How About This Presents PoP NB

A Q&A with the folks behind PoP NB and NB_COVID_INFO

Hello, this is a special Q&A post from How About This where we hear from some concerned people from the province of New Brunswick. PoP NB (Protect Our Province New Brunswick) and the affiliated Twitter account @nb_covid_info have contributed to a Q&A post that we are sharing here. The focus of the Q&A is COVID-19 and how it has impacted New Brunswick, as described by the individuals of PoP NB. We hope you find this Q&A to be informative and thought provoking.

---

Why was @nb_covid_info (Twitter account) created?

GNB used to only release the case counts (then, PCR only) for kids in one 0-19 lumped category, while all the other age ranges reported were in 10-year intervals. In August 2021, I realized it was possible to deduce the number of 0-9 and 10-19 PCR tests and positive cases (and also test positivity rates by age range) from the GNB Dashboard. As a parent of children under the age of 12, I felt there was a big difference between a child aged 12-19 and a child aged 0-11 (or by the categories, 0-9/10-19). For one thing, the vaccine was available to kids 12+ but wasn't yet available to anyone under 12. But the protections, rules, and restrictions were changing for everyone all the same, regardless of the fact that kids under 12 didn't have the option for the protection vaccines confer. It was actually my NS-based twitter friends whom I saw often mentioning that they felt people and families with members 12+ were able to relax, while for parents of kids under 12 it was still March 2020.

I'm from NB originally, but most of my closest friends went to university in NS, and many of them stayed there for well over a decade or are still there today. So for whatever reason, on my personal twitter account that I've had for many years, I follow a lot more HaliTwitter folks than NB twitter folks. My personal twitter has been private for a long time, like over a decade. So I mostly interacted with the same handful of folks, really just tweeting with a handful of childhood friends, and then their friends just happen to be mostly HaliTwitter people.

I didn't really know any NB twitter people before the pandemic. But I had been following Katy Jean, Raccoon at Home (who was at my 5th or 6th birthday party and is a human I've always liked and respected), a lot of the mainstays of HaliTwitter. And it was parents in their circle who were very honest and forthcoming about how it felt when everyone 12+ could get vaccinated, but not the younger kids. Now being in fairly rural NB, I hadn't really thought of it like that - for the first 15 months of the pandemic we were very well protected. Sure my life had changed - but I followed the rules and felt pretty safe. There was very little COVID where I was. And because my kids were the ages they were, my life was very simple anyway - we were busy, but it wasn't complex. Pre-pandemic we went to kids' activities, spent a lot of time with family, cooked a lot of meals at home, spent a lot of time getting kids to sleep, woke up to do it all over again the next day.

For me, my days of going out, travelling, all that stuff that really disappeared overnight for lots of people in March 2020 - that had already disappeared for me. I recognized that the pandemic affected everyone differently. Some of my friends were getting paid to stay home and they couldn't really work that well from home, but that didn't matter - they still got paid (and some played a lot of video games or threw themselves into hobbies - though I'm sure they were lonely and bored!). Some of my friends were risking their lives to go to work, and their family's health due to their exposures - sometimes having to still send their kids to childcare so they could work, which was stressful given the closures and the risks when everyone else got to stay safe at home for the most part.

Seniors and others who relied on visits from family and friends in really significant ways were incredibly lonely and at risk. And some parents with young kids were stuck trying to work from home full-time and also supervise and entertain their young kids, without the respite they normally got from activities or external childcare. I had friends with young kids who both had to work from home and both had to do it well - they couldn't slack off. They got up at 6, one of them worked the first half of the day while the other looked after the young kids, and after 8 hours they swapped. That's incredibly hard to do day after day. There was no 8pm exhausted-but-happy crash on the couch where they could zone out watching a show together or something. Just very lonely intensity either having to look after the kids (and keep them quiet-ish because mom is teleworking) and then working your own shift after. Having to stay at home and/or limit contacts affected everyone differently.

When I started thinking about it, it felt really important to me that the public be able to have access to the info regarding how many cases were circulating in the 0-9 age range. Because those kids can't be on their own. They have to be with a caregiver, or at daycare, or school, at all times. Kids in that age range are really vulnerable to whatever is going on in the wider community. And their health and safety is really connected with the health and safety of the caregiver, and vice versa, which we all eventually saw when so many kids in NB contracted COVID at school and that's how the parents or caregivers got COVID. I thought about who my kids came in contact with in 2019 - it was overwhelmingly other kids in that same age rage. Their friends, their cousins, the other kids aged 0-9 at swimming lessons and dance and at the Easter Bunny event in the local gym that was jam packed with heaps of people and had little ventilation... it was important to me to know how many cases were in the 0-9 range because if I was going to take my kids somewhere public, or put them in an activity, that's the age range they'd be encountering in this post-2020 world where we now have to consider highly infectious disease risks. The way GNB presented that data, they obviously had the 0-9 and 10-19 info separately but for whatever reason they were reporting it in one larger lump, which wasn't that useful to me. 

For the 12+ kids, their lives are really different too - I knew as soon as the pandemic hit that I was really lucky to have young kids (and luckily not under age two! Pandemic life with an infant or young toddler would have been super challenging too.). My kids were old enough that their immediate family was practically their whole world - they didn't really care about friends, as long as they could be with us and occasionally other family members, which made all the bubble stuff fairly easy to navigate compared to families who had tweens and teens. I thought about teens and tweens with their more complex social lives, the importance of their activities, their part-time jobs, all of that.

In our case, in late February 2020 we discussed what lifesaving measures we'd want done if we ended up in the hospital, and we made a plan where my partner could isolate within our house for a long time if needed - we were mentally prepared that we might not see each other for a while or that it might not be as safe to cohabitate in the same way. And this was quite common in healthcare worker (HCW) families. Maybe not as much in NB, but I'm connected with other HCW families in North America, and for parts of Canada and the US that were hit hard, many HCW did isolate from their families for weeks or months while going to work. We didn't end up having to implement that, thankfully! Some other local HCW did, because they had much more clinically vulnerable family members. If one had to work in person with the public, they stayed in a separate part of their home from the more vulnerable person.

I guess what I'm saying though, is that I've always been willing to approach this pragmatically and have not been afraid of the realities of COVID, in terms of being able to accept and deal with the fact that it has made some people's work lives risky, and we just reduce those risks and try to carry on. I was also in the background while people I've known - some for my whole adult life, others for just a few years - willingly volunteered to take the shifts on the COVID units, back when there were PPE shortages and vaccines weren't available yet. I was surrounded by people who had jobs to do, to take care of people and be part of the healthcare system, and regardless of the risks to themselves, they did their jobs (and more) - while being constantly exposed to the public, not being able to work from home. So I wanted to respect and protect those people by reducing the amount of cases in the community, and helping people to understand how transmission works.

We had already kind of been through a shade of this - my partner happened to be doing a rotation in pediatric respirology when H1N1 happened, at the IWK, and there was significant illness from H1N1 there. He had seen many kids very sick from viral illness - kids from all over the Maritimes who ended up there. He had seen the seriousness of it and how all-encompassing it can be when you are working in that environment during times of high transmission or high burden of disease from something like that - we had already been through that and faced it head on for what it was.

Fortunately in that case, it was a short rotation, and while H1N1 continued to be a serious threat it didn't affect everyone the same way that COVID has. Once he was done with that rotation, we were able to breathe a little easier, he wasn't working quite the same very heavy hours in those intense conditions. He ended up being a really big part of the care for those kids while he was there, and I helped a bit too with research looking up off-label treatment. That's when you have drugs that have already been approved for one use, but in some circumstances if they have beneficial effects for a different situation, the decision can be made to use them. The floor he was working on was so incredibly overwhelmed, and like today with COVID, there were workers who were burnt out and on stress leave from the intensity of the work. So they were short staffed and had to lean on more junior people in ways that they normally wouldn't have, but it truly was life or death. I remember the very long lines outside the Halifax Forum for the H1N1 vaccination clinic. I remember my mom pointing out obituaries in the paper for young people in the Maritimes who had died from H1N1. And I remember a co-worker with young kids who really hoped that despite there being a tamiflu shortage, her neighbour who happened to be a pediatrician might be able to get tamiflu for her kids if they got sick. I don't think that would have actually come to pass, but I just wanted to pull out these memories - COVID is unique to us alive today in the duration and scale of the pandemic, but for people who were working in healthcare during H1N1, I think they would remember some of this intensity and scarcity happening back then too.

After that rotation, H1N1 was still there, but it wasn't at the centre of our lives like had been for those weeks, or the way COVID can be sometimes now. But as a family unit we had been through that. I think that's helpful to us to not have the illusion that the life we had in 2019 is owed to any of us. "Safety not guaranteed."

