Day in and day out, Hans and Harper witnessed acts, big and small, that gave them hope. One woman in Mississauga shared that she was down to her last meal for her three children. She hadn’t eaten that day at all and she had no money coming in for another week. Hans phoned her and the woman broke down on the call: “I don’t know what to do.” Hans passed the story on to her sister in Mississauga, who helped the woman connect with their local caremongering group. Within a couple of hours, someone had delivered two Little Caesars pizzas to the woman’s front door. Within a couple more, she had $350 in grocery gift cards. People contacted her offering pasta, canned goods, stuff with shelf life. The woman, in turn, contacted Hans again, a new worry on her tongue: “Am I allowed to take it?” Hans told her, “Yes, if somebody offers you something, you take it.” That was the whole point. To freely give and receive was something beautiful in the gloom. Hans knows those little moments of generosity helped many donors get through the early months of the pandemic, too. Being isolated at home while others are suffering is a different kind of helplessness; it’s an absence of faith, optimism, community, worthwhile tomorrows.
In many ways, it’s unsurprising that the idea of caremongering resonated so deeply and so widely. Justin Trudeau tweeted about the movement, saying, “We’re only going to get through this by pulling together.” Barack Obama called it “a great example of the kind of community spirit we need to get through this.” In April, the Oxford English Dictionary’s senior editor called caremongering her favourite word to emerge from the pandemic, defining the term as: “the provision of help, such as shopping, for vulnerable members of the community during the COVID-19 breakout.” She added that it was “a relief to focus on something positive in all the darkness.” International media, from the BBC to the Washington Post, ran stories about the movement. The former pointed out that Canada is “a country whose inhabitants are stereotyped in the media as being kind to a fault” and called the cumulative #caremongering posts “an uplifting read during anxious times.” The latter deemed caremongering “the antithesis in name and spirit to fearmongering.” The media storm was intense and often overwhelming, but it wasn’t what underscored for Hans how quickly her neighbourhood movement had gone global.
That realization, she said, came when caremongers in Malaysia helped three hundred stranded Rohingya refugees, a group that the UN has dubbed the most “persecuted minority in the world.” Though Human Rights Watch has condemned Malaysia’s treatment of the thousands who’ve fled the tyrannical rule in their home country, Myanmar, the caremongers in Malaysia led with defiant kindness. When one member found the refugees in the mountains, too far from any town and begging for water and help, he brought Jeeps full of supplies, donated by other caremongers. In short order, he saved their lives. “And that was the day the magnitude of what we were doing hit me,” said Hans. She realized the philosophy of caremongering wasn’t only being applied to local challenges, but world-stage tragedies. “The weight on my shoulders felt so enormous. I had a full-on panic attack. I was hyperventilating. This was no longer just a Facebook group. Our actions had very, very real consequences. People’s lives depended on how we moved forward.” That kind of pressure can make you feel like a bent bough, waiting to crack. Hans and Harper found the increased attention to be heavy and surreal and also, at times, incredibly frustrating.
More than once, they got the chilling sense that both corporate interests and narrowmindedness were co-opting their movement. They saw trendy caremongering T-shirts being sold for profit. And, in some groups, judgment had seeped in like bitter tea. Instead of giving what they could, certain members had started to ask why. To expunge the bad taste, they trademarked the term “caremongering” and began to block and vet members who weren’t into giving radical kindness. But it was more than that: too many people were simply missing the point. The problem, wrote Yvonne Su, an assistant professor at York University, is that aw-shucks-Canadians coverage runs the risk of “happy-washing” the pandemic. “While there is an upside to this solidarity, it is often short-lived and romanticized by both media and politicians,” wrote Su in an April Policy Options piece. “In fact, it may allow the government to download its responsibilities to Canadians and the private sector and abdicate its role in ensuring that everyone is protected and secure.” Hans and Harper hadn’t started the movement because they were nice Canadians doing nice Canadian things—and they hated to see their movement flattened into a pat-on-the-back moment, especially without discussion of the deeper issues. “The thing is that if Canadians were really nice,” said Harper, “we wouldn’t be in this predicament.”
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For many people, the first weeks of the pandemic must have felt like being catapulted into the air, then crashing down, with no safety net in sight. For some, this feeling stretched into months, an endless sense of being Alice in Wonderland, tumbling through infinite strangeness, never once landing. Even worse, they may have looked up as they plunged and seen others cradled in safety: a woven lattice of family, government support, a job, their own savings. It’s tempting to blame COVID-19 for this free-falling, but the pandemic only exacerbated inequalities that already existed—snipping the last strings of an already-fraying net. The truth is, a lot of people who felt the worst effects of the pandemic never had much of a net in the first place. Public health messaging around “flattening the curve” urged people to retreat inside. And it worked—but only for the whitest, richest neighbourhoods. For others, it made only slight or no impact. Within the first few months of Canada’s national lockdown, what little data there was revealed that in Ontario the rates of infection and death were significantly higher in the province’s most ethnically and culturally diverse neighbourhoods. Compared to the least diverse areas, the rate of hospitalization there was four times higher and the rate of death was twice as high. In addition, Toronto discovered that newcomers and those living below the poverty line had higher case and hospitalization rates. Such dismal patterns were echoed in other cities. Contrary to the popular refrain, we were not, it appeared, “all in this together.”
