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Archives for April 2020

Adaptive Fitness Classes Move Online

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Many fitness facilities that offer training programs for people with disabilities have been forced to close because of the pandemic. This, combined with the fact that the support workers of people with disabilities may no longer be able to provide respite care due to the restrictions around the virus, has increased isolation issues for an already vulnerable group. Some adaptive fitness programs, however, are taking their classes online to try to alleviate isolation for people with disabilities during the pandemic.

The Active Souls Project in Kitchener, Ontario, is the largest adaptive training facility in the province. It was forced to close its doors in March due to the pandemic, but owner, founder and coach, Sascha King, has been working around the clock to keep her members moving and connected since then. She has been doing no-contact drop offs of gym equipment such as exercise mats, weights, and skipping ropes at no charge so members can still exercise at home. She also offers virtual training sessions to her members, which offer much needed interaction and socialization.

“They’re so used to seeing us every day or every week, their routines are so set in stone that their worlds are turned upside down right now,” King said of her members. “We’ve had to constantly reassure our kids and our adults with exceptional needs and adaptive needs that we haven’t left them.”

Similar virtual training is being offered here in British Columbia. The Cerebral Palsy Association of BC is now offering virtual adapted yoga, and dance without limits, with classes being held through Zoom.

Move Adapted Fitness in Victoria is offering customized exercise programs, video conferencing, and support from athletic therapists and kinesiologists.

Many other facilities, such as the YMCA, have created workout videos that can be followed at home, and many gyms and training facilities are loaning equipment out to members.

It may be worth giving your local facility a call to see what is being offered that can help you maintain your exercise and rehabilitation routine. While many programs are no longer able to proceed in person, many facilities are finding creative solutions to keep people fit, healthy and connected during this time of social distancing.

Did your Premature Baby Receive Adequate Protection with Magnesium Sulphate?

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Being born prematurely, before 37 weeks, can place babies at increased risk of certain health conditions, including cerebral palsy. Research shows these babies have a lower risk of having cerebral palsy when their mother is given a magnesium sulphate infusion before delivery.  A new study has been published which shows that when women, who are about to deliver premature babies, receive this treatment, their babies had just over 30% less risk of developing cerebral palsy.

When a baby is born prematurely, their brain is more vulnerable to damage.  Damage can occur when there is bleeding in the brain and research has shown that this can affect between 15 – 20% of babies born earlier than 32 weeks.  Magnesium sulphate is known to help protect the brain of babies born prematurely but it is not fully understood how it does this.  It may help keep blood pressure in the baby’s brain more stable or block certain chemicals from causing damage to the cells in the brain.

Around 2 – 9% of the total number of premature babies born before 34 weeks are affected by cerebral palsy.  Cerebral palsy affects the way the body moves and is usually diagnosed when a child or infant does not use their arms, hands or legs in a way expected for its age.  They may have reduced movement or stiffness in their limbs or they may have movements that they cannot control. The way the body moves is controlled by the brain and damage to a baby’s brain in pregnancy, birth or early childhood can cause cerebral palsy.

In Canada, magnesium sulphate infusions should be considered for those who are likely to deliver a baby before 34 weeks’ gestation within the next 4 – 24 hours.  A premature delivery may be suspected when the membranes around baby have prematurely ruptured, or broken, or where the cervix (the neck of the womb) is found to be dilated when mom is examined. The infusions are given through an intravenous (IV) line directly into the mother’s vein.  The infusion may be given as one dose over 30 minutes alone, or with an additional infusion continuing until the premature baby is born. The infusion can make the mother feel flushed, nauseous and warm and so women often know if they have received this form of treatment. Magnesium sulphate infusions are considered safe for both mother and baby, and serious adverse effects are rare.  There are certain circumstances where it is not advised that the mother receive this treatment, including where she is known to have suffered an allergic reaction to magnesium sulphate in the past or has certain heart conditions.

This new research looked at studies which included over 6,000 babies born prematurely and followed them up to 18 months to 2 years of age.  The premature babies who were born to mothers who received magnesium sulphate were compared with premature babies born to mothers who did not receive magnesium sulphate.  Babies whose moms had received magnesium sulphate had a relative risk reduction of 0.68 which means a more than 30% reduced risk of developing cerebral palsy. This research is encouraging for those providing medical care for mothers about to deliver before 34 weeks as this form of treatment has the potential to reduce the risk of cerebral palsy and impact significantly on the families caring for premature babies. 

