Hanging out with my carrots!

 Yep. I am hanging out with my carrots. The ones you helped save. Joy in the dirt. It's still out there. Joy I mean. Harder to find, clouded by anxiety and uncertainty but it's still there. Your brain needs you to look for it. Just so happens, I found mine in the dirt today.

I feel like I need to summarize. Lot's going on. I need some perspective. Carrots give me perspective.

Today:

The 7 day rolling average for new cases of COVID 19 is 80.29. At Ontario's peak on April 4th our 7 day rolling average was 569.

Since July 30th, there have been only 5 days when Ontario has seen over 100 new daily cases. On August 11th, there were only 33 new cases. I felt absolute joy when I read that!

That is fantastic progress. So, lets start the summary by saying that in the last five months, since the pandemic was announced, we have survived lock done, shuttered every place of work except essential businesses and then slowly opened them up again. We closed schools, started working from home, teaching our kids online and a lot of people spent the early spring baking! We built hundreds of COVID 19 testing centres and tested over 2.5 million people. We protected our hospitals from becoming overwhelmed. We watched while elderly folks died needlessly in nursing homes. We lived in social bubbles of five and then 10. We started wearing masks and physically distancing. Remember in March when a trip to the grocery store was terrifying? We watched our neighbours to the south suffer under non-existent leadership. We watched Canadian leaders step up to the plate to create a massive, collaborative plan that allowed us to avoid the ugly numbers given in those first projections on April 3rd.

In Wellington-Dufferin-Guelph, a Section 22 class order was put into place on June 12th, the first region in the country thanks to our forward thinking, smart and courageous public health office, Dr. Nicola Mercer. Almost every region followed suit by the middle of July. Our cases started to come down when we put masks on.

One of my brilliant followers but it this way:

"We're keeping the numbers under control here because the the municipalities have been taking the initiative with signage and mask bylaws to keep people in the right mindset, not get lax about it and let their guard down. The day the province started to enter Stage 2 of reopening, Guelph took the lead and enacted the first mandatory masking bylaw. Pretty well every other region followed suit, and I think it has made a huge difference, both because masks help curb the spread and because they serve as a daily reminder that these are not normal times." Matt Robertshaw

Thanks Matt. I agree. The masks remind us that life as we knew it is long gone. They also remind us that we are in this together and we have the capacity and tenacity to work as a united people with a great purpose; to turn the tide of COVID 19 and save lives.

I feel like we are now sitting on a cliff. Parents, teachers and students, their community standing with them, are perched on a cliff, one that none of us want to or should be forced to jump from. So much accomplished by such great leadership, will we bury all that or move forward with an effective plan for a return to school that follows the science as we know it today?

The anticipated fall surge of COVID 19 does not need to happen. But it might if we do not move forward cautiously and wisely. Researchers out of Cambridge, England ( yeah that really old university filled with impossibly intelligent people) have shown that a resurgence is not a given. Physical distancing and mask wearing combined are effective enough to lower the R value to less than 1. That R value again. The reproductive number which is the number of people a person infected with COVID 19 will transmit the virus to. Stand close together in a confined physical space indoors and don't wear a mask. That'll do the trick. One infected person in a scenario like that has ample opportunity to transmit to everyone in the room. Our one saving grace is that we have done so extremely well to reduce the number of infections in our community, that the risk of transmitting the virus in schools is very low but we are learning that for this virus, that reprieve will not last long. Oh, and one other thing, I think we can avoid a resurgence and reduce the number of colds and flus this fall. The mask will keep those viruses down too.

Man. In my idealistic mind, I see that vision. I can see us sailing smoothly to a vaccine.

Let's be smart about this. Even if the provincial government does not come up with a better plan, we can come up with a better plan. As individual communities, neighbours, families and friends, we can create a better plan. I am an optimist and an idealist but I truly believe that. Let's ask the right questions: How can we keep our kids safely distanced at schools? How can we encourage the majority of kids under 10 to wear a mask too? I don't have the answers but I have some ideas and I know that people who understand the education system much better than I do, have great ideas too.

Anne-Marie.

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We need the capacity to allow for physical distancing in elementary schools!

