unrelated. They're not brothers, but Brother Jake, Brother Bill are in BC. And we talk about things.

And Mike Crawley, actually, I'll quote his, he did a tweet yesterday, a CBC reporter, and he said, 96% of new COVID cases reported in Canada in the past 24 hours are either Ontario or Quebec. Is this like, is like why I understand we have most of the people, but we don't have 96% of the people. Like, is this is this a failing on the part of leadership or like, why? Why are we getting hammered so hard compared to the rest of the country? Well, there's one thing you can say.

As we do more tests, we're going to make more diagnoses. I know I'm starting to sound like Donald Trump when I say that. You see, there you go. You want tests? Now you've got more tests, you've got more cases.

I'm not saying that. I'm not saying that at all. That's ridiculous. That's a ridiculous notion. But it is true that some people would point to seeing more cases that are positive as a sign that we're testing more. And that's good. That's important. We're also, you know, Ontario is the most populous province by far. And so I would expect that because we have more Ontarians, we have larger cities. Toronto is a huge metropolis that the potential, just as New York City has had a lot of cases of COVID-19, an incredible number. You know, so so we have to acknowledge that it's possible that we could be seeing a lot of cases in Toronto.

We could be seeing a lot of cases in Ontario just simply because we're the most populous. Density. Density. There are other places, though, that have high density that have not seen the numbers that we've seen in Toronto. Not as bad as Italy, not as bad as Spain. So, you know, we may be doing some things right. But if you want to know what some of the issues are, as we open things up, as the economy starts to rev up again, as people start to venture out of their homes and start doing, you know, going back to work, we have to be really careful. We need to know who has COVID-19. We should be,

our system of public health should be testing, should be surveying asymptomatic people and finding out how quickly, how many of them are getting infected with COVID-19 and how quickly it's happening so that we get a sense of how much of it is in the community. And, you know, community spread isn't just a phrase. It means how much what's the likelihood that you go to a supermarket that you're going to run into somebody or a donut shop or standing outside a donut shop? What's what's the likelihood that you're going to run into somebody who's infected and you don't know it? somebody who's infected and you don't know it. And maybe they don't know it because asymptomatic people can,

can infect others, you know, with, with COVID, you know, maybe 20, 30, 40% of, of, of the cases, the new cases of COVID-19 come from people who don't have symptoms. Okay. I'm going to ask the question from Levi Fumka, who's a listener. And this is a question I had for many people regarding testing. So Levi wrote, what about testing? There's a push for it, but how do we know if we should be tested? I see Doug Ford saying asymptomatic people should be tested, but essentially isn't everyone who isn't sick potentially asymptomatic? So who should, who, Doug, who should be tested right now? It's a great question. And in theory, I think we should be doing what they're doing, what they did in China, which is to test millions of people in Wuhan.

Because the resources, if you think about what the resources that would be required, the test kits, the people to administer the test, the people to, to analyze the test results and to trace contacts would be huge. But, and, and, and maybe you can only do that in, in an authoritarian regime, you know, country with an authoritarian regime, but, but the more testing you do, the more, you know, um, who's got it and, and who could potentially spread it to other people who must go into isolation right now because they're a direct threat to other people. Because what we don't want to have is one person infecting two other people, or even on average 1.5 other people, because that means that it's growing. We want at most, well, ideally, nobody infecting anybody else. But if we had each person infecting half a person, meaning that half the time that person doesn't infect somebody and the next person does infect somebody, it means that you're not replacing the infections that exist. And that means that you're flattening the curve. It also

means that you're on the happy side of the hill where the numbers are going down, down, which they were until we started to open things up a few weeks ago. You know, when you made that comment earlier about how you have family members who had symptoms and they didn't test at the testing, it infuriates me because I guess, is it a lack of tests? Is there some shortage? Like, why would somebody with symptoms be denied a test at these testing sites? So, so first of all, early on, we ration tests. There's no other way of putting it. We rationed them because there weren't enough test kits. There weren't enough reagents, which is the

substance that you, you, you run the test on to see if it's showing evidence of, of the, of the coronavirus of COVID-19. And then even when we did tests, far too often people didn't get the results. They were told they'd be called by public health and they weren't called because public health was overwhelmed by the number of people, the number of positive tests they had to follow up on. And, and, and, you know, at our hospital, as in many other hospitals, as a courtesy, our quality assurance people would get the results when we started doing them in our own hospital and phoning patients ourselves because we knew public health would never get around to it. What good is it to tell somebody, to do a test and not follow up and give them the result?

Now, you know, if you're sure that they're going to go into isolation and they're not going to talk to anybody else, then maybe it's okay. They wait 14 days and then now they can spend more time talking to their family members, but they're still practicing physical distancing, so it's not a big deal. But we know that not every human being is going to follow instructions. And I'm quite sure that we would test plenty of patients who might go out and about, even though we told them to go home and to physically distance themselves from others. For sure. So like straight up, should I go get tested? Good luck. If you have symptoms, they'll test you. If you go to an emergency department and not a COVID assessment center,

then you'll probably get tested. On the other hand, you know, if they have criteria and the criteria right now are, and they've actually been more relaxed. Today, unlike that time when my family member didn't get tested, even though she had obvious symptoms of COVID-19 and was sick, by the way, for weeks after that. You know, today, the criteria have been relaxed enough that if you have one, even one symptom of COVID-19, so if you have a dry cough, shortness of breath, if you have, you know, a runny nose, if you have lost your sense of smell, if you have vomiting, if you're just feeling weak and sick and tired, like you've been run over by a truck or like you've had the worst case of flu that you've had in 20 years, if you go to an assessment and sick and tired, like you've been run over by a truck or like you've had the worst case of flu that you've had in 20 years.

If you go to an assessment center, you will be tested right now. Okay, good. I'm going to quote the Premier of Ontario, something he said yesterday. Okay, so here we come. Doug Ford, even if you're not showing symptoms,

please go get a test. You will not be turned away even if you or your family don't have symptoms. If you feel you need a test, you will be able to get a test you or your family don't have symptoms if you feel you need a test you will be able to get a test so that's doug ford yesterday and you can see why i mean it doesn't take a rocket surgeon to to find out why there's uh such confusion yeah uh it's mixed like even even i saw on twitter people at these testing facilities basically pleading with the public not to just show up willy-nilly. Meanwhile, Doug's telling everyone, and I mean, I just read it, he opened that testing to everyone effective today.

