Ep 191 Transcript

The following transcript is for Ep 191: COVID pharma politics. Thanks to our patrons for helping make this possible. Forgive any minor errors in the text.

Ian Bushfield: Joining us on PolitiCoast to talk about the politics of pharmaceuticals is, I guess, long time listener Sasha Malecki. 

Sasha Maleki: Thank you guys for having me. Yeah, we were just saying in the pre-show, I listened to you guys when you first appeared on The Docket. This is going way back to your very, very first episode, so it’s really exciting to be here. 

Ian Bushfield: Sasha, could you tell our listeners a little bit more about yourself, what your background is, what is your expertise?

Sasha Maleki: Of course. So my name is Sasha. I’m a pharmacist by training. I went to SFU for part of my undergrad, and then I went to UVic for pharmacy school and then after that I did a residency in a hospital pharmacy practice in Victoria. And I’m now working in Nanaimo, primarily working in neuropsychiatry, but also in general internal medicine.

So you might be wondering, well, what does a pharmacist do in the hospital? We’re not just pill pushers. We don’t count pills all day. What we’re doing is we’re essentially making sure that medications are being used correctly. And what that means is that they’re being used in the correct scenarios that they’re being, that the ones that are being prescribed are being, are the best ones to use and that they’re also safe. 

And how I kinda got involved in this whole COVID, I guess commentary is, Rob Tarzwell and his podcast, Viral Transmissions. He actually gave a talk to the Island Health staff, all medical staff and pharmacy staff about some imaging stuff and I reached out to him and I gave a talk on his show. And I reached out to you guys and Rob, we could talk about similar stuff. So here we are. 

Ian Bushfield: So I want to start off by talking about this news out of Alberta that a test, a trial on the drug hydroxychloroquine has been abandoned following additional reports that it’s just not effective, it’s just not working. And the side effects are serious to it. This follows news last month that the Kenney government would pursue trials, tests, vaccines without waiting for health Canada to quote, catch up to the European Medicines Agency or the FDA in the US.

Since so much of COVID-19 coverage relies on studies and science and all of this, could you give a little bit of a background for those who can’t keep up or don’t have, don’t remember, their high school science about, you know, what is the difference between the trial and what is, how does science work?

Sasha Maleki: Yeah and I think that’s a really important piece to discuss, because we can debate the merit of these drugs and the usefulness of them as much as we want. But before we even really understand the perspective of healthcare providers, we have to understand scientific evidence. So I’ll just kinda go, just dive into that. 

So essentially, what is scientific evidence? Well, to put it simply, we have to be objective in healthcare. We can’t really use our feelings because those are going to introduce bias very quickly and we need a sound and easily reproducible way to approach a case and approach a decision in healthcare. So we rely on evidence to guide our decision making. The evidence that’s out there can vary on a hierarchy. So this hierarchy can be as simple as what we call expert opinion, which is someone who’s been in the area for a while and makes a judgment call, to the highest level and as advanced as what’s called a meta-systematic review with a meta-analysis. And within all those classifications of hierarchy, there’s many different kinds of studies out there. What we’re seeing primarily in the evidence pool is that there’s a large amount of what’s called case reports.

And so case reports on the hierarchy, I’d say are probably a step or two above expert opinion. It’s essentially just what reporters would do in the news. They just report what they saw. They don’t necessarily give analysis of where their case report would fit into the context of the broader health paradigm.

It’s more just saying, here’s what we tried and here’s what we did and here’s what happened. Usually case reports are on one person. If they’re on more, or if they compile different case reports, we go into something called case series. Then it would go higher into case controlled studies or case cohort studies, and then it goes higher and higher and higher.

The next thing that you guys would have probably heard of is a randomized control trial. And so I want to get the definition of that clear. So randomized means that there is an objective, non-biased way of assigning people to two different or three different or four or five, whatever, different interventions.

Usually one intervention will be an active drug or an active comparator versus placebo. Placebo can be a sugar pill, which essentially has no active ingredient or placebo could be, in many cases of COVID trials, is standard of care, which is what we do for treating any viral illness, which is rest, fluids and supportive oxygen therapy.

So where we kind of dive in with hydroxychloroquine, this anti-malarial drug, which is used also for rheumatoid arthritis, which is primarily where we see it. We don’t really use hydroxychloroquine for malaria, not because it’s the best option, just we don’t use it that often.

Where this comes in is kind of to like to explain the idea is you have to kind of understand human behavior, which is we want the easy answer. We want the easy pill to fix. Any problem that we have and in all of healthcare, essentially, before we go try and find a novel solution for something, we want to go back and try stuff that we have. So we tried stuff that was already out there and that had possible impact on treating these viruses. And hydroxychloroquine was one of them. 

So hydroxychloroquine has something called disease modifying properties, which it essentially helps to let your immune system calm down. That’s the easiest way to explain it. There is also theoretical ideas of its antiviral properties, I don’t know too much about the biochemistry behind that. My focus with hydroxychloroquine in my training was more so with what’s already been established, but that was their idea was that it seemed to work for other highly inflammatory driven processes. And it apparently has an antiviral property.

So let’s give it a try is essentially what I gather is why they went about it. 

