As Canadian doctors brace for the full surge of the COVID-19 tsunami, its ripples are already causing delays in cancer care.
The pandemic has created surreal experiences for everyone, including the 617 people in this country who are diagnosed with cancer each day on average, according to the Canadian Cancer Society.
“My biggest fear would be the collateral damage caused by the pandemic and the collateral damage is something like cancer care,” said Dr. Jory Simpson, a surgeon at St. Michael’s Hospital in Toronto who treats breast cancer.
Cara Heitmann, 53, of Toronto had her breast reconstruction cancelled and her mastectomy that was scheduled for next week is being postponed.
“I’m angry and I’m scared,” said Heitmann, who lives alone and runs her own business. “I don’t know if or when I will have surgery. I don’t know if the cancer will spread. I don’t know if it will metastasize. I don’t know if I will survive this.”
Heitmann said she has access to her surgeon’s case notes that list her as a priority case. “I haven’t been told what is now my prognosis.”
Cancer care prioritized for patient safety
Simpson said that so far, if a patient has a deadly tumour needing emergency surgery, it will be removed. But as hospitals struggle to make space for COVID-19 patients, there’s a new set of priorities including:
Patients with solid tumours, including breast and colon cancer, may wait up to four weeks.
Early-stage cancers such as prostate or thyroid may wait up to two months.
Ontario’s health minister, Christine Elliott, said the decisions are made based on the evidence for each case.
“I know that is not a comfort to people with cancer that are having their surgeries postponed,” Elliott told reporters on Thursday. “Those decisions are being made based in consultation with cancer-care experts.”
Dr. Mary Gospodarowicz, a radiation oncologist and medical director of the Princess Margaret Cancer Centre in Toronto, said the hospital is focusing on preserving capacity to treat people with COVID-19 and keeping the hospital environment safe for patients and staff.
“Physicians would like to treat patients as quickly as possible and very promptly, but in these times of community transmission of COVID, decreasing the number of patients that come to the hospital and also interact with us is also safer for patients,” Gospodarowicz said.
That’s because people with cancer are more susceptible to COVID-19 infection and, in those with reduced immune systems because of chemotherapy or radiation, the course of the infection may be more severe, she said.
Chemotherapy treatment and follow-up is being delayed unless critical, and where possible, follow-up appointments are conducted online or by phone, she said.
“We’re trying to call as many patients who had appointments as possible and then decide based on the phone call whether the patient needs to be seen in person or not,” Gospodarowicz said.
Since clinic visits for follow-up and assessment are deferred, the number of patients coming to Princess Margaret has dropped from about 2,000 a day to 1,000 a day, with as many appointments as possible done by phone or virtually.
“The trickle-down effect of this is it causes a lot of anxiety,” Simpson said. “Physicians and surgeons can provide reassurance right now that in some cases of cancer, waiting four weeks extra for surgery probably won’t impact your ultimate prognosis.”
Cancer specialists said, while the situation is fluid and unpredictable, they’re doing their best to expedite cancer surgeries, while routine screening of healthy people has stopped.
WATCH | Mary Swark-Hougaard talks about her frustration at having to delay her breast cancer surgery because of COVID-19:
The ornate halls of Moscow’s Kremlin have hardly been a welcoming place for Canadian delegations of late, which is what makes John Durrant’s visit there this week especially remarkable.
On Russia’s Day of National Unity on Monday, one of its most significant holidays, Durrant, a Russian literature professor from St. John’s, was the guest of honour at the head table in the grand Georgievsky Hall, seated right beside President Vladimir Putin.
“Who would have thought I’d be here? It’s the highest moment,” he told CBC News in an interview at the Kremlin, shortly after Putin bestowed upon him the Order of Friendship, one of Russia’s highest civilian awards.
“What can I say? I’m honoured.”
A ‘thank you’ for decade of work
Durrant was given the award primarily for his decade of work serving as Russia’s honorary consul in St. John’s, a position that he said involved everything from helping stranded Russian sailors to hockey players and escorting official Russian delegations around Newfoundland and Labrador.