Yeah, and only to have people show up and have the people who are running those clinics who are running off their feet saying, uh, ain't going to happen. And, and, uh, and, and, you know, certainly when the, when the story, when the history of how we manage COVID-19 is written, um, one of the things that they'll talk about is mixed messaging and muddied messages, vague messages and contradictory ones. And this, this is a big contradiction because, because, you know, why would you want to, this is a big contradiction because, because, you know, why would you want to, I can imagine people who have no symptoms, who've been urged to go to a COVID assessment center where, by the way, they're going to be around people who have COVID-19,

they'll be, they'll be far enough away from them. They'll have masks on, but they're going to be thinking, why did I come here to, if, if, if not to get tested. So I agree with you. It's almost like the most dangerous place because at least you, you know, definitively for sure, some people with COVID-19 are going to that exact same place. And meanwhile, you have no symptoms and you've basically gone there. By the way, you're an emergency physician. Uh, you must be tested. Uh, you know what? I haven't been tested yet. I am going to be tested because the new criteria call for all healthcare, all frontline workers to be tested, which is long overdue. Up until now, people who work in the emergency department, and I'm only speaking for the ER, but that would be true of hospitals as well, who've had symptoms, were tested. They were the ones who got tested.

And there have been changing criteria and, and, you know, part of this is that is that we're learning more about the Corona virus as we go along. And so as we go along, we, you know, keep in mind that that before this began, no, this was a brand new Corona virus and, and nobody had been exposed to it before. Now, Mike, there's one thing, there's one thing I want to hammer. It's a really important point. I'm not suggesting that you shouldn't go to a COVID assessment center to be tested because

you might get COVID there. You're not going to get COVID there. And likewise, if you think you have an emergency, like chest pain, or you're having a stroke, or you're having severe abdominal pain, it's not just a minor bellyache, you've taken some Tums, it's not working, you've taken the Tylenol, it's not working, go to the emergency department. Do not fear that you're going to get COVID-19 by going to the emergency department. We've seen far too many, far few patients going and far too many patients who have had serious emergencies that had we seen them sooner, they would have had fewer complications and might've done better. Okay. I'm glad you brought this up because in late March,

like March 30th or something, I had a bike crash and I broke my left wrist. And the, I remember it was by the way, don't do that. It hurt. It hurt. It's the only time.

Yeah. It's although now, I mean, the cast, I i had i've already come the cast was on for almost six weeks and i'm already back biking and stuff but this is late march but anyway i went i went to emergency because i had to and uh i will say it was empty like this is saint joe's health center and i've had a few sports injuries where i've gone there and you know it's jam-packed with people uh you got your parkdale people you got everybody's there and i went i went in late march and it was i it was what was the best er experience i've ever had in this city so it's eerie yeah so i mean you're there

you're there all the time but i did i did do a video i wanted to tell people about my experience i had my cast and i talked about it and I talked about basically how, honestly, how safe I felt through the whole thing. I didn't touch anything. I never touched my face and had a mask on and it just felt very, like, I mean, I ended up going to that fracture clinic several times over the next six weeks or whatever. And I mean, I, you know, knock on wood and never got symptoms anyways, but it felt very safe, but very, very eerily empty, uh, at, at the ER. So are people who have, are people who are having, I don't know, chest pains and different symptoms where they should go to ER saying I'm not going there during a pandemic? Yeah. You know, we ask them, you know, especially the people who,

you know, you never want to make people feel bad that they came too late. But we are asking, you know, glad you came. And, you know, we're starting to ask questions like, were you reluctant to come? And a lot of them have said, yeah, they're just anxious for two reasons. You know, to a lesser extent, they're concerned that they might get COVID, that there might be a patient with COVID. But, you know, we're actually very good at putting people into isolation right away, putting a mask on them. It you know, they ask questions at the front door designed to to determine whether somebody might be, you know, a possible COVID contact or not. So that that's one reason. The other reason, though, for for

people being reluctant to come to the emergency department is that they're terrified, they're going to be admitted to hospital, and they're going to be separated from their loved ones. And a lot of people have said exactly that. And the visitor policy, well-intentioned, I think that's one of the things that I'd like to see people review. Did we go overboard on that with very tight criteria that prevented people from bringing one you know, one significant other with them. You know, surely we could have taught them infection control procedures. I know there was a fear that there wouldn't be enough personal protective equipment, but, you know, I think that's one of the things we went overboard on. And, you know, I have, you know, on White Coat Blackheart,

we talked to people who are, who watched the patient-centered, you know, on White Coat Blackheart, we talk to people who are, who watch the patient-centered, you know, the patient-centered care approach, the people who want the voice of the patient or the family member to be brought into all the decisions that are made when it comes to health care. You know, people like Julie Drury from her Twitter handle is at Solid Footing. and, you know, she brought us stories on our show of people who had loved ones who died, who were admitted to hospital during COVID died, and they never got to say goodbye, except on a phone, on a cell phone. And I, you know, my heart just goes out to people who've had that kind of awful experience. Yeah, I guess the two the two events where you really do need to make exceptions,

I suppose, are entering life, the birth of a child, and exiting life, the death, passing. Yeah, neither event should happen alone, if you will. No, no, they shouldn't. And, you know, hospitals certainly permit you know, you know, hospitals, you know, certainly permit one person to arrive in the hospital, to be in the hospital with, with a woman giving birth, with the mother giving birth and, and, and they,

if they know that a patient is dying, they will usually permit one family member to be at the bedside, but, but not every death is predictable. You know, somebody has a fractured hip and they die 24 hours later and unfortunately, they may have had their last few hours before they died alone.