Scott de Lange Boom: So I’m actually a little curious, what was the rationale for why this particular medicine was the one to try? 

Sasha Maleki: No. Yeah, totally. And you know, there’s, it wasn’t just hydroxychloroquine when there’s a lot of drugs that have been tried.

I think the number was something around 10 different kinds of drugs were tried to treat COVID-19. And so this is kind of where I can start diving into the specific evidence of each thing. 

Essentially, whenever someone says, Hey, this works for a drug or this drug works for, for this disease state. As clinicians, we have to ask ourselves, okay, what does that actually mean? Right? What do you mean by work? Well, okay, that’s where the studies tell you or they should tell you what the outcome is and the outcomes that they use. 

And these hydroxychloroquine studies are just, they vary quite a bit. Some were designed on what’s called a microbiological cure, which is where they test people for the virus before they test positive, obviously in the beginning enrolled. And then they test them after and they say, okay, you are now sure that means that your test was negative. That’s one way. 

Another way would just be the duration of hospital stay. Another one could be that they look at a specific blood markers. So there’s the difference and the outcomes really vary.

And the other problem that there is out there is the patients that they’re testing are not all the same. And what that means is the demographics are quite different. So, yes, of course, we’re not all going to have the same age of people, the same comorbidities and the same, I don’t know, like colors of hair and whatever.

But really what’s more important for the COVID trials is where they are in their disease state. So are they at the very beginning of the disease or are they in the middle or at the end? Cause that can really change how you interpret the data. So what I mean by that is if we enroll someone into a trial who is in the middle to the end of the disease course, which is usually between, if we just eyeball, at seven to 14 days after they first got symptoms, they can be at the most critical time.

But if they’re in day 10, day 12, then in that case, they’ve actually probably survived the majority of the course, and so you have to look at where they were in their disease progression. And now notice how I haven’t even talked about hydroxychloroquine, and it’s been about 12 minutes we’ve been into the show.

That’s because this is how much context is needed to really explain why everyone is, everyone in the healthcare world, is so against these drugs because the studies are weak, just to be flat out. But what they do show is that it’s very unsafe if they use it in patients who have COVID-19 who are in hospital.

This was most recently brought up in a study that was published in the Lancet, maybe two weeks ago now. They did a retrospective review. So retrospective means that they looked at the charts from the past of 96,000 patients. And you might be thinking, well, what does that mean, 96,000. That’s a lot, the largest trials that we have to, and we consider these very, very medically robust trials, are 30,000 patients. So 96,000 is a lot of people. 

They looked at, I think it was like 600 hospitals around the world, and what they found is that there is a significantly increased risk of death associated with people who took hydroxychloroquine or hydroxychloroquine plus an antibiotic called Zithromycin when they were in hospital.

And when you actually look at the risk factors that they also included in their analysis, the risk of you dying while you had COVID and you’re taking one of the drugs was also similar to you dying if you were a smoker and had COVID-19 and you were in hospital. And we’ve regarded, or we’ve been kind of hyping smoking as this major risk factor.

So it just goes to show how dangerous that this was. Then there were the early reports in Brazil where there was, I think it was, like 60 people died from taking hydroxychloroquine in the studies. Yeah, so it was really problematic. 

And hydroxychloroquine on the surface is really appealing, especially for a government. It’s a once a day drug. It’s very inexpensive. I think if you were to purchase it on a bulk basis, it’d be just a couple of cents a day. And so that’s why it was pushed as this big contender. Unfortunately though it caused these arrhythmias, which had made your heart beat irregularly and put you at risk of getting your heart to stop, which is quite obviously dangerous.

And there’s a lot of reasons for that. One of the big ones is that the people who get COVID-19 and go to hospital generally tend to have more cardiovascular disease. But also we find that the virus and people who get very sick, it tends to make the heart a bit twitchy. And what I mean by that is this more prone to getting an arrhythmia in the first place.

So that’s why we saw this, or those are reasons that are suggesting why there were so many deaths to begin with this drug. 

Scott de Lange Boom: Right. So what other drugs are being looked at and are there any hopeful ones on the horizon? 

Sasha Maleki: Yeah, there is one, that you may have heard of, and it’s especially being pushed in the US. It’s called remdesivir, or as Trump pronounced at REM-desert-guar, which I dunno, I just thought that was funny. 

But anyway, so it has a bit of an interesting history during the Ebola epidemic there, remdesivir came out as a potential solution for the problem, but they found that actually it didn’t work and the harm was quite severe compared to the benefit that it gave for the virus.

Right now, what’s going on is it’s being pushed and they’re trying it to see if it’s going to work as a potential option to help treat COVID19 and, Dr [Fauci] Fau-see or Fau-chi. I really don’t know how to say this last name…

Scott de Lange Boom: Fau-chi

Sasha Maleki: Yeah, that’s what I thought 

Scott de Lange Boom: It’s a, I think the C’s in Italian are pronounced as CHs.

Sasha Maleki: Yeah. So, let’s just call him Dr F. So he had talked about this trial that the drug company Gilead, who is the one who makes this medication, they had tried giving it to people who had COVID-19 and who were in hospital. And the big fanfare that came out of the end of April was that they stopped the trial early.

