Search Results for: COVID-19

Dr Chloe Hamza

Dr. Chloe Hamza is an assistant professor in the department of Applied Psychology and Human Development at the Ontario Institute for Studies in Education at the University of Toronto. She’s the lab director of the CARE lab (Coping, Affect, and Resilience in Education), and her research has been broadly about stress and coping among postsecondary students. It was with this focus that she and her team ran a study looking at the psychological impacts of COVID-19 among postsecondary students.

Like so many other studies at this time, Dr. Hamza and her team were lucky to have already done a similar survey, that one in May of 2019. This meant that repeating many of the same questions with many of the same participants could give a good indication of where they were now, with the pandemic, compared to where they were before.

“We had some pre-COVID assessment data, and then we went back in May 2020 and surveyed students again. We were looking at stress, coping, and mental health before and during the pandemic. What we had originally hypothesized was that students with pre-existing mental health concerns would be those who would be most adversely impacted by the pandemic. But what we found was that students who had pre-existing mental health concerns fared similarly or were actually improving during the pandemic. Whereas students without pre-existing mental health concerns showed the greatest decline in mental health.”

This study, and these results, have resulted in an article that will be published in this month’s COVID-19 special issue of the journal Canadian Psychology. (See our upcoming profile of Dr. Vina Goghari for more on the journal the day the special edition comes out.) The article is called ‘When Social Isolation is Nothing New’, and it details these findings from Dr. Hamza and her team.

“When we looked at why those students without pre-existing concerns were declining, we found that increasing social isolation seemed to be associated with deteriorating mental health. What that seems to suggest is that if you were feeling socially disconnected before the pandemic, which in our case was among students with pre-existing mental health concerns, the start of the pandemic and distancing guidelines may have been less impactful. In contrast, if you weren’t used to experiencing social isolation, and this was a real change for you, your mental health was more likely to decline.”

It looks, for now, as though students with pre-existing concerns were already experiencing some kind of isolation socially pre-pandemic, and that has made the adjustment easier and less impactful for them than it has for others. There are of course other possibilities that might account for the findings of Dr. Hamza and her team, and they plan to explore those in a follow-up study that is beginning right now.

“For many students some stressors actually decreased. For example, having multiple competing demands, or academic pressures, lessened. Which sort of makes sense if you think about how universities initially responded to the pandemic. Students weren’t going to class any more, they may not be going to work, and so the demands on their time – both academic and vocational – may have decreased.”

The follow-up study is currently under way, where Dr. Hamza and her team are asking those same students how they’re coping now during the pandemic. Some of it will involve the results of the previous study, where they will ask the participants about the results. “Here are some of our findings – how does this resonate with you? Do you think it’s accurate? What are some of the reasons you think we might have seen this result back in May?”

While that study is ongoing, Dr. Hamza is also focused on her own students – trying her best to ensure that they remain engaged, well, and healthy through what has been a very difficult school year. Her department does a ‘wellness challenge’ which challenges people to get outside and walk, or pick up and learn a new instrument, or try a new recipe. All things we can do to maintain better mental health during this time of isolation. Things that are good both for those of us who are still new to distancing and socializing remotely, and for those of us for whom social isolation is nothing new.

Mélanie Joanisse

“I wrote this in what I would call a hypomanic phase…as psychologists, we always have to pathologize any kind of creativity.”

Dr. Mélanie Joanisse was still processing the fact that she was not going to be able to attend a Pearl Jam concert when she had something of a viral moment in the early days of the pandemic. Can we still say ‘going viral’? Or has that phrase now passed out of the lexicon like so many others before it that conjure unwelcome memories? Anyway, a lot of people suddenly found Dr. Joanisse’s work. Like, a LOT of people. Her ‘Guide To Wellness’ was being discovered.

“I got a call from the communications director at the Montfort hospital, who said ‘what was your marketing and communication strategy for this? [Mélanie laughs heartily] I was like…none? She said we were being bombarded with messages from people who said they like it, and I was starting to receive a lot of emails – even from people in Europe – saying ‘we like this, can we translate it?’ And so I said sure, go for it! So the communications team at the Montfort helped me to create a creative commune so people would understand that they could just take it.”