Oh, terrible, terrible. Man, I want to swear. I know you don't swear on the CBC, but we swear on Toronto, Mike. This is such a clusterfuck, if I may. I apologize. But okay. I'll have to censor myself later. So one more quote, though, from the Premier regarding testing, though, and it kind of lends to this confusion. Because even chatting with you now, I'm still

a little confused. So I'm going to ask this question, and then we're going to definitively make a statement about testing, and then I'm going to move on from testing. But Doug Ford said that he wants people who live in Ontario's COVID-19 hotspots to go get tested. But they don't actually share postal codes or any kind of indication as to where the hotspots are. So that type of communication, all that does to me is muddy the water

to a point where you're going to get people who say, F it. I'll just use my common sense on everything because I don't know how to follow the rules anymore. Can you speak to that? Yeah, well, the first thing I can say about that is that we don't know the hotspots. So I'm going to, and that, and Mike Crawley, my colleague at CBC, found that out.

And he's done he's done some great work, you know, getting information, you know, on on admissions to the intensive care unit, number of ventilators that we've had that we weren't getting before. And we're getting a much more of the CBC, I think, presents a more accurate picture of the true number of deaths from COVID-19. it. And we're getting a much more of the CBC, I think presents a more accurate picture of the true number of deaths from COVID-19. So but if we don't know the hotspots, how can you tell people to from a hotspot to to to to to be tested? One way that we would know and just, you know, the larger context here is that is that is that Canadian society is very ambivalent about the idea of of having people with smartphones have an app on their smartphone that tracks them. And, you know, authoritarian regimes aren't worried about

privacy, patient privacy, or, you know, what's the state's right to know where you go and who you're with? You know, I think that the result of the pandemic, one of the results of the pandemic is that it may spur more debate in our country over whether we prize privacy that much that we tell the state it's none of to track where I go versus others who would say, for God's sakes, we want to flatten this curve. We want to slow it down. We want to buy as much time as possible until there's treatments and a vaccine. Of course, we're going to sacrifice a bit of privacy for that, but we haven't decided yet. Right, right.

And I find it very cultural. I used to travel for work before I started my own business. I used to travel a lot. And I remember distinctly one business trip. I remember I was in Copenhagen for a week and then I was in Frankfurt for a week. And in Copenhagen, every form of payment was electrical and there was no cash used anywhere and then in in frankfurt it was precisely the opposite at least with the colleagues i was talking to and i was asking like about you know why and the germans basically said uh with cash they the government nobody knows where you've been what you've spent money on but once you turn electrical there's an audit trail there and they were adamantly against this whole uh audit trail if you will. And it's just interesting how some cultures and philosophies, you know, rebel against any kind of tracking system on that note. or concerns about privacy, call it privacy paranoia, has been the third rail of innovation

in healthcare. You know, if you want to know why we don't have kind of a cradle to grave electronic health record that follows you, that you own, that follows you everywhere, that would be accessible by your physician, it's because, you know, we tend to fear that that record will get into the wrong hands. Insurers will get access to your, your record and they'll, you know, jack up your, your, your insurance rates. And, and you know, it'll, it'll affect everything from what job you're allowed to do to, to whether you're allowed to drive a car or not. So, so, you know, and there are arguments to make about the abuse of private information.

I'm not saying that we shouldn't, but we are reaching a part where when it comes to a pandemic, we might want to say, hey, is there a value in surrendering some privacy rights if it helps to track infections more readily? So this cradle to grave e-health database that you kind of described there, I have a question now. It's not quite COVID related, but I mentioned I broke my wrist at the end of March and the next, so I go in and I'm in emergency. So they put on that plaster cast and they say, come back and see the, come back and see the fracture clinic doctor. And that's fine. The expert, I came back the next day

and the doc was looking at a, at an x-ray of my same wrist that was taken 21 days earlier. Now, this sounds like I crash a lot. I don't. But I did have two crashes where I thought I broke my wrist in the month of March. Okay. So I just thought it was interesting that he was comparing the two x-rays. Like he had all this. This was not the same facility.

I should point that out. The first time I went to Trillium up near Sherway Gardens. And then this second time I went to St. Joe's Health Center. But he had this. So there must be some kind of centralized sharing of health records going on. Yeah, there is. It's called Connecting Ontario. And I use it all the time. It's a patch that is an application that is connected to our patient tracking system at Sinai Health System. It's called FirstNet. And so when I click on that link in the record of a patient, it will take me to the provincial record of that patient.

And I can review things like previous lab tests, discharge summaries, ultrasound, CT scans, and x-rays. And, and it's a godsend. It's, it is vitally important because, you know, with a portable healthcare system, people do, like you, go to different hospitals, sometimes for the same ailment. Sometimes the first hospital didn't, didn't make the diagnosis, or maybe the symptoms were early, you know, the symptoms were early in the course of the disease, and now it's more obvious what's going on. You go, maybe you were in cottage country when you had your first visit to the hospital, and now you're back home, and you're going to a completely different hospital. Without that, there'd be nothing to stop me from having to reinvent the wheel,

nothing to stop me from having to reinvent the wheel, redo the entire record, expose somebody to another CT scan, more radiation. This way we can save time, we can save money, we can save side effects. And it's all because we have, you know, a system, you know, now where we can look up records of patients. And so, you know, is there a privacy threat there? You know, it's a secure system. So that's good. So You know, it's a secure system. So that's good. So they can, they're capable of making a secure system. So, so maybe that's the forerunner, maybe Connecting Ontario is the forerunner of an electronic health record. Well, I thought it was great. Like I thought, my thought was, why isn't there this single database where, you know, all Ontario doctors could access when you come in with different, and it would be great for like allergies and prescriptions and all that

stuff. Like instead of asking the patient every time, what do you, I've been asked every time I come in, I mean, it's probably a, a good practice. I'm not even criticizing it,

but are you allergic to any medications? I can, I, you know, I think I got asked that in the last eight weeks, I probably was asked that question like 10 times. So, but again, no, no criticism there, except if it was in a database.

