My op ed in iPolitics yesterday:
With severe lockdowns in effect in many parts of the country, Canadians are told again and again that these measures are required to keep our health system from collapsing due to an influx of COVID-19 patients.
It’s a potent message. And who can help but sympathise with the exhausted nurses and doctors watching too many patients die in the hardest hit regions?
But what Canadians should be asking is why, 11 months into the pandemic and in the midst of a second wave everyone knew was coming, are we again faced with a choice of locking down or having our hospitals overrun? Had we used our time wisely, we would be having a much different debate about the necessity of locking down.
COVID gave medicare the stress test we had long hoped to avoid. Pre-COVID, Canada had 2.5 hospital beds per 1000 population compared with 4.7 for the OECD average. Ontario has even fewer per capita. Ontario had 22,400 acute beds pre-COVID. It needs 68,000 beds overall to match the OECD average. Despite this massive shortfall, Premier Ford added only 3,100 beds in 2020 – fifteen times less than needed to close the gap to the OECD average.
Given low bed numbers, Canadian hospitals often overflow. Hospital bed occupancy rates routinely hit 100 percent capacity and higher. Headlines about patients in bathrooms and sunrooms appear each winter in Canada. By comparison, average OECD hospital occupancy usually hovered between 70-80 percent pre-COVID, ideal for patient flow.
Overcrowding, hallway medicine, shortages in long-term care, world-famous wait times, technology shortages, and spiralling costs are just a few of the problems which warranted concern long before COVID. In hockey, ignoring risk is called skating with your head down. The result can be a thunderous body check from an opposing defenceman you never saw coming.
When COVID stepped on the ice last spring, we panicked. COVID presented an unknown threat in the face of a well-known lack of health care capacity. We needed to flatten the curve and slow the spread in order to protect the health care system.
So, we cancelled surgeries, hauled retired ventilator machines out of storage, added acute care beds to the system, and moved some patients to alternative places of care. The Canadian Medical association put together ethical guidelines to guide the distribution of care given overwhelming demand for limited resources. Community physicians signed up to provide mercenary back-up, in the event of a flood of COVID patients needing ICU. Retired nurses and doctors offered to help in the expected deluge.
Are there things we can do now? Yes, absolutely.
We could set up staff bubbles around long-term care homes, much like the NBA and NHL, if we wanted. Point of care testing now delivers COVID test results in minutes. We could have decanted all patients waiting to leave acute-care hospitals using patient hotels, a proven solution in other countries. It would have taken far less than 11 months to set them up and offered 10,000 beds pre-COVID (presumably more given current hotel occupancy). Field hospitals also offer a proven solution given emergency demand. Brampton finally set one up last week.
But what about a shortage of frontline care workers? Doctors, nurses, and other staff at the hardest-hit hospitals in Scarborough and Brampton are swamped and feeling desperate.
Yet it should also be noted that, despite the major localized challenges, frontline care workers in much of the country face a shortage of work. Temporary opportunities have dried up. Walk-in clinics are closed or seeing drastically reduced volumes. Physicians who used to work at multiple long-term care facilities can now work at only one. Physician surgical assistants cannot find surgeries to assist. Community volumes are down as patients avoid going to their family doctor.
On the other hand, social workers have never been so busy dealing with the mental health crisis. The Canadian Federation of Independent Businesses reported this week that up to one in six small businesses contemplate permanent closure by the end of the pandemic – many of these businesses are not known to spread COVID in the first place. Cancers are showing up more advanced.
COVID is likely here to stay. Many predict that as new strains emerge, COVID will require annual vaccination much like influenza.
But we have squandered the time we had, and I see no plan to make sure things do not evolve the same way for the rest of wave two or any subsequent waves. We need to stop talking about lockdowns vs. health system collapse and start talking about greatly increasing health care capacity while pursuing meaningful system change.
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Thanks Shawn.
Thoughtful submission.
