The debate around paid sick leave has grown louder and more urgent in the past several weeks as COVID-19 cases have continued to soar in many parts of the country along with concern that people are going to work sick because they can’t afford to lose their pay.
B.C. Health Minister Adrian Dix told CBC’s As It Happensthis week that “it’s indoor social and indoor workplace circumstances where we’ve seen the largest level of transmission” of COVID-19.
And in Ontario, it’s a similar story.
“The bulk of cases now that seem to be driving this pandemic are happening in workplaces where essential workers are unable to fully physically distance from one another,” said Dr. Camille Lemieux, medical lead for the University Health Network’s COVID-19 assessment centre.
Many worker advocates say what is needed is better paid sick leave.
At the end of February, the labour federations from all 10 provinces and three territories joined together to call for “seamless access to universal, permanent and adequate employer-paid sick days for all workers.”
That has not happened.
Here’s a brief look at where paid sick leave stands right now in Canada.
Fifty-eight per cent of workers in Canada reported having no access to paid sick days, the report found, citing a University of B.C. analysis of 2016 Statistics Canada data. It’s even higher for those who earn less than $ 25,000 — more than 70 per cent had no paid sick leave.
In Quebec, a worker is entitled to two days per year, after six months of employment, to be paid by the employer. In Prince Edward Island, a worker is entitled to one employer-paid day per year, after five years of employment.
Despite ongoing demands that the other provinces do something to help workers who are sick, the pleas have fallen on mostly deaf ears.
Ontario Premier Doug Ford has argued for months, and as recently as this week, that there is no need for provinces to bring in paid sick leave because the federal program brought in specifically to deal with COVID-19 is adequate.
Ford’s government has refused to pass a bill put forward by the opposition NDP, and supported by the Ontario Federation of Labour, that would guarantee paid sick days for every worker, delivered by their employer.
He accuses those calling for his government to ensure paid sick days of “playing politics.”
WATCH | Ford says people should help others apply for the federal sick leave:
Ontario Premier Doug Ford says his critics ‘are playing politics’ as he explains why his government isn’t instituting paid sick leave. Instead, he’s encouraging Ontarians to use a federal program. 1:07
What does the federal program cover?
The $ 1.1 billion Canada recovery sickness benefit (CRSB), which was unveiled last fall, offers workers $ 500 ($ 450 after taxes) for a one-week period. If the illness lasts longer, the worker must reapply.
Some advocates say it falls short of what is needed.
“What we’re trying to address here is a worker who wakes up in the morning and they have symptoms,” said Laird Cronk, president of the B.C. Federation of Labour, one of the 13 federations that made the joint request for employer-paid sick leave.
The application process and eligibility criteria make it difficult for a worker to just decide to stay home, he said.
“We don’t want them to say, I’m so worried about this untenable decision, so worried about paying rent or groceries and food or medications or for the kids, that they convince themselves that it’s probably seasonal allergies and they hope for the best because they can’t afford to lose the money.”
His federation, for example, is urging the B.C. government to change the Employment Standards Act to let that worker stay home and continue to receive his or her wage for up to 10 days, which could then be reimbursed by the province.
“Employers who can show that they’ve been, in the short term, affected by COVID-19 economically, would receive relief from the government on a sliding scale … up to 75 or 80 per cent reimbursed.”
The head of the Canadian Federation of Independent Business told CBC News in January that the CRSB is sufficient and that it is right that the government pay for sick leave — not employers.
“To impose the costs on small firms at this stage would be really challenging, of course, because most small firms are desperately hanging to say stay on,” said Kelly. “Any additional cost would be absolutely devastating.”
How much is COVID-19 care costing the government?
According to the Canadian Institute for Health Information (CIHI), between January and November 2020, stays in hospital for COVID-19 related illness costs about $ 23,000 per stay — four times higher than the average stay. The average length of COVID-19 stay was about two weeks, according to CIHI.
In that time period, the estimated total cost of COVID-19 related hospitalizations in Canada was more than $ 317 million.
There were more than 13,900 hospital stays for patients with a diagnosis of COVID-19 in Canada between last January and November, along with more than 85,400 emergency department visits for COVID-19.
The CIHI data does not include numbers from Quebec.
The lead Minnesota state investigator on the George Floyd case changed his testimony at the trial of Derek Chauvin on Wednesday, telling the court that he now believed Floyd said, “I ain’t do no drugs,” not “I ate too many drugs,” during his May 2020 arrest.
Senior Special Agent James Reyerson of Minnesota’s Bureau of Criminal Apprehension initially agreed with Floyd’s defence attorney that it sounded like Floyd said the latter in police body-camera video played in Hennepin County District Court in Minneapolis Wednesday.
But after listening to a longer version of the recording, Reyerson said, he believed Floyd was, in fact, saying: “I ain’t do no drugs.”
Floyd, a 46-year-old Black man, died on May 25, 2020, after Chauvin, who is white, pressed a knee on the back of Floyd’s neck and his back for around nine minutes as two other officers held him down. Video of the arrest captured by a bystander prompted widespread outrage, setting off protests across the U.S. and around the world.
Chauvin, 45, is facing trial on charges of second-degree unintentional murder; third-degree murder; and second-degree manslaughter. Wednesday marked the eighth day of the trial.
Drug use a key question in trial
The issue of Floyd’s drug use is significant to Chauvin’s defence. The prosecution says Chauvin pressing his knee into Floyd’s neck caused his death. But the defence argues Chauvin did what his training taught him and that it was a combination of Floyd’s underlying medical conditions, drug use and adrenaline flowing through his system that ultimately killed him.
Floyd had been detained outside a convenience store after being suspected of paying with a counterfeit bill. All four officers were later fired.
Chauvin’s lawyer, Eric Nelson, had earlier in the day introduced this evidence during his cross-examination of prosecution witness Jody Stiger, a Los Angeles Police Department sergeant and use-of-force expert.
Nelson played a snippet of video from the body-worn camera of J. Alexander Kueng, one of four officers involved in the arrest and later fired, and asked Stiger if he could hear Floyd say, “I ate too many drug” as he was handcuffed and prone on the pavement, pinned by the officers.
