Women of the Pandemic

by Lauren McKeon

  “I would go home to my husband and say, ‘You don’t understand,’ ” says Fiorella Talarico, a sixty-year-old hospital cleaner in Ontario’s Peel Region, who, during the first wave of the pandemic, primarily worked on the COVID-19 floor. What she meant was: nobody could understand the exact toll of COVID-19 until they had witnessed the front line; until they had seen dozens of intubated patients, eerily empty waiting rooms, void of anxious families and loving visitors, rooms occupied one day and not the next; until they came home, day after day, and burst into tears. Talarico quickly realized people were experiencing the pandemic in separate realities. In one, the virus was distant, still scary but also unlikely—a bogeyman that wrecked economies, vacations, mental health, and social bonds. In another, hers, it was a mind-boggling, untreatable onslaught of death and pain—a fickle Grim Reaper that claimed both the susceptible and previously healthy, unyielding and without reason. Women of the Pandemic aims to merge those realities, to bring us closer to one another, and to ground us in our shared humanity: to help us see how, as Talarico put it, “COVID-19 changed all of us.”

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  I’m writing this introduction in July 2020, and I’m still afraid. I’m afraid when I see photos of exuberant crowds of bronzed and burned bodies at the beach, at the park. I understand why they want to hug each other, delight in casual touch, share a beer. I understand and empathize with their need for connection, but I am afraid of their disregard, of their selfishness. I am afraid for the countries that appear to have given up on containing the virus, and I’m afraid for those who are so fatigued with this fight they appear to have forgotten it. I am very afraid of those who believe the virus doesn’t exist, that governments played make-believe with a pandemic, that the current worldwide death count of over 161,000 is inconsequential. A couple of weeks ago, on my thirty-sixth birthday, a sixtyish woman in a white sundress and gold jewellery confronted my aunt and me about our masks. It was sweltering out and she asked if we enjoyed wearing them. We carefully told her they were a pain but that they were necessary for everyone’s safety. She shook her head at us, the fools, and remarked, “It’s all a hoax.”

  There is a generous reading of such deliberate distortion. That is, in the face of enormous global upheaval and a forever-altered world, perhaps it is human to want to deny. Maybe certain pandemic conspiracy theorists and rule-breakers have something in common that everybody else, however angrily, can understand: an inability to confront the immeasurable loss of COVID-19. It’s tempting to pretend nothing has to change; it’s daunting to accept there is no firm end date. But to do either is to undercut every death, every sacrifice, every loss, every woman who did her job. In this time of large, unfathomable griefs, I have my own small griefs, too. Like many of us, I haven’t seen my family in months. I haven’t celebrated over dinner, or toasted a glass. My hair has split ends and I have cried alone, more times than I can count. My boxing club—my place of community, strength, and mental stillness—didn’t make it through the pandemic. I have spent the early stages of Toronto’s reopening this summer masked and helping to tear down a place that felt like a second home, or sometimes a first. Even as we mourn, though, we reimagine. For now, my club meets in a public park and, spread six feet apart, we punch the air. Next year: who knows? All of us are trying.

  It’s impossible to guess at the full consequences of COVID-19. University of British Columbia sociology professor Sylvia Fuller said in July of the disproportionate impact of the virus on women, “By this point it’s become clear that the pandemic is not the ‘great equalizer.’ ” As much as we pine for, or rush toward, the new normal, the pandemic isn’t over. We cannot know how far the ripples will extend, or what else will be redrawn. Surely, we’ll see both good and bad changes, resurgent kindness and unaffordable setbacks. Already, we’ve seen calls for better social supports, health care, and higher pay for essential workers. Already we’ve seen a widening gender pay gap, an uneven return to work, and an increase in gender-based violence. As we attempt to chart our paths forward, it’s important for us to reflect on this exceptional year, to honour it, and to unflinchingly examine its darkest truths. So, yes, let us rebuild with hope and generosity, but first let us pause and pay attention to what this time, and these extraordinary women, have to teach us.

  “IT CERTAINLY HASN’T BEEN BORING.”

  Dr. Vanessa Allen, Public Health Ontario

  One

  THE PANDEMIC ARRIVES

  For Dr. Samira Mubareka, January 2020 was the taut silence of an oncoming Maritime storm. The Toronto virologist grew up in Saint-Joseph-de-Madawaska, and was used to watching the wide New Brunswick skies darken, rend, still. Then, plop—one bell-shaped raindrop, rippling into an echo. Then, a few lazy seconds later, another. A strange stillness before the downpour. This anticipation felt like that, only worse. Much worse. She knew her hospital, Sunnybrook Health Sciences Centre, was equipped to handle a high-consequence pathogen. When Ebola hit in 2015, they screened patients under investigation for the deadly virus. Every year, her team also screens returning travellers with possible symptoms of MERS, a coronavirus with an alarming fatality rate. They were already planning for a what-if pathogen exercise with multiple public health agencies, scheduled for February. Mubareka herself had spent a decade building capacity at the hospital’s infectious disease lab, focusing on respiratory illnesses. If any place could be prepared for a new virus outbreak, it was Sunnybrook.

