Below the Radar Transcript
Pandemic Conversations: COVID-19 and Inequities in Health — with Meaghan Thumath
Speakers: Paige Smith, Am Johal, Meaghan Thumath
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Paige Smith 0:06
Hello, everyone, and welcome to the fourth episode of our Below the Radar conversation series. Today we talk with Meaghan Thumath, clinical scientist at The Center for Gender and Sexual Health Equity, and clinical associate professor at UBC School of Nursing. With our host Am Johal she discusses her previous international work, studying and combating pandemics and how this has informed her current understanding of COVID-19. Both internationally and locally here in Vancouver, British Columbia. Enjoy!
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Am Johal 0:40
Hi there, everyone. Welcome to Below the Radar, we're lucky to have our guest Meaghan Thumath here with us. I'm probably completely destroying your last name, Meaghan. She's a former neighbor of mine who lived across the alley from me. But Meaghan, would you be able to introduce yourself?
Meaghan Thumath 0:59
Great, thanks very much Am, really great to catch up. So I'm Meaghan Thumath, and I'm a clinical scientist with The Center for Gender and Sexual Health Equity, which is out of Providence Healthcare, and UBC and I'm also a clinical Associate Professor at the School of Nursing with the University of British Columbia as well, UBC.
Am Johal 1:19
Great, you know, I think along with pretty much everyone in the world, we're going through varying degrees of anxiety with the pandemic, COVID-19. And as someone like you who has not only studied pandemics but you've, in many parts of the world, also have traveled and were on the frontlines of pandemics before. So before COVID-19 hit what has been your experience working internationally?
Meaghan Thumath 1:53
Yeah, I've been very blessed as a registered nurse and a sort of public health practitioner to work. I initially started working in global health in Haiti, mainly and HIV AIDS, which has been the bulk of my expertise, sort of at the intersection of HIV and human rights. And so focusing mostly on infectious diseases among people who use drugs, sex workers, LGBTQ community members, and figuring out how we can, using a human rights lens, really prevent HIV, but also get get treatment to folks so that we didn't see this really, really vastly and disturbing inequities among mortality for people who use drugs in particular. And so that work led me to lots of different work with the Global Fund and AIDS, TB and Malaria. I think, last counted, maybe like, probably 36 different countries had the privilege to work with primarily around their global fund grant implementation for what we what in HIV we call key populations and that would often be, you know, as a technical adviser for UN Aids or United Nations Development Programme UNDP.
And then, more recently worked with the World Health Organization on Ebola in the DRC, in the Democratic Republic of Congo, and that was in October, where I got to work on infection prevention and control, mainly as an evaluator, but also capacity building among local health systems on a really interesting project for youth. That was primarily youth who were involved in sort of the resistance around the outbreak of Ebola at the time in West Africa. As well as working with medical students and helping them to build capacity of local clinics, because they were sort of a resource that wasn't already being well deployed. And then from there, I also have worked a little bit with WHO Afro on COVID 19 preparedness as well as the Red Cross, the Canadian Red Cross, really unusually, put out a call to their international delegates and one of the, on their emergency response team. And it was the first time I got a call from them. Usually, it's, it's, you know, can you go to this cholera outbreak in this place, but it was actually can you go to Trenton, Ontario, and many of us from the IOT were like, why are we being deployed in our own country and it was actually the first time the Red Cross has ever deployed international delegates to a response. So that's where I was in February. Working with Wuhan evacuees and evacuees from some of the cruise ships in Canada's first large quarantine zone. I think it's the largest ever quarantine operation that we've had and that was to bring home those Canadians that were stuck in Wuhan.
Am Johal 4:57
In terms of it in relation to more recent pandemics in terms of the global health system, what are some characteristics or features of COVID-19 that place particular challenges around health system responses, be they globally, nationally, locally, you know, you having dealt with others in the context that you just described? Obviously there's the spread, the rapidity of it and there's particular challenges and features that it poses that makes this perhaps a lot more complicated than other more recent pandemics that we've had.
Meaghan Thumath 5:41
Yeah, I mean, I think one of the difficulties is, is the asymptomatic transmission, I mean, with Ebola one of the good and the bad things is you're quite unlikely to transmit when you're not don't have symptoms and and the mortality rate is so high the attack rate in Ebola that that's both deeply distressing and very disturbing feature of Ebola, but also means that it's harder to spread, because cases that have passed away are not as likely to spread, although they're certainly around safe and dignified burials, some, some transmission risk there, which is why there's such an emphasis on that practice in Ebola. What's unique about COVID, I think, is just a lack—you know, we don't have any immunity in the community. And at the same time, we don't have a vaccine. And so Ebola, after many, many years of work, we're super fortunate that eventually we had a breakthrough around the vaccine. And so a big part of Ebola outbreak management is having this multi-pillared approach of communications, of infection prevention control, and then of also the vaccine team and epidemiology and contact tracing. And many of those same lessons and pillars are applicable in COVID, and our COVID response. But the difficulty is that we’re missing that core pillar, which is vaccine distribution, because we don’t have a vaccine yet. And so, as difficult as it is to watch our politicians and others sort of cage their bets on when we can return to normal, I think many of us who have worked in infectious disease outbreaks before are not so surprised to hear that we won’t be having a return to normal a year, a year and a half, two years, because that’s just the horizon for most new—I mean, even that’s a very tight horizon for a vaccine—and I think that that’s what’s really unprecedented.
