IN JUNE 2003, at the midpoint of the SARS epidemic, I visited my sister, Dr. Bonnie Henry, on the eleventh floor of the public-health building in downtown Toronto, Canada, where she was leading the city’s operational response under the direction of the extraordinary, empathetic, and impressive Dr. Sheela Basrur. Almost two decades later, I can still see in my mind’s eye one particular scene: my sister leading me through a warren of cubicles and offices into a hushed, windowless boardroom, where we paused for a few minutes while she consulted urgently with colleagues. Left on my own for a moment, my eyes were drawn to the far wall, which featured a whiteboard bristling from end to end with Post-it Notes of various colours, connected by thin unbroken lines of black ink. As I stared at this strangely beautiful abstraction, its meaning slowly came into focus: this was the track of the awful disease itself, and these colours were the stages of its relentless progress within the web of people it had infected.
Today, in mid-March 2020, I sit in the sun (spring still proceeds; the cherry trees still blossom) at my sister’s kitchen table in British Columbia, Canada, in the messy middle of a far more extensive worldwide pandemic whose full shape and range and effect we do not yet know — although we understand more every day and scramble to assimilate and disseminate life-saving scraps of knowledge before the unyielding calculus of the disease engulfs us. The memory of the rainbow of notes on that whiteboard haunts me, with its eerie combination of the abstract, precise, and mathematical with the fragile and personal. It occurs to me that we all exist, right now, somewhere as-yet undiscovered on that whiteboard — in the space between those poles of the coolly abstract and the shockingly personal. And we are dependent upon the few who can effectively articulate and traverse that space for us, with us, and hopefully one small step ahead of us.
Now, ten years after the publication of the first edition of Soap and Water & Common Sense, Dr. Bonnie Henry has emerged as one of the most influential, calm, and compassionate voices tracing the precipitous, dizzying curve of the COVID-19 pandemic in (at the time of this writing) almost-daily press conferences. I stole a few minutes from her nearly impossible schedule to ask her two questions for this updated edition of the book.
LYNN HENRY: Bonnie, in my lifetime and yours we have lived through AIDS, SARS, Ebola, and H1N1, to name but a few infectious diseases that have affected large populations. Yet today we seem to be dealing with something that has no precedent in living memory, at least where pandemics are concerned. Do you think the COVID-19 pandemic is different and, if so, why and how?
DR. BONNIE HENRY: Well, as you know, I have been studying the transmission of disease nationally and internationally for decades. I’ve sat on many, many public-health committees in Canada and worldwide and attended countless conferences and gatherings. I’ve participated in studying the modelling of infectious disease and in drafting numerous responses and plans for outbreaks. But I will be completely honest: I just never, ever, ever thought I would have to do what I am doing right now [declaring a state of emergency to deal with the COVID-19 pandemic in my home province of British Columbia].
Why is this different? Is it really different? Well, yes and no. COVID-19 is not dissimilar to aids and Ebola in terms of the fear it generates, although I would suggest that the sense of fear for one’s personal physical health around both of those diseases was perhaps greater — especially among those who contracted either of them, and in their early stages. AIDS was, for a time, equivalent to a death sentence. And of course, that fact generated other terrible and destructive fears beyond the physical. The same was, and is, true in a somewhat different fashion with Ebola. But the difference between those two diseases and COVID-19 has to do with the means of transmission: this new coronavirus spreads through droplets in the air, which makes it a far greater unknown and instills in us a sense that we have no individual control over whether or not we come in contact with it. We cannot see its pathway with the naked eye, and the behavioural controls we can exercise involve not just us, but our entire communities (as we are seeing in the lockdowns of countries at this moment and the practice of so-called social distancing). To know that we can get sick simply by the basic, necessary act of breathing itself — something that is true with COVID-19 but not with AIDS and Ebola — means that of course we are fearful.
When we look at SARS and influenza, we see that in one way COVID-19 is not so different. Those diseases, too, can spread through droplets in the air. But COVID-19 has that perfect storm of qualities: it is far more infectious than SARS, and it is more lethal than influenza. Add to this the fact that we have never before been more physically connected than we are now, with far greater global community interaction, and we arrive at the very moment we are living through.
LYNN HENRY: It has been ten years since the original publication of Soap and Water & Common Sense. We know that there have been advances in certain diseases since 2009, so of course some of the information has changed a bit, and that there have been setbacks in some areas and with some diseases, too — an alarming rise in TB in some places, for example. But is there anything you would change or add to the basic advice and public health tenets you cover in this book? I ask this being mindful especially of our current moment, when people worldwide are isolating to try to “flatten the curve” of the new pandemic.
DR. BONNIE HENRY: Perhaps it seems a little odd to say, but William Osler’s words from more than a century ago remain true and are, if anything, more relevant than ever: “Soap and water and common sense are the best disinfectants.” I would perhaps expand or amend the basic rules just a little, to say:
I would also add one further life-enhancing daily practice, something that we can all do, and that will undoubtedly save us in troubling times: let us all show kindness and awareness and compassion.
— Lynn Henry and Dr. Bonnie Henry, March 2020