I am thrilled to report that I have heard from the CanAssist African Relief Trust Trustees that the recent Giving Tuesday campaign was successful in raising (over) the $30,000 that will be matched by the Frank Family Foundation in Toronto.
I want to thank friends and family who donated and I am particularly happy that the proposed Adam Nkuyan School Kitchen Project has been fully funded and will start construction early in the new year. Asante sana.
I hope donors are excited to know that their donations have barely cleared the bank and are already being put to use in East Africa. CanAssist gifts not only fund sustainable infrastructure but also provide employment and economic benefits to their communities as these various projects are realized. About 95% of what is collected by CanAssist ends up being spent in Africa.
When I was in Kenya in September I wandered past the Mbita Community Health Centre where this all started for me in 2005 when I visited the hospital (then a smaller rural health centre) with a group of McGill students. We were astounded by the condition of their delivery room and the fact that they had no sustainable water supply. I came home to Canada and gathered about $1200 from friends to supply a hook up to a municipal water source and a water tank to store it as the supply tended to be intermittent.
Little did I know where this would lead. In September 2022, Dan grabbed a photo of me in front of that tank – a “project” that was the seed for the CanAssist African Relief Trust that I started with friends the next year. From that beginning, CanAssist has steadily grown and as of 2022 has supplied about $1,800,000 in funding of infrastructure projects in East Africa.
My thanks goes to all who have supported CanAssist over the years and to those who have donated during this most recent campaign to help make the Nkuyan School Kitchen project a go. Thanks also to the Frank Family Foundation who have matched recent donations, adding $30,000 to the CanAssist coffers to fund new projects.
I also want to express my thanks to Dave Kay who has made a significant donation in memory of his late father, to fund purchase of computers for the Hope for Youth School near Mukono, Uganda. (Dave and I visited H4Y together in 2013 so he has a special connection to them).
Nancy Grew, the current Director of CanAssist, is sending the MOU for the computer purchase to H4Y today and when the students return from their December/January break they will have a stocked computer lab. My first visit to this school was to a small dirt-floored set of classrooms with no windows or doors and rudimentary desks. It is so rewarding to see this progress and gratifying to know that CanAssist donors have played a significant part in helping with this growth.
( If you are viewing this post through and email you may need to open it in a browser to see the video links johnageddes.com)
Last week while visiting a school in Nyanza Province with Dan, I experienced a particularly touching moment.
Two schools, Nyangulu Secondary School the adjacent primary school, also called Nyangulu are in a valley (Nyangulu apparently means “a place of valleys”) that’s down a very bumpy road that gets partly washed out by the rain. It rivals a bumper-car ride at the fair to get there. The schools are virtually on the equator.
The secondary school looked orderly and well managed. We were there to bring greetings on behalf of the CanAssist Trustees and donors and to officially turn over a new 10,000 litre water tank that was already full to the brim because of the late afternoon rains we have received in the past week. While I had been visiting the district for the previous week, the mornings were often bright and sunny and hot and then, at about four, thunder rolled in the distance and brought a brief but torrential downpour. Then the skies cleared in about an hour.
The Nyangulu secondary school has about 700 students who all met outside during their morning break to receive our greetings. One of the girls thanked CanAssist for their contributions to the school. She requested that CanAssist help next with some kitchen improvements. After the assembly, Dan and I strolled over to see where three cooks work to provide two meals a day for the 700 pupils. It was a tiny smokey shack with a couple of huge pots and a lean-to beside it with another open fire. It was unimaginable that they could provide food daily from this environment for all of these kids.
Then we walked next door to the primary school where another water tank had just been installed. Once again we were greeted by staff and students and I went from classroom to classroom to say hello. In once class they sang for me.
As we were about to leave, we were directed to a group of very young students under a tree by the primary classes who wanted to greet me with a couple of poems.
One of the poems was about being a Good Samaritan and thanking CanAssist for the contributions made to the school.
