Good morning. Well trained. So the idea that Inuit peoples who ate almost nothing but meat for most of the year in the most plant-generous of interpretations has sparked a hot fire of debate in the paleo and ketogenic world. There seems to be a lot at stake. People have argued on the one hand that the diet isn't really ketogenic, maybe the levels of protein in the diet are too high for ketosis or the plant intake was much higher than we recognize or even that muscle glycogen has somehow escaped its normal biological fate of turning into lactate and thereby made the diet high in carbs. But a potentially more fatal blow is the fact that a recently discovered genetic variant that affects arctic peoples worldwide, including Inuit, seems to show that they can't get into ketosis at all even when fasting. This has been discovered tragically because there's a high rate of hospitalization in Alaska of infants and young children who are homozygous for the gene and who happen to maybe get a viral illness so they have no appetite or they can't keep food down and what happens is their glucose goes down, but the ketones don't go up to compensate and so it becomes an emergency. Researchers who have studied children with two copies of the gene have confirmed this fasting intolerance and if you look at studies in the last century on Inuit, it seems to also confirm this idea, although not all of them and so I'm going to examine some of that literature. The heat in this discussion though comes from downstream questions. If the Inuit mostly ate a diet that would be ketogenic in others and Inuit on their traditional diets were usually in ketosis, then sustained ketosis in humans has a definite precedent and so it would stand to reason that long-term ketosis is a natural and safe state for humans. If on the other hand, even the Inuit weren't in ketosis, either because some aspect of their diet prevented it or more strongly they developed a genetic mutation specifically to avoid it, then long-term ketosis seems like a modern hack that might be harmful. These potential consequences have then thrown the actual question out of proportion and bias us to interpret observations one way or the other out of commitment to one of these bottom lines. So in this talk, I'll examine the question of whether Inuit really were in ketosis and the effect of that gene and I'll try to do it in as unbiased way as possible given that I do have a preference among these interpretations. So let's look at some studies. The earliest study that I could find on diet was this Krogan-Krogue study. They were looking at Greenlanders. In the first row there, they had also collected some data that a previous researcher had reported on just a whole annual amount of food intake and so they did calculations to divide it up per year and came out with about a kilogram of meat per day per person plus another half kilogram of fish. Note that already at that time in 1857 they were already eating 36 grams of bread a day on average and there was a berry component but that 50 grams of berries again is amortized over the whole year and that was probably compressed into maybe three weeks and the amount of carbohydrate may have come out to 50 grams a day per day if it was in just three weeks, so not a large component. They didn't do any ketosis experiments in this paper but they did discuss many cultural and dietary things. The paper is fascinating and it's available on the Internet Archive for you to read. The dietary components that they emphasized were seal, reindeer, walrus, whale, birds and fish that there were negligible plants but the time of that writing they compared it to Rinks study and said that they estimate that people were already in the early 1900s when they were there eating 200 grams of bread a day. So we're already not going to be able to get the kind of data we would hope for about traditional diets from this population. The first experiments that measured ketosis that I could find were both from Heinbecker. He did the experiment twice once in 1928 and then he went back to confirm in 1931. This was in Baffin Island. He also, the way he described the diet was the Eskimo in his natural state eats practically only flesh. It is impossible for him to do otherwise as plant life of a type yielding edible material does not exist. Very occasionally a bit of kelp or a few blueberries are eaten, but they cannot be considered articles of diet. He measured, in both cases, he measured ketosis starting from non-fasting and for a period of four days of fasting and the way he measured it was breath acetone and urine beta-hydroxybutyrate, which is not what we usually measure in urine or not how we usually measure beta-hydroxybutyrate and he did find that on day zero of the fasting they were not detectably in ketosis, but as the days went on they certainly did develop ketosis. So that's one data point. He did say that the levels were milder than expected, except for in both cases there was one subject who was in one case nursing in one case pregnant and nursing and those levels went up to the expected in fasting. Sinclair did an extensive review of North America, so it included Baffin Island, Greenland, Northwest Canada and Alaska in 1953. His comments about the diet were similar to what comments we've already seen, but he also added this extraordinary claim that Inuit were eating four kilograms of meat a day in a single meal and there were also some anecdotes where people had asked natives to eat as much as they could and eight, maybe eight kilograms a day, but I don't think that was a normal occurrence. And so in his conclusions, he said this diet is obviously too much protein for ketosis, but he himself didn't make any measurements in this study. He did cite a previous study that he was involved in, which I was unable to find, but he said that there were four Eskimos eating Pemmican only for six days and then fasted. They tested urine acetoacetate and there was no ketoneuria on the Pemmican days, but definitely ketoneuria in the fasted days. And then finally, fast forward to 1972, where ketosis was again measured, these two papers turn out to be the same study, which is obvious if you look at it. It's mostly the same characters involved and it's in Alaska. In the first study, they emphasized that they had measured the people that they were measuring, measured their diet and they were already at 15 to 20 percent of carbohydrate. In the second study, they talked about the surrounding population and they said that the adult population was eating 28 percent carbohydrate at the time and the adolescents were eating 40 percent, a third of which was coming from candy. So already by 1972, we can't really say much about the effect of a traditional diet. They did measure blood acetoacetate, also not something we normally do today and it was a little bit fasted, 16 to 26 hours fasted and it came out negative, which they said wasn't surprising because it wasn't long enough to detect. So most of these tests that were used in these studies have been developed to detect fasting levels of ketosis or clinical or ketoacidosis levels. And so I want to go over these tests just briefly and talk about what they can detect and the influence of mild levels of ketosis or ketoacidosis on these tests. So if you look at a classical ketogenic diet, you can see that acetoacetate levels and beta hydroxybutyrate levels are approximately the same before the diet, maybe up to twice as much beta hydroxybutyrate, but very quickly the ratio climbs in favor of beta hydroxybutyrate and here even with the beta hydroxybutyrate up to over four, the acetoacetate levels have leveled off at about 1.2. These two graphics are from fasting and it shows the same pattern, but the thing to notice about this, if you are hanging out in the lower end of nutritional ketosis range and your levels of beta hydroxybutyrate are say between 0.5 and 1.5, your blood acetoacetate levels are going to be fairly low, maybe around 0.3. And 0.3 is well below the detection limits of some of the tests that were used in those studies, the blood acetoacetate test in particular. Now the relationship between blood levels and urine levels isn't straightforward. I think this is actually taken just in fasting. Well with acetoacetate it is kind of straightforward. Urine output is directly related to the blood, but beta hydroxybutyrate, which we don't normally measure in urine, has a very different pattern. It really doesn't start to show up in urine until you've passed a certain threshold after which it goes up very steeply. So again, if you're in mild nutritional ketosis, urine measurements of acetoacetate are going to be hard to pick up and beta hydroxybutyrate is also going to be hard to pick up, which is especially important if you're accustomed to looking for the levels that you would find in fasting. To make matters worse, the nitropreside test, which is what is used for both urine and blood, even at the current state of the art has a very high false negative rate. This chart shows an experiment with given levels of urine acetoacetate and the range of beta hydroxybutyrate in the blood. And again, if you think about the person with beta hydroxybutyrate levels between 0.5 and 1.5, there's a significant chance that your urine acetoacetate is going to be negative. This problem is exacerbated by ketoadaptation. This study isn't about the relevant population and I only bring it up to point out a couple of things that they brought up in their introduction. It was already known at that time in 1954 that ketoadaptation reduces ketoneuria. So the notes about ketoadaptation are in the red here. In one point they say that it was known from a previous study that ketoneuria reaches a peak at three to five days during fasting and then it drops off. And the second part in the red is saying that after months on a carbohydrate-free diet ketoneuria diminishes. And then the part in blue is just to highlight that in this paper they had in their company an Eskimo soldier who had been eating the normal army rations and when they put him on a ketogenic diet he showed ketones immediately the way that would be expected. So all of these points point out that ketoadaptation may be having a real effect on our ability to detect ketosis in these cases. So where are we? I think that these studies do show that the traditional diet was low enough in carbohydrate. Maybe it was high in protein that's a little unclear but there was already a growing intake of flour that's in the diet by the early 1900s. As for ketosis it was not detected during fasting and during or sorry not well not fasted but during fasting it was definitely present though in some cases there is evidence that the level is not at what we would expect. So as to hypotheses that we can make at this point we can either think that there wasn't really ketosis or it was really really low and that could have been because of a diet being too high in protein or maybe some carb cream or we can it's still the data is still compatible with believing that there was ketosis but it was too mild and ketoadaptation was making it too hard to detect. But there's more information so as I've already alluded to there is a genetic variant of CPT1a that's coming into play in this population. CPT1a is an enzyme that is used to transport long chain fatty acids into mitochondria for fatty acid oxidation which you need to be able to get energy or ketone bodies. A is the form in the liver so this isn't affecting all the other tissues if you're on a very high fat diet and CPT1a is compromised you're still going to be able to get energy into your muscles for example but the ketone glucose sparing effect is what's going to be compromised. And this genetic variant is found across the world in Arctic populations it's not just Inuit. What does that variant do? Well it's been