So what does that mean medically? Well, that could be for… we have to ask ourselves the, the important question, which is why did they stop it? So there’s usually two reasons why. One is they either killed too many people or it was way too unsafe, or it was actually very effective, and they met what’s called their preset efficacy end point.

And so when they meet it ethically, you can’t justify continuing the study, because you’ve already proved your point, essentially. So why would you put more people at risk as essentially the rationale in medical ethics? So what happened is that in this case, they actually met the preset efficacy endpoint.

Now that’s great, but when you look at the data, it’s again, it’s not, there is no statistical difference. So that means if I were to tell you remdesivir is better than a sugar pill or a sugar Ivy drug in this case to solve or to treat someone’s COVID-19. I have to say that because I have a statistical reason to do so.

In the case of this study, there was no statistical difference for the mortality risk. So it was 8% versus 11% for the risk of,  I believe, it was mortality, or was it the reduction in stay in the hospital, I have to double check that number, but the point is, is that there was no statistical difference between the two.

So what that tells us is, okay, well we don’t know really if we can use the drug, because if there’s no difference between essentially chance, then why would we want to put someone on a drug that is just being used with chance, if that makes sense. The other thing to consider is, politically, well, what’s the reason for them pushing this and really trying to make this the next big thing?

Ultimately it comes down to money is a big one, and patents, so. Remdesivir is exclusively owned by Gilead. What that means is that they’re the ones who can make it and only them. But the other thing too is that we have to remember that this drug is actually not approved for use anywhere in the world outside of a clinical trial.

So what that means is that we can’t just order it from some drug supply company like McKesson, you have to access it through what’s called compassionate access. And that’s directly through the manufacturer. Now, the thing is that they, the company Gilead decides who gets the drug. 

So why that’s a problem is for this study we don’t know who is getting the drug, the study hasn’t even been published. They just told us that this is the report from the data. So that’s problem number one. Problem two is that, are they cherry picking patients who are getting this drug? And so that actually seems to have happened with an earlier study that they reported at the beginning of the pandemic. So now a similar thing is happening and ultimately, if you just think about the current political climate of the US with an election coming up, having this drug be the winner, so to speak, in this sweepstakes of finding the first drug to cure the disease, which it doesn’t, it would be a huge boost to Trump’s campaign because he can easily say, yeah, I’ve found the drug that saves people. 

So that’s kind of where this drug is coming from. But medically speaking, it’s, we don’t know if it even works.

And I have to be very careful in saying it does or it doesn’t work because we just don’t have the trial published yet. So we still need to wait. And unfortunately, it’s kind of hard to wait because this pandemic is ongoing and people are dying. So it’s challenging. 

Scott de Lange Boom: So that actually brings up something that I’d like to pivot to that’s related to this is for very good reasons: Getting approval for drugs is difficult. It’s quite medically or needs to meet a very high scientific bar. And the medical profession is quite a risk averse, as it should be. But in a situation like this, when there are a lot of people dying every day, how does the profession approach that – where there’s very real trade-offs to even a day’s delay in getting approvals?

Sasha Maleki: Yeah. So that’s, well, as frontline healthcare providers, there’s only so much that we can legally do. So, when it comes to medical liability, so I have to kind of explain how decision making is made. But essentially we have guidelines for how things should be done. The guidelines – inherently in the name is a suggestion – but the suggestion is backed by hopefully some very good evidence.

Right now no reasonable guideline is recommending the use of these medications because some of them are unsafe. Not to mention, we just don’t have enough information to say that the potential benefit is better than the risk of the drug brings on. So that’s the first thing. 

But if there is no guideline, as in the case for COVID, like there isn’t really a very robust guideline like there is for cardiology diseases like heart attacks and all that, we kind of have to rely on the strength of the trials and making decisions as health authorities, as a collective, infectious disease groups as a cohort to people really.

And so those decisions are being made. I’m definitely not making those decisions. There are way smarter people than me doing that.

Scott de Lange Boom: I was kind of, I guess, looking for a high level view rather than kind of the direct clinicians view. But it’s interesting nonetheless. 

Sasha Maleki: Yeah, and I mean, the high level view ultimately comes down, as I understand it, is there are these processes in place in Canada for drugs to get approved for certain uses.

So there are many drugs out there that are not approved by Health Canada for use where we can use them as “off label”. And that off label use is kind of essentially up to the prescriber. But for Health Canada to give a stamp of approval, there needs to be a lot of research put in. So you need what’s called a phase one trial, a phase two trial, phase three and then has to go through something called the Canadian Association of Drug Technologies and Health. And then there’s a couple other checks to go through. And then finally, Health Canada can say, here you go.

In the US there, they have a fast track process, which is that they’re essentially cutting what can be a 10 year process sometimes down to a few months. Which now you might think, well, hold on, What are they cutting out? Right? And so Canada’s process, I don’t know too much about it to be honest, of how they’re expediting things, but if I were to speculate, I think they would want to make sure that the safety data is robust and then the efficacy is really, you’re just going to have to guess, when you’re fast tracking a drug.