“A Good Samaritan becomes a good neighbor. A neighbour is anyone in need. We were in need of hand-washing containers, latrines, storybooks, balls for play and fresh water to drink. CanAssist was there for us. You provided all these. You are our Good Samaritan, a wonderful partner. God bless you and thank you.”
I found this very touching. I told them that I remembered a stained glass window depiction of the Good Samaritan in New St James Church in London, Ontario beside the pew where my family usually sat when I was a their age. I probably spent a lot of time looking up at that colorful window and daydreaming during the sermon.
I realized as I heard these kids and thought about this childhood memory of the Good Samaritan window that the message of that parable must have had an influence on me in choosing both my vocation as a physician and the development work that I have done over the years. I reflected on what a privilege it has been for me to be able to work with communities in East Africa, to meet so many friends there and to have unique interactions with them. My life has been incredibly enriched by these experiences. Hearing the children recite this little poem triggered a surprisingly emotional response in me as and will be a moment that I will long remember.
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I have visited my friends, Liz and Stephen Moiko and thief family several times over the past 18 years. They live on a farm-like property near Kiserian, Kenya, about 45 minutes southwest of Nairobi.
On every visit (and when I have traveled with friends to Kenya) I always take time to hike up the hill to visit a tree that hangs out over the edge of the Rift Valley.
The valley below is often lush and green but this time it is dry and brown. There is always peace and quiet there with a refreshing breeze and maybe the tinkle of goat bells in the distance. It is one of my favourite places on earth.
Once again I hiked up to my tree and soaked up the ambiance, reflecting and remembering. And taking the same photo I have taken for years of the tree arched out over the valley like in a group of seven painting.
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In 2011 I met Meshack Andiwo who lived in a small Kenyan village near the Luanda K’Otieno ferry that takes passengers and cars across Homa Bay to Mbita Point. He told me that small children in his community were struggling when they went to Primary School because they didn’t have the basics of English and arithmetic. They were too young to walk the distance to the nearest Primary School. Once the were old enough to walk the distance to school they were behind many of their peers and they became discouraged and lagged behind. He wanted them to have some early childhood education so they would not struggle or be discouraged and quit when they were old enough to walk to school.
I told my late Dad who was about 92 at the time,about this challenge and he offered some financial support through the CanAssist African Relied Trust to start to build a school for the community and it began with one small tin classroom and a latrine. And so it began.
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I visited the school today. There are several buildings now, a kitchen, clean new latrine, a fenced playground and a small office. There are currently about 50 kids at the school from preschool age to grade 4. They are learning the basics and being fed a breakfast of porridge and a lunch of beans or rice and vegetables, sometimes their only nutrition in a community that struggles with food security.
When we formed the CanAssist African Relief Trust in 2008, we determined that it’s mandate would be to provide sustainable tangible infrastructure and not programming or management costs (like teachers’ salaries or feeding programmes. This is for two reasons. One is that it would commit for a longer term and limit the number of communities that CanAssist donors could help. It also would foster reliance on outside help and May might foster dependency rather than encourage financial planning and self sufficiency. The latrines, classrooms, water catchment, text books, solar panels, fencing etc are tangible gifts to give the building blocks for running a school or clinic or community sanitation programme. Responsibility for managing and funding the programming is up to the recipient.
.Food supplies for the fifty kids at SP Geddes school cost about $15-$20 per day. Parents pay a small fee to cover the cost of the food but by the end of the week, they sometimes run out and Meshack and Caroline have to dip into their own means to support this. I plan to send a bit of money every so often to help them with this expense. If you want to help a bit with this, let me know as even a couple of dollars a week would be of great value to sustain these beautiful kids.
Caroline and Meshack’s grandson was named “SP” in recognition of my Dad’s generosity and the school was named the SP Geddes School. I met SP as an infant several years ago and what a treat it was to see him again today. He is now 9 years old.
Meshack and Caroline take good care of the children at SPGeddes School
This week, I am feeling like a butterfly emerging from a cocoon. I probably look more like one of those cicadas that has spent 17 years underground.