 

Please consider signing this petition:

http://chng.it/rckL2Kwj

The province of Ontario has done an excellent job of controlling the COVID 19 pandemic.  Their return to school plan puts the progress made by the people of this province at risk by not creating a system that allows for physical distancing.   All evidence points to the need for lower class sizes, well ventilated learning spaces, an outdoor learning curriculum and more teachers to accommodate COVID 19 public health restrictions that have been proven effective.   Without the ability to adhere to Ontario's public health guidelines, we believe the students of this province, their teachers, school staff, their parents and relatives will be at risk of contracting COVID 19, that transmission rates of the virus will surge  and that lives will be lost.  The health and well being of our students is at risk.  We ask that the provincial government create a new return to school plan that allows for proper physical distancing and adherence to well learned COVID 19 guidelines for the prevention of transmission of COVID 19 in our schools and communities.

http://chng.it/rckL2Kwj

Thirty Three Cases in Ontario today!!!

 Man, are you seeing this? You gotta be kidding me.

33 Cases in Ontario today? I am humbled and so grateful. It's the masks and the physical distancing and being outside when we socialize. We have come so close to whipping this thing. So close......

"Canada performed well during the COVID crisis because of our social contract, the bonds of community, the trust for each other and our institutions, our health care system in particular, with hospitals that cater to the medical needs of the collective, not the individual, and certainly not the private investor who views every hospital bed as if a rental property. The measure of wealth in a civilized nation is not the currency accumulated by the lucky few, but rather the strength and resonance of social relations and the bonds of reciprocity that connect all people in common purpose." The Unraveling of America by Anthropologist Wade Davis

But I dread the fall and winter. I dread the return to school without the proper public health guidelines in place.

WE MUST REDUCE CLASS SIZES. I can imagine what a tough decision this must be for our provincial government. I CAN'T imagine how they must have wrestled with all the facts, the pros and the cons to come up with a back to school plan. What they are trying to do, the balancing act, tight rope walking, stressing, negotiating? I am glad it is not me. I am grateful for the work they have done up until now to keep us on the right track. Their leadership and our collective response is why there were only 33 new cases today, why we are so close to smashing COVID 19.

But, WE MUST REDUCE CLASS SIZES in some way in order to prevent this good work from unravelling by October.

In Canada, there have been 9500 cases of COVID 19 which is 8.2 % of the total infections. Twenty-six of them ended up in the ICU and one died. That is not nothing.

In Israel, hundreds of schools were shut down when the new cases of COVID 19 increased after a return to school. In the US, 97,000 kids have been infected with COVID 19 during the last 2 weeks of July in part because of schools re-opening and a president who pushed for a too early return. That man has caused a significant and shameful loss of life. Thousands have been sent into quarantine. Canada will not suffer the same fate even if we send our kids back to school under the present guidelines. Our incidence of infection is so low that a return is so much safer. But can we risk a return if not all of the public health guidelines that we all have adhered to so well, are not in place in our schools?

Denmark and Finland sent their kids back to school and both countries have not seen an increase in spread of COVID -19. Why? Because they split their class sizes in two.

"Once the decision on which schools to reopen first is made, a clear plan must first and foremost prioritize the health and safety of students, educators, and families. In both countries, a number of public health measures were put in place. Among these, schools prohibited the usual morning meetings held in classes at the beginning of the school day, forbade food sharing, and introduced new preventative practices like staggered student arrivals and much more frequent cleaning and hand-washing practices throughout the day. In Denmark, where average class sizes were around 20 students prior to COVID-19, classes were divided into two to three smaller groups and, whenever possible, held outside."

We must do this too. I am a physician, not an educator. But, at this point in time, all professions that care for kids and all the parents who love their kids need to stand together and insist on a safe return to school.

BC is delaying their return to school to give teachers time to learn the CDC guidelines around COVID 19 prevention and to make sure they get this right. We must advocate to delay a premature return in this province too.

More on my thoughts on COVID 19 and how to survive the winter months in an upcoming post.

