“There’s nothing radical about clean air and compassion.”

❦ “The truth is that SARS2 is so contagious, so virulent, and reinfects so easily that there is no off-ramp for masking in healthcare. At least not without better vaccines and therapeutics that actually stop transmission and prevent Long Covid, Cardiovascular Covid and Neurocovid.”

❦ “Whenever I hear someone ask if we’re expected to continue masking in healthcare settings forever, I immediately think of Semmelweis – the man who discovered that healthcare workers’ dirty hands were causing fever and death in patients. The result of his discovery wasn’t the widespread implementation of hand hygiene though... Instead he was shunned, ostracized, lost his job and eventually institutionalized. It took around fifty years before the life-saving value of hand-washing was fully recognized in healthcare. Fifty years. It turns out that doctors didn’t take kindly to the idea that their own hands were unhygienic – and the source of disease and death for some of their patients. Despite the evidence, the denial was rampant and it was strong. The majority consensus was that Semmelweis was a crank... The resistance to the idea that the air we exhale while caring for patients can be unhygienic, and a source of illness and death for some, feels exactly the same to me. Despite the evidence, the denial is strong. Many prefer to cling to the status quo they knew before the pandemic. But that status quo was when we didn’t know better, and when we didn’t have such a virulent and dangerous new airborne pathogen in permanent circulation. Now that we do, and now that we know better, we should be willing to do better. So if the air we breathe can be unhygienic, and cause illness and death in our patients, and we know there’s a simple, effective solution – filtering it through a respirator – then it seems logical that this would become the new standard in our clinics, hospitals and long-term care facilities. Permanently. But as with Semmelweis’ experience, I expect that suggestion to get a lot of pushback, and for it to take a very long time for the medical field to accept that the old status quo is gone, and that masking in healthcare is the new normal. I just hope it won’t take another fifty years.”

❦ “Yesterday someone confronted me about my social media content – saying that while I’m not wrong, I’m too radical. They asked me: — “OK. What happens once everyone agrees (that Covid reinfections are problematic ) – then what?” Then we clean the air. HEPA filters are not radical. I don’t know what they expected as an answer. We regulate water safety and food safety in an effort to decrease population rates of waterborne and foodborne illnesses. Having clean air standards to lower the rates of respiratory illnesses isn’t radical. It’s also not radical to suggest we keep masking in healthcare and in essential indoor spaces so that the disabled, the high-risk, the elderly and their families can safely enjoy community life again. Wearing a respirator is not hard. Wearing 4-inch heels is hard, and I do that all the time for no good reason other than vanity. Accessibility is not radical. Advocating in favor of a public health response to an on-going threat is not extremism. SARS-CoV-2 is the Number One infectious-disease killer in Canada, and our excess deaths are still high. It’s not radical to think we should do something about it... It’s also not radical to advocate for the bare minimum in terms of public health education campaigns on Long Covid / Post-Covid Syndrome, and airborne transmission. Empowering people through education is not radical. It’s just wild for me that someone would think my Covid public health advocacy is radical when, in reality, they agree that we should clean the air, mask in healthcare and other essential places, and educate the public. Did they think I was going to answer with “lockdowns” ? Or is the radical part that I care enough to advocate out loud? Even when it’s not popular? Even when there’s an increasingly intense push to frame Covid health advocates as radicals and extremists? Or maybe I’m a radical because I don’t value brunch or maskless grocery shopping enough to risk Long Covid, or to betray my values? Is it radical that my physical health and my integrity are important enough to me that I’m at peace with my decision not to conform to societal expectations? If you’ve misclassified people you actually don’t disagree with as “radicals” in your mind, you should take half a second to examine how and why that happened, and re-examine your assumptions. There’s nothing radical about clean air and compassion. We don’t lack scientific consensus. The pandemic is complicated because we lack values consensus .”

❦ “I’m a little confused at the “making people feel bad about how their choices harm others is bad advocacy” takes. Didn’t we do that with smoking? Wasn’t the “second-hand smoke kills” education campaign exactly that? Isn’t “if you drive drunk, you could kill someone” exactly that? Since when is it controversial to point out how our choices could harm other people? Some people seem to think that advocacy should never make anyone feel uncomfortable… Do they really not realize that they’re out here shaming the oppressed for making their oppressors feel bad? We’ve created a system of structural violence against the immunocompromised, disabled, and clinically vulnerable. One that now extends to healthcare. We deserve to feel ashamed about it and we should always feel uncomfortable with perpetuating structural violence against others.”