It’s common for foreign nations to appoint non-diplomatic representatives in cities where they don’t have an embassy to help with consular matters. Durrant said he believes the Russian government initially asked him to take on the role because it was familiar with his work as a translator and as a Russian language expert.
As part of a “thank you” speech to Putin and the dignitaries, Durrant promised to work tirelessly to “establish understanding between our people.”
“It involves a lot of different duties,” he said, of the honorary consul position. Over the years he said he has helped the families of Russian fishermen who have died and dealt with the crews of various Russian ships that have stopped in St. John’s.
Durrant, who speaks six languages, has also facilitated trips for hundreds of Memorial University students over the years to Russia as part of their language studies.
As for his hour-long one-on-one with Putin, he said they first talked about hockey to “break the ice, so to speak.”
And Durrant said the pair also chatted about dogs.
“When he learned that I was from St. John’s he spoke about dogs — because of Labradors — and I think his favourite pet was a Labrador named Konni.”
Indeed, Konni, a female black lab, was a fixture at Putin’s side for the first 15 years of his rule in Russia and often accompanied the Russian leader to international conferences. Russian state media frequently showed photos of the pair together, in part to help portray Putin in a friendly, softer light.
Konni died in 2015.
I find President Putin to be a very attentive conversationalist.– John Durrant
“I find President Putin to be a very attentive conversationalist,” said Durrant, who studied Russian at Lomonosov State University in Moscow, in what was then the U.S.S.R.
Beyond that though, Durrant was reluctant to give away much about his conversation with Russia’s president, suggesting it may be “breaking protocol” to do so.
Nor would he reveal how political things got.
Canada, Russia should be ‘close neighbours’
Durrant said he’s a strong believer in engaging with Russia, to “develop trust through positive and effective collaboration.”
“I profoundly believe that because of so many basic similarities — too many to list — Canada and Russia should be very close neighbours and loyal friends,” Durrant later wrote in an email to CBC News.
The official policy of successive Canadian governments has been more or less the diametric opposite.
Since 2014, Canada has frozen most high-level governmental contacts with Russia in response to Putin’s annexation of Crimea and its role in fuelling the war in Eastern Ukraine.
Both Liberal and Conservative governments have sanctioned scores of Russian companies and individuals linked to the conflict, as well as in response to the poisonings of Sergei and Yulia Skripal in London last year and Russia’s alleged role in the downing of Malaysia Airlines flight MH17, which killed 300 people.
For its part, Russia has banned a number of senior Canadian officials with ties to Ukraine, including Canada’s Foreign Affairs Minister Chrystia Freeland.
In an emailed statement, Freeland’s spokesperson Adam Austin stated: “Attempts by Russia to destabilize the rules-based international order and the multilateral institutions that underpin it require firm and strong condemnation and concrete action by all countries that believe in a stable and prosperous world.”
Durrant said he doesn’t see those measures as being effective.
“If you look at the Russian reactions to sanctions, I think it only means — as they say in Russian — ‘If you hit the nail, it just sticks even harder.'”
However, Canada’s hardline approach to dealing with the Kremlin has been widely praised by Russian human rights activists, including Vladimir Kara-Murza, who told CBC News in an interview Oct. 30 that Western governments must constantly put pressure on Russia over its treatment of those who oppose the regime.
Kara-Murza claims there are 314 political prisoners in Russia at the moment — more than in the 1970s under the Soviet Union.
Durrant said while he accepts there are serious “points of contention” he tries to stay focused on his role helping individual Russians when they’re in Canada.
Other Canadians to receive the Order of Friendship included former prime minister Jean Chrétien and former governor general Adrienne Clarkson. Chrétien received his award in 2014 just prior to the deep freeze in relations.
Durrant said he takes heart from experiences, such as when the Russian tall ship, Kruzenstern, last visited St. John’s before the sanctions.