As you are well aware, many of us,
not the least of whom are Mary Fernando, Ally Abdullah, Alan Drummond, Health City ( Kingston community physicians in concert)and of course yourself, to name a few, have been banging the “Canadian Healthcare lack of capacity
Gong “ for several years now.
If in the context of a Pandemic, a real “experienced by all” healthcare emergency, we are unable to agree on the need for change and which change, how do we light that fuse?
In addition I would like to make a comment about the evil necessity that Lockdowns have become. In my view, had we an effective communicator leading the Pandemic response in Canada, such as POH Dr. Kieran Moore, buy-in and therefore compliance with Public Health recommendations may well have obviated the need to lockdown at all. It is the likes of MPP Randy Hillier, who rather than investing their time and energy to ensure those most affected in their communities are supported, choose to actively subvert our collective efforts to defend ourselves against COViD.
This should not be tolerated and individuals engaging in such subversive activities should be subject to swift and visible prosecution and consequence.
Thank you, Joy.
Excellent as always. You and I are asking the same question. Police now break up small groups of people, because our system has too little capacity. Why don’t people ask for more capacity? Why aren’t people making the direct connection between the debate about lockdowns and the lack of capacity? If we had appropriate capacity in the system, we would not need to lockdown anywhere — we could simply pursue regular infection prevention.
As for lockdowns themselves, I’m sure you saw this study from Jan 5th, which reviewed mandatory stay-at-home orders. It found they have little, if any, impact.
You guys in Kingston are fortunate to have Kieran! He follows the evidence wherever possible. He holds a much more benign view of central planning and government authority than I do, but we can work together towards solutions. Very sorry to hear that some people in your area have not been working to protect the vulnerable … this is a top priority in any outbreak.
Great to hear from you. Thanks so much for reading, for all the work you do with Health City, and for posting a comment!
Hi Shawn. The Chinese have a saying – and it is likely not exclusive to my ethnic cohort:
“Money does not pass 3 generations.” (or something like that).
The first generation makes it.
The second guards it.
The third generation spends it all.
My version involves 2 more generations i.e. FIVE
The first generation makes it.
The second grows it.
The third generation guards it.
The fourth generation spends it all.
And the fifth generation destroys the system that built the wealth.
Such is human nature and the failure to learn from history.
In the medical field it is similar.
The system will have to reach a stage where it will inevitably collapse before it will change.
The pandemic is merely a preview of what is coming.
There is enough fault to pass around but all the parties involved are not only blind and oblivious to the elephants (note plural) in the room but also like the proverbial ostrich, have their heads buried in the sand.
Leadership should always listen to the frontline workers to find out where the problems are but they invariably do not do so. Instead, top down management based on theory (that has rarely worked) is mandated rather than real world experience.
Our generation of colleagues are the lucky ones in a way – most of us have the option of retiring if nothing else out of frustration with the system. I fear for our younger colleagues. The government, regulatory bodies and the public continue to demand, want and expect “gourmet” medicine out of a “fast food restaurant” system while paying its workers (us) at 40% of the OMA fee guide (I wish I could phrase that better). What a recipe for burnout, frustration and poor quality of care given that there are only 24 hours in a day.
Frequently mentioned at CMEs is the infamous “care gap” that results in inadequate outcomes or targets not reached. While we may be in part contributing to that, the elephant in that room is the patients’ “don’t really care enough gap” and do not listen to medical advice even when dispensed in exemplary manner. There are many reasons for that too, too many to discuss now.
Your article as usual nails it but I fear little will change because the inept system itself is programmed to self destruction because of politics.
Paix et santé
Brilliant comment, Robert.
Love your 5 levels. You’ve packed so many good ideas into this comment that I cannot do justice to them without a very long response. I will let them stand with a simply plea that readers take time to reflect on what you’ve just said. The pandemic is a preview, not just from a system perspective but also from a governance lens.
I sure appreciate you taking time to read and post a comment!
Peace and health (love it!)
Cheers