Dr. Joanisse’s has a private practice in Ottawa, but does a lot of work at the Montfort Hospital, Ontario’s only francophone hospital. When the pandemic first hit, she saw at the Montfort the stress that the staff was experiencing. The sudden worry among doctors and nurses. The occupational therapists and social workers who were wearing masks and gowns, something they would never have done before. It was all hands on deckand changed how everyone was working. She wanted to do whatever she could in her capacity as a psychologist to help.

“As a psychologist I’m not trained in acute care – no one would want me in the ER! So I figured maybe doing a guide would be helpful. I was reading a lot online, and there are a lot of good resources, but I was just picturing a physician or a nurse or an RT sitting down with a list of 25 papers that they could read on wellness. I just pictured them shutting down their computers and saying ‘I don’t have time or the capacity for this’.”

So Dr. Joanisse set about writing something that encompassed as much as possible about the evidence-based ways to wellness, but to package it in a more engaging way. Visually attractive, a little bit funny, and representative of what frontline healthcare workers were experiencing. An easily-digestible light read, rather than another arduous undertaking.

“The only mask you should be wearing is a medical mask; please discard the infallible mask, as research has shown it suffocates its users.”

• From the Guide To Wellness

The humour in the guide comes from Dr. Joanisse herself. She’s extremely funny, in a very natural way, and that good humour has helped her get through this pandemic and all the setbacks. Like the Pearl Jam concert she missed – her first realization of how big COVID-19 was going to be was that cancelation. Or, more recently, the Chiefs loss in the Super Bowl – her husband is a huge Chiefs fan and just after they were married they flew to Kansas City to take in a game at Arrowhead. In 2019, moments before the pandemic really took hold, the Chiefs finally overcame decades of ineptitude to deliver a Super Bowl victory to fans like Mélanie’s husband.

“Last year when they won, it was pre-pandemic so we were at a friend’s house for the Super Bowl. He got up and spontaneously screamed ‘this is the best day of my life!’ There was a silence, and everyone looked at me. I was like, sorry daughter…birth…wedding…I’m just putting that in my pocket. The next time I spend I don’t know what on what, I’m bringing that card out!”

Now, after watching her husband celebrate the greatest day of his life, Dr. Joanisse is something of a Chiefs fan too. This is perhaps more because of Laurent Duvernay-Tardif, the French-Canadian starting right guard with a doctorate in medicine who left the Chiefs in the offseason to join the front lines of the pandemic back in Montreal. Just the kind of person who might benefit from the Guide to Wellness.

Dr. Joanisse still sees stress in her co-workers at the Montfort. Now, it’s not the stress of uncertainty that existed at the beginning of the pandemic, but rather a stress borne of long hours, fluctuating numbers, a desire for the pandemic to be over, and sheer exhaustion. She’s heartened, however, that many have taken her Guide To Wellness to heart – not only at her own hospital, but at institutions around the world.

“Now I know people in Hawaii, BC, all over the world. All types of different healthcare workers have reached out to me. It has been quite the experience, I have to say. And very moving, to know that this has touched people in that way.”

Maya Yampolsky

In the spring of 2020, there was a COVID outbreak at a homeless shelter in Ottawa. The outbreak was traced back to two immigrant women who were both working at multiple long-term care homes in the city, and who lived at the homeless shelter. As new Canadians with few job prospects, personal support worker positions were some of the only jobs the two women could get. Those jobs paid so little that they were forced to work in more than one location in order to make enough money to live. Even then, they did not make enough to afford rent and so they had to live at the homeless shelter. It was a perfect storm of transmission as vulnerable people in one population brought the virus to vulnerable people in another. As many pointed out at the time, this was eminently predictable.

COVID-19 has had a disproportionately devastating effect on Black people, Indigenous people, immigrants and refugees. Pretty much anyone that has been disadvantaged by institutions and societies over generations are now even more vulnerable because of health inequities. Dr. Maya Yampolsky is an Assistant Professor in Psychology at Université Laval. She specializes in social and cultural psychology, with a particular focus in her research on the experience of managing multicultural and intersectional identities, and how those identities are related to our broader social relationships and broader social issues – especially systemic racism and how racism enters into our personal lives.

