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The Current Transcript for April 12, 2021

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

JULIA: I think our brains are kind of broken, the continuous stress people have been under, whether you're an essential worker, whether you're a mom. So, our brains under this stress have been sort of short circuiting, like our short term memory isn't very good.

MATT GALLOWAY: How are you feeling? Fried. You're not alone. A year plus into this pandemic. And with new restrictions in place for much of the country, people have hit a wall. A look at burnout and what it does to our brain coming up in just a minute.

MG: Also this morning, while we continue to fight this pandemic, scientists are already trying to prevent the next one. And a key step they believe is limiting the spill-over of animal viruses to us humans. In 30 minutes, how deforestation raises the risk of the next big one.

MG: Plus:

CHASE BLODGETT: When this policy came up for me, I've seen the names and faces of the people whose lives are going to be changed instantaneously. I'm seeing them being able to be their authentic self and bring their light and medicine to the world and to Yukon.

MG: Yukon has implemented some of the most comprehensive health care in North America for trans people. We'll hear what that means there and across this country. But we begin with your pandemic brain. Good morning. I'm Matt Galloway. And this is The Current.

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Understanding pandemic burnout

Guests: Dr. Roger McIntyre, Dr. Natasha Rajah, Julia from Toronto

JULIA: It was about four months into the pandemic when I realised I couldn't remember, like the simplest things, words, definitions and making decisions, even the smallest decisions that I would have probably made almost unconsciously before, started to become really overwhelming. Everything was becoming harder, which is kind of odd because my days were more and more similar than they had ever been before, but just my ability to really be productive or effective was decreasing. It's kind of weird how doing the same thing every day is actually so exhausting. I think I'm just spent.

MG: Does that sound familiar? I think a lot of people can probably relate to that feeling. The third wave of covid-19 is here. The pandemic has been with us for over a year. And many of us, yes, are just spent. As it turns out, there is a scientific explanation for feeling burned out. Now, the stress of the past year is impacting our brain function. Dr. Roger Macintyre is a professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders and Psychopharmacology Unit.

MG: Doctor, good morning.

ROGER MCINTYRE: Good morning, Matt. Great to be with you.

MG: Great to have you. That was Julia, we just heard. She's a mom in Toronto. And the feeling she just described, I mean, of almost being like in quicksand, where you've hit a wall, does that square with your definition of burnout?

RM: It does. And to add to that, what we're hearing from people all across the country along with this brain fog, diminished cognitive function. People are describing fatigue. They're describing a sense of lack of enjoyment in their life. And this squares entirely with what we understand about brain science, specifically brain science as it relates to chronic, unpredictable stress. And Matt, that's the key word, unpredictable. Chronic stress is bad, chronic, unpredictable stress is malignant to the brain.

MG: OK, so explain in terms that we can all understand when someone's feeling the way that many of us are feeling right now, what's going on in our brain?

RM: Three areas of the brain are affected by stress. So when we're under stress, which is a subjective experience. So every person experiences an external event very differently. We process it and there are three areas of our brain that are interconnected. These three brain regions are responsible for our thinking, the pleasure and motivation and also the fear. And from an evolutionary perspective, these circuits are interconnected. And what happens is, is that when the brain is exposed to chronic, unpredictable stress, the body releases hormones and chemistries that in the short term serve us an advantage, they keep us vigilant and increase our ability to perform on the spot. But in the longer term, start to do collateral damage. They actually metastasise right to your brain and begin to disrupt those key circuits. That's why we feel fogie, we actually start feeling lack of motivation. We feel tired and we also don't feel much joy. There's not much [inaudible]. It literally maps right on to the brain circuits that are effective in chronic stress.

MG: You've used the word unpredictable a few different times. How is unpredictable stress different than just, you know, the usual grind that people might face?

RM: It's an incredibly important distinction Matt. When we're under chronic stress, which I think that the covid-19 meets that definition, it is detrimental to brain function. What is so interesting about the brain, and this won't surprise anybody, the brain likes predictability and when stress is chronic, but it has a defined endpoint, that's a very different ball game then when a situation's present when we don't have a defined endpoint. In other words, when animals, and when the biology of this is sussed out in the research, are exposed to stress, when the stress is unpredictable, they don't know when it's going to end, when the next grief is going to happen. That's what we see the most detrimental effects on the brain structure and the brain function. Now, think about what's happening across Canada. We've had now 13 months and counting. We don't have a defined endpoint. We have the ongoing situation of uncertainty. This fits exactly onto what's been shown in the laboratory experiments of what really is unpredictable. So we need to do what we can to try and bring some predictability to this chronic stress.

MG: So when people describe this as a marathon, but then we can't see, I mean, anyone who's done any running knows that at the marathon there's a finish line, but we can't see the finish line right now. That's that unpredictability.

RM: That's the unpredictability, not knowing when it's going to end. And if you've sort of noticed what some people are doing, especially in some parts of the world, what the communication has been is not that this is bad, not that this is chronic, but they're trying to give the population defined milestones. Defined, if you will, goal posts along the way. That doesn't just keep sort of a check in balance and accountability. It does something very powerful. It tells us that there's an endpoint. This is why I have believed all along to use sort of Bandura, the famous social cognitive [inaudible] language of really collective agency. As a collective group, we need to have information that's concise, clear and accurate. But also this information needs to be conveyed to the Canadian public, where we're not only being told about the number of cases, but how are we rolling out the vaccine? There are some good news stories in the vaccine, and by telling people this information, they have a sense of predictability and this is what Canadians need.

MG: How concerned are you about the possibility of long term psychological or cognitive impacts of this? If this is affecting our brain in the way that you're describing, could this hang around after, you know, whenever we get out of this moment?

RM: Yes. I mean, we have a history as lessons approach in the sense that we've learnt from previous macroeconomic and public health events that are nothing similar to this, but certainly have some aspects of similarity to this, that there will be a fallout. Now, the fallout is not a fait accompli. We know from history that these events will result in a rise in, not just distress, but decreased function and in some cases actually outright mental illness like major depression or other conditions. But it's not a done deal, as I said. And we know based on some of the previous research on stress and the outcome of stress, that when there are resources put in place, when there are, in fact, government activities put in place to identify to protect people, not just in terms of their physical well-being, but their mental well-being. And when people take charge, a real sense of personal agency, structure in your day and managing your day in a way that you can't change the external environment with respect to this vaccine and the virus, but you can change your response to it. And the literature has shown when you do this that can greatly mitigate some of the long term deleterious effects of this. I tell you who does as well as the military. The military is fully aware of how training and managing and structuring and bringing about personal agency can decrease the long term deleterious effects of chronic, unpredictable stress, which the military knows well.

MG: So what are we supposed to do about this? I mean, you mentioned communication and that comes from politicians and public health officials. Making sure that the news is not all bad news, but also that it's clear and that it's concise and it's not confusing. But for individuals, what can we do to help manage this unpredictable stress?