shown in certain experiments to actually reduce the activity of CPT1a. Various measurements have shown anywhere between 2 and 54 percent of activity and so it's called a deficiency and as we saw earlier can be very dangerous because it will diminish your ability to fast and this has shown up in increased infant mortality rates in the Alaskan population so it's very serious. But this is astonishing. Given a gene that increases infant mortality rate I can hardly imagine a genetic variant that would be more subject to selective pressure against it so I think this means that there must have been a very strong selective advantage to offset this or there's more going on to the story than we're seeing. It's not a rare one-off mutation like an inborn error of metabolism it's extremely prevalent in the Arctic populations. So for example here are the Inupia and Yupik people in Alaska. The red dots are for being homozygous and the green ones are for being heterozygous. I think the average of that population is about 0.7 and a similar story happens in north of Canada particularly in Nunavut. These columns show no copies, one copy and both copies of the gene. The northwest territories it only showed up in the Inuit and Inuvia loop populations in much less than the first nations which is interesting and the Yukon it showed up barely at all but we can't tell from this data whether that's because non-native people or lineage or in the data pool or if there's a difference, a drastic difference when you start going inland. All of these in the previous ones were data taken from infant screening which is now a practice because of that problem but there's also data showing that the gene is prevalent across the world in Arctic populations. So the first idea that I heard about why this gene might be selected is that the diet is low in carbohydrate and the gene was selected to avoid chronic ketosis from this naturally low carb diet. Now note that this hypothesis only makes sense if you're going to concede that the diet was ketogenic in the first place. If you don't believe the diet was ketogenic you can't then say that the gene selected against it that makes no sense so you have to choose one of those at most. What was special about the environment that this gene is prevalent in? Well we know the diet was low in carbohydrate it was also potentially high in animal protein but it's also very high in cold water fish and sea mammals and it's cold and coastal. Well what would be so special about a diet of cold water fish, seal, walrus and polar bear that would make it different from caribou or reindeer in the inland populations. What those kinds of foods have in common is very high levels of polyunsaturated fatty acids. This study is from 1980 and so the Eskimo population are already eating a large amount of biscuits and sugar but the meat that they were eating was at least the same kind of meat that they had been eating previously and if you look at it compared to the Danish control population you can see that the percent of saturated fatty acids is much less and polyunsaturated fat is much higher in these greenlanders and when you compound this with the previous fact of 135 grams of fat per day as estimated in that first study I showed you that's going to be some 25 or 30 grams a day of just polyunsaturated fatty acid which is mostly omega-3. Well we know that polyunsaturated fat upregulates CPT1A. This study was done in rats and they were looking at the enzyme activity in various ways and showed that if you were using fatty acids that were high in saturated fat and low in polyunsaturated fat and vice versa it had a big effect on the activity of the enzyme. Specifically, polyunsaturated fat is much more activating even omega-6 but more so omega-3 and this translates directly into ketosis levels.  They said beta hydroxybutyrate increased 8.4 milligrams per deciliter in the polyunsaturated group compared with 3.1 in the saturated group. Of course, I think normally most of our fat is mono-unsaturated but just to compare those directly. So there is a reason to believe that without this gene arctic peoples would have had much higher levels of ketosis than people with similarly low carbohydrate meat-based diets inland. And there are other ways that the polyunsaturated fat could compensate just other than just the way that it's being oxidized. For example, there's a reason to believe it will increase the P-PAR alpha transcription factor. It could increase the expression of the actual gene for the enzyme itself. If you're in a low glucose situation, you probably have increased mitochondrial biogenesis. And so, you know, if you had twice as much gene expression, that's nearly going to compensate or at least do a go a long way to compensate for a deficit that takes it to 22%. And none of these compensations would show up in any of the data that we have because we're looking at children who are on high carb diets or we're looking at fibroblasts that are grown in glucose. So we don't have the data that would show what would happen if we were under the right context. This allows us to amend our first hypothesis and say maybe the gene was selected to reduce ketosis but it wasn't to eliminate ketosis. It was just to reduce high levels of ketosis that it exceeded some safe threshold. Of course, that makes us wonder what that threshold would be and what it means to be in ketosis at various levels. But if this were the case of the gene, then we would still have mild ketosis being perfectly sustainable. But the Arctic variant has another effect that hasn't been acknowledged very widely. The second effect of the gene is that it reduces the sensitivity of CPT1A to malonyl-CoA and I'll explain what that means if I can. Malonyl-CoA is a result of the carb metabolism pathway on the path to generating fat.  You don't want to have the gas and the break on at the same time. And so in the presence of malonyl-CoA, CPT1 activity goes way, way down. The study that this graphic is from is showing that if you desensitize CPT1A to malonyl-CoA, you can increase fat oxidation even more than you can by overexpressing the CPT1A gene and enzyme itself. So if you look, this study was, I've messed with this slide because the study was on different mutations of fatty acid oxidation. The only one that is the relevant gene mutation is patient 6. You can see that there is a big drop in baseline activity, but that it's much less affected by the presence of malonyl-CoA. You might think that this is irrelevant, giving that the levels are already so low, but you remember that the baseline levels are in the wrong dietary context. So it's an empirical question and I think a reasonable hypothesis that with high exposure to polyunsaturated fatty acids, those baseline levels would be significantly higher in the first place. So at this point, it seems like we may be at a bit of a theoretical impasse. We have the high polyunsaturated fatty acids in the diet, which are offsetting the deficiency, and then we have potentially high levels of protein, which could be addressed by the low malonyl-CoA sensitivity because a higher protein diet, of course, results in more glucose oxidation. So this suggests a different hypothesis. This hypothesis was first published in Greenberg 2009. He said that instead of the selective advantage being to reduce ketosis, the selective advantage is actually to maintain ketosis in lean times. And that this is only made possible. We only see this in the Arctic because only there are the levels of polyunsaturated fats so high that ketosis is so high that we can afford to bring it back without losing it entirely. And so if this hypothesis is correct, then it's quite possible that high polyunsaturated fatty acid diets would give a higher baseline of CPT1 activity, and maybe those children who have too fast for illness would not have the same symptoms. And that question is right now under investigation by David Kohler at the Oregon Health and Science University. When I spoke to Dr. Kohler, he also suggested that there may be a mixed copy effect. So in this case, the people who are heterozygous for the gene may have the best of both worlds because it turns out that the reduction in fatty acid oxidation behaves more recessively. It's not nearly as big a blow if you only have one copy of the gene as if you have two. Whereas the benefit from the reduction in sensitivity to malinal CoA behaves more dominantly and you only need one copy of the gene to get a benefit. So in this case, the homozygous people would be the worst off because they have reduced fatty acid oxidation. And not only does that limit ketosis, but if you remember in the earlier slide, two of the five homozygous children that were in that study not only were not generating enough ketones, but were having dangerous levels of hypoglycemia. And so if this gene is actually causing a limitation in gluconeogenesis, then it's much more serious and it's not necessarily easy to understand how it could be successful in a population that relies on both gluconeogenesis and ketosis. So what can we conclude? Was the Inuit diet ketogenic in the sense of it would be ketogenic, at least without the context of that gene? I think that the evidence is pretty strong that it would be. There is some question about higher protein levels, but it seems to be offset by the amount of carbohydrate and the amount of fat, especially in light of the nature of the fat. And of course, notice that both of these competing hypotheses, whether it's mitigating or maintaining ketosis, rely on the fact that ketosis would have been higher or they make no sense. But were the Inuit on a traditional diet in ketosis? Here is where we need more empirical data because there are conflicting sources of information. We know there is reduced CPT1A activity, at least in the modern context. The diet may have compensated. We also have to talk about the degree because maybe we're arguing about different things if one person is saying, of course they weren't at level 4 beta hydroxybutyrate all the time and maybe we're only talking about level 1, then it's not as much of a contentious issue. So if the Inuit genes were actually selecting against ketosis, that was their function. We don't know if that was the advantage itself or if it was just a tolerable side effect for some other greater advantage, but the problem with that hypothesis is that it doesn't account for the in tandem hypoglycemia that sometimes occurs and it doesn't really address what would happen with possible compensations from the diet and from the other effect of the gene that we've seen. But even if we grant that, can we conclude from this that long-term ketosis is harmful? I'm not sure we can. It's not automatic, at least, because we have to remember that this is a very specific population with a very specific diet. If we look at, for example, the Mongolians who were nomadic people and had a very low carbohydrate and high animal intake as well before they were introduced to flour and sugar, I don't see that there are any medical issues or genetic issues so far as yet that I've heard that have come up. Of course, also, people argue that during the ice ages, which did affect the climates of Africa and Asia where we would have been induced a similar kind of dietary constraints, but we can't know that for sure. Certainly though, if there really was no human precedent for long-term ketosis, it does make the basis for recommending long-term ketogenic diets a little bit less of a, gives it less of a foundation. On the other hand, if we can establish that they probably were in ketosis, then we would definitely have a precedent of sustained ketosis in human history, and although I can see that it could have been merely tolerated for in exchange for some other advantage, we know it's not a deal-breaker, right? We know that there