I would like to clarify a couple of things. There is proof from countries that are now in winter ( in the southern hemisphere) that mask wearing has not only curtailed the spread of COVID 19 but also the spread of colds and flus with some countries seeing a 75 % reduction in flu infection rates. This means that if kids wear masks at school, regardless of whether physical distancing is possible, we will not see the usual onslaught of colds and flus this fall. That is good news. Your child is less likely to develops signs and symptoms that are cold/flu related, which reduces the frequency at which you will have to decide to whether or not to keep a child home from school. If your symptomatic child is sent home with symptoms, a COVID 19 test is recommended but will not be enforced. A two week quarantine from school without a negative COVID 19 test will be enforced. I would opt for the testing but no one can be forced into a test.

Such tough times folks. My heart aches for our teachers and parents who are stuck in this mess.

Anne-Marie

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I have only praised our leaders.....up until this point. But I don't agree now. I think this is me out on limb number 3

We are ready for a return to school for several epidemiological, economical and mental health related reasons. To the awesome people of Ontario, we had 70 new cases yesterday. It was our fifth day of cases staying under 100. That is so remarkable. You put on a mask in public and you kept your distance from folks not in your bubble. This was and is a remarkable public health collaboration that worked to control COVID 19 in the province. This low level of transmission is right where we need to be and to stay to allow for a safe return to school. Thank you to all of you who have continued to follow the guidelines even when the amount of COVID 19 in the community remains so low. This is how we outsmart the virus and move as closely back to normal as we possibly can while waiting for a vaccine.

I was at a BBQ last night with my husband's colleagues that I love dearly. It was so hard not to be close to them which I find surprising. It is not the same as when I could cosy up my adirondack chair beside a dear friend and listen closely to the details of their life and their take on the state of the world. But we all adhered to the physical distancing rules knowing that everyone must in order to move this virus out of our lives as quickly as possible. Stay focused on the guidelines. We have the resilience and strength to do this. Stay strong..... and well done......70 new cases in Ontario yesterday. So proud of my fellow citizens.

This document from Sick Kids Toronto is a great document to review: https://bit.ly/2XMdYKK

A key quote from that document: "It is anticipated that

there will likely be an increase in cases of COVID-19 upon

the resumption of school and as such, the appropriate

measures should be proactively put in place to mitigate the

effects of such an increase."

Medical experts, public health experts and epidemiologists now know what needs to be in place before a return to school can safely happen.

1/ The first thing we need, we already have which is low community transmission rates ( <100 new cases a day). The lower the number of infections in the general community, the less likely the virus gets into the schools.

2/ We need a hospital like model of multiple layers of infection prevention and control.

KEEP COVID 19 OUT OF THE SCHOOLS

The first layer is just keep it out of the school setting to the best of your ability which involves daily screening and making sure that kids do not come to school sick.

KEEP COVID 19 FROM SPREADING IN SCHOOLS

The next layer involves steps to lessen the chances of students and staff transmitting infections, which means PHYSICAL DISTANCING, hand washing and masks and reducing the amount of interaction among the school population. Use the concept of COHORTING. separating students into small groups, perhaps 15 at the most, who spend their whole day in the same classroom with one teacher, take their lunch and breaks together, and do not mingle with anyone else in the school.

3/ If there are new cases in the classroom, health officials should be able to identify where new cases are coming from with a strong system of screening , rapid testing and contact tracing. Contact tracing is much easier if kids are bubbled into COHORTS. You quarantine the cohort group of kids and test their out of school contacts instead of shutting down an entire school and forcing every person's contacts into lock down. That could be thousands of people connected to larger schools.

Here's what I think. We have done the work of driving new cases of COViD 19 down to <100 cases/day.

Check.

Parents and teachers are being trained to carefully assess their kids for symptoms, keeping symptomatic kids home.

Check.

We can wear masks and wash hands.

Check.

Public health is ready to quarantine and contact trace. Public Health officials are working closely with the Ministry of Education to put this strategy in place.

Check.

Physical distancing, cohorts of 15 or less.....not even close.

I don't think we should send kids back to school unless physical distancing and cohorting is possible. The risk is too high. The risk to our kids is low but the risk of transmitting to teachers and family members is way too high and the risk of a surge that puts us back into lockdown and towards an economic mess is unacceptable.