Stiger replied that he could not make out those words in the footage.
Later, Nelson attempted to get confirmation of the comment while cross-examining Reyerson. Nelson played the clip again, and asked whether it sounded like Floyd said, “I ate too many drugs.”
“Yes, it did,” Reyerson said.
After a short break, Reyerson was questioned by prosecutor Matthew Frank and told the court that during the break, he was able to watch a longer version of the clip that included discussion by officers about Floyd’s potential drug use.
“Having heard it in context, were you able to tell what Mr. Floyd was saying there?” Frank asked Reyerson after the clip was played again in court.
“Yes, I believe Mr. Floyd is saying, ‘I ain’t doing no drugs,'” Reyerson said.
Chauvin had responsibility to re-evaluate use of force: expert witness
Earlier in the day, court heard from Stiger, appearing as a paid prosecution witness providing expert testimony on use of force, say that Chauvin had a responsibility to re-evaluate pressing his knee into Floyd’s neck during their encounter as the health of the 46-year old Black man was clearly “deteriorating.”
Stiger had testified the day before that the pressure being exerted on Floyd was excessive and could cause positional asphyxia and lead to death. On Wednesday he reaffirmed that the force Chauvin used on Floyd was “not objectively reasonable.”
Prosecutor Steve Schleicher asked Stiger whether Chauvin had an obligation to take into account the distress Floyd was displaying when considering whether to continue the type of force he was applying.
“Absolutely. As the time went on … his health was deteriorating,” Stiger said. “His breath was getting lower. His tone of voice was getting lower. His movements were starting to cease.
“So at that point, as on officer on scene, you have a responsibility to realize, ‘OK, something is not right. Something has changed drastically from what was occurring earlier.’ So therefore, you have responsibility to take some type of action.”
During cross-examination, Chauvin’s lawyer asked a question he has posed to other witnesses — whether there are times when a suspect can fake the need for medical attention. Stiger agreed there were.
Obligated to believe
But when asked by the prosecutor whether an officer can “opt not to believe” the detained individual, Stiger said an officer is still obligated to believe them.
“That’s part of our duty,” he said.
Stiger also testified that Chauvin knelt on Floyd’s neck or neck area from the time officers put Floyd on the ground until paramedics arrived.
“That particular force did not change during the entire restraint period?” Schleicher asked as he showed the jury a composite image of five photos taken from various bystander and body-cam videos of the arrest.
“Correct,” Stiger replied.
But Nelson was able to get Stiger to agree with a number of statements. Stiger agreed with Nelson, for example, that an officer’s actions must be viewed from the point of view of a reasonable officer on the scene, not in hindsight.
He also agreed that a not-risky situation can suddenly escalate and that a person in handcuffs can still pose a threat to an officer.
Stiger also agreed that when Chauvin arrived at the scene and saw officers struggling to get him in the back seat of the squad car, it would have been within police policy guidelines for Chauvin to have stunned Floyd with a Taser.
And he agreed with Nelson that sometimes the use of force “looks really bad” but is still lawful.
Kiran Kaur surveys her family’s paltry plot of land in Mansa, in the northern Indian state of Punjab, and gestures dismissively at the three acres of wheat that will soon yield to cotton plants, which bring in little profit.
“Cotton is a complete failure for us,” she said. Prices are low, and the cost of producing the fibre is far too high.
It’s what drove her father, Gurnam Singh, to take his own life nearly five years ago on the same plot of land that defeated him, driving the family to the edge of economic ruin, she says.
“Life is still very tough without him here,” Kaur, 25, told CBC News. “But that first year after his death almost destroyed me and my family.
“I dropped my studies and sat at home. The world blacked out for me. I have no recollection of the 10 days that followed his death.”
What fills Kaur with guilt is that she didn’t see it coming. Her father was one of her best friends, and yet, he kept the crippling debt he was struggling to manage hidden from her and the family.
“When he died, things were falling apart,” acknowledged Shinderpal Kaur, Kiran’s mother.
She knew about the massive loans her husband had taken out to pay for their eldest daughter’s wedding and to cover medical treatment for Kiran. Even so, the notion that her husband would kill himself never entered her mind.
“I never thought [the suicide crisis] would hit me,” Shinderpal said. “Not in my wildest dreams.”
The crisis is deeply felt in Mansa, one of the poorest districts in Punjab, which is often referred to as the country’s breadbasket, because of its rich soil and rice fields.
Nearly every village here has had a string of suicides over the past few decades, but the problem goes beyond the district and even the state.
Bankruptcy, debt major factors
As in the rest of the world, the agriculture sector in India is hit disproportionately hard by suicide. Sixty per cent of the country’s population works in agriculture.
The latest data from the National Crime Records Bureau shows more than 10,000 farmers and agricultural labourers killed themselves in 2019 — that’s 7.4 per cent of India’s total suicide victims. (As a comparison, students also made up 7.4 per cent while civil servants accounted for 1.2 per cent.)
That means an average of 28 suicides in India’s farming community every day.
WATCH | How one Punjabi woman is dealing with the death of her father:
Hidden behind the headlines of the massive farmer protests in India is a suicide crisis that’s devastating families. The latest numbers show 30 farmers die by suicide every day in the country. 4:00
While there’s rarely just one factor that leads to suicide, the root causes for the suicides among India’s farmers highlighted in the government’s data are mainly linked to despair over their livelihoods. That ranges from bankruptcy and debt to farming-related issues and crop failure.
The crisis is spread across two dozen of India’s states, with the highest number of agricultural suicides in the densely populated Maharashtra state. But it is particularly acute in Punjab, where farmer suicides have increased more than tenfold in the past five years.
The state was transformed in the mid-1960s by the Green Revolution, when the government introduced subsidies to encourage farmers to grow high-yielding rice and wheat varieties that eventually led to the country becoming self-sufficient in those grains.
But over the years, problems started to accumulate. All those water-intensive paddy fields led to the depletion of the area’s groundwater. Many farmers poured money into digging deeper wells and into pesticides to protect their crops, but their costs spiralled, leading to crushing debt for many.