would, we would know at that point that there was a healthy population that was not adversely affected by that. What we really need, the bottom line, is that we can't tell what the selective advantage was at this point, and maybe never because that's speculation, but there are competing theories that are very different that can't be ruled out. We need to look at the genes acting in the environment that they adapted to, not in people eating high-carb diets or in fibroblasts that have been grown in glucose. We need better experiments to be able to resolve this question regardless of what the consequences are for us. Thank you. All right, just a couple of minutes for questions, and please stay up here so people can ask you questions. And the microphone is over there, please line up with the microphone. Thank you. Hi, Amber, an interesting talk. And the one thing that comes to my mind when you're talking about this, the homozygous case of this gene variant, is that human infants are in ketosis, especially strongly when they're first born. Look at the picture on your end slide here. Unlike great apes and other primates, humans are born with a really high amount of white adipose tissue, and that's to maintain ketosis. Do these children have a problem early in infancy? I am not sure about early, and I think that if their breastfed, especially the adipose tissue of infants, is also higher in those polyunsaturated fatty acids, and that might help. I don't know, and that it's a bit of a mystery to me. I think that early cessation of breastfeeding might be part of the problem in the population as well. What time do they, do you know when they traditionally wean? No. But I know that they were often just strapped along and carried, and I don't think that they would naturally be fasting, unless I suppose if they were really ill. I just had a question. I didn't actually catch the date in the first slide. Oh, sure. This was three and four year olds who were homozygous and were put under fasting conditions, and so the gray area is the 90th and 10th percentile of the non with the wild type variant, what ketosis level you would expect there, and that was the results they got. And then on the right hand side there is the glucose levels where two of the subjects have fallen below the normal glucose level. The other question would be if you assume that you're trying to prevent effects of ketosis, what kind of effects would be harmful? That I can't really speak. I don't know what would be harmful. I think people have suggested that it's inefficient or that it's stressful to the body somehow. I don't really buy those arguments. That doesn't sound good. No, I mean I think it's a bad principle to assume harm when there is no. I think the idea is it's got to be growing out of the idea that a high carbohydrate diet is the default diet, and to deviate from that would be messing with our evolutionary adaptations. That does sound like a good principle. So we hear stories from the laboratory about new discoveries, and then you ask the researcher, well, are you taking this product? And that kind of is the witness test, how good is that product? So ma'am, what diet are you on and why or why not? Thank you. I am on a carnivorous diet. I probably don't get the level of polyunsaturated fatty acids that they do in the north, but I don't eat any plants, and I do that because it's made me the healthiest that I've been in my adult life.  So sure, I eat animal-based foods, many of them mostly ruminants like beef and lamb, but I also eat pork and chicken and fish and eggs. Very occasionally I eat dairy, sometimes more than others. Yeah, and I was drinking coffee for many, many years, but I have stopped drinking coffee, at least for a little while, too, to see what that would do. Thank you. Thanks, Amber. This was great, as always. Thank you. I've been asked to ask you a question about uncoupling. So you're obviously, I won't butcher his surname, but you'll obviously be familiar with Peter from hyperlipids hypothesis of high free fatty acids outside the mitochondria, driving greater mitochondrial uncoupling for heat generation in these populations. And if you look at mitochondrial haplotypes, the further away you get away from the equator, the more likely you are to have uncoupled mitochondria probably for heat generation. So do you have any thoughts on that in this context? I do, and I'm so glad you asked that because I didn't have time to talk about that. One idea that I came up with, and I'm sure it's not just my own, is that when you're in that cold Arctic environment, that the heat generation is really important. In fact, if you remember that study where I was looking at just the points about keto adaptation, that study was actually done in non-native explorers. They had heard that ketosis is happening to their explorers on their rations, and they thought maybe they should try to prevent it because it might be dangerous. So they studied, they gave them all carbohydrate rations and all meat rations in a mix. And they concluded that while the meat rations did result in more ketosis, it actually made such a difference in their heat generation that they thought it was preferable. Further to that, I'm not sure it makes biochemical sense. I'll have to get a biochemist to tell me if this is crazy, but I think if your rate limit of entry into the mitochondria of fatty acids goes, is limited, and you still have fatty acids left over, even if they're long chain fatty acids, they'll begin to be burned in the peroxisome instead of in the mitochondria. And if I understand correctly, that results in even more uncoupling than ketosis. And so that could be a great selective advantage that wouldn't have any bearing on ketosis. And ketosis lowering would be just a side effect. One other thing from what you said, though, is obviously the thermic effect of protein is much higher than, so if you're comparing meat versus carbohydrate, that does kind of bring in another confounder. That's true. That's true. It was more deeply ketogenic too, but that's a really good point. Yeah. I just wanted to remark that chronic ketosis has to be defined because a population that eats a lot of protein will get out of ketosis and inco-ketosis, especially if they are fat adapted and also depending on how much protein there is in the animal that they hunt. So I think it's better to talk about chronic ketosis, but not 100% of the time in ketosis. I don't know if it makes any difference from a health point of view, but this is, in my opinion, what was prevalent throughout the Paleolithic, throughout the world, not just by... So it's in and out of ketosis on a daily basis. On a daily basis. On a daily basis. Yes. I can attest from my personal experience.  In the morning, I'm ketosis. I think that's an excellent distinction to make. If you're eating a low-carb diet that's high in protein, right after you eat, you may well go out of ketosis, but the amount of time it takes to get back to that level that would take many days in a person on a high-carb diet of fasting, you and I, on our diets, would be back in that level after the post-absorptive phase within a day easily. And so maybe we're looking at percentage of time in ketosis and the level of ketosis all come into play when you're evaluating whether or not they're in ketosis, which really is a qualitative word. My questions were going to be also about the high protein, the context of a low-carb diet, but this has me thinking about when were they testing ketones on these populations? Was it immediately after they'd eaten? Was it, I know some of what was fast and so on, but, and then also bringing in Ben Bickman's research that he's most recently presented this year, right? In the context of a low-carb diet that high protein does not suppress ketosis, I know that several of us have been experimenting with that, me being one of those, and I can eat up to 180 grams of even lean protein like from fish and seafood and maintain my state of ketosis, even increasing that. So how that all fits into this picture is yet to be seen, right? That's a good point. Yes, the effective protein I think our understanding of it has been overly affected by high-carb or people with high blood glucose levels in the first place, and the glucagon to insulin ratio is going to be affected much to a much worse way if you have high blood glucose in the first place in a way that it wouldn't on a low-carb diet. Moreover, if you're looking at a diet that has taken all carbohydrate out instead of say, suppose you have a diet that has 25 grams of carbohydrate, because you know you can stay in ketosis that way, you can add less protein in that situation. If you take out those 25 grams, suddenly you have a lot more leeway before the insulin level is going to be reactive. Thank you for the talk. Last question. I was really looking forward to this talk and it's just sparked so many questions in my mind because I'm a First Nations ancestry from the west coast of British Columbia mixed with some European. And some of the data points that you had on one of the slides was showing some spots in an area called Metla Katla in the south end of Alaska. And my nation is a little way south from there, not very far. And along that coastal pathway all down the west coast, our diet traditionally has always been seafood, water-based, whatever we could get out of the ocean. But there was also more opportunity for plant gathering because as you go further and further south, the climate gets warmer and warmer and there's more plants. So I'm super curious if these variants, how far south they persist, where the seafood diet is still there, but then you start adding more carbohydrate-rich foods, especially in the summertime there's a lot of berries and stuff available. The other thing is a little bit of a tragic feeling from what you presented in terms of how the introduced foods have already clouded the picture very, very early when studies were being done like flour and bread in the 1800s. It was already starting. And we see, I belong to a chair, actually a committee called the Indigenous Women's Health Initiatives Committee for the Society of Obstetricians and Gynecologies of Canada. And we look at health outcomes and issues in Indigenous populations across Canada. In the Inuit, we still see of all of the Indigenous peoples who have and we all have higher infant mortality rates than mainstream Canadians, but in the Inuit they have the highest rate of infant mortality to this day. But one of the issues, like there's so many confounding issues because they also have the highest rate of maternal smoking and many other factors like that that might totally override whatever this variant might have. If this is at play somehow still, it's confounded by other things. But anyway, thank you so much for your talk. I found it fascinating. Thank you very much.


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So if you like I can show you quickly some of the features from our app. So basically you can easily listen to anything that you have programmed here. And also our 1200 series panel has really high fidelity speakers so it's enabled you really to listen actively to your auto monitoring source. In addition to that the audio monitoring app is really easy to understand. So the UI is quickly to understand to grab. It indicates if something is wrong with your audio and you can quickly also change if you want sources. So it's really intuitive with our touch screens you can easily put something new on and just accept it and now you have a new source on your panel. And if you want to change something you can for example isolate one of these channels so that you can only listen to the left one or also take back to stereo. So it's really easy for our customers to use and to understand this app. Okay thanks a lot. Thank you very much.