Anyway, with the GNB dashboard, I don't think it was possible to access data from previous days. I never figured it out, anyway. The only way to know how many kids 0-9 or 10-19 had tested positive in a day was to find the difference between the current day's positive tests by age range and the previous day's. So for someone to keep track of that, they'd just have to note the new numbers every single day. If you missed a day, you'd end up missing 2 days worth of data because you had to deduce it anew every day, using the previous day's numbers too. So I realized that having somebody dedicated to even just checking that every day would be a big help. Nobody else initially was reporting on the breakdown between 0-9/10-19. Some of our most beloved COVID reporters didn't even know where to find the info initially. It tended to be laypeople. There was myself, and Ruth Ann who has a big facebook group where she used to also deduce the 0-9 cases and 10-19, as well as collecting all the school exposures in the fall and making them easily available to parents.

So that was where I started, just deciding that because I was home with my kids everyday anyway, it would always be possible for me to at least check the dashboard when it was updated and note the positive case numbers for those pediatric age ranges. As long as I wrote that down, it would be possible to have a record of what the kids' cases were every day. And I thought, I should start now, in August, before school is back - so if things start to go south with kids' case numbers, at least someone will know and can sound the alarm. Because I knew from what my NS friends were saying - the kids were being left behind. Nobody in power was worried about the kids. It was really only the parents who took note and spoke about being left behind, about protections easing even though there was no vaccine available for our kids, how the risks were rising unfairly for them compared to the rest of the population. So it started with the kids cases.

From there I became interested in rapid tests, and why had NS had access to rapid tests for almost a year while NB didn't at all? Initially I was just providing very focused areas of information that GNB wasn't, and then I started learning more about airborne transmission, and I think the frustration of trying to deal with the school system not acknowledging airborne transmission - that's when I started to realize how systemic the problems were, and how broad the need for accurate information was, for the public. Before that, the questions I got were mostly from my friends - and the most common question I ever got personally was from people who were concerned that the vaccine would affect their female children's future reproduction. And that's thanks to misinformation - when the vaccines for younger people came out, many everyday people really were concerned with fertility effects regarding their female children. There must have been a lot of memes and disinformation circulating about that. I had put it out there to my friends generally - what questions do you have? I'll go find sources in the literature for you. And doing a version of that on twitter just made those conversations a bit more widely available.

I'd used twitter off and on for many years. I've always followed a few scientists, researchers, physicians. I remember seeing the first CBC article about the mysterious disease discovered in China. I think it was January 2020. Many years before the pandemic I started following Ian Mackay, an Australian virologist. He would post about Australia's influenza season, which takes place during our summer. The WHO updates the recommended influenza vaccine composition for the Northern hemisphere using the Southern hemisphere's influenza season. Being in the healthcare world, I liked having an idea of what the upcoming influenza season was going to be like, because that can have such a big effect on the hospitals and on the workload for healthcare workers. I'm pretty sure it was Dr. Mackay who posted about COVID early on as well - either through a CBC article or one of his tweets were the first places I learned about COVID. I would also read about the couple stuck on the cruise ship who were posting on Reddit. It's the ADHD. My kids were still waking up in the night and taking a long time to get back to sleep, so I needed something to read. Cruise ship couple COVID updates were like an ongoing story - a serialized Dickens tale for the current day.

So that's the kind of nerd I am, along with following my childhood friends, prior to 2020 I was killing time on twitter just keeping up with the Australian influenza season and some hockey and wrestling stuff. Starting in 2020, a lot of the COVID scholarship and knowledge translation was happening on twitter naturally - directly from the researchers themselves. These were people whose day jobs involved treating COVID patients, researching COVID as part of governments and universities, and they were posting about their work and their publications. Twitter can be a more natural social media home for research dissemination and knowledge translation than let's say facebook, IG, etc. - though I know some great stuff is happening on IG and TikTok too. I also knew it was decently easy to have a public twitter account compared to facebook - you could block, mute, features like that. So I felt reasonably comfortable with it as a platform in terms of being able to engage positively in a public way while dealing with as little of the trolling world as possible. Somehow I started following Edmonton's Dr. Darren Markland, who wrote so beautifully about his experiences caring for COVID patients, and through Dr. Markland I started following Dr. Joe Vipond, who would post Alberta's numbers daily. And it was really Alberta's case counts (and then hospitalization and ICU data) through that summer 2021 that made me realize things were not going well and that possibly, that could also happen here - and it was worth paying close attention to. I had already started keeping track of the NB pediatric cases in a way that no one else was doing publicly. I was already following what turned out to be some of Canada's best COVID scientists, physicians, and communicators on my longtime personal account. So at the end of the summer of 2021 I made a public account dedicated to NB COVID info.

Why do you wish to remain anonymous?

Personal safety is the main reason. For people in NB whose paid employment requires them to engage with the public on COVID - I know they have received threats, abuse, been on the receiving end of all kinds of behaviour that shouldn't be happening. That's wrong, and it shouldn't be happening to them. I mean, that horrific Q lady has outright called for her followers to murder people who vaccinate children. My family members vaccinate children. That's personal, those are my loved ones being threatened. Violence, intimidation, and threats of violence like that need to stop. For people whose employment deals with COVID, and the public, because it's part of their job, they need to be protected in some way, or have access to resources, management, support. They should have some recourse. I know not all of them do, and some people are very vulnerable and powerless in the face of the violence that's become somehow tolerated against people in healthcare, science, public health, or even just caring for others by wearing a mask - which is still recommended by Public Health at the national level!

For a private citizen to willingly put themselves out there more than necessary and be targeted in the same way - by my assessment, it didn't make sense. I did have a few people message me originally and say hey, you'd probably be able to do more if you weren't anonymous. But I just wasn't willing to compromise on that. This is a volunteer effort, and there were already nameless accounts in Canada who were also posting excellent information. What I was doing wasn't new.

There are dozens of people in NB whose paid employment involves communicating the same kinds of of things I do, but they're compensated for it and exist in a structure. (And notice how very little we've been hearing from them since the last COVID briefing on February 24. Some of them were also silenced before that - some great communicators who haven't been made available to media for many months.) I don't have any of that - not the compensation, not the structure, not the support. And then the convoy happened and I think most people would understand after that why the account is anonymous. I also have young kids and other family members and I wouldn't want to put them at risk or inconvenience them just because I personally feel it's unethical to decline to communicate with the public when you know things that would help others reduce the burden of COVID. I feel very compelled to help, but I don't want my family put in danger because of that. Some of my friends do use their full names - and some of them have been significantly ostracized and have received written threats through the mail, to their home address.

What kind of success (or lack thereof) have you had with attempting to engage the NB government about the COVID-19 concerns?

That's a good question. I think in the moment it's hard to evaluate this, because we're still in the thick of it. That's one question I've had myself sometimes - like were we close? We'll never know. Did something we tried come close to working, to breaking that dam that is preventing a lot of people in health from actually communicating accurately with the public and protecting them?

One success has nothing to do with engaging the government directly, but it's building our network and community of people who care about each other and understand that unmitigated spread of disease is not the correct course of action. Even though the government isn't recognizing that, it's really important and has been so helpful to many of us who have managed to find each other and get to know each other. Right now GNB isn't really acknowledging the resources and information that POPNB makes available - but before too long, people who value the work POPNB does will be part of that elected government. And a few MLAs have been really great with reviewing resources we've sent along and attending meetings we've suggested or made available with scientists and researchers. We organized a special virtual info session with Dr. Tara Moriarty in June, and the event filled up. David Coon did attend and I was so grateful that he took the time to do that.

In terms of engaging directly with the public, I think @HallwayOrchard's weekly summary graphic is really appreciated by the public, and I know I love John Gunn's graphs with the RHA data. We hold a weekly Twitter Space which is somewhat of a layperson briefing - right now it's on Wednesday nights at 8pm NB time and we try to discuss anything relevant or important from the week.

Right now, GNB seems to be trying to suffocate people's concern for COVID by taking away all the oxygen. NB hasn't had a COVID briefing since Feb 24. I had a look on YouTube, which was just one of the various ways people could watch those briefings (so the viewer counts aren't the sum total of everyone in NB who did watch the briefing), and the February 2022 briefings had 25,000-29,000 views. GNB used to take the time and effort to communicate with the public. It's unreal that they made us go through the whole BA.2 wave without a single briefing. And now they're doing it again with BA.5.  Someone looked at the official Premier Higgs twitter account and saw there was only 1 tweet about COVID since Feb 24, and I think that was on March 9. Even though COVID has killed so many people in NB in 2022, GNB has decided that communicating about COVID is at odds with whatever else they're trying to do, and they do it as little as they possibly can now. (NB has had an estimated 489 COVID deaths from omicron alone, per Dr. Moriarty - but only 299 of them have been reported.) And when they don't talk about it, the media can't talk about it as much, and the media don't get the opportunities to ask questions like they had when we had briefings.

