Ariana deVries

So for those who may not know, you are an epidemiologist and you spent the last 20 years as the primary consultant for epi research Incorporated. You currently reside in Winnipeg, Manitoba, and are passionate about helping people make informed decisions. So welcome to the podcast today. Thank you for having me. Yeah, I'm so glad that you could be here to help me and our listeners understand more about epidemics. So how did you first become interested in the study of epidemics?

Cynthia Carr

Well, it's very interesting, actually, it wasn't a direct path. So people that study epidemiology, they participate in a master's program in community health science or epidemiology. And then they may go on to do a PhD. And many people in those classes will be doctors or nurses or people in health care. So that they can go ahead and use that information for like running clinical trials, or being any kind of a public health doctor. So all of the public health doctors, like Dr. Tam, etc, would have epidemiology training.

For me, I actually did my undergraduate degree in psychology, because I was very interested in mental health and well being. And then I did a master's degree in Public Administration, specializing in health policy. And when I did that, I thought, okay, so I can take my passion for well being, but I don't want to really be a researcher, I don't want to do a lot of statistics. So I'll go this route. And then when I did that, I had to take as part of the core course to specialize in health policy, Introduction to epidemiology, and I fell in love with it. Okay, I get a Masters of Science in epidemiology, but never with the thinking that I would be kind of an outbreak specialist or in a lab. I always thought it would be more kind of chronic disease and applying, again, sort of broadly mental health and physical health for optimal public policy.

So I have a long answer, just for anybody who's listening, because my daughter's in first year university now and, you know, so many young people think that they have to know the answer right away of what am I going to, quote, be when I grow up, and if I go to university, I have to know on day one, what I'm doing, I can tell you that until I started a graduate degree, I never heard the word epidemiology. I didn't know anything about it. So for all of you thinking about your future, just think, first of all, where will I thrive? Where will I feel best, and an opportunity will come to you that you've never heard about today. So just keep that in mind. And I've had a 25 year career in something I didn't know for my first five years existed.

Ariana deVries

Right! Well, that's crazy. I mean, I only just recently started doing podcasting, too. And I never thought that would be a passion of mine. But here we are today. Yeah. So can you explain the difference between an epidemic and a pandemic, because right now we're in a pandemic, right?

Cynthia Carr

We are in a pandemic right now. And sort of different from an epidemiological context and epidemic is more kind of a statistical thing, where we would say it's a statistically higher number of cases than we would expect. So that means it's not necessarily something new. But it might be at a higher rate. And we'd say, okay, right now we're having, whether it's an opioid epidemic. So that's related to drug use. So a sudden escalation in something that isn't new, but was occurring, but it's too much. So a flu season epidemic would be an example of each one and one a new variation of that strain. And it impacted large numbers of people. But an epidemic can occur in one country, or one sort of area more than an outbreak. So an outbreak would be like you're on a cruise ship to keep it simple. an epidemic would be within Canada, we're suddenly seeing increases of tuberculosis or name your illness. So within a larger geography is an epidemic.

A pandemic is now more of a concept. The pandemic isn't about a number of cases, but it's about how it moved. And it's not about...I was infected in in Kingston, Ontario, and I got on an airplane to Winnipeg, and now I'm a case in Winnipeg. But associated from me coming from a place where the disease was. A pandemic means now the disease is...we're seeing community spread throughout the world, not just related to somebody flying into that area, but actually now it's taken hold. Now it's a pandemic. It's going up and down, up and down, all over the world and it has nothing to do with people flying in and out of the countries or communities.

Ariana deVries

Right. So then, as you are tracking these contagious diseases and the routes that they're taking, in your research, especially in regards to COVID-19, have you noticed a difference in infection rates between those who care a lot about their individual safety versus those who are more focused on their community and being a part of people's lives in a community?

Cynthia Carr

That's an interesting question, because there's sort of a web of things to consider, and one of which is leadership; one of which is the way the community responds. And then, of course, there's all the other factors that are really outside of the control of a community member, and maybe even a challenge for leadership, which would be... Are you in a situation where there's poverty, where there's overcrowded housing, where there's not a good public health system? Other things that the World Health Organization talk about as co-occurring threats. Is there a war going on? Is there a famine going on? Is there another disease circulating at the same time, and which is why we want to get on top of things with flu season coming up, will impact both our individual health and the health system. There's all of those things that go along with, you know, people being in close density and population that impacts how quickly the disease can spread. And the more poor an area is, the harder it is for people to comply with all of those measures that we try to put in place to stop the spread of disease.

