Category: Health & Well-Being

Written by Sibo Chen, Ryerson University. Photo credit [Frank Gunn/THE CANADIAN PRESS. Originally published in The Conversation.

The first Pfizer-BioNTech COVID-19 vaccine dose in Canada sits ready for use at The Michener Institute in Toronto in mid-December 2020, less than a year from when the World Health Organization declared COVID-19 a pandemic.

The race for developing effective COVID-19 vaccines has put the pharmaceutical industry in the spotlight.

Over the past few months, the world has witnessed rapid clinical trials and approvals of several highly effective vaccines like Pfizer, Moderna and AstraZeneca. This unprecedented achievement has been made possible by close intra-industry, state industry and international collaborations.

Big Pharma’s proactive approach to vaccine development has also brought an unexpected consequence: its reputation has been notably enhanced since early 2020. A survey conducted in February 2021 found that almost two-thirds of Americans now give the pharmaceutical industry high marks.

But reputation risks loom even as pharma companies are being celebrated as pandemic heroes.

The controversy over the AstraZeneca vaccine’s potential serious side-effects is a prime example. The English company has experienced a public backlash due to a lack of a crisis response plan and conflicting messages delivered by different stakeholders.

Will the reputation boost enable the pharmaceutical industry to fundamentally rebuild its negative public image? As someone who researches public relations, I believe that only by prioritizing socially responsible practices can Big Pharma achieve true reputation redemption.

Big Pharma’s damaged reputation

Prior to the COVID-19 pandemic, the pharmaceutical industry had been battling reputational damage for years. Notably, it sank to the bottom of Gallup’s August 2019 United States industry favourability poll, with a total positive score of only 27 per cent. According to Gallup’s analysis, high drug costs, massive advertising and lobbying spending and the opioid crisis have all tarnished the industry’s public image.

This is consistent with public relations research conducted in Europe. In a qualitative analysis published by Public Relations Inquiry, a team of Ghent University researchers analyzed how Belgian pharma companies responded to the pervasive “Bad Pharma” public image.

Their analysis revealed that Bad Pharma perceptions reflected larger societal issues, including widening income and health gaps. The public expects the pharmaceutical industry to save and improve lives by developing innovative, affordable and effective medicines. Accordingly, the industry loses trust when the public believes its actions and motives are at odds with those expectations. Such a decline in public trust can’t be easily fixed by corporate responsibility reports or public relations campaigns.

The pharmaceutical industry’s reputational challenges also correlate to how the media covers it. A 2020 analysis of Big Pharma-related coverage found that the majority of stories were neutral and involved reporting on topics like finances, stocks, profits, mergers, acquisitions and restructuring. Coverage is more negative when it delves, less often, into more sentimental topics.

In other words, the media mostly reports on Big Pharma from a business perspective instead of from a social and public health perspective. This lack of media attention to the industry’s social responsibilities contributes to growing public distrust of it in recent years.

Risks underlie vaccine-led reputation boost

Considering the above factors, it’s unsurprising that the pharmaceutical industry’s all-hands-on-deck efforts on COVID-19 vaccines, in combination with extensive media coverage, has resulted in a substantial improvement in public sentiment. According to a survey conducted by think tank Data for Progress in March 2021, 56 per cent of respondents had a favourable view of pharmaceutical companies, double the rating of Gallup’s 2019 poll.

Nonetheless, a closer look at the data reveals two caveats.

First, drug costs remain the top concern for the public. The Data for Progress survey suggests that 72 per cent of American voters support policy measures that would lower the cost of prescription drugs. The pharma industry, meantime, insists that the discounted prices it’s currently offering for COVID-19 vaccines will not last very long.

Vaccine prices to rise?

In February, Pfizer CFO Frank D’Amelio said in a call with Wall Street analysts that after the pandemic, Pfizer is “going to get more on price” and hinted there would be a substantial price increase for its COVID-19 vaccine.

The company currently charges US$19.50 per dose for its vaccine, but the typical price is $150 to $175 per dose for other vaccines it sells. If implemented, this aggressive pricing policy would undoubtedly result in public criticism, especially from developing countries that have already been neglected during the first round of global vaccine allocation.

Second, the remarkable speed of research and innovation achieved during COVID-19 vaccine development is mainly due to intensive government funding support and concerted collaborations across multiple sectors. It’s uncertain whether these special measures herald the arrival of a new model in which governments have better regulation over Big Pharma issues like patent control, advertising, clinical data transparency and spending on lobbying.

If the pharmaceutical industry wants to achieve the ultimate image makeover, it must capitalize on the current goodwill by prioritizing socially responsible practices. That begins with fairer drug pricing and a genuine commitment to resolving public health disparities.

Written by Sibo Chen, Ryerson University. Photo credit: THE CANADIAN PRESS/Nathan Denette. Originally published in The Conversation.

People line up at a mass vaccination centre during the COVID-19 pandemic in Mississauga, Ont.

It’s a frightening and perplexing time for Canadians who have either been vaccinated against COVID-19 or are trying to determine what vaccine to get.

On May 3, the National Advisory Committee on Immunization (NACI) updated its COVID-19 vaccine statement and recommended that Canadians less likely to contract COVID-19 may want to wait for a Pfizer or Moderna vaccine instead of AstraZeneca (AZ).

Days later, Ontario said it would not administer AZ as a first dose due to the risk of rare blood clots.

Although the NACI update did not contradict its earlier guidance when it recommended expanding the use of the AZ vaccine to all Canadians over the age of 30, people were understandably left with the impression that viral vector vaccines — including AZ and Janssen/Johnson & Johnson — are less safe and effective than their mRNA counterparts. Combined with Ontario’s move, that impression will undoubtedly intensify.

NACI’s advice of “waiting for preferred vaccines if you can” provoked an immediate backlash both in the virtual House of Commons and on social media.

When questioned by Michelle Rempel Garner, the Conservative health critic, on whether Health Canada still recommends “taking the first vaccine you’re offered,” Health Minister Patty Hajdu dodged the question by suggesting that “people should consult their health-care professional to decide which vaccine is right for them.”

On social media, other health experts expressed their frustration that NACI’s message may fuel vaccine hesitancy, while some recipients of AZ were startled to learn, after being advised weeks earlier to get the vaccine, that it’s second-rate or possibly dangerous.

David Williams, Ontario’s chief medical of health, has also faced a social media backlash.

There's a greater risk of you developing a blood clot trying to understand Dr Williams explanation of something than there is from getting the AZ shot.