I am two weeks past my second COVID shot so I am about as protected as I can get at the moment. I am also encouraged by Kingston COVID numbers dropping to barely countable and a steady drop happening across Ontario and Canada. We ended last week in Kingston with a case positivity rate in the past 7 days near zero and only 2 unresolved cases in the whole KFLA Health unit area of over 225,000 people. Across Canada over 75% of our adult population are reported as having had one vaccine dose and 20% have completed their regimen with two. This is all great news and something to celebrate.
Hopefully we will continue our upward climb of getting people vaccinated because in addition to following sensible Public Health measures, that is the key to breaking the hold COVID-19 has had on us for months. Canadians are stepping up in droves to be immunized, thereby responsibly protecting themselves and their friends and colleagues. After a very slow start, Canada now leads the world in proportion of the population with at least one dose of a COVID vaccine. We need the enthusiasm for first dose vaccinations to persist into acquiring second shots since complete two-dose immunization is more than twice as effective in protecting against the Delta variant which is catching hold now. Single dose vaccination only provides about 33% coverage for this variant. Regardless of which vaccine you have started with, it is imperative that you complete your full vaccination programme. People who had the A-Z vaccine for a first dose may now be complete their course with one of the m-RNA (Pfizer or Moderna) vaccines. In all likelihood we will all need a booster dose in a few months and this will likely be with an m-RNA vaccine that can be adjusted every once in a while to cover new variant mutations.
Unfortunately, there will still be some folks who decline to participate in the vaccination programme. They will get a free ride because the relative herd immunity that occurs when the rest of us get vaccinated will protect them as well. But their resistance will also put a limit on how far we can get to squash this virus. Ultimately they will likely pay a price for their reticence in that they may not not be able to travel on some public transport, go to some concerts or events or attend at some educational facilities as freely as vaccinated people.
I predict that the summer will be good – with more outdoor activities, a gradual reopening toward indoor options, continued care with regard to masking and hand washing and social distancing where necessary. My guess is that, even if we get a few local surges in virus activity across Canada, the worst is behind us. New variants may arise (it is normal for mutations to occur) but with time, vaccines can be altered to accommodate these changes. Until the whole world gets adequate vaccination coverage there is still a global threat that will continue to disrupt lives and economies worldwide. I have talked with my friends in Kenya where they are having more older or vulnerable people dying without much explanation. They do not have access to COVID testing in rural areas so they have no confirmation that it is COVID. And vaccines are a distant dream for them at the moment.
We are not out of the woods yet but the outlook is much more promising and encouraging that it has been for quite a while. For the next few weeks we must be patient and stay the course to gradual reopening. We are all eager to open up but the mistake Ontario made earlier this year that augmented the third wave numbers was to be too quick to try to resume normalcy and too slow to shut down. We all need to get fully immunized as soon as it is available to us and encourage those around us to do the same. We may need to stay masked for a while when we are in close contact with others indoors or even outdoors if we sense that we are not able to adequately distance particularly with folks who have not yet been able to get their full immunization in order to protect them from infection. Please respect the boundaries that others set regarding interaction. We all have different comfort with potential COVID exposure and some friends may want to remain more cautious than others for a bit longer.
Fully vaccinated people can safely enjoy connecting with others who also have completed their immunization schedule. Let’s enjoy the great Canadian outdoors and safely reconnect with friends and family. If we follow the Public Health guidelines we will soon get back to what might be close to “normal”. I am starting to remember what that felt like. And if feels good!
The next thing on my wish list is to get a much-needed haircut!
I started writing articles about COVID-19 over a year ago when we were not swamped with COVID information. But we are inundated now so I will put my COVID pen down. This will be the last of my COVID articles but I will continue to post about topics that interest me (and hopefully interest you as well.)
Today I am thinking about that meme of Jack Nicholson in The Shining with “I’m Back” written on it.