There is still time. I fully support any effort that gives the government the opportunity to put these vital pieces in place before a return happens, even if it means we delay a return by a few weeks.

COVID 19 is too big of a threat to send kids back to classrooms of 29 kids where physical distancing is not possible.

Anne-Marie

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Just keeping a tiny part of this light. Thank you to the person who made me surgical caps and cloth masks with CARROT material. I love it. My carrots are thriving and I have found a way to can them!

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To App or not to App....well that's one of the questions.

Way too much to cover and that tomato patch with the hornworm infestation is taking me at least an hour every night. But, I am winning the battle. Those could be famous last words.

I wanted to cover the new COVID 19 tracing app tonight but I have not had time to research it enough. I am downloading it as I write this. Should you download it? I think so but let me do a little more research. One of my patients is an IT nerd who works with product security at Blackberry. Blackberry is all about security. World experts. She gave me an easy to understand explanation as to why the app is secure and how our personal identification information cannot be shared by using the app. I trust her enough to download the app myself but, a bit of a review is necessary before I can recommend that to 15,000 followers. It is a great idea. Not much value when the rate of new infections are low but brilliant if the number of new cases rise or a second surge hits. It will be invaluable if and when a surge happens.

An early update on my research about kids as super-spreaders of the virus:

Of the thirty some odd research papers reviewed by the top pediatric minds in our province from all the children's hospitals in Ontario, with Sick Kids, Toronto leading the way, only two suggested a differing opinion. One of them is this article from the Journal of American Medical Association.

JAMA Pediatr. Published online July 30, 2020. doi:10.1001/jamapediatrics.2020.3651

The article does not state that kids under 10 are super spreaders, it just shows that, in a very small number of children studied, there is proof that they are infected with the virus with few or no symptoms.

Infected children have at least as much of the coronavirus in their noses and throats as infected adults, according to the research. But this does not prove that the virus is being spread to others. The study size was too small to make any conclusions at all except that the noses of kids in the study had evidence that parts of the virus was there but not the live virus itself. That's fascinating. There is evidence that the virus was there but not evidence that it is replicating. In order to spread a virus to someone else, you need to spread live virus that is replicating. Spreading parts of a virus that is no longer alive, does not spread infection. We will figure this out in time but several theories are circulating. Do kids neutralize the virus quickly, killing it more effectively than adults, therefore making them much less likely to spread live virus? Does COVID 19 just not like kids as a host? Sounds like a silly question but kids are different than adults. There are a host of diseases that happen primarily in kids. Is this a virus that can replicate and spread in the bodies of older children and adults, but not younger kids due to some physiological difference between kids and adults?

Several of my followers sent me a link to this article:

https://bit.ly/3kjXGlJ

The author of this article makes some pretty false assumptions about the JAMA article and does not give any references to a second study done in Italy which he refers to extensively. No references, no conclusions. I am not interested in a lay persons interpretation of the evidence. Let me make my own interpretations of the evidence. Give the references or don't comment at all.

This is from the most recent review from Sick Kids:

"Current evidence suggests that young children may be less susceptible to COVID-19 and children younger than 10 years of age are probably less likely to transmit the disease than older children and adults. There is also strong evidence that the majority of children who get COVID-19 may not display any symptoms or have only mild symptoms."

Read their document.

https://www.sickkids.ca/…/Past-News/2020/covid19-school-gui…

Read who the authors are:

" a collaborative effort between SickKids, CHEO, Holland Bloorview Kids Rehabilitation Hospital, Kingston Health Sciences Centre, Children’s Hospital at London Health Sciences Centre, McMaster Children’s Hospital and Unity Health. Paediatric and adult infectious diseases specialists, epidemiologists, paediatricians, psychiatrists, public health officials, teachers and parents provided input"

Say not more. Oh to be a fly on the wall when these folks put their brains into one room....excuse me, it was likely one Zoom. Brilliant. I trust them.