We’re speaking on Zoom, Dr. Yampolsky in her apartment in Quebec City, in front of a blank wall that I notice looks a lot like the hallway outside my high school gym. It turns out this is by design – an avid yoga practitioner, Dr. Yampolsky has been with a group call the Art of Living Foundation for about 20 years. They are an organization that promotes individual and community development through yoga and yogic philosophy. When teaching a course, Dr. Yampolsky prefers a neutral, blank background. That said, I get the sense that a yoga class with Maya would be an awful lot of fun. She is exuberant, cheerful, friendly and animated in a way that comes through even a Zoom screen. Even when the subjects we’re discussing are rather sombre and depressing compared to yoga. Subjects like COVID, and racism.

“A lot of research showed that Black Canadians of Caribbean origin or African origin, populations that are descendants of enslaved peoples from previous centuries, these groups have continuously been targeted. As a result there’s stress, and there’s illness that builds up in the body. So a lot more of these members of our population have chronic illness, which makes them more vulnerable to COVID, and to having a more intense experience with it. This means they have worse cases and a higher mortality.”

Around the world, Black, Indigenous, Hispanic and Southeast Asian people have felt the greatest impact from the pandemic. This is in part because of the stress that comes along with the continuous targeting Dr. Yampolsky speaks about, but also because those groups are the most likely to be essential workers. Frontline healthcare employees, people who work in long-term care facilities, areas that are more susceptible to exposure. Worse health outcomes, increased exposure, and more long-term neglect of marginalized communities have combined to create a storm during the pandemic.

“This isn’t overt racism, like hatred. But it is something that manifests from the existence of structural racism that creates inequalities that then come to the surface when a pandemic hits.”

Dr. Yampolsky, along with her colleagues Andrew Ryder, John Berry, and Saba Safdar, created the fact sheet ‘Why Does Culture Matter to COVID-19’ for the CPA. That fact sheet inspired a review article she is currently working on with Rebecca Bayeh (1^st author) and Andrew Ryder (last and corresponding author). Every time culture and COVID is discussed, it takes Dr. Yampolsky and her colleagues in new directions. Racism is a big part of that. With the pandemic, one thing leapt out very early.

“The World Health Organization has said that we don’t name diseases after places. And yet, people kept insisting on calling this the China Virus or worse. From there we saw a lot of hate speech emerging, and there’s been a lot of hate crime. Here in cities like Toronto and Montreal, there were a lot of defacements of businesses and sacred spaces like Buddhist temples. Asian-Canadians and Asian people abroad, in the global diaspora, and people who looked phenotypically Asian (like Northeastern states in India) were being targeted as the source of the virus and being associated with disease.”

This is sadly not a new thing. We’ve seen this before many times, with virtually every epidemic and pandemic in human history (the 1918 influenza pandemic is still called the ‘Spanish flu’ today, even though the first reports of the outbreak were in Kansas, and no evidence suggests that Spain was particularly hard-hit or that outbreaks occurred there earlier than anywhere else).

Dr. Yampolsky explains that part of the reason for this is that the human brain has shortcuts wired into it to be able to avoid danger – we see disease and immediately try to determine the source of the danger, leading us to associate a virus with a whole group. But of course, it’s more complicated than just this. It wasn’t as though everything was great, and then suddenly the pandemic created more racism – there had been a steady rise in overt racism and hate groups leading up to the onset of COVID-19, a trend that was merely accelerated by the pandemic.

Racism has always existed, and it is always there among the public – the rise has been in overt, or as Dr. Yampolsky put it, “audacious” racism. Hate groups and far-right terror groups in North America and Europe have been more bold in sharing their vitriol publicly. Even some political actions have acted to exacerbate racial tensions. Dr. Yampolsky points to Bill-21 in Quebec, the law that bans people working in public services from wearing ‘religious symbols’ of any kind.

“Anything that essentially targets a minority group will also condone hate toward that group. By its very nature, it singles them out for discrimination. And we were seeing a lot of that already.”

Discrimination against virtually all minority groups has been amped up as a result of COVID-19, in large part because that discrimination was on the rise already. The advent of the pandemic became an excuse to further scapegoat those marginalized groups among those who were already trafficking in hate. These populations already tended to be more vulnerable than others because a history of systemic racism has set them up that way.