‘A social phenomenon’
Decades in the making, it’s such a deep-rooted crisis that many farmers take their own lives by consuming a pesticide called Sulfas. In Haryana state, the phrase “consuming Sulfas” has become shorthand for suicide.
“It’s become a social phenomenon,” said Vikas Rawal, an economics professor specializing in agrarian distress at New Delhi’s Jawaharlal Nehru University. He noted that references to Sulfas have also turned up in songs dealing with the plight of India’s farmers.
“It’s a loss-making enterprise, but these farmers don’t have anything else to do, so they just keep doing it,” Rawal said. Jobs are scarce, and many people are also reluctant to give up even the smallest plot of land their families own to work for someone else. Rawal said they end up having few options but to descend further into debt.
He said up to 90 per cent of India’s farmers can’t cover the basic costs of fertilizer, seeds, pesticide and other equipment.
“Your cost of production has gone up and then you’ve been made to compete with the world,” Rawal said, especially with the majority of India’s farmers tilling tiny plots of land.
“That has squeezed incomes of farmers so much that basically they’re being forced to commit suicide.”
‘We never had a happy day’
Kiran Kaur’s family in Mansa has been especially hard hit. Her father was one of three brothers out of four who took their own lives, leaving behind three widows and their young children.
Kiran’s aunt Malkeet lost her husband to suicide 17 years ago, when their two sons were eight and 10 years old. The years since have been difficult, she said, wiping away tears, with a nephew taking care of the fields because her children were too young.
It took five years before anyone explained to Malkeet how to apply for her government-issued widow’s pension. Once she got it, it only came intermittently, disappearing inexplicably for years at a time before being re-introduced.
The pension is the equivalent of $ 12 Cdn a month.
“It’s a pittance and makes little difference anyway,” Malkeet Kaur said wryly.
Another of Kiran’s aunts, Gurmeet Kaur, sat staring into the distance during our interview, clearly still mourning her husband, Gumdoor. He took his life two years ago, on New Year’s Day.
“We never had a happy day,” Gurmeet told CBC. “The daily struggle basically destroys you.
“We used to think we were doing all this work for our children. But once the father dies, the children are burdened.”
She also said she felt betrayed by nature when bad weather led to crop failure.
No national prevention strategy
India’s suicide rate was 12.7 per 100,000 as of 2019, according to the WHO, but experts have said the actual numbers are likely far higher than the official figures because of the stigma in a country where trying to take your own life is still listed as a crime in the penal code.
The country also lacks a national suicide prevention strategy, although some initiatives are folded into India’s mental health plan. In 2016, the Modi government introduced a crop failure insurance program in an attempt to address a spate of farmer suicides following a lengthy drought.
WATCH | Indian farmers hold firm in protests over agricultural laws:
For nearly four months, farmers in India have held protests to oppose new agricultural laws they say will strip them of their livelihoods. But the government has only offered them only a few concessions, and the protesters say they won’t back down until there are more changes. 2:32
The fact that India, like nearly every other economy, has been hobbled by the coronavirus pandemic and strict lockdowns has drastically compounded the suicide problem, according to Rawal.
He also fears the potential impact of Prime Minister Narendra Modi’s new farm laws, which have prompted months of protests, has also driven up suicide rates.
In September, India abruptly transformed the way the country’s massive agricultural sector works, passing new laws that reduce the role of the government in grain markets in an attempt to modernize the industry. It’s a move the farmers fear will push prices down and further ruin livelihoods.
“Having fought for so long to survive … [they] just don’t see this government giving a damn about it,” Rawal said. “That’s forced some people to actually take their lives there in the protest sites or when they went back home.”
It’s estimated several hundred farmers have died at the three large protest camps currently surrounding India’s capital, New Delhi, but it’s unclear how many of those killed themselves.
As a result of the severe backlash, the proposed laws are now on hold, but tens of thousands of farmers are still camped out in protest, pushing for a complete repeal of the legislation.
‘There needs to be reform’
The standoff is in its fourth month even though both sides know the system as it stands is unsustainable, said Harish Damodaran, agriculture editor at the daily newspaper The Indian Express.
“Everyone agrees that there needs to be reform … that this cannot be sustained forever,” Damodaran said. “Even the farmers themselves.”
But he said the Modi government’s error was not moving slowly and prioritizing financial incentives for India’s farmers to diversify the crops they grow.
“It has to be done very sensibly, very carefully, very sensitively. No reform is possible without consulting the stakeholders,” Damodaran said.
The protesting farmers see the so-called black laws as a path to allowing large corporations in and a means to decimate the traditional “mandi” system, which guarantees a minimum price for their produce.
“We’re not going to leave until we get what we came here for,” said Surinder Singh, who has a small farm in Punjab, while sitting near his chai stand at Singhu, the largest protest site surrounding Delhi.
“We know we’ll be here for the long haul, years if needed,” Singh said. He said the harvest will continue to be done by others at home, allowing the protesters to stay put.
“We will win this war,” he said.
Helping widows ‘to be heard’
Even with the regulated minimum price for rice and wheat in some areas, many farmers are barely making ends meet. The fact it could disappear is a devastating thought for many at the protests.
Many don’t trust the Indian government, which has promised it will not get rid of the floor price. Kiran feels that fear whenever she walks around the protest camp.
She often visits a community kitchen set up by a rotating group of widows at the Singhu camp. On one recent visit, the women were making rotis for other protesters, loudly joking that India’s prime minister should come visit and speak to them directly to truly understand the life of an Indian farmer.
After the loss of her father, Kiran started an organization to help widows in her home state. She now buses around Punjab, meeting widows and their families to explain the services available to them, and to emotionally support those “teetering on the brink” and contemplating suicide.
She sees it as another way to honour what her father would have wanted for her.
“The government does not care,” Kiran said. “Nobody wants to talk to or listen to the widows or the families of suicide victims.”
Hearing the stories, day after day, of widows struggling is not easy, but it gives Kiran strength. “It furthers my resolve to fight for them, to help them be heard.”