RM: The basics and the basics are underscored by what's known as personal agency, taking full control. In other words, the basics are: sleep, structuring your day, healthier lifestyle on exercise and appropriate food intake and portion control, all those things that we've known, you know, you were taught since you were a youngster. But in addition to that: engagement, social engagement obviously more difficult during this time, respect the public health recommendations. The division of Labour. The division of Labour, when it comes to stress, is the most powerful way to boost your resiliency. And this has been shown to have long term protective effects. But the key issue here, Matt, is unpredictability. And when we can introduce personal agency by exerting control on our lives, on the aspects we can control,

MG: Like creating a schedule or creating a routine?

RM: Absolutely it's more powerful than just the structure. It's telling the brain you've got predictability. And then that, along with our collective agency bringing predictability to this, is not going to take the chronicity out of this. It's not going to take the stress out of this. It's going to mitigate the stress somewhat, but it's going to reduce the unpredictability. And that's the malignant part of this.

MG: Is part of this about also just taking burnout seriously? I mean, the idea of burnout can seem to be a bit of an amorphous idea. I'm burnt out, what does that mean? And people might just say suck it up and get back to work. But what you're suggesting seems to be that this is actually affecting how our brain functions. So is this about actually understanding that this is a serious thing?

RM: It is very serious. Now, to be very clear, I think that we know that, you know, we remember Justice Porter, from the United States and his quip about porn. Everyone knows what it is, but it's hard to define. When it comes to... in fact, burnout is a little hard to define and burnout, not always lead to later serious physical and mental health complications, but burnout should not be dismissed. Burnout is an early portent. It's an early concerning experience that for many people does predispose, does portend some serious functional impairment later on. And Canadians are experiencing a lot of this currently.

MG: What about employers and their role in this? We, many of us are in different work scenarios now where if you can, people are working from home and obviously not everybody's able to do that. And there are those who are on the front lines who are facing that burnout as well. For them and for those who are working at home and don't have any separation between work and the rest of their life. What should employers be doing to think differently about burnout in this moment?

RM: Well, I think that action should be preceded by thought. And the thought is education and being aware of this very serious effect. This isn't just, you know, because people are going through a bad day. This is a serious experience that people are going through. Secondly, the Wall Street Journal reported on this about two, three weeks ago, companies that are small, medium and large, private and public sector are beginning to allow for people to have time outs, to have time outs, to have a proportionality to the week where they can sort of do other things. They can divest and other things as a way to regroup. Thirdly, and I think this is where employers can be helpful is what used to happen years ago with the old brick and mortar offices where people would get together. You know, often it was a Friday just to get together to socially engage with colleagues in the workplace. It's harder to do now with the virtual and the gig economy. But recognising that for a lot of people, work is not just a place for a paycheque, it's also a place for social connectedness. And that's obviously very protective. And companies are beginning to recognise this. And this is now being imposed upon this current virtual environment. So I think it begins with education. You actually, in fact, have to encourage people to do what they can to protect their mental health and emotional health during this time and start to introduce some of these programmes, which we take for granted many, many years ago.

MG: Just before I let you go, in addition to knowing all about this, you're living through this moment with the rest of us. So what are you doing to ensure that you don't get burnt out?

RM: Well, I spent a lot of my time trying to practise what I preach. I'm not perfect, but I try to do a lot of personal agency. Like everyone else. The gyms have been closed, which has been a great outlet for me and a great resiliency for me. But I do what I say. I engaged in militant Matt, militant portion control not just on food and also my alcohol, but also with respect to what I'm doing on social media. The exercise is critical. Look, I frankly, a week after this whole thing started, I was socialising on Zoom. Look, it was kind of cool back. Matt, I don't find it cool now, but I'm still doing it because I think it's good for my mental health, it's good for my emotional health, good to see my friends and colleagues. So I stay connected.

MG: Roger, good to speak with you. Thank you.

RM: Matt, thanks for covering it. Take good care.

MG: Doctor Roger McIntyre, professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit.

MG: Another part of all of this is forgetting. Having trouble remembering the details of what you did yesterday or the day before, as we often do, forgetting even what day it is, pandemic stress can affect the brain's memory function. Dr. Natasha Rajah is a professor in the Department of Psychiatry at McGill University and the Douglas Research Centre in Montreal.

MG: Good morning to you.

NATASHA RAJAH: Good morning. Thanks for having me.

MG: Thanks for being here. How is the stress of the pandemic and the burnout that we were just talking about affecting our memory?

NR: So when we build new memories... So, the research that I do, I use MRI to study how the brain learns and remember details about our past experiences and why disability changes with ageing and also diseases of ageing. So what I know from that type of research is that to learn and to acquire these new memories and rich contextual detail, we actually require temporal and spatial landmarks and novelty to help us form these memories. So before covid, our days were broken up temporally. We went to the office, we came home, you know, we picked up our children from day-care. And so we had a lot of temporal kind of segments to our day. And we also had more variety in our interpersonal interactions. And the spatial cues that we experienced throughout our day. So this variety and novelty of information really helps us to discriminate and form distinct memories in rich detail. However, now a lot of us have a more monotonous, boring life where there's, you know, we're home. We're not really getting a lot of variety in our spatial cues, the days kind of drag on. We really don't have events breaking up our day, maybe our zoom meetings are the only events that break up our day. And so all of this lack of novelty and lack of segments in our day really cause our memory to suffer. So we have a lack of detail as a result.

MG: When you say suffer, I mean, what is the absence of that variety due to our brains memory function?

NR: So it really hurts the circuitry. So the hippocampus and its associated brain regions, that are important for the forming of new memories and for recollecting the details of memories. And so when you have this lack of detail and this more kind of monotonous day, that might be why when you look back on your, you know, last week or last month, it actually has a weird kind of effect where the days drag on. But time flies by because you don't have these kind of breaks or segments in your day to day life. And so as a result, you don't have any distinct or richness to your past experiences over the last few weeks or months that you've been experiencing covid. So in addition to that, it also changes the quality of the memories you have. So not necessarily the amount of memory you have, but what about your past do you remember? So a lot of us are bored and some of us are, you know, expressing grief and loneliness and social isolation and some even depression and anxiety, as the previous doctor was talking about. And all these extremes have a compounding negative effect on our memory systems. And so we really are kind of skewed towards the negative right now. And so the content of our memories under such conditions tend to kind of emphasise the negative more than the positive. So there's a lot of nuance differences that's going on with how you're encoding and what you're remembering at this time.

MG: How does sleep affect this? I think a lot of us aren't sleeping particularly well. And if we are, we're having these very strange pandemic dreams. How does that impact our memory?

NR: So sleep disruption definitely has the same negative effects on our memory circuits. So it's just like all these things, the grief, the depression, the sleep, the anxiety, the chronic stress, they're kind of having a similar and compounded effect on our memory systems. And also what Dr. McIntyre was speaking about earlier, which is what we call cognitive control functions. So a complement to these memory systems are these more frontal and parietal cortical cognitive control functions which really help us strategize and control the type of information we focus on to encode and what we retrieve. So this kind of taps into what a lot of people might be experiencing with the brain fog, which is a lack of ability to stay on task and going to the fridge, not knowing why you went there, not knowing what you are supposed to do for the rest of the day or forgetting, having these lapses. So this all plays together, sort of, you know, these different networks in the brain talk to each other and are integrated. And so with stress, not only are the memory systems impacted, but also what we call these cognitive control systems. So you have this lowered ability to really guide what you want to remember and how you remember it later. So there's this interaction between our planning and our strategy and our memory systems.