In the middle of this perfect storm, Dr. Yampolsky sees a silver lining, maybe a light at the end of the tunnel.

“Hopefully the fact that COVID happened, and then this latest big anti-racism movement – as far as I can tell, the biggest since the civil rights movement – in a way COVID facilitated drawing our attention to what was an existing situation. We weren’t going out, we weren’t being distracted, and so our attention was drawn towards anti-racism. This, positively, has yielded a lot more awareness about racism, and institutional valuing and awareness about racism as well. So that also gives me hope – in the sense that COVID showed us that we’re all connected, it also drew our attention to these things that needed repair, and needed work. I hope that it does end up building more responsible, more healthy, and happier connections with one another.”

There’s still a huge amount of work to do building those connections. To avoid another scenario like the one that happened in Ottawa in the spring, immigrants and refugees require greater supports. Personal support workers, and others we consider essential, require higher salaries. We also need to build ethical and cooperative interactions with Black and Indigenous peoples. There must be equitable and affordable housing for all. And the structural systems that create these conditions must be dismantled.

Dr. Maya Yampolsky is one of the people that will move us closer, as a society, to creating those connections. After an hour with her on Zoom, it’s almost impossible not to be inspired to get out there and start working on dismantling racist structures and historic disenfranchisement. And also, maybe even to sign up for her yoga class.

Karen Blair

“One student broke up with her girlfriend just as the pandemic began. She was sent home but wasn’t out to her family. So she was heartbroken, that young love heartbreak that totally guts you, but her family didn’t even know she was gay. And so she couldn’t be heartbroken in front of them. At the same time her brother was home, with his girlfriend stuck in another city. And so their parents were doting on him – empathetic and supportive of the poor moping brother, sad at being separated from his girlfriend. And she’s watching this knowing she can’t even tell them that she’s heartbroken, that she got dumped because of the pandemic.”

Dr. Karen Blair is an assistant professor of psychology at Trent University. She is also the Chair of the Sexual Orientation and Gender Identity Section of the CPA, and has been since 2014, a fairly long time to be the chair of a section. She says she’s likely to remain the Chair until at least 2022, as it would be a pretty big ask to get someone to take over virtually, in the middle of our current pandemic.

One of the things Dr. Blair has done during the pandemic is the ‘COVID-19 Interpersonal & Social Coping Study’. It was a large, ongoing survey of hundreds of Canadians on a variety of topics. It found as the pandemic progressed between May and July, Canadians wore masks more often and supported mandatory mask mandates more strongly.

Dr. Blair and her team also looked at Intimate Partner Violence (IPV), and found that the sample couples who had negative reactions to COVID-19 were at greater risk of perpetrating and being the victim of IPV. Their results found that married or common law couples are at greater risk for psychological IPV victimization; women and married or common law couples are at greater risk for psychological IPV perpetration; and younger individuals, parents, mixed-sex couples, and individuals in newer relationships are at greater risk for sexual IPV victimization.

They also looked specifically at Nova Scotians and how they were coping with the pandemic relative to other Canadians. Nova Scotians reported higher levels of social support, mental wellbeing, and medical help seeking behaviours. Nova Scotians also reported more engagement in WHO recommendations, feelings of competency to engage in social distancing and more positive attitudes toward mandatory mask regulations.

Part of the survey had participants writing notes to their past and future selves - one was a message to a past self, before the pandemic began. The other, a message to a future self several weeks later (see Courtney Gosselin profile).

Perhaps the biggest thing Dr. Blair and her team keyed on in the survey was LGBTQ+ university students who were dealing with the pandemic, home life, and distance learning.

When the first lockdown and stay-at-home orders came down way back in March of 2020, students from all over Canada were sent home from school. Accommodations were made for those who could not return home – those whose home was in a hot spot, like Italy. Or those who may not have been able to get back to Canada once they left for their home countries. But students whose needs could be met only on campus, like the LGBTQ+ population, were not considered.

Universities across Canada closed on March 13^th. Students were, for the most part, given 24 hours notice that they would be moving back home. For LGBTQ+ students, that meant giving up the support systems they had cultivated at school – social groups, roommates, dorm communities and so on. It also meant that for many of them, they were going home to a place where there was simply no support at all. Everything else in the family might be fine, but for these kids there is a huge part of themselves that is having to hide.