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Hello, my name is William, and I wanted to talk today about how you can work on multiple merge requests using GitLab at the same time And so this is where today. I was just doing some work using both my local dev environment and GitLab's web IDE and I thought this is such a nice workflow. I love what's going on with the web IDE here I thought, hey, I'll just record a quick video to show all of you what I'm doing and how I use it And maybe somebody else can find it helpful as well So I'll just go ahead and share my screen for a moment and show you an MR that I am currently working on So here's a merge request to add Jenkins content to our comparison page and I have checked out this branch locally and And I have it here in my Adam editor where I've been doing some work by Updating features.yaml and this markdown file and this hamel file And so in these files, these are all related to this one MR where I'm essentially doing some work and doing an update and The use case here is I want one branch to do my development work But I also want to document the process that I'm going through So I created another merge request for the documentation Now I really really don't want this all in one merge request Because I don't necessarily want to block like I don't want to block on shipping the development work if the docs aren't done I want to be able to get it live and to iterate and for people to see and provide feedback So I really want these things to be separated so I can get individual feedback on each component You know, for example, if the instructions are clear what not So in this use case where you're doing one bit of development work on on one branch or one part recode base And then likely if you're then documenting what you're doing in the process for how to do that is in is in a separate place So here is my MR for the For the documentation changes and here I am using the web IDE So here's my other branch. So I'm essentially working on to get branches at the same time Almost and you know, you basically using two different editors and what's pretty cool about this is with the web IDE You could just open it in different tabs and work on multiple branches at the same time So here are my instructions for how to update The comparison page, you know, for example open this file and edit this So as I've been making changes here and Committing them to to this MR. I have also been simultaneously updating what I've been doing and documenting it In the GitLab handbook So I'll just finish this up the last thing I want to show is I have an example here of Adding a feature that GitLab has that a competitor or another tool does not have but I want to be sure to add an example of something that A competitor has for example Like puppet has a domain specific language For infrastructure configuration and that's something that is true for another tool But it's actually false for GitLab and so for us. It's important that our Comparisons are transparent and honest Just updates and formatting here add this one in like this and so Now I have the work that I've done in one branch and the documentation and the instructions in one branch and here I can commit locally and and push up on the one MR and here I can make commits in the you know added instructions on Features GitLab Does not have and I can commit to that branch. So I hope you all found this video fun entertaining just wanted to share with you how I use both my local dev environment and the GitLab web IDE to work on two Git branches at the same time that are Pushing changes to two different merge requests at the same time and I thought that was pretty fun So hope you all have a great day


It is now time for oral questions that I recognize the member for Brampton Center. Thank you and my question is for the Premier. Speaker, this pandemic has shown how after years of neglect from the Liberals, the Conservative government has allowed the horrible conditions in for-profit long-term care homes to continue. The Canadian Armed Forces had to be called in to provide staffing support and shore up services in our long-term care homes. The Armed Forces also found horrifying conditions in seven of the homes where they were located. They found the seniors died after frontline military personnel revealed that all they needed and all, quote, was water and a wipe-down, end quote. It's clear, Speaker, for-profit care should not be the blueprint of Ontario's future. So why is the Premier and the Minister doubling down on the wrong model and increasing the number of for-profit homes here in the province? You're on behalf of the government, the Minister of Long-Term Care. Mr. Speaker, I thank the member for the question and appreciate the opportunity to talk about our plan to fix long-term care. Mr. Speaker, there are currently 220 projects ongoing, Mr. Speaker, to build new long-term care homes. As the member opposite noted, and I'll add some detail to it, during the seven years prior to this government's election, only 611 net new long-term care beds were built. Mr. Speaker, that was unacceptable, and that's why this government committed to building 30,000 beds. Mr. Speaker, those are in the form of those 220 projects. And in fact, last week we sent out an invitation for more opportunities to build beds. But Mr. Speaker, the opposition's plan would stop in their tracks 140 of those projects, stop the building of new homes, stop the creation of modern facilities for our seniors. I'd like to hear from the member opposite how that is a plan to fix long-term care. A supplementary question. Speaker, the only thing the opposition is trying to stop is rewarding the Conservative government's friends and insiders with for-profit projects. That's what we're trying to stop. But last Wednesday the minister very clearly said in a meeting at the Canadian club that he was dramatically increasing privatisation of long-term care homes in Ontario. He told attendees that he would be allocating 140 projects out of the 220 that are proposed, about 64% of them, to the private sector. Speaker, that's more for-profit long-term care homes than even the Liberals allowed here in Ontario. We currently have the highest proportion of private long-term care homes in the country at 58%. So, Speaker, why after all we've learned throughout this pandemic is the Premier rewarding his buddies in the for-profit care sector with even more contracts instead of helping this province transition to more public, not-for-profit homes in Ontario? Mr. Speaker, and the member is also the long-term care critic. I know she follows the file closely, but she may not have noted that that is just the announcements we've already made. That wasn't news. That's in fact the choices as we've built these new beds, as we bring these new beds online, even in her own community, and I'll speak to that in my final supplementary. But, Mr. Speaker, we have a plan to create new long-term care beds. Our plan focuses billions of dollars, almost $3 billion, on building those new long-term care beds. Through the last allocation of long-term care beds, in fact, two-thirds of those were for the not-for-profit sector. So we will make sure that there's not-for-profit, municipal, and yes, for-profit beds. But, Mr. Speaker, that is in opposition to what the opposition's plan is, and it's good for them for putting out a plan. They would spend billions and billions of dollars paying off those same-for-profit care providers by expropriating their assets, Mr. Speaker. We're going to spend billions and billions of dollars building new long-term care homes and hiring more staffers. The final supplementary. Mr. Speaker, the pandemic made it clear that this system in Ontario was ill-prepared for a pandemic, and that resulted in nearly 4,000 seniors losing their lives in long-term care. We need investments in safe, quality spaces in long-term care homes. New Democrats have laid out a plan to build 50,000 new quality beds that are properly staffed, so that seniors enjoy the dignity that they deserve. The for-profit model is the wrong way to go. Frontline heroes and PSWs know it. The Canadian Armed Forces personnel saw it. So instead of continuing down the wrong path with for-profit care in Ontario, why won't the government show some leadership and ensure that new homes are built solely by public, not-for-profit entities? Dan, reply to Minister of Long-Term Care. Mr. Speaker, to answer that question bluntly, because we're not going to spend billions and billions of dollars to pay private companies to expropriate their assets, Mr. Speaker, instead, and I'll just focus on Brampton for one, between 2011 and 2018 of the 611 net new beds that were built by the previous government, and I'll remind people that 2011, 2012, 2003, it was supported by the NDP, zero of those beds went to Brampton, zero. Mr. Speaker, we currently have 680 beds, more than would be outward built to the entire seven-year period in the province here, just in the community of Brampton, Mr. Speaker. Mr. Speaker, we're not done with, we're not done yet. Mr. Speaker, we will continue to fund the building of beds through the various means that that can be done. We will continue to fund training of staff, and we will bring legislation that will support increased transparency, increased accountability, and increased enforcement for the long-term cost area. The next question, once again, the member for Brampton East, Brampton, Senator. Thank you, Speaker. My question is for the Premier. Federal support programs for individuals and businesses are coming to an end, and it's unclear what, if anything, will follow. This has left a big gap that leaves small businesses just barely hanging on. In Brampton, I've heard from businesses needing supports, and they're concerned that they will continue to fall through the cracks. It hasn't been an even playing field for many of the small businesses as they struggle to reopen, while big box stores throughout the pandemic were able to stay open. Small businesses need leadership right now, Speaker, not promises of new supports sometime in the future. Will the Premier be introducing a third round of supports to keep our small businesses afloat this fall? Would you reply to the Premier? For the question, and through you, Mr. Speaker, we stood up when the small businesses needed us. We spent over $4 billion in supporting the businesses, and we're going to give credit where credit is due with the federal government as well. We were taking care of payroll. We were taking care of their rent. We were taking care of their heat. We're taking care of their taxes. We made sure that they were taken care of because I know they were struggling. We're going to continue making sure that small businesses and all businesses in this province thrive and grow and prosper. Let me just remind the member from the NDP. We gave a reduction of 8.75% to small businesses, but they voted against it. They voted against every single item that we put in place to support small businesses. It's always no, no, no. We're going to continue supporting small businesses. Small businesses are going to thrive. The most important thing, like I said last week, Mr. Speaker, we need great people coming here. They need, every single small business has help wanted in the window. So things are thriving, unlike when they do. Thank you. Thank you very much. Well, Speaker, not every small business can line up for a meeting in the Premier's backyard to request support. We also know that businesses like restaurants have been ignored by this government with the tourism minister skipping a vital meeting just a week ago. The tourism sector is reeling, Speaker, and we need better leadership in this province. We need to see this government provide real support, like a tax credit for Ontarians to help keep the tourism sector afloat. Will the Premier step up and help these businesses, particularly in the hospitality and tourism sectors, to survive this challenging time? For you, Mr. Speaker, the Minister of Tourism and the Minister of Small Business, especially tourism, we put a fund together for $100 million to help these folks in the tourism business. They were hurt. There's no doubt. But we also have tax credits for stay vacations, and right now the small businesses and tourism are bouncing back. I talk to so many people every single day, and you're right. Not everyone shows up in our backyard. Only about 250,000 people have showed up over the last 20 years, which we're proud of, because you have two options down here, Mr. Speaker.  