So the government doesn't talk about it, the media are covering lots more topics and don't have access to the politicians and health personnel they had for the first 2 years of the pandemic - so their articles are missing voices, experts, details, local data, and aren't as frequent. We used to hear from Dr. Dow and Mathieu Chalifoux. We haven't been able to hear directly from them in a long time. (Dr. Dow may have even retired, I'm not sure. I had heard late last year that he was going to retire this spring.) Nurses and teachers feel they cannot speak out under threat of losing their employment. So who can the media talk with? Now that so many regular business activities have resumed they have lots more to cover as well - and understandably nobody can cover COVID 24/7. There is still more to life. But the way that GNB has been responding to COVID since the Higgs majority hasn't been proportional to the actual threat of COVID to our province.

And the longer this goes on, the more incentivized they are to double down. Because now a lot of the problems we're facing were directly caused by their policies. So how can they admit that and improve things, when to do so acknowledges their culpability? This government has a great deal of difficulty saying "we were wrong." Dr. Raina MacIntyre, who is an Australian physician and epidemiologist, calls this "an escalating commitment to a failing proposition."

Throughout fall 2021, I couldn't believe they'd rather implement a snitch line and try to keep people in parts of zone 1 from gathering indoors or outdoors with another household for like 5 weeks, than try airborne precautions. They would rather do things that aren't based in evidence whatsoever, than admit that COVID is airborne and try airborne precautions. I just can't understand that. It made no sense whatsoever that 2 households couldn't gather outdoors, but people still had to go to school and work in person. With exponential spread and airborne transmission, that just makes no sense. That's never going to work, it's not going to give you the results of reduced cases to the extent other periods of limiting contacts had (because previously, heavily impacted zones saw their contacts reduced way more by in person school closing or wok contact being reduced). But they'd rather implement a snitch line and keep 2 households from gathering than address airborne transmission and educate the public on it! And yes masks were required at that time, but because the government has never publicly discussed airborne transmission, people don't understand that taking off your mask when seated at your desk is not safe, right - nor is taking off your mask to eat in the lunch room when others are eating there or have been eating there recently, school lunch with masks off, all of that. Even in those times when indoor restaurant dining was closed, people were still unmasked together to eat at work and at school. That's a risky time for COVID to spread. Anyone contagious is just breathing it out and the others in the room are breathing it in. And that's never been communicated to the public.

By March 2022, GNB got to the point where they felt they could implement largely no protections (some still exist in certain circumstances, like hospitals and LTC). And they'd still rather deal with the incredible amounts of excess deaths, the absolute chaos and unsafe conditions created by staffing ratios in the hospitals and long term care and the school system, rather than acknowledge airborne transmission!

So I think that covers why GNB doesn't want to engage on COVID. They've publicly said it's over, it's just a cold. They skew the numbers so they have to report the least cases, ICU admissions, and deaths they possibly can - but it's going to catch up to them with the excess death reporting from Statistics Canada. They feel they can't change course because to do so means they were wrong, and many of these deaths and other problems are directly their fault. They also painted themselves into a corner by minimizing the severity of COVID, and that has affected public behaviour.

The Minister of Education was on the radio in January telling people their kids won't get sick. Well, is it any wonder that fewer than 50% of NB's kids aged 5-11 got the primary series of 2 doses of COVID vaccine? When your non-physician premier and Cabinet members are telling the public that it's just a cold and it's not a concern, people who've been flooded with disinformation and misunderstand the risks and benefits of vaccines are not going to choose vaccination for their young kids under those circumstances. The deputy Chief Medical Officer of Health said they only expect 30% of kids aged 6 months to 5 years will get vaccinated this summer. That's so heartbreaking. Explain to people about the higher rates of hospitalization in younger kids, about the cases of hepatitis in kids that have risen in relation to COVID waves, engage with people about how safe the vaccine is - especially compared to COVID infection, which doesn't confer much immunity compared to vaccination, but has much higher risks.

The government may also have a hard time directing funds to COVID concerns because they repeatedly refer to it in the past tense and as just a cold. That's what they communicate to the public, so how are they going to get buy-in from the public on the work that's actually required to truly reduce the risks to us all? They've made this whole situation very difficult for themselves, and I can't see how they start to make progress without admitting they were wrong, which seems especially difficult for them to do. Meanwhile, we are all paying the price for the obstinance of a few people at the top.

In terms of success, while I can never know how much was due to our work, there's been a few quick changes in access to interventions. In fall 2021 Dr. Russell said there were no plans for broad public access to rapid tests, and then 1 week later, there was public access to rapid tests (and I don't think it was possible for them to organize that in just 1 week. They had to have been working on it). Just recently, Dr. Russell said there were no plans to open up 4th dose eligibility, and 1 week later, they opened up 4th dose eligibility.

Something I felt was successful was having Joey Fox, P. Eng, on the radio with Julia Wright, talking about reducing household transmission. Public Health and GNB should be doing that communication in English and French to all NBers. It's unethical that they don't. That same day, Dr. Tara Moriarty who is an expert in excess deaths was on a different CBC morning program. I didn't arrange for those things to happen, but I'd let a few journalists know about Dr. Moriarty and her work, which they're all aware of now thanks to her excellent excess mortality work and communication about it. It felt like a success to me to have these "twitter people" appearing in the mainstream media which makes their work accessible to the many NBers who aren't on twitter.

Regarding accuracy of information, the GNB website used to say you'd test positive on a rapid test for 90 days, which is not true at all. This completely incorrect information was up for many months. And people heard it directly from 811 when they called and spoke with government healthcare workers also. Once people online started really drawing attention to it, it was corrected in the same week. However, there's never been an announcement that the site used to have incorrect info - dangerously misleading incorrect info! It's been corrected, but it's never talked about - the wrong information was there for so long, and so many people are now misinformed. People don't test positive on a PCR for 90 days either. But that incorrect information is still out there and being shared. Only a very small number of people would ever test positive past 20 days on PCR. I only learned that this spring, about the PCR part. These are important facts for people to know that change how they feel about testing once they have symptoms. And it's really important now that so many people have already had COVID once, and we're seeing reinfections.

In the realm of education specifically, I was honoured last fall to be a small part of the group that started tracking reported school COVID cases and putting them on a public map. Eventually GNB also added a map and list of schools with cases to the dashboard, but all of that ended when they stopped informing the public of school cases and then eventually stopped recording school cases whatsoever.

For the schools in NB that don't have mechanical ventilation, at the end of 2021 they did get HEPA filtration - but it was the same underpowered HEPA filtration that all the Atlantic provinces pursued, based on a totally flawed tendering process in Newfoundland. When I read the RTI that Erica Feltford had obtained regarding school ventilation - I was up until 4am reading it and I contacted WorkSafe the next day. I could tell from the e-mails in the RTI that there wasn't enough urgency in correcting the problems. It's unconscionable that children and workers were subjected to a classroom that reached 4400ppm CO2. And I could tell it wasn't being dealt with with the urgency it warranted. So I contacted them because it really was unacceptably hazardous, and had a few conversations with WorkSafe that week. Some aspects of the hazards will be remediated with the HEPA filters that school would have now, but not all of them. (HEPA filtering doesn't reduce CO2, but it does remove pathogens from the air, and high CO2 is a proxy for measuring the ventilation in the space because of how human respiration works. So that classroom may still measure at 4400ppm CO2, but at least now some of the risk from pathogens accumulating in that space will have been mitigated. At that level, 10.5% of every breath a person takes has already been in their own lungs, or someone else's.) I was reassured to know that WorkSafe is keeping a close eye on the Department of Education, but they acknowledge that improvements have come very slowly.

Teachers did get access to free N95s, when school resumed in 2022 - but when the mask requirement was dropped, almost no teachers continued to mask. So our whole province has failed in getting their profession to understand why masks are important, including our group. We haven't succeeded in getting free masks for kids. We haven't succeeded in getting the districts to allow community donations of HEPA filters so that all spaces in schools can have filtration. We haven't yet succeeded in getting a CO2 monitor lending program at libraries in NB.

The government, the medical society, unions, the media - none of them in NB have acknowledged that the dominant route of COVID transmission is the airborne or inhalation route. None of the regional medical officers of health, who do have certain powers under the law, have spoken directly to the people in their regions about COVID concerns particular to their areas or brought back protections in their areas. None of the District Education Councils have managed to take COVID seriously - and they have a duty of care. None of our municipalities seem to have taken appropriate actions on COVID, although there are some individual mayors and council members who seem to understand and model good mask use, but the vast majority don't. So many of them seem trapped promoting economic interests, and there doesn't seem to be an understanding of the fact that unmitigated spread of virus is also bad for the economy. So I see a lot of maskless selfies from politicians at all levels at local businesses and events, even though if they truly wanted the best for their constituents they would be wearing masks in public. So there's a lot of work left to do, a lot of stuff that hasn't translated to something we could call success yet. 