“Parents were scrambling to get their kids home, kids were scrambling to move out. In all that chaos we never stopped to ask if we were sending closeted kids home to unaccepting families.”

In addition to the students who remain closeted at home, there are some who may have it even worse – their family knows, but is hostile about their orientation or identity. Which means they are being berated for it every day, stuck in a place they can’t escape, where the support system they’ve built outside the home is inaccessible.

Even virtual support becomes difficult for these students. Now stuck at home with a family that doesn’t accept their sexual orientation, or their gender identity, there is often not a place private enough to have that conversation over Zoom or Skype without the danger of a parent or sibling overhearing the discussion.

These youth, while experiencing all the same upheaval the rest of us went through with the pandemic, had this added layer of a difficult home life. Dr. Blair says this difficulty doesn’t tend to extend to adult LGBTQ+ people – the 30- or 40-year-olds who are settled and married.

“Someone asked me the other day how it has affected me, and I thought not really – I might actually be doing really well. I’m stuck at home with my wife… we’re both academics and often collaborate with each other so we’ve been able to be great supports to each other throughout the various lockdowns.”

Dr. Blair herself relocated during the pandemic to be closer to family. While her wife’s family is now within driving distance and they are only one flight (instead of two) from her own family, the pandemic has meant they haven’t been able to realize the benefits of seeing their families more despite living closer. But the fact that they both have families that want them to visit, and that are happy to be cooped up with one another, puts them in a place many of the university youth Dr. Blair speaks about can only dream of being.

One day, hopefully, those LGBTQ+ youth will get to that place. For now, they must navigate their way through a difficult school year, the same global pandemic with which we’re all dealing, and a certain kind of isolation and difficult home situation most of us won’t experience. What they are missing is a community, a peer group, and a support system. And someone with whom they can share their heartbreak.

Jonathan N. Stea

“That the outbreaks of Spanish influenza, which have given army officials some concern, may have been started by German agents who were put ashore from a submarine, was the belief expressed today by Lieut. Col. Phillip S. Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation. … 'It is quite possible that the epidemic was started by Huns sent ashore by Boche submarine commanders,’ he said. ‘We know that men have been ashore from German submarine boats, for they have been in New York and other places. It would be quite easy for one of these German agents to turn loose Spanish influenza germs in a theatre or some other place where large numbers of persons are assembled.’” (New York Times, ‘Think influenza came in U-boat’, September 19, 1918).

You can find that story on Page 11 of Dr. Steven Taylor’s book The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Conspiracy theories are nothing new. Conspiracies surrounding pandemics are nothing new. What has changed is the speed at which they are spread, and the maliciousness with which they are created.

Lieut. Col. Doane may have thought German U-Boat submariners were coming ashore to spread the flu in movie theatres, and his story was told to the New York Times. It was read by New Yorkers who may, or may not, have believed him. The fact that this opinion exists only in archival material and does not persist to this day, is indicative that either few people read it, few of them believed it, or both.

Lieut. Col. Doane’s theory was not posted to an 8-Chan thread, picked up by a Russian bot farm, posted to Facebook by sixty accounts, disseminated by dozens of questionable ‘news’ platforms, discovered by the President of the United States and tweeted to 90 million people, many of whom were eager to believe and spread the rumour.

This is where we live now, where disinformation and falsehoods can spread from one person to millions across the world in the blink of an eye. And in the time of a pandemic, this can be dangerous, destructive, and harmful in more ways than just fighting between friends and family members. It can put whole populations in greater danger than they need to be.

It is for this reason that scientists across Canada have come together to create the #ScienceUpFirst initiative. Dr. Jonathan N. Stea, a clinical psychologist and an adjunct assistant professor at the University of Calgary, is one of two psychologists who were asked to join the team. Along with Dr. Christine Chambers, Dr. Stea is providing his psychological expertise to combatting disinformation online – specifically, for , disinformation about COVID-19 and COVID-19 vaccines.

“It’s an ethical imperative for psychologists to promote evidence-based patient care and public health– so I’ve always been interested in things like pseudoscience and health-related misinformation. Calling that stuff out is one of our ethical imperatives.”

