Category: COVID

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.

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.

Doctors are at high risk for becoming bossy — especially towards their colleagues. Otherwise kind, rational doctors can become tyrants in the face of chaos and fear.

If we were hunting for bossy docs, we might start with medical leaders and physicians in niche specialities.

External Causes

Leadership carries a high risk for bossiness.

Some medical Chiefs gain humility from caring for sick complex patients. It shapes their approach to leadership. Unfortunately, many forget their failures. Others never learned in the first place.

Many Chiefs of Staff have never seen sick patients at all. But as Chief, they see all the medical disasters and deal with the most difficult doctors. They run the risk of thinking all docs are difficult and basically failures waiting to happen.

Like leadership, some specialities are also more likely to foster bossiness. Niches with low medical risk and high paternalism present the biggest risk. These docs never see sick patients but spend all day giving definitive advice.

However, chiefs and niches do not explain enough. Not all docs become bossy from being chief or a member of a medical niche.

Blaming bossiness on a chief-niche explanation assumes an external locus of control: bossy docs were victims of a bossiness-inducing environment.

7 Reasons Why Some Doctors Become Bossy

We could also assume an internal locus of control. What goes on inside a doctor to make him/her so bossy?

A. Good intentions

Children torture kittens with cute outfits, “Because Kitty likes it.”

Parents torture children with cute outfits, “Because it makes you look smart, dear.”

Politicians torture citizens with things they would never choose themselves — so-called merit goods.

Doctors do the same.

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies.

The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

CS Lewis

B.  Habit

Many doctors give orders for a living.

A group of us asked a young cardiac surgeon about life with his new baby. Had he changed any diapers yet?

In a heavy accident, he said:

“Oh sure. I call my wife. She comes. I hold out my hand, like this.”

He held out hand, palm up.

“Then I say, ‘Wet wipes!’ And she give it.

‘Lotion!’ And she give it.

‘Diaper!…’

Just like surgery.”

C. Prudence

Most doctors are practical. Especially in procedural specialties, we use the shortest path between intervention and outcome.

Barking orders wastes less time than decision by committee.

D. Ignorance

Doctors do not study leadership to become doctors. Aside from loads of math and science, most doctors do not study much of anything else. Medicine demands total commitment without room for non-clinical things.

E. Hubris

Many docs assume they are so much smarter than everyone else that they should be the boss.

F. Arrogance

Arrogance goes beyond hubris. Some doctors cannot tolerate anyone else in control. They hold others in disdain.

G. Maleficence

A few doctors hate their colleagues. They want to cause pain. A position of power, such as Chief of Staff, lets them exercise their wish.

Hubris, arrogance, and maleficence are less common, but we have to admit they exist.

Helpful Bossiness

Many situations demand a level of control which looks bossy. In this sense, bossiness may not be bad in itself, only when misapplied.

It is a bit like debridement. Dead tissue needs to be cut off to save the healthy bits underneath. Cutting too little is bad. Removing vital parts is worse.

Fortunately, only rare wounds need major debridement. Most need a light cleaning or nothing at all. Too often people use bossiness when it is not necessary — like debriding healthy tissue.

Internal Cause, External Opportunity

Pandemic chaos and fear created a petri dish for bossiness. It turned some otherwise rational doctors into dictators.

COVID gave literal or social media microphones to some very bossy docs. Politicians deferred to a handful of experts. No one dared speak against them. The few who did faced punishment.

As pandemic fear subsides and normal chaos returns, we should ask:

Who were the bossiest docs?

Who needs counselling after losing their COVID pulpit?

Can we protect ourselves from bossy docs in the future?

Some docs are just born bossy. They use power to work out their own issues. But we don’t need to let them ruin our lives in the process.

Photo credit: Pixabay

We will look back on COVID as a time when we had to pick sides. Do you support vaccine mandates? Or do you oppose them? You must choose your position on principle, for or against.

This confuses policy with morality. It makes any change immoral, by definition.

There is a better way.

A Prudent Approach To Vaccine Mandates

Here’s a short piece I wrote for The Hub, which suggests prudence instead of principle. You can read the first part below, or click on the link to take you to the full article right away.

Enjoy!

Shawn Whatley: Why we need a flexible, prudent approach to vaccine mandates

Pandemics create fear, and fear extinguishes appetite for balanced discussion. Instead, governments take bold, expansive action. Prime Minister Justin Trudeau’s “sweeping federal vaccine mandate” to “target last holdouts” offers a case in point. The public supports vaccine travel passports, but broad mandates fuelled by emotional rhetoric create affective polarization: partisan groups with anger and frustration on each side.

To date, most discussion on vaccine mandates reflects a principled approach. People must choose a side, for or against. Some argue mandates are a necessarily good thing; mandates will get us back to normal; and they serve the greater good. Others argue mandates are intrinsically bad. They insult individual autonomy—the greatest good any country can ever get.

But a principled approach turns policy positions into moral absolutes. If mandates are good on principle, there should be no limit to their scope. We should pursue them with vigour for all the various diseases for which we have vaccines. Restrictions to freedom of movement “should be tailored to verifiable risk,” according to one opinion in the New England Journal of Medicine.

Prudence offers a better way to craft policy. It avoids turning policy into morality. Prudence uses current circumstance to create policy, in the same way we might choose to carry an umbrella if the sky looks grey. Prudence applies general principles, with nuance, based on the particular need at hand. It makes policy flexible and responsive—something pandemic policy too often lacks.

Michelle Mello, Ross Silverman, and Saad Omer tackled this concept in an article that appeared in the New England Journal of Medicine. They suggested guidelines for mandates based on experience in other infections and pandemics: the 1976 Swine Flu, H1N1, and others. Using past experience, they suggested a five-level rubric to help policy-makers decide whether or not we need vaccine mandates at this time. … (Continues here)

Photo credit CBC article: Trudeau says post-election priority is vaccine mandate for public servants, travellers