“At the end of the evening, the Russian [crew members] returned to the ship, each with a Canadian officer’s hat, and on the way back in the bus, they sang their favourite Russian song, which expresses love for Russia, adding Canada-Russia to the lyrics,” he recalled.
“Russia has an entirely different set of chromosomes — cultural chromosomes — than countries in the West. It’s a matter of working out the differences.”
Bianca Andreescu began her day Saturday the same way she started every morning during her run to the U.S. Open title. By meditating and visualizing how she could beat her next opponent.
Those practices, adopted by the Canadian teenager years ago, seem to be working for her throughout her breakout season.
And Saturday’s visualization session, where she saw herself defeating American superstar Serena Williams for the U.S. Open championship, worked especially well.
“I put myself in situations [that] I think can happen in a match, basically,” Andreescu said Saturday night, hours after downing Williams 6-3, 7-5 in a thrilling women’s final at Arthur Ashe Stadium in New York. “I just find ways to deal with that so I’m prepared for anything that comes my way.
“I think your biggest weapon is to be as prepared as you can. I really think that working your mind [is important] because at this level everyone knows how to play tennis.
“The thing that separates the best from the rest is just the mindset.”
Watch highlights from Bianca Andreescu’s U.S. Open victory:
Dream come true
The 19-year-old from Mississauga, Ont. — Canada’s first Grand Slam singles champion — added meditation to her daily routine when her mother introduced her to it as a young adolescent.
It wasn’t the first time Andreescu had thought about playing the 37-year-old in a Grand Slam final.
“It’s so crazy, man,” she said, pausing to wipe tears from her eyes. “I’ve been dreaming of this moment for the longest time.
“I guess these visualizations really, really work,” she added with a laugh.
Andreescu talked about her meditative process throughout the U.S. Open, and said after her semifinal victory against Belinda Bencic that she had visualized winning the Grand Slam in New York, even writing herself a fake winner’s cheque when she was 15.
8-0 vs. top-10 opponents
The $ 3.85 million US she earned with Saturday’s victory was more than she had envisioned back then, though.
“I’ve never held that much money in my life,” she said with a wide smile. “But yeah, like I said, I guess those visualizations are really working for me. It’s just crazy.”
Watch Championship Point:
Andreescu’s win extends her championship run to two straight tournaments, including last month’s Rogers Cup when she also beat Williams, and improves her ranking to a career-high No. 5 — up from No. 152 at the start of this year.
While Andreescu looks unstoppable now, she remembers a time when she would beat herself up after a tough loss.
“I would get really down on myself and I would get very negative thoughts going through my mind,” she said. “I would smash rackets. I’d just yell at myself during matches … even during practice, too.
“But I found that that way wasn’t working to my advantage at all. So I started seeing — I’ll say I started seeking some advice from other people. Ever since then, I’ve been trying to have a very positive outlook on everything.
Andreescu still lets her emotions shine through in tense moments on court though, often pumping herself up after big points by shouting “yeah” and “come on” into the air. Sometimes those emotions get her in trouble — like during her fourth-round match against American Taylor Townsend, when she drew a code violation for throwing her racket.
Who knows? Maybe I can even be better.— Bianca Andreescu, 19, after becoming Canada’s first Grand Slam singles champion
Andreescu maintained after that match that the racket toss was unintentional, and said she thought she did well keeping her cool with the rowdy New York fans actively cheering against her.
“If I just keep calm, stay as positive as I can, I think the crowd can’t beat me,” she added.
Andreescu said at the Rogers Cup in Toronto last month that her goal was to crack the top 10 by the end of the year. Now that she’s there, she’s adjusted her vision to new heights.
And Williams has provided the inspiration to get there.
“I’m sure I’m not the only person that’s looked up to her. She’s an inspiration to many, many people,” Andreescu said after beating the 23-time Grand Slam winner. “She’s truly a champion. … But yeah, I’ve really strived to be like her.
“Who knows? Maybe I can be even better.”