But ultimately safety is the biggest thing that these agencies would be looking for. So, yeah. 

So then just to go back to that point that I said about remdesivir, the 8% versus 11.6. So it was in regards to the survival benefit, which is a mortality rate of 8% in the group of people who are getting remdesivir versus 11.6% for the placebo group.

However, that was not a statistically significant because it’s P value is not less than 0.05. So I just wanted to make sure that was in there. 

Scott de Lange Boom: Okay. Yeah, no, appreciate that. 

So let’s kind of pivot over to some, I think, general policy, questions. So, earlier today, Dr Bonnie Henry, during her normal press conference, talked about wanting to decriminalize, drugs and expand the safe supply program.

Can you kind of talk on what’s involved in safe supply and how that’s gone about?

Sasha Maleki: Yeah, definitely. And I think this is a really, really important thing to talk about. So, COVID-19 has highlighted a lot of important things in our healthcare system, but we also can’t forget that there’s a lot of other disease states that are going on.

As a matter of fact, we still have another public health emergency, which is that of the overdose deaths, not just in the Downtown Eastside, but everywhere in BC. So what she’s talking about is in regards to this larger conversation of trying to prevent further deaths and further criminalization from the use of recreational substances.

So actually, when I was doing the research for this topic, there was an article published by the same journalist, her last name is Wu from The Globe and Mail last year in April, where Bonnie Henry went up there, and gave a press conference about potentially decriminalizing drugs. And almost a year later, 13 months later, almost to the day, actually it was published last year, April 29th, they talked about how again, we need to have this conversation and I couldn’t agree more. 

The reason being is that, right now and what’s been happening as I’ve heard from colleagues who were in the substance use treatment world is that when COVID was happening, there was a shortage of recreational drug supply, partly due to the borders being closed.

But there were other reasons we couldn’t quite understand. So that led to a lot of problems, especially in the Downtown Eastside, unfortunately. So this conversation about decriminalizing is really also a conversation about harm reduction. For those of you who don’t know, harm reduction is a set of approaches that are taken to help mitigate the risk associated with using substances. So what that could be is as simple as education. So that means how to recognize an overdose; how to use a drug safely; what to look for when you’re buying your drugs. The harm reduction conversation can also go to Naloxone. 

So we talked about, or not we, you guys have talked about Naloxone before, and not to mention society has been dealing with this for so long now, but also then there’s the bigger things like safe injection sites, which are hugely helpful to preventing not only overdose, but helping to safely deal with an overdose. In addition to also preventing the risk of transmittable diseases like HIV and hepatitis C. So it’s really important that they’re still continuing, especially in the case of COVID, where a lot of the societal supports are difficult to get to now.

And not to mention if you have HIV or if you have hepatitis C and you’re on an immunosuppressive therapy, you’re at risk of getting this virus. And so it’s very dangerous and we need to make sure that the supports are in place for these folks. So the approach is still to use harm reduction strategies.

And this kind of comes to this whole discussion of safe supply. So what safe supply is, is a way, as a harm reduction strategy, of essentially substituting the illicit drugs that are being used on the street for a medical equivalent.

What I mean by that is, so instead of using, Okay what you might call heroin on the street. We don’t know what’s in there. We don’t know the many impurities that are probably in there. We can either give patients something called opiate agonist therapy, which is a couple of different versions of things like methadone or ketamine and which is a long release morphine. Or a Suboxone is another option.

Or there are other places in the world that are doing injectable hydromorphone, which is where they give hydromorphone, which is a similar potency to diacetyl morphine, which is heroin. And they give that to people instead. So there’s many different ways of approaching this. Then there’s the other illicit drugs out there, like, crack cocaine, which we’re trying to substitute with stimulants like Dexedrine. 

The troubling one though is benzos. So on the street, people are saying that they’re using something called Xannies or Xanax, but we have no idea if it’s actually Xanax, which has all pres alum. There could be an actual diverted supply out there. We don’t know, but it also could be just like a smorgasbord of stuff that they’ve mashed together and put into a pill. We have no idea. So that’s a lot harder to treat because we have to slowly titrate people up on a real benzodiazepine.

But essentially that’s the idea of safe supply is that’s where that’s coming from. Politically there is also discussion about using the powers of the provincial health office to essentially divert the ability of a law enforcement to combat these offenses. So one way is by telling police officers, Hey, instead of arresting these people, putting them in jail, let’s refer them to mental health treatment instead.

The next step beyond that would be, as I understand it, to actually limit the ability of the law enforcement agencies to use the funds that they have in actually prosecuting and investigating people who’ve used drugs or who are selling drugs and we’re talking like, you know, very low level amounts.

Obviously if you’re trafficking a bunch of drugs, that’s completely different. 

Scott de Lange Boom: Right. So would this be something that the public health officer, Dr Bonnie Henry, would perform? Or is this something that has to come from the Solicitor General. What’s the process? 

Sasha Maleki: Yeah, so as I understand it, it’s actually from Dr Bonnie Henry’s power.

But there was an interview where Mike Farnworth was up there with her, I think. And they talked, and this is before COVID, and they talked about, or I think Mike Farnworth said something about, that’s not going to happen. So I don’t really know whose jurisdiction this is. It’ll probably get contested in the courts.