#ScienceUpFirst emerged from conversations between Timothy Caulfield, a professor of health, law, and policy at the University of Alberta, and Senator Stan Kutcher of Nova Scotia. Professor Caulfield has been researching online disinformation and how to debunk it for decades. Senator Kutcher, before becoming a senator, was the Department Head of Psychiatry at Dalhousie University. They got together to assemble a team of science communicators, epidemiologists, chemists, biologists, geneticists, bioethicists, infectious disease experts, and of course psychologists. Dr. Stea says,

“There is a lot that psychology can bring to the table. We’re trained extensively in science, we’re trained in critical thinking, and we’re trained to understand the ways in which we interpret information and the world more generally. I’ve personally applied these skills to communicate to the public through mainstream media channels, such as articles about tackling health-related misinformation, like how to address vaccine hesitancy and how to identify fake science news.”

This coalition of scientists is dedicated to debunking the misinformation that is out there now. They also want to do the same, as quickly as possible, after a new false narrative emerges online. And there are a lot of them – Bill Gates is microchipping you through vaccines, the numbers are being inflated to control people somehow, alternative medicine cures the virus, the list goes on. And on, and on, and on. Add to that the already loud and vocal anti-vaccination movement that predated the pandemic, and it looks like an uphill battle. But it’s one Dr. Stea is ready to wage.

“Science is an ever-evolving process, and sometimes there are disagreements between scientists. I think for the first time, science is being exposed to the public the way it has always been – as an iterative, evolving process. But for people who are unaware of that, sometimes it can be kind of jarring and it can leave people vulnerable to traps of misinformation. You’ll hear anecdotes, or testimonials on Facebook about how vaccines are extremely dangerous or how Bill Gates caused all this or something. And we want to take accurate, science-informed information and amplify that.”

The initiative is not just scientists railing against misinformation, it is designed for regular Canadians, and regular people around the world, to help amplify the message in the name of public health and protecting their communities.

Your brother-in-law posted online that the COVID-19 was engineered in a lab in China. Your former boss is constantly posting memes about the vaccine being unsafe and untested. Hank from high school is pretty convinced the virus itself is a hoax, meant to distract us all from Pizzagate. Go to #ScienceUpFirstFirst.com, the site that’s designed to help you in combatting these conspiracy theories and false information. They’re fully committed to this fight and want to provide you with the tools to join in as well so that you are not railing against misinformation alone.

Dr. Stea’s day job involves providing psychological treatment in a specialized interdisciplinary outpatient clinic for people who present with both substance use and psychiatric disorders. With the pandemic, he and his colleagues have helped people with these conditions adapt and cope with the additional stressful layer of COVID-related anxiety and uncertainty.. Social media, and the conspiracy theories it perpetuates, does not help. And the volume of these things is only increasing. And of course, that’s where Dr. Stea is spending a fair amount of his spare time.

In 1963, Republican Presidential candidate Barry Goldwater refused to distance himself from the John Birch Society, a powerful conservative group claiming that the bulk of the American congress, including President Eisenhower, were communist conspirators. Later the JBS would push the bogus claim that laetrile, a chemical compound found mostly in the seeds of apricots, was a cure for cancer. In 1964, Goldwater was defeated in one of the biggest landslides in American history, and the John Birch Society was forced out of respectable Republican circles

In 2019, Marjorie Taylor Greene voiced support for the theory that the school shooting at Marjorie Stoneman Douglas High School was a “false flag” attack. She also advanced the conspiracy theory that there was a video – though she hadn’t seen it herself because it does not exist – circulating on the “dark web” of Hillary Clinton cutting off a young girl’s face and wearing it herself as a mask while drinking that young girl’s blood. In November of 2020, Marjorie Taylor Greene was elected to Congress as a Republican Representative from Georgia.

Much of this, of course, stems from Donald Trump who was the biggest source of disinformation and conspiracy theories in the world. Disinformation about COVID-19 is estimated to have declined by 73% on Twitter since Trump had his account disconnected by the platform. And so now may be the perfect time to strike. If genuine science and fact can flood the internet at the same pace as false stories can be spread by trolls, then perhaps we have a chance to stem what the WHO calls a “global infodemic”.

It’s an uphill battle, but it is one that must be waged. Dr. Stea and his colleagues are ready to take it on – and they’re in it for the long haul.