For example, if you're in a situation where your hand to mouth every single day, you must go out and do some kind of work, to get some money just to feed yourself for that day, you don't have the option to just stay home, you're you have to make a riskier determination or decision because you have other more immediate concerns that are weighing on you. So it's not even about your own agency or your own concern for your health, or willingness to comply. It's, Are you even able to? There's so many factors that go on that ultimately can impact the control of infectious disease, and they all kind of come together at once. And it's kind of like a tidal wave.

Ariana deVries

Yeah.

Cynthia Carr

And then your question, though, there's looking at leadership, and transformational leadership versus what we might call transitional leadership. So what you want right now is transformational leadership. And some of those characteristics are willingness of leadership to adapt and change as new information comes in, willingness of leadership to identify who the key points are, that they're going to listen to, who's my scientific leader, who's my policy leader, and I'm actually not going to put them down, particularly in front of other people. I am going to give them respect, both in public and in private, because this is what they do. And myself as the leader, I cannot know everything, I have to have people that I trust, that are going to tell me what they think I should do. I'm going to defer to their knowledge. And then I'm going to implement, on the policy side, what I think is achievable and what I think is the best balance of what I understand about the science of the disease, while still keeping in mind all of the aspects of social well being and the economic impact. It’s very challenging.

We see very different strategies and countries in different countries. You can see the outcomes with disease and death, leadership matters. The hospitals, and as amazing as doctors are, they cannot treat everyone in a situation where there actually is no direct treatment for the virus, only for the complications. And you have to be able to have the room in your hospitals to treat people.

So the best prevention, or the best road to success, is in prevention in public health. And that's where you need leadership to say to us as community members, “Here's how I'm going to educate and empower you. And you've got to trust me. You gotta trust your government, that we're being transparent, and that we're telling you what we know. So that each of you as individuals will understand the importance of working together so that we don't have to become this society of, this is now criminal behaviour”.

Ariana deVries

Yeah, right.

Cynthia Carr

When it's just, “Trust us and let's all work together”. So you can see from what I'm saying is it's very complicated.

Ariana deVries

Oh, yeah.

Cynthia Carr

But we as community members, we are the wild card, we are the ones that were either going to help out government, we're going to be part of the solution, or we're going to be part of the problem. And, you know, there's there's no doubt that we really are informed in terms of what our solutions that we can work together towards. And there are some challenges, you know, that people are working on, which of course, are vaccine development and direct treatment.

Ariana deVries

Yep. So then how can we reconcile the fact that numbers are growing, and there are these people in the minorities that have no choice but to go and continue working and to expose themselves. People with mental health who can't stay home for their mental health reasons, and they can't be home by themselves? How do we support people like that? And how can we come alongside them?

Cynthia Carr

And again I think that's why government has tried this staged reopening approach. Because, the impact on well being has been profound. And we know that, well, less than 1% of the Canadian population may have been impacted or infected by this virus, as we know right now, significantly more have been impacted economically, and in terms of their mental and social well being. And were worried about having enough resources to help all of us who have been impacted in those ways to continue to try to thrive through a very difficult situation. So that those are sort of considerations that have to be taken in terms of allowing opportunity for getting back to some semblance of normal.

But again, ourselves, we need to keep in mind, okay, so with this, what do I understand? I understand now that symptoms are not a good sign of infection. I understand now that if I feel anything that I think could be a symptom of this, I need to isolate, I need to do my part to stay away from other people. And then if I need to, I go and get tested, and I call the public health lines for direction to confirm that. What are the actions that we should take? If I'm out and about, I should wear a mask, because I understand now that all of us need to think of ourselves as potentially infected because this virus is tricky. It's got a great strategy. It can take a long time, up to two weeks, between infection and symptoms. And we know that up to half of people that have tested positive, didn't have any symptoms at all. So that's why this virus is particularly different, difficult, and why we've seen it going up and down, and we thought we are on top of it. And then we start to loosen up the rules, and then we're seeing more cases again, because with infectious disease, the more we come back together as a group, the more opportunity you give that virus, that's still circulating under the radar, to spread.