After a few weeks of no new cases of COVID-19 in Kingston, with the exception of two cases that had a link to the GTA, the KFLA Health unit has reported 10 new cases in the past week. Apparently none of them have known connections outside our district. One of these is associated with a unit at the hospital, another works at a local restaurant and several associated with a nail salon**. Public Health officials will be working hard to track down, test, and isolate any known contacts. By the time you read this, there may be more.
In the KFLA district, we’ve been both lucky and responsible so far. This recent little outbreak in Kingston should act as a wake-up call to all of us that we are not done with COVID-19 despite our relatively light exposure over the past few weeks. Maybe the fact that we have had so little in our community has seduced us to be more negligent about following the advised recommendations.
In recent days, I have seen groups of people clustering, not within 2 metres of each other and not wearing masks outside an ice-cream shop, on the street, and in the barber shop. I have had friends say “It’s OK to get together as long as it is less than 10 people”, seemingly unaware that this comes with the additional caveat that small groups can gather but only if they are following the distancing guidelines. I see lots of people in stores, even clerks, not wearing a mask. It is encouraging to see the numbers in Ontario and Canada abating. However, we only need to look at what is happening in parts of the US where the guidelines are being resisted to see how quickly this virus can gain control.
There has also been a shift in the demographic of COVID-19 cases to include more younger people. Perhaps this is because they are more likely to be mingling with each other and they might feel a bit less vulnerable than their older fellows. I worry about when students will inevitably return to Kingston for university or college and we have all heard of tourists being spotted in Kingston from other districts. Protecting ourselves by being cloistered is simply not going to be an option.
I fear that complacency is asking for trouble. While we are able to be outdoors, our risks are certainly reduced but because of our luck and success at avoiding a major outbreak so far in Kingston we have become lax with following the guidelines.
I admit to having relaxed in some respects, too. But I am going to try to tighten up.
I have a small group of friends that I will continue to walk with (less than 5) and we will do our best to keep our distance as much as possible and only meet outdoors. I have only been in 3 houses of other people in the past 14 weeks and have only had two others come into mine on limited occasions. I will continue to limit indoor visits anywhere. I will wear a mask whenever I am inside a store of any kind and often on the street when I see that distancing is going to be tricky because of narrow sidewalks or busier pedestrian traffic. I am aware that this will offer me limited protection but any advantage is better than none. It will also act to protect others from me if I am infected and don’t know it. If more of us wear masks under these circumstances it will become the norm, rather than the exception. This will help our community to limit spread. I will wear a mask in a car if anyone else is in the vehicle and insist that they do as well. I will continue to wash my hands whenever I return from being out anywhere. If I become sick at all, I will avoid others and will consider getting a COVID-19 test if symptoms are suggestive of that in any way. Testing is easily available now to anyone and widespread testing with appropriate contact tracing will help to squash any outbreak we have.
It is discouraging to have to admit that this COVID-19 thing is going to be a challenge for several months to come. Like you, I was hoping it would just go away. But it is here for a while. We need to continue to be diligent, without being antisocial or paranoid, in order to keep it under control, to protect our community and our Health Care System and to limit the adverse effects of this virus to as much as we can.
Stay calm but stay the course. Protect yourself and your community by continuing to act responsibly.
John A Geddes MSc MD CCFP June 25, 2020.
** In the six hours since I posted this blog i have heard that most of the new cases in Kingston are connected to the nail salon. Amazing how one breach in security can have unfortunate ripple effects through the whole community.
Kingstonians can continue to breathe a collective sigh of relief as we enter this holiday weekend, knowing that there has been no new COVID-19 case identified in our Health Unit cohort for over two weeks. All 61 of the previously identified cases have been declared “resolved”. This is reason for appropriate celebration and considerable relief that we have passed a first wave of COVID-19 without experiencing the feared, overwhelming situations like those we have seen in some other centres around the world.
