This flu season, remember Sweden’s no-mask pandemic success (repost)

As flu season returns, some public health authorities are considering the return of mask mandates. PHOTO BY GETTY IMAGES/ISTOCKPHOTO

I wrote this to emphasize Sweden’s reliance on voluntarism and common sense. For some readers, the whole piece was about masks. Sorry about that. It generated 535 comments on the National Post site.

New COVID variants, cooler weather and crowded classrooms have made many people wonder when, not if, restrictive public health measures will return.

Before 2020, we dismissed seasonal flu bugs and reacted in surprise at overcrowded hospitals each January. Today, Canada seems primed to embrace restrictive measures to “protect the system.” Many other countries would agree.

Sweden stood alone during the pandemic. The Swedes stuck to the standard pandemic public health protocols of the time. They refused to follow the restrictive European public health crowd, demanding evidence before adopting the new method. As a result, Sweden experienced the lowest rate of excess mortality in Europe.

Why don’t we learn from Sweden?

Matt Hancock, Britain’s former health secretary, privately called it the “f—–g Sweden argument.” Hancock saw no need for discussion. At the height of the pandemic, he instructed an aide to “supply three or four bullet (points) of why Sweden is wrong.”

Of course, Hancock never intended these writings become part of The Lockdown Files, an investigation by The Telegraph into 100,000 leaked WhatsApp messages exchanged within the British government during the pandemic. Regardless, his comments captured what every other government did: dismiss or diminish Swedish pandemic performance.

Sweden’s voluntary approach resulted in far fewer deaths during the pandemic, no matter how you measure it.

Canada performed better than most of Europe, but not as well as Sweden. In early 2023, Statistics Canada reported that there were 7.6 per cent more deaths than expected between March 2020 and August 2022. Of the country’s 53,741 excess deaths, 42,215 have been attributed directly to COVID-19. Canada beat Europe’s average excess mortality rate of 11.1 per cent from 2020 to 2022, but not Sweden’s 4.4 per cent.

In a new analysis for the Cato Institute, Johan Norberg describes how Sweden followed a voluntary approach to pandemic policy interventions. Its emphasis on personal responsibility achieved the smallest economic impact, and the least educational loss for students.

Voluntary action does not mean zero restrictions. Sweden limited public gatherings (for example, in theatres and churches) to less than 50 people, but it did not restrict “workplaces, shopping centres or private gatherings.” It banned private visits to nursing homes. Bars and restaurants could offer only table service, and alcohol sales had an earlier cut-off time during 2020 and 2021. Universities and secondary schools were recommended to go online.

However, preschools and elementary schools stayed open. Borders stayed open; no curfews or stay-at-home orders were made; no state of emergency was declared. Public transportation kept running, and there were no mask mandates, especially in schools.

Past experience does not guarantee future performance. In a society that craves certainty, medicine cannot eliminate all cause for anxiety. Therein lies the crux.

The new BA.2.86 COVID variant has some specialists in Ontario and British Columbia concerned. We could even face COVID, RSV and influenza all at the same time: a “tridemic.” Some are calling again for masking. However, Ontario Education Minister Stephen Lecce announced last week that his province’s schools would not make masks mandatory.

Many experts in acute care hospitals seem determined to bring back masks for any virus, despite the evidence. In 2019, the World Health Organization (WHO) published an extensive review of “non-pharmaceutical public health measures” for mitigating influenza. The WHO could not find any evidence that wearing a mask reduced influenza transmission. A Cochrane review published in January also found little evidence to support masking. A study of a London hospital in the United Kingdom during Omicron demonstrated no difference in hospital transmission rates with or without mask mandates.

Dr. Martha Fulford, an infectious disease specialist in Hamilton, Ont., says that new mask mandates are a matter of optics.

“The sad part is that I think masking is now being done because (hospitals) are expecting increasing patient volumes as (respiratory virus) season starts up,” Dr. Fulford told me in a direct message late August. “They have built zero extra capacity, and the masks make it seem like they are doing something. It’s not about data; it’s all about optics…. Now we are just masking for any old virus, it would seem.”

Mandatory masking relies on force to implement. Sweden avoided force, relied on voluntary measures and outperformed its neighbours as a result.

The Lancet published research in June which suggests people transmit viruses primarily when they have viral symptoms. Simply finding virus particles on a nasal swab probably does not matter anywhere near as much as feeling sick. Applying those findings, we can probably go to work safely when we feel well, and we should probably stay home when we feel sick. Healthy people are healthy — who knew?

In a crisis, governments crave conformity, not individual success. Sticking together matters more than standing out. As such, Sweden drove neighbouring governments nuts. The Swedes outperformed everyone else. Maybe we can learn from them.

Jordan Peterson’s regulator is fighting for itself, not patients (repost)

Here’s a piece the National Post just published. Check out the comments on their page and leave your own here!

Jordan Peterson’s regulator is fighting for itself, not patients

Professional colleges claim that they serve the public, but self-interest is the priority

Jordan Peterson’s fight with his professional regulator, the College of Psychologists of Ontario, reveals the heart of battle between professionals and the regulatory state: it’s the self-interest of the regulator, rather than the wellbeing of patients, that is the priority.