Scott de Lange Boom: Yeah. And that the health officer is basically, I think, fireable by the province if they do step out of line. Although at the moment I can’t imagine anything Dr Bonnie Henry could do that would actually get her fired. She’s so popular and well liked. 

Sasha Maleki: Exactly. And, and I think that that’s kind of one of the opportunistic things of COVID is that it’ll really help to push a lot of things that have just been talked about forward.

So that’s one way that the best could happen. I would imagine though that the public would really be on her side. Especially just how serious the overdose crisis is. 

And the other thing is that I know your next question might be, well, how bad is it? The problem is that we don’t have data in the past two months. It hasn’t been reported yet. So in a sense I got lucky cause I can’t answer your question, but, we also have to wait and see it. It could be very serious. but I’m hoping that it at least was on the same track. And if not, it got better. 

Scott de Lange Boom: From what I’m hearing from around Vancouver, that’s not the track it’s on. It’s actually got worse. 

Sasha Maleki: Oh, no. 

Scott de Lange Boom: But likewise, I don’t have any data on that. And unfortunately, one of those things that’s taking a hit, you’re in to just the data collection on this. 

Sasha Maleki: Yeah. And, and that’s something that we just, I really hope it hasn’t gone, not bad, but unfortunately this is something that maybe this will push us as a province and as people to move forward with these things. What has happened at least is that the access to these treatment programs has gotten much better. So, the pharmacists, for example, are actually allowed to deliver these medications like methadone and Suboxone and all that to patients now, and that’s huge. Before we weren’t allowed to. And you might be thinking, well, why? The reason is 

Scott de Lange Boom: …people are taking it in a clinical setting.

Sasha Maleki: Right, exactly. Yeah. So, the reason for that is because based on the federal health act, it says that the controlled substances, if you were to move them in a car, it’s considered trafficking.

And you know that when you think about that, like, yeah, I guess it is trafficking, but I mean, that’s not at all the intent. But the larger point being that yes, they had to take these drugs by physically coming into either a methadone clinic or a doctor’s clinic or to a pharmacy where they would have to do what’s called the daily witnessed ingestion.

At some point when the physician and pharmacist feel comfortable, then they can move on to what’s called weekly carries. And then eventually they can take the drug at home whenever they want, which is what we want them to get to. So yeah, those restrictions are being eased, which is really good.

And yeah, I just want to add one thing, if I can, the one thing is just more of a social thing that this overdose crisis does not just affect the Downtown Eastside. I really want to get that clear. The Downtown East side is disproportionately affected, but the rest of the province is not doing great with this either.

A lot of the overdose cases, actually, the ones that result in fatalities are the ones that are people who overdose at home alone. And so we need to follow the advice of Dr Bonnie Henry as well as the Vancouver Coastal Health officers, by which they have said that don’t use alone, use with other people. And I know that goes against the idea of a physical distancing, but they’ve explicitly said, in this case it doesn’t. So, just be aware that’s out there. But anyway, sorry, I just had to say that last point. 

Scott de Lange Boom: Yeah, no, I appreciate it. So before I let you go, is there anything we didn’t touch on that you wanted to briefly discuss?

Sasha Maleki: I think the important thing is that we have to understand that the processes that are in place to make sure these drugs are safe. Yes, they take a while, but they’re there to protect us. And I know that it must be frustrating that you can’t take a pill but what I can say is that the vaccine trials are underway.

There seems to be some promise, we have to really wait and see with that, but that’s all I can say is that the wait and see patience is key here. Just make sure to stay home, stay safe, wash your freaking hands and yeah, just keep on going. We’re doing really well as a province, very, very well actually.

So don’t think that your efforts as people are being undermined. Like it’s helping out a lot. 

Scott de Lange Boom: Yeah the numbers are definitely trending in the right direction here in BC. 

Well, Sasha, thanks for coming on the podcast. Do you have any social media you’d like to share? 

Sasha Maleki: No, but I will leave my contact info for you guys to put in the show notes. So if anyone has questions, I’m happy to answer them. 

Scott de Lange Boom: Okay. That’s good. Well, greatly appreciated your time tonight. Thanks for joining us. 

Sasha Maleki: Thank you guys.

Quick Takes

Scott de Lange Boom: So now for quick tapes. 

I think the big news out of Vancouver this week was there was a court decision related to the Meng Whanzou, I hope I’m pronouncing that right, extradition hearings that have been ongoing for a while. So as you may remember, she is the chief financial officer of Huawei and was arrested at the Vancouver international airport back in December 2018.

Seems like a really long time, or at least things go slowly. But we got a ruling in this that granted the judicial approval for it to proceed. And now the extradition is moving on to the attorney general and minister for justice to approve. 

Ian Bushfield: Although I’m not clear if she has the ability to appeal this, I think she could. 

Scott de Lange Boom: I believe it is appealable 

Ian Bushfield: So that could drag it out further.

Specifically, this was around double criminality, which is far as I understand, is the idea that she can’t be charged for the same crime in multiple jurisdictions. 