WATCH | The world reacts to farmers’ protests:
Supporters of farmers protesting for months in India are grateful for the international response to the movement. But there are others who think the outside world shouldn’t meddle with India’s affairs. 2:42
If you are thinking of suicide or know someone who is, help is available nationwide by calling the Canada Suicide Prevention Service toll-free at 1-833-456-4566, 24 hours a day, or texting 45645. (The text service is available from 4 p.m. to midnight Eastern time).
If you feel your mental health or the mental health of a loved one is at risk of an immediate crisis, call 911.
Kim will never forget the moment the specialist touched her arm and believed her.
She had been living with excruciating pain for more than half her life, yet, she says, a long list of doctors had either misdiagnosed or dismissed her condition.
It was only when she was treated at a special unit of B.C. Women’s Hospital in 2017 that she felt understood.
“For the first time someone from the medical community was telling me: ‘Not only do I believe you but I also have successfully treated other patients. Let’s give it a try and if it doesn’t work, I will not abandon you,'” she said.
Kim, 34, has endometriosis, a condition that is still widely unknown even though it affects one in 10 women around the world and more than a million in Canada, according to advocacy group EndoAct.
Endometriosis occurs when tissue similar to the lining of the uterus implants in the pelvic cavity outside the uterus to form lesions, cysts and other growths, according to Endometriosis Network Canada. This can cause pain, internal scarring, infertility and other medical complications.
Each case is different. There is no cure. Those who have it need to learn to live with it. The pain may briefly lessen, but it is only a matter of time before it comes back with a vengeance.
‘There are a lot of unanswered questions’
Kim — CBC is not using her real name — agreed to talk on the condition of anonymity, because she tries to hide her condition whenever possible. She feels like her condition already takes up too much space in her life.
”It feels like someone is stabbing you in your vagina with a knife, while there is another knife moving through your uterus and ovaries,” Kim said, adding the pain then moves to her hips and can extend all the way down to her ankles, preventing her from walking.
WATCH | Journalist and poet Danielle d’Entremont describes the pain of endometriosis:
Ever wonder what endometriosis can feel like? Watch this video by journalist and poet Danielle d’Entremont. 1:59
Much about the condition is still unknown.
“It is complex because there are a lot of unanswered questions. We do not completely understand how endometriosis starts,” said Dr. Catherine Allaire, medical director of the Centre for Pelvic Pain and Endometriosis at B.C. Women’s Hospital in Vancouver, where Kim was diagnosed after many years of searching.
Allaire’s centre is one of the few in Canada that takes an interdisciplinary approach to the condition. Patients here can see not only a surgeon but a fertility specialist, a nurse and physiotherapist to help deal with chronic pain, and a psychologist to address mental health, among others.
The waiting list for treatment is about six months once a patient gets a referral. But getting that referral can take a much longer time, such are the misconceptions around endometriosis. Kim says it took her seven years.
More support, funding and research is needed into the condition and those who suffer from it, experts and advocates say.
In the past 20 years, only $ 7 million has been spent on research into endometriosis in Canada, Allaire said. Diabetes, another chronic disease, received 150 times more in public money.
She says that’s because endometriosis doesn’t kill — and because it doesn’t affect men. With a bitter laugh, Allaire said she’s pretty sure a cure would have been found 50 years ago if endometriosis affected men.
Pushing for a plan
EndoAct is now bringing together people living with endometriosis and professionals in the medical community in order to get governments to move forward on support and research.
“There’s a need to advance our understanding about basically everything,” says Kate Wahl, the volunteer executive director of EndoAct Canada and a PhD student at the University of British Columbia.
“You’ve got the cause of the condition, non-invasive methods for diagnosis, personalized treatment, patient-centred care … so many things that would benefit from further investigation.”
EndoAct’s ultimate goal is to have a national action plan like the one that exists in Australia — a three-pillar strategy that focuses on increased education, improved clinical management and care, and research.
Asked if a national action plan for endometriosis was in the works in Canada, a Ministry of Health spokesperson replied that the federal government is funding nine research projects on the condition to further understanding, diagnosis and treatment.
”Women’s health is a top priority, and we are committed to improving health care for women, girls, and transgender individuals,” the spokesperson said.
‘They don’t believe you. They don’t listen to you’
In Kim’s Vancouver apartment, painkillers are strategically placed by the entrance, in the living room, in the bathroom and on her bedside table. She needs to access them quickly when a bout of crippling pain occurs.
Her couch is close to the heating pad, towels and castor oil she uses to wrap herself in to calm the pain. She makes sure her fridge and freezer are stocked with a week’s worth of food, just in case.
“When I leave my house I can forget my cellphone — but my medication? No. I never leave my house without my painkillers,” she said.
Kim says the first three times she had her period, when she was 13, she ended up in hospital from pain so severe it caused her to vomit and faint.
Yet for years she thought the pain related to her period was normal. She says she saw doctor after doctor who told her so. They never mentioned endometriosis.
“They don’t believe you. They don’t listen to you. They don’t do followups. They do not take you seriously,” she said.
She tried several treatments, from birth-control pills and hormones to ever-stronger painkillers. She says one gynecologist even advised her to have a baby, as that could reduce the pain.
“Really? What do I do with the baby after?” she recalls asking him.
Kim found some comfort in support groups for people with endometriosis. She says she noticed a common theme when she was meeting with her “endo sisters”: they were all, at some point, not believed.
She thinks her condition would have been easier psychologically had she not had to fight against a health-care system that didn’t appear to recognize her condition. Falling into deep depression, she even started to doubt herself.
So when a diagnosis of endometriosis was confirmed after she opted to have surgery at B.C. Women’s Hospital, she was tremendously relieved.
“To have that diagnosis, like a paper confirming something that nobody sees, that changed a lot for me,” she said.
“I have my certificate. I am not crazy.”
‘Periods should never prevent you from functioning’
The centre for pelvic pain and endometriosis is now trying to catch cases of endometriosis early, so that girls who have abnormal period pain can consult a doctor to get help and, hopefully, avoid the downward spiral that leads toward chronic pain.