Last spring, the college investigated several complaints about Peterson’s tweets on politics, social issues and transgenderism. Complaints came from concerned citizens — not Peterson’s clients. In November, the college ruled that Peterson’s conduct “poses moderate risks to the public,” and was “degrading to the profession.”

For Peterson to keep his clinical license, the college required him to hire a coach, at his own expense, to learn how to tweet in a professional manner. Peterson appealed this to the courts, countering that the college had no business adjudicating private political commentary. Last week, three judges in the Ontario Divisional Court ruled for the college.

The case raises obvious concerns about free speech, Charter rights and professional regulation. Surely, the college saw these issues coming — yet it still chose to pursue Peterson.

Ignorance or maleficence explains many of the silly things regulatory colleges do, but not all. We must also consider self-preservation. According to the college’s decision, which was quoted in last week’s court ruling, Peterson risked “undermining public trust in the profession of psychology, and trust in the college’s ability to regulate the profession in the public interest.”

Peterson’s case pivots on public trust in the college, not patient safety. No active patients were involved; Peterson named public figures and mentioned on a Joe Rogan podcast that a “vindictive” former patient, who was not named, had once filed an unfounded complaint about him. The college felt the comment was inappropriate and warranted re-education. The only entity at risk in the Peterson case is the college itself. Why worry so much about public trust?

The College of Psychologists is one of 26 distinct regulatory colleges in Ontario, which regulate 29 separate health professions. Each college reports to the Minister of Health, as outlined in the Regulated Health Professions Act.

Like other public institutions, such as hospitals and public schools, regulatory colleges answer to government. Colleges must appease the minister and maintain a “tough on crime” public image.

This puts colleges in a bind. They say they have a “duty to protect the public, making sure healthcare professionals are safe, ethical and competent.” But colleges cannot stay in business without government support.

Each regulatory college collects membership fees (dues) from its members. For example, the College of Physicians and Surgeons of Ontario collects $1,725 each year from the province’s 31,500 practicing physicians, in addition to a long list of other fees. The College of Psychologists has half as many psychologists and lower membership fees, but it’s still a multi-million-dollar organization filled with well-paid employees.

If college employees want to keep their jobs and protect their organizations, they must serve one master while pretending to serve another. They must maintain a public image of pure devotion to patient safety, even though serving government remains their primary concern.

This problem is not unique to regulatory colleges; economists and institutional theorists call it the “principal-agent problem.” Public institutions often face conflicts of interest. They say they exist to protect the public, but they must protect themselves. They cannot avoid self-interest.

The Ontario court chose to ignore the principal-agent problem. Instead, it focused only on whether or not the regulator had the right to restrict Peterson’s freedom of speech, outside of clinical practice. (Presumably, the court is not immune to the principal-agent problem either.)

In fairness, some of Peterson’s social media comments are cutting. Screenshots pasted into mainstream media create an effect much like locker-room banter at a dinner party. Right or wrong, speech codes differ by audience and location. Regulators shouldn’t have a right to control it all.

The colleges might protest they are simply bound by legislation to restrict the speech of professionals. Regulatory control ballooned when Bob Rae’s New Democratic Party tabled the Regulated Health Professions Act; we should blame Rae and not the regulators, they could argue.

It’s true that the case against Peterson could not have occurred without the enabling legislation. Even so, regulators should not say they simply serve the public when they (clearly) prioritize their own public image.

‘Noses in fingers out’ – How Danielle Smith could transform healthcare (repost)

In case you missed my op ed. It’s available on the NP website also.

Albertans re-elected Danielle Smith’s United Conservative Party with a majority last week. Smith now offers a chance to change the way we think about health care — a radically conservative vision. What might that include?

Many conservatives trumpet out-of-pocket payments as the embodiment of conservative health-care policy. Danielle Smith’s critics inflamed fears of patient payment central in their campaign attacks.

One month before the election, Smith took out-of-pocket payments off her campaign table.

“I believe actions speak louder than anything,” said Smith. “One of the first things I’ve done as premier is sign a 10-year, $24-billion health-care agreement with the federal government, where we jointly agree to uphold the principles of the Canada Health Act.

“One of those main principles is no one pays out-of-pocket for a family doctor, and no one pays for hospital services. That’s in writing.”

Smith’s pledge of allegiance to the Act sounds like other conservatives who have caved before her. True, Smith might govern health care like other “conservative” governments. But her pledge need not bind her. A big opportunity lies at the heart of her pledge, if she has the courage to chase it.

The “accessibility” principle of the Canada Health Act bans out-of-pocket payments: “charges made to insured persons.” Out-of-pocket charges disqualify provinces for federal health transfer payments.

The accessibility principle is the only reason the CHA exists. The first four principles — public administration, comprehensiveness, universality, and portability — come from the Medical Care Act, 1966.

Many conservatives bristle at the Canada Health Act, precisely because of its ban on patient out-of-pocket payments. That is partly right but mostly wrong. Yes, the CHA prohibits federal transfer payments to provinces which allow user fees for medical services. But no, that is not why Canadian medicare suffers.

Conservatives bristle at the wrong end of the bill. Conservatives fume at federal overreach on access but forget the CHA’s first principle, public administration. Continue reading “‘Noses in fingers out’ – How Danielle Smith could transform healthcare (repost)”