And you hear the great ideas that they come up with, and then we implement those great ideas to support them. But I can assure you, we have the... Thank you. Thank you. And the final supplement, please. Mr. Speaker, businesses need a real strategy, especially in this time in between programs, and the Premier can show leadership and help these businesses with a third round of business support grants. That would include things like a $1,000 tourism tax credit and a plan for businesses to help them reopen and stay open. It would also include targeted support for personal care businesses that have really struggled to survive, Speaker. And it would also include things like readily available loans for businesses struggling to access funds. The Premier had no problem stepping up to the plate to help Big Box stores and his buddies. Will the Premier stop listening only to his buddies and start helping the small businesses in communities across Ontario that need a hand to get through the winter? Thank you for your applause, Premier. Through you, Mr. Speaker, this is what I keep saying. So ironic listening to the NDP and the Liberal. What the NDP member forgot to tell the people listening today, they voted against all the help that we were given, the $4 billion. They voted against it. They didn't believe in it. I can assure you, Mr. Speaker, we're going to continue supporting small businesses. And as for my buddies, I don't know anyone in these big, huge corporations, but I can tell you who I do know. I know the mom and pop shops. I speak to them every single day. And yes, I always take care of the little guy and the little gal. And it's shown over and over again that they constantly vote against anything we do for small businesses. And as I say, the little guy and little gal that runs their businesses, you don't like them. You will never vote for them. And it's very simple as that. You can't stand business.  Order. The next question, the member for Hamilton West and Caster Dundas. Mr. Speaker, my question this morning for the Premier. It's good to see you this morning, Premier. The medical community has given clear advice that Ontario needs mandatory vaccines for healthcare workers. Last week, the science table said, and I quote, there's already significant fatigue and burnout among hospital health care workers. There will be further strain and at risk for burnout if their unvaccinated colleagues are unable to work due to COVID-19 infection. So will the Premier listen to his own experts and bring in mandatory vaccines for frontline healthcare and education workers? Mr. Speaker, it's easy to sit on the sidelines and criticize, but the reality is that right now we're already down 15% healthcare workers. And what they don't take into consideration, because they live in their little bubble here, they don't think about the hospitals in Timmins or hospitals in Thunder Bay or hospitals in Sudbury in the rural areas. And I'm still waiting for a response from the hospitals. I went to the experts. I went to the CEOs and asked them, what is their plan? What is their plan to catch up on the backlog surgeries? What are their plans for the diagnostics? What are their plans to catch up on the cancer surgeries? That's what we need to know before we determine that. But it's easy to sit back and say, let's just cut another 20,000 healthcare workers off the top, or let's cut off 40,000 people in the education system. And then you ask the people of Ontario when little Johnny is sitting at home online because we don't have enough teachers, we don't have enough custodians at schools, or we don't have enough custodians in the hospitals. Take care of things. Everyone changes their opinion. Thank you. Thank you very much. And the supplementary question. Thank you, Mr. Speaker. I'm not sure if the Premier is saying that the science table sitting on the sidelines criticizing, I think they've been doing excellent work in the province. Other medical experts that you may think are on the sidelines have an opinion as well, and they've weighed in. The Ontario Hospital Association wants provincial action to mandate vaccines. They said, quote, far too many healthcare workers remain unvaccinated or partially vaccinated, posing a significant and ongoing risk for patient safety. The Ontario Association of Family Health Teams also wants a vaccine mandate. They said it's critical to protect patients and will help to address the severe staff shortage we're seeing in healthcare. So again, will the Premier finally listen to front-line healthcare workers and hospitals and experts and bring in an immediate vaccine mandate that covers all hospitals in Ontario? Deputy Premier and Minister of Health. Thank you very much. Well, certainly, we can appreciate that there are many different positions on this, which indicates this is not just a simple do it and everything will be fine. It's not that way. As the Premier indicated, we have to listen to the experts in the field, the people that run the hospitals, the people that are knowledgeable, the nurses groups, the doctors groups, everybody else to understand what the ramifications of a mandatory vaccination program would be. It's not good if somebody comes in and affects someone because they're not vaccinated, but on the other hand, if a whole group of people leaves, then there's nobody to take care of people in the hospital. So the Premier has done his homework. We've received some responses. We're still receiving others in order to be able to make a proper decision based on the clinical evidence, based on the knowledge that we have out there. So we need to take this in proper order, and we're going to do that to make sure our hospitals will be able to continue to run and our schools will still be able to operate. Next question. The number for Scarborough... Agent Court. Good morning, Mr. Speaker. Ontario is the destination for many who have immigrated to Canada in search of greater opportunities for themselves and their families. Immigrants create businesses, fill much-needed roles, and spark our entrepreneurial spirit. Will the Minister of Labour, Training and Skills Development please share with us the changes he's proposing to help thousands of internationally trained immigrants practice their profession or trade? Thank you. Minister of Labour, Training and Skills Development. Well, thank you very much, Mr. Speaker, and I want to thank the member from Scarborough Agent Court for this very important question. Mr. Speaker, he's right. Ontario welcomes more immigrants and refugees than any other province in the country. We're facing a generational labour shortage with 300,000 jobs today going unfilled. Yet only a quarter of newcomers are working in a job that matches their skills. Mr. Speaker, because of the leadership of Premier Ford and our government, we're breaking down barriers so newcomers can unlock their full potential here in Ontario. We're eliminating unfair requirements for Canadian work experience, streamlining language testing and ensuring licenses are processed faster. We're the very first province in Canada to be levelling the playing field for skilled professionals. Thank you. Back to the member for Scarborough Agent Court. Thank you, Mr. Speaker. I hear firsthand from the constituents in my riding how connecting a newcomer with a job here or she is qualified to do means more than just a paycheck. It returns to them a sense of meaning, dignity and purpose and allows them to provide for their families. Can the minister please explain more about how these proposed changes if passed will strengthen immigrants, their families and their communities. Thank you. Mr. Labour. Thank you again to member for this very important question. Mr. Speaker, the changes we're making aren't contentious, they're just long overdue. The endless bureaucracy and red tape newcomers face has denied many the chance to contribute in professions they've trained for all their lives. Our government is working for workers and helping them restart their careers would be life changing. We know, Mr. Speaker, that the NDP is the party of no. But it is wrong that they want to deny newcomers a chance to succeed and keep the engineers and architects we desperately need in taxis. Thank you. Next question, member for Toronto Senate. Thank you, Premier. My question is for the Premier. Over the last few months, tenants have been reaching out to my office shocked to learn that this government will not have rent freeze even though we are still in a pandemic. Many are only now learning that the new apartments and condominiums that they've moved into during the pandemic do not have rent control because of a loophole that this Premier wrote into law in 2018. Gregory is a new resident to Toronto and he contacted my office after learning that his rent would be increasing by 18% that's an extra $350 a month his rent is going up by and that's just for this year. He moved into a brand new unit not realising at the end of his one year lease that his landlord would be able to increase his rent with absolutely no limit. Gregory is furious he wants this government to explain why they cut rent control protections and why this outrageous loophole exists in Ontario at all. Good question. Thank you very much, Mr. Speaker. I appreciate the question. The question highlights the fact that increasingly there is more supply that is in Ontario. Increasingly there is more supply that is coming online in the rental housing sector. Bit ironic coming from this member because she fought very hard to stop affordable housing in her own right. Having said that, we're going to continue to soldier on because we know how important it is to bring more housing supply not only for renters but for individuals who at one day would like to stop paying rent and own their own home. That's why we've brought forward as you all know this will help unleash development of new housing affordable housing around transit locations, transit hubs so that people can get to work even quicker. Having said that, rent control is still in place in the province of Ontario and we will continue to work not only for tenants but for all of those individuals who want to bring more supply online so that we can have really more opportunity for all Ontarians. And the supplementary question. Respectfully back to the government house leader, what is the point of building any new amount of affordable housing if it's not affordable because people are getting $350 a year a month rent increases every single year? Speaker, this government's decision to remove rent control on rental units occupied for the first time after November 15, 2018 because of that tenants now have to worry every single month about being forced out of their units by unaffordable rent hikes. We are talking about economic evictions with no due process. On top of that we know that many of these tenants are still struggling from income and job losses caused by the pandemic. We need to help tenants catch up on their rent to stay housed and then not take the chair out from underneath them before they've had a chance to recover. What does this government have to say to tenants who are now struggling to cover deeply the costs of this government's decision to roll back rent control? Thank you, Mr. Speaker. Well, the member obviously will know that during the pandemic we did stay any evictions, Mr. Speaker. We of course have limited rent increases I believe about 1.2% speakers so a lot of work is being done to ensure that rents remain affordable for the people of the province of Ontario. Ultimately, Mr. Speaker, what we want is to do a supportive system that brings more supply online. That is what will help drive down rents not only in Toronto but across the province. We saw for many, many years that that just simply wasn't the case in Ontario so that is why things like transit oriented communities and other opportunities to speed up development in areas where affordable housing is needed is so important. It is unfortunate that the opposition continues to say no to those types of initiatives, Mr. Speaker, but as the