In addition the KFLA Health Unit figures indicate that only 18% of the cases in our district were “Community Acquired”, the rest being found in returning travellers or direct contacts of known cases. Our Health Unit serves about 215,000 people. That means that of the 61 diagnosed cases – I say “diagnosed” because we don’t know if there are others out there that we have missed because they were not tested – 11 of them arose from sources unknown or random community transmission. That is one such case in 20,000 people. Those are not bad odds.
Does this mean we can let down our guard? NO, indeed!
It means that the measures that have been put in place in our community have minimized the spread of the virus and it has had nowhere to go so it has temporarily petered out. But it is still there. And it is still there with a vengeance in Montreal, only 250 kilometres away. The reality is that our community remains highly vulnerable because we are still quite COVID-naive. So far, we Kingstonians are living in a bit of a bubble.
I wonder what will happen when we open up a bit or when people go to their cottage near Ottawa or when they visit their family in Toronto and return to Kingston. What will happen if we start to get people from Montreal coming for a summer weekend vacation? Or when some college or university students return to Kingston in September? If we become overly confident and let our guard down too much will we start to see more community spread of this virus that is still out there, waiting to find an entry point?
The World Health Organization this week has suggested that we are in for a long haul with COVID-19. Like HIV, it may be a pathogen that we will have to accept is here to stay. We will eventually develop some “herd immunity” that lowers its prevalence but it may always be there, lurking and threatening to surge if given the chance. There are also studies this week from both Spain and France suggesting that in these countries, where there has been a significant burden from disease this spring, only about 5% of the general population has antibodies. A similar study done in Boston and reported today discovered about 10% of the population had antibodies. This suggests that the prevalence of undiagnosed infection or sub-clinical infection is less than we had hoped for and that significant proportions of the population are still vulnerable to infection.
This week, the Canadian government approved an antibody test that will be very helpful in identifying what is happening in our various communities to track this infection and aid in management. It is not ready for widespread clinical use yet but this is a start.
Just like what has happened with malaria, and TB and influenza and HIV, I am confident that we will eventually come to learn much more about this novel coronavirus and develop strategies and medical managements that will lessen the impact or be able to treat it. We will develop better/quicker screening and testing for COVID-19 and be able to earlier identify and quarantine those with an active infection and their contacts. Maybe there will be a drug that can be taken by contacts that will suppress the infection proactively. Hopefully, we will come up with immunization that will help to improve the herd immunity. It will take a while to provide immunization to 7 billion people. Unfortunately, there will likely be a backlash and resistance from those who oppose vaccinations of any kind that will slow the process for the rest of us.
In the meantime we need to stick to what we have found is actually protecting us so far. Wash those hands often. Limit your close exposure to others. Don’t gather in groups where distancing is not practical and particularly in indoor closed areas. Work from home when you can. Consider wearing a mask when you are shopping or in a situation where physical distancing is impractical. When you are sick, stay home. Better yet, get medical advice and possibly a COVID test if it is advised so your recent contacts can be warned if you are infected and so you don’t spread it unwittingly to others. We will need to take particular care of those in Long Term Care facilities and, as a community, protect individuals whose co-morbidities put them at increased risk of serious consequences of the infection.
Although the last 9 weeks have felt like a lifetime, we are only just starting. The COVID-19 virus is new to the world. We are guessing to a certain extent, using scientific reasoning, how best to mitigate its effects at the moment but how this unfolds over the next couple of years is taking us down an unknown path. International cooperation and learning from the experience in other parts of the world has been helpful.
Some folks are eager and others might be understandably anxious about re-opening the economy. The bottom line is that we can’t remain in total isolation forever. My opinion is that if we proceed gradually in a responsible way and remain ready and responsive to deal with any emerging infection clusters that develop, we can go ahead with caution. It will be slower than we want and there will be challenges to working around new restrictions that will be in place for some time. We will adjust.
Life will change. Our societal habits will change. But humans are pretty resilient and flexible and we have science and technology that was not there for past pandemics on our side. Our short-term success shows that we can do it. It’s a long course ahead, however, and we will have to buckle down and accept that sobering reality.
