COVID-19 Pandemic Reflections and The Next Pandemic

Well the pandemic is over, at least according to most governments, science and medicine not so much. So now it is time to look back, and to look forward.

Perhaps my biggest reflection is that governments, at least in Canada, did not receive the rational criticism for their failures that they should have. The media was intent on concentrating on the irrational response of the anti-science, anti-public health, anti-vaxer crew who were co-opted by the far right white supremacist convoy types in Canada. The left, on the other hand, felt so strongly the need to defend the principle of governments acting to protect Canadians from this deadly pandemic that they failed to properly criticize governments failures in doing so. Not that there was no rational criticism, but what there was was overwhelmed by the Freedumb Convoy Shitshow.

The biggest failure was in not being prepared, even though scientists and public health officials had predicted that pandemics would be commonplace in the future, along with not following the precautionary principle and treating it as airborne until that could be completely ruled out.

But the most egregious, and I would say unforgivable decision, was to not utilize the front line of our health care system, but rather shutting down the vast majority of family physicians’ offices pushing an even greater workload onto the overwhelmed hospital system. This was either complete negligence on the part of the health care system or a clear indication we don’t actually have a health care system but just a bunch of disconnected parts.

As far as messaging goes, we had the use of the language “social distancing” rather than “physical distancing” at a time when maintaining social connections was critical to people’s mental health. Along with that error in messaging was the message to stay inside, rather than stay away from other people, at a time when getting outdoors (with appropriate precautions) could be critical people’s mental health.

However, in the long run, if only coincidental, there is some truth to the arguments for “no more lockdowns” and “we have to learn to live with the pandemic”.

If and when pandemics become a normal part of our reality we will indeed have to learn to live with them and it will not be sustainable to completely shut down our economy and society everytime they occur. Shutdowns or lockdowns, whatever you want to call them, will have to only occur rarely and for short periods when necessary to get an initial grasp of what is happening. And they will of necessity have to be political decisions.

But living with pandemics does not mean ignoring them. It means taking necessary precautions, such as physical distancing, masking with high quality masks, extensive vaccination programs, and, at times, restricting the highest risk activities such as large indoor gatherings of people packed closely together for long periods, methods that have been proven to work and reduce the incidence and seriousness of the outbreaks and most of all save lives.

But most importantly it means being prepared beforehand.

The first step in being prepared is having a primary care system where everyone has access to a primary care physician. In Ontario everyone does not have access to a primary care physician so we urgently need to drain more family doctors, fast track the approval of foreign trained doctors to work in Ontario and increase immigration and training of doctors from abroad, along with increasing the number of nurse practitioners available. And, of course, not shutting the primary care system down during a public health emergency.

We also need to have a hospital system that is not running at over 100% of capacity during the best of times. How do we build in excess capacity without it being inefficient. By using that excess capacity. As it is now so-called elective surgery is ridiculously backlogged. But this elective surgery is not elective at all. What we call elective surgery is surgery for non-life threatening conditions. Knee and hip replacements, eye surgery and many other so called elective surgeries may not be life saving but they certainly can be life changing for many patients for whom they make life worth living again. We can then, in the case of a public health emergency, divert that capacity to save more lives during a future pandemic. Purpose built publicly funded and operated specialty clinics can be part of that solution, and can be used to treat pandemic patients separate from hospitals, reducing the risk of infecting patients in the general hospital population.

And, though it need not be said, when the problem is the lack of doctors and nurses adding profit into the system is not going to solve the problem, only add unnecessary costs.

It also should not have to be said that the lives of vulnerable elderly persons should not be routinely sacrificed to ensure the profit margins of private long-term care facilities, creating a situation where those needless deaths increase exponentially during a pandemic. Being prepared for future pandemics requires that all health care should be publicly funded and operated. Private profit has no place in health care because that profit always has to come at the expense of patient care.

The other need for preparedness is economic. During the COVID pandemic the government scrambled to implement makeshift assistance programs for those economically impacted by the pandemic, and though it helped many it was a very messy solution. What we need is a permanent solution that will not only deal with public health emergencies but also with the economic disruptions of a transition from a fossil fuels based economy to a sustainable energy based economy. What we need is a guaranteed basic income along with a fair progressive taxation system.

There is no justification for not being prepared for the next pandemic.