It is safe to return to school. Something special about kids prevents them from developing serious infection in most cases and something special about them makes them much less likely to spread the virus. If they wear masks, the risk of them being a spreader is even less. If teachers wear masks, it is highly unlikely that they will get COVID 19 from their students. MORE IMPORTANTLY, there is so little COVID 19 in Ontario...No new cases in Guelph today, no one in hospital and under 100 cases in the entire province for the last two days. Why? Masks. You can't spread a virus is there is no virus to spread.

COVID 10 tracking app information to follow but, mine is already downloaded!

Anne-Marie

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Close to a new school year

I spent the day with my eggplants and my tomatoes, in between thunderstorms of course. I love the look of an eggplant. There is an elegance and richness to it's colour and shape. Thanks to many of these Facebook followers, I spent the evening identifying and eliminating tomato hornworms. Yep, feet in the mud, face in the plant, eyes pealed looking for these nasty creatures. You were right! They eat their way through a branch of a tomato plant in a day.

My husband joined me at one point. I think by working together we will stay ahead of game. At one point I complained that I would have to be out here every night to keep up. He said, " It's just like COVID Anne-Marie. Keep on working and you'll stay ahead of the curve". I'd swear right now but it's not polite. He's a smart man and it's not a bad analogy. Lot's of work staying ahead of these hornworms but the plants are healthy and there are hundreds of tomatoes. More than I will ever need.

It's hard, consistent, relentless work and I won't be done until the season is over. We need to see COVID 19 in the same way. So far so good. I am amazed at how well we are doing as a country. Every where I went this weekend, EVERYONE, was wearing a mask. EVERYONE. I caught a glimpse of the front page of the Toronto Star on Saturday. The journalist who wrote this pretty well sums up how I feel about our nation:

August 1/20
Toronto Star- “ The view from here”

“ Here’s how we got here, not to the end but to this place of cautious hope: We took responsibility for one another. We sacrificed for the common good. We trusted experts, imperfect though they are. We let governments, imperfect though they are, do what only governments can do. Not all of us, of course, not all the time, but enough of us enough of the time that we saved lives. We found refuge in art. We laughed together at what was ridiculous. We grieved together over what was tragic. It wasn’t obvious that we could do this, that in this world such a surge of solidarity was possible. Nor is it obvious, though so much depends upon it, that we can seize the lessons of these last months and hold on, hold, on, hold on. "

HOLD ON, HOLD ON, HOLD ON. Can we do that? You bet we can. Wear a mask everywhere in public. Stay in a bubble of TEN and in that 10 there should be no drifting into other bubbles whatsoever. Stay six feet apart. Wash hands. That's how we hold on. That's how we save lives and that is how we make it very safe for our teachers and our kids to head back to school.

New data is emerging everyday that is showing that kids under the age of ten do not easily transmit the virus. Evidence from around the world is showing how rare in-school transmissions are. In outbreaks in schools and daycares, the virus has been tracked back to an adult that brought the virus into the school not from kids transmitting to other kids and their teachers.

"What we see from the reports that have been published to date up to July 20th from around the world is that children are not a major source of COVID-19 transmission," said Sarah Neil-Sztramko, an assistant professor at McMaster University.

How do we avoid adults bringing the virus in? Keep up with the public health guidelines outside of the school so that community transmission is rare. Adults won't have the virus to bring into schools.

The alternative? It's happening in so many parts of the world and it's grim; the unabated spread of COVID 19. There have been 1 million newly reported cases globally in the last 4 days. The reason? Public health guidelines are not being adhered to or enforced enough. My fear is for the poorest countries who have no public health system at all. May I just state how grateful I am to be living in a country like Canada where there is an intact, publicly funded healthcare system and a public health system that has shone across the country during this pandemic? I am just grateful. To whom much is given, much is expected.

Hunker down folks. The storm has not passed yet. Far from it. The is still a very long 'mask-wearing, physical distancing, massive testing, contact tracing' road ahead of us.

I have not said it lately, but.....We've got this.

Thirty-three studies from around the world were analyzed in detail by the medical experts who helped put the return to school guidelines in place. I am going to read everyone of them. Something else to do at night besides disseminating the hornworm infestation in my garden.

I will do my best to keep you updated as I do this review.

Anne-Marie

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