John A Geddes MSc MD CCFP
Here is a message from our Local Medical Officer of Health posted today on the KFLA website.
We are all traumatized by the incredible changes in our lives that have happened in the past couple of weeks. We also worry about what is to come. Canada could be swamped in the next few weeks with cases of COVID-19. Just how swamped will depend on how much we pay attention to the physical distance warnings we have been receiving from all directions.
We are being deluged by the worst case scenarios that are being presented to us in order to make us sit up and take notice and do something now to try to reduce the inevitable increase in numbers of sick people and the extraordinary strain on our Health Care System and other resources in general. We know, from our experience in the past couple of weeks, that it is impossible to predict how this will have unfolded a month from now.
Rather than dwell on only an apocalyptic view of the future, I think we need to be aware that there are glimmers of hope out there. What I will present here is entirely my own opinion but it is these thoughts that give me some hope that we can eventually get past this challenge.
At the moment, the number of cases in Canada is rising. This is certainly discouraging but is entirely expected. They will continue to rise in the next couple of weeks as people who have been infected prior to our physical distancing efforts, people returning from international destinations and cases that have not been counted yet rise. We can not expect this curve to flatten until we get over this initial phase. I continue to watch the cases per million number on the Worldometer site and Canada is sneaking up but not near with the slope that we see in the USA for example. I am hoping that this slope will flatten after a couple of weeks to keep our total number of cases per million at a manageable number.
How “flat” we can make that curve is yet to be seen. At the moment, we are buying time to make the current escalating situation more manageable and until some more definitive management can be in place. It may not be working quickly or as much as we would like but we are having some influence by our combined efforts to reduce spread. Keep working on this, Canada.
We are still not able to determine with certainty just how many cases are really out there in the community because testing has been limited and mainly used to test those who are either at significant risk or seriously ill. If this virus infects some people who develop few symptoms or even with symptoms that have been diagnosed as “flu”, there may be a cohort out there who have already had it or even have it now. This is both encouraging and discouraging because it would mean that there are folks who have some immunity in the community, lowering the number of people at risk, but it also means that there are people who have been spreading this virus unknowingly.
Availability of testing has been limited although we are doing better than many countries at testing high risk people. Testing resources are becoming more available and will ramp up in the next while. There will be a lot of folks who may have, or have had, this virus who are under the radar in terms of confirmation. We don’t know how many who have had an Acute Respiratory Illness and have been told to isolate themselves and treat it symptomatically might have had COVID-19. But that, in some creepy way, is good news in that they are recovering without needing special medical care and they will be developing, we hope, antibodies to this virus. The more people who have antibodies, the fewer in the population who can be infected or spread it. Herd immunity is something that will help down the road. But it may be a while before that herd is big enough to affect the numbers.
Current tests for COVID-10 consist of a swab from the back of your nasopharynx that identifies specific COVID-19 RNA. It takes time to process and is not comfortable to obtain. Researchers have developed a rapid blood test that will show whether someone is infected or even has immunity from prior infection. It is done with a finger prick of blood and results are available in 15 minutes. The results would read as negative (not infected and not immune), having IgM antibodies (the first antibodies that are produced in response to an infection and suggest active infection) and IgG antibodies (the later immunological response we get when we develop some sort of longer lasting immunity to a particular infection). Imagine if we could immediately test everyone presenting to a hospital, for example, like this. It would allow us to isolate those who are infected immediately. We could also know what health care workers, store clerks, and other front line workers were already protected somewhat by their past exposure and antibody titres. We could identify the silent asymptomatic carriers so they could isolate until they have recovered and not spread the virus to other vulnerable people. Having this available will make a huge difference to understanding the prevalence of the virus in our communities. It will also help with management and control. It is on the horizon. Not sure when but it is something that provides me some hope. It might be the first significant tool to help manage this pandemic.