It's very demoralizing, every day, knowing there are thousands of NBers whose roles in society, whose education, whose oaths, whose purported care and responsibility for others - especially the vulnerable - should be requiring and/or inspiring them to do better, and they overwhelmingly don't. There are a lot of perverse incentives going on. People have a normalcy bias. What the government is saying - "it's just a cold, it's mild, resuming our 2019 lives with no protections is living with COVID, nobody needs to isolate, attendance is down in schools because people are struggling to pivot to endemic measures, the only people who wear masks are only doing it because they're anxious" - a lot of people are really happy to hear that. It's exactly what they want to hear. So it makes it easier to swallow.

And for those of us who understand that what the government is saying right now is not evidence based at all, and is perpetuating harms in 360* but is especially negatively impactful on the vulnerable and those who are already disadvantaged or at risk - we're isolated islands. And it's a very hard message to sell, because it's not "Who will you invite?" or "Let's Get Back Out There!" (NB and NS's tourism slogans for the summer). It's - COVID is airborne, even mild cases can result in large increases in your relative risks of serious adverse health effects, vaccination does not protect very well against long COVID. It's a lonely message. And it doesn't have to be - the hardest part is, if the government was rowing in the direction of the evidence, our transmissions would be way down, and everything would be safer for everyone. We could all at least know the score and make informed decisions about how we spend our risk and how we work most effectively to prevent the worst harms to the most vulnerable people.

It's such a horrible cycle we're trapped in where the government is promoting the spread of disease, and the spread of disease makes everything worse - basic necessities like going to the grocery store, the pharmacy, accessing dental care, health care - are now riskier than ever in terms of COVID transmission and infection, and getting COVID is how you get long COVID. It's not just about death - but even that happens at rates in NB far higher than GNB admits. Additionally, vulnerable people deserve to be able to safely access more than just the basic necessities - but that would be at least a start! Vulnerable and COVID-conscious people should also be able to enjoy fun things in a safer way - and it's been really nice to see some great events requiring masks, like Fredericton Pride's indoor events and Sappyfest in Sackville.

I think a couple of the big successes have been getting the petition submitted - I think that was quite remarkable, especially given how few days the legislature sat in 2022 to date. We were the first group in the Atlantic provinces to raise any concerns about masks not being required in schools. We spoke up before the NBMS, the pediatricians, the pandemic advisory group at the IWK. And that was a very difficult thing to do, in the absence of those qualified voices speaking up at the time. Because I think a lot of people would assume - well if this was really a concern, where are the physicians? And they were not there yet. But there was already cause for concern.

Ultimately in NB, by the time the physicians became involved, the date had passed and the masks were dropped in schools before they said anything. Whereas in NS, the pandemic advisory group at the IWK managed to reach Dr. Strang before the actual announcement was made. But NB and PEI's sickest kids are also served by the IWK. So I wish they had been able to speak up in time to have an effect in NB. NB was just that eager to beat everyone else in dropping masks. At all of our peril. Bad timing with our March Break too. Plus everyone was on vacation that week, and into the next week, which was odd. Nobody could reach the NBTA, the NBTF, and Dr. Russell and Minister Cardy were also on vacation. Which, fair, it's March Break - but also when your province is set to drop all protections the day after March Break ends it would have been kind of them to leave someone behind who could have been available. Because that was a horrible week, knowing what was coming and that nobody was even going to try to stop it.

In NS the open letter from the physicians was last minute as well, but at least they reached their CMOH before it was announced. And that felt really awful, that the CMOHs in PEI, NS, and NL ultimately extended the universal mask requirements in schools, and QC too (though masks by then were only required in hallways, buses, common areas, and could be removed when seated at desks - which also makes no sense given that COVID is airborne) - but not in NB. It was a terrible feeling. Why were our children in NB not worth protecting as much as all the other kids around us? GNB forced many families to be infected. (During the entire time BA.2 was the dominant variant, we didn't have a single live briefing. The same thing is happening now that BA. 5 is dominant.) And if you lived in any of the other provinces around us, your child could have still attended school and been protected by the fact that masks were required for everyone. But not here. Absolutely cases happened elsewhere, for all kinds of reasons - but there's a big difference between what happened in NB and the effect that had on all families, and what happened around us.

For families where there is a cancer patient at home and other medical concerns within that household, it just wasn't safe. That was horrific. Now if you're lucky, you might think - how many families really have someone in the household with cancer and also have kids in school? And what I've come to learn is - many families. For one thing, multigenerational households exist in NB. I speak with so many people who have grandparents, parents, and young kids under the same roof, and it is the grandparents who are extremely vulnerable. But it can be the parents too. I have a really sweet friend whom I've known for 12 years whose child is close in age to mine. She's not that much older than me, and she has recurrent cancer. She is going to be on chemotherapy for a long time, and her school-aged child could no longer attend NB public school because the risks of catching COVID were so high once universal masks were dropped. But there was no recourse, and I just can't understand that.

I'll never get over the way NB, particularly the education department - including the superintendents who all signed nearly identical letters attributing mask usage to anxiety alone - treated families and kids. I'll never trust our school system again. There was no evidence for that. It was public information that at the time we dropped universal masks in school, NB's case rates were 3x the national average. Any person anywhere in NB could have gone on the PHAC website and seen that information. It wasn't hidden. I can't believe people didn't push back. Cases beget cases. What was ever realistically going to happen, other than what we all witnessed? That was never going to go well. I can't believe people whose jobs include being responsible for the safety of school kids and school employees allowed that to happen. Yes I am a science-minded individual with a Master's degree, but I work from home part-time and am largely a stay-at-home mom. If I could very confidently see that was going to happen, there's absolutely no excuse for anyone actively working in the department of health or education, or public safety, not being able to anticipate that was going to happen.

All you needed to know in order to understand that was going to be a disaster and play out exactly the way it did, was to read the media reports about omicron in late November 2021, early December. There were 111 fully vaccinated people at a dinner in Oslo, tested negative beforehand, and in the subsequent two weeks 80 of them tested positive. That means being maskless indoors is going to result in a very high level of transmissions. Omicron's immune evasiveness was known. NB's school kids aged 5-11 - only 40% were fully vaccinated in March. And that number hasn't meaningfully changed now in July, since March. If omicron had an attack rate that high among fully vaccinated people, how on earth was it going to go any differently here with our schools? And in our workplaces? It's just horrific that that was allowed to happen, and that nothing has changed since, nobody has taken responsibility, nobody has admitted they were wrong.

The Child and Youth Advocate's report, while not a direct result of our group as a whole but thanks to work by some of our individual members, was vindicating despite not resulting in changes yet. The day that report came out, I realized that people could be activists for decades and never get the vindication that report delivered in black and white. But ultimately, the government completely ignored the findings and recommendations, and nothing has changed.

What are we to make of it when someone who is personally close with the education minister still finds that many significant problems in the approach to school safety, and the end result is still just ignored? The next step is likely court cases, and at the moment it's been hard to find any NB lawyers willing to represent people against the government regarding their handling of COVID policies. The success right now with something like the Child and Youth Advocate's report is that the government can no longer claim they didn't know, or they weren't warned, or nobody told them what they did was wrong. It's part of the record now, and we can point people to that. Things are slowly being brought to light. It's extremely frustrating when we know that there's so many evidence-based interventions that we can and should be doing to reduce transmissions, AND that it's actually important to reduce transmissions. That part is hard. But I think we are getting there, because more of this information is becoming part of the public record, and their plausible deniability is gone now.

Ultimately, it's a huge slog. In the fall of 2021, I would have hoped for efficiency. That simply notifying the ministers and superintendents about airborne transmission and the fact that N95s and air filtration would reduce cases in schools, would be enough for them to take the steps outlined in the evidence and reduce transmissions. Now I realize they're not interested in reducing transmissions, or even communicating to the public about how one does this. Don't get me started on how people can be in positions of such responsibility and not be motivated to reduce transmissions. I can't comprehend it.

Anyway, at the moment the success comes from just reaching one more person. And it would be a heck of a lot more efficient if some prominent healthcare personnel and politicians, unions in NB would take it up as well. Why is no one in NB in any position of power talking about the fact that COVID is airborne?

It's settled now; the White House talks about it. Quirks and Quarks talked about it in October 2021. The had Canadian scientist Dr. Lydia Bourouiba on - she's at MIT and her work is excellent. We really need people with bigger platforms to amplify the lifesaving information that COVID spreads through the air. The most effective ways to prevent COVID transmission are for everyone sharing air indoors to wear an N95 respirator for the entire duration of the time they share the air. That means sometimes even when you're alone, if someone else is going to be entering the space after you, because COVID hangs in the air and can infect people when they breathe it in. So going into a bathroom or elevator alone - you still want to wear your mask. Singing and shouting, loud talking produce far more aerosols than just breathing. So that's part of the science of superspreaders. If you have an indoor event where there is insufficient ventilation (many buildings in Canada) and no filtration, and especially no masks, if anyone in the room has COVID they can just be seeding the air in the room with COVID, and people working and attending the event breathe it in. One of the things I've learned as well is that we need to assume indoor locations have poor ventilation unless proven otherwise. It's wrong to assume that indoor locations have sufficient ventilation, because many don't - so we need to address that, and people need to have confidence that indoor locations have good indoor air quality. This can be done by having a public-facing display of a CO2 monitor, or by having portable HEPA filters that people can see are operating. 