If you have questions about whether or not your premature baby received adequate protection from magnesium sulphate before birth, please contact infant child injuries attorney for a free consultation to discuss your concerns.  Our cerebral palsy lawyers will do their best to answer your questions and provide you with legal advice about whether or not your child may be entitled to fair compensation for any special care or support required by your child as a result of a birth related injury.  You may reach us at info@pacificmedicallaw.ca or at 604 685-2361. 

Is Inducing Labour at 39 Weeks Safer Than Waiting?

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A pregnant woman’s estimated due date is 40 weeks after the date of conception. Even without a premature delivery, however, not all women will deliver at 40 weeks. Forty weeks has the highest percentage of deliveries, on average, in comparison to any other length of pregnancy, but there is a wide range for how long a pregnancy lasts. Term pregnancy ranges from 37 weeks 0 days to 41 weeks 6 days. Once a woman reaches 42 weeks, she is classified as post term. Within term pregnancies, there are now a few subclassifications. Early term is the period from 37 weeks 0 days to 38 weeks 6 days. Full term is 39 weeks 0 days to 40 weeks 6 days. From 41 weeks 0 days to 41 weeks 6 days is considered late term.

In a previous blog article, I discussed the current British Columbia guideline for induction of labour in late term versus post term pregnancies, and the medical evidence supporting this guideline. The current standard of care in British Columbia is to continue pregnancy (absent signs of fetal or maternal compromise) until 41 weeks and then offer the woman an induction. The standard of care requires that women be informed of the risks and benefits of induction versus expectant management (monitoring while awaiting spontaneous labour) and allowing the woman to make the best choice for her and her child. For post term pregnancy, the standard of care is to induce.

Guidelines, however, are constructed based on the current, widely accepted, medical knowledge of various conditions and situations. This medical knowledge is constantly growing, changing, being confirmed or getting disproven. As knowledge is accumulated, standards of practice evolve. In the context of pregnancy, an example of this is the shift in recommendation from offering induction of labour to women only when they reached post term (42 weeks) to offering induction of labour at 41 weeks. Will the evolution of pregnancy guidelines continue to progress towards even earlier delivery? Some physicians are now advocating for induction of labour at 39 weeks. This subset of physicians believe that the safest option is to deliver the baby as soon as the mother reaches full term.

One such physician, Dr. Errol Norwitz MD, PhD, MBA, recently presented on this topic at the 36th Annual Obstetrics, Gynecology, Perinatal Medicine, Neonatology and the Law Conference.1 In considering whether to continue a pregnancy beyond 39 weeks, a physician and his or her pregnant patient must consider the risks of continuing the pregnancy and balance that against the potential benefits (to both mother and baby) of continuing the pregnancy. Let’s start with the induction of labour itself. One benefit to continuing pregnancy would be to potentially avoid the induction by having the woman go into labour spontaneously. There are some risks of induction of labour, but Dr. Norwitz argued, with studies to reinforce his position, that the risks of routine induction of labour are lower than previously thought. One of the risks is a risk of failed induction leading to caesarean section. Newer studies cited by Dr. Norwitz, however, have shown that there is no increased caesarean section rates in elective induction of labour at 39 weeks. The ARRIVE trial by Dr. William Grobman (and others) actually showed a lower rate of caesarean section with elective induction of labour at 39 weeks compared to expectant management until at least 41 weeks.

Dr. Norwitz argues that there are no benefits to continuing pregnancy beyond 39 weeks sufficient to overcome the risks associated with doing so. Benefits to a baby in continuing pregnancy before 39 weeks are a result of the decreasing risk of complications associated with prematurity. This decrease in risks, however, stops at 39 weeks. Dr. Norwitz cited a study by Dr. Brian Mercer showing the frequency of a baby developing problems at each gestational age. The risk of sepsis (infection), respiratory distress syndrome, intraventricular hemorrhage (a brain bleed), necrotizing enterocolitis (a disease affecting the intestines), retinopathy of prematurity (a potentially blinding disease), bronchopulmonary dysplasia (chronic lung disease) and need for hospital stay are all at their lowest at 39 weeks. Dr. Norwitz also looked at a study by Dr. Joann Petrini (and others) showing that the risk of cerebral palsy, developmental delay and seizures are also at their lowest point at 39 weeks. Now, some of these risks remain at that same low level throughout 40-42 weeks. Others rise, in terms of risk, at 40 weeks. None, however, ever get lower than they are at 39 weeks.