We need to think, again. “Okay, I wear a mask, I maintain hygiene, I try to keep the social distancing of six feet., but how do I keep my world a little bit smaller than it used to be just to stop the potential spread of the disease, but still have my social well being?” I want to go to church, I want to go to my gym, I want to go to choir, I want to go to a concert. Okay, I want, I want, I want. Maybe now, if I'm thinking from a public health risk reduction approach, maybe I'm going to prioritize what are the two or three things that I'm going to do. But in every case, I'm going to wear a mask. I'm not going to do it if I feel any sign at all that I might have symptoms. But, what's going to help me the most, and I'm going to pick those one or two things. The other things I'm going to leave for now, because the smaller I keep my group of people with whom I'm in contact, the more I am still doing my part to reduce risk of transmitting that disease.

Ariana deVries

Right. And I think it takes a element of empathy to be aware of the people that you are affecting, and who may be affected by this, even if we might not be, right?

Cynthia Carr

That's right. And we are seeing more and more cases in younger people. I'm over 50 now, so I can say younger. But that is where the data are showing more and more cases in, you know, teens, 20-30 year olds, because again, the opportunities with restaurants and bars and schools are opening. Those are activities that people within certain age groups tend to enjoy. And those, unfortunately, are activities where if you're in enclosed spaces, you're together for lengthier periods of time, if you're eating/drinking; you're not going to have your mask on. It has the opportunity for respiratory droplets to spread.

So again, thinking about in the beginning, who was impacted are our most vulnerable, our elderly population. We've done a good job of trying to get on top of that. But we're seeing now the cases increasing quite dramatically in these younger age groups. We might not today be seeing an associated increase, a huge increase in hospitalizations, or ICU or death. But don't rest on that. Because what we've learned from the States and from other situations is in a week, or two or three, what we call an epidemiological lag, this case, this group, now we're seeing more and more cases, we don't live in a vacuum. So then this person could then infect - in a week or two or three by virtue of, you know, six degrees of separation - somebody that they've never even met, but could be vulnerable.

Ariana deVries

Yep.

Cynthia Carr

And then they're impacted by the decision that other person made two or three weeks ago. So that's what we need to be careful about now is remembering even if you yourself have a great immune system, you're young, you don't have another co-occurring chronic disease, your immune system hasn't been compromised by, for example, cancer or treatments that you've had in the past, you're lucky and you are blessed. But take those blessings and remember that I don't get to then just take advantage of that, or take it for granted. I'm part of the solution here, and I need to protect those people who aren't as lucky as me, they're not as healthy as me, maybe they're not as young as me anymore. They're doing their part; they're probably quite lonely, because they're trying not to get out and about. Maybe one or two times they do go out something could happen; and maybe somewhere down the line I played a role in enhancing the transmission of this.

Ariana deVries

Yeah. And that's something my husband and I have talked about a lot is just how we don't fully understand like exponential numbers and how those actually work and how the transfer can actually work is like, well, I just saw this one person, but then that person sees more people and just gets bigger and bigger and bigger. And yeah, kind of blows my mind sometimes when I actually think about it, and then it freaks me out.

Cynthia Carr

That's right, and exponential increase is just as hard for people to understand as exponential decrease,. The sort of a sudden spike and then all the sudden it goes down, you're like wait a second, I thought that city was really in a difficult situation. And now all of a sudden, their active case rate has gone down exponentially. So what we need to learn from that, again, is what we in epidemiology call this reproductive rate. And so you know how many other people could one person potentially infect. In the measles, literally, you walk into a room, and you can you can infect everybody in that room.

Ariana deVries

That’s crazy.

Cynthia Carr

So the reproductive rate there is 18 to 1, but it could be even higher. In this it’s, I think, between one and two, maybe about 2.2. In order to stop the chain of transmission, it has to be below one. Meaning that I can infect less than me, not more than me. So if you think about; just an easy example is a reproduction rate of two. If today we have 100 cases, and every one case can impact two other people, in just 40 days you're gonna have a minimum of 3,200 cases.

Ariana deVries

Wow.

Cynthia Carr

100 cases just 30 days before. And within that 3,200 cases, some of those people are going to end up in the hospital, the IC and ICU or passing away. If you can bring that reproduction rate down to just .7, meaning I can only impact less than me that 100 cases in in 40 days could be 17.

Ariana deVries

Yeah?

Cynthia Carr

So 17 or 3,200. And the wild card is our human behaviour, because that reproduction rate is basically, “how much opportunity did you give that virus to spread?" So the reproduction rate gets higher and higher the more you bring people together for longer periods of time that aren't wearing masks and aren't staying far apart.