— Barney Panofsky's Best Intentions (@mynamesnotgordy) May 11, 2021

There’s no doubt NACI, Health Canada and now Ontario’s top public health official have run into a serious communication problem.

Let’s delve into crisis management and communication theories to elaborate on what’s gone wrong in NACI’s vaccine messaging, and what lessons can be learned to improve future communications.

Communicating uncertainty

How messages are framed has a significant impact on the public. For instance, it has been found that media discourses emphasizing the connection between COVID-19 and China, and deeming the pandemic a threat caused by foreigners, have been a major contributor to the notable increase in racist and xenophobic attitudes during the pandemic.

News can be conveyed via a variety of communication strategies, and story-telling is arguably the most powerful one. British media scholar Philip Seargeant argues in his analysis of the rise of conspiracy theories and post-truth politics that stories framing “corrupt states controlled by ruthless elites” fuel the prevailing anti-establishment sentiments found in both right-wing populist movements and disinformation online.

A vivid story can easily capture public attention away from abstract charts and figures because it plays on our emotions.

What initially triggered recent public anxiety and confusion about COVID-19 vaccinations was NACI’s statement that “it continues to preferentially recommend authorized mRNA COVID-19 vaccines due to the excellent protection they provide and the absence of safety signals of concern.” The word preferentially inevitably provoked readers to think a comparison to other vaccines was being made.

Making a bad situation worse

Then on May 4, NACI’s chair, Dr. Caroline Quach-Thanh, appeared on CTV’s Power Play in an apparent attempt to clarify confusion and ease public anger. Yet the hypothetical story she presented further worsened the situation.

When explaining why NACI advocated for an “informed consent” regarding which vaccine to take, Quach-Thanh commented:

“If, for instance, my sister was to get the AstraZeneca vaccine and die of a thrombosis when I know that it could have been prevented and that she’s not in a high-risk area, I’m not sure I could live with it.”

Dr. Caroline Quach-Thanh appears on CTV News.

As soon as a hypothetical story of this nature lodges in people’s minds, scientific information about the extreme rarity of vaccine-induced blood clots becomes less relevant for people wondering whether they should opt for AstraZeneca. Getting the vaccine, after all, has been framed as a “risk-taking” behaviour by a top public health official.

There are two additional problems in advocating that people should make their own risk assessments. First, people tend to under-estimate the risk of contracting COVID-19, especially in the absence of relevant knowledge.

With so many uncertainties associated with the community spread of COVID-19, it’s inherently difficult for the general public to figure out whether the infection risk in the areas they live is high enough to warrant an immediate AZ shot.

Second, an individual cost-benefit analysis encourages a personal calculation: If I feel comfortable that I have a low risk of contracting COVID-19, then I can wait for my preferred vaccine. This contradicts early vaccine communication efforts in which getting vaccinated was portrayed as an act of responsibility that could protect family members, neighbours, front-line workers and colleagues.

A unique crisis

None of this is meant to discredit NACI’s critical contributions to public health. The COVID-19 pandemic has surpassed all previous public health crises in terms of its scope, duration and severity, creating enormous challenges to public health communicators on a daily basis.

The ongoing situation also defies the conventional wisdom about crisis communication in many ways. Traditionally, crisis management and communications instruction involves training students to handle tasks arising from a potential crisis and to prepare for it, and to provide daily updates both during the crisis and in its aftermath.

When conflicting messages appear in news media, the spokespeople for organizations often adopt strategic ambiguity to grapple with uncertainty while maintaining a public image of transparency and openness.

This playbook has been rewritten by the outbreak of COVID-19. The pandemic’s abrupt, evolving and global nature has transformed it into what’s known as a syndemic in which unexpected communication crises can be triggered by even a single word — in this case, “preferentially.”

Meanwhile, with almost all public conversations taking place online, it’s almost impossible for a public institution to single-handedly control the mainstream narrative. Any ambiguity can lead to outright misinformation.

Ultimately, the NACI and other COVID-19 messaging controversies highlight the importance of closely co-ordinating communication among different stakeholders. That will ensure any possible conflicting messages can be negotiated and presented in a far less confusing and damaging manner to the public.

Written by Ethan Pancer, Saint Mary’s University; Matthew Philp, Ryerson University. Photo credit: Shutterstock. Originally published in The Conversation.

We’re more attracted to foods with a higher caloric density, and this is reflected in our social media activity.

Life outside our living rooms has been in short supply since the beginning of the COVID-19 pandemic, so it’s no surprise that people have increasingly turned to producing and consuming social media posts that focus on food. With limited access to our favourite restaurants, cafés or fast-food joints, social media has become a safe way for people to get their culinary fix.

But what is it about videos of food that engages users and generates the most likes, comments and shares?

Our recent investigation, published in the Journal of Consumer Psychology, focused on the nutritional makeup of dishes depicted on social media. We examined the recipes and ingredients for hundreds of Facebook videos from Buzzfeed’s Tasty profile and found that caloric density can positively influence social media engagement.

Interestingly, not all nutrients are created equal when it comes to engagement. Rather, the ones that people can readily see, like saturated fats, may be more responsible.

Eating with your eyes

The COVID-19 pandemic has fundamentally altered our relationship with food: what we’re eating, where we’re eating, why we’re eating the way we are and even when we’re eating.

Not surprisingly, people are also spending more time on social media since the start of the pandemic. Taken together, the pervasive use of social media has also changed how people are exposed to food.

With more than 400 million posts tagged #food and 250 million tagged #foodporn on Instagram at the time of this article’s publication, social media users are inundated with visual displays of food.

Perhaps most notably, Buzzfeed’s Tasty has become the world’s largest digital culinary network, amassing more than 100 million followers on Facebook and over a billion monthly views.

Given the ubiquity of food media online, understanding the specific characteristics that shape engagement is of critical importance to several groups: content producers looking to tailor media towards viewer preferences; advertisers seeking to increase marketing impact; and health advocates interested in helping consumers make better eating choices.

Nutrition and social media engagement

Humans are hard-wired to seek foods with characteristics that the brain instinctively recognizes as valuable. Seeing calorie-dense foods like those high in fat content (like burgers, pizza and cookies) typically precedes pleasurable consumption, so it is natural that humans visually attend to food.

Finding and eating calorie-dense foods typically makes people feel good, releasing dopamine and stimulating pleasure centres of the brain. This suggests that nutritional content can be broadly gauged by a dish’s appearance and that the simple exposure to calorie-dense meals can make people feel good.