Premier has said, we will say yes to tenants, we will say yes to those individuals that want to invest in bringing affordable housing even in ridings that are represented or don't seek that represented by the NDP. The next question, the member for Don Valley wants. Thank you very much, Mr. Speaker. The people of Ontario are getting a lot of fundraising messages from the Premier these days and in fact, Speaker, yesterday afternoon I received a solicitation from Mr. Kathleen on my work email for claiming that he is the yes man and that I should send some money his way. As I read the email, he's proud of saying yes to the unnecessary Highway 413 and no to environmental protection. He's proud of saying yes to his developer friends and sprawl and no to responsible community building. Needless to say, Mr. Speaker, I am not sold. And Speaker, neither are the thousands of education workers and healthcare workers, the families, the institutions and students who simply cannot understand the big no from this government on mandatory vaccination for education and healthcare workers. Why is the Premier insisting on saying yes to damaging the environment and no to protecting our most vulnerable people, Mr. Speaker? Great to see the former Premier in here today and I find it ironic about fundraising. Yeah, because we get a lot of people who have a lot of traditional liberal vote and traditional NDP vote. They know it. That's why we're here and they are over there. But in saying that I want to remind the leader, the former leader of the liberals, we don't sell $10,000 seat dinners and special events with the ministers like they did. I also want to remind I also want to remind the previous liberal leader that we have not touched the streets, but we've touched it down to seven times, Mr. Speaker. We've even played a grass out of the green belt that we do in backflips, but not with her, buddies, her buddies. It's all about changing the lines.   Speaker, I have a niece who is disabled and who has a severely compromised respiratory system. Her mom died in January and my sisters and I are doing our best to care for her in her home. But, Speaker, we do need to bring in outside caregivers. We all had a shock a couple of weeks ago when we learned that one of the PSWs who was coming into her home was not vaccinated and did not believe in the vaccine. Speaker, even though she was being tested every week, she was putting my niece at risk. Speaker, why does the Premier think it is appropriate to put an already compromised young woman at further risk of illness or death? Minister of Health. Thank you very much. And I'm sorry for the situation with your family member. But we expect health care workers to be vaccinated. We're asking everyone to be vaccinated. That's why we've had one of the most successful vaccination campaigns, not just in Canada, but in the world. We have over 87.8% of everyone over 12 years of age of older having received the first vaccine. We're encouraging people to receive the second vaccine. However, there is a situation as the member will know with health human resources. We expect that if people have not received the vaccine that they are being tested regularly before they go into anyone's homes or before they go to work in hospitals because there's other consequences that could arise as a result of a mandatory vaccine campaign or requirement, which means that we could lose vast numbers of people working both in the home and in hospital who wouldn't be there. So we need to have those people to be there in the hospitals and in home care. But there are safeguards in place for people currently. If they're not vaccinated, they need to be tested regularly to ensure that it is safe for them to go into someone's home response. So I'm going to remind us that the supplementary question needs to be related to the initial question and must follow it logically follow up on the issues that were raised in the initial question as opposed to introducing a brand new issue. The next question, the member for Eglinton Lawrence. Thank you, Speaker. I was happy to hear last week that the government announced that the 2020 to Ontario Municipal Partnership Fund allocations were made so early this year. Ontario's municipalities have faced many challenges during the COVID-19 pandemic. They have faced a variety of new challenges and a once in a century health crisis on top of the old ones. And it's these municipalities, frankly, that are really on the front lines against COVID-19 and fighting our battle there and are also responsible for so many of the services that ensure our quality of life here in Ontario. So Speaker, I would like to ask the Minister of Finance to please tell this house how the government is supporting Ontario's municipal partners through the Ontario Municipal Partnership Fund and other measures. Thank you. The great member for Eglinton Lawrence for that question, Mr Speaker, she couldn't be more correct. Since the beginning of the pandemic, our government has been steadfast in our commitment to make every necessary resource available to protect people and to protect jobs. And part of that, Mr Speaker, is supporting our municipal partners. And we know just how important the Ontario Municipal Partnership Fund is to so many Ontario communities. And that's why we announced the OMPF allocations this year, the earliest they've ever been announced, Speaker. And we heard from municipalities that they wanted stability and predictability, which is why we are maintaining both the structure of the OMPF and the $500 million program envelope for 2022. Because, Speaker, our government is the government that says yes. And we are committed to saying yes to supporting growing our municipal partners who've been on the front line supporting Ontarians since day one of this pandemic. Thank you, Speaker. It's great to hear that this government is using the OMPF to help ensure stability and predictability for Ontario's municipalities in these very challenging times. And I know the news has thrilled many municipalities. But the many people at home may not be familiar with programs like the OMPF or how much the province actually works with municipalities to ensure that they can provide vital services to their residents. So, Speaker, back to the Minister of Finance. Could the minister please provide some detail on any other ways the government has worked with municipalities to support them during the COVID-19 pandemic? Great question. Thank you, Speaker. And again, I want to thank my colleague for the question. And again, she's absolutely right. Supporting municipalities throughout the pandemic has been a huge priority for our government. And keeping the stability of the OMPF envelope is just one part of that effort, Mr. Speaker. From day one, we have been working with all levels government to ensure the municipalities have the support, flexibility, and the tools they need to address the critical public health and economic challenges brought on by the pandemic. In March of this year, we provided almost a billion dollars in additional COVID-19 financial relief for 2021. And this is on top of the historic federal provincial safe restart agreement that our government negotiated. This program allocated $4 billion in assistance to all 444 municipalities in Ontario and 11 public transit systems. This government will never, ever let our municipal partners down. We'll stand with them and support them along the way as they have done for the people of Ontario throughout the pandemic. Thank you. The next question, the member for London. Thank you very much, Speaker. My question is to the Premier. Casper Van der Helm is 90 years old and lives independently at home. He had a catheter inserted after day surgery and was told to wait for a call from the paramet home care clinic to remove it. Speaker, he never received a call. When he contacted paramet himself, he was told they didn't have time to see him and he would have to wait two more days for the catheter to be removed. Later in pain and with pus at the site, Casper was prescribed antibiotics because the catheter had been left in too long. Speaker Casper's story highlights the abysmal treatment that too many home care patients received from paramet and other for profit agencies. Will the Premier apologize to Casper? And will he explain why his government is further privatizing home care when it continually fails the patients who need it? Very much. Well, the situation with Casper is unacceptable. I would agree with you.  That's why we are transforming our health care system with the introduction of Ontario Health and the local Ontario Health teams. With those teams in place, the situation such as Oscar experience should not happen because the partners will provide a warm handoff when someone's leaving hospital to go to home care that they will receive it. Before they even leave the hospital, they will know who's providing the care when and what services will be provided. That's what we need to do to make sure we create an all inclusive, comprehensive, patient centered system of care so that people like Oscar don't have to have the same experience again. Speaker, I didn't hear the minister answer the question as to whether Casper will get an apology. Casper is doing everything he can to manage his own care needs at home, which is important for his well being, but also reduces pressure on our health care system. He deserves home care services that are there when he needs it. Instead, he felt ignored, dismissed and disrespected by Pyramid and developed an infection because of their unacceptable follow up. When my office called the Southwest Linn about Casper's experience, the Linn said they will escalate it, but are having difficulty getting Pyramid to return any of their phone calls. Thousands of patients like Casper are being failed by privatized home care. Again, I asked the minister, where is the accountability? Where is the oversight when even the Linn can't get its calls returned? Well, as I indicated to the member across earlier, this is not a situation that's acceptable. This is something that I will follow up with to understand what the situation is to make sure that Oscar gets the support and services that he deserves. However, the situation, as I described with the local Ontario health teams, is also very important because that is what connects the care for patients. So the patients don't ever feel that they're shut out of their home care system or their health care system in any respect. That's what's been happening to too many people. That is why we are transforming our system of health care to make it truly patient centered. We are also looking at our home care service provision to make sure that home care is there when people need it and that they know what they're going to be receiving and that they have the services they need and the equipment that they need. So while I will look into Oscar's specific situation, we are dealing with the situation, generally speaking, to make sure that every patient receives the care that they need in their home when they need it. Thank you. And the next question, the member for Chatham, Kent Leamington. Thank you very much speaker and my questions to the Minister of Health. In order to get the vaccine numbers up, the science table recommended kids 12 to 17 evaxed. You may remember how when I was back in caucus, I even questioned the safety of such a move. What scientific data? What clinical testing? Size of the test group? Short, mid and long term side effects. It was all inconclusive. Now, many students have developed irreparable heart issues, myocarditis, and then decisions were made to jab kids without the need of parental consent. Only informed consent was given by whom? Peer pressure, coercion, and now you want to inject kids five to 11 years old. How do we know these jabs will be safe? My big guess is that Big Pharma doesn't really know a certainty, but we're given a get out of jail card free because of the rush under emergency youth ossurization. Yet unintended consequences are not acceptable. And I'm fighting for my grandkids and the millions of other little ones who have suffered way too much. So my question, Minister, is why is the government pushing so hard to inject little ones with an experimental drug without parental consent? Doing so was