  And yet, with each suspected case of the world’s new mystery illness, the knots in her stomach pulled tighter. Is it starting? Then, one Thursday evening late that month, another drop fell. A fifty-six-year-old man who had been travelling in Wuhan, China, for three months began coughing on his flight home. The next day, he turned feverish, his temperature pitching to 38.6 degrees Celsius. Paramedics arrived in full PPE and hightailed it to Sunnybrook, where receiving nurses waited, safety gear obscuring familiar cheery scrubs. Doctors tested the man for at least seven different viruses, including SARS-CoV-2, which causes COVID-19, then still-unnamed. He wasn’t having trouble breathing, but a lung X-ray showed splotches spread like tree roots. Soon, Mubareka got the call: positive. He was Canada’s first confirmed novel coronavirus case; his wife soon became the second. Within forty-eight hours, Mubareka’s team had secured permission to collect samples from the patient, from his room, and from the air around him. The knot in her gut constricted.

  Mubareka donned her N95 mask, gown, gloves, and protective booties. Of all the sites she’d ever visited, this would be the “hottest”—microbiologist parlance for pretty damn bad. It had been barely a month since China had reported its first case, and little was known about how the virus was transmitted, what it did to the body, how contagious it was, or how deadly. To answer those questions, and to have any hope of stopping, treating, or vaccinating it, scientists needed to study it, whatever it was. But to do that, they first needed samples, lots of them. Not knowing where the virus lurked, Mubareka decided to take surface swabs from several high-touch areas, including the washroom, bed railings, and door handles, as well as bioaerosol samples from both near the man’s head and around the room. She felt bad shuffling around him, dressed like an astronaut, the two of them silent; he didn’t speak English and she didn’t speak Chinese. She could tell he was scared. It would have been nice to talk while she worked, to reassure him as she was swiping and bagging, setting cannisters to capture the air.

  Somewhere at the back of her mind, worry hummed. She wondered what would happen if there were a breach. The virus was—and, for that matter, still is—enigmatic. She had no idea if she would survive it, if her immune system could battle it. This new bug was unlike anything science currently understood. What would happen if a single particle, called a virion, slunk inside her body? She was used to handling human viruses, but only when they were captive and controlled in a flask or cryotube. The patient was in a negative pressure room, which allows air to
flow into the room but not to escape it, under strict entry and exit protocols. She knew she was as safe as she could be. But none of those details changed the fact that Mubareka was taking samples from a living, very sick man who was potentially expelling a killer virus with every troubled breath. She worked quickly and efficiently. Within ten minutes, she was out. She stripped her safety gear and, just for good measure, immediately showered. She had secured Canada’s first sample of the virus and jump-started vital research. In response, the knots stitched tighter. Now that the country had its first case, how much worse would it get?

  Within days, Sunnybrook admitted another potential SARS-CoV-2 case. Then another. And another—each one a fat raindrop, pinging faster. Mubareka collected sample after sample, eventually hitting ten, twenty, fifty. (By the end of 2020, she would collect thousands.) Her team moved to secure permission to work on the virus in her lab at Sunnybrook. By then, it was nearing the end of February. The virus had finally been named but had not yet been declared a pandemic. Mubareka didn’t need the official designation to know now. She felt like she had aged five years; stress had winnowed her body. Guilt pooled as she spent day after day, hour after hour, at the lab. She missed her husband and her two children, ages eight and ten, and felt heartbroken about not being there for them. But at least the knot in her stomach had started to unspool. “As more patients arrived at the hospital,” she says, “there was almost this sense of relief.” That horrible anticipation, that sense of watching the fraught and roiling sky, was gone. She didn’t have to wonder what would happen anymore. The storm was here.

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  On January 3, the last day of her Christmas vacation, Dr. Vanessa Allen absconded to a nearby café. The chief of microbiology and laboratory science at Public Health Ontario (PHO) wanted to catch up on work before Monday, and she needed somewhere quiet, secluded, and, most importantly, away from her twin three-year-olds to do it. (“I love them,” she said, laughing. “But they’re little monsters.”) She was checking her emails when she saw an alert about the worsening situation in Wuhan. Allen had worked in a hospital during the SARS outbreak, had seen the devastation and disorganization first-hand, and had joined PHO because of the agency’s mandate to anticipate and better respond to outbreaks. Launched in 2008, PHO is a direct result, as the organization’s first annual report puts it, of “Ontario’s wake-up call from a series of outbreaks.” Those included SARS, of course, but also Legionnaires’ disease and the E. coli outbreak in Walkerton. When Allen joined the organization that same year, the province was in the midst of a listeriosis outbreak linked to contaminated cold cuts from Maple Leaf Foods. It eventually killed more than twenty people. Since then, it had seemed like the province had to contend with a possible outbreak nearly every week. She couldn’t exactly say a worldwide pandemic was in her comfort zone, but by 2020 she’d had two decades of experience working with outbreaks. She wasn’t about to panic—and besides, nobody had yet guessed how big the outbreak was about to become. There was something about its potential, though, that did make Allen want to move fast. She called her colleagues, and by the end of the day they had a testing algorithm in place should anybody in Ontario turn up with symptoms.