When it comes to influencing online behaviours, the link between feeling good and digital engagement is well documented. Positive content is more likely to go viral and social media content that makes consumers feel good increases the likelihood of being liked, commented upon and shared. Taken together, visual exposure to food media that looks calorie-dense — as opposed to calorie-light — should drive social media engagement.

More fat = more engagement?

Our research examined the recipes and ingredients for hundreds of Facebook videos from Buzzfeed’s Tasty using a text-processing algorithm. We found that caloric density can positively influence social media engagement. Several follow-up experiments suggest that positive affect, the extent to which we feel good after visual exposure to calorie-dense foods, helps explain the connection.

Interestingly, it seems that not all nutrients are created equal when it comes to engagement. Rather, the ones that people can readily see, like saturated fats, may be more responsible.

Saturated fats are prevalent in butter, cheese, meats and oils, and are known to give foods their juicy, chewy and creamy sensory experiences.

Our findings align with a particular approach to food photography, where adding an artificial sheen with WD-40 can make food look more plump, moist and juicy.

These findings raise an interesting question: Is it possible to make healthier foods, like vegetables, more appealing by applying visual characteristics associated with fattier foods by, for example, coating them with a sheen?

Identifying these visual characteristics of nutrients can better inform strategies to increase engagement with more health-conscious food media content.

Importance of amplification

But why does social media engagement even matter?

Social media platforms use rank-ordering algorithms to prioritize and boost content that receives more engagement. Simply posting content online does not mean it will be viewed. Rather, it is engagement with content that amplifies reach and serves content to a wider audience. If content featuring unhealthy or calorie-dense foods is more likely to receive engagement, it is also more likely to reach more people.

Overall, our research offers some initial insight into how the nutritional composition of food media influences social media engagement. As consumers’ preoccupation with digital food media continues to grow, especially during pandemic lockdowns, understanding the factors that increase engagement with this content is crucial, with public health implications.

Not only does nutrition influence what people eat, but this research suggests that it may also shape social dynamics in terms of what people share with others, ultimately influencing and normalizing what others eat.

Next time you like, comment on, or share a food video on social media, consider what it is about the food you find so appealing.

Written by Kenneth Fung, University of Toronto; Josephine Pui-Hing Wong, Ryerson University. Photo credit: Pixabay/Canva. Originally published in The Conversation.

There are many complex pandemic-related risk factors for suicide, and suicide prevention is a crucial public health response to COVID-19.

The mental health crisis is a parallel pandemic of COVID-19 across the globe. There are increased concerns about pandemic-related risks of suicide in Canada and elsewhere. Studies from different countries present a complex picture with varying suicide trends, but increased rates of depression, anxiety and suicidal ideation were found to be consistent across countries.

Data from previous pandemics show a significant positive association between pandemic and suicide. The Toronto Transit Commission reported a nearly one-third increase of suicide attempts or fatalities during the first eight months of the pandemic. Suicide prevention is a critical public health response to COVID-19.

There are many complex pandemic-related risk factors for suicide:

• Anxiety and fear of being infected and becoming a contagion for one’s family;
• Financial stressors;
• Decreased social interactions with friends and community activities, disruption of life goals and normal activities;
• Catastrophic thinking;
• A sense of hopelessness and helplessness;
• Increased family stressors due to working/schooling from home;
• Relationship conflicts and break-ups;
• Increased risk of family violence.

A recent study shows that people in quarantine are twice as likely to have suicidal thoughts.

Vulnerable populations

Front-line health-care providers are also at increased risks of mental health distress. Furthermore, usual adaptive and coping resources may be decreased — less social support from friends and family, limited or no access to primary care, community support, health-care services and social recreational activities.

The impact of diminished coping resources is particularly critical to vulnerable populations experiencing pre-existing social, economic and health inequities. Elderly people are cut off from supportive programs and in-home services, and those in long-term care homes have had family visits restricted.

People with pre-existing mental illness are more likely to experience deteriorated physical and mental health. Some children and youth are beset by the uncertainty of learning modes and disruption of social connections; many report experiencing difficulty focusing on online learning.

For Indigenous, Black and racialized communities, pre-existing social inequities are translated into disproportionate burden of COVID-19 cases related to increased risk of workplace exposure, inadequate housing and reliance on public transportation. For immigrants and refugees, disruption of community support and limited access to linguistically appropriate services are worsened during the pandemic.

These increased stressors and decreased coping resources may interact to escalate the risk of self-harm and suicide.

The following vignettes are anonymized composites of cases based on real clinical presentations. They provide a human story behind the complex issues at hand:

Ms. Smith

Ms. Smith is a veteran intensive-care nurse. She presented to the emergency department with worsening depression and suicidal thoughts, with an unsuccessful overdose attempt after a recent breakup. She feels that her partner did not show understanding when she came home from her shift exhausted, and they had frequent fights. She suspects that her partner is abandoning her to avoid the risk of infection.

Every day, work is like a war zone, always short-staffed, and the manager seems heartless. She is resentful that many colleagues are taking sick time, and that the system learned nothing from the first wave. She cannot take care of patients like she used to due to isolation precautions and work demands, and she is feeling numb facing so much illness and death.

While she gives reassurances to anxious families and dying patients, she feels like a fraud and a failure, ashamed of her own helplessness and hopelessness. She blames herself for not having more positive thoughts and not doing more meditation, and has begun to use alcohol to fall asleep at night.

Ms. Chan

Ms. Chan is a 75-year-old widow living alone with multiple medical illnesses. She does not speak English. All her regular community activities and medical appointments have been shut down and she has been feeling terrified because of her high-risk COVID-19 category.

At the beginning of the pandemic, most people were not wearing masks and gave her dirty looks for wearing one. She was anxious about people disregarding elevator capacity at her apartment, sometimes seeming to crowd around her deliberately. Once, while lining up at the grocery store, the person behind her yelled at her to go back to her home country. She was so shocked that she left her cart there and headed straight home.

She began to feel useless and hopeless. Her daughter started dropping off food for her at the door weekly. She tried to get her daughter to come in to listen to her fears, but her daughter angrily told her that she could not take any more stress and stormed off. Ms. Chan asks if she can get medically assisted suicide to end her meaningless suffering.

Proactive outreach

These brief composite cases illustrate the complex contextual determinants of suicide risk. People become vulnerable when multiple internal and external factors conspire to overwhelm their capacity to cope. There is a need to proactively reach out to those who are isolated, disadvantaged and marginalized, as well as to front-line health-care workers at high risk of burnout.

Suicide prevention is possible through increased public awareness of the warning signs, responsive mental health care and access to comprehensive interventions that address the complex psychosocial and structural determinants.