So, the risks of known, common complications do not get lower than they are at 39 weeks. What about the risk of unexplained death or stillbirth? Dr. Norwitz cited studies by Dr. Christina S. Cotzias (and others) and by Dr. Ruth Fretts showing that the number of stillbirths is far greater than the number of Sudden Infant Death Syndrome (SIDS). Dr. Norwitz cited numerous studies showing that the risk of stillbirth increases after 39 weeks. Stillbirth is the death of a baby during pregnancy or during delivery. If a woman’s baby is assessed to be alive and healthy at 39 weeks, and is delivered at that time, the risk of stillbirth drops to the risk that the baby will die during the delivery. If the pregnancy continues, there is a continuing risk of stillbirth. It may be a small risk, but any risk is higher than the risk of stillbirth at 39 weeks when the baby was assessed to be alive. In other words, if a baby has been delivered at 39 weeks, it cannot die in utero at 40 weeks. That risk of stillbirth disappears. A 1985 study by Drs. George Feldman and Jennie Freiman includes the following quote: “[b]etween 1 in 50 and 1 in 500 fetuses reach maturity in utero and then suffer a catastrophic event leading to permanent neurological injury or death.”2 If a baby has survived and is healthy at 39 weeks, full maturity, why do we accept any risk of stillbirth by continuing the pregnancy beyond that point?

As mentioned above, the current standard of care according to the British Columbia guidelines is to offer induction of labour at 41 weeks, not before. Medicine and knowledge evolve with time, however, and this is one area where some physicians are advocating for further change.

ENDNOTES
  1. Norwitz, Errol R. 2019. “Optimal Timing Of Delivery: Should It Be 39 Weeks And Out?”. Presentation, 36th Annual Obstetrics, Gynecology, Perinatal Medicine, Neonatology and the Law Conference, 2019.
  2. Feldman GB, Freiman JA. N Engl J Med 1985; 312:1264-7

The Evolution of the Law of Informed Consent

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This is the second article in an 8 part series published in the Verdict law journal on medical malpractice litigation. In this article Susanne Raab reviews the law of informed consent1, and how it has evolved over the years.

INTRODUCTION

The Supreme Court of Canada decisions of Hopp v. Lepp2 and Reibl v. Hughes3  marked a shift in the law away from the medical paternalistic approach to informed consent toward a more patient-centered approach. 

The issue first came before the Supreme Court of Canada Hopp v. Lepp. In this case, the plaintiff underwent a disc operation, competently performed, which left him with a permanent disability. The plaintiff sued the orthopedic surgeon for, among other things, failing to disclose to him that this was the surgeon’s first such operation since completing his orthopedic fellowship training and failing to disclose the alternative of undergoing the operation in a larger facility.

Chief Justice Laskin, writing for a unanimous court, rejected the professional medical standard of disclosure, which essentially held that it was for the medical profession to decide what risks should be disclosed to patients, and instead held that physicians must inform their patients of risks that the “reasonable person in the position of the patient” would want to know. Laskin C.J., described the required standard of disclosure as follow:

In summary, the decided cases appear to indicate that, in obtaining the consent of a patient for the performance upon him of a surgical operation, a surgeon, generally, should answer any specific questions posed by the patient as to the risks involved and should, without being questioned, disclose to him the nature of the proposed operation, its gravity, any material risks and any special or unusual risks attendant upon the performance of the operation.”4

Having found the defendant surgeon properly discharged his duty of disclosure to the plaintiff, Chief Justice Laskin declined to analyze the distinction between whether the claim would be one of battery or negligence, leaving that for another day.

That day came quickly, only a few months later, in the decision of Reibl v. Hughes. In that case, the plaintiff underwent an endarterectomy, also competently performed, which resulted in him suffering a stroke causing right-sided permanent paralysis. The plaintiff alleged the surgeon failed to inform him of the risk of stroke associated with the surgery. In particular, in response to his questions about the risk of stroke, the surgeon advised him that the risk of stroke was greater if he did not undergo the surgery, but failed to advise him of his risk of stroke if he did undergo the surgery. The plaintiff alleged that had he been informed of the risk of stroke associated with the surgery, he would have deferred the surgery until after his retirement pension had vested – 18 months hence. At trial, the defendant was found liable in both negligence and battery for failing to disclose this risk of surgery. This decision was overturned on appeal. The Court of Appeal ruled out battery as a ground for liability and ordered a new trial on the negligence claim. The decision was then appealed to the Supreme Court of Canada. Chief Justice Laskin took this opportunity to clearly distinguish between claims in battery and negligence arising from alleged failure to fully disclosure medical information in the course of obtaining consent for medical care, stating that breach of a duty of disclosure of attendant risks of medical care and treatment was to be subsumed into the law of negligence and an action in battery would only be appropriate “where surgery or treatment had been performed or given to which there has been no consent at all or where, emergency situations aside, surgery or treatment had been performed or given beyond that to which there was consent”.5 He continued, 