Scott de Lange Boom: So from what I was reading in the coverage of this, the central argument that her legal team put forward, is because basically this wouldn’t have been a crime in Canada.

So what she is accused of doing is Huawei was doing business with Iran, which is in violation of US sanctions. And you know, they’re a Chinese based company. They can do what they want as long as it complies with Chinese law. But she’s alleged to have falsified statements to American banks who do have to follow American laws when it comes to sanctions on Iran, and as a result, that’s allegedly fraud, and that’s what she’s being charged with in the States. 

Now their argument was the Iranian sanctions, that’s an American law. That’s not something Canada is partaking in. So this isn’t a crime in Canada. You can’t extradite on this and the court basically ruled no, fraud’s fraud in all countries and we’re not going to stop the extradition on that account.

Ian Bushfield: And this comes into a little bit of extra focus as The Globe and Mail is talking this week about how we still haven’t come to a decision on whether to allow Huawei to build 5G technology in Canada, something that a lot of other countries are wavering on, looking more skeptical at and instead using other options.

Bell and Telus really want to use Huawei, but a number of the five eyes alliance for example, are concerned. 

Scott de Lange Boom: Yeah. So the five eyes is an espionage alliance, between us, the US. Britain, Australia, and New Zealand. We share intelligence information that we gather with all of our other partners in it.

And that raises particular concerns because that’s obviously a prime target for espionage for an adversary such as the Chinese government, and there’s concern that, especially in China, there’s very little distinction between companies and the government and that putting technology that is produced by a Chinese company into critical infrastructure like communications, it opens up Canada to risks, as well as our allies. And that we potentially risk losing access to information and intelligence gathered by America or other five eyes partners that have banned Huawei and don’t consider it safe if Canada does have Huawei to share that intelligence with us. 

Ian Bushfield: Yeah.

And there’s a new round of protests in Hong Kong and China seems to be moving to end some of the longstanding freedoms in that zone. And so there’s additional scrutiny around all of this, and I think we want to dedicate more time to China specifically, and hopefully bring a guest on to really help us break that down, hopefully next week.

Scott de Lange Boom: Yeah. We’re looking to get that set up, but it’s also worth remembering that China’s holding two Canadian citizens hostage at the moment. Well, that’s a pretty clear and direct retaliation for our arrest of Meng Whanzou. Additionally, they’ve been flexing their muscles in quite a few other ways. There’s a whole bunch we can discuss and we’re looking forward to doing that in a future episode.

But fundamentally, China is not a good partner and is a potential adversary for us and our allies. And I am just unsure of why Trudeau and the government are not willing to just rule out using Huawei for critical infrastructure. 

Ian Bushfield: Yeah, it’s complicated. I think there’s some desire in the federal government to continue that kind of traditional role Canada’s played where we’re not as black and white as the American. Or, you know, we don’t approach foreign policy as black and white as the Americans sometimes do. We would have relations with Cuba when they wouldn’t, and in some other situations tried to build bridges with China. You know, it’s debatable whether it’s a good policy or not, but it’s where we’ve been.

Scott de Lange Boom: Well, I mean, that’s a bit of historical mythmaking as well in that Canada’s a founding member of NATO. It’s very, I mean, it’s a key player in kind of the Western and North Atlantic political and military alliances. Like we’re not as neutral a third party as a lot of Canadians like to pretend we are.

And you know, it’s important that we approach geopolitics from a perspective that’s realistic about where our interests lie. And it’s pretty clear that China’s interests and our interests are not aligned on a lot of fronts. And unfortunately, I don’t know why this is, but the Liberals in particular have, going back several prime ministers, have had I think unrealistically optimistic view when it comes to China that hasn’t really been born out.

And I think not deciding, you know right away, that we don’t want a, I don’t want to say adversary, but at least potentially hostile country to have a key role in our critical infrastructure, it’s a little baffling.

Ian Bushfield: Well, moving from one extended quick take to what could potentially be another, and the through line through this is if things turn really bad with China, we’ll have to withdraw the military from our longterm care homes in Ontario and send them overseas. That’s not going to happen, I hope.

But what they have discovered as the Canadian armed forces has been deployed in a number of care homes in Ontario, is that some of the soldiers have described it as worse than they’ve seen elsewhere in the world. Specifically, they use the quote, “it’s borderline abusive, if not abusive” in some facilities, and there are just a lot of shockingly bad situations in many of these facilities. 

Scott de Lange Boom: Yeah. So this was an internal report that was made available. It’s part of operation laser, which is the Canadian forces response to the pandemic, and it’s a letter to the command officer. But within it there’s a couple of annexes where it goes into each of the five longterm care homes and the observations from the Canadian forces member stationed there. And it is quite shocking. 

Ian Bushfield: So to get into more of the specifics, there’s a lot around flagrant disregards for infection prevention and personal protective equipment to measures. I think the most standout one was the reports from a Brampton facility where staff were dancing to a Taylor Swift song between areas that were deemed to be infected with COVID-19 and areas without, and they were doing this without PPE on.

I mean this begs all kinds of questions like what song are they singing? There’s such terrible Taylor Swift songs, like Bad Blood or You need to calm down or Shake it off. That would all be very inappropriate in this situation. 