In response, our PROTECH (Pandemic Rapid-response Optimization To Enhance Community resilience and Health) team has applied our resilience-building Acceptance and Commitment to Empowerment model to address pandemic stress and sense of hopelessness associated with suicide. The PACER online intervention integrates Acceptance and Commitment Therapy and social justice-based Group Empowerment Psychoeducation, comprising six self-guided reflective online modules with live video group conferencing.

Participants are encouraged to acknowledge and make room for their distressing thoughts and feelings without believing in them, while finding renewed value and meaning in their life. The group sessions facilitate social connection and mutual support. The social justice perspective supports participants to make sense of their suffering in a larger social context, enabling them to engage in “self-care” and “we-care” actions that promote personal and collective resilience.

Since June 2020, we have implemented 12 cohorts of PACER (Pandemic Acceptance and Commitment to Empowerment Response) training with two priority populations: front-line health-care providers and the Chinese/Asian Canadians who experienced COVID-19 related racism. Our preliminary results showed significant reduction in distress and increased resilience.

We have used the train-the-trainer approach and mentored 20 PACER graduates to become co-facilitators. We will continue to start new PACER cohorts biweekly over the next six months with a goal of delivering 30 additional cohorts.

The global pandemic has had a devastating impact on us all. To combat catastrophic demoralization, it is critical to proactively support people to reconnect with their values, meaning of life, one other and the larger world. Our spirit to survive and thrive collectively is bigger than the virus.

If you are experiencing suicidal thoughts, you need to know you’re not alone. If your life or someone else’s is in danger, call 911 for emergency services. For support, call Canada Suicide Prevention Service (CSPS) at 1-833-456-4566. Visit Crisis Services Canada for more resources.

Explore our interactive map to discover how researchers from across the university have reacted to the pandemic.

Ryerson researchers have been at the forefront of responding to the global health crisis of COVID-19, whether it’s pivoting ongoing research or undertaking entirely new projects. From examining social impacts and the effects on our mental health, to advancing policy, to tracking the virus and developing new technologies, our researchers are meeting the many challenges presented by the pandemic.

Hover over the flashing dots in the map below to begin, click through to read the articles.

To view the complete lists of Mapping Ryerson’s COVID-19 Research, visit the OVPRI website.

Written by Louis-Etienne Dubois, Ryerson University. Photo credit: Shutterstock. Originally published in The Conversation.

There’s strong pressure to use more technology to capture student attention, but what about inviting students to adopt a contemplative posture?

As another virtual university semester unfolds — the second or even third for some since the beginning of the pandemic — fatigue and declining satisfaction with this remote format seem to be increasingly felt on both sides of the screen.

On the one hand, there are students worried about the quality of the courses they are taking, but above all, they are missing out on campus and community life. On the other hand, there are teachers feeling breathlessly short of resources, who have been pushed overnight to change their practices and run their classes from home.

Beyond the purely pedagogical impacts, the issue of mental health for everyone is of concern today. Having personally had to give online courses to more than 250 undergraduate students over these past weeks, I have been able to experience these issues and to feel the limits of this new way of teaching.

Web influencer or academic expert?

The temptation — but also often the pressure — to draw out a host of technological tools to capture and maintain the attention of students or facilitate their collaboration is often very strong. Certainly, the idea of teaching a class live on Twitch or in a fictional world on Minecraft and then continuing the discussion on Discord or Slack can be exciting. But in this particular context, the teacher is sometimes more of a online influencer than an academic expert.

These technological choices also confront teachers with limits, both logistical and human. What can we say to the many students who access this content from their cell phones and therefore from their cellular data, or to those who do not yet have a computer and a high-performance internet connection?

What to do with students who have to share their workspace with the rest of the family, who don’t have a good grasp of these different tools or who have to learn how to use a range of different applications for each of their courses?

These issues also illustrate the very real risk of creating new barriers to inclusion in education.

So, before mobilizing such hardware, it is important to consider not only the ability of students to grasp it, but also the ability of teachers to train themselves sufficiently to offer a positive learning experience. More importantly, this is also an opportunity to learn about other modes of distance education and finally to move away from a vision requiring more and more tools and overstimulation.

A more human approach

What if one of the answers to the challenges of distance learning is to go back to basics and set up contexts that are less “techno” and more human?

In their work on the experience economy, consultants Joseph Pine and Jim Gilmore explore how value can be created based on the experience of “guests” (whether as consumers in shops or visitors to museums). They propose four categories for experience: educational, entertainment, escapist and esthetic. “Esthetic” experiences, they argue, are those in which participants are invited to adopt a contemplative posture. The experience then aims at harmony of the senses and attaining a kind of individual fullness.

An example of that could be a visit to a museum, where people walk around, sit on a bench and get lost in their thoughts. It contrasts sharply with an entertainment experience such as a music show or an amusement park. It’s a celebration of slowness, of a more subtle but equally engaging non-technological stimulation.

This kind of call for a slower, more informal pedagogical approach isn’t new. Moreover, the idea of lowering the pace, or to prune the content a little to facilitate retention without affecting the quality, was slowly gaining ground long before the pandemic.

Create an atmosphere conducive to reflection

So, instead of using yet another collaborative tool during a Zoom course, why not simply create an atmosphere conducive to reflection through a warm decor, a little nature, something to watch or music that is pleasant to listen to?

Similarly, why not open the virtual rooms earlier, or close them later, for those who want to exchange in a more informal setting. Why not send the content in advance so as to take advantage of these so-called “synchronous moments” to interact and inject some human warmth?

Finally, it is possible to enhance non-visual stimuli to allow students to take a break from their screens for even a brief moment. The simple act of recording podcast episodes or transmitting assessments via audio not only gives students a break for their eyes but also offers more flexibility in when and where they can view the content. The opportunity has also come to rediscover the charms of a simple telephone conversation, instead of another videoconference.

Since this virtual mode of teaching is expected to continue at least until next fall or winter and to play a greater role in university curricula after the pandemic, it is not too late to imagine modes of engagement that are more mindful of individual constraints.

According to Pine and Gilmore, any good experience must be thought of in the broader context in which it takes place. So, rather than relying on the equivalent of an online lecture, let’s reconsider. Keep in mind the constraints of the moment and imagine courses that allow you to vary the contexts in which you immerse yourself, whether it’s by the fire or even under the comforter!