[i]n situations where the allegation is that attendant risks which should have been disclosed were not communicated to the patient and yet the surgery or the medical treatment carried out was that to which the plaintiff consented … I do not understand how it can be said that the consent was vitiated by the failure of disclosure so as to make the surgery or other treatment an unprivileged, unconsented to and intentional invasion of the patient’s bodily integrity. …

[I]n my view, unless there had been misrepresentation or fraud to secure the consent to the treatment, a failure to disclose the attendant risks, however serious, should go to negligence rather than battery.”6

Chief Justice Laskin also re-emphasized the patient-centered test for disclosure set out in Hopp v. Lepp, supra, stating, 

[t]o allow expert medical evidence to determine what risks are material and, hence, should be disclosed and, correlatively, what risks are not material is to hand over to the medical profession the entire question of the scope of the duty of disclosure, including the question whether there has been a breach of that duty. Expert medical evidence is, or course, relevant to findings as to the risks that reside in or are a result of recommended surgery or other treatment. It will also have a bearing on their materiality but this is not a question that is to be concluded on the basis of the expert medical evidence alone. The issue under consideration is a different issue from that involved where the question is whether the doctor carried out his professional activities by applicable professional standards. What is under consideration here is the patient’s right to know what risks are involved in undergoing or foregoing certain surgery or treatment.”7

Together, the decisions of the Supreme Court of Canada in Hopp v. Lepp, supra, and Reibl v. Hughes, clarify that unless fraud or misrepresentation are involved in the process of obtaining consent to medical care or treatment, claims for failure to disclose material risks or alternatives to medical care or treatment are properly pled as negligence claims. The required standard for disclosure is what the reasonable patient in the position of the plaintiff would want to know, which is informed by the special circumstances of the plaintiff as well as questions asked by the plaintiff.8 This was expanded upon by the Supreme Court of Canada in Ediger (Guardian ad litem) v. Johnston2013 SCC 18, in which the court reaffirmed the trial judge’s analysis that the required scope of disclosure included the fact that a reasonable person in the position of the plaintiff would want to know the consequences of a given risk (rather than just a recitation of the risks with their respective statistical probabilities). In this case, the scope of disclosure imposed a duty upon the defendant obstetrician to advise the plaintiff not only that proceeding with the proposed treatment included a risk of bradycardia, but also that in the event that that risk materialized, her baby would necessarily be born with severe and permanent brain damage because of the time required to arrange for surgical back-up.

In practice, whether or not a material risk was in fact disclosed is typically an evidentiary and credibility contest with the plaintiff’s specific memory of not being told of the risk on the one hand, and the defendant physician’s evidence of his or her standard, invariable practice on the other hand, usually in the context of a vague chart entry or consent form that generally references risks having been discussed without specific reference to which risks, and often many years after the encounter. While the findings by the court will be largely fact-driven, it bears noting that a defendant’s evidence of his or her standard invariable practice has been accepted as cogent and reliable evidence by the court.9

THE CAUSATION TEST IN INFORMED CONSENT CASES

To succeed with any negligence action, the plaintiff must establish a causal link between the doctor’s negligence and the injury which occurred.

In the context of informed consent cases, damages are not awarded to a plaintiff simply because the defendant physician failed to disclose material risks or alternatives to medical care or treatment, but only if the plaintiff has been injured by the undisclosed risk and can establish that, but for the failure to disclose the risk, the injury would not have occurred.

There are two separate causation tests built into this analysis: 

1) The modified objective test; and 

2) The “but for” test.

THE MODIFIED OBJECTIVE TEST

In Reibl v. Hughes, Mr. Justice Laskin grappled with the competing approaches of the purely subjective test (i.e. what the patient would have done), and the purely objective test (i.e. what the reasonable patient would have done) of causation, and the evidentiary/credibility quandries associated with each. He settled on a hybrid – the modified objective test, namely, what a reasonable person in the plaintiff’s position would have done had he or she been properly informed of the material risks and alternatives to the medical care or treatment.