MG: Those of us who get caught up in, as you say, the brain fog. I mean, we might be wondering what it is that we can do right now to improve our memory or prevent any damage from happening. So what is it? I mean, we were hearing earlier, but he was saying militant portion control and being very, very vigilant to set up kind of a routine. What can we do for our memory?

NR: So one thing I do want to say is our brains are very plastic and so we are all experiencing this collectively right now. But we like there's a lot of research showing that exercise and meditation and good health practises really, you know, improve the functions of these memory systems and cognitive control systems. So I encourage everyone to do that exercise and eat healthy and, you know, engage as best as you can socially. However, I wouldn't be as concerned with the long term effects. Of course, there's going to be some fallout as the doctor pointed out, and there will be some individuals that this experience will, you know, trigger anxiety and depression in the long term. But for the majority of people, our brains are very plastic and they do bounce back. And so as we get reintegrated into society and we do have more enriched day to day experiences and greater social contact and less isolation, I do predict that the majority that our memories and our cognitive functions will, you know, be fine in the long term. However, there are those that, you know, if they have a history of mental health disorders or if they have a history of other chronic illnesses that may have this longer term fallout that we will have to, you know, addressed in policy and in care.

MG: But in the meantime, just follow that. I mean, the guidance that we keep hearing, which is take your time and be diligent about creating that routine.

NR: Exactly. And take time for yourself. Like self care is important. You should practise meditation or whatever brings you joy and whatever can help break up the day. So maybe have those face times, even though you might be not wanting to right now, because you are sick of seeing people on the computer screen. Take that time to enjoy yourself because that really does enrich your cognitive function and will help mitigate some of these effects.

MG: Doctor, thank you very much.

NR: Thank you for having me.

MG: Dr. Natasha Rajah is a professor in the Department of Psychiatry at McGill University and the Douglas Research Centre. What does burnout look like to you in the midst of this pandemic? Let us know. Thecurrent@CBC.ca. Your news is next. And then:

JONATHAN EPSTEIN: Anytime we talk about getting ready for big epidemics, they always focus on recognising the outbreak once it's already in human populations. It's like trying to deal with climate change by giving everybody fans and it's just not effective.

MG: We're in the midst of this pandemic. We'll talk about preventing the next one in the natural world, coming up in about six minutes.

Why tackling deforestation could be key to stopping future viral outbreaks

Guest: Dr. Jonathan Epstein, Kimberly Fornace, Terry Sunderland

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

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MG: Still to come, Yukon has passed some of the most progressive legislation on the continent when it comes to transgender health care. It's already making a difference. We'll tell you how. But first, why what you eat really does matter.

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MG: We have already learnt a lot of lessons from this pandemic, but it remains to be seen whether we really have learned what some scientists say is the most important lesson of all, and that how we treat the natural world has consequences for the spread of disease in humans. The Coalition for Preventing Pandemics at the Source says deforestation and agriculture are key drivers of what's known as spill-over when diseases jump from animals to humans. And they say that unless governments act now, they are playing a game of Russian roulette. Dr. Jonathan Epstein is part of that coalition. He's a veterinarian, disease ecologist and vice president for science and outreach at Eco Health Alliance. He's in New York City.

MG: Doctor, good morning.

JONATHAN EPSTEIN: Good morning, Matt. Thank you for having me.

MG: Thanks for being here. How urgent is this message that you and this coalition are trying to deliver?

JE: This message is critical and it needs to be delivered now more than ever, because in the midst of this crisis, we need to make sure that it doesn't happen again. And to really do that, we have to start thinking about how these things happen in the first place. We have a very good understanding of that, which has everything to do with spill-over, the jumping of viruses or other pathogens from animals, typically wildlife into people or into livestock and then into people. So we need to focus on that process if we're going to actually hope to prevent this from happening again.

MG: Can you explain I mean, the spill-over when it comes to covid, because there seems to be a general consensus that the virus that causes covid spilled over from the animal world. So what do we know about how that happened?

JE: That's a great question. And to answer that, let me just step back a little bit and say that we have a very good understanding now based on a lot of scientific research that the majority of pandemics and epidemics are caused by zoonotic pathogens. These are viruses typically, that are carried by animals that make their way into people and are able to spread among people to cause widespread outbreaks. Much of what we know about covid and the virus that causes it, which is called sars-cov-2, really stems from what we learned about the original SARS outbreak back in 2002, which we knew from investigations at the time that that was traced back to bats. Specifically, horseshoe bats that carry not only SARS and related coronaviruses, but an enormous diversity of related coronaviruses. We also have found the closest known relative to sars-cov-2 the virus causing covid in a similar type of bat back from the same group. And that virus is about 96 percent similar genetically to sars-cov-2. So we have a lot of confidence to say that this is probably a virus that originated in bats. And what we really now have to understand is how it made its way from bats into people.

MG: How is human activity contributing to the spill-over?

JE: The majority of epidemics and pandemics we see, whether it's Ebola, covid-19, HIV, these are zoonotic viruses and they emerge because of human activities. We know the science now is at a state, where we know that the major reasons that viruses emerge are things like land-use change. One of the biggest drivers of disease emergence responsible for about a third of all the epidemics we see are processes like deforestation, or forest fragmentation, or conversion of agricultural land to more urbanized landscapes. This dynamic process influences the way that we come into contact with wildlife, or our domestic animals, our livestock, come into contact with wildlife, and that directly allows for viruses to make the jump from their natural wildlife reservoirs, either into livestock or into people.

MG: In that deforestation, I mean, there's a lot of talk, particularly around tropical deforestation. Why is that specifically such a concern?

JE: The reason that tropical areas particularly are a concern and high risk for disease emergence is that it has everything to do with biodiversity. If you imagine that any given species of animal has its own normal suite of viruses and bacteria that have grown up with that animal, have evolved with that animal, most of these will be benign. But a small portion of them are going to be pathogenic or able to cause disease, and particularly when they jump from one species into another. And so the more diversity you have, the more different species you have in one location, the more variety of viruses, particularly those that are able to jump from species to species, will exist. And that's all fine when it happens in a remote, isolated part of a forest where people don't venture. But when you start cutting roads and logging roads into those forests and having more access to those animals, where bushmeat hunting creates opportunity for people to come in contact with bodily fluids from those animals, or when we pull those animals out of the forest and bring them into commercialised wildlife market systems where they're trucked overland into these large urban animal markets, that's when we really create opportunity for spill-over. So high, biodiverse areas coupled with large human populations, livestock populations and importantly, the dynamic process of environmental change -- those are the things that create risk for viruses emerging from wildlife into people.