Okay. So Mike, one thing I know you want to get on. Oh, yeah. There's one thing. There's a big gap in the electronic health record thing. And that is that none of the family doctor records in our province are available to everybody else. So I can't, I don't know what the family, if the patient shows up at two o o'clock in the morning i can't call the family doctor and say what's going on with this patient right uh it would be nice to be able to have access to their records and that's that's the

big gap okay so this is more we have access to emergency facilities in the province i i got you that's right hospitals and okay gotcha in emergency clinics okay gotcha now just before we leave the testing again because even though we've just chatted about it for 25 minutes, I'm not. So just one succinct sentence. Who should get tested right now? And then I'll move on to this next great topic. Okay, the rules in Ontario say that if you have a symptom, you should go to a COVID assessment center and you will be tested and you won't be turned down this time. What I think personally is that we should be, that we want public health officials to be figuring out who else should be tested in addition to the people who have symptoms. I think asymptomatic people who work in vulnerable,

where they look after vulnerable people, long-term care facilities, homeless shelters, meatpacking plants, places where workers are forced to congregate because of their work. And any other place where their spidey sense says they think this could be the source of the next outbreak in the community. A listener told me that this might be the most important episode I've ever recorded. So if I'm a little off my game, it's that guy's fault. That's too much pressure for one man.

I'd like to take a moment to thank the, uh, people who helped make this possible. Those who help to fuel the real talk. It's tough times for everybody. We're in the midst of a global pandemic, if you haven't heard. Yet, Palma Pasta keep their doors open. Stringent safety effects in practice. Palmapasta.com is where you go. They're in Mississauga and Oakville. You can order online.

They're on Skip the Dishes. Let them know sponsoring Toronto Mike Works. Great Lakes Brewery have curbside pickup. They're at 30 Queen Elizabeth Boulevard, not too far from Royal York and Queensway. And it's delicious, fresh craft beer. Support local. If you're looking to buy and or sell in the next six months,

I urge you, I highly urge you to chat with Austin Keitner from the Keitner Group. Just text Toronto Mike to 59559, and that will engage Austin and you can have a phone call or a Zoom call. He's a great guy to talk to. CDN Technologies

if you have network issues, your home network or your home network as if there's a difference right now. Anything with your computer, the network, malware, cybersecurity. Anything with your computer, the network, malware, cybersecurity, cdntechnologies.com. Call Barb.

Literally pick up the phone. She actually really likes to talk to people on the phone. So have a friendly chat with Barb. Garbageday.com slash Toronto Mike. i signed up it was effortless again garbage day.com slash toronto mike i get once a week i get a convenient alert as to what do i need to bring to the curb is it garbage is it recycling is it yard waste it just takes the guesswork out of it and it's fun i enjoy it and everybody i've encouraged to sign up has said they dig it too so do it help the show on that note you got kids at home kids love stickers

sticker you.com they can literally uh they could draw something you could take a digital photograph of it or scan it and upload it to stickeru.com and get magnets and stickers and temporary tattoos and all these cool things. Decals of your child's artwork. I mean, it's a great work. I was going to say work from home project. It's a great school project from home. Stickeru.com, great sponsors of the program.

And I thank them. So when Doug says, if you're not showing symptoms, please go get a test, is he erroneous in his thought process there? Well, he may be well-intentioned but but he's the premier and and he has to you know he has to have a realistic take on what the system is capable of doing at the present time and and frankly right now unfortunately the province of ontario cannot take every asymptomatic person who demands a test and test them and give them result within a timely fashion we just don't have the facilities for that be nice if we nice if we did, but we don't.

Now, James Edgar is a listener who wants me to ask you, and I'm glad James brought this up because the latest info on surface transmission of COVID I'm hearing now is that it's actually not, doesn't really transfer very easily through surface transmission. But again, we've been hearing forever about, you know, I can tell you this. My four-year-old is obsessed with grapes and we're always buying bunches of grapes. And my

wife actually washes them with like hot water and vinegar solution and then washes that. Like, this is what she's doing with the grapes. And I think it's like a little bit overprotective, but I don't say anything during our global pandemic. I'm like, if you want to wash on a surface, that the virus can survive there depending on the type of surface for anywhere from a few hours to even a day or a day and a half. But that's not every surface. Plastic surfaces may be a little longer metallic surfaces. Maybe a little bit less Copper surfaces have some antiviral properties. So so, you know, we can I think the general principle here is that hard surfaces Cova 19 can can can survive for a few hours. So that's why they need to be wiped down

But your your real danger is if somebody spews virus directly on the surface, and then somebody touches the surface and then touches their eyes or their nose, or, or puts their finger in their mouth. So anything that breaks up that cycle, from the moment when the germs were coughed onto the surface until until somebody touches the wet surface, the contaminated surface, and then touches the inside of the mouth, anything that you can do to break that cycle will break the chain of

infection. So wipe the surfaces down. If you're not sure they've been wiped down, wipe them again. If you're, you know, if you're still worried, then after you've touched the surface,

wash your hands and don't touch your nose, you know, don't touch your face. So, so all of those things will, you know, any of those things will break the chain and, uh, the chain of infection. And, and so that's what you should be doing. And that's, these are the messages that we need to keep hammering. People can't stop doing those. Uh, you know, I think that, that if you're worried about cardboard pizza boxes, you're probably not going to get, you know, a lot of people are ordering pizza or takeout food, you're almost certainly not going to get COVID-19 from those takeout boxes. So you know she's going to be listening to this. Okay. So can we address this grape washing thing? So, because you're a doctor, she's going to listen to you. Yeah. Does my wife need to wash the grapes with vinegar and hot water? She doesn't need to. Well, it, you know, cold water's fine.