Consistent with the standard for disclosure, this test imports a consideration of the plaintiff’s unique circumstances. The modified objective test was reaffirmed and elaborated upon by the Supreme Court of Canada in Arndt v. Smith10, a wrongful birth case. Cory J, writing for the majority of the court, described how personal circumstances should be appropriately considered in the application of the modified objective approach:

[i]n my view this means that the “reasonable person” who sets the standard for the objective test must be taken to possess the patient’s reasonable beliefs, fears and expectations. Further, the patient’s expectations and concerns will usually be revealed by the questions posed. Certainly, they will indicate the specific concerns of the particular patient at the time consent was given to a proposed course of treatment. The questions, by revealing the patient’s concerns, will provide an indication of the patient’s state of mind, which can be relevant in considering and applying the modified objective test.”11

The reality is that most claims based on lack of informed consent fail on this branch of the analysis because of the difficulty in convincing the court that the reasonable person in the plaintiff’s position would have declined the recommended medical treatment had he or she been properly informed of the attendant risks. The difficulty arises from the level of deference and trust afforded to medical professionals by the typical, reasonable patient. Simply put, patients tend to follow their physician’s advice. This observation was made by Chief Justice McEachern (as he then was) in Diack v. Bardsley who concluded that, “[l]ike most of our citizens who consult professionals, I think he would have decided to go ahead with the procedure which was recommended.”12 Indeed, medicine is a complex discipline which often exceeds the understanding of the average patient, and physicians in our society enjoy an elevated status and level of respect. When a physician recommends a certain course of action, the patient is often ill suited to second guess the wisdom of that recommendation, and simply assumes the recommended medical treatment must be the best possible option available in the circumstances. Defence counsel typically lead expert evidence of the frequency with which patients simply follow their physicians’ recommendations, and while the courts have made it clear that these cases are not determined by expert evidence, this type of evidence is persuasive, and is very effective in defending an allegation of lack of informed consent. For these reasons, there typically must be something unique about the plaintiff in order to persuade the court that the plaintiff would have acted contrary to his or her physician’s recommendations. A good example of this is found in the case of Cojocaru (Guardian ad litem) v. British Columbia Womens Hospital, 2009 BCSC 49413 in which the Plaintiff, who was of Romanian descent, had experienced trauma surrounding a malformation affecting her first child in a culture which was not very accepting of such differences. This heightened her concern to ensure everything possible was done to avoid problems with the health of her second child, making her unusually risk adverse, and unlikely to accept the risk associated with the recommended proposed medical care. 

THE “BUT-FOR” TEST

It is also necessary to prove, on a balance of probabilities, that failure to inform the plaintiff of a material risk or alternative caused the plaintiff’s injury. Simply put, it is not enough to prove that the reasonable patient in the plaintiff’s position would have refused (or postponed) the surgery had they been properly informed of the materials risks, benefits and alternatives of the proposed medical treatment or procedure. It is also necessary to prove, as in all medical negligence cases, that “but for” the medical treatment or procedure, the injury would not have occurred.

While this aspect of the test does not arise in all informed consent cases, it is important to give careful consideration to its effect in certain factual scenarios. For example, the alternative of postponing the medical care or treatment gives rise to some interesting issues, especially when the effect of postponement may have implications for the injury suffered. This was the argument in the seminal case of Reibl v. Hughes where the plaintiff successfully argued that had he been advised of the risk of stroke associated with the surgery, he would have postponed it until after his retirement pension had vested. While he did not argue that but for the failure to disclose the material risk of surgery he would not have suffered the stroke, he did argue that this caused the loss of his retirement pension. The question arises, if there is, for example, a 10% risk of an injury occurring during surgery, can a plaintiff argue that had the surgery been postponed to a later date, the chance of it occurring during this later surgery was only 10% and therefore does not meet the threshold for causation?14 Whether or not such a claim would succeed in Canada would be very fact-driven and depend upon the specific mechanism of injury, in particular whether the risk was related to patient, physician or facility related factors, and the statistical or epidemiological evidence relating to whether the outcome would have been different had the surgery been performed at a later date.

Another example is the case of Cojocaru (Guardian ad litem) v. British Columbia Womens Hospital, 2013 SCC 30 in which it was found that while the defendant failed to disclose the risks of induction, and the plaintiff argued she would have declined induction had the risks been disclosed, there was no evidence upon which to find it was in fact the induction which caused the injury to the infant plaintiff (although the plaintiff was successful on lack of informed consent in relation to the VBAC). The Supreme Court of Canada held that the but-for test to causation had not been met, stating:

[98] …The trial judge failed to conduct a separate causation analysis for the failure to obtain informed consent to induction, as distinct from the failure to obtain informed consent to VBAC. In my view, there is no evidence to support a causal relationship between the induction and the harm suffered. 