Ariana deVries

Mm hmm. So talking about the younger generation, and that brings to mind for me social media, especially. How do you believe the perceived or actual severity of the pandemic is swayed by social media or the media in general?

Cynthia Carr

Well, I think there's two sort of threads to that. One is if I think about how different age groups get their information. So my children are aged 18 and 20. I'm on TV probably four or five times a week. My children have never seen me.

Ariana deVries

Right.

Cynthia Carr

Because they don't watch what we normally think of as we turn on the TV and there's CVC or Global are our typical. That's not what they are watching. They’re watching Netflix and using apps. They're literally not even watching what we think of as a standard radio or television means of communication where I think a significant focus is. So I think we need to think about using some of these things that I don't even understand. I don't have Instagram, I don't understand TikTok, [Laughter] I don't have a hot clue where our kids are getting their information and where they're sharing it.

Ariana deVries

Yeah.

Cynthia Carr

And so there's opportunities there for us to think outside the box from a public health perspective. How do we get short, clear messages to the people that right now are actually pushing the increased numbers of cases? But the challenge on the other thread of that is with social media, the opportunity for people to put out information that is not at all true.

Ariana deVries

Uh, huh.

Cynthia Carr

That keeps getting repeated without actually ever being reality checked. So people would just look at that and say, “Well, I saw a message about this. I didn't reality check it, but I did pass it on.”

Ariana deVries

Mmhmm.

Cynthia Carr

Now this misinformation, these myths (which can be, this is not existing at all, or don't wear a mask, or Oh my God, the world is ending). It's really along that continuum. But none of it is helpful. None of it is empowering. And there's no checks and balances there. So one is looking at how do we get the right messaging out and taking advantage of the media by which each group uses. But, how do we stop the spread of, toxic misinformation? I myself when I see sometimes interviews with me are posted online, whether they're just, you know, print online, or they're actually excerpts of television that I participated in, or podcasts, I'm shocked by some of the really, um not productive, and personal, and, frankly, mean comments that are made.

Ariana deVries

Hmm. Yeah.

Cynthia Carr

I'm trying to help with public health messaging. And I understand that people are anxious and angry, and sometimes just hearing this is escalating anxiety. And so there can be a sort of a desire to immediately go “Shut up, Cynthia.”

Ariana deVries

Yes. Right.

Cynthia Carr

Well, you don't know what you're talking about. And I think, in fairness, I'm not the smartest person in the room, I never said I was, but I have been doing this exact job for 25 years. I probably know what I don't know. But I probably also have a good handle on what I'm willing to talk about. Because by knowing what I don't know, I wouldn't put that information out there. I would defer to somebody else who I would know would know better. So it's really challenging to try to, even from my perspective, want to continue sometimes, because I feel like did this even help anybody? Or did this escalate anxiety?

Ariana deVries

Right. And that's something that I think about a lot too, is...this is something that is creating a lot of fear and a lot of anxiety for people. How do we help support them and help them to go through that fear? And sit with it and not just, not be okay with it, but to not let it overtake them. How do we continue on with our lives and support people in that way, and not be afraid of grieving what we've lost and moving forward? And yeah, it's a big, big topic.

Cynthia Carr

It has been a dramatic shift in a very short period of time. If you think, even just our lives, but think about just generations like how things typically kind of take a while to change, unless there's like a tsunami or an earthquake that happens like this. This is, unfortunately, the worst combination of a tsunami. It's not going away. So we can't clean up the problem.

Ariana deVries

Right.

Cynthia Carr

We can’t save people, come up with the solution to rebuild and move forward and grieve those that in that immediate situation, experienced loss of life or illness or something dramatic. That traumatic event is done, and then we clean up and we move forward, and we build. We've had a tsunami of an impact of something. Oh my goodness, this is a new disease. Is this a science fiction movie? Or is this really happening? This is really happening and it's not stopping. What we know is that as uncertainty continues, even if uncertainty is just think of it as a level ruler, that uncertainty from, “What was that I heard about New Year's Eve about something in China?” To January to February. Oh, this is coming closer now. So now my uncertainty is not, What exactly is the disease? But now my uncertainty is, Am I going to be impacting others? Is this becoming a pandemic? Is this coming to Canada?" Now it's here. Now my uncertainty is...Did my school year just end?

Ariana deVries

Yep, yep.