I was just catching up on some of the literature with WHO Afro colleagues earlier today, and but also realizing as much as it’s very much as it is a pandemic and meets that definition of being in every corner in the world. There is some emerging literature about, you know, how Africa has not been hit as much as we thought it might be and that's both because there is a lot of experience dealing with these types of outbreaks in the continent, there's also you know, environmental factors that might be helpful for them. But there's also been a very quick lockdown and a ton of, I think, experience. And to me, it's one of I think the most beautiful opportunities of this outbreak, is that it sort of shining a light, I think on the flaws of the very colonial, sort of Western, imperialistic approach to global health, and the idea that that knowledge and expertise is centered in the West. And I certainly felt very privileged to work in Africa and come away thinking “Wow, there are so many lessons here that we need to learn in Canada, in the US, and I've always been kind of struck that, particularly, no disrespect to American colleagues, but that there—don’t necessarily have universal healthcare in their own country, there’s a lot of work to be done there, and there’s also this sort of assumption that they are the experts in everything and I think this, a lot of scholars from the content have been really disputing that and saying this is finally shining a light on those, these inequities that are both in academia but also in practice.
Am Johal 9:20
This is, the pandemics, you know, change society because they come in on the blind spots and even looking at the World Health Organization's standards on readiness for pandemics the US was rated quite highly. That certainly isn't going to be the case afterwards because you definitely see the blind spots in systems just like here around seniors care facilities, privatized models, that come into play. You know, here in Vancouver, we already had a public health emergency declared around, related to fentanyl and overdose deaths. We’ve had, also, vulnerable communities that are disproportionately affected when something like COVID-19 happens and wondering if you can speak just a little bit about, you know, how the spread of COVID-19 and approaches, particularly around inner city neighborhoods have been approached, given the complex challenges there?
Meaghan Thumath 10:29
Yeah, I think that's certainly been a unique focus in Canada around our focus on health equity and working with marginalized populations. And we've seen that, I think, some national leadership on that, and certainly provincial leadership in British Columbia, and I've been very fortunate to have been a bit, a small part of that response, working primarily with Vancouver Coastal Health, and that team there has really put a major emphasis on and I think there three-pillared approach for working with inner cities and that's been primarily around testing. So even when we didn't have broad access to testing because of lack of lab capacity, there always was a major emphasis on testing in shelters, because we know that people who have to live in congregate settings because of our homelessness crisis, which is sort of a third component, overdose crisis, and then our homelessness crisis has meant that those people are extremely vulnerable. We know from the US context, you know, some shelters in California, where there's been, you know, major outbreaks, you know, 60 people testing positive in one shelter, if you're, if with COVID, we know it spreads really easily among household contacts and if your home is a 70, bed shelter, or 100, bed shelter, that's, that's a potential for a lot of transmission. And so, early on, in this pandemic, we focused on testing. And then the second aspect was contact tracing. And really, a lot of COVID is about test and trace. And so by focusing on contacts, and really, when there was cases and in the congregate living situations, immediately isolating those cases, getting them to a hotel. And so BC Housing and another's invested in a large scale up of hotels, which were being used because of the lack of tourism. And we were able to get people into a safe apartment where they had their own room in their own washroom and then the third aspect of support, and that has really been about addressing some of the underlying causes of the overdose crisis, which has been pandemic prescribing as what we're calling it. So a safe supply to replace street drugs so that people who are at risk of COVID aren't having to go out and engage with dealers and continue to purchase. And so if they've been asked to self isolate, we thought it was only fair to give them the tools that they needed to isolate safely. And that meant giving them pharmaceutical replacement for their drugs, whether those were stimulants or opioids, alcohol, cannabis, even tobacco. And that I think, has been where BC has been a big leader, it's something many of us have been wanting for a long time. And, you know, really replacing the criminal approach to drug use with a public health approach. One that recognizes that the roots of addiction are complex, and that they many times are rooted in trauma, and that simply wishing people would stop using drugs and not addressing the underlying determinants of their drug use, their trauma, their homelessness, their, you know, mental health, underlying mental health conditions, while asking them to continue to hustle to, have to steal or engage in survival sex work, and then on top of all that have time to get healthy. That just doesn't work in my experience as a nurse. And so we were seeing really great early success with our safe supply guidance and hoping that that it's something that will, will continue after the pandemic. I know that's what, what everyone's hoping for, and so we're just sort of building that evidence based on that.