MG: And when you say risk, I mean in the introduction, I said that in some ways, if this isn't dealt with, governments are playing Russian roulette with pathogens. What do you mean by that?

JE: Well, it is very much an odds game in some ways, a numbers game, in that there are some number of viruses that already have the genetic ability to jump from the animals that they normally occur in, into other animals or people. And so it's a matter of opportunity. The more chances we give that virus to do so, the more shots on goal, the more likely we're going to see a virus that is able to efficiently spread amongst people. The good news is there's actually a lot of barriers to prevent viruses from successfully making the way into people. Otherwise we'd be seeing pandemics every other month because this type of spill-over probably occurs more frequently than we're even aware. But every once in a while, the right virus comes along that gets into people and is able to spread from person to person very efficiently and cause a widespread epidemic or pandemic like we're seeing with covid-19.

MG: And when you talk about the right virus, a lot of people talk about the Nipah virus and say that this could be... I mean, we're in the midst of this right now. We don't need to think about anything else, perhaps. But people say the Nipah virus could be the next big one. Why is that?

JE: Well, even though coronaviruses are on everybody's radar right now for obvious reasons, there are other viruses, unrelated viruses that have similarly shown the ability to jump from animals into people. Nipah virus is an interesting one. It's carried also by bats, by a different type of bat, large fruit bats that are common throughout Asia, parts of Africa. And these bats interact with people mostly by way of eating fruit that we cultivate. And every so often we eat fruit or eat food that's contaminated by saliva or urine from these bats that also contains Nipah virus and Nipah virus is a virus that causes a very severe central nervous system, disease, encephalitis, when it gets into people and it's fatal up to about 75 percent of the time on average. And we've seen outbreaks of Nipah virus occur in parts of South Asia, India and Bangladesh, where we see outbreaks occur seasonally through contamination of date palm sap, which is sap from a palm tree that's collected overnight, kind of like sugarcane juice, a very a sweet drink. People collected overnight and they drink it in the morning. But these fruit bats have learnt to use date palm sap as a food resource. So they come in and land on the trees overnight while the sap is flowing down the trunk into collection pots. They lick the sap, they eat sap and occasionally contaminate it with Nipah virus and then people get infected that way. So Nipah is an example of a virus that is regularly jumping from its wildlife hosts into people. Fortunately, it doesn't yet efficiently spread from person to person. Now the concern is, should there be a genetic variant of Nipah virus already circulating in bats that has the ability to more efficiently spread from person to person. Now we have an opportunity for a virus to emerge to spill over into people that has a 75 percent case fatality rate. Let's just think about that. Covid has a one to two percent case fatality rate.

MG: In the face of that, you're calling for more action on this, particularly at the G7 meeting in June. What do you want the government to do, given what you have just laid out?

JE: The problem we have in the policies that currently exist about pandemic preparedness or any time we talk about getting ready for big epidemics is they always focus on recognizing the outbreak once it's already in human populations. But the problem is, it is already way too late when that happens. We have to really work on prevention, real prevention, which is preventing that virus from ever making the jump from its animal host into people. And we just don't yet have the right policies and we're not investing the right amounts of money to really focus on prevention at that level. But that's where we should be thinking. Otherwise, it's like trying to deal with climate change by giving everybody fans, you know, and it's just not effective.

MG: Is your sense just finally, that there is the political will to deal with this? You mentioned climate change. I mean, we're coming out of this pandemic at some point in time, and that's going to be one of the other giant, existential, wicked problems we have to face. Do you think that politicians will want to turn their attention to this sort of issue?

JE: I think that it's in their interest to do so. I mean, one of the differences now between really any other point in history, except for perhaps 1918 with the influenza pandemic, is we're at a point where covid has touched everybody. So we have the shared understanding of how severe and serious a pandemic can be. And now is the time where I think policymakers need to understand that if we're going to prevent this from happening again, the investments required are actually relatively modest, fractions and pennies on the dollar in terms of what we have to spend to prevent spill-over from happening in the parts of the world where we know the risk is highest and if we just focus those resources there, it will have incredible returns, not just economically, but, of course, in terms of protecting our health and our livelihoods.

MG: John, good to speak with you again. Thank you very much.

JE: Thank you.

MG: Dr. Jonathan Epstein is a veterinarian and disease ecologist and vice president for science and outreach at Eco Health Alliance.

MG: Kimberly Fornace has been leading some of the research looking at exactly how diseases jump from animals to humans. She is an epidemiologist at the London School of Hygiene and Tropical Medicine and has studied a particular form of malaria that's found in macaque monkeys in Malaysian Borneo. She's done it using drone technology and GPS trackers.

MG: Kimberly, good morning to you.

KIMBERLY FORNACE: Good morning.

MG: Tell me about this particular type of malaria. When did scientists realize that it was making its way to humans from those monkeys?

KF: Yeah, this is a Plasmodium [inaudible]. So it's a type of malaria that was first discovered in the 1930s. But there is only one human case reported until 2004. And in 2004, there was a very large cluster of cases identified in Malaysian Borneo. And since this time in the past two decades, this has become the main cause of human malaria in Malaysia and it's been reported across Southeast Asia.

MG: How sick can we humans get from it?

KF: It can be fatal and it's a particular concern because it has a very high replication rate so it can make people sick very quickly. So it's difficult to get to healthcare in time.

MG: So when you turned your attention to this, what initially were you trying to figure out?

KF: Our first real question about this was what was driving the emergence? And we had some hypotheses around land use and deforestation, driving these increases in cases and by bringing macaques and mosquitoes and people in much closer proximity.

MG: How did you go about trying to figure that out, that link between deforestation and the spread of this?

KF: We first started looking at case data, so we analysed this with a lot of different metrics of deforestation and forest cover from satellite data. But then we wanted to look at a much finer scale. So we used a number of different types of technology. So looking at drones to map forests and how they were changing and then tracking where people were going and where macaque monkeys were going within these environments.

MG: And what did you find?

KF: We found that the risks are highest in forest fragments or forest edges. So these small patches, the forest that remain after clearing occurs. And this is what was really driving transmissions that we found some very strong link between deforestation and these edge environments, and the increases in human risks.

MG: What was happening there in those forest edges?

KF: This was creating new habitats from mosquitoes, but also bringing macaques in much closer proximity to human houses. So macaques were increasingly moving into farm areas, raiding crops and actually roosting or spending the night in very close proximity to where people were staying as well.

MG: And is that the specific type of deforestation that would lead to the conditions for this kind of spillover?

KF: We find it in this case. I think it's quite different for different diseases, depending on the ecology of the species. But this is very much determined by the ecology of mosquito species as well as where these macaques can live and find food.

MG: How quickly after the deforestation was complete would the spill-over occur?

KF: We see different effects. We often find that after deforestation occurs, there's an increase in the number of [inaudible] cases immediately after. But where we really see the effect is several years after, after these habitats have stabilised and then two to three years after large scale deforestation, we tend to see a very sharp peak.