So. The government is VERY motivated to not engage. And I think that says all kinds of terrible things about their morals, their ethics, their humanity. They're willing to let your ERs be dangerous and for you and your family to wait for many hours rather than tell you to wear a mask and that COVID is airborne. They know this. There's no reason why in 2022 people who are supposed to be in charge would not know that COVID is airborne. They're willing to let people develop long COVID, diabetes, cardiac problems, pulmonary embolisms, even from mild cases of COVID, rather than tell you it's airborne and that we need to address indoor air quality. Why are they willing to let all this harm come to innocent people rather than actually address how COVID transmits? I don't know. They must be very heavily incentivized not to address the dominant route of transmission, probably for a variety of reasons. The immediate costs of remediation (ventilation, filtration, UV inactivation of pathogens); the social and political challenges of reinstating mask requirements - even though that would save lives and reduce disability and lifelong health problems; the fact that they were SO wrong so many times and so many significant and even fatal harms came to so many people directly due to their policy changes which were never justified; other incentives or threats to those in power being offered by large corporations - I really don't know.

Do you worry that the current COVID-19 situation in NB is going to spiral (even more) out of control?  Do you see any positive signs?

I'll start with the positive! In general, worldwide, some more effective vaccines are coming. One option will be updated intramuscular vaccines - our current vaccines are based on the original or wild type (Wuhan) strain of the virus, and it has mutated many times since then, so continuing to boost with the original vaccines is having diminishing returns against the new variants (although they're still somewhat effective against transmission, and moreso against severe outcomes - I was very willing to "Robin Hood" a dose for myself, and wouldn't hesitate to do it again if the updated vaccine is not yet available when it's time for my next dose). It's very much worth it to get a second booster or 4th dose - but we also have to recognize the limitations of the original vaccine against what the circulating virus has turned into. So what's coming in the fall is a bivalent vaccine that still has the original strain, and is also updated with omicron as well. Some kids in the US vaccine trial for under 6 recently had the opportunity to get the new bivalent vaccine as part of their trial, for some that had been in the placebo group initially. That's a really nice reward for them having had the placebo, to have the first shot at something more protective against omicron.

Beyond updated vaccines, people are also at work on "pan-Coronavirus" or universal vaccines which should work better against future variants.

Finally in terms of vaccination, also in development are intranasal vaccines. One by Dr. Akiko Iwasaki is an intramuscular vaccine first (Prime) and then a nasal spray (Spike). The intranasal vaccine is important for developing mucosal immunity in the respiratory tract, which is where our bodies first meet the virus. A lot of the surface area of our bodies that interacts with the outside world is mucosal tissue - think about the ultimate size in square inches of our lungs. These tissues in our noses, mouths, lungs encounter virus and the antibodies from the intramuscular vaccine can have a hard time reaching the mucosal tissues. So if we can get the antibodies to the mucosal tissues through intranasal vaccines, we should have something that's much more effective against infection.

Cases beget cases. So when our vaccines don't prevent infection very well, cases just continue to grow and spread. Whereas once we have intranasal vaccines, far more of those transmissions should be stopped. You might not have to worry about your nurse or doctor or pilot getting COVID, because they and their child have had their intranasal vaccine, so when they encounter COVID at school, they don't get it, and thus they don't expose their parents to it at home, and your healthcare system or your airport system isn't as vulnerable.

In terms of indoor air quality, we haven't even scratched the surface of using this technology - engineering and industrial hygiene solutions, really, and occupational health and safety - to stop superspreader events. It may be harder to stop near-field transmission - if you're both maskless and having a close face-to-face conversation, you are going to get a big plume of aerosols from the other person. But indoor air quality can reduce those risks too. Beyond near field, addressing indoor air quality should have a big effect reducing shared room air exposures and far field transmission. If there's a UV light fixture high up on the wall that is inactivating viruses, and fans mixing the air in the room ensuring that the air ends up in that UV zone before coming back down. That's what's going to make bars, restaurants, gyms, places where you really want to be maskless around other people for extended periods of time, much safer. Immediately, something we can all do today is put portable filtration in place. You can get a HEPA filter at most department stores or hardware stores. You can also build a DIY air filter with a fan and MERV-13 furnace filters. Those are called Corsi-Rosenthal boxes, and you can find instructions online and people can always reach out for help. There's a number of us in NB now who have built them.

Mitigation done with UV and filtration won't show up on CO2 monitoring, because filtration and UV inactivation in the absence of ventilation changes won't be measured with CO2 monitors. But, we can use CO2 monitors and public-facing displays to show people how well-ventilated indoor spaces are. This can alert you to riskier areas that you should avoid or spend less time in, or alert people to a problem with the ventilation that should be addressed right away - something's broken or not working well in the system, or something has been mistakenly turned off. For some of the people I follow online who keep a close eye on CO2 levels, they do find a problem from time to time with the ventilation in their workplaces and their kids' classrooms. It's important that people learn a bit about ventilation now that we're all learning that various diseases do spread through the airborne route, and can be drastically reduced by improving indoor air quality. If you display the CO2 for the room, people can see if levels are too high and there's either poor ventilation in general and too many people in the room, or the existing ventilation system has a problem that requires troubleshooting or repair.

So I personally have a lot of hope, because there are numerous things we can do today that cut down on transmissions. There isn't an N95 shortage anymore. There's Donate a Mask charity where people can request free rapid tests and high-quality masks. There are Canadian companies making respirators, making elastomeric respirators which are reusable and very comfortable. We do have access to PPE - and PPE works against all variants! Your N95, your N99, your P100 respirator will protect you well against all variants. If organizations or small groups of citizens wanted to fundraise or chip in on bulk mask orders, you can get these respirators for $1.30 each and you can re-use them multiple times. There's no real barrier to us protecting ourselves much more effectively, except politics and will - and at this moment, a lack of awareness in the general public that COVID is airborne.

So many of us have learned how to make Corsi-Rosenthal boxes, which clean the air. $45 box fan and a $30 MERV-13 furnace filter to start. If you have more money you can get 4 filters and make a cube. There's lots of HEPA machines around in our hardware and department stores. UV technology is coming. Updated vaccines are coming. There are lots of reasons to hope. And best of all, more and more regular folks are educating themselves on all these aspects. That's the only bonkers part - for 4 months now the White House has had info available about filtration, masks, UV, all this - what on earth is the holdup for our provincial governments? If they were communicating about this stuff with the same fervour they put into their information campaigns about the CUPE strike last fall, we'd have fewer dead New Brunswickers. 

Re: COVID spiraling out of control in NB. Yes. I think we're in for tragedy and pain over the next month through this BA.5 wave. Dr. Moriarty expects it will wind down at the end of August. But BA.2.75 is the newest variant that seems to have advantages over others and is growing in a few parts of the world. In early June, NB had 40% of Canada's BA.5 sequences. No other single province had more BA.5 cases than we did. Given that we've made testing harder to access, that isolation is not required, that masks aren't required - NB is promoting disease. There's no other way to say it. When BA.2.75 arrives, we'll be in trouble all over again. The rest of the summer is going to be awful for LTC, healthcare, and people who need access to healthcare, thanks to BA.5. And that's potentially all of us. Anybody could end up needing healthcare due to illness, an accident, a medical condition.

EDITOR’S NOTE: the author would also like to note that variant BA.4.6 is also gaining ground in a number of countries.

BA.5 showed up in late spring and quickly overtook BA.2, including BA.2.12.1. There's no real gap between waves anymore. Canadian researchers like Dr. Gasperowicz and Dr. Bassani have shown that the waves are coming closer and closer together. So while we're still struggling with BA.5, there's no reason why BA.2.75 won't show up and start growing. Infections aren't conferring durable immunity. So many people are just susceptible to infection over and over again. We haven't heard a word about the plan for schools. If September 2022 is going to start with the same approach as school ended in June 2022, there's nothing working in our favour. People need to isolate. You can't have COVID+ve people coming to school and working at school, or on the buses. People need to be wearing masks. School lunch needs to be safer than everyone using the cafeteria. Air quality in all schools needs to be addressed. September will drive more transmissions all over again, and it will be chaos all over again for those in the education system and families whose kids come home with COVID. And lots of folks who work in LTC, paramedics, and in the hospitals have kids in school.

The other hard fact to keep in mind is that long COVID affects around 8% of all people who get COVID, and it can affect people who have mild cases too. Some people's symptoms do resolve in time, but others haven't yet. There's no cure right now, and no guarantee there will ever be one. So the more we let COVID circulate in NB, the more people we're going to have who have persistent symptoms. For some people, it's a change to their sense of taste or smell. For others, it's trouble word finding, and cognitive difficulties. For others, it's fatigue. And for some proportion of those who get long COVID, it affects their activities of daily living. It affects their ability to return to work, to caregive for their children or others for whom they're providing care. So the longer we all try to pretend that NB's approach is in any way okay, we're really allowing increasing numbers of people to get sick - and not only for the 10-14 days of the acute illness. This isn't a situation that's going to become all the way better eventually. There's increasing numbers of people who live in this province whose longterm health is being significantly damaged. Every day this continues.