The disproportionate statistics make an awful kind of sense. People who live in marginalized and lower-income neighbourhoods often did not have the luxury of working from home. They left their houses every day, risking exposure, because they couldn’t afford not to. In particular, racialized women and immigrants made up a lopsided share of those on the front lines, underscoring a long-known wage inequity—they were those who had to keep showing up for work, in large part because they never earned enough money in the first place. When you’re making sixty-two cents for every dollar a white man is paid, it’s hard, if not impossible, to build an income cushion. Add to that a history of inadequate access to health care, fuelled by a woefully racist medical system, and the reasons behind the disparities become even starker. To afford housing, many lower-income families also live together in smaller dwellings, while others are crammed into crowded apartments and public housing, all places where the virus is at its greediest. And yet, such families still may have fared better than those who were precariously underhoused or homeless during the pandemic. After all, it’s also exceedingly difficult to follow the “Stay Home, Save Lives” mantra when you have no home to go to.
Not only was it harder for such people to access hygiene prevention tools, but social distancing meant many shelters were not able to operate anywhere near their usual capacity, even as need increased—in May, one shelter went from handing out three or four hundred meals a week to well over six hundred. It certainly didn’t help that people who are homeless tend to have a higher prevalence of chronic health conditions, including heart disease, liver disease, and respiratory issues. Plenty of them are also over sixty-five, the age at which COVID-19 health outcomes become more perilous, more grim. All across the country, many of the services vulnerable populations relied on, including safe consumption sites, day programs, and food banks, were temporaril
y or permanently shuttered. Fentanyl overdose deaths rose, and many shelters, including those who serve youth, reported being unable to access health care for those who were symptomatic. As the crisis wore on, some cities rented shuttered hotels to help house street-involved populations. In Toronto, a cluster of those hotels were located in the city’s higher-income neighbourhoods; protestors rallied to denounce the “criminal element.”
Lucy Doan is a nurse practitioner in Toronto. In March, she was midway through a one-year fellowship sponsored by the Medical Psychiatry Alliance. The program is designed to provide better care to people in Ontario who suffer from co-morbid physical and mental health illnesses—two streams of care that are typically, and often disastrously, separated. For the year, Doan rotated through different placements, gleaning all she could about how to give better care. During COVID-19, much of her patient population was racialized, low-income, and living in public housing or relying on the shelter system (or, as the pandemic grew, the expanding tent cities). They may have a diagnosed mental illness such as schizophrenia or may be using antipsychotic medication while also suffering from concurrent chronic illnesses, such as heart disease or asthma. They may also be engaged in substance abuse. In normal times, it’s already a vulnerable group that does not usually get the care it needs, she explained. But as spring and silence settled over the city, the situation got even worse. “For the general population, it was like ‘Oh my God, it’s so awesome that GPs are switching to telemedicine, so care is still accessible and doctors don’t have to see you in person,” said Doan. “But many of our patients don’t have homes. They barely have an income—let alone a cellphone or the capacity to access that kind of care. It seemed like the entire population was an afterthought.”
She was supposed to stay at her then-current workplace for three months. That tipped into five, putting her on the healthcare front lines of the pandemic everyone seemed to forget. At the start of it all, she matter-of-factly accepted that she would likely contract the virus. She was less worried for herself, though, than she was about becoming an asymptomatic carrier and transporting the virus from place to place like a bad housewarming gift. She knew her clients already had a low baseline of health, and she knew that they’d have a much tougher time accessing care—and worse outcomes—if they did contract COVID-19. The pandemic had destabilized already-shaky ground: some patients battled paranoid delusions, and if they did start exhibiting symptoms, they and many others might also fear going to the hospital. Many such patients also feel stigmatized by the traditional healthcare system. Distrust ran high. Plus, unlike in a hospital, where every patient is treated in a quarantined, vigorously sanitized room and PPE is donned and doffed in crucially sterile settings, the home calls Doan was making required that she dip in and out of poorly maintained and rundown buildings and shelters. She left her own gear on her porch each evening, tied in a garbage bag, and dashed into her house yelling to her husband, “Don’t touch me!” She didn’t go to the grocery store for months. Risk crackled the air around her.
One day in April (she thinks; everything blended together) Doan changed into her PPE in a creepy downtown alleyway beside a dumpster. A nice, older woman ambled over to chat with Doan and her fellow nurse; they had to frantically ask her to keep two metres’ distance. It felt to Doan like she was watching her life from far away, on TV. She made a lot of less-than-ideal wardrobe changes like that, adjusting her armour outside in public spaces before entering high-density buildings. She knew it wasn’t proper protocol, but she doused her hands in portable sanitizer and accepted that it was the best she could do. On that particular day, she was making a house call to a woman with a rash. Many of her patients have chronic illnesses that are never addressed and they can be poor historians of their own health, so Doan tries to make as many in-person visits as she can—a seemingly benign symptom can easily be something else. And in this case, it was. Looking at the woman’s chart, she realized she had untreated heart failure. After some detective work (a common part of her job), Doan discovered the woman had a GP whom she refused to see. She called the GP and, to her surprise, he also agreed to do a home visit to the woman; he’d been worried about her, too. A few days later, he called Doan to tell her that, when he arrived, the woman’s oxygen saturation had dipped to the low eighties. A healthy person is at 92 per cent and above. She was admitted into the ICU and intubated for several weeks. Without intervention, her body would have begun to slowly shut down.