To join the #ScienceUpFirst movement, follow @ScienceUpFirst on Twitter, Instagram, and Facebook, and please visit www.ScienceUpFirst.com to learn more.

Andrew Ryder

Why have some countries dealt with the COVID-19 so much better than others? How is it that others have fared so very, very badly? It’s not always as simple as good government vs. bad, or effective messaging vs. chaotic messaging. More often, it comes down to the people themselves. Do they tend to be rule-followers? Is there societal pressure to take public health seriously, and how do citizens of those countries respond to that pressure?

These are the type of questions that are of particular interest to Dr. Andrew Ryder. An Associate Professor and, currently, Associate Chair in the psychology department at Concordia University, Dr. Ryder self-identifies as a ‘cultural-clinical’ psychologist. His research is largely about how cultural context shapes mental illness like depression and anxiety. With COVID now, there are some new avenues to explore.

“I’ve turned my attention to whether culture may be involved in shaping physical illnesses, which we’re accustomed to seeing as strictly biological. Rather than retooling myself as a COVID-19 researcher, what I’ve been doing is applying the cultural-clinical framework to research that is being done by many of my colleagues.”

Of course, no country is a cultural monolith. Within every larger society are smaller cultural groups, each with their own ethno-cultural backgrounds, residing in different parts of the country and having different socio-economic statuses. And the difference between those groups in terms of combatting the pandemic can be stark, even within the borders of the same country. And on an even smaller scale, each individual within each community differs on their belief, approach, and conformity to the larger group ethos.

But let’s begin on the “macro” level – how might culture be involved in shaping physical illness?

“It’s an infectious disease, and an infectious disease that is socially transmitted. You have to get it from someone. Many of the things we are being told to stop the spread are behavioural. For example, wearing a mask. You might say ‘well that’s the same behaviour everywhere’, but it isn’t really. In Japan, Korea, Taiwan, it’s doing that thing you always do even when you just have the sniffles. For another cultural group it might be doing something absolutely novel.”

Then on the “meso” level – how might smaller cultural groups within those larger societies approach this?

“We know of some cultural groups where [mask-wearing] immediately seems like an imposition on liberty. Like there’s some kind of core cultural value that is violated by the government telling you to do something unusual. Your psychological state is different when you’re doing something that feels normal versus abnormal under the circumstances.”

What ends up happening, says Dr. Ryder, is that while we all feel like we’re doing the same things – mask wearing, social distancing – those things actually play out very differently for different people. He has spoken to some clients who were into the second week of lockdown before they even knew there was a lockdown. Computer programmers who lived in their basement and had their lives changed very little. Then there are others whose entire way of life was upended overnight.

So what, given the significant differences across cultures on a large scale and a small scale, should be done? Dr. Ryder co-authored a fact sheet for the CPA on Culture and COVID-19 with his colleagues Dr. Maya Yampolsky, Dr. John Berry, and Dr. Saba Safdar, that sought to answer that question. (‘Why Does Culture Matter to COVID-19’)

“An unprecedented number of people worldwide are concerned about the same disease and are experiencing broadly the same distancing measures. As such, there may be a temptation to focus on the similarities. At a minimum, policymakers, healthcare workers, and the public at large should keep in mind that the pandemic experience may be very different for different people. These differences are shaped by the society in which one lives, the communities of which one is a part, and culturally-shaped individual variations. Complicating matters, appreciation for difference does not mean treating all responses equally when it comes to effectively mitigating a pandemic. Clearly, some cultural patterns are more effective than others.”

Cultural differences seem to be enormous factors both in containing the spread of COVID-19 and in accelerating it. Some countries are doing exceptionally well, others not so much. And no one factor can determine why but Dr. Ryder points to a few factors. One is the “tightness” of a society, meaning the level of uniformity and narrowness in that society’s understanding and expectation is when it comes to rules, norms and customs. This seems to correlate directly with the degree to which that society accepts and implements public health guidelines. Another is “relational mobility”, which is a measure of how much people move around, and especially how much they move around between various social groups. This tends to correlate with the speed of the spread in those societies.