MG: Knowing that, how do you think this information could be used to John's point to help prevent the spread of disease in future?

KF: We have a lot of opportunities for thinking about how we design land management and how we can kind of design practises to prevent these edges from occurring or target health programs and surveillance to where these populations are in contact. It's an area that's the focus of our current research, which is looking at how different methods of land management practises can actually reduce these risks by keeping more habitats more intact and conserved.

MG: So it's not about completely stopping deforestation, but changing how it's done?

KF: It's a combination. I think we need to kind of think about what's needed in terms of agriculture development and what areas are very high value, both in terms of biodiversity and other purposes, but also in terms of preventing future pandemics.

MG: Having done this research, I mean, we're talking about this now as the pandemic continues. But is there some sort of predictability that you would have seen in terms of what we're in the midst of now with COVID? Like, could you have seen this coming, given what you have learned through your research?

KF: Yes, unfortunately, I think it is predictable in some ways. We do know that as we disturb environments and we're in close proximity to wildlife, that there's increased opportunities for pathogens to jump from wildlife to people. So it's something that we are very aware of and we've been thinking more about how we can manage these risks in the future.

MG: John Epstein said there's a real urgency to this and is pointing it, you know, government leaders at the next G7 meeting to say, listen, this is what we've just come through, you need to act now to prevent it. Do you see the urgency that John sees in trying to slow this process down?

KF: I completely agree with that. I think it's essential to act now. And I think it's critical that health and pandemic risks are kind of put into this general framework of how we make economic decisions, how we decide land management strategies and how we can think about different, more sustainable forms of agriculture.

MG: Is your sense that government leaders would be able to connect those dots? I mean, in some ways it's about stepping back and seeing a much, much bigger picture.

KF: I think so. And I do think the political will is there now. We mostly work in Malaysia and we've seen in Malaysia that this has had a huge amount of political will behind it, even just for this one particular species of malaria, as this is the main barrier to malaria elimination within the country.

MG: Kimberly, it's great to speak with you about this. Thank you very much.

KF: Thank you.

MG: Kimberly Fornace is an epidemiologist at the London School of Hygiene and Tropical Medicine.

MG: All right. So now that we know how dangerous deforestation can be, the next question is why clear so many trees? Terry Sunderland says we need to take a serious look at the food we eat and how we produce it. He is a professor of forestry at the University of British Columbia whose research focuses on agriculture, land use and food security. Terry, good morning to you.

TERRY SUNDERLAND: Good morning.

MG: When you take a look at the global problem of deforestation, I mean, for a lot of people, the assumption is that this is tied directly into food and food production. How accurate is that?

TS: That's absolutely spot on. Our whole food system is reliant on a very few commodities which require large amounts of land. And the transformation of land into agriculture is directly related to deforestation. So emerging into the forest frontier, if you like. So commodities like oil, palm, soy, chocolate, coffee, all the things we love and they're part of our processed diets, are driving this change. And up to 25 percent of deforestation is permanent deforestation, which means those commodities are there for life. So we're seeing massive land-use changes, particularly in the tropics.

MG: Has that process in terms of the way that we produce food, has that changed in recent decades?

TS: Yeah, we've shifted from a diverse and nutritious and kind of local dietary base to a much more simplified, processed diet, which is reliant on a very few commodities. And that is essentially reliant on these very highly processed, simplified carbohydrate, very sort of sugar based diets, which essentially are bad for us, but also equivalently bad for the environment.

MG: Well, take me to one of those places where the sort of spill-over is happening, where the viruses are jumping from animals to humans. I mean, describe what the process of agriculture is like in one of those places.

TS: Well, if you think of countries like Indonesia, Malaysia, where we've seen massive expansion of the oil-palm estates, for example, what you'll see is large areas of forest being cleared. The timber is recouped for sale, obviously it's profitable. And then the landscapes themselves are transformed into vast monocultures of oil palm, regardless of the communities there that rely on the forest resources and the agricultural land that they need for their own purposes. So there's not only an environmental impact, but there's also a cultural impact.

MG: So how do you go about reversing that? I mean, how do you change a food system to move away from deforestation and the effects of deforestation that we've just heard about from our previous two guests?

TS: Yeah, it's a really good question. And I think this is a bit of the Holy Grail in terms of the connection between forestry and agriculture. I mean, ultimately, there are two sides of that coin. One is we need to really reflect on the current food system that we have. Do we need as much palm oil or sugar or soy or cattle in our diets? So we need to question that for a start. The other thing is, is that there are numerous commitments to avoid and reduce deforestation. The New York Declaration of Forests, for example, of 2014, many, many companies and governments signed up to that to essentially avoid deforestation based on commodity expansion. None of those commitments have been met. And I think what we need to start looking at is not making those commitments voluntary and start thinking more about the stick approach rather than the carrot, making sure that there are systems in place so that deforestation is actually punished. Countries being called to account, if you like, for this prolonged deforestation. What we've seen in 2020, for example, during the pandemic is deforestation's actually increased exponentially, particularly in Indonesia, Brazil, other tropical countries. So we're seeing countries turn their back on the commitments that they've made related to deforestation, and that needs to be addressed.

MG: Is it possible to take something like palm oil out of the diets that we live in now? Once you start, you know, going down the palm oil rabbit hole, you learn just how ubiquitous the substance is. Is it possible to do that?

TS: Well, I think the great example is Norway. And they had a massive campaign highlighting just how ubiquitous, as you say, oil palm is. And it's in lipstick's, it's in gear oil, it's in everything. And it's hidden in many respects. You know, you look at a list of ingredients of a particular foodstuff and never really says palm oil, rarely says palm oil. It's hidden in many different ways. And Norway managed to cut palm oil consumption by about 60 percent just through this awareness campaign. So it is possible. It's also possible that we need to reflect on our diets. Do we need the ready meals that contain these kind of products? And so moving away from the processed type food that we've become used to.

MG: How do you go about dealing with this in the face of a growing population? Because the argument can be made by some that as the population continues to grow, all efforts need to be made to ensure that people have enough to eat. So is there a way to downsize that agriculture or rightsize that agricultural process without leaving people without enough to eat?

TS: Yeah, I mean, this is always the discussion that comes up. Yes, we have a growing population, but, you know, we grow enough food in the world and 30 percent of the food growing in the world is actually wasted. So that needs to be addressed. We need to think about different ways of growing food. Smallholder farmers in the tropics in particular, produce vast amounts of the world's food. And it's often forgotten that we have probably two billion smallholder farmers who farm plots of less than two hectares who produce maybe between 50 to 70 percent of the world's food. Not many people know that. If we promote those types of systems, which are much more diverse, much more resilient, then nobody puts all their eggs in one basket. They grow a multitude of different crops. Those kind of systems are much more sustainable and much more resilient against environmental shocks, including zoonotic spill-over, but also climate change and economic shocks too.

MG: What do you see is just finally the opportunity here? I mean, again, at some point in time will come out of this pandemic. And people have talked about creating, you know, a better future, not going back to the normal that we had, but correcting some of those mistakes. Are you optimistic that given what we have been through, this will be an opportunity that is seized upon?

