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Interview with Lynora Saxinger

Updated: Aug 25, 2020

By Jay Kim, Communications Editor

Graphic by Alex Jeon

Jay Kim: Can you tell me about the work you’ve done as an Associate Professor of Medicine at the University of Alberta, and also about your concentrated area of research and work?

Lynora Saxinger: I’m guilty of being interested in many things. I started off being more focused on the theory and practice of medical education, with a fair amount of teaching and lots of clinical work. Then I switched more into antimicrobial stewardship. My recent academic portfolio has been focused on appropriate targeted use of antibiotics to reduce the development of antimicrobial resistance. Most recently, with COVID-19, I’ve pursued my interest in knowledge translation, which is crucial as we often fail to communicate scientific findings to the public effectively. Information that consumers were getting appeared to be of different messages, and I don’t think that we’ve equipped everyone in our society to be able to work through some of the nuances of the literature world, so I’ve been more recently interested in public message teaching around COVID. It’s clear that good science communication can make a huge difference.

JK: How specifically have you dealt with the COVID-19 pandemic through your job?

LS: I’m an Infectious Diseases Doc, so I was seeing COVID-19 cases early on. I was actually following its epidemiology since the very end of December and was not super surprised by the way things were going down. When it really became clear that North America had a problem, I was brought in to co-chair a scientific advisory group for our provincial COVID emergency coordinating center, which took over all the public health and health authorities’ command structure. They would ask us to synthesize current knowledge about COVID-19, present questions that might change policy, for example mask use in hospitals and communities, determine the real risk of asymptomatic transmission, the risks associated with using particular types of ventilator support for patients, the risk factors based on current evidence, etc. I was working 80 to 200 hours a week since April. But it’s calmed down more now in the last few weeks, and we’re kind of catching up because we’ve kind of gone over at least the first hump here and are regrouping. But there was pretty intense activity in the advisory group, but it was weirdly scholarly intense activity: lots of meetings, literature reviews, searching. I’ve been doing my clinic, and I’m working in a hospital as an Infectious Diseases Consult. So it’s been quite consuming.

JK: What is something you think people ought to know about COVID-19?

LS: If there is one concrete thing that worries me the most right now on public messaging is that although it’s appalling to say it, the evidence behind masks actually reducing transmission is not great. A lot of the evidence behind mask use is lab-based, showing that they’re pretty good at catching droplets from someone who is infected. But we do have a little bit of actual clinical data suggesting that they don’t necessarily help that much in terms of preventing getting the infection … I think that we should not assume that masks alone will get us that kind of improvement and instead know that masks should always be used with the whole package. I think there’s a lot of places that are tempted to say, “well, we can keep on doing everything, keep our businesses open and keep meeting people, if we wear masks.” But there actually isn’t direct evidence for that. I’m hoping we get better evidence, but in the meantime, people ask me, “What do you think about masking?” I think masking is something we should do with physical distancing and hand hygiene because at the moment, that’s the package. If we overstall the use of masks, we might actually be creating for people at higher risk. That’s my big worry right now, but it’s hard because as soon as you say anything like “the evidence is not great,” people call you an anti-masker and attack you. So that’s one piece of messaging around COVID-19 right now that I think is problematic. It’s around masks because I think there’s an implicit overreliance on them that I don’t think is justified by current data. And I’m hopeful that we’ll get enough data that we'll be able to say, “Okay definitely everyone needs a mask,” But right now, I really don’t think it’s true. And I think there’s a bit of a natural human tendency: when you have something on your face, you feel protected, and you might be less likely to wash your hands and stay away from people. And I’m a little worried about that too, although it hasn’t been proven.

I think that the idea is not that you should be against masks, but that at the moment, they should be part of the package. Another thing that people might want to be aware of is contemplating what kind of mask they need. The World Health Organization (WHO) put up a document that was quite useful: because all masks are using a single piece of cotton fabric, depending on the weave, it might give you as little as 3% filtration efficiency. Different construction or multi-layered fabrics might give you up to 60% filtration efficiency. Obviously, those are pretty different. Medical and surgical masks usually come in at around 60 to 90% filtration efficiency, so the type of mask is also important. For some reason, people are just churning out cool-looking masks, so the other thing that I think is a bit funny is that we’re talking about masks as if they’re one thing. But the difference between a gauge mask that filters nothing and a well-fitted multi-layer mask is quite considerable.