Am Johal 14:14
And, Meaghan, with the international work you've done both with the World Health Organization, and certainly in the academic work that you do, looking at the way different nation states and regions have dealt with the response to COVID-19. What are some your thoughts and reflections in terms of international health systems or even national ones in terms of preparedness for pandemics? In some sense, there's almost more preparedness being done in this region on earthquakes than there is for pandemics plays and I think obviously, these things come in blind spots, very easy to do sort of hindsight 20/20 Monday morning, quarterback. I think it's also, it'd be interesting to get your read on what you think are some of the critiques of the broader systems at play?
Meaghan Thumath 15:09
Yeah, I mean, certainly we are such a large country, that it's hard. I mean, many of the regions where they do this really well are geographically a lot tighter and smaller, although we have a really small population, compared to many of their big cities globally and big nations. But I do think so it's sort of there's a lot, Canada is quite unique, I think, that way and how dispersed we are. But one of the big things I think is difficult for us is having a really well funded national public health system with a lot of support behind it, and one that's really well coordinated. And that's that's one thing. I've certainly learned from my time working with Global Fund, and AIDS, TB and Malaria, and with WHO is that, you know, to really coordinate well on whether it's personal protective equipment, PPE supplies, whether it's access to essential medicines and supply chain, whether it's to really understand what's going on nationally with contact tracing or testing, you need a very strong, coordinated response. And I think for how dispersed, given that health is a provincial responsibility that's often been a real challenge for for Public Health Agency of Canada. And it's certainly something I think that everyone is really well aware of. Its National Nursing week, this week, and it would be remiss not to also mention we were one of the only Western nations that doesn't have a chief nursing officer, for instance, we have a Chief PHO, Dr. Theresa Tam, who has done some really wonderful work, but I would also want to plug that that's a I think, a real gap that we don't have a strong National Nursing voice and that public health, maybe in Canada from my vantage point hasn't been as interdisciplinary as it could be. It's very physician driven here compared to many other regions I've worked in. And, of course, the physician voice is really important but what we've learned from Ebola is that you need social scientists, you need communications experts, you need social media experts. I think that's that's one of the things I've seen missing from our response compared to other countries is really understanding that crucial role of, you know, the impact of COVID, or other pandemics on gender and gender based violence, you know, to really understand that you need all of those key disciplines at the table, you need social work, nursing. And here, I think that as we look back and have the opportunity to understand what went well, and what didn't, I think I continue to see task forces being announced that have really just one or two disciplines in them. And that's unusual in my experience to to how other countries are addressing large pandemics, especially ones that have the experience we had in Ebola, where we realized that our communications weren't working, and that that was actually leading to making the conflict worse, running Ebola in DRC, in the middle of a conflict setting, it became very clear that we had to address rumors and myths and them very seriously and get very sophisticated about how we addressed social media myth making in in that outbreak.
Am Johal 18:33
You know, with the sort of lessons of the 20th century pandemics, be it 1918 or 56/57, the ones from 68 to 70. There's certainly some ways we can read into the present moment. But of course, I think, as with most pandemics, you can't really look that far into the future we don't the fall and the spring, are looking like it really puts a lot of planning into disarray and as we start moving into opening up to some degree here in BC, universities are deciding whether to open up or not and, you know, from a health perspective, of course, one thing that we know is that we don't know what's going to happen, but what are from a health perspective, what are things that people are going to be looking for in terms of indicators and other developments that will help make sense of, of what, what some kind of normal will look like or what kind of “new normal” will look like?