criminal, unconstitutional, and illegal. I'm going to ask the member to withdraw. I withdraw. Minister of Health. Thank you very much, Speaker. And let me say through you to the member that we are not speaking about an experimental drug. These vaccines have been accredited internationally by the World Health Organization, by the FDA, by Health Care Health on Canada, as well as by the national advisory community on immunization. They are safe. They are effective and they are saving lives. We do not give any inoculations or vaccinations to children where parental consent is required. We do not do that. We always obtain parental consent if it is necessary. The 12 to 17-year-olds are already being inoculated. We are waiting for Health Canada consent to be able to inoculate children ages 5 to 11. But it is safe, it is vital, and they are saving lives and hospitalizations and intensive care unit admissions. Thanks, Speaker. Back to the Minister of Health. Doctors are seeing increases in unexpected, vascular adverse reactions in their patients. These include strokes, heart attacks, blood clots, and a never seen before concept of micro-vascular clotting. This is suggested by huge increases in a clotting test called D Diamond. Now in the vaccine clinical trials, the pharmaceutical companies never tested any subjects of blood in the range, in the large phase, rather, in the large phase three trials. And now you want to start jabbing kids 5 to 11. Don't you think that until these trials are completed that the administration of these experimental products should be halted before more Canadians are harmed of all ages? How can the Minister and Health Canada assure Canadians the vaccines are safe when they never looked for safety signals, which were so easy to perform? Minister of Health. Thank you, Speaker. And once again, we are not speaking about experimental drugs. These are vaccines that have been tested at the highest levels. I'm not in a position to comment on the specific trials that were conducted and the effects of them, because I'm not a doctor, nor is the member opposite. However, we do know that people who are experts in this field, the epidemiologists, the people who have developed the vaccines, they've been tested and tested and they are working, they are saving lives, they are saving young people, teens, adults and seniors. We can see that by what's happening in Ontario right now. We have one of the lowest rates of hospitalizations and intensive care unit. Our intensive care unit now has about 130 people in it. Whereas months ago, before these vaccines were being delivered, we're at six, seven, eight hundred. Clearly these vaccines are working. Clearly they are safe and clearly they are needed for everyone. Thank you very much. Next question, the member for Kitchener, Conestoga. Well, thank you very much, Speaker. My question is to the Minister of Labor Training and Skills Development. Minister, our government, under the leadership of the Premier, is making every effort to protect and support our frontline heroes, including those who have kept products that families depend on moving throughout the pandemic. On average, over 200,000 people in Ontario work as mail couriers, messengers and door-to-door distributors. Can the Minister please share with this House how his ministry is proposing to make every day on the road easier for these workers? Minister of Labor Training and Skills Development. Thank you, Mr. Speaker, and thank you to the member from Kitchener, Conestoga for this very important question. Mr. Speaker, we applaud the truck drivers, couriers and delivery workers who have been bringing food to our tables since the start of this pandemic. Thank you for your selfless service to families right across Ontario. Last week, Mr. Speaker, we announced changes to make it law for business owners to let these women and men use their company's washrooms. Delivery workers are part of our team and they've been there for us throughout the pandemic. It's time that we were all there for them. Giving people a clean washroom is a matter of common decency. Thank you. Supplementary question. Well, thank you very much, Speaker, and I can tell you in my riding of Kitchener, Conestoga, I've heard directly from couriers and delivery workers. And these people are really excited to see these big changes. And it's clear our government is standing shoulder to shoulder with hardworking people across my riding and, of course, across the province of Ontario. Earlier in the pandemic, we opened additional rest stops for truck drivers, and it's great to hear we're now doing even more, Mr. Speaker. So, may the Minister please share with us why our government is taking these actions now? Mr. Labour. Well, thank you again to the member for that question. Mr. Speaker, every day our government is working for workers. Last week's announcement is just one of the many ways we are lifting people up and not just going back to where we were before. It is a disgrace and it's wrong that those who go above and beyond to serve our communities need to plan their day around when they can find an open door. The changes our governments introducing give drivers the respect and dignity that each one of them deserve. Mr. Speaker, I hope the NDP doesn't vote no to giving workers a place to go. Next question, remember from a Schegelach James Bay. Thank you, Mr. President. My question is for the Premier. My question is for the Premier. Government made an announcement about reducing gas tax by 10 cents a liter. Looking at gas pricing in my riding today, it is clear that this government did not intend to protect consumers. I say this at a time when the lowest price of gas in my riding sits at 157.9, 144 in Huntsville and an average of 142 in Kingston. Nordiners need to travel for medical appointments, for work. Having to pay 157 for gas is frankly unacceptable and practically unaffordable. Mr. Speaker, will the Premier act rather than continue to stall like the Liberals before them on a problem that is hitting Nordiners harder than anyone else and offer relief at the pump? Thank you, Mr. Speaker. Well, of course, we offered relief the moment we came into into office. Mr. Speaker, we didn't wait. Speaker, we knew how important it was to continue to make life more affordable for the people of the province of Ontario. It was this member who supported initiatives by the previous Liberal government that saw the gas tax increase, Mr. Speaker, through a carbon tax. We have said right from the beginning that we were not going to support a carbon tax. We fought against the carbon tax, Mr. Speaker. We were able to reduce the cost to all Ontarians when one of the first things that we did was remove that tax on the people of the province of Ontario. Speaker, he now supports and his party now continues to support a federal carbon tax colleagues that could reach 38 cents a liter. Speaker, 38 cents a liter, we will continue to fight that speaker because we don't believe that is the best way to reduce our emissions in the province of Ontario. Mr. Speaker, we've seen the cost of the carbon tax all across, not only Ontario, but across Canada. And I would ask the member to support us in stopping that. Mr. Speaker, the premier again. I feel like the member of this government do not understand what a promise is. Considering the price of the gas prices right now, families have to choose between gas or to eat. Residents in my constituency are have are struggling because of gas prices. It's already three years with nothing being done. You could have act on this front, but there was a bill that was tabled by the Prime Minister, but it's still on the table. Obviously, this government is not listening. Will the premier stop ignoring this problem and wait or wait until gas prices reach $2 before he acts on his electoral promises? Thank you, Speaker. This is not true. We have reduced taxes for all Ontarians immediately. We've started on day one. We wanted to eliminate with the we wanted to eliminate the carbon tax, obviously. It is not. That tax is not in the best interest of taxpayers in Ontario. Consider again. How important it is that we eliminate this carbon tax, Mr. Speaker. A thirty eight cent carbon tax will not help the people of Northern Ontario. We are seeing the impacts of that every single day. Inflation has gone up across the board, not only in Ontario, but all across Canada, Mr. Speaker. We said it right from the beginning when you increase the cost of getting goods to market, prices will increase. That is why we fought the carbon tax, Mr. Speaker. But that doesn't mean we have to stop fighting to make our environment cleaner, Mr. Speaker. And that is why we do that. Thank you very much. The next question to member for on a lot so. Thank you much, Mr. Speaker. My question is for the premier. Ontario's nurses have been in the front lines of the pandemic. They've been working flat out for the last 19 months, often going above and beyond the call of duty. So many of them are exhausted and burnt out. We have a nursing shortage due to stress and an increasing workload that's causing too many to leave the profession. So the premier calls the nurses heroes their reward bill one twenty four and a one percent wage freeze. The premier can say that he values nurses on one hand in one breath and then say in the next breath you don't have the right to bargain fairly for your wages. And by the way, they're frozen. So speakers through you will the government show that they really value nurses that the premier really values nurses by repealing bill one twenty four. Allowing the bargain for a fair wage and address the nursing shortage here in Ontario. The parliamentary assistant member for Aurora Oak Ridge is Richard. Thanks very much. Thank you, Speaker. And I want to thank the member for the question. And let me start off again, Mr. Speaker, by thanking all our health care workers who've been on the front lines every single day, Mr. Speaker. And it really is because of the selfless and dedicated in the individuals that all Ontarians are able to move forward and away from this challenging period, Mr. Speaker. And we're fully aware of the critical role that our health care workers have played throughout the pandemic. And we are incredibly grateful for the sacrifices they've made. Speaker, our health care heroes are the reasons that patients were able to receive timely, safe and equitable access, which is why, Mr. Speaker, we invested over fifty two million dollars to recruit, retain and support over thirty seven hundred more frontline health care workers and caregivers. Mr. Speaker, the one bill one twenty four that the member is referring to is designed to protect public sector jobs and vital frontline services that all Ontarians rely on, Mr. Speaker. And it's inaccurate to suggest the bill one twenty four caps wages, Mr. Speaker, because they can receive salaries for seniority. Thank you very much. Thank you. What's up? Thank you, Speaker. I'll do respect to the member. His thank yous, the government's thank yous. They don't buy groceries. So, Speaker, the government's just not listening to Ontario's nurses. And for three months now, Ontario's nurses have been calling for mandatory vaccinations for frontline health care and education workers. So of Ontario's hospitals, Ontario's doctors, Ontario's schools and the COVID-19 science table, they all want to do this to protect the most vulnerable and also to have a safe workplace. And just like the Minister of Long Term Care says, mandatory vaccinations will they prevent staff shortages due to an outbreak caused by an unvaccinated staff member? That's what I don't understand why the government doesn't understand the Minister of Long Term Care. So the government's ignoring nurses on mandatory vaccinations for frontline workers and by refusing to repeal Bill 124. So, Speaker, at what point? Question. At what point is this government going to listen to nurses, repeal Bill 124, and make vaccinations mandatory for frontline health care and education workers? I want your assistant to reply. Thank you very much, Mr. Speaker. And I do thank my colleague for the question he referred to Ontario hospitals and Ontario schools in order to remind everyone that's watching and my colleague that it was his party and his government that cut funding in our health care