Never before has there been an event like the COVID-19 pandemic that can highlight the cultural differences in communities, cities, regions, and countries around the world, in terms of how they respond. For self-identified cultural-clinical psychologists like Dr. Ryder, that presents a whole new fascinating series of studies upon which to build his understanding and his work.

His attention is now turning toward cultural variations in how we will recover. Who will bounce back first, and who will bounce back better? How will the logistics of vaccines be handled, and how will those logistics intersect with public concerns about those vaccines? More than anything else, Dr. Ryder’s interest is in the long term. How effectively will different people in different societies respond to the crisis, learn from it, and be better prepared down the line for any future similar outbreaks?

Some of those questions are being answered right now, others will take some time before a larger picture emerges. In the meantime, each of us is fighting a devastating global disaster in our own way. It’s the difference in the ways each of us fight it that could be most illustrative in mitigating potential future damage the next time something like COVID-19 occurs.

Gabrielle Pagé

“Chronic pain has always been one of the more neglected areas within the health care system. Within the context of the pandemic, we didn’t expect that to improve – rather, the opposite.”

Dr. Gabrielle Pagé is an assistant professor in the Department of Anesthesiology and Pain Medicine at the Université de Montréal. She is also a clinical psychologist working out of the Montreal General Hospital specializing in chronic pain conditions. When COVID-19 struck, Dr. Pagé and her team decided now was the time to move more toward an advocacy role, to inform the public about chronic pain, and to make this a larger part of the overall health care discussion.

They began by launching a Canada-wide survey of people experiencing chronic pain, and found out that over the first few weeks of the pandemic and the lockdown, 2/3 of them reported that their pain was getting worse. This was in April-May, right as the first wave was rising across all provinces. The idea that most people’s chronic pain would get worse at this time was an expected result given the magnified difficulties to access pain treatment, increased stress and social isolation.

What was less expected – and almost shocking for Dr. Pagé and her team – was that a small group, 5-10% of respondents, actually reported that their pain had been lessened during this time.

Stress is a big predictor of the severity of chronic pain. When patients are stressed out, they experience more pain – more pain leads to more stress, which leads to…well, you get the idea. So it was very surprising that such a large number of people reported an improvement. Maybe they were going for walks, taking the time to connect with family members, or were laid off from a job that had been causing the bulk of their stress. Dr. Pagé can’t say what the cause is, or was, but she is determined to find out.

As I’m speaking with Dr. Pagé, her team is wrapping up a follow-up study to the one they conducted in May. Will the outcomes be similar, or will something new present itself? They should know soon enough. Also, as we’re speaking, Montreal is entering Day One of the big winter lockdown. Curfews in place, all non-essential businesses closed, and the multidisciplinary pain clinic in the Montreal General Hospital is deciding how to move forward.

Dr. Pagé’s clients, for the most part, have been receptive to virtual therapy. Even the group therapy programs which were a concern seem to have adapted well.

“The social bond, the connection that they make and just being around other people who get what it’s like to have pain every day, is one of the central elements of group psychotherapy in chronic pain. So we were wondering how that would translate into a virtual format, being able to see people only through a screen. We’re doing a qualitative research study around this. And while it’s very preliminary, so far it appears that the screen is not a barrier for them to create bonds between one another.”

Because of the nature of the work, however, many of Dr. Pagé’s clients either don’t have access to computers, phones, or tablets – or are unable to use them. For this reason, the clinic has moved to a more hybrid form of care. Group sessions and many individual meetings are still conducted online, but for those who are unable, or uncomfortable doing so, the clinic remains open for in-person masked and distanced visits. While it`s great to be able to offer this service, it`s quite a challenge to demonstrate presence and empathy during therapy through a mask and face shield!

This means Dr. Pagé still goes into the hospital, in one of Canada’s COVID hotspots. She gets screened for symptoms at the door goes through the protocols every time and then she goes home to an 8-year-old who is, at the time of this writing, doing virtual schooling, and a 4-year-old boy going to daycare.

It can be a demanding situation. Thankfully, Dr. Pagé does not experience chronic pain herself. But she is doing everything she can to collect data and get the message out. It’s stressful to have pain. And it`s painful to be stressed. There is a vicious cycle there, and one that is under-recognized in the overall health care system. A system that is starting to realize, more than ever before, where all those gaps lie.