Meaghan Thumath 19:36
Yeah, I mean, I think certainly most pandemics in history have had a second wave and so we talk a lot about that and in public health and you do hear nationally and provincially Dr. Bonnie Henry has done some amazing leadership in BC, talking about we really do expect a second wave that could be as early as this fall, it could be later. And so I think many of us are bracing for that, and you know, prepare for the worst and hope for the best is a very classic adage but it's certainly the case in outbreak response. And the system here I think has, is really keeping, we're trying to keep staff, keep everybody at the ready because we anticipate that while we may have a lull in the summer, things could certainly pick up again. In terms of what how people are using this time, I think globally, in certainly in Europe, speaking to colleagues there as well, is preparing and really looking taking a deep dive to understand what the unintended consequences have been to the sort of intensive lockdown that many countries have taken in to have and lockdown measures countries have implemented. And so there's some really interesting work happening now with economists and other disciplines on figuring out really, you know, health is about so much more than just the body, it's about the determinants of health and so we know that job losses, and loss of income, and even feelings of isolation, impact different different communities differently and the less privilege you have, the more likely these are to impact you. And we also know I'm particularly passionate about the lot of precarious workers and people with precarious employment and how difficult that is. How easy it is to say, you know, "stay home" but how difficult that is if you are living paycheque to paycheque, and you know that your employer isn't going to support you to stay home. And so I think now is the perfect time to prepare for that and to understand what those unintended consequences are, and how we can really create a livable wage for people. That means that people have, you know, essential policies like there's, there is punishment, if you are not allowed to stay home sick, there are consequences for employers that don't respect that, that there be genuine acceptance of people needing to stay home, and then there'd be childcare. From a gender perspective, I know, it's been really difficult for me. I have two kids and I've been working full time on the BC Pandemic Response as a nurse, and the idea that I can homeschool my child with ADHD. it's laughable, and he, you know, my husband is also an essential service worker. So it really impacts children with disabilities differently, and especially the children of essential workers, whether you're a grocery store clerk, a nurse, bus driver, all of us are trying to do our best and so I'm hoping that as we move into the fall that we start to realize that, you know, different families will need different approaches. And that we, we learn from from the sort of last eight weeks.
Am Johal 22:56
Now, Meaghan in terms of international institutions, The World Health Organization, they've both come under criticism for not acting, oddly enough. Just like a lot of international organizations like the UN, they're made up of member states, there's politics of play, there's a lack of resources, oftentimes, but if there were some recommendations that you would have around how we can rebuild trust with international institutions, and also to have them do what they need to do to help getting a sense very early on when a pandemic is arising and for them to be able to work well what ought to be in place, or what does COVID-19 perhaps show us about the weakness of some of these systems that are in place?
Meaghan Thumath 23:51
Yeah, I think it's, it's a really great question. I mean, I'm not often the, perhaps acknowledging my bias as someone that's worked directly for WHO, I definitely don't subscribe to, you know, President Trump's comments around the sort of uselessness of it. I don't think that's backed up by facts. I think Dr. Tadros and others sounded the alarm really loudly. I think sometimes, again, it goes back to my point about communications. When you starve an organization, that organization is very famously underfunded, it's really difficult for it to do the work that it needs to do to be effective, especially when you're pushing against this tide of very well funded and well financed alternative narratives in the media. Whether that be, I think someone, some scholars recently published a paper that you know, some of the conspiracy websites get like 45 million hits in a day and WHO gets 6 million. And you just, that kind of the massive funding of troll networks and sort of these bad actors. I think sometimes people feel Public Health are quite naive about how that impacts our work. And certainly, you don't have to look too far to sort of have the impact on elections globally to understand how well financed and resourced those those bad actors are and how difficult and important and crucial it is that we not be naive about that, and that we resource our response and that we address these these attacks on democracy. And, and WHO has, certainly there's many smarter political scientists and public health scholars than me that have written about, you know, ways to reform WHO, and I know, my colleague at LSHTM, Peter Piot, recently just recovered from COVID himself, talks about some of his ideas for reform, among others. I think it's no secret there, that many people wish that WHO had a little bit of a stronger power, it's made up of its member states, and it has to be involved in politics, because that's how diplomacy works. And there's good and bad things about that having worked for the Red Cross as well, you know, you have your MSF, your Doctors Without Borders, approach of Tim one edge where you speak truth to power. And that's something in my activist days I certainly did more of, but I've also learned that there's you can get a lot done working behind the scenes, as well. And there's a lot that WHO is doing that they can't necessarily talk about and that's their role to be that sort of health diplomat, and then to have actors like MSF, and others being the stronger voice of voices and I think you need both. It's not an either or, and it's not true that one system is better. And the Red Cross' principle of neutrality has them sort of in a very different place, neutral role that comes from their role, after the war, and being that's why they're able to work in prisons, why they're able to work in refugee camps and in conflicts, in many ways, because they maintain that position of neutrality. And so this, this is something that COVID in the context of conflict is is another really interesting area that people are now starting to turn to and how do we address COVID? There's been global calls for ceasefires, the US has not joined that. So I think that, as things sort of quiet down, it's going to be interesting to see if conflicts start to rear their heads further, how we handle that as a—clearly that'll be the UN family working on that together with member states.
Am Johal 27:38
Well thank you so much for joining us on Below the Radar and thank you for all the amazing work that you've been doing and best wishes and and I realize it's going to be a long haul, as you said and and hopefully we'll get through this together.
Meaghan Thumath 27:57
Thanks to you, neighbor! Take care.
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