system, Mr. Speaker. That cut funding in our education. It was our government that increased funding, Mr. Speaker. We've taken real decisive measures to support our frontline health care heroes, Mr. Speaker. We have invested, as I said, money to be able to recruit, retain and support our staff. We always have their back throughout the pandemic, Mr. Speaker, because they've been on the front lines, helping us, having every single Ontario. It's this government, this minister, this premier that will always stand up for them today, tomorrow and long after the pandemic, Mr. Speaker. That's the question. Member for Toronto, Dan Ford. Thank you, Speaker. My questions for the Premier. Last week, the Premier announced another round of raises for PC MPPs. That's right, Speaker. The Premier who originally ran on a promise to stop the gravy train now has more gravy going around than on Thanksgiving and Christmas Day combined. Can you imagine? Speaker, on top of a big $30,000 raise to the Premier's right-hand man and new Minister of Legislature, Reynolds, he also gave a big raise to the former, now demoted, environment minister. This is the minister with one of the worst records on climate and the minister whose attempts to drag us back to the Stone Age are still being fought in court. Speaker, my questions for you to the Premier. Why do PC ministers deserve a pay raise but hardworking front-line workers and minimum wage earners deserve virtually nothing? Mr. Speaker, what you see from the NDP day in and day out is a party that is literally bankrupt of any ideas whatsoever, Mr. Speaker. What we are doing and what we've decided to do from day one is to reinvest in the people of the province of Ontario, something that they have fought against every single day. We've made costs. We've reduced costs for the people of the province of Ontario, reduced costs for small businesses. The Minister of Labor is working on new bills to ensure that our front-line workers have access to them. The different things like the washroom, Mr. Speaker. The Minister of Small Business is making sure credential recognition is finally something that happens in the province of Ontario, something they've talked about, something they talked about, but we'll get done, Mr. Speaker. We're talking about building transit and transportation. That member talks about it. We'll get it done. They talk about reducing costs for people. They talk about it. We get it done. They talk about a clean environment. You talk about it. The member for Hamilton East, Stony Creek, will come to order. The member for Hamilton East, Stony Creek, is warned. The member government house leader will withdraw. I withdraw. The member for Hamilton West and Castor Dundas will withdraw. Anybody else want to withdraw? Supplementary question. Start the call. Thank you, Speaker. Again to the Premier. The Premier and the Minister of Legislature, Reynolds, who just spoke, justified their big payout by saying it's better for everyone to have politicians in charge of these kind of things, Reynolds and some purchases. Speaker, the last time politicians were in charge of or tried to put themselves in charge of purchasing things like this, the Premier tried to buy himself a pimped out ride on the taxpayer dime. Ask the member to withdraw. I will withdraw. My question through you again to the Premier. Nurses, PSWs and other frontline workers, including minimum wage workers, put themselves on the line every day during the pandemic. I'll ask again, why are they worth less than PC party MPPs and the Premier's buddies? Will he repeal Bill 124? Mr. Speaker, we have come to office and we came to office and we had to restore the province of Monterra, the economic engine of this country. Mr. Speaker, this is something that this member voted against, of course. We saw the previous Liberal government close, I think over 600 schools. We're seeing this Minister of Education build new schools. Mr. Speaker, we saw the previous Liberal government build next to no long-term care. We see this government and this minister building 30,000 new spaces, long-term care spaces, Mr. Speaker. We saw these members talk about affordability. We're seeing us do something about it, Mr. Speaker. We're reducing costs for a small, medium and large job creators, Mr. Speaker. We hear them talk about health care all the time about it. It's this minister who's increased ICU capacity It's this minister that has increased funding for our health care professionals, Mr. Speaker. What has that member accomplished? Well, he's been able to say no constantly and in a what, 30-year career? Not. Thank you very much. The next question, the member for Chatham Kent Leamington. Thank you again, Mr. Speaker. My question to the Minister of Labor. I'm hearing from constituents both in and outside of my writing of their fear of losing their jobs, all because their employer is threatening to fire them if they don't get the vaccine. My question, who mandated mandatory vaccines for these long-serving employees? You're announcing funding for employers, but as new hires come in the front door, many are going out the back door. So my question to you, Minister, is will you direct these employers to discontinue these firings? Employees' choice should be respected. Labor, training and skills development. Mr. Speaker, again to the member opposite, we're going to continue working every single day to protect the health and the wellbeing of all of the people in this province. We've come so far, Mr. Speaker. We don't want to jeopardize the gains we've made. We need to continue to promote health and safety. That's why we've added a hundred new inspectors to ensure that workplace protocols are in place. Mr. Speaker, the Minister of Health has been leading the charge to encourage people to get vaccinated. We heard today that about 89% of people have had their first dose here in the province. 84% approximately have had their second dose. This is how we've come so far as a province. And Mr. Speaker, it is the responsibility of every MPP in this house to encourage people to get vaccinated. Let's get through COVID-19 once and for all. Supplementary question. Thank you, Mr. Speaker. And again, back to the Minister of Labor. You know, workplaces were safe before as COVID protocols were, in fact, put in place. And people were working safely now in health care. As an example, respectfully, health care workers have gone from heroes to zeros. We are inadvertently creating a labor crisis in all sectors. So, Minister, will you step in and save these employees from losing their livelihoods? It is unfair and it is unconstitutional. Mr. Labour. Mr. Speaker, on this side of the house, and I would say that the overwhelming majority of MPPs in this chamber believe that every single health care worker in Ontario is a hero. And we're going to continue to ensure the health and safety of those workers, those people that use our health care facilities are protected. We're going to work every day always to protect the health and well-being of all of the people. That is the responsible and the right approach to battling this pandemic. Mr. Speaker, that's why on day one when COVID hit the province, we brought in job protected leave. If anyone was impacted by COVID-19 to stay home. Mr. Speaker, we issued hundreds of guidance documents, posters and tip sheets and videos in multiple languages to protect all workplaces in this province. We move forward almost immediately to hire 100 new health and safety inspectors. That's the largest inspector at response in provincial history. My message to everyone in every sector, employers, employees, let's keep working together. We've made so many gains. We're leading the Western world. Let's keep it going. The next question from the Minister of Ottawa. Thank you. Thank you, Speaker. Speaker, last week, a man visited Ottawa Centre to protest what he called gender ideology. The previous week, this same person filmed children outside Toronto schools while displaying transphobic messages. And he tried to do the same thing at three schools in Ottawa. We organized in Ottawa, Senator Speaker, my questions for the Premier, pardon me.  We took a stand, Speaker, but we want this government to take a stand too. Will the Premier openly denounce this hate that we saw in Toronto and Ottawa? And will he support school safety zones to make sure people promoting hate speech against anyone are not allowed to harm children at our schools? To apply to government hate speech. Sorry, Mr. Speaker. I don't think anybody would disagree that on all sides. And I know that that's not the members in suggesting that anyone in this chamber wouldn't disagree with anybody who's encouraging hate to anybody, Speaker. That's predominantly what our main purpose is here is to make sure that people are safe. So I will say that with respect to enforcement, there are a number of laws that are already in place to ensure that that people remain safe in their communities. I understand how challenging it must be. But again, there are rules in place and those rules should be enforced by local law enforcement at the same time, Mr. Speaker. I know that that member and all members, of course, would denounce anybody, anybody respond who would say things or bring harm to anybody in the community, make people feel unsafe in their community. I think we would all agree on that. Complementary. Thank you, Speaker. While I appreciate the sentiment the House leaders just expressed, the fact of the matter is that this gentleman has been in two communities in Ontario and we have not heard from the Premier, who is the leader of this province about whether this man's views are welcome in the province of Ontario. There's been no comment despite this being not just a municipal story in Ottawa and Toronto, a provincial and a national news story. The silence is deafening. And when I hear the House speakers say that we have laws that are good enough and that if we just ignore these acts after episodic comments, it'll go away. History tells us different, Speaker. I want to quote the Southern Poverty Law Centre. They say in the face of hate, silence is deadly. Apathy will be interpreted as acceptance. And if the victims will be left unchallenged, hate persists and grows. We need clarity, Speaker. We have been in touch with law enforcement officers who have said the law does not allow them to take a gentleman who is promoting transphobic hate, who is asking our children to hate themselves who are already in a highly vulnerable position to hate themselves. We have done days against transphobic hate in this legislature. We need this Premier to be clear. Does he support what this gentleman did? Question. Are we going to take a step in this province to make sure no one does this outside of school ever again? Yes or no? And once again, go ahead, please. Speaker, look. It should be very clear to this member and to all members of this this assembly that there is absolutely no place in this province for that type of behavior. This is a legislature that recognizes and holds a moment of silence for the trans community, Mr. Speaker, by law, something that was brought in by one of the former members of that party. This is a legislature that actually stopped question period, stopped question period for the first time ever to make sure that we could recognize and pay and pay respect for for that community, Mr. Speaker. So very clearly through you to the member, Mr. Speaker, there is absolutely no place in the province of Ontario for beliefs like that. There is no place for that. This is a welcoming province, Mr. Speaker, it is a province that we've said it and we're all proud of proud is built on diversity, but it is a province that will protect everybody's right to be who they are, Mr. Speaker. That is what our main job here is in this place. Yes, we can talk about economy, we can talk about health care, but our main job is to protect all Ontarians and we will continue to do that. And this premier will make sure that that continues to happen. Thank you very much. I can change our question period for this morning. We now have a deferred vote on private members. Notice of motion number four has moved by Ms. Fight. The bells will now ring for 30 minutes during which time members may cast their votes and I will ask the clerks to please prepare the logics.