A pilot project in a New Westminster, B.C., school — currently on hold because of the pandemic — is teaching students about endometriosis, while a social media campaign is scheduled to be launched this spring to teach girls about what constitutes a normal period.
“What I usually say is that periods should never prevent you from functioning,” Allaire said.
“You may have to take an analgesic like ibuprofen, but then you should be able to go to school and do your activities. You should not have to plan your life around your period. When it interferes with your life and you have to miss school and work when you have your cycle, that is not normal.”
Allaire has met many young women whose lives are completely dictated by endometriosis. They had to miss classes and their grades suffered; they couldn’t choose the career they wanted. Some had pain during sex, others had fertility problems, others had chronic pain.
Around 60 per cent of the patients at the Vancouver clinic suffer from depression and anxiety, Allaire said.
The centre has been able to help about four out of every five of its patients, she said.
“They do better, have less anxiety and depression. The symptoms are better. They are still there, but the women have a better quality of life.”
For many, however, the only hope for respite from the pain comes from menopause — as the majority of women with endometriosis are shown to experience fewer symptoms afterward.
The surgery Kim underwent to diagnose her condition also attempted to alleviate her pain by removing some endometrial tissue. Unfortunately, it didn’t work. In fact, she says, it made it worse, causing her to fall into the deepest depression of her life.
But still, she says, she doesn’t regret the surgery because she needed the validation of the diagnosis.
Now, a few years later, she has learned to live with the pain. Part of that involves a healthy work-life balance, with regular sleep — pain permitting.
Her story is far from unique. But Allaire is determined to make sure more people don’t suffer like Kim has.
”Those life experiences are not acceptable. We need to do something to change that,” Allaire said.
As COVID-19 surged across Canada, many operating rooms were idled, freeing up needed space for infected patients and redirecting medical staff and students to care for them. But the unprecedented move came at a cost.
“Learning has essentially ceased for a lot of the surgeons around the world,” Dr. Danny Goel said.
The orthopedic surgeon saw the problem as an opportunity for an idea germinated when he met two video game developers in a Vancouver pub in 2016. They got talking, and PrecisionOS was born.
In the months following that initial conversation, the small team built an elaborate virtual reality trainer, where medical students and surgeons could hone their tactile craft repeatedly and realistically by donning goggles and using simulated scalpels, surgical drills and other tools. All while physically distanced, and practiced on an artificial patient who wouldn’t get hurt if they made a mistake.
The system was unveiled in 2018, and interest has grown over the past year as the pandemic has closed ORs or restricted surgeries. The technology has now been adopted by 22 medical schools and health systems across North America.
“I was amazed at how realistic it was,” said Dr. Peter Ferguson, the head of orthopedic surgery at the University of Toronto’s Temerty Faculty of Medicine, who first tried the goggle-based VR system in his living room.
“I went to our faculty and I said this is something that we really have to get on board with.”
The medical school soon bought a dozen of the made-in-Canada virtual reality systems, allowing surgical residents to practice knee replacements, resetting broken legs, or drilling into bone to install supportive screws, all through a simulated process Dr. Ferguson describes as “a blast.”
He sees the system as an opportunity to reduce risk, even beyond COVID-19. For instance, in hospitals where medical students are taught, studies have shown patients are more likely to experience problems post-surgery.
“That’s a fact,” says the surgeon for the largest health network in Canada. “So if we can decrease that incidence of complications by allowing these individuals to become more competent in this low-stakes environment, it will theoretically improve patient outcomes.”
A big shift for game developers
The two developers behind the complex graphics and VR technology are veterans of Vancouver’s video game industry.
Colin O’Connor and Rob Oliveira spent years creating blockbuster games including Need For Speed, Sleeping Dogs and NHL hockey titles.
Now they’re focused on mirroring the experience and look of an operating theatre.
“It improves the confidence of surgeons or residents,” O’Connor said. “If they haven’t done a certain technique for many, many months, they can go into the OR in VR and they can train up on that technique again, and then go and operate on that procedure the next day with a higher level of confidence.”
It’s been a big shift for Oliveira to go from designing popular video games to creating detailed simulations for cutting into flesh and bone. The transition, he says, is “blowing my mind. It’s great to be able to transfer some of this technology so it serves a higher purpose.”
It takes up to six months to build a surgical teaching module from scratch. All the visuals are developed in-house and the workflow is identical to building a video game.
However, the team also had to educate themselves about the medical device industry to understand the challenges surgeons face. They attended real surgeries to witness in-person the procedures they would be simulating. And they mine expertise from a group of nearly 100 medical consultants from around the globe.
WATCH | Dr. Danny Goel uses the PrecisionOS surgical simulation to demonstrate a procedure called a revision knee arthroplasty on a virtual patient:
Dr. Danny Goel uses the PrecisionOS surgical simulation to demonstrate a procedure called a revision knee arthroplasty on a virtual patient. 0:31
To make the animation as realistic as possible, O’Connor designed a simulation that allows a surgeon to saw, ream or drill at any location or angle inside the virtual patient, and have the effects of that action to the bone and soft tissue displayed in real-time.
PrecisionOS was recognized as Start Up of the Year 2019, an award sponsored by Microsoft, and won the highly competitive Global EdTech and VR awards in 2020, sponsored by Reimagine Education.
Dr. Goel gives part of the credit to the company’s local environment.
“The success of this story is highly contingent on its location,” he said, “Vancouver has really sort of led the charge on game development, film and computer graphics. And I think that marriage between medicine and technology is unique to our city here.”
“Vancouver has been a tech hub for game development,” added O’Connor. “They’re hiring a lot of artists and they’re hiring a lot of programmers … so there’s a whole ecosystem that’s being built up here.”
Keeping skills and confidence sharp
With some surgeries postponed due to COVID-19, third-year University of Toronto surgical resident Maegan Shields has fewer opportunities to perfect her skills. In an operating room idled by pandemic demands, she slips on the PrecisionOS VR goggles, picks up a set of tool-paddles and does simulated surgery on the hip of a virtual patient.
“It’s a pretty impressive technology,” Dr. Shields said after her first experience doing that procedure in VR. “I think it has a lot of potential, especially right now with all this cutting back on OR time.”