Maybe I didn't get long COVID with my first infection - it's still too early to tell, for me personally. But if I catch it again, that's another roll of the dice. Risks increase for all kinds of adverse health conditions following COVID as well. My risks may be low to start out with, but that's not the case for many NBers - and many of us may have health factors we're not even aware of. So while we focus on the short-term and acute problems that come with COVID infections - not enough teachers to safely staff the school; not enough nurses to safely staff the hospital and provide care for all the patients; the number of COVID hospitalizations, etc. - we're also adding to NB's burden of chronic illness and disability, which was high to begin with, and we're adding to that number every single day. The return of an indoor mask mandate and communication about airborne transmission would reduce the number of people that we're rendering ill every day. Also, we've heard from an NBer who is confident they caught monkeypox in NB. There's a significant amount of cases in Quebec. In addition to COVID, there will be monkeypox to deal with as well, which also spreads via the airborne route amongst perhaps other routes.

How do you determine whether a resource you've evaluated is a worthwhile resource?

This is such a fun and important question! It's a whole field of study - critical appraisal. I used to teach some of this to medical students. And it's changing all the time. In my degree we learned about the hierarchy of evidence, with randomized controlled trials (RCT) at the top of the pyramid. But rightly so, during the pandemic the superiority of RCTs has come under fire in a more prominent way. Some of the critiques of RCT have of course been around for a while but more people are becoming aware of it because more members of the public are aware of things like trials and scientific publishing now. RCT is a great study design for evaluating pharmaceutical treatments. But as many engineers have pointed out during the pandemic, we don't do RCTs on parachutes. There are some questions that are not at all suitable to being answered by an RCT, because it's unethical to design a study that would randomize some sky divers to the "parachute" arm and some sky divers to the "no parachute" arm.

Some interventions are proven to work because we can physically tell that they work, due to the way they're designed, and tested in different ways than through an RCT - like we know parachutes, seatbelts, airbags, lifejackets, and other safety measures work when used properly - e.g. you put your lifejacket on and keep it on while on the boat instead of just saying well I'll grab a lifejacket from where they're stored if it seems like I need it. e.g. you wear your N95 mask for the duration of time you're sharing indoor air with others outside of your household or bubble, instead of leaving it around your neck or chin or hanging from your wrist!

So some snarky people will say, well show me the RCT in a peer-reviewed journal that shows that N95s are superior. Well, some Ontario physicians and scientists were going to randomize some nurses to N95s and others to surgical masks, and one of the endpoints they were going to be studying during the pandemic was how many nurses died. That's unethical, since N95s are designed to address the airborne route of transmission, and surgical masks aren't. We already know that one arm of that study exposes people to much greater harms than the other. I don't think they've published anything from their study yet, and I'm not sure if it proceeded as planned.

Some study designs are also totally flawed. In one study they did have some healthcare workers using N95s and some using surgical masks, but they only had the workers put the masks on when they were within close range of the patient. Well, with airborne diseases, the aerosols remain suspended in the air and they can and do make their way out into the hall. If you're trying to evaluate something like that, and people are only putting their PPE on at close range, of course you're going to see infections in the N95 arm, because it's likely they were exposed in all that time they were at the nurses' station, in the break room, in the hall, and in the patient's room before they put the N95 on. It comes up as well with sampling the air when trying to determine if viruses are with the aerosols in the air. One study held a moist q-tip in the air for a minute to collect aerosols. Another used a zip-lock bag. These are not valid ways to study aerosols. So unless you're familiar with what's valid in that field, it can be hard to look at a study and determine, these findings are accurate - or these findings aren't.

There are some general things a layperson can do - check the journal it's published in. Is it a peer-reviewed article published in a reputable journal? Check the date. Open the article and look at the date the work was done. The article might come out in 2022 but it might be dealing with cases from the delta variant, or before. Maybe those findings are still valid with the currently circulating virus, or maybe they aren't. You can note who the authors are, and you can look them up to see what else they've written and you can tell with Google Scholar who has cited certain papers. For those who are really interested, you can find some good critical appraisal tools to guide you through evaluating different types of articles - this is a good link to start with: https://www.cebm.ox.ac.uk/resources/ebm-tools/critical-appraisal-tools

At this point, I'm not too concerned with cutting edge stuff - because we're stuck on masks and airborne transmission. It's well proven that COVID is airborne and that N95s work to reduce transmissions, that mask mandates themselves are actually effective. That's a huge stumbling block for NB. So I don't necessarily need to be evaluating all the newest things - we need to get people in power to recognize a paper from November 2021 (https://pubmed.ncbi.nlm.nih.gov/34748374/).

Also, by now I've amassed a good collection of researchers and communicators who have been the least wrong throughout the pandemic. I'm not saying they'll never be wrong. But why on earth would you interview someone like popular interview subject "AR," which CBC did the other weekend in a high-profile article, when she's been wrong time and time again. There are many researchers who can admit they're wrong when they have been, and some who really have understood this virus so well that they generally haven't been wrong. I know who those people are. They've proven a willingness to communicate accurately and they've proven a deep understanding of the situations we're in. People correct each other, too. So I'm confident that if I did amplify something that was flawed, it would be brought to my attention, or I would notice others criticizing the same source or idea even if no one directly corrected me.

In general, the greater the claim, the higher the burden of proof - some things are pretty solid now with COVID. If something is particularly groundbreaking, new, or especially scary or sensationalist looking/sounding, I don't share it right away. I wait. I haven't had to retract much of what I've shared because I do that first pass on how accurate something likely is. But like I said, in NB we're stuck on people not understanding the importance of masks. It doesn't have to be flashy new info for people to end the day better informed than they started it.

I see other "Protect Our Province" accounts and websites popping up.  Is this part of a coordinated national movement of citizen advocacy?

Yes, in a sense. Protect our Province Alberta was the first group, and it started when their premier went away for 20 days last summer while cases were rising and there was absolutely no communication with the people of Alberta. They've done fantastic work, and the archive of videos on their website is still really helpful and informative (https://popab.ca/). POPBC started next and they've also given tremendous briefings (https://protectbc.ca/). Then there was POPQC, which provides really valuable information in French - I know in NB that's been part of the challenge for francophone communities, so much of this information is only in English (https://www.popqc.ca/).

I had been wanting to start a POPNB for a long time, but those first 3 are all lead by MDs. I assumed we needed an MD to lead us. I knew it would make our work more impactful. I waited, and waited, and I asked a few MDs if they would be involved and none of them felt they could lead the group. Eventually I realized that the mutual aid network we had already built while waiting for an MD was an amazing group just as it was - we didn't need an MD at the helm. I think that's a problem all of us have had in Atlantic Canada. It's so small, and MDs are by and large reluctant to publicly criticize each other, and it can be career-limiting for some of them to criticize the government. I understand how, even just by sheer numbers, it could be easier to find a handful of MDs in the bigger provinces who are willing to be more vocal in an organized way. We do have many MDs who are willing to speak out, and they've been doing so, but I think it's harder for them to publicly align themselves with a group like ours.

Anyway, there are now other groups in PEI and NS, and they're not physician lead either - we're in communication all the time and helping each other. It's coordinated in the sense that we do chat sometimes and try to help each other with things, and the people who are involved are really wonderful, but it's not like some kind of secret club where someone is behind the scenes setting up these POP groups. Provinces like AB have had poor COVID management for a long time, so they got organized first. In Atlantic Canada we were generally fortuante for a long time. People eventually do see the need to speak up once they realize how poor the communication is with the public and the fact that no one else will do it. It does have to be us right now. No one on the payroll in the Preventive Medicine branch of the Department of Health is out there telling people COVID is airborne, for some reason.

We haven't had the capacity to do the video briefings like POPAB did, but we're working on a few different ideas for the weeks to come. And the experts have been SO generous and willing to help. I had epidemiologists sending me NB's sequencing data because I couldn't get access to it directly myself. I have had questions about masks and airborne transmission and filtration and worldwide experts have answered my questions within minutes. They're so generous and generally happy to help because they just want people to be able to get the correct information.

What is your experience with long COVID-19:  have you or other people you personally know had to deal with this health condition?

I hope I won't have long COVID. I only recovered from the acute infection in early July. Some people feel fine for a while and then symptoms re-emerge. I have had lingering chest discomfort, like a tightness, especially after days when I have been most active with my family. Luckily I haven't felt it in the last week or so.