I have to make a joke cause this is terrible. A discussion about cockroaches, flies…

Scott de Lange Boom: …unsanitary conditions and insufficient levels of staffing. PPE wasn’t provided or changed appropriately, contaminated PPE was worn outside of the areas with infected people. Some residents were not properly isolated when they did have confirmed cases. Rotting food was found in some places. It’s just a pretty terrible list all around. 

Ian Bushfield: Yeah. Residents left in soiled diapers, crying. One reportedly had not had a bath in over a week.

So you know, these were the worst of the worst care homes in Ontario. But you know, these are not acceptable in any way. For our own BC perspective, Horgan and ministry staff have said that no care homes in BC are anywhere near as bad as this. They’re still working through untangling the staffing, a mess and subcontracts, to make sure there’s one- each staff member is assigned to one facility, but yeah, this stuff out of Ontario is really shocking.

Longterm care homes have been the epicenter of COVID-19 deaths in Canada, Nora Loreto is tracking them in a single spreadsheet because there’s no other data source for that. She is basically digging through all of the data from each province every day and updating the sheet and there are of all the deaths in Canada, 5,871 as of recording have been in care homes.

96 of BC’s, that’s 87% of every person who’s died. I think there’s a couple, like Mission Prison is in there, but for the most part it’s care homes.

Scott de Lange Boom: Although that’s an outbreak. The Mission Prison outbreak, I believe, was declared over today after two weeks of no confirmed cases. 

Ian Bushfield: The key flag there is that there’s been a crisis in longterm care homes and well, you know, I kind of begrudged when the reports were first coming out that the military is not the first to raise this alarm. There’ve been a lot of seniors, advocates, activists, people in these families who have brought story after story about how bad this is and how a longterm trend in many provinces from a very, not government-run system, but there was a lot more public ownership and involvement in it to this contracted out, kind of passing the buck system, where no one’s really held responsible. 

And one of the worst elements of this is that one of the care homes in this armed forces report is owned by a federal pension fund. And so it actually is in a way… 

Scott de Lange Boom: I believe it’s a partial shareholder. 

Ian Bushfield: Yeah.

…in a way it is publicly owned then, but it’s a chase the dollar thing as opposed to put the care of our seniors first, which is bad. 

Scott de Lange Boom: So it is important that public pensions they invested so that they earn a return so you can pay off the pensions. It’s an important part of the model here.

And at the same time, it is also important that the decision making process is removed from politics, and obviously there’s been a lack of oversight here. But I’m not entirely sure how much shareholders got reported directly on this. And at the same time from what, you know, what are the policies that government should lay out with regards to its own pension plans?

It’s not clear ahead of time that don’t invest in longterm care homes would have necessarily risen to that level the way that some pension funds, for example, won’t invest in fossil fuels or won’t invest in arms companies 

Ian Bushfield: Definitely. What was interesting is, and in the question period today Jagmeet Singh was questioning Chrystia Freeland on this question of care homes and brought up that example, but more broadly, and she actually spoke pretty strongly that all options must be on the table when it comes to how cares for elders is provided.

“I think it’s clear to all of us that root and branch reform is necessary. We need to act with speed, but not haste and work with our provincial partners.” They want to look at everything up to ownership structure to put it on the table. 

Scott de Lange Boom: I feel like it’s only a matter of time before the Royal Commission gets called into this.

But yeah, before we move on, I just also quickly want to mention that as of the reports I’ve seen two days ago, which is the most research I could find, 39 Canadian forces members who’ve been working in these longterm care homes have also tested positive for COVID-19. 

Ian Bushfield: That’s unfortunate. Yeah the other charts that Loreto has in her sheet detailed the number of longterm care staff who are also contracting COVID-19. So it’s not just, you know, the seniors, it’s everyone who has to go into these facilities. 

And as far as I can tell, it’s not, you know, the shiny most expensive ones. It’s the ones where people are cutting corners, where things are being contracted and subcontracted. I think one of the things that was pointed out in BC Today about why they’re still trying to get those last few care homes to have assigned staff is because every single staff member who came into that facility was a contractor, and so they didn’t have a list of who works there.

It could, and if you think about that from a resident’s point of view, that means different people are coming into your home every day. It might be different cleaning staff every week. It might be different cooks. And these are people you can, could develop relationships with if they were assigned permanently.

And that’s somewhat of an incalculable value to having a comfortable life. So a lot needs to change even in the good situation here in BC 

Scott de Lange Boom: And also like anyone and anyone who’s working, like any organization, knows that only so much of the implicit organizational knowledge and procedures can actually be just written down and transferred, which makes it hard to do a lot of the stuff if you’re rotating staff in and out every day.

But let’s move on to another announcement out of the federal government this week that they were looking at possibly allowing a 10 days paid sick leave program to come into effect. So this was a deal reached between the NDP and the Liberals that basically the Liberals got Parliament to operate in the way they’d want that, reduce some of the sittings, and extends out some of the hybrid parliament workings that they’ve been working on so far and the NDP is getting a sick day policy, brought forward. 