Written by Katie Lebel, Ryerson University; Ann Pegoraro, University of Guelph; Dunja Antunovic, University of Minnesota; Nancy Lough, University of Nevada, Las Vegas; Nicole M. LaVoi, University of Minnesota. Photo credit: Phelan M. Ebenhack. Originally published in The Conversation.

Players for the Connecticut Sun and the Las Vegas Aces square off during basketball’s WNBA semi-final in September 2020 in Bradenton, Fla.

Elite women’s sports are predicted to generate US$1 billion in revenue in 2021.

With just a fraction of the investment dollars and comparatively paltry marketing and promotional budgets compared to those allocated to men’s sports, this is conceivably a conservative estimate. As sport emerges from the challenges imposed by COVID-19, women’s sports are becoming a lucrative business opportunity.

Don’t believe us? You’re not alone.

Despite record-setting momentum, the sports industry has continued to ignore the economic viability of women’s sports.

Many decisions are still based on outdated assumptions. Marketing has largely positioned women’s sport as the “right thing to do” as opposed to an exciting investment opportunity, and fans are treated as monolithic. The resulting narrative has left the women’s sport market both under-served and undervalued.

Women's sport receives just 4% of media coverage (in the US). That means it would take an entire childhood for girls and boys to see the same amount of sports media coverage for women that they will see for men in just one year. #WomenInSport

Source: https://t.co/RutjAuohaK pic.twitter.com/QKqWFX7hmj

— Danielle Warby (@DanielleWarby) September 17, 2020

Sports fans, however, are telling a different story.

A Nielsen study found that 84 per cent of general sports enthusiasts of all genders are interested in women’s sport. If more women’s sports were available to watch, 46 per cent of fans indicated they’d tune in.

Giving fans what they want

What happens when you give sports fans what they want? The 2019 FIFA Women’s World Cup drew 1.12 billion viewers. Viewership for the WNBA this season was up 68 per cent; media coverage of their championship finals increased 15 per cent.

National Women’s Soccer League (NWSL) viewership swelled 493 per cent for their 2020 Challenge Cup and 500 per cent year over year, LPGA viewership increased 21 per cent and this year’s U.S. Open tennis final between Naomi Osaka and Victoria Azarenka averaged 2.1 million viewers on ESPN.

Keep in mind this was during a time when many sports were competing simultaneously and ratings for the NBA, MLB, NHL and NFL all declined significantly. What’s more, women athletes have also been at the forefront of advocacy for social and political change.

The bottom line? Women are doing more with less.

They’re finding innovative solutions during these most challenging times. They’re seizing the moment and exceeding expectations. They’re putting on a master class in resilience — because for the past several decades, that’s how they’ve been conditioned to do business.

The changing sport landscape

The COVID-19 pandemic has resulted in unprecedented disruption. While the sports sector adapts to these new and uncertain conditions, resilience as a coping mechanism is serving women’s sports well.

Through this lens, the distinguishing qualities of persistence, adaptability and agility are assets that women in sport have been fine-tuning for years. As the world of sport continues to mount its recovery efforts and the sports landscape evolves, we argue this innately gives women a leg up in the new normal.

And make no mistake. The sports landscape is in the midst of a revolution.

Gen Z has rapidly become the most influential generational cohort, commanding US$3.2 trillion in purchasing power. This demographic has high expectations around diversity and inclusion and they are following sports in very different ways than their predecessors.

With a preference for highlights on Instagram, they’re more likely to follow an athlete than a team, and the role of sport in their social life has redefined their fandom.

53% of Gen Zers identify as sports fans, compared to 63% of all adults and 69% of millennials.

Gen Zers are half as likely as millennials to watch live sports regularly and twice as likely to never watch.https://t.co/NJNySNDdAo pic.twitter.com/3KKa1Poz0o

— Morning Consult (@MorningConsult) September 28, 2020

Layered on top of this, we know that women now control a third of the world’s wealth, adding US$5 trillion to the wealth pool globally every year. While traditional sport properties are struggling, women’s sports have the flexibility to be nimble and adapt to the new, increasingly diverse sport environment.

We’re already seeing early evidence of this, with a 468 per cent increase in tweet volume around representation and equality. Advertising featuring women in sport is perceived as 148 per cent more empowering than similar ads with men.

Twitter has also found sports ads featuring women held viewers’ attention for an average of 6.5 seconds and drove 4.8 times higher ad recall than a control group. When women were featured in non-traditional gender roles, recall was 6.3 times higher.

If we consider merchandise as a proxy for demand, a whole new series of supporting metrics emerge. Nike’s 2019 U.S. Women’s National Team home jersey became the No. 1 selling soccer jersey ever, men’s or women’s. The WNBA’s now-famed orange hoodie has nine million impressions on social media, 238,000 engagements and US$250,000 in social media value. According to the online retailer Fanatics, the orange hoodie was the best-selling item across its website in August.

Pandemic disruptions

We’re currently witnessing a continuous series of disruptions exposing the widening gaps in society accelerated by the pandemic.

In sport, these disruptions have exposed the weaknesses of the traditional sports model. As we look towards the future of sport, COVID-19 may well be the catalyst for change that women’s sports have been waiting for.

Did you know that there are ZERO up-and-running women's professional sports leagues in Canada right now? 🤔

Let's talk about it.https://t.co/7rDt503i4t@cmoscato4@J16H pic.twitter.com/7PUGFjZlde

— CBC Sports (@cbcsports) October 8, 2020

Women in sport understand that success is not easy, convenient or comfortable because it never has been. They’re accustomed to coming up with constructive solutions that showcase persistence.

As the sports market reemerges in a post-pandemic world, women’s sports may be strategically positioned to not only better adapt to the rapid changes brought about by COVID-19 — they may be better prepared to lead the way forward in the development of a new model for sport. The future may be unwritten, but the time to invest in it is now.

Written by Lauren McNamara, Ryerson University & Pasi Sahlberg, UNSW. Photo credit: Shutterstock. Originally published in The Conversation.

The COVID-19 pandemic provides an opportunity for us to rethink and redesign how schools support children’s social connections and opportunities for informal play and recreation.

School leaders globally are tasked with the unenviable challenge of planning for school reopenings after COVID-19 pandemic shut downs. Having experienced their own isolation, anxiety, exhaustion and challenges of taking schools online, they are now challenged to redesign their schools to mitigate the effects of a pandemic.

Amid concerns about social distancing, it would be easy for education authorities to consider recess as a low priority, and perhaps even easier to cancel it.

Please don’t. In anticipation that recess might be sidelined by the pandemic, we are among a newly formed group of researchers, pediatricians and school leaders concerned about recess. We are leveraging three decades of evidence related to children’s developmental needs to highlight, in a global statement, why recess should be prioritized.