Cynthia Carr

Am I going to lose my job? Can I pay my bills? Now there's more uncertainty, more uncertainty, more uncertainty. I'm seeing the virus increase. Oh, over the summer it went down. But now I'm still uncertain, like, does that mean everything's okay? I still don't know the answer. And so the uncertainty keeps going. And we know that as uncertainty keeps going, anxiety does not stay horizontal to that; it escalates. So now anxiety is like a mountain. And in fact, in the beginning, the anxiety might have been a little bit lower then the uncertainty, and different people would have been at different levels at different times.

Ariana deVries

Right.

Cynthia Carr

An easy example would be, at the beginning of this, for us, for my family in March, my daughter was in grade 12. My son was in second year university, but my son is also a passionate hockey player. Hockey is everything. So when things shut down for us around the third week of March, for my daughter, it was March Break starting early. This is kind of fun, I'm uncertain, I don't really understand what's happening, but I'm not anxious yet, because it's sort of like, I don't have a frame of reference for what's going to come. So I'm not worried yet. I'm just thinking of it like a bit of time off school.

And then it kind of got into, Okay, but now I can't go to Mexico for March Break. Hmm. Now my anxiety is going up because I was expecting, I was excited about something. I'm not going back to school. I miss my friends. I miss dance. It’s my last year of high school. Am I really going to miss my graduation? Am I going to university? Wait a second, wait a second. I didn't know that last day in March. I didn't know that was my last day of school. I didn't get a goodbye to my teachers. I didn't get to empty my locker in the normal way. So her anxiety started to creep.

My son was, right away, What do you mean hockey's done? What? No! Hockey's everything to me! Yes, I'm in university, but is my season done? Immediately in March, his anxiety was at or above that uncertainty level, because he'd already lost something just like that [snap].

Ariana deVries

Right.

Cynthia Carr

And it hit him because that was everything. He was less worried about university. [Laughter] It was hockey, because that's his soul. That's who he thinks he is every day. And that was gone [snap] immediately. And then his anxiety continued to escalate. For all of us it’s that increasing anxiety and losing those coping strategies.

For me, as a mom, it's now I'm losing sleep. As an epidemiologist, I'm thinking about this as part of my occupational world. But I'm also a mom, and I'm a single mom, and I'm trying to manage their mental health, and all of the things that are going on with them with my need to keep working. Now there's the enhanced workload, and my passion for public health so I can never turn it off. Now I can't go to church with my parents, but that's when I see my parents. But I can't go to the gym because my gym is closed. And it's kind of cold outside. I can't get exercise that helps me cope. My son is going stir crazy, because I've already talked about his hockey that helps him.

We're losing some of those things that we've always used to help us cope with our stress and to enhance our social or mental well being. So anxiety keeps going up and up and we're losing our ability to cope. And what we're seeing is, unfortunately, even today I saw a very discouraging video of a young man insisting that he wear a Halloween mask and escalating a situation that didn't need to be, and you see other videos of people getting into huge arguments or even fights over things that are like this. Seven months ago, you would never have anticipated yourself doing that or snapping so easily, but it's because...give yourself a break. You've been under months and months and months of anxiety, all of us have been, even if we don't know anybody who's been sick. So it's really tough for all of us.

Ariana deVries

Mm hmm.

Cynthia Carr

So recognize it, and understand that you might have to look for different coping strategies or different resources. But you need to. You need to do it, because it's not good for you physically, socially, spiritually. And, you know, our physical health is impacted by stress and anxiety.

Ariana deVries

Mm hmm. I had originally phrase this next question, as How long do you foresee this pandemic lasting for? And you brought up a really good point and said that there's no way to be certain about that. And it's difficult to offer people hope when you don't know. Plus, I'd also add that you probably don't want people being angry at you if you get it wrong.

Cynthia Carr

Right. That's the danger. You want people to be hopeful. And you don't want what - I’ll bring it back to my early days in psychology - is called learned helplessness. Learned helplessness is if I keep pushing a trigger, in the beginning, when I push the trigger, I got food. But now if I push the trigger, or I don't, sometimes I get food. But now sometimes I get shocked, and I can't predict. I don't know what's going to happen. Nothing seems to be responding to what I thought I was supposed to do. I give up. I've learned helplessness, because I just think it didn't matter what I did, nothing seemed to help. So the dangers are in trying to say, “Let's be hopeful and continue to work together with these strategies, even if sometimes things start going in a way back in a direction we didn't want them to. We're not helpless, and we're not hopeless.