And, you know, like I'm kind of a mild soap, but you like, it's not the soap that gets rid of or the vinegar that gets rid of the virus. It's the mechanical action. It's the scrubbing. So that's when you wash your hands, for instance, that's why you have to, it's just rubbing your hands again and again, and you're singing happy birthday because you've got to do it for at least 20 seconds. That's what gets rid of the virus. And again, if you're worried that somebody has coughed or sneezed on the virus, sorry, virus onto the grapes, and God knows how long ago it's been since that happened, the virus has almost certainly died by the time it gets to your home. But, you know, if you're just simply washing them, you know, in water would probably be

sufficient to get rid of any virus, however unlikely it is that there's still virus remaining on the grapes. You are a good, clear communicator here. I know why you host the radio show and the podcast, The Dose here. So thank you. And a very timely guest. I'm glad youator here. I know why you host the radio show and the podcast, the dose here. So, and a very timely guest. I'm glad you're here. I'm only going to take up another six hours of your time because I'm just kidding. I kid. Only half kidding. Weren't you warned? No, just kidding. So, I'm going to ask about the transference of COVID-19. Transference? Yeah. Outdoors versus indoors. I'm hearing a lot of info

that it wouldn't transfer very easily outdoors. In fact, I will just tell you, speaking for myself, that I am very, as we should be, I treat like everybody I encounter has COVID-19. If you don't live with me,

and six people live here, but if you don't live with me, I just assume that you have COVID-19. That if you, if you don't live with me and you know, six people live here, but if you don't live with me, I just assume that you have, uh, COVID-19. That's how I've, I've been kind of, uh, pursuing this thing. And, uh, when I, I, maybe, maybe I'll let the, the doc, the expert here speak to the fact that when I'm going, when I go indoors, uh, I'm far more careful. Like I feel much less safe, but when I'm outdoors, I feel a little more, not that I'm getting within six feet of anybody, but could you speak to outdoor versus indoors and how that transfers sure um you know i guess the the i think i think a lot of people think that there's this massive difference between indoors and outdoors uh and that's it's based perhaps it's it's based on the misconception that COVID is an aerosol virus particle, like it's aerosolized.

And it can be briefly aerosolized, which means that it can, you know, if we find in the emergency department, you throat of somebody who has COVID-19, that there's a risk that that procedure can cause the patient to cough and cause germs that are spewing forth through their mouth to get kicked up into the air inside the room where we're doing the resuscitation And that's why we have this thing called the protected code blue. We wear masks and and face shields and all that kind of stuff That's not what happens uh in ordinary conversation indoors or outdoors for most of the rest of of the Transmissibility of covid. It is spread by droplets. Droplets don't stay in the air.

Eventually, if they cough out of somebody's mouth, they're going to fall to the ground because that's what droplets do. They don't float in the air so that you breathe them. They may remain there for a few moments afterwards. So really, droplet spread means that whether you are indoors or outdoors, you need to fear somebody who has COVID-19 germs and is either about to cough or sneeze or spit on you. So you don't want to be close enough to them,

whether you are indoors or outdoors. You don't want to be close enough to them, whether you are indoors or outdoors, you don't want to be close enough to them, that their droplets that issue forth from their nose or their mouth land on you, land on your mouth, or eyes so that they get inside your system. And it really, you know, I guess, if you're there on a windy day, it's entirely possible that the germs that are spewed out by somebody who's infectious will kind of travel, will disperse faster. And which means that you'll be less likely to be infected if you're, say, three meters away from that person. three meters away from that person. But whether you're indoors or outdoors, you should never be inside of two meters away from anybody because that's the kind of radius of the droplets

in most circumstances issuing forth from somebody who's infected. Unless they, by the way, unless they cough. If they cough, look out because it can fling probably 10 meters away. Right. And that's why we're teaching our, you know, in preschool, we're teaching to cough into your elbow.

This is the whole idea there, right? To prevent that. Yes. We got to remember what we learned in kindergarten. The, I wonder about, that was great explanation, but I wonder about runners, like joggers, runners, or cyclists. Like these, sometimes they're traveling. Cyclists could easily, I'm on the Martin Goodman Trail all the time, and they could be going like 35 clicks sometimes.

Like what about that trail of sweat or saliva from a cyclist? It's more the secretions from their respiratory tract, but you're quite right. They're breathing fast. I know I run, I ran, I ran 10 kilometers this morning and, uh, and, uh, you know, but I happened to do it at an hour when, when, when nobody, nobody, but nobody was out. I passed nobody. Uh, it was like five o'clock in the morning. Um, and, and, and, you know, there are, there are, there is now, you know, growing anecdotal evidence that, that runners cyclists, you know, if they, if they are exercising aerobically, they're breathing fast, they could be spewing more germs in a faster period of time. Now, of course, that assumes that they feel like running and cycling when they have COVID-19 or when they're asymptomatic and they have COVID-19. And it's possible to have that. I'm not saying it can't happen. So yeah, that's the reason why people seem to be, you know, passersby seem to be inordinately concerned with people who are running. And, you know, I tried wearing a mask, jogging, and I couldn't do it. I found when I was going up the highest hills, I was sucking

mask into my mouth and I just couldn't get enough air. No, I tried to cycle with a mask and you're right. And I think this might be another reason why what happened the last couple of weekends when they shut down, for example, they shut down Lakeshore between Windermere and almost Bathurst, like Fleet Street there. And it basically cyclists kind of, and rollerbladers, I noticed, would kind of end up on the street. And then that kind of left the Martin Goodman Trail for the pedestrians who are walking. That to me seemed like a smart move anyways. Yeah. And I think that we have to kind of watch for more studies and more definitive information.

And of course, this is becoming a lot more pertinent as the weather's nicer and more people are outside. And I know people are stir crazy. They want to get outside and I don't blame them. And I was never somebody who said, don't exercise, don't go outside. I think it's really important for your wellbeing that you, that you, you know, Martin Goodman trail is great because it's nature, you know, hiking, even just walking, wandering around the neighborhood, looking at flowers and, you know, their magnolias, they've come and gone and tulips, etc. You know, to enjoy

the colors because it's so important for our well-being. Well, I'm glad you're bringing this up because some people are using the hashtag stay home. And I can tell you, I can tell you that when I, again, it's all about me and my broken wrist here, but when I did break that wrist in late March, at least one regular commenter slash listener at torontomic.com said that I got what I deserved because I was supposed to be at home. And we're still walking and cycling. We're just, maybe this is a good chance to bang home the one rule, the big rule as I see it, which is, and you'll correct me if I state it incorrectly, but if you don't live with the person, you got to be two meters away from the person. Like that's essentially, if we have a golden rule right now in all of this, that's it. Am I right? Yeah, I think you're absolutely right.