Yes, prioritize recess

Recess is typically the only unstructured time in the school day that provides a setting for children’s physical, social and emotional development — all of which are foundational for mental well-being, school engagement and learning.

But when children return to school, we must ensure recess is meaningful, playful and inclusive. Why is recess so important, and why now?

After months of physical and social isolation, stress and uncertainty, students are going to need a supportive, safe and inclusive place to connect with each other — far more than they need the opportunity to catch up with schoolwork.

From the students’ perspective, recess is a social space; it is less about a break from class or accumulating their necessary daily physical activity.

Friendships, belonging

What matters to students, first and foremost, is friendships, social connections and feelings of acceptance and belonging. And this happens through play, recreation and leisure activities — at every age.

Recess is the best time in the school day when students can connect with peers and engage in meaningful, self-directed, recreational play.

And for many children, especially those who live in high-poverty urban neighbourhoods, recess may be may be their only chance for outdoor, self-directed play in their entire day. Increases in screen time, urban density, neighbourhood violence, fears of injury and abduction, lack of accessible or affordable recreation and a focus on organized sports all contribute to declining opportunities for informal play and recreation. And under the current pandemic, children’s mental health and emotional well-being will depend on it.

Critical for health, well-being

It is already clear that the mental health effects of the pandemic are pervasive and are likely to persist. Given that 70 per cent of mental disorders begin in childhood, children will need time and space to heal from the collective trauma.

Social relationships, in particular, provide a context for emotional support, enjoyment, creative play, physical activity and the development of social identities — all of which contribute to overall development and well-being. School planning efforts must focus on reducing sustained feelings of isolation and loneliness in order to protect against widespread increases in anxiety, depression and suicide.

Recess can ease the effects of inequality

This pandemic exacerbates the effects of pre-existing social inequality. Many schools in Canada, especially those serving the most vulnerable children, don’t have a history of supporting meaningful, quality recess experiences for students.

Recess is typically overlooked in policy and practice, resulting in minimal funds, supervision and equipment. Canada has one of the highest rates of school-based violence of all the developed nations, disproportionately affecting children from vulnerable populations and undermining the positive benefits of social connection and play.

School environments themselves are telling, especially in our more vulnerable urban neighborhoods: concrete, rusty, barren and soulless. And instead of enjoyment and connection there is boredom, exclusion, conflict, behaviour challenges and violence — factors that promote social patterns that perpetuate inequity in schools. There is much more we can do to support children, and we have an unprecedented opportunity now to do better.

The right to recess

Yes, recess is a fundamental human right. Canada is a ratified member of the United Nations Convention on the Rights of the Child. Of the 54 articles, one of the most overlooked and unprotected of the rights is Article 31, “the right to rest and leisure, to engage in play and recreational activities appropriate to the age of the child.”

Schools are not exempt from playing a role in protecting and promoting children’s right to play, rest and leisure. Schools have a responsibility to ensure the recess environment is inclusive, fully accessible, secure from the effects of social harm and appropriate for all genders, ages, stages and abilities.

But what about COVID-19?

Our research group has combined our expertise to provide answers and concrete strategies for a recess that not only works under the current circumstances but paves the way for a better recess. The purpose of our global statement is to provide educators with practical evidence-based strategies that ensure opportunities for healthy, meaningful play while simultaneously minimizing the spread of the virus.

The U.S. Centers for Disease Control and Prevention currently recommends segregating recess by class. Smaller groups will not only minimize the spread of the virus but provide an opportunity to ensure recess is much more manageable, inclusive and enjoyable.

5 recommendations

In collaboration with local health officials, schools could consider the following recommendations:

1. Count recess as instructional time to enable teachers to remain with and support their class, and provide a separate dedicated break time for the teacher.
2. Schedule at least two sustained periods of recess every day for every child and hold it outdoors whenever possible.
3. Engage children in planning and ensure they include a continuum of options to choose from. Engage them in setting expectations and rules for health and safety. Provide leadership opportunities for students to help support each other, maintain the equipment and emphasize the importance of diversity and inclusion.
4. Avoid strict rules like “no running” and “no ball throwing” that can undermine the benefits of play and physical activity.
5. Don’t withhold recess as punishment for missed schoolwork, poor classroom behaviour or any other reason. Instead, ensure that all children have access, feel safe and included and are able to experience meaningful and playful engagement.

This pandemic provides us with an opportunity to rethink — and redesign — the way we support social connection and opportunities for informal play and recreation in school.

Written by Deena Shaffer, Ryerson University. Photo credit: AP Photo/Noah Berger. Originally published in The Conversation.

Circles painted on the grass in San Francisco’s Dolores Park encourage social distancing and help prevent the spread of coronavirus.

When the long-awaited warm sunny weather arrived in Toronto over the weekend, hundreds flocked to Trinity Bellwoods Park in the city’s west end. Ontario Premier Doug Ford said it looked like a “rock concert,” but added that he understood people wanted to be outside and enjoy the outdoors.

These days, with social distancing rules still in place, it can be difficult to get outdoors, and to know whether or not to. High-rise apartment buildings have elevator limits. Neighbourhoods may have more parking lots than parkland. Or it could be that you are caring for someone with a high risk of developing severe illness from a COVID-19 infection.

Hikes, picnics or bike rides along a tree-lined path feel a long way off when you’re quarantined in a low-light basement apartment or a balcony-less condo, and you’re screen-saturated from work, school and social gatherings.

Seems like almost everyone in Toronto decided to go to Trinity Bellwoods Park today 📹camillebartul #Toronto #TrinityBellwoods pic.twitter.com/5fqVeoJEyi

— blogTO (@blogTO) May 23, 2020

Written by Gillian Parekh, York University, and Kathryn Underwood, Ryerson University. Photo credit: THE CANADIAN PRESS/Chris Young. Originally published in The Conversation.

Nationwide, long-term care facilities, primarily occupied by residents who are elderly or live with disabilities, are in deteriorating condition. But little has been done to actually address the organizational decisions that lead to these dangerous conditions. COVID-19 has exposed many inequities within Canada’s care systems.

When we look at who is disproportionately affected by this pandemic, we can’t help but ask how ableism shapes notions of whose lives are valued and whose are not. As governments plan for a “return to normal” while serious systemic issues remain in long-term living facilities, is normal really what we want to return to?