I know a number of NBers who have experienced long COVID or are continuing to experience it. A local friend got COVID in March and hasn't felt well yet. It's been affecting them at work and at home in a fairly significant way. Cognitive effects, heart rate, different systemic effects. It's tremendously eye-opening to witness someone go through that. I've met a few people who had long COVID already when I met them, but this is the first person that I met and then witnessed their family experience their first COVID infections, and in this person's case they haven't felt well yet since. It's eye-opening to see that happen to someone - makes it harder to feel like 'oh this is something that will happen to unlucky other people.' I just witnessed it happen to someone. Some other people that I just know from Atlantic Canada twitter do seem to have recovered, but it's slow going for others, and in some cases they may never experience full recovery. Which is something we should have known from SARS in 2003 - this news article from 2010 talks about lingering symptoms in healthcare workers from their SARS infections: https://www.thestar.com/life/health_wellness/2010/09/02/sars_survivors_struggle_with_symptoms_years_later.html

I've seen significant post-viral effects before as well. My family had an adenovirus a few years back. One of my kids had to be hospitalized. The adults felt unwell, and I may have wished for death, but we were able to recover at home. However, there were occular effects that impacted driving and night vision for some time within my family. Unfortunately, due to the prevalence of COVID, a lot more people are going to be familiar with lingering effects after a viral infection.

I find it very frustrating that Nova Scotia has a long COVID clinic, a great website, and a survey that people can use to self-refer to their long COVID clinic. As far as I'm aware, NB does not have a long COVID clinic at all. NS's website has really helpful info even though their clinic won't treat NBers - the info can still help: https://library.nshealth.ca/CovidRecovery/welcome

One of your key themes is the quality of air ventilation, particularly in schools.  I sense you feel frustrated that more isn't being done, is that a fair assessment?

The school issue is practically worldwide, but we live in NB, these are our kids and families. We can fix this here. This could be a manufacturing or innovation success for NB, just like implementing Smartboards in classrooms in the early 2000s, or the leadership NB used to have in the early days of the World Wide Web. We've been a leader with technology before, and in schools to boot.

Indoor air quality is a huge component for reducing the burden of COVID and other diseases that transmit through the air, like influenza and RSV. It's an infrastructure problem and we all realize that all of the classrooms and other school spaces in NB can't be upgraded all at once - we don't have the workforce or the funds for that. But the HEPAs that were chosen for the classrooms in schools without mechanical ventilation are an awful choice, even after all that was said about commissioning a study. They're underpowered and overpriced and they have an air chemistry function that isn't effective or necessary. So it truly is frustrating that even the bare minimum of what our province has  done is objectively a bad choice. We have access to some documentation from the Ventilation Working Group that was established. We know that an engineering firm reached out and gave a presentation on filtration to the Ventilation Working Group regarding the schools, which seems to have been ultimately ignored. A much more appropriate filtration solution should have been chosen. There's no excuse for choosing the bulk of the units that NB ended up going with.

In the near future, UV technology is going to allow for the safe inactivation of pathogens in places like classrooms. Right now you can get upper room UVGI, and eventually there will be far UV which doesn't damage our cells. But I'm unwilling to pretend that what's being done between now and then is adequate. It's not. There are studies showing that universal masking reduces cases and outbreaks. Universal masking must be in place in schools until case rates are lower. In the 2020-2021 school year, there was oversight in place, and policies in place that reduced the impact of illness on the school system. Where is all that now? NB has experienced 30% of its COVID deaths in the most recent 15% of the pandemic. We need the plans and approaches that were in place that first year that people returned to the classroom, but with the added knowledge that COVID is airborne and we now have rapid tests we can use.

In schools, we have a big problem with lunchtime. Earlier in the pandemic, kids were cohorted and many schools weren't using their cafeterias for lunch - kids ate in their classrooms. Everyone has to take their masks off to eat. This would be most safely done in the classroom, distanced, with filtration being used, and windows open. Being maskless in a big group in the cafeteria is going to result in transmissions. But the education system's structure for responding to COVID and issuing guidance has been disbanded, from what I understand. Everything they used to have a relatively safe 2020-2021 school year is no longer in place. Some other jurisdictions are exploring outdoor lunch. I can see how that's very challenging in NB. And it's also hard supervision-wise for staff to have people eating in their classrooms. Something has to be done though. Lunchtime is risky. It's hard to deal with putting a great N95 on your kid and having them understand the importance of wearing it, only for them to have 20 minutes where it's off and they're sharing air with dozens of other people, 5 days a week. That's easily enough time to become infected depending on who is in the room, or who was in the room before them. Infectious aerosols can stay suspended in the air for hours depending on the ventilation in the room and if any filtration is being used.

A personal frustration has been the school system's unwillingness to accept donations of HEPA machines or Corsi-Rosenthal boxes from the community. I can completely understand that it's difficult to purchase a HEPA for every single school space in the province. I worry that the school system is "too big to fail" - because it functions as our childcare too. Closures to in-person school, in addition to effects on learning, teaching, planning, social lives, support students receive at school, all the rest of it - ultimately impact family and childcare centres because families need childcare for kids under 12. So I've really been quite concerned that even though the situation with schools has been horrific by times - again the government is heavily incentivized to keep schools open - they don't seem interested at all in making schools safer, and it's hard to imagine what conditions would result in them closing again. If the government was honest and transparent, and willing to use the other layers of the Swiss cheese model, such as masks, regular use of rapid tests, isolation with negative test needed to return to school after COVID, and airborne precautions on buses and in schools (masks, ventilation, filtration, UV inactivation of virus where possible) then we wouldn't be in the position of needing to close in-person school, or needing to beg for supply teachers, or having kids show up and there's no adult in their classroom, or unsafe staffing ratios and heaps of supply teachers who don't know the local procedures and protocols (which also affect student safety).

Minister Cardy has poo-pooed Corsi-Rosenthal boxes - DIY air filters - but they have been tested and validated. They're not a fire hazard. They're not a big power draw. Out in Medicine Hat, there's a school principal who is from NB originally. Their whole school district has CR boxes in their classrooms. They were funded and built by the government. It would be an incredible learning opportunity for middle and high school kids to learn about filtration and indoor air quality. In other schools around the world, the older kids have built CR boxes for all the classrooms, and have given them to the younger kids' classrooms. There's just so much we could be doing, and should be doing. It's not right that we're being made to live with a level of risk that could so easily be reduced, and is being reduced in other jurisdictions.

Our Education Minister also blocked Dr. Kim Prather on twitter back in September 2021 when she politely tried to correct an error he was making about her field of research. She's been elected to the National Academy of Engineering in the US as well as the National Academy of Science. She's one of the legitimate and qualified experts in the world who could help make our schools safer. But our Education Minister is not interested in learning from her, or the chair of the Pandemic Task force for ASHRAE, Bill Bahnfleth. International experts have criticized NB's non-evidence-based approaches to COVID in schools, so yes I am frustrated, because what we're doing here AND how what we're doing has been presented to the public by those in charge has been so awful.

It doesn't have to be this way. COVID is a complex problem - like climate change is a complex problem. They don't go away when we ignore them; we actively make these complex problems worse for ourselves when we refuse to address them and pretend the status quo is okay. It's not okay, and it's not okay for us to give up and pretend all is well. Just because it's a complex problem doesn't mean we shouldn't do "the next right thing" and work away on the stuff we can do today, which is required masks and working with our communities to get portable filtration into every class, and educating our educators and school families about ventilation and airborne transmission. When UV technology is available, when the new vaccines are available, things will be easier - but it's wrong for us to pretend that the status quo is fine until the other tools are more easily accessible. A lot of harms are ongoing while we pretend everything is fine.

How do you keep going with your advocacy in the face of disinterest from political leaders and outright hostility from some other NBers?  Do you feel that enough people do care and are willing to act?

Well, it's a mix of things - for one, I have ADHD, and getting the best resources to NBers regarding COVID has become my hyperfocus. This is pretty common in grassroots advocacy groups. Apparently injustice has a way of really bothering people with ADHD. There's a high rate of people with ADHD in the POP groups compared to the general population.

The fact that the government is doing such an awful job makes it relatively easier for me to keep going, because the scale of the injustice is just huge. What's being done to us all, what the government is doing is egregious, and I could never stop what I'm doing - and everyone I work with in the group feels the same way. If GNB had come out in November, after the Klompas paper on airborne transmission was published and after Dr. Tam came out with her statement on the role of aerosols, and acknowledged airborne transmission - if workers were given access to N95s - then maybe I wouldn't be going this hard. But the injustices are so rampant and so serious.

I find it tremendously unfair that people are being given incorrect information by our government - regarding how long you test positive for, how long you're transmissible for, and how transmissions happen. The lies by Higgs about the severity ("it's just like a cold"), and him stating that Public Health has never told him that Long COVID is a concern. Meanwhile, Nova Scotia screened all its COVID cases for long COVID from May 2021 to late fall 2021, and they have a long COVID clinic that people can self-refer to. Other provinces have long COVID clinics. New Brunswick isn't an exception - Dr. Moriarty estimates that since early December 2021, 24,000 NBers have ended up with symptoms lasting longer than 4 weeks which affect activities of daily living! (https://covid19resources.ca/data-discussions/) There are thousands of people in NB suffering from long COVID, and no dedicated place for them to seek treatment.