JK: How has the pandemic affected your family or the way you relate to your family?

LS: Very early on, when we were starting to see some cases in hospitals, there had just been a whole bunch of media that portrayed healthcare workers dying (which is not super cheerful). I think a lot of people were stressed about what might be coming and about maybe having a situation where you’re having to make terribly tough choices, for example, if there are limited ventilators. There’s this massive dark cloud of the unknown, which is profoundly distressing. Plus, I was working my butt off with extra committee work. When I came home, I actually was afraid to let my little girl hug me until I changed clothes. So, I tried to sneak into the house and go change before she saw me. But one time when I was coming out of the garage, she saw me and ran towards me for a hug, and I said “No!” and backed away. She was so upset that she started crying. That’s like the worst thing ever. Then, after we started looking more at what the evidence is that clothes are something that might be a problem, I’ve actually relaxed considerably. But that was when we didn’t have much information. Since then, I think that there’s also been a lot of burden on my husband because the burden of having a four year old at home while trying to work from home was falling more on him than me. My son, who is older than my daughter, was worried about me as well. One time, he overheard us talking about updating our wills, and it kind of freaked him out.

I think we all kind of spend so much time trying to figure out where the risk is and how we can minimize it, but I’ve actually really got my routines down for things that I think are important, reasonable, and sustainable. Because I think people [were overly cautious,] want[ing] to wipe down their veil and stuff and clean their vegetables, and it’s like you know what? There’s a level where there’s diminishing return, and it becomes almost like psychological damage to keep on focusing on things that probably are not a big deal. Because what you really want to do is spend your energy on the things that are important. So, I think I found a new balance, and I think my family is getting into a marathon, but it’s just the way things are going to be for a while. So, it’s been hard, and we’re less able to go out to eat. I’m trying to minimize going to the grocery store, and no one helps clean the house (laughs). We’re dealing with different ways to do things.

JK: What long term effects of COVID-19 (if any) do you foresee?

LS: For me personally, I see that a lot of us are realizing how a lot of things can be done remotely reasonably well. So, I think because of the shift in our practice, for patients who live further away, it might be quicker to go with virtual health options. I think I’d like to see certain patients at least once a year to do exams and give vaccines and things, but I’d be much more likely to offer remote appointments. I’ve actually found that they seem to work quite well and now that I am used to it, I can see that virtual care might become more common. And that might actually really be helpful to people because then they don’t have to take as much time off work if they live far away. There might also be more benefits to have fewer face-to-face meetings for larger group discussions … I think people have gotten more used to virtual work and that skillset is useful for bringing people together. Ordinarily, it would’ve been difficult to get people together, so there might be better collaboration because people are just more comfortable with virtual stuff.

I think that the whole health system is going to be, hopefully, more attentive to infection prevention and control for the foreseeable future. Because a lot of the things that you learn tells you that making sure routine things are done very very well can make a huge difference. For education, I’m not sure yet. I’ve got the first-year medical student block to teach this year. Usually, I like teaching, but now it’s like omg I’m so busy, and we have to do the whole new delivery system, so it’s going to be a lot of work. And we’re going to have to try hard to make it engaging. So there are a lot of questions for higher level students and how we can structure things to make it work for them. And of course, the world is taking a massive hit in terms of many many deaths and economic upheaval. It will be important that the planning and recovery from this worldwide event are done properly to not let dysfunctional structures stay dysfunctional.

JK: How has the pandemic affected your lifestyle? LS: The pandemic has added significant stress, and I can’t remember a more intense period of work in my life. But at the same time, I think that the group I’ve been working with has been a real fluff, so there’s also been some stress-bonding. It’s a pretty remarkable time, and I think everyone who’s been heavily involved in planning has been constantly second guessing whether they’re making right decisions, and it can be very hard to keep on carrying because you just want to be right but are trying to build a foundation on a shifting body of knowledge. But so far, I think I’ve honestly done pretty well. And we have to just accept that we do the best we can. The idea that you’re working closely and really hard with a group of people and you feel like you’re doing good work can actually be somewhat satisfying.

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