Cases like this haunted Doan throughout the early months of 2020. “What would the outcome have been if I never saw her in person for some rash, never contacted the GP, and he never saw her?” she wondered, even though she already knew the answer. “She would have been dead.” She had heard of at least one separate case in which a COVID-positive person who lived in a shelter wasn’t intubated at all—if he were someone else, would he have been? She herself had spent one sweltering day, sweating a river through her PPE in an unairconditioned room, trying for nearly two hours to convince a patient to go to the ER. But for every person she caught, how many others slipped through? The helplessness of it all could eat at her. In the public outpouring of gratitude for workers, Doan saw far fewer people delivering free meals and coffee for the nurses and social workers caring for the homeless, thanking them; patients and workers alike were swept under. Doan has never been much of a drinker, and the pandemic didn’t turn her into one, but she had also never before finished every shift with a drink, either. She never had more than one drink a day, yet it still felt like a drastic change. She also rented a spin bike and began to exercise constantly. Both distractions numbed her in their own ways.
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One Friday spring evening near the end of March 2020, Karen Dougherty was scrolling through social media, thinking about the dire kaleidoscope of images from Wuhan, Italy, New York. As a psychoanalyst and registered psychotherapist, who, at the time, had a practice in Toronto, she worried not only about the virus invading her city but about how the healthcare workers tasked with holding the lines of defence would fare—or, rather, how they were faring right then, watching the virus advance across the globe, unstoppable and untreatable. If SARS-CoV-2 attacked the body, then the pandemic could attack the mind. Depression, anxiety, fear, insomnia, loneliness, stress—each condition could appear in, and even come to define, a healthcare worker’s life as the weight of COVID-19 care crushed down. In particular, Dougherty thought about what she and others call “pre-TSD,” or, in other words, the anticipation trauma: the worry, “Will it happen here?” and, potentially even more palpitation-inducing, the question, “What will we do if it does?” Talk of a repeat of the SARS outbreak, during which 43 per cent of those who caught the virus in Canada were healthcare workers, was already in the air. So when she saw that a group of New York City mental health practitioners had banded together to offer free mental health services to frontline healthcare workers, her first thought was to fire off a tweet that said, “We should do this here.” She barely had time to wonder if people would respond.
Within two and a half hours, someone had helped her make a website and an intake form. Another person helped her put out a call for volunteers. She found her administrator in a friend from grade five whom she hadn’t spoken to in forty years. They called themselves the Ontario COVID-19 Mental Health Network. Within two days, 450 licensed therapists had signed on to offer pro bono phone and video sessions to healthcare and social workers in the province. By the end of April, more than 900 registered therapists had signed on to help; Dougherty eventually had to stop taking on new volunteers. They made the process as simple as possible: fill out the form and they’d send you two potential referrals, according to your preferences (maybe, say, you wanted a woman therapist or someone who matched your own racial or cultural background). If you decided not to call, that was up to you. But if you did need to talk to someone, the therapists were there, waiting. Dougherty and her colleagues knew health cris
es could trigger distress and trauma in healthcare workers, and that the shadow mental health crisis often went untreated. She also felt like the provincial government wasn’t ready to step up—in part because “it had no bloody idea this was coming” and in part because it had never rectified the dearth in access post-SARS. She also knew she’d be fighting stigma against accessing mental health care. Whatever the reason, Dougherty didn’t want history to carbon-copy itself.
In the end, more than one thousand healthcare and social workers reached out to the grassroots group. Together, their stories were a rushing undercurrent of anxiety, bubbling deep with fear and betrayal, often at odds with the “we got this” narrative the federal and provincial governments presented. Some called to talk about feeling that their hospitals or the provincial government, or both, weren’t taking the crisis seriously enough. Many worried that they wouldn’t have adequate PPE, or that it would run out, especially those who worked in long-term care homes. Nurses and doctors feared being moved from their regular wards and being made to work exclusively with COVID-19 patients. Their minds chewed on the mystery of it all: Would they know enough to treat patients? What procedures should they follow? How would they keep up with the information, which changed by the day, by the hour? They were terrified of getting sick, and most of all, they were terrified of being the ones who got their families sick. They agonized over the possibility of ventilator shortages and being forced to make gut-wrenching, impossible decisions about who would live and die. And they also worried about regular, everyday human issues that were suddenly, as Dougherty put it, “on steroids.” Would somebody’s ex-partner use the threat of COVID-19 as an excuse not to let them see their children? Would they not get to say final words to a dying parent? Would lockdown topple a relationship over to divorce?
Women of the Pandemic Page 7