TS: I would like to say yes. But as a society, we tend to be reactive. Estimates of what this pandemic has cost range from 15 to 20 trillion dollars in economic losses, in developing vaccines, et cetera, et cetera. But for around 300 billion dollars a year we estimate that you can avoid deforestation. So you could avoid these situations in the first place, so for a relatively small amount. And John, actually mentioned earlier for small dollars, basically, you can avoid these situations. And I think the same with climate change. We need to be proactive instead of reactive as a society and start looking at what we can do to avoid these situations in the future.

MG: Terry, great to talk to you. Thank you very much.

TS: Thank you too.

MG: Terry Sunderland is a professor of forestry at UBC and a senior associate at the Centre for International Forestry Research and in Bogor, Indonesia. Well, coming up after your regional update:

CHASE BLODGETT: Being repeatedly denied access to health care for me for a two year period of time and having to constantly fight and advocate for myself. To acquire the care I needed to be who I was.

MG: That's exhausting being trans. And Yukon has not been easy for people like Chase Blodgett, but it might have gotten just a bit easier in the wake of a new policy. Will tell you all about it in 90 seconds.

MG: I'm Matt Galloway and this is The Current on CBC Radio One.

[Music: Theme]

Yukon enacts comprehensive transgender health care; and Canadian universities battling COVID-19 outbreaks

Guest: Chase Blodgett, Dr. Michael Marshall, Dr. Kieran Moore, Lucy Freilich

MG: Hello, I'm Matt Galloway and this is The Current.

MG: If you identify as transgender and you live in Yukon, you now have access to what is being called the most comprehensive and progressive health care in the country. The territorial government has expanded coverage of gender affirming care. It now includes more surgeries and procedures that are part of transitioning. And supporters of this new policy call that care life saving. Chase Blodgett is the president of the All Genders Yarkon Society and joins me from Whitehorse.

MG: Chase, good morning.

CHASE BLODGETT: Good morning, Matt. Thanks for having me.

MG: Thanks for being here. For you, I mean, broadly, what stands out in this new policy in Yukon?

CB: I think one of the most significant aspects of it is that the government is recognising that these kind of medical interventions are life saving procedures. So historically, kind of prior to that, both across Canada and in the Yukon, these kind of surgeries for transgender, two spirit and non binary folks were viewed as cosmetic. So I think it's really significant for the government to recognise the huge impact these surgeries have on the quality of life for the folks who will be seeking them out.

MG: Before these changes were made. How would people in Yukon who were looking for gender affirming care, how would they get that care?

CB: When I started my medical transition in August 2014 in the Yukon, there was no policy and the first publicly funded gender affirming, surgery procedure happened July 6, 2016. So it was two years of back and forth to get approval. And I know that because that was the procedure I had. So at that time, we were all treated on an individual case by case basis. So our privilege, our ability to advocate, our literacy levels all impacted, our ability to access care, as did the willingness of our service provider, medical professionals, to advocate for us as well.

MG: Do you mind telling me more about your own experience in transitioning?

CB: Well, like I said, I started my journey in 2014, and at the time there was nothing and most Yukon residents would move to B.C. and they would get the B.C. health care system. And at the time I was making my decisions around medically transitioning and whether or not to move to B.C., relocate elsewhere in Canada. What I realised was a lot of things were going to change in my life. And the one thing that I did not want to have to lose at that time was my sense of belonging, my sense of community and the supports that I had around me. So that largely framed my decision to remain in Yukon. And so, yeah, that set off kind of this journey of advocacy and getting my first surgery in 2016. And then the Yukon came out with their first gender affirming surgery care policy in 2017, which at the time it was already a little bit archaic, could have been considered discriminatory in certain aspects. So All Genders Yukon society pushback at the government when that happened. And now in 2021, we're here with the most progressive policy in Canada and most likely North America.

MG: You made that decision not, as you said, to go to B.C., to stay home. You can imagine, I mean, the importance of staying home. But at the same time, I mean, you could have gotten different care had you left your home. So what was it like for you not to have the care that you needed despite the fact that, as I say, you decided to stay home?

CB: It was really hard. Like it was emotionally, physically, mentally, spiritually. You know, they took four parts of self and First Nations communities up here. And, you know, for me, it had a really significant impact and a negative impact on all aspects of my health and wellbeing. And I had to fight for everything. And from being 28 years old in 2014 to 35 years old now, seven years later. My capacity and ability to well, I didn't even know what legislation was. Now I know the difference between policy and legislation. I have a deep understanding of human rights legislation. I know about federal and territorial information and privacy laws [inaudible] these are all things I could not know seven years ago. And my knowledge in those areas were birthed out of necessity. And the government at the time in 2014 was not only not receptive to the trans, two spirited, non binary community, but they actually actively worked against us.

MG: Did it feel like you had to fight in some ways for your own health care?

CB: Oh. Oh, 100 percent. We had to fight every step of the way for those first two years. If I had the skills I had now, back then, it would have been a much shorter fight. But I didn't know any of those things back then.

MG: Let me go back to what you started with, which is that you were commenting on, you know, calling gender affirming care, life saving. How does that phrase apply to what you have been through over those seven years?

CB: Yes, I mean, I encountered what a lot of people in the trans, two spirited, non binary world do, which is, you know, the trans poll study out of Ontario, 43 percent of the community has or will attempt suicide. And the depression numbers for trans men and women, I believe, are, you know, clinically significant levels are 63 and 66 percent, respectively. And I think the most important aspect of that study is that it wasn't somebodies experience of being trans that caused those high rates of suicide attempts in the high rates of depression. It was actually the systemic barriers that we face on a daily basis and the micro and macro aggressions. So being repeatedly denied access to health care for me for a two year period of time and having to constantly fight and advocate for myself to acquire the care I needed to be who I was. That's exhausting. That impacts your mental health. Right. And so, like, I think what's amazing about this policy is it not only affirms the importance of these procedures as life saving, but it also really validates our lived experience and the voice of all our members who been saying that these aren't elective procedures, these are medically necessary procedures and providing access to them, is saving lives.

MG: Which is really powerful. I was going to say, what do you think the legacy of a change like this is? But when you say that it's about saving lives, I mean that in some ways says everything.

CB: Yeah. And I mean, for me, I mean, our society supports over 200 trans, two spirit, non-binary Yukon residents as well as significant others. So partners, parents, grandparents, etc.. So, you know, when this policy came out, what I saw was the faces of people who have been desperately trying to access something to be who they are, people who are saving every nickel and dime they can to try to save up for a surgery, people who cannot acquire or maintain employment because they are repeatedly discriminated against, because their physical appearance doesn't match who they are inside. So when this policy came out for me, I'm seeing the names and faces of people and the warriors who came before to lay, you know, the tracks for this and the people whose lives are going to be changed instantaneously. And I'm seeing them being able to be their authentic self and bring their light and medicine to the world and to Yukon.

MG: What do you see just finally as the parts of this that other areas of the country might take from what Yukon has done?

