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.

Intuitive Lessons from The Pandemic – A Fantasy

This post is not based on comprehensive research or particular expertise on my part. Rather it is more what we would have called “common sense” before Mike Harris completely destroyed the meaning of the phrase.

We start off with the most obvious. We need a public health care system that is not overloaded to begin with. We can solve two problems here, provide pandemic readiness and provide timely life enhancing health care. We currently provide timely care for life threatening situations like cancer, heart surgery and emergency trauma but have created an artificial class of so called “elective surgery” we consider to be of lesser importance. This includes things like hip and knee surgery and replacements and many other types of health care that are necessary to allow people to live fulfilling lives. Health care is much more than preventing premature deaths. If we provided the necessary resources to provide all necessary health care without unreasonable wait times we would have the capacity to deal with a pandemic without putting peoples lives at risk.

Equally obvious is the need to bring long term care into the public health care system. Before the pandemic the horror stories of private long term care were well known even if the body counts were not as inexcusable as they became with the pandemic meeting the profit motive.

And still looking at the health care system, why did doctors offices shut down or become virtual during the pandemic when they should have been part of the response to it. Family physicians provide the first source of diagnosis for many serious illnesses like heart disease and cancer where early detection can be a matter of life and death. The system may respond quickly when these diseases are diagnosed but it does not respond at all when they are not detected. And why was the network of family physicians not used for pandemic testing and vaccinations.

And what of government policies. The big thing we got right was vaccines. In comparison to some jurisdictions to the south of us, all jurisdictions understand the importance and effectiveness of vaccines. The federal government did an admirable job of making vaccines available to the provinces and the provinces did a decent job in administering them. The main things Ontario could have done better was utilizing doctors offices and the school system to more efficiently get vaccines to the public.

As to the timely and appropriate response to the threat that is where we could have done better. We knew it was coming but we didn’t know what it would be like so it was a learning process. There is lots to criticize in hindsight but more importantly is learning going forward.

The biggest lesson was that internationally jurisdictions that put public health first and took strong, even drastic, measures quickly were able to get out of it faster than those that took half measures being more concerned with protecting the so-called economy than the public’s health. Having a provincial leader that considered himself a “businessman first” and by implication a Premier second did not help. We are still stumbling through in Ontario.

What is saving us is our sense of community. This works on two levels. On the personal level, it means in our personal behaviour, such as distancing, mask wearing and getting vaccinated, we base our decisions not just on what will keep us safe but also on what will keep our neighbours safe. This has made the big difference on how Canada has fared, compared to the United States, who arguably had better resources available to fight the pandemic.

The other level is the collective level, our collective actions taken together through our governments.

Here we are talking about three levels of government, federal, provincial and local, sometimes with differing philosophies and priorities. We really need to find a way to make federalism work better in these sorts of, not just national but international emergencies, climate change being another example.

If the pandemic has shown us anything is that individual action cannot replace collective action, and some things are just done better by acting collectively rather than acting individually. This is where we need to do better, particularly by strengthening our health care system and providing social supports. We are not financially prepared for the next pandemic because the political parties in power have chosen to go down the populist road of under-taxation thinking that would buy them votes. This is perhaps the most disastrous public policy position of the last half century.

Fortunately, because of that trend, there is substantial room to increase taxes to fill the void, particularly on that portion of the population that are excessively wealthy and under-taxed. This is a group in society that actually stands to gain more from collective spending by government than they can from individual spending by themselves. There is only so much you can spend on a wealthy lifestyle and the benefits of a better society far outweigh the benefits of people who have everything buying more everything for themselves.

We can be better prepared next time, and there will be a next time, but only if we choose to.

And the fantasy part – the belief that those in power will actually choose to learn these lessons and implement the necessary measures.

Public Education and Public Health - The HPV Vaccine

I was all set to go on a tirade against the Catholic school system for attempting to thwart local health units HPV vaccine programs. However it appears that the boards have backed down from their threat to put religion before public health. But it could have happened.

The Catholic Church is free to have it’s religious position on non-marital sex but do the church leaders really believe that Jesus would have thought cervical cancer was an appropriate punishment for engaging in non-marital sex.

Our public health system uses the school system to provide effective and efficient vaccination programs. None of the vaccines provided are without controversy, including the HPV vaccine. But it is the responsibility of our public health system to decide which are appropriate to be provided, not the responsibility of religious leaders. The HPV vaccine program is supported by medical experts as well as federal, provincial and local health officials.

This is just another example of the problem with publicly funded religious based schools. It goes beyond education into public health. The Catholics may have backed down but there are certainly many “Christian” and other religious schools that will not allow public health units to use their schools to provide the HPV vaccine, or perhaps any vaccines. With the extension of public funding to all religious schools this will become a real problem, whether the schools co-operate or not.

The benefit of using the school system to provide vaccinations, and this applies to all vaccines including the standard childhood vaccines, is the efficiency provided by only having to deal with two school systems in each community. With public funding of all religious schools we will undoubtedly have more of them and the effectiveness of using the school system to provide vaccines will be greatly diminished.

And, of course, the effectiveness of sex education to prevent the spread of STDs and HIV/AIDS, as well as reduce teenage pregnancies, will also be reduced by the increased number of religious based schools.

Public education and public health go hand in hand and that is just one more reason to have a single public education system.