❦ “The way I see it, if somehow all the data on the cumulative risk of death, hospitalisation, disability, heart attacks, strokes, etc. with repeat Covid infections turns out to be wrong, I will have worn a mask for longer than I needed to and missed a few social events. I’m OK with that. Whereas if I decided to follow the crowd instead of the available science, and the available data turns out to be right about the risks of cumulative Covid infections, then I’d be facing high odds of poor health, disability, and premature death. Those are very high stakes. When the stakes are high, you can’t afford to be wrong. So seeing ‘experts’ wave around the absence of certainty as their justification for choosing the high-stakes position, when the high-stakes position is the one that requires the most certainty… it’s just so absurd. On the other hand, I can pull up multiple scientific studies on how Covid (and the loss of parents/primary/secondary caregivers) harms children…”

❦ “I’m so pro-mask and anti-infection that I started masking in 2019. Why? Because I was pregnant and working in healthcare. And in the before-times, it was normal to try your best to avoid contracting pathogens in pregnancy. We didn’t worry about the (illegitimately-termed) “generational immunity debt”. I was doing it wrong – intermittent masking with leaky, blue surgical masks, haha – but I was masking every day because I was pregnant during RSV/flu season, and I was acutely aware that both of those viruses (and several others) could put both myself and the baby at risk. Pregnancy is a state of relative immunosuppression, and there’s research associating fever, regardless of the pathogen, to neurodevelopmental disorders. Pathogens are always unwelcome, but especially so in pregnancy. I picked up the idea of masking while pregnant as a med student during my pediatrics rotation. One of my attendings (supervising physician) was pregnant, and she masked to protect herself. It really bothered me. Not the mask. It bothered me that she and her baby had to be in harm’s way at all. Where I live, women that work in childcare get preventative leave during pregnancy because of the risk of contracting viral illnesses. Not doctors, though. So here was this pediatrician working specifically with young children who have viral illnesses, while she was pregnant. It seemed so unfair. It left me upset. But she was doing what she could to protect herself. Gloves. Scrubs. Hand hygiene. And a mask all day. With every patient. Even with us. So years later, when I was pregnant, I masked at work, too. I actively tried to avoid viral illness. After all, if I had a job in childcare, I’d be on preventative leave, right? So why would I expose my pregnant self to viruses in a healthcare setting, when doctors were taking women in other high-infectious-risk environments off work entirely? So anyway, imagine my utter shock when 2020 rolled around, and the “experts” started telling the population that masks don’t work. Remember that? — “Masks only protect others and not the wearer,” they said. That was the first lie in what we now know would be a long stream of lies. It was with that first lie that I understood that I needed to rely on myself, and not just the official messaging. That to keep my newborn safe, I would have to diligently double-check what we were being told. I knew I needed to find the truth-tellers among the “experts”. And this is not just about masks. Maybe the decision to mask in pregnancy wasn’t common pre-2020 – but looking out for each other absolutely was. In dermatology, we’d try to do the fever-plus-rash consults (and any other virus-risky consults) for pregnant colleagues. Why? Because why take unnecessary risks? Pathogens in pregnancy are bad. We’d often worry about the risk of the rash-plus-fever consult being measles or varicella. — “But aren’t you vaccinated?” Yes, and why take the risk? That was the mindset before the “vax-and-relax” lie. We got vaccinated against influenza in pregnancy as recommended, because we didn’t want to catch it – not so that we could go out and expose ourselves to it. We didn’t “vax and relax”. We “vaxxed and continued to actively avoid” . It was an easier task with the flu than it is with Covid, given how much less contagious flu is. With Covid, individual effort is insufficient. For it to be avoidable with small individual efforts, there needs to be not much of it circulating. Which would require a big Public Health project. So the deciders decided that that was not going to happen. We were going to live with infinite, forever Covid. But that would endanger so many people. So that’s when the “pandemic of the unvaccinated” lie was born. And the “Omicron is mild” lie. And the “Long Covid is rare” lie. Honestly, there are just so many lies that I can’t keep them all straight. We’re just constantly being “nudged” with nonsense messaging to get us to accept unmitigated exposure to SARS and other pathogens as normal. And it’s working. People seem even less cautious than they were before. We had crushed RSV and the flu, emptied pediatric hospitals, and had negative pediatric excess mortality. And we took zero lessons from that time forward with us. We figured out how to dramatically lower infant/childhood morbidity/mortality, and they made sure we unlearned it ASAP. They didn’t marvel at that achievement, and strive to do the non-disruptive stuff like cleaning the air and normalizing masks during the winter viral season. Instead, the “let a SARS virus mass-infect kids”, and the lies to normalize all the suffering that we’re seeing just keep on coming. See, that’s the problem with siding with the disinformers. Maybe you let the lies go because you agreed that kids shouldn’t have to wear masks for the benefit of “the vulnerable”. But now the disinformers are saying that society shouldn’t have to mask up for the safety of your kids, either. Siding with people that openly devalue the lives and right to safety of other human beings, because you are not personally in the devalued group, rarely ever goes well. And that’s the point of this essay. We’ve slowly and tragically slid down a slippery slope.  This is nothing like 2019. In 2019 we would have cared that pediatric ICUs were overflowing, and worn masks to flatten the curve for kids. We’ve fallen so far since 2019. And with each passing day that our society can be convinced not to wear a mask to work – or in the mall, or on the bus – to prevent others from dying, or to keep babies out of the ICU, we slip a little further down the slope. And the scary thought is that this is very unlikely to be rock bottom. We still have further to fall.”