[99] There was no evidence to suggest that the alternative to induction — and, thus, the course of action that would have been followed had induction been refused — was a scheduled caesarean section. The most that can be said is that if Ms. Cojocaru had refused induction, her labour would not have been induced. The question is what harm flowed from the induction with prostaglandin gel. 

[100] The trial judge neither explicitly not implicitly found that the prostaglandin gel over-stimulated the uterus and caused the uterine rupture. Although there is evidence to support his finding that induction increases the risk of uterine rupture, it does not go so far as to show a causal relationship between the induction and the rupture in this case.

[101] I would not sustain the finding of liability against Dr. Yue on this basis.”15

CONCLUSION

In conclusion, cases based on lack of informed consent are highly fact-driven cases which are to be assessed on the basis of what a reasonable person would want to know, informed by any relevant unique circumstances of the plaintiff, and including a discussion of the consequences of those risks, and what a reasonable person in the position of the plaintiff would have done had they been properly informed. While this more patient-centered approach to informed consent in health care arose four decades ago out of a greater recognition and respect for patient autonomy, a review of the case law shows that these cases are rarely successfully, in part due to the continued deference patients afford to their care providers.

The full article can be viewed here on our publications page.

END NOTES
  1. The scope of this discussion is limited to competent adults.
  2. [1980] 2 S.C.R 192
  3. [1980] S.C.R. 880
  4. Hopp, Supra note 2 at 210. 
  5. Reibl, Supra note 3 at 890.
  6. Reibl, Supra note 3 at 891.
  7. Reibl, Supra note 3 at 894
  8. Also see Health Care (Consent) and Care Facility (Admission) Act RSBC 1996 C. 181 s. 6
  9. Belknap v. Meakes (1989), 1 C.C.L.T. (2d) 192.
  10. [1997] 2 SCR 539
  11. Ibid, at 550.
  12. 1983 CanLII 541 (BC SC) at para 47
  13. Aff’d 2013 SCC 30
  14. See Chester v. Afshar [2004] UK House of Lords 41.
  15. Cojocaru at para 98-101.

People with Disabilities Among Those Most at Risk from Covid-19

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Public health and government officials are urging Canadians to practice social distancing. For some, social distancing could make the difference between life and death.

Andrew Gurza, a Toronto-based disability awareness consultant, has cerebral palsy. His condition could make him seriously vulnerable if he were to contract COVID-19. In an interview with CBC, Gurza, who uses a wheelchair for mobility, said that his lung function is impacted due to the fact that he is sitting down all the time. This makes him more vulnerable to complications from respiratory illnesses, such as COVID-19. Gurza indicated that in addition to the toll of the illness, he fears catching the illness at a time when the hospital staff is overwhelmed, especially if they need to manage someone with complex disability needs such as himself.

Gurza has taken steps to reduced risk and practicing social distancing as much as possible. He has cancelled all of his speaking engagements, and he is doing his best to reduce contact with his caregivers, who he relies on for many daily activities such as bathing and dressing.

Gurza asks the public to please be responsible. You never know if the person sitting next to you is vulnerable due to a visible or invisible disability. While contracting the virus may not be serious for one individual, it could have dire ramifications for someone else. He urges the government to let the public know who is going to be particularly affected: the elderly, the disabled, and the immunocompromised.

Staying positive at this time is important to Gurza. He suggests thinking of social distancing as a chance to take a break, and do things we may otherwise not have time for.

The goal of social distancing is to reduce transmission of the virus. It is transmitted when an infected person speaks, coughs, or sneezes. Droplets may land on surfaces in common spaces when someone coughs, and then be transmitted when someone touches the surface later.

Social distancing may be difficult or even impossible for some people with disabilities who may rely on close caregiver support for daily living tasks such as washing and dressing, and use shared services, such as public transportation. They also may have stamina and immune issues which can increase risk of catching the virus. Therefore, it is important for those who are able to reduce their contact with others to do so, in order to protect the vulnerable.

The full interview with Gurza as well as an interview with a public health expert can be found here: https://www.cbc.ca/radio/frontburner/when-social-distancing-is-a-matter-of-life-and-death-1.5499767

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