I think it's kind of pointless to try to isolate in that way when you live in the same house, unless one member of that household has been out and about, or I work in the emergency department. If I have the sniffles, then I have to isolate from my family. And during this time, certainly a number of my colleagues have considered living in a hotel room or living in a special space that's been designated for people who, who have suspected COVID-19 because they don't want to infect their families. Right. That would be like, yeah, high risk person like yourself, that, that would make sense there. But aside from that, if you live in the same household, then, and you know, there's nobody who's, who's, who's encountering people

who, you know, working with people who could potentially have COVID, then, then there's nobody who's encountering people, working with people who could potentially have COVID, then there's no reason why you have to isolate from one another in the house. So this will be a good segue to the Trinity Bellwoods Park incident from Saturday because a lot of people, I saw a lot of people shaking their fist at the selfish millennials.

And I mean, the photos, I was there yesterday and there was nobody there. It was very safe. And I took a photo, it was very safe. But on Saturday, I understand there yesterday and there was nobody there. It was very safe. And I took a photo. It was very safe. But on Saturday, I understand there were thousands of people in Trinity Bellwood Park. What is your personal opinion of that big news event we had here? Well, you know, people have their initial reaction.

I'm not going to make comments about millennials. I think that's pointless. I'm not going to make comments about millennials. I think that's pointless. I think that your first reaction is you see the images and you are thinking that this is similar to the images that we've seen in the United States where there has been a lot of politics that has gone into the decision of whether or not to open up the states, the beaches, or keep them closed. And you want those decisions to be guided by science. So you look at the images of Trinity Bellwoods Park and, are we are we infected with the same kind of politics? Are people did people go to Trinity Bellwoods Park to kind of flaunt the, the rules? And and if they did, what does that mean? What does that mean for all of us? So that that's your first reaction. I know a lot of people were angry, you know, kind of WTF reactions. And that's as close as I'm going to come to swearing. Lots of, you know, lots of reactions like that. I must confess, I had those reactions.

And then sober second thought, people were saying, well, what was going on there? You know, is it their fault or was it mixed messaging? And, you know, after a while, some of the more thoughtful columnists like Andre Picard started to say, you know, after a while, some of the more thoughtful columnists like André Picard started to say, you know, the Globe and Mail started to say, you know what, attacking, pointing fingers at people who went to Trinity Bellwood Park, telling them they're bad, they're selfish, is not going to accomplish anything. And I have to agree. I think that's true. behavioral science, sometimes called behavioral economics, which is the study of why people do what they do, why they decide to follow rules and why they flaunt rules. And there's a lot of really, and that takes us directly into parents who readily vaccinate, get their kids vaccinated, and parents who don't. Parents who say, you know, I would never vaccinate my child.

They're called vaccine refusers. They're a small percentage. And then there's a larger percentage of parents who are anxious about vaccines. They've heard there might be something going on with side effects of some of the vaccines and they don't know what to do. And saying that they're bad parents, attacking them because they have questions about vaccinating. Well, what are you talking about? You think it'd be better if your child had measles? And that they say to you, well, I don't know. I've heard that maybe it's better for your immune system. view that that's a bad idea, that's a bad notion, attacking people for having notions that you don't

agree with, or maybe, you know, not based in good science, is not helpful. Because the first reaction of people who are told, you know, you're an idiot for believing, or you're a fool for believing that, is that they're going to toughen up their viewpoint. They're gonna they're gonna wonder you know am i do i have a conflict of interest in in my attacks far better to empathize with that person to empathize with the people who went to trinity bellwoods park and say wow you must have you must have really felt like you needed to to feel like this was all over yeah so it's and and education, right? We talked earlier in this episode about how muddied some of the communication has been. It has been far from clear, and it's not surprising. So if the golden rule that we just mentioned is if you don't live with the person, you got to be

two meters apart from the person. So that, this, I mean, the scenes from trinity bellwoods park as i see it were the fact that uh they definitely don't all they couldn't all possibly be you know living together you know what i mean like it just you know so it and and yourself having that initial reaction uh i don't know if you said anger i don't put words in your mouth but that would make sense to me because to me that seeing them kind of uh ignore the big rule we're all trying to live by, it's particularly disrespectful for the people like yourself who are frontline workers and going out there and putting yourselves in danger for the greater good here. It just seems to be extremely disrespectful. be extremely disrespectful. And, you know, Mike, I, you know, I agree with that. And, and, and I would say that, that, you know, I have empathy for all the shop owners who have all but shuttered their businesses in the last 10 or 12 weeks. And, and, and, um, you know, I, I can't, maybe,

maybe it's a non-secret or or maybe these two don't belong together. But I'm thinking that they close their businesses by law so that, you know, and of course, it all depends on what happens with Trinity Bellwoods. If it turns into lots of, you know, high rates of infections that they do end up tracking, And I really hope that public health authorities do test as many of the people who went there and follow them because it's a great natural experiment to see as an illustrative example of what could go wrong

or maybe it didn't go wrong. I don't know, but we need to study that. But if that were to happen, juxtaposed against all those businesses that have been living month to month not knowing if they can pay their rent uh you know i think i think people should be angry because because you know the the uh it means that that those businesses were sacrificed essentially for nothing and and i think that would be a shame because everybody's got to live.

Everybody's got to put food on the table and support their families. There are a lot of people who sunk a lot of money into businesses that they didn't see this coming. And that includes small businesses and big ones like airlines and car rental agencies. I mean, it's staggering. Well said, well said. And I keep hearing people will say,

oh, this is going to cause the second wave. And I'll be honest, my initial thought is we haven't finished the first wave yet, right? Like we haven't finished that first wave that we could be worried about a second wave. Am I right? No, you're right. You're right about that.

And I think we might've thought know, I think, you know, we might've thought a few weeks ago, maybe three, four weeks ago that we were getting to that point where we were past the peak. Um, you know, disturbingly recently, uh, cases in Ontario have been going up and, and, but we're still not testing as much as, as, as we should to know, you know, and, and it's, it's hard to know where you are on that peak if you're not doing enough testing to know how many people actually have the infection and how much it's actually spreading in your community. But, you know, this is probably the most sobering thing I can say. Up to this point in time, with all the measures that we've taken to flatten the curve,

we estimate that just 3% of the population has been infected with COVID-19. 3% three out of every hundred people. This is an infection that could end up infecting 70 to 80 out of every hundred people. So so we flattened the curve for what to end it? No, to delay it until we have a vaccine or better treatments. And that means that until we have a vaccine or until we have effective treatments, we have to be incredibly vigilant.