MG: My kind of hope is that other activists and other jurisdictions or other allied governments will look at this policy. And, you know, it set a precedent for now. And sometimes, you know, my experience in the past has been governments are a little hesitant sometimes to do things that nobody else has done before. And I think that's one of the really beautiful things about a smaller jurisdiction like Yukon is, it's easier to take a risk and it's easier to assess that risk. And I hope that the next jurisdiction to adopt something like this, I hope they do one thing that makes that policy even better than ours. Right. And if each jurisdiction does that, when we're up for renewal again, we can increase ours and we can elevate, you know, a whole demographic that's been struggling for years.

MG: Chase, it's great to talk to you about this. I really appreciate your time this morning. Thank you very much.

CB: Yeah, thank you very much.

MG: Chase Blodgett is the president of the All Gender's Yukon Society. The author of Yukon's gender affirming care policy is Dr. Michael Marshall. He's also president of the Canadian Professional Association for Transgender Health and he's in Edmonton.

MG: Doctor, good morning to you.

MICHAELL MARSHALL: Good morning. How are you?

MG: I'm well, thanks. Listening to someone like Chase describe what this policy means personally. For you, I mean, having created this, having written this, how does it feel to hear those comments?

MM: I think it contributes to the feeling that we are maybe getting close. It's been an extended period where folks like Chase have told us repeatedly that the policies in place were not meeting their needs. So it is good to hear that we're close, not there yet, but getting there.

MG: Chase talked about the importance of this being seen as life saving. What does that phrase mean to you in the context of medical care?

MM: Trans care that is affirming and wraparound is indeed life saving. There are a number of studies all over the world published in all sorts of journals highlighting the disadvantage that trans persons face and the experience of that and the effects of that. So, yes, there are studies showing high rates of suicidal ideation, high rates of acts of suicide, high rates of underemployment and under housing and high rates of homelessness. And these aren't a result of just by virtue of being trans. These are a result of the failures in health care systems and services to meet the needs of trans persons. So when we say that this policy is lifesaving, it removes the arbitrary boundary of medical and cosmetic and just includes everything as whole care for the person and as a result contributes to things not being as disadvantageous as they have been for a considerable period.

MG: We've called this the most comprehensive plan in North America. What does that entail?

MM: I think it's... briefly and quite simply, it's the removal of the arbitrary line between cosmetic and medical. So previously in other, well we'll see in other jurisdictions, there is the medical interventions [inaudible] hormones, some surgeries that are considered necessary by, you know, an arbitrary group of folk are covered very easily. But things that are actually also important, but not traditionally considered medical, but are actually lifesaving are also covered, too. So that removal of that line, that some things are deemed necessary and medical by health care services and others are not, is what makes it lifesaving.

MG: What would those procedures be? I mean, what were the most common procedures that would not typically be covered in Canada?

MM: One easy one to discuss is actually hair removal, so hair removal is sometimes covered in some jurisdictions only as an adjunct, adjunct to specific procedures such as lower surgery or other things like that. But general hair removal to allow a trans female to feel herself is generally not covered. And it's remarkably expensive. And we know from the trans polls project that trans people are underemployed, are under housed, have less money, not by virtue of being trans, but because, again, they're unable to get employment and so forth, get the documents to match themselves. They cannot afford hair removal. And so persons feel that deep dysphoria and face... and face being visibly trans when sometimes they don't want that. Sometimes it doesn't matter, but sometimes they don't want that and face the risks that come with that. So hair removal is one, body contouring, facial feminisation surgery is another one that is a first. Now, a body that has been exposed to testosterone has some bony changes that sometimes some people need to have addressed as part of their journey. And that facial feminisation surgery is lifesaving, not cosmetic.

MG: How did it come to be that the most comprehensive coverage and the most comprehensive plan in North America is in Yukon?

MM: You know, I have said this before, Yukon is a rather progressive place and has been a trailblazer in a number of different ways. People go there for a freedom to be, sometimes. And certainly when I visited the ease that I felt there was palpable. But there has also been a groundswell of discontent. There's been people like Chase saying you need to do better. Groups run by trans people saying we have the people telling you what we need, do it.

MG: What do folk in the trans community tell you about the discrimination they face broadly when it comes to accessing health care?

MM: Trans persons face discrimination from an early age throughout their lives and by the time trans people reach health care, the barriers that they've already surmounted are many and they are tired and still fixing health health care barriers. Trans people say this all the time, basic things like entering a family physician's office and being called themselves or having a bathroom they could use that reflects who they are or getting a physician to even see them sometimes because we know that health care and medical care in North America, there is about two to three hours of 2SLGBTQ+ health education only, and that includes the trans care. So sometimes physicians feel unable or undertrained to provide care. So the primary barrier is that trans people are people. There's nothing more complicated about the provision of care to trans persons, but trans persons face that primary barrier all the time.

MG: What is the best way to go about addressing that barrier to knock that barrier down?

MM: Well, one of the first... one of the ways of having policies that say that trans care is lifesaving and necessary and we will cover it, but basic things like having mandatory training for physicians about 2SLGBTQ+ matters. And if we can get physicians, health care providers, social workers, everyone to just learn a little bit more in their training, I think we could go further.

MG: Chase talked about the optimism of seeing something like this in Yukon and hoping that perhaps it would be replicated across the country. What are you hoping to see? I mean, do you see this as a precedent?

MM: It is. I do, I do indeed, I do hope that other provinces and territories are looking at this and trying to figure out how they could do the same or better. We cannot have one such disparity of provision of care or one territory providing comprehensive care and others having piecemeal patchwork care.

MG: Is there the opportunity for a national standard of care? People have talked about this when it comes to other matters over the course of this pandemic, for example, long term care. Is this an opportunity for a national standard?

MM: Well, national, worldwide standards exist already, and that's the beauty of the Yukon policy. It is very clearly a match with the standards of care by the World Professional Association of Transgender Health, which is the Bible of care for provision of trans care. So that exists already. All we merely have to do is allow the standards to be reflected in policy within the territories and provinces.

MG: Dr. Marshall, good to speak with you about this. Thank you very much.

MM: Thank you. Have a good day.

MG: Bye bye.

MG: Dr. Michael Marshall is president of the Canadian Professional Association for Transgender Health. He was in Edmonton. You're listening to The Current on CBC Radio One. My name is Matt Galloway.

LUCY FREILICH: I'm feeling OK right now. This morning I woke up with a little bit of a headache.

MG: Lucy Freilich is monitoring her health pretty closely right now. Lucy is a fourth year student at Queen's University in Kingston, Ontario, one of dozens of students recently diagnosed with covid.

LF: One of my friends that I had seen got an alert on their covid-19 app. So she went and got tested. She tested positive. And unfortunately, I had seen her earlier that week and I tested positive as well. There's a handful of people I know that do have covid right now.

MG: Most classes may still be virtual, but outbreaks are indeed popping up on university campuses across Canada. In Ontario alone, Western, the University of Waterloo and Queens are fighting rising case counts. Dr. Kieran Moore is the medical officer of health for Kingston, Frontenac and Lennox and Addington in Eastern Ontario.