When you don't correctly understand the route of transmissions, people are in danger. First of all, they can't properly assess risks because they think if they're at a table with their friends 6 feet away from anyone else they're safe. But they're all breathing the same air, and that's where the far greater risk is, not someone who sneezed on their hand passing you a menu. The greatest risk is in the shared air, and if people aren't told that, they can't correctly assess their own safety. They think they're playing by the rules, but in reality the game is completely different from what they've been told. If you're trying not to get infected, it's imperative that you understand airborne transmission.

On top of that, when people incorrectly understand transmission, they have a false sense of security when they see measures targeted at other routes of transmission, like when they see that hand sanitizer is available (but that no one is wearing masks, and they aren't able to recognize that as very risky). Which describes most grocery store and pharmacy trips in NB right now. Hand sanitizer at the door - and in some cases, places require you to use it before you come in - but you step inside, and nobody is wearing masks. They might incorrectly think that's a safe enough environment, because of the hand sanitizer, since they're not even aware of the airborne/inhalation route of transmission.

And finally, there's a massive opportunity cost when we use limited resources on other routes of transmission. We all only have so much time, money, energy, and other resources. Everyone wearing masks when sharing air would be the cheapest and most effective intervention right now, but people aren't aware of that - and for those who are, they lack the will to stand up for it. In the past, people spent money on plexiglass and hand sanitizer, or increased the budget for surface cleaning (which might be justified right now with monkeypox, which is also airborne but uses other transmission routes too) - that was money that wasn't available anymore to spend on indoor air quality. So we're continuing to put time, money, and effort into mitigation measures that would only prevent a small number of cases, while leaving the airborne route wide open. So no wonder we're having tons of cases. People generally aren't targeting the actual route that's responsible for most transmissions!

Given the scale of that injustice and incompetence, how can I stop? We're doing so poorly with this. The injustice associated with long term care homes not providing their staff with N95s, or with positive cases in long term care having a sign on their door saying "isolation" because that resident is positive - but the door to the room is wide open to the hall, and any aerosols that patient is generating are travelling out into the hall and able to infect people who come into contact with the virus, which floats in the air like smoke. The mode of transmission is a big one for me. There's just no reason why at this point in time everyone running the long term care homes, the schools, any congregate living facility, the prisons, the hospitals isn't aware of the fact that COVID is airborne AND well versed in all the various layers of protections we should be using right now to reduce transmissions.

Beyond those locations where people lack agency, the same thing goes for the more voluntary aspects of our lives - the people planning events and in charge of tourism and recreation need to know these things too! We should be able to more safely gather and partake in the joys of life. And when the government persists in neglecting to communicate about airborne transmission and the effectiveness of mitigation measures that target the airborne route, like ventilation, filtration, and masks, we can't gather safely. Not only is this hard on people like me who understand airborne transmission, but it completely excludes the most vulnerable people from society, because the danger level everywhere is heightened by the lack of appropriate protections.

I don't really deal with hostility because another approach I've taken for my own safety is that I block people on twitter who are pro-COVID. There's 800,000 people in this province - I think the vast majority of them can engage on these topics in a non-hostile way, and I'll do more good engaging with them than with someone hostile. Other people and groups can make it their mission to communicate with pro-COVID people. I know that any public twitter account is still visible even if people don't have an account, and people can take screenshots and I'll never know. So maybe there is a group out there of pro-COVID people who are screenshotting and circulating all my tweets and planning to mass report my account or threatening to punch me in the face if they see a respirator like mine out and about. But I highly doubt that will actually happen. I try my best to maximize my personal safety while doing the things I've decided are important to me, which is science communication and informing the public.

Overall, no, over the last few months - enough people haven't cared enough, but that's not necessarily their fault. The government has manufactured consent for mass infection, and in the case of schools, pretty much forced infection. For two years, NBers trusted GNB very much, and they were given a lot of information, engagement, and media were able to ask questions. That stopped, but for a lot of people, their trust remained, despite a significant (and largely unstated) shift in NB's approach to the virus and to communicating with the public.

So it makes sense that it has sadly taken a lot of time for people to realize that the sand has shifted beneath them. For a lot of us regular people with fairly quotidian lives, it's not a fun feeling to realize you can't trust your CMOH or your department of health, your education minister, the entire education system, the premier. It's a terrible feeling, and it's so bad that it's very hard to accept that it's true. It took me a long time. But I had a head start because I was paying such close attention. Even for me it took me a tremendously long time to believe that they'd be willing to let us get infected on purpose.

And for people who are actively working within that system, like our MDs and educators for example, it's an even worse feeling - and perhaps an even slower realization, because they're part of it. It's very hard when your job requires you to trust the system and the people working in it, and then suddenly the transparency is gone and the goals have changed, but nobody at the top can come out and say, actually there's stuff we could do and we're just not willing to do it (masks, cleaning the air, CO2 monitors, education and communication on airborne spread), because we think the best approach now is to let you all get infected (even though that turned out to be a terribly wrong approach). They can't say that, because terrible outcomes will happen to some % of people, and if they were honest about their change in approach they could be held responsible for those bad outcomes. So they can't say it, which is why there was silence for so long from the government. What they were doing was indefensible and it wasn't based in solid evidence. So they said nothing, and they let it happen to so many of us, and to our systems and institutions like the schools, the hospitals, transit. Anyway, because the government couldn't honestly communicate, people lost interest and lost urgency, we lost that momentum of mostly paddling in the same direction.

I think we can build back up to an appropriate and effective level of care again - but GNB could accomplish that tomorrow, if they held a briefing where they communicated accurately about COVID to the public. Talk about long COVID - how common it is, what it can do to people, how there's no cure yet (though some people seem to recover in time), how some symptoms can be managed or treated, how NB doesn't have a long COVID clinic yet but what they're planning to do to support people with long COVID. Because Dr. Moriarty estimates that at 24,000 NBers. And that's going to affect the labour market, among other things.

Tomorrow, GNB could talk about airborne transmission and how we effectively reduce it (respirators - N95s, indoor air quality). Give incentives to businesses to address airborne transmission - air quality upgrades. Require masking indoors while we drive cases lower with smarter measures. Make it possible for government departments to address airborne transmission. Inform the public that 50% of people still test positive on a rapid test on day 8 and are thus still contagious to others. That very very few people will test positive beyond day 14 on a rapid test or even a PCR (people don't think they should rapid test to exit isolation because they incorrectly believe they'll test positive for months). Implement paid sick days and support for people to stay home, and use a test to exit strategy with rapid tests and isolation. Make rapid tests more accessible again by removing registration requirement. Implement wastewater monitoring with data communicated to the public, like 11 of the other provinces and territories have already been doing.

COVID isn't the only airborne disease. The steps we take to reduce COVID transmissions also reduce influenza, RSV, and cases of other viruses as well. And evidently COVID is going to be threatening us all for some time. So sadly it hasn't been as simple as, get 80% of people 2 vaccine doses and do nothing else. Or as simple as, get everyone infected once and just deal with the severe outcomes and after that it's all done - it's not. This is a relatively recent problem for NB compared to other jurisdictions in the world, and if we keep on trying to ignore COVID, it is going to get worse. So we need to act.

So every day I get up and try my best. And maybe I reach one more household, or five more households. But GNB's 2022 briefings got 25-29,000 views on YouTube alone. So. There's dozens and dozens of people our tax dollars are compensating whose job descriptions and responsibilities include figuring this stuff out, implementing it, communicating about it and educating the public. This stuff is not at all mysterious. The only mystery is why people who are paid to protect our health aren't doing it right now.

The other aspect that we're already seeing is that more NBers, including more prominent and outspoken ones, are being directly affected by COVID. It's unfortunate that it's taking more sickness, inconvenience, disability, and death for people to realize that we're currently treating COVID in a way that's unsustainable for all of us. The evidence was there a long time ago. But there were perverse incentives at play. It was much more convenient for people to believe the government than to look harder at the actual evidence. FAFO, as the youth say. Right now it's the summer of finding out. GNB could have done this the easy way, but they've chosen to do it the hard way. I think the end result will be the same, it's just that this way, many more people are going to die or become disabled. The only question is, how many will we let that happen to before we take the responsible steps of communicating accurately with the public and implementing measures that are effective against airborne transmission. For great info I highly suggest the resources compiled at sites:

https://cleanaircrew.org/

and

http://urgencyofequity.org/

Pretend you wake up one morning and the Internet has been destroyed.  What's the first thing that you do?

Hug my kids, pet the cats, have a coffee outdoors - that sounds pretty good. I'll try that tomorrow!

---

Thanks so much to PoPNB and @NB_Covid_Info for participating in this Q&A session!