Well, Doc, how can we even talk about kids getting back to school in September if we know a vaccine might be a year off still? We don't even have an answer to when the vaccine will arrive, obviously. How can we talk about that? I got an email from my kids sorry quick rant but i got an email from my my six-year-old soccer league say you know the plan is if they get the permission

from the health whatever authorities the plan is to start up in july and then they're going to run it through october and they're going to have less teams at each field and i'm all i can think about is like are we dreaming in Technicolor here? Like, how are we going to have soccer leagues this summer? Well, not without testing, not without being sure that the risk of having kids playing soccer is low and manageable.

And, you know, I think most, you know, I guess the most important thing I want to say full stop is, is that, um, is that we expect as things open up, you know, every authority, every smart person, people, people much smarter than I, you know, public health experts, epidemiologists, uh, infectious disease specialists expect that as things open up, there will be more cases. You can't avoid it because we're talking about an infection that's still there unless it disappears, miraculously disappears from the community. And, you know, unless and until that happens, really, it's going to be an ever present concern until we have a vaccine or until we have

effective treatments where we can dispense them to people. And, you know, maybe we have a vaccine or until we have effective treatments where we can dispense them to people. And, you know, maybe we have, you know, somebody can go to their doctor and say, I think I might've been exposed to COVID here, take these pills for the next five days and you won't get, uh, the, you won't get infected. Um, and, uh, and, uh, and, you know, until that happens, uh, you know, we have to be vigilant. And we know what causes people to be infected. We know, you know, the rules.

We know that when we have people in close proximity to one another, and the more people you're exposed to who come from different households, the more likely that if one of them is infected, many of them will become infected. And so for that reason, we've said no to soccer games and kids going to summer camp. to summer camp. Now, there are places in the world where we've been able to get, you know, where authorities have been able to bring back school, and they do it, you know, typically, these are environments where they've done a lot of testing, and they know exactly how much or pretty close to exactly how much COVID is in the community. And when they start schools again, they practice physical distancing. They screen kids on the way in. They do a lot of testing of kids in the school.

And they separate the desks. Maybe they have certain grades coming some days of the week, so it's not full curriculum. And so it has to be a well-thought thought out plan backed by a lot of testing if you do that then then yeah i think it's possible that that that you know and i'd be hopeful that school will start up again in september uh and and but it's going to require a lot of effort and it's going to cost a lot of money to do that do we know uh brian if we get this twice like do we know definitively like if you get covid you're immune from getting it a second time. No, we don't know definitively.

We think our best evidence right now is that while the COVID virus, coronavirus mutates, it doesn't mutate so rapidly and so definitively that if you were infected today, that you could get infected again in three months, two months. You're probably good for several months. You know, somewhere down the road, it will mutate. You know, the prevalent strains of coronavirus will mutate to the point where you might get a milder case of COVID than you might have gotten the first time. But we think that you're not at immediate risk of getting it a second time. Okay.

Another Brian, not you, because it'd be weird if you asked yourself a question, but Brian says, I went to Longo's yesterday and for the first time felt safe grocery shopping. Why is it not mandated that all staff and customers have to be masked to enter for the protection of all of us? Well, you know, that's an interesting question because, because first of all, it's one of those mixed message situations where Canada's chief public health officer, Dr. Theresa Tam, you know, said fairly definitively that, that you don't have to wear a mask unless you're a healthcare provider working in a healthcare setting, or you're a suspected, a patient suspected of having COVID-19. And, and, you know, we know she did an about face. You know, in politics,

we call those flip flops. You know, in science and in medicine, we call that dealing with uncertainty. And there's evidence, you know, as the evidence grew, that societies that wear masks, you know, the Czech Republic, for instance, they adopted masks fairly early on and had a much higher prevalence of mask use. They found that they had lower rates of transmission. And so I think that now there's a lot more evidence for masks. There is a raging, just like privacy and apps to track people who have COVID-19, there's a raging debate right now as to whether masks should be mandatory.

COVID-19, there's a raging debate right now as to whether masks should be mandatory. To me, I can tell you what I do. When I go out in public to, for instance, a store where I might encounter two or three people, if I'm shopping for a barbecue or if I'm buying some takeout, I wear a mask in that establishment because I don't know who's been there recently. And so I think that's a sensible precaution to take. I'm not talking about a medical mask. I'm talking about a disposable mask, you know, that just filters out some of the virus particles

or one of these cloth masks that you can make at home or you can buy for too much money on Amazon. Yeah, you and I do the exact same thing. If I'm popping in, in fact, later today, I have to drop by the No Frills and go inside and get my pc express order and i'll be wearing a mask when i enter the uh the no frills and i do it because uh i feel it makes others more comfortable like i just think i feel better when i'm talking to somebody in a like you said going to buy a barbecue or whatever if they're

wearing a mask and i'm wearing a mask i just feel feel, and we're still trying it. We're still keeping our two meters. Don't get me wrong. That's always happening. But it just makes me feel safer. And I think that's important. As long as it's not a false sense of security. As long as you're washing your hands and wiping table surfaces and not touching your face otherwise. Yeah.