I also think that we will likely come up with some sort of antiviral or medical management that can be safe and effective for helping to treat those with severe disease. I don’t want to sound like “you know who” on this because it is a bit down the road, but I think it will eventually happen. Medical researchers in the entire world are working ( I was going to say feverishly, but that might be a poor choice of words right now) to find effective medical management.
There will eventually be immunization for this virus. It may take a year to get it on the market and we will have to produce millions/billions of doses but, if combined with the antibody test, those who are not yet immune and vulnerable service workers could get the immunization first if supplies are limited. The caution is that, like influenza, this virus might change over time so keeping up with the specific viral mutations could be a challenge. With any luck, the combination of acquired immunity and immunization will be able to bring some element of control. Widespread immunization is still months away but it will happen.
Don’t take from this that I am underestimating the serious consequences that we might face soon as a result of the impending viral surge. However, in addition to heeding the warnings and scary projections, we should keep in mind that there will be advances that help us to get out from under this oppressive threat to our community health and our economy.
Prime Minister Trudeau, this morning, put it this way. “The best way we can work together is by staying apart.”
I have had some excellent questions come to me as a result of my recent blog articles and am happy to respond with my opinions which are, I hope, knowledgable but I will reiterate that I don’t claim to be a world expert. I am giving you my opinions as a local family doctor and neighbour.
One question that I thought was a very good one went something like this. “If the number of cases under the curve on the graph are the same, the blue ones the same as the red ones, why don’t we just let this virus run it’s course and get it over with quickly since the curve shows that the illness will deplete faster with the red curve. Get it over with.”
If we quickly look at the graph, that seems like a very logical question and the idea that eventually at least half of us are going to get this virus, one way or another, would suggest that we might as well just bear it now and get on with it. More people will have immunity and the virus will run out of steam.
The problem with this view is that we are not looking at that dotted line that indicates what our Healthcare System capacity is. If we go for the red curve you can see that very quickly we will overwhelm what resources we have to manage it. Conceivably the number of people infected if it is totally out of control might not be 50% but 70%. As a consequence, many more people will die because they will not have access to life-saving ventilation or hospital care.
A younger demographic may argue that the severe illness and death rates are in the elderly and those with chronic illnesses mainly. That fact is true, but others do succumb from this virus. And if the hospitals and medical staff are depleted of resources and spaces, where will your kid go when they are hit by a car and have a head injury, or you have a heart attack and need bypass surgery, or your sister needs cancer surgery or your wife has a postpartum bleed? The argument is not entirely about suppressing the total number of cases, but about making the inevitable manageable so we can continue to provide adequate health care to all.
I think many senior folks (I don’t like being called elderly) will agree with me that we might have a bit of a fatalistic attitude to the prospect of death from this virus. We realize that we will all die sooner or later. For those of us over 70, there is a bit more sooner and a bit less later in that equation and we know it. Sure, we think about our increased risk, but I suspect most of us worry more about our families and friends than ourselves.
To put this in perspective, let’s say in the greater Kingston area we have about 200,000 people. If half of those gets COVID-19 in the next few weeks that means 100,000 infections. Of those, 80,000 will take acetaminophen, stay home from work, feel lousy but get better. That will mean 80,000 people off work for at least two weeks, by the way. Another 10,000 will need some sort of medical care and a further 10,000 would benefit from hospitalization. Do we have 10,000 hospital beds to offer them? Even more drastic is that 5,000 will need ventilation. We have 35 ICU beds currently at Kingston General Hospital and they are usually full with people who need immediate intensive care with things other than COVID-19. So where will these 5000 people get their needed intensive care? Maybe we could handle it if they came in slowly but in a glut, the system would be overwhelmed and unmanageable. Bear in mind that with a high peak that means more health care workers would also be ill and out of commission to serve as well.