Ian Bushfield: Yeah. Speaking of areas where it seems like the NDP is actually getting some movement and at the same time are also things that people really love to rail are provincial jurisdiction. But you know, when it comes to federalism in Canada, when you have a lot of money to throw around, you’ll be surprised what can actually become a federal jurisdiction in a way. 

So it’s unclear exactly what the policy is going to be laid out. Trudeau has praised Horgan for pushing on this issue, but there’s a lot of talk of money being thrown around. 

So what it sounds like is rather than just encouraging every province to change their labour code, and I guess there is a federal labour code for the few industries that are federal, to ensure that there are 10 days paid sick leave if you are an employer, just as you have to have vacation days and several other benefits by law, it will be sort of an EI type program where the government will throw money to make sure you’re paid while you’re on leave. 

My worry is it will be too much in the EI realm, which is very bureaucratic and slow.

What we really want …

Scott de Lange Boom: there already is an EI sick program as well. 

Ian Bushfield: and it’s more for long, longer sickness. 

But yeah. You know, the best case scenario I envision is just, I mean, it’s just requiring businesses to pay people when they’re sick, but the second best is government’s essentially backstopping businesses who then can file for remittance for, you know, my employees were off seven people off sick this month. Can I get paid for the salary hours? And that’s a simple way. 

Scott de Lange Boom: Yeah. I mean, I don’t necessarily want to say the simplest, or the best way to do it is just mandate companies pay for it directly, because there are a lot of small businesses that don’t necessarily have the reserves and the ability to cover long extended sick periods.

So having a system that allows more resources to be pooled might be better than trying to load on a new cost to a lot of businesses, particularly a lot of them are struggling right now.

Ian Bushfield: I get the struggling right now point. I just think it’s 10 days. In my mind, it’s the same as raising the minimum wage and you know, there’s always grumbling, when we do that, but I guess we’ll find out in the coming weeks and months what this policy will be, but hopefully it comes sooner than later because people need assurance that they can stay home when they’re sick. And too many people don’t have that.

Scott de Lange Boom: Yeah. It is only that, I mean, having new policies, good. But like there does need to be cultural change around this and that isn’t something that can simply be legislated. But, we’ve definitely seen that the cultural norm of just go into work when you’re feeling a little under the weather might not be a great one from a public health policy perspective.

Ian Bushfield: Well and another workplace idea that’s being bandied about is the idea of a four day work week, which BC Green leadership candidate Sonia Furstenau pitched in a Twitter poll. And I guess it’s also part of her platform for the leadership of the Green Party. 

But former Green MLA and former Green {arty leader, Andrew Weaver decided to rail against this publicly on Twitter, calling it a “very kooky idea” and that we can’t just import what works in New Zealand to BC because we are a very different place. He went on in the replies to continue tweeting well after 11, 11:30 PM that evening to mention that he was super ready to actually bring down the government over LNG at some point in the past. 

He clarified, it was early in the term, but that Furstenau and Adam Olsen were more concerned about their reelection bids, which they both later denied. And many people also pointed out that even if all three Greens voted against LNG, the NDP would just get the Liberal votes to move it forward.

So it was unclear what he was on about there.

Scott de Lange Boom: Yeah. Although I do recall that, when the LNG thing was brought up that there were a lot of people raising the question of kind of what’s the point of the Green Party if they aren’t actually going to use the one bit of leverage they have over the NDP on something like LNG.

So I can see why he would be somewhat frustrated that his fellow caucus members were wanting to go along with that. Nevertheless, not a great look for an outgoing party leader to be slamming his potential successor during the leadership race on social media. 

Ian Bushfield: I do know – I will speak one little bit in Weaver’s defense – I do know he has been going through a lot of personal issues regarding, I believe he has sick family members that he is worried about, and that’s part of why he was stepping away from the legislature. So I imagine there’s a lot of stress and anxiety on him right now. It’s still, you know, part of his role as an elected MLA too. You don’t have to maintain decorum but it’s unbecoming to go out like this, attacking your former colleagues. 

Scott de Lange Boom: Yeah. I mean, it’s kind of interesting though to see what kind of fractures exist within the Green Party. And, yeah, it’s kind of clear that what the Green Party should be, that Weaver has, is a lot different than Sonia Furstenau or Adam Olsen.

Ian Bushfield: Well, and I guess they may get the chance to hash those differences out in person or by Zoom, whatever they end up using, as it’s official that the BC Legislature will be returning on June 22nd. And it’s not clear how long it will go for but in his press conference, I believe it was yesterday, Premier John Horgan said some members will be here in person.

Some will be “beaming in with technology”, which I caught as his Star Trek reference squeezed in there. But at the end of the day, debate will take place. Votes will be cast and democracy will be well-served. 

Scott de Lange Boom: It’s an awkward Star Trek reference cause it really wouldn’t be beaming. It’s more like putting it on the main view screen. Star Trek already does video conferencing. You don’t need to pull the transporter metaphor in.

Ian Bushfield: Yeah. Oh my, he’s going to start the first session with “on screen” 

Scott de Lange Boom: Oh god he is. It’s definitely going to happen. 

Ian Bushfield: Make it so Scott! 

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Background in physics, works in non-profit, an excess of opinions.

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