She deftly works around muscle tissue to take aim at a fractured hip. And she’ll do this same process over and over, honing her technique.
“If there’s anything you can do to sort of become a little bit more efficient at knowing the steps,” she said, especially in a “low risk, low stakes environment,” it’s helpful.
Her instructor, Dr. Ferguson, is quick to note the VR technology does not replace the real thing. It’s a less tactile experience, in a profession where touch and feel are integral to locating anatomy and identifying medical issues, for example.
But he adds that it’s much better than any simulation doctors and students previously had. And, during a pandemic, it’s better than the alternative, which would often be to do nothing and risk having a doctor’s surgical skills and confidence atrophy.
“It’s significantly so much more important now that we are able to educate physicians from all over the world on how to perform surgery safely, and do it in a digital way where travel and meeting in labs is just not possible,” Dr. Goel said.
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Haitian President Jovenel Moise announced Sunday that police have arrested more than 20 people he accused of trying to kill him and overthrow his government, including a Supreme Court judge who has the support of opposition leaders demanding that Moise step down.
Moise spoke at Haiti’s airport in Port-au-Prince, flanked by the country’s prime minister and the police chief as he prepared to leave for the southern coastal town of Jacmel for the opening ceremony of its yearly carnival, which is being held amid the pandemic.
“There was an attempt on my life,” he said.
Moise said the alleged plot began on Nov. 20 but did not provide further details or any evidence except to say among the people arrested is a judge and an inspector general with the police. Moise then said other high-ranking officials would provide more information but they all walked away and did not speak further to reporters.
Prime Minister Joseph Joute said later in the day Sunday that authorities found several weapons and a speech that Supreme Court Judge Yvickel Dabrezil had allegedly prepared if he were to become provisional president. Dabrezil is one of three judges that the opposition favours as a potential transitional president.
Meanwhile, Justice Minister Rockefeller Vincent accused the inspector general of being in touch with high-ranking security officials at the National Palace over an alleged plot to have the president arrested.
Andre Michel, one of Haiti’s top opposition leaders, held a press conference hours after the arrests and called for civil disobedience and demanded that Moise be arrested. Michel, an attorney, said it was illegal to arrest Dabrezil because he has automatic immunity.
Reynold Georges, an attorney who once worked as a consultant for Moise’s administration but has since joined the opposition, denounced the arrests in an interview with radio station Zenith FM.
“We ask for his release immediately,” he said of Irvikel Dabresil, the Supreme Court judge who is being detained, adding that the court system should shut down until he’s free.
Georges also called on people to rise up against Moise.
Also arrested was Police General Inspector Antoinette Gauthier, according to a statement from the Young Bar Association of Port-au-Prince, which accused Moise’s administration of sowing terror and said Sunday’s actions should not be tolerated.
The arrests come on the day that opposition leaders claim Moise should resign, saying that his term ends on Sunday. Moise has repeatedly stated that his five-year term ends in February 2022. Former President Michel Martelly’s term ended in 2016, but a chaotic election forced the appointment of a provisional president for one year until Moise was sworn in in 2017.
The opposition has organized recent protests demanding that Moise step down, and normally congested streets in Haiti’s capital and elsewhere remained empty on Sunday as a handful of demonstrators burned tires.
Meanwhile, Moise appears to have the support of the administration of U.S. President Joe Biden. Ned Price, a U.S. State Department spokesperson, said Friday that the U.S. has urged Haiti to organize free and fair elections so that Parliament can resume operations, adding that a new elected president should succeed Moise when his terms ends in February 2022.
Moise is currently ruling by decree after dissolving a majority of Parliament in January 2020 after no legislative elections were held. He is planning an upcoming constitutional referendum in April that critics say could award him more power, while general elections are scheduled for later this year.
After arriving in Jacmel, Moise broadcast an address that lasted more than an hour. He spoke largely about the infrastructure projects that his administration has accomplished, but also called on the opposition to work with him.
“It’s not too late,” he said, rejecting accusations that he is on his way to becoming a dictator. “I’m not a dictator. Dictators are people who take power and don’t know when they’re leaving. I know my mandate ends on Feb. 7, 2022.”
As many as 150 people were feared dead in northern India after a Himalayan glacier broke and crashed into a dam early on Sunday, with floods forcing the evacuation of villages downstream.
“The actual number has not been confirmed yet,” but 100 to 150 people were feared dead, said Om Prakash, chief secretary of Uttarakhand state where the incident occurred.
A witness reported a wall of dust, rock and water as an avalanche roared down a river valley.
“It came very fast; there was no time to alert anyone,” Sanjay Singh Rana, who lives on the upper reaches of Raini village, told Reuters by phone. “I felt that even we would be swept away.”
Locals fear that people working at a nearby hydro-power project had been swept away, as well as villagers roaming near the river looking for firewood or grazing their cattle, Rana said. “We have no idea how many people are missing.”
Prime Minister Narendra Modi said he was closely monitoring the situation.
“India stands with Uttarakhand and the nation prays for everyone’s safety there,” he said on Twitter after speaking with the state chief minister.
Air force joining rescue effort
India’s air force was being readied to help with rescue operations, the federal government said, while Home Minister Amit Shah said disaster-response teams were being airlifted in to help with relief and rescue.
“All the concerned officers are working on a war footing,” Shah said on Twitter, referring to Uttarakhand by its nickname, the Hindi term for “land of the gods” — due to the numerous Hindu temples and pilgrimage centres located across the state.
The neighbouring state of Uttar Pradesh, India’s most populous, also put its riverside areas on high alert.
Footage shared by locals showed the water washing away parts of the dam as well as whatever else was in its path.
Videos on social media, which Reuters could not immediately verify, showed water surging through a small dam site, washing away construction equipment.
“The flow of the Alaknanda River beyond Nandprayag (stretch) has become normal,” Uttarakhand Chief Minister Trivendra Singh Rawat said on Twitter.
“The water level of the river is now one metre above normal but the flow is decreasing.”