MG: Doctor, good morning.

KIERAN MOORE: Good morning, Matt.

MG: What sort of spread have you seen with university students in the area that you would cover?

KM: Well, it's been very sudden and dramatic. We've seen a rapid rise in cases in the student population off campus mainly, and that's been over the last three weeks. It appears that we're fighting really a new pandemic. It's being driven by these variants of concern and they tend to spread much more quickly, rapidly, and they can end up with you ending up in hospital. So we're really fighting a new enemy and it has spread rapidly. We have over 80 students that have tested positive in the off campus area of Kingston.

MG: How surprising is this? Given, I mean, where we are generally in this pandemic and certainly what's happening in the province of Ontario right now, are you surprised that there are outbreaks on university campuses?

KM: Absolutely not. We know students of that age want to socialise. They come to university to make lifetime friends. And it's just natural that they're going to go from house to house and have small parties. In general the vast majority of students in Kingston have adhered to all the best practises. But because this is a new variant and it's spreading so dramatically, it really has taken hold. The students are doing their best. They're isolating, certainly if they get ill and they're quarantining if they've been high risk contacts. But it is a lot of work to try to limit the spread given the natural social atmosphere off campus.

MG: And you're saying this is largely happening off campus?

KM: Yeah, we had some on campus in the residence, but we have a very good system in partnership with Queen's. We were able to limit the spread. We have an isolation residence and work very closely with them with best protocols in the residence area where we have much better control and partnerships. But off campus, clearly, you know, the students are members of the community. They have the ability to have small, small social circles. And it's through those small social circles really that it spreads so, so rapidly.

MG: How much of this is also about housing and employment? I mean, I cast my mind back into the Wayback Machine when I was in university and we lived in tiny little apartments and there were a lot of people who were crammed into those spaces. Is it also about the housing but the jobs that those students would be working, jobs that require them to be out in the public, perhaps in a restaurant, in a cafe, what have you?

KM: Well, we have had it spread to the community because the students work in the community and are members of our community. But through great partnerships, we've been able to limit the spread outside into the community. The houses, absolutely, we see it spread. If there's four or five, eight students in a house, it spreads very rapidly throughout the household. Given the nature of these smaller homes. And as a result, you know, one person goes to the next house just to say hello to a friend. It doesn't need much time or contact for that virus then to go to another house. So, you know, we haven't done too badly to limit it to 80 students off campus. We've heard there could be up to 8000 students off campus. So really, as a community, they've done well at limiting the spread. We have a tough April ahead of us to try to continue to limit the spread. Given what's going on around us in Ontario, and hopefully everyone will, you know, hunker down, stop travelling, stay to your household, follow the public health rules, that will really get us through this very difficult April.

MG: You've been very clear in saying a number of times that for the most part, students are following the public health recommendations. And I wonder why that's important. I mean, in British Columbia, officials have been criticised for singling out young people, saying don't blow it for the rest of us, you kids. Why is it important for you to emphasise the fact that these young people generally are following the rules?

KM: Well, this can create conflict, especially in university towns where it's us against them. And we really do have to remember that we are a community. They've been a historic partnership with us for over a hundred and eighty years in Kingston. They are foundational to our community. Many people are employed at Queen's University and we have to work together as a community. It's not them against us. Our nasty enemy is the virus and it has changed and it's spreading much more rapidly. And really, we've had a very good year in Kingston, in KFL&A, and we'll get this under control. But we can only do it together as a community, not pointing fingers, but all trying to adhere to the best practises of staying home, limiting travel and minimising your social contacts. We'll get through it, but it'll be tough.

MG: What happens this fall? Students will return to campus and new students will go to school and the fear is that we will be back in a similar situation. In the United States there are universities like Rutgers and Brown and Cornell that are saying that students, if they want to come to campus, need to be vaccinated. Do you think that that is an approach that should be considered here in Canada?

KM: Well, I know the government is working on a policy in Ontario and B.C. has come up with a policy. We do want to have a new normal in September. We want to get back to people coming to our community and enjoying the university and college atmosphere. I am optimistic that given that the increase in availability of vaccines in June, July, that will have much better population protection. I do hope that in September we'll get back to having our economy open. And for us, our economy is universities, colleges, and we must remain optimistic. I do think we'll have enough vaccine to be able to provide it to students in late August and protect them as we move through all the other high risk groups. So, you know, I don't have a crystal ball, but I am very optimistic for September.

MG: Do you think that that should be mandatory, though, those vaccines?

KM: I think in residence, I would suggest everyone be vaccinated if they can take the vaccine. I think that's very important for that congregate setting and certainly would endorse it off campus. And we'd work with student health services if they were willing to be a vaccine partner to provide vaccine to that population.

MG: Just because I have you on the line, let me ask in the last couple of minutes, where you think we're at right now in this pandemic? 4400 or so cases in Ontario yesterday. We're seeing rising case counts in British Columbia, in Alberta, in Saskatchewan, in Quebec. Aside from Atlantic Canada, it feels like history repeating itself. Where are we?

KM: It's a new pandemic. This April will really be very difficult for Ontario. I've been very saddened to see our numbers rise. We have twenty people in our ICU in Kingston from elsewhere because their ICU's are overwhelmed. This will need a Team Ontario approach. All of our intensive care partners are going to have to try to keep as many people alive as possible. This is a very, very dangerous month. With a new emerging enemy and a new pandemic, we all have to adhere to the best practises across Ontario. These public health measures are very, very important. They've worked for us in the past, but this is even a more virulent enemy that we're fighting. So if I can appeal to anyone listening, we all have to decrease our social contacts. We all have to stay home as much as possible, limit our travel, not moving from high risk region to low risk region, staying in your neighbourhood and your home, that's the only way we'll get through it. We don't have enough vaccine.

MG: Do you see just in the last thirty seconds, optimism coming out of this? I mean, April is going to be tough. Will May and June be better?

KM: May and June will be better. I've seen, you know, in Thunder Bay, they've been in lockdown. Their schools went to virtual. Their numbers have come back down. Public health measures do work. If we as a community across Canada can limit our travel, our contacts and stay within our households as best we can, we can give the vaccination strategy hope and get back in May and June to better protecting our vulnerable members of our community but, it'll be very, very difficult.

MG: We will take that optimism such as it is. In the meantime, it's always good to talk to you, Doctor. Thank you.

KM: Thank you so much, Matt.

MG: Dr. Kieran Moore, the medical officer of health for Kingston, Frontenac and Lenox and Addiction in eastern Ontario.

MG: That is The Current for this Monday. Coming up next on CBC Radio One, it's Q. Tom Power, speaking with John Classon, recipient of the Order of Canada, star in the world of Children's Illustrated Books. Let's talk about drawing with Tom Power. It's coming up in just a few moments on CBC Radio One.

MG: I Matt Galloway. Thanks for listening to The Current. Take care. And we will talk to you again tomorrow.

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