The proposal is that if we follow the advice we are receiving for Social Distancing (in addition to all the handwashing, sleeve-sneezing advice) we can spread these infections out over time. Flatten the curve. Perhaps, if we can slow the spread over the next few weeks or months, science will come up with an anti-viral medication that can blunt the curve even more. Eventually there will be immunization available. People will develop natural immunity. With time the infection rate will slow down. China has put very stringent social interaction controls in place. In the last 24 hours, China has reported 24 new cases. Canada has had 89.
I present this to you to emphasize that we need to be doing everything we can NOW to minimize the shape of this curve and keep the inevitable crisis to within manageable bounds. I saw a headline somewhere that said “This is not a snow day.” We will all be required to sacrifice in some way in order to keep our community as safe as possible from a situation that could overwhelm our Healthcare System and be detrimental to us all, not just our vulnerable elderly neighbours and relatives. We can not just think about “me” but rather aim to help “us”.
I got an unexpected and sad reply from a friend in Africa when I sent him a birthday greeting this weekend. And it all resonated particularly harshly because of the theatre piece I saw last night.
Tobias is the Beach Management Unit Chairman at the Kamin Oningo beach on Lake Victoria, a small fishing community in Kenya where I have visited several times.Through The CanAssist African Relief Trust we have been able to build up a small school there. The school, in fact, is named after my Dad as is one of the kids in the community!
Tobias responded to my cheery birthday note with the sad news of the death of two relatively young people in the village.
Now I will take one step back.
Last night, I attended the Theatre Kingston performance of What a Young Wife Ought to Know. The show was really well produced and there were some very funny and intimate moments. The general theme was a tough one, however. It centred on the desperation of young women in Canada in the early 1900’s to limit their family size . Living in relative poverty put them at increased health risk and they were simply not able to care for either themselves or their children adequately. Their family planning choices were limited and sometimes the only choice was abstinence, a solution that strained their marriages. Desperate attempts to terminate the pregnancy were life-threatening and distressing. The show was dramatic and intense and personal and, for us in Canada now, it was “historical”.
Well in some parts of the world it is not history.
One of the deaths at Kamin Oningo was a 35 year old woman who already had four kids and who delivered the fifth two weeks ago. She must have been anemic during the pregnancy or, like many there, had some post-partum bleeding that was not fully addressed. Like many African mothers, there really was no time to recuperate and she had to take up the usual household tasks immediately. Apparently she had been given some iron tablets for the severe anemia but she collapsed on Saturday and died at home. Three of the older kids go to the SP Geddes school from pre-school age to grade 2. The husband, a fisherman with a meagre and unreliable income, is left with this young family.
So this news drove home the message of the play even more (not that it needed any more driving home). It was not that long ago that this conundrum was being played out in Ottawa. It still is a concern in Africa and with people I know there. And women die. Less than two years ago, another young mother that I know died with a post-partum hemorrhage. The baby survived but without a mother.
The other fellow who passed away in the community this week, a 32 year old fisherman with three young children, died of what sounds to me like an Upper Gi Bleed. Here, he would likely have had access to the medical care to prevent or manage this. In Kamin Oningo there is no medical care in close proximity and most people can not afford transport to the nearest facilities that can deal with this or the meagre fees that are charged for health services. So they leave it too late.
Tobias has reached out to his friends for financial help so the families can achieve release of the bodies of these two community members from the mortuary and to help to provide a funeral and burial for them. I struggle to imagine what it is like to lose your wife, have a newborn baby at home and four other children and not have enough money to retrieve the body from the mortuary. Of course, the families will also be distraught by the deaths and suffer even more financially.
If anyone feels they want to reach out in support, I will be pleased to receive any donations and forward them directly to Africa where they will be used in support of these two bereaved families. Even $10 will help. An online transfer is best (email@example.com) or give me ten bucks when you see me next. I promise that every cent will reach this community and the grieving families.
(This is not a CanAssist request, by the way, but a personal one from me.)
I would also recommend you seeing What a Young Wife Ought to Know at the Baby Grand – playing from now until February 16. And when you see it, realize what many women/families around the world are still going through and how it is not that long ago that this was the situation here in Canada.