Criticism of dam’s construction
Uttarakhand in the Himalayas is prone to flash floods and landslides. In June 2013, record rainfall caused devastating floods that claimed close to 6,000 lives.
That disaster was dubbed the “Himalayan tsunami” by the media due to the torrents of water unleashed in the mountainous area, which sent mud and rocks crashing down, burying homes, sweeping away buildings, roads and bridges.
Uma Bharti, India’s former water resources minister and a senior leader of Modi’s party, criticized the construction of a power project in the area.
“When I was a minister I had requested that Himalaya is a very sensitive place, so power projects should not be built on Ganga and its main tributaries,” she said on Twitter, referring to the main river that flows from the mountain.
We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received more than 65,000 emails from all corners of the country.
Why is there no flu but so many COVID cases?
According to the Public Health Agency of Canada’s most recent weekly Flu Watch report “all indicators of influenza activity remain exceptionally low for this time of year.” In fact, there were no laboratory detections of influenza in the first three weeks of 2021.
So why are flu numbers so low but COVID-19 cases surging in many parts of the country?
There are a number of reasons.
“Influenza is way behind the eight ball here,” said Dr. Gerald Evans, chair of infectious disease in the department of medicine at Queen’s University in Kingston, Ont., in a recent article.
For one, SARS-CoV-2 — the virus that causes COVID-19 — is more prevalent because it got a head start, settling into communities before flu season got going.
Experts also credit the public health measures taken to slow COVID-19 — the hand washing, physical distancing and mask-wearing — as well as the dramatic drop in international travel.
Dr. James Dickinson, a professor of family medicine at the University of Calgary’s Cumming School of Medicine, who also runs the Alberta community influenza surveillance program, said that other countries are seeing the same trend.
“We’re not getting any [flu] coming in because we’re just not getting enough people arriving, bringing the flu with them,” he told the Calgary Eyeopener, adding that the places they’re coming from don’t have any flu either.
In addition, many Canadians heeded the health warnings to get their flu shot. Although Canadian provinces ordered almost 25 per cent more flu shots than last year, many struggled to keep up with demand.
When it comes to testing, the PCR tests for COVID-19 detect the virus’s genetic material, so they won’t be tricked by a case of the flu, and vice-versa. Health Canada says a suspected case of the flu becomes a “lab-confirmed case” only after certified lab personnel tests a sample and confirms that the flu virus is present. You can find answers to more common testing questions here.
Why aren’t vaccine providers wearing gloves?
While you may see vaccine providers wear personal protective equipment — medical masks, gowns, face shields or goggles — you won’t always see them wear gloves.
That’s because gloves are not a part of routine infection control practices when delivering most forms of immunizations.
According to the Public Health Agency of Canada (PHAC), gloves are “not recommended” unless the vaccine provider’s skin is broken, like with cuts or blisters, for example, or when administering certain kinds of vaccines, such as smallpox.
The advice is the same in the U.S. with the U.S. Centers for Disease Control advising that gloves aren’t necessary unless vaccine providers are “likely to come into contact with a patient’s body fluids.”
Instead, vaccine providers are required to perform hand hygiene measures before vaccinating each person, such as washing with soap and water or using alcohol-based hand sanitizers, and whenever the hands are dirty.
If gloves are worn, PHAC says they should be changed between each vaccine recipient.
The important point to note is that the virus that causes COVID-19 can’t be transmitted via skin-to-skin contact, said Dr. Sumon Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.
“Obviously health-care workers should wash their hands before doing a procedure of any kind,” Chakrabarti said in an email, but for COVID precautions “the highest-yield interventions are to physically distance, wear masks when indoors, and ensure good ventilation.”
Gamers around the world spend eight years waiting for CD Projekt Red to release Cyberpunk 2077. CDPR is coming off a massive success with The Witcher 3, and the Cyberpunk trailers made the game look incredible. No game could live up to all that hype, but Cyberpunk 2077 is still underperforming in its current state. Gamers have griped loudly about the bugs and performance issues, and there’s a new issue to note today: if you collect too many in-game items, your save file will break forever.
CDPR marketed Cyberpunk 2077 as an RPG, but many players have noted that it plays more like an action game with some role-playing elements. One of those elements is the plethora of loot you collect. You can disassemble most items to get crafting materials, which is the only way to obtain some of the game’s best gear. The problem, however, is that each item in your inventory makes the save file a bit bigger. CDPR set an 8MB size limit for save files, and when you exceed that, the file just stops working.
Like the event horizon of a black hole, CDPR support says there’s no way to restore a save file that crosses the 8MB limit. While a future patch “might” raise the file size cap (I would hope “definitely” is more accurate), that won’t fix your save files. The developers suggest going back to an earlier save that wasn’t over the limit and clearing out your inventory. Yes, it’s not a very good solution.
Cyberpunk has some great visuals, but the bugs are out of hand.
Threads on the GOG forums and Reddit have confirmed this is a concern for the PC version of the game, and some claim to have seen the same issue with the console versions. Although, console performance is so bad right now that I’d assume fewer gamers have been able to collect enough items to break their games. Some also suggest this was fixed with the v1.05 patch that started rolling out on consoles recently. The PC version is still waiting on this update, which could explain why almost everyone reporting save issues is playing on PC.
While most players won’t encounter the glitch, it’s not that hard to break your save files. I’ve done just a little crafting after about 15 hours in Cyberpunk, and my save files are coming up on 4MB. You may get a little warning if your save file is near the breaking point — some players say their game takes much longer to load if the save is near the file size limit. You can check on your files sizes in C:\Users\[username]\Saved Games\CD Projekt Red\Cyberpunk 2077.
After several days of silence, perhaps the only surprising thing about Russian President Vladimir Putin’s denials Thursday that his secret police played a role in poisoning a political opponent was that he punctuated his comments with an uncomfortable-sounding chuckle.
“Who needs him?” Putin said of political foe Alexei Navalny during a news conference, laughing as he dismissed news reports that members of Russia’s federal security service, the FSB, specializing in nerve agents, followed Navalny during a trip to Siberia in August, where he was poisoned by the nerve agent Novichok and nearly died.