❦ Medical school lectures on respiratory pathogens in 2060: “Interestingly in the 1900s and early 2000s, doctors thought respiratory viruses were transmitted by fomites, not aerosols. They spent a tremendous amount of energy cleaning hands and surfaces instead of cleaning indoor air. Unsurprisingly, they were quite terrible at limiting the spread of respiratory viruses and had terrible epidemics each year leading to thousands of deaths, including many among infants and young children.” “Air hygiene has been one of the greatest public health advancements of the century.”

❦ “Something my skin cancer patients say to me all the time is “You know, my parents’ generation didn’t protect us from the sun when we were kids...” and it of course gets me wondering what today’s kids will one day tell their doctors about what our generation didn’t do for them.”

❦ “If you’re an MD [medical doctor] that spends time counseling patients to exercise and quit smoking in order to reduce their risk of a heart attack or stroke, and you haven’t yet added “Avoid Covid” to your ‘Cardiovascular risk factors’ counseling speech – you may want to re-evaluate that oversight.”

❦ “Immunity debt” is making the rounds again. So here’s my reminder that while there are viruses that are more severe if caught as a teen or adult (like polio or chickenpox), that isn’t the case for respiratory viruses . There’s a mortality benefit from first RSV and flu infections being delayed. So no, your toddler doesn’t need to catch all the viruses before the age of two to “build their immune system”. In fact, it’s the opposite: infants and young toddlers are more at risk of hospitalization and death from many respiratory viruses at their age than older children. You know how we’re asked not to give kids honey until they’re one? Or how Health Canada has a whole list of unsafe foods for kids under five? “ For many pathogens, kids are more susceptible to severe outcomes when they’re very young. ” And there is benefit to delaying exposure. This new (and very politically convenient) idea that it’s always best to catch pathogens very early in life “to build your immune system” can actually be quite dangerous when you take the time to think it all the way through. Stop blindly promoting “immunity debt” pseudoscience. Three years ago, I never would have believed that I’d one day see scientists and MDs [medical doctors] promoting the idea that it’s good for infants and young toddlers to be exposed to dangerous respiratory viruses like flu and RSV, instead of trying to delay those first infections – and yet here we are.”

❦ “It’s interesting to see people treat the statement “Catching Covid repeatedly until it kills you” as hyperbole. Covid is a leading cause of death across all ages.  If nothing changes, then losing people we care about to Covid will be as common as cancer, heart disease or dementia. We’ve all lost loved ones to cancer, heart disease or dementia – but not all in the same year. The losses occurred over many years. Since Covid is still a brand new “leading cause of death” we don’t feel the full impact of this reality yet, but give it a few years and we will. If Covid remains a Top 3 leading cause of death going forward then inevitably, given enough time, “Catching Covid repeatedly until it kills you” will prove to be a true statement for a lot of people. It’s not as controversial a statement as some people would like to believe.”

❦ “Engineers raised the entire city of Chicago in the 1850s so they could install a sewage system in response to repeated epidemics of typhoid and cholera, but please tell me again how you don’t believe engineers can retrofit buildings with proper ventilation and filtration in 2022.”

❦ “It can be lonely to be the type of person that copes with uncertainty by running towards information instead of away from it.”