Localized, facility-based outbreaks of the coronavirus have led to high numbers of residents and staff contracting COVID-19. More than 40 per cent of the residents of Pinecrest Nursing Home in Bobcaygeon, Ont., have lost their lives to COVID-19. Similar patterns have surfaced in British Columbia, other communities in Ontario, Alberta, Québec (most severely) and Nova Scotia.

This is also true in facilities dedicated to people with disabilities. A Markham, Ont., facility reported that 40 of 42 residents and 38 health-care workers tested positive for COVID-19 towards the end of April.

According to the Toronto Star, deaths of residents in long-term care facilities made up 82 per cent of the country’s total number of fatalities due to COVID-19 as of May 7, 2020. Despite the continuing threat of COVID-19 to residents in care facilities and warnings of a resurgence, many jurisdictions are now making plans to lighten travel and social restrictions.

Long-term care, long-term problems

Even before the pandemic, long-term care facilities had disturbing incidences of abuse, neglect and even murder. Yet the conditions that allow such atrocities to occur continue.

Long-term care facilities often experience severe deficits in funding and staff. Typically, there is far greater demand for beds than there are beds available, leaving no opportunity for choice of facility.

For many Canadians, the choice to move into residential care is not really a choice at all. There are limited options for many people who require around-the-clock care. Independent living centres are not broadly available and many have extensive waiting lists. Self-directed care options may be available, however, there are limitations for those who require full-time support.

These services are also vulnerable to staffing shortages, lack of training and funding cuts. While personal support workers (PSWs) provide a critical service and support many personal care activities for daily living, their work is often undervalued. Many are overworked, underpaid and precariously employed.

In addition, care work is often fulfilled through the labour of poor, racialized and/or immigrant women who may face additional barriers in drawing attention to exploitative working conditions. During the pandemic, it has been revealed that PSWs are not always provided with adequate personal protective equipment to keep themselves or the residents safe.

But none of this is new or, at least, unexpected. For generations, the dangers that arise when we organize populations into institutional settings have been abundantly clear. COVID-19 may have shone a spotlight on these issues, but the inequities were always there.

An indifference towards people with disabilities

At a March 23 news conference, Dr. Deborah Birx, the White House coronavirus response co-ordinator, spoke on the global mortality rates of COVID-19. She assured the public that the majority of people who do and will perish from the virus are largely elderly and those with pre-existing conditions.

“Still 99 per cent of all the mortality coming out of Europe, in general, is over 50 and pre-existing conditions. The pre-existing condition piece still holds in Italy with the majority of the mortality having three or more pre-existing conditions. I think this is reassuring to all of us, but it doesn’t change the need to continue to protect the elderly….”

Birx’s statement echoes a dangerous discourse that people with disabilities as well as disability activists and allies have been challenging for some time — an insidious indifference towards the lives of persons who are disabled or elderly.

To whom would this be reassuring? This casual and callous indifference has come further into focus as jurisdictions weigh the economic implications of returning to normal despite the continued, and possibly heightened, risk for persons in residential care.

Nirmala Erevelles, a critical disability studies scholar, explores the role capitalism and capitalist principles play in producing bodies that matter and bodies that do not. Ableism is keenly expressed by attempting to justify human value through the lens of economic productivity and perceived expense. As disability justice activist Mia Mingus writes: “Ableism is connected to all of our struggles because it undergirds notions of whose bodies are considered valuable, desirable and disposable.”

This crisis exposes how ableism has long shaped how we think about care and those who receive care. Ableism shapes how we organize long-term care funding, staffing and crisis management as well as day-to-day care.

As governments and organizations re-imagine how care can be more effectively delivered, there are lessons to be learned from people who have navigated care and service systems before the global crisis began. People with disabilities and those who have experienced life in long-term care need to be at the forefront, leading and advising on systemic change.

Written by Anatoliy Gruzd & Philip Mai, Ryerson University. Photo credit The Canadian Press/Darryl Dyck. Originally published in The Conversation.

A sign outside Lions Gate Hospital in North Vancouver, B.C., explains visitor restrictions to limit the spread of the novel coronavirus COVID-19.

In the midst of a global pandemic, conspiracy theorists have found yet another way to spread dangerous disinformation and misinformation about COVID-19, sowing seeds of doubts about its severity and denying the very existence of the pandemic.

Since March 28, conspiracy theorists — “coronavirus deniers” — have been using the hashtag #FilmYourHospital to encourage people to visit local hospitals to take pictures and videos to prove that the COVID-19 pandemic is an elaborate hoax.

The premise for this conspiracy theory rests on the baseless assumption that if hospital parking lots and waiting rooms are empty then the pandemic must not be real or is not as severe as reported by health authorities and the media.

Necessary precautions

Of course, there is a simple explanation for why some hospital parking lots and waiting rooms might have been empty. As part of pandemic planning, many hospitals have banned visitors and doctors have had to postpone or cancel elective and non-urgent procedures to free up medical staff and resources. This is in keeping with expert advice from the Centers for Disease Control and Prevention (CDC) and other health authorities.

In addition, to slow the spread of the virus and prevent cross infections with non-COVID-19 patients, the CDC also recommended that health-care facilities create separate intake and waiting areas for coronavirus patients and reserve emergency areas for emergencies such as heart attacks and broken arms. Furthermore, with the lockdown, fewer people are exerting and hurting themselves, which has resulted in fewer visits to the emergency department for heart attacks and strokes.

This empty-hospital conspiracy theory joins a parade of false, unproven and misleading claims about the virus that have been making the rounds on social media including allegations that 5G wireless technology somehow plays a role in the spread of the COVID-19 virus, or consuming silver particles or drinking water with lemon prevents or cures you of the virus. None of these are true.

Hashtag theories

At the Ryerson University Social Media Lab, some of our research investigates how misinformation propagates across different social media platforms. One of the first steps when examining trending topics on social media is to look for signs of social bots — social media accounts designed to act on Twitter and other platforms with some level of autonomy — and coordinated inauthentic behaviour that may include coordinated activities that attempt to artificially manipulate conversations to make them appear more popular than they are.

These two forms of social manipulation, when left unchecked, can skew the conversation, manufacture anger where there is none, suppress opposition or dampen debate. These tactics may undermine our ability as citizens to make decisions and reach consensus as a society.

This new conspiracy campaign against the media and public health officials, with hospitals and medical staff caught in the middle, started on March 28 with a simple tweet by a Twitter user posing a question: “#FilmYourHospital Can this become a thing?”

Social media analysis

For our analysis, we collected a sample dataset consisting of nearly 100,000 #FilmYourHospital public tweets and retweets posted by 43,000 public accounts on Twitter from March 28, the beginning of this campaign, until April 9.