“If someone had wanted to poison him, they would have finished him off,” said Putin, returning to the well-worn Kremlin talking point that Russia’s secret services are too good to make such clumsy mistakes.
Putin denigrated Navalny as a nobody striving for political legitimacy, even providing a mocking imitation of his rival.
“Pay attention — it means I am a person of the same calibre [as Putin],” he said.
While the revelations about the FSB’s activities, published earlier this week by several Western news outlets, have enthralled many in the West, the Navalny case has long been largely ignored by the Russian media — and so, perhaps not surprisingly, by many Russians as well.
Navalny was airlifted to a hospital in Berlin shortly after he was poisoned on Aug. 20, and has remained in that country even as his crusade against Putin has continued.
A lawyer by training, Navalny is one of the very few political figures in Russia who has directly challenged Putin’s authority and risked his own life and security by organizing mass protests. Yet, while his investigations into corruption involving senior members of Putin’s inner circle have been viewed tens of millions times on YouTube, he remains a polarizing figure.
Many Russians appear to believe Putin’s claim that Navalny works for foreign intelligence agencies, and even some Western-leaning liberals see him as a divisive figure who has failed to create a strong anti-Putin coalition.
The new revelations in the Navalny case come via a detailed investigation led by the international journalism collective Bellingcat.
Its investigative team says the findings were procured from data that can easily be purchased on the black market, including cellphone records and passenger flight logs.
The findings include evidence suggesting Russia’s secret police have used a special unit to trail Navalny since 2017, following him to 37 different locations around Russia. Bellingcat alleges it tracked the cellphone usage of several members of the team and those records put them with Navalny at the time he was poisoned in Siberia.
The journalists even released photos of the men, as well as their aliases and work and home addresses. A CNN reporter knocked on the apartment door of one of the men, but he quickly shut it after she introduced herself.
Bellingcat also alleges the men reported to a senior officer who was once associated with the Novichok nerve agent program, and that the chain of command led straight to Putin himself.
At Thursday’s news conference, Putin didn’t deny that Russian agents could be tracked by their cellphones, or that they may have had reason to keep an eye on Navalny.
“Don’t we know that [foreign intelligence agencies] track geo-location? Our intelligence services fully understand that and know it,” said Putin, as he repeated his claim that Navalny himself must be an agent of the U.S.
“It’s not an investigation — it is the legalization of data from the U.S special services,” Putin said.
Putin’s constant refusal to discuss Navalny has seen him resort to using different descriptors rather than simply saying Navalny’s name.
On Thursday, Navalny was the “Berlin clinic patient.”
While the allegations about the FSB’s activities have been widely reported outside of Russia, within the country itself, it’s an entirely different story.
Until Putin’s comments Thursday, state TV programs ignored the story. Even the social media feeds of many of the Kremlin’s usual critics have been quiet on the topic.
At the news conference in Moscow, the CBC approached several prominent Russian journalists to ask why.
“I think Western media just pays too much attention to this person,” said host Mikhail Akinchenko of Channel One, borrowing Putin’s technique of not referring to Navalny by name.
“He’s not so interesting for our news agenda as for you, maybe because he’s not [such a] significant person for us.”
WATCH | State TV journalist explains lack of coverage of Navalny case:
Russia Channel 1 political host Mikhail Akincheko explains why Russian state TV is ignoring the poisoning of Kremlin foe Alexei Navalny. 0:51
And what of the evidence that suggests the FSB may have tried to kill Navalny?
“Only that person who does not know the real situation in Russia,” would take the poison allegations seriously, Akinchenko said.
“It can’t happen in real life.”
Navalny and his supporters have been arrested repeatedly by Russian police for organizing anti-Putin protests. He’s also been physically attacked and had corrosive green paint thrown in his face.
A video Navalny posted this week, in which he directly accused Putin of being complicit in his attempted murder, had already been viewed more than 10 million times by the time the Russian president addressed the news conference.
Nonetheless, there’s also persuasive evidence that the Kremlin’s efforts to marginalize Navalny and minimize his political impact have been effective.
A survey conducted in late October by respected independent pollster the Levada Center suggests 55 per cent of Russian respondents said they don’t believe Navalny was poisoned.
Of the one third who said they believe he had been poisoned, only a third of those said they believe the Russian state was behind it.
In the days after Bellingcat’s revelations were released but before Putin spoke about them, the CBC visited the community of Zvenigorod, a town of about 15,000 people located 70 kilometres west of Moscow.
Former railway worker Alexy Provorovsky, 39, stopped to talk on his way out of church but, like many people, was reluctant to discuss the Navalny story directly.
“I don’t really want to say anything about this,” he said. “[People] are only thinking about their families and their close ones now. They only think about themselves, just to survive.”
Elena Pomina, 30, said she was only vaguely aware of the Navalny case and what might have happened to him.
“I’m not for or against him. It’s not really my business,” she said.
Younger Russians who spoke with the CBC were generally more aware of the details and more sympathetic toward Navalny.
WATCH | Putin laughs off accusations of Kremlin-controlled hit against Navalny:
Russian President Vladimir Putin laughed off damning new allegations that a Kremlin-controlled hit squad uses nerve agents to eliminate opponents, including Alexei Navalny. 1:59
Daria Generalova, an 18-year-old artist who works in a gift shop in the town, said the government’s comments that Navalny might not have been poisoned aren’t credible.
“It can’t be that a person who is healthy like this, and quite young still, that he just suddenly falls so ill,” she said.
“It’s awful. It’s even frightening, actually.”
Levada pollster Denis Volkov told a forum earlier this week that support for Putin is strongest among the older generation that still gets their news from state TV sources, while younger people who rely on the internet are far more likely to favour Kremlin outsiders, such as Navalny.
After Putin’s news conference, Navalny was sounding pleased with how his week had gone.
“Of course they can’t open a criminal case now, because this would be a criminal case against Putin,” he told host Lyubov Sobol, one of his supporters, who was broadcasting on Navalny’s YouTube channel.
“And Putin, who is the king of lies, who can lie about anything no problem, even he in this situation can’t deny that there were FSB agents that followed me.”