  At the time, the full genomic sequence of SARS-CoV-2 didn’t even exist. But Allen and her team knew the virus was similar enough to both MERS and SARS for them to make what was, essentially, a very educated scientific guess—one that could give them a jump-start on testing. About a week later, on Saturday, January 11, Chinese health authorities released the full sequence for SARS-CoV-2, confirming its striking similarity to the other coronaviruses (and, in particular, to two unnamed bat-derived coronaviruses). That same weekend, Allen’s team completed their first test. The results were negative for the virus, and so too was every other test the team performed over the next week. Their ironically lucky strike-out record didn’t stop the team from saying yes to testing every sample sent to the lab. If you were the on-call microbiologist during that time, you were constantly fielding calls, accepting samples. In what turned out to be a controversial decision, Allen decided to test everything she was asked to, no matter how unlikely it was to be SARS-CoV-2. As worry multiplied, she made it clear to anxiety-filled hospitals that she would never refuse a request. “It was a huge debate,” she said of the policy. “People were worried we were making more of it than we needed to.”

  There are countless ways a human body can get sick. Before the microscope was perfected in the 1600s, scientists tended to blame outbreaks on everything from social class to divine punishment to clouds of disease-laden air. To them, the idea that an imperceptible organism could invade a person’s body and cause illness or even death would have sounded far more ludicrous than even their most bizarre theories. But the microscope literally opened a rich, new world to discovery—that of germs. Working in Berlin, Robert Koch discovered the first bacterium, bacillus anthracis, which causes anthrax, in 1876. In time, bacteria became classified as living, single-celled creatures that can cause deadly infections in their host. Bacteria cells are not so dissimilar to mammalian ones, although they are far more simplistic. Think of an air balloon that contains water, nutrients, and a single molecule of DNA. They can replicate on their own and cause harm by directly killing their human host’s cells, or by triggering an immune response so severe it damages a person’s body. Bacteria’s long-awaited discovery led scientists to finally declare the cause of relatively common diseases such as tuberculosis, cholera, and syphilis. The cause of certain other prevalent and deadly diseases, like smallpox, however, remained a mystery. Scientists took sample after sample, but no bacteria could be found.

  Initially, they assumed such diseases must be caused by bacteria that were too tiny to be captured through the microscope. They were half-right. It wasn’t until the 1930s, with the invention and development of the more powerful electron microscope, that they were able to finally detect the much smaller microbes. Unlike bacteria, viruses are not cells. They consist of a protein coat, called a capsid, inside which the virus stores its genetic material, which in turn carries the code for making new viruses. Many viruses may be deadly, but they lack one key thing: any of their own biochemical machinery to build more particles. In other words, they can’t procreate on their own. Viruses overcome this by invading a host’s cells and hijacking their machinery to transform them into virus-making factories. In the process, they usually kill the cell itself, either through nutrient depletion or the creation of a toxic environment. After this, sometimes the cell will burst, sending more virus particles into the body. Today, it’s estimated that our immune system goes to war against tens of millions of germs every single day. Of them, viruses are the most ubiquitous: they’re at least ten times more common than bacteria, and there are at least a hundred million different types. In fact, they are the most plentiful lifeform on Earth—and, every now and then, a new one comes along.

  After completing dozens of tests that identified other viruses and bacteria, Allen received Mubareka’s sample. Also a clinician at Sunnybrook, she knew about the patient’s symptoms and history, and like Mubareka, she suspected this sample would, finally, be a match. Allen ran the virus test only a few days after her twins’ birthday, which was on January 16. After the sample was confirmed positive for SARS-CoV-2, she barely saw her family again for months. Her life became a blur of planning, testing, meeting, and troubleshooting—she was in charge of, or a key voice for, it all. During that time, additional leadership responsibilities were also heaped onto her plate: she became the executive lead for PHO’s lab response and served as the inaugural medical director of the provincial diagnostic network housed at Ontario Health. From the beginning, Allen worked seven days a week, often for eighteen hours a day. It wasn’t uncommon for her to be booked into a mind-boggling twenty-four meetings in a single day. If women had been historically relegated to the scientific sidelines during past pandemics, then it was clear to Allen things would be di
fferent this time. Every gender lined the Brady Bunch–style tiles of her virtual meetings, and many of the leaders she dealt with most frequently were women.

  When I spoke to Allen shortly after the six-month mark of the pandemic, she had just started taking one day off a week. Like Mubareka, she worried about her singular focus on work and felt guilty about being so unavailable to her family. In trying to explain her new-normal busyness, she picked a random day from her calendar, April 6. On that day, she led discussions on finding better processes around the province’s prioritization and allocation of testing swabs; prepped for an urgent meeting with the premier’s office; sat in on Ontario’s weekly command table gathering, which assembles experts from across the province to discuss their concentrated approach to COVID-19; launched and met with another testing strategy panel to address what she saw as a lack of diversity in voices at the table; and helped plot a way to fix underserviced testing areas in Ontario’s north—to name only a few things. An average day might include more, but rarely less. “So,” she quipped, “it certainly hasn’t been boring.”