Our analysis suggests that while the #FilmYourHospital campaign on Twitter is full of misleading and false COVID-19 claims, most of the active and influential accounts behind it don’t appear to be automated. However, we did find signs of ad hoc co-ordination among conservative internet personalities and far-right groups attempting to take a baseless conspiracy theory and turn it into a weapon against their political opponents.

Importantly, we found that while much of the content came from users with limited reach, the oxygen that fuelled this conspiracy in its early days came from just a handful of prominent conservative politicians and far right political activists like @DeAnna4Congress, @realcandaceo and @DonnaWR8. These power users employed the #FilmYourHospital hashtag to build awareness about the campaign and to encourage their followers to film what’s happening in their local hospitals. After the initial boost by a few prominent accounts, the campaign was mostly sustained by pro-Trump supporters, followed by a secondary wave of propagation outside the U.S.

As part of our ongoing research on COVID-19 misinformation, we developed the COVID-19 Misinformation Portal that features a range of resources to inform and inoculate Canadians against false and misleading claims about the pandemic. This includes documenting coronavirus claims debunked by professional fact checkers, and a Twitter dashboard tracking the presence of possible bot accounts.

Heightened awareness

In normal times, outlandish conspiracies like this might make us shake our heads, but as COVID-19 cases continue to stalk the hallways of nursing homes in Canada and fill beds in New York hospitals, it is harder to ignore such upsetting conspiracies from the dark recesses of the internet.

The rise of this conspiracy from a single tweet reminds us that while the spread of misinformation can be mitigated by fact-checking and directing people to credible sources of information from public health agencies, false and misleading claims that are driven by politics and supported by strong convictions and not science are much harder to root out.

Written by Manavi Handa, Ryerson University. Photo credit Shutterstock. Originally published in The Conversation.

A woman holds her newborn son right after giving birth; they are still in the birthing pool after labour at home

For many health-care providers who worked through the 2003 SARS epidemic, especially in epicentres, like Toronto, the COVID-19 pandemic is a reminder of the many lessons health-care providers learned at that time. Social distancing measures are the most effective way to “flatten the curve” and minimize the spread of the epidemic.

However, as a midwife working in Toronto for over 20 years, I can also speak about another important lesson learned during SARS that is often forgotten or overlooked: the importance of home birth and the role of midwives during an epidemic.

There is ample evidence from high-income countries like Canada, the United States and the United Kingdom to demonstrate the safety of home births for healthy people who have a trained midwife. In fact, research shows that home birth may even be beneficial in terms of rates of unnecessary interventions, complications and associated cost to the system.

The evidence is so compelling that in 2014, U.K.’s NICE, the National Institute for Health and Care Excellence — the main body responsible for setting guidelines for health care in the U.K. — recommended home births for all low-risk healthy pregnant people. Since the selection criteria for home birth is vitally important to safety, being a low-risk pregnant person is an important factor. For people with high blood pressure, diabetes, preterm labour and other health issues, home birth would not be the safest option.

However, despite these recommendations, mainstream perception has not greatly changed regarding hospital as the preferred place of birth for the large majority. The reasons for this are numerous and complicated, and highly related to social norms, preferences and perceptions of risk.

I have seen many news articles, targeted campaigns, TV shows and even movies supporting home births. But in all my 20 years as a regulated midwife, nothing in my recollection came close to changing people’s minds about place of birth than SARS.

For midwives, this was not necessarily surprising, as we know the safety of a home birth. But it was one of the first times mainstream public perception was greatly altered.

Home births during a pandemic

During a pandemic, people quickly remember that hospitals are, and should be, for sick people; that is, those needing medical care. Ironically, however, in Canada and the U.S., health-care systems the No. 1 reason people are admitted to hospital is for childbirth.

During a pandemic it soon becomes apparent what a bad idea it is to have healthy women and newborns in the same places and spaces as those who are unwell, and increasingly so as more get infected.

Suddenly — our high tech, bells and whistles “for the normal” starts to seem like a really poor idea. In fact, research shows all those bells and whistles lead to more intervention — more episiotomies, more use of forceps and vacuum, and more severe vaginal tearing — with no better outcomes for either the pregnant woman or newborn.

As soon as that babe is here, it becomes even more apparent what a bad idea it is to have a vulnerable new human in a place with lots of sick people.

Home birth starts looking better every second.

I fully appreciate all the bells and whistles — when they are needed. But, like many of my colleagues, I personally prefer a home birth for low-risk births with a healthy uncomplicated pregnancy and normal labour. Not just because it can be very beautiful — quiet, intimate, family oriented — but also because it is actually safer for healthy people — at least during a pandemic.

Although I could talk about the great benefits of home births in general, I’m specifically advocating for home births, or out-of-hospital births, during a pandemic. So, as our health resources and hospital beds become more scarce, I hope we remember the importance of home birth.

Lessons from SARS

SARS was one of the rare times in my career that I had both obstetrical and pediatric colleagues openly supporting the idea of home births and encouraging people to stay out of hospital. At that time, we understood hospital care should be saved for those who were high risk. This was even more clear as the situation worsened during the SARS epidemic.

There were many other important lessons learned during SARS, particularly for Canadian midwifery — although there is almost no academic literature on this subject. However, I do have some anecdotal experience to share as a front-line care provider during that time.

If there is one essential service that we know must continue during a pandemic, it is the business of birthing.

Midwives are an important part of the health force that is often overlooked. Our speciality is low-risk normal birth: this is where we have the most expertise and where we can be most effective.

This is a time when other birth attendants — mainly obstetricians — will be called on for their clinical and surgical speciality skills to manage those pregnant people who have complications, have COVID-19 or are unwell for other reasons.

Midwives can be divided into those who work within the hospital setting and those that work outside within the community. This would help prevent movement in and out of people’s homes and health-care settings.

Midwives have a lot of crossover skills between nurses and physicians. We can stitch and prescribe, like a physician, but also start an IV and take blood, like a nurse. There are many things we can use our skills for beyond birthing.

Some midwives have more advanced skills such as being able to assist during surgery, perform bedside ultrasounds and conduct vacuum deliveries. These skills could be important as the health force declines.

Birth centres, or other out-of-hospital birth locations, should be considered and opened as places for low-risk people to give birth and for healthy newborns to stay.

Finally, the needs of those who are pregnant are often overlooked. Home birth has many potential benefits, but most importantly in a pandemic, we need healthy people to give birth with the best chances of staying healthy — which doesn’t always mean hospital.