But if what we saw in the States, unfortunately, with respect to our neighbours to the south, with overly optimistic messaging, not based on any factual scientific background - “You're going to have a vaccine in a month, you're gonna have a vaccine, and by the fall, you're gonna have a vaccine by this” - and then it didn't happen. It didn't happen. You gave people a target, you were giving them dates that were not achievable.

Ariana deVries

Mm hmm.

Cynthia Carr

The fastest vaccine ever developed was malaria, it took five years. It's going to be better, I believe, it's going to be better because of resources being thrown at this. So don't think, “Oh, gosh, Cynthia just said five years”.

Ariana deVries

[Laughter] Yeah.

Cynthia Carr

But just for a reality check. That's the fastest vaccine ever developed. So to give people a target that was not achievable, just makes people feel hopeless, helpless and angry. I don't have an answer for you as to when this will be over, because again, there's all kinds of factors.

Ariana deVries

Right.

Cynthia Carr

Please virus don't do this, but should the virus decide to mutate, which can happen the more times it copies itself - again why we want to stop that spread within our bodies - every time that virus gets in, it's using ourselves to multiply, multiply, multiply into the millions. And it's supposed to make an exact copy every time. But mistakes can happen. And that mistake can lead to a mutation, which can be good, it's less dangerous. Or it can be bad; in the sense that it's more dangerous. But in either case, a change impacts research into treatment and vaccines and we want to stop that. So how long this lasts depends on the virus itself. It’d be nice if it was like SARS. It kind of just tired itself out. We haven't seen it again since 2003/2004. Maybe it'll be more endemic, like there's four strains of Coronavirus, accounting for about one in four common colds. So we don't know what's going to happen. But we do know how important it is to continue to work together to stop it as much as we can from transmitting from one person to the other.

Ariana deVries

Yeah. So as we start to bring this conversation to a close, I just have one final question. Putting all stats and facts aside, what final words of hope can you offer our listeners? And what can they hold on to during this time?

Cynthia Carr

So quite a few years ago now, political ideology aside, I saw Bill Clinton speak (he was post presidency), and he was talking about the work that he was doing kind of on a global basis. And the discussion was around, at that time, HIV and about is this going to be become a chronic disease or a highly deadly illness? And anyway, what I took away from that conversation and his comments I never forgot. In fact, my husband at the time made fun of me because I put it in my Christmas cards. [Laughter] And the statement he made was, “Hope but be determined”. And I never forgot that, because what he was saying is that we can always hope for the best. But by saying be determined, he meant, it's not enough just to hope.

So each of us in being determined can say, I am actually a scientist, and I'm going to focus my effort on vaccine development. I am actually a doctor, and I'm determined to learn as much as I can about this so that I can do my part in treating people. But all of us can be determined and say, I am educated and I am empowered. These are the things that I know matter and make a difference that I can do every day. I'm hoping that those others that we need on the science side, on the research side, on the policy side, that they're all going to do their part. I'm hoping for them and I'm supporting them.

“My hope but be determined” for each of us is, What do I know? How empowered am I? What steps can I take so that I'm part of the solution; so that the scientists, the doctors, the policymakers, they can keep doing their part, and I don't make it harder?

And everybody, please, the flu is not the Coronavirus. Get your flu shot. Because the healthier you are, the healthier your body is. This way you're not fighting the flu while you might come in contact with COVID-19. You will help yourselves, your bodies, and you will help the healthcare system.

So when the flu shots becomes available near the end of October - typically at your pharmacy, public health clinics, your doctor's office - please as much as you can, that's one part of you being determined, is just taking that off the table as a risk factor in participating with that side of things. In addition with maintaining all that we've learned about how to do our part to stop the spread.

And reach out to each other. Even if you can’t hold hands in person, reach out by phone, by Zoom. Send somebody a postcard or a letter that might not be expecting it who might feel lonely. Just getting a letter in the mail really can make somebody feel like I'm not all alone here. Somebody is thinking about me and cares about me and and we're going to get through this. Together.

Ariana deVries

Mm hmm. Well, thank you so much, Cynthia. I really appreciate our conversation and for some of the clarity that you've helped to bring to this, because I know it's a scary time for people. So thank you.

Cynthia Carr

You’re very welcome and a pleasure to meet you.

Transcribed by https://otter.ai