Right. Yeah. And that's and that's that's what some of the critics of masks have said, that that that if it gives you a false sense of security, that you flaunt the other rules, then then masks could potentially do more harm than good. But but, you know, I think if you're following the other rules, adding a mask just adds to your overall level of protection. And that thought process doesn't give us much credit as intelligent human beings who can understand that it doesn't replace that. It's an additional layer of security, if you will. Mike Gregotsky says he has two children. They want to see their grandparents and vice versa. What has to happen in the battle against COVID-19 for them to be able to spend extended time together other than this front? They've been doing a front yard social distance visit. By the way, I just want to let you know dr goldman that mike

is a huge fan of white coat black art and i'm sure he's uh already subscribed to the dose so so so mike and mike uh you know it's a great question i i think that that reason why we said that grandkids can't hug their grandparents is that at the time, if kids were going to school, it meant that they were potentially being exposed to coronavirus, may not have much in the way of symptoms and that if they hug their grandparents, their grandparents are older and have, you know, those medical illnesses like high blood pressure and diabetes that put them at risk, at increased risk, or you may have a smoking history that put them at increased risk of having a bad case of COVID and ending up in the intensive care unit. And so, you know, and certainly if you look at all the data, the people who have the most serious illness with COVID-19, the ones who are more likely to die are older people living in the province. So people who live in long-term care, retirement homes, seniors, and, you know, particular when they get to the 70s and 80s. Uh, so, so that's the reason why, um, it was, and, you know, in the off chance that that grandchild would have picked up the, picked up a case of, of COVID-19, maybe they saw

a friend, you know, it's very, you know, with toddlers, it's very hard if they were still playing together in a playground, it's very hard to isolate them and prevent them from getting into physical contact with one another, with fellow toddlers, preschoolers. And so, you know, to reduce the risk that infection acquired through that would then be carried to a grandparent, it was recommended that you not hug your grandparents. You stay within, you know, you stay within the two meters. Right. And we paid a huge price for that. You know, there are seniors living in retirement homes and long-term care who,

who have, you know, who, who miss their families greatly because of, because of that. And I, you know, I look forward to the day when that's relaxed. So when will it be okay for hugging to happen again? I would say that, that there's a couple of, a couple of ways to answer that once we have COVID-19 eradicated from the population, the long answer is when there's a vaccine, you'll be able to hug. Until there's a vaccine,

I would think twice about hugging because that close physical contact takes you within two meters. And if you're that grandchild or the parent you know, the parent who said it was okay to hug you would feel bad. If, if, if short, it may be 10 days later, 14 days later, that grandparent got COVID-19 and you weren't sure you couldn't disprove that

it came from your grant from your own child. So, so, so until there's a vaccine, you know, the smartest place to not is to not hug. That's one, one way of answering it. The other way is the question is, are we at the end of handshakes and hugs in our society? And you know what? We may be, you know, this COVID is changing business. It's changing. It's, you know, how many people never shopped online are now only shopping online. Right. Right. So, so maybe the end of

handshakes and hugs. And, uh, you know, I, I had, I don't know about you, but I had a lot of, uh, speeches lined up right across the country, all canceled, all of them, one virtual conference. Uh, and, and, you know, things are changing. Uh, so, so maybe that's one of the things that's going to change. I can tell you that I'll never look at handshakes and hugs the same way again. And I'm not talking about grandparents and their grandkids, because I think there's at some point, you have to find that balance between the cure being worse than the disease and all that. I think a grandparent hugging their grandchild is a different category. But I can tell you that last week, I mentioned David Ryder's the last guest I

had in person here, but that week there was already a rule in the studio where, uh, we weren't having any physical contact. Like typically I'd shake the hand of my guest at the door that had already been, uh, that had already disappeared. And I don't think that's coming back. Uh, just, just, I look at everything differently now. Yeah. And, and, you know, it's like, you know, we all, um, you know, there's a kind of a post-traumatic stress that our entire society is going through right now. You know, obviously people who have lost loved ones are going through

it much worse. People who've had COVID-19 who've been in the intensive care unit far worse, but, but I would not negate, uh, the stress that we're all going through right now. And, and, you know, in that context, hugging and handshakes may be trivial, you know, compared to the stress that you're feeling right now. And, you know, you know, I think the worst, probably the worst impact of COVID-19 is that, you know, our brains are hardwired to be kind and empathic to one another. They're also hardwired in the most primitive parts of our brain to within nanoseconds to look at the face of somebody else or their tone of

voice or their accent and say, you're not a member of my group. And so you could potentially be my enemy. And, you know, when you're walking in the neighborhood, you may note some people are smiling and nodding. You may notice other people who are kind of turning their face away from you as if you're the enemy. And we have to guard against that. And stress is, you know, stress from precarious employment, precarious business, you know, precarious health, precarious security. All of those factors are putting us under stress.

And that's what's making this us and them kind of come to the fore. Wow, this has been very informative. I think I took a little more of your time than I said I would because I'm sneaky that way. But I really enjoyed this conversation and it did help to hear from, you're not only a subject matter expert,

but you're an expert in communications. And I urge everybody to listen to White Coat Black Art. It's a great show on CBC Radio, but also to subscribe to The Dose where, you know, Dr. Brian Goldman will answer questions sort of like this on a regular basis. And how often do you drop new episodes? We drop episodes of The Dose once a week on thursdays and uh you know occasionally we have we have a bonus podcast as well but uh uh we're we're just getting started and we got a lot of topics to go maybe the last question since it ties into the show is uh do i have to wait for a vaccine before i can have in-person guests again on toronto mic'd and well if the treatment

becomes available you you know, if there's a cocktail of medications, then, then maybe not. Maybe you don't have to wait, but, but stay tuned for that. And there are, I mean, there are, you know, we, we had a, we had a, a, some good study results with the, with a drug called remdesivir. We had lousy results. In fact, you know, horrible results with hydroxychloroquine. So President Trump can

stop taking that. Uh, but, but there are other medications that are being, that are being tested and, you know, maybe the right cocktail will, will, will knock this down. Uh, and you know, that's, that would certainly be the interim hope that we have. Uh, it would be practical and, and, and could be well in advance of a vaccine, But, but until then, um, you're probably going to have to keep your guests at a distance. Thanks, Dr. Brian Goldman. That was fantastic and very informative. Thanks for your time today. My pleasure, Mike. And that brings us to the end of our 653rd show. You can follow me on Twitter. I'm at Toronto Mike. Dr. Goldman is at night shift.

MD. Our friends at great lakes brewery or at great lakes beer. Palma pasta is at Palma pasta. Sticker. You is at sticker. You the Kite-ner group are at the Kite-ner group. CDN technologies are at CDN technologies and garbage day are at garbage See you tomorrow when my special guest is Dave Randor. This podcast has been produced by TMDS and accelerated by Rome Phone. Rome Phone brings you the most reliable virtual phone service to run your business

and protect your home number from unwanted calls. Visit RoamPhone.ca to get started.