“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.” (Charles Dickens, A Tale of Two Cities).
We are living in extraordinary times. It has been a century since we faced the 1918 H1N1 (“Spanish” flu) pandemic which infected an estimated 500 million and killed over 50 million people. At that time there were no vaccines, antiviral medications or antibiotics to fight secondary bacterial pneumonia, hence the high death rate.
Over the last 6 months COVID-19 has globally infected over 16 million and killed over six hundred thousand people (…and counting). To date, Canada has recorded over 110,000 cases and almost 9,000 deaths. This is in stark contrast to our neighbors to the south (i.e. USA) who have over four million cases and about 150,000 deaths which amounts to almost a double per capita COVID-19 death rate compared to Canada.
Humility is needed by those, including myself, who provide critiques on responses to the CoVID-19 pandemic. No matter what control measures are put in place our government, and public health agencies, will be criticized for: not initiating control measures sooner, maintaining control measures too long, and loosening restrictions too soon as the second (3rd, 4th …) waves spike. It is a hard gig to manage pandemics.
However, we are going to be in this pandemic “soup” for at least another 6 months and there is room for constructive discussions on how, as a society, we best weather this storm.
From a purely mechanical point of view Canada, and especially Manitoba, has done quite well at “flattening the curve”.
However, epidemiological controls to “flatten the curve” involve curtailing individual freedoms (e.g. social distancing, self-isolation, quarantine and fines) which impose duties on the government to mitigate the short and long term adverse consequences of such control measures beyond reducing the spread of disease, the risk of hospitalization and ICU admissions. Governments need to be transparent about how they are monitoring, and mitigating, the broader impacts of their control measures and share this information with the public.
There are economic provisions to assist workers, students, renters, childcare and seniors. Measures have been put in place to better protect essential workers (e.g. health care, grocery, gas stations etc.) noting access to personal protective equipment has been variable through time.
What is lacking is consistent and well packaged information on the social, mental health and economic impacts of current public health orders. MB Health has posted 138 COVID-19 bulletins (as of July 25, 2020) which generally focus on evolving control measures, number of active, hospitalized, recovered and COVID-19 associated deaths. What is missing is an analysis on impacts on homelessness, drug addition, suicide, depression, domestic abuse, child protection services, education, physical fitness and obesity, bankruptcy, employment, divorce/separation rates and crime in general. The faith-based community would also add spiritual health.
All levels of government need to come clean about what the short, medium, and long-term economic implications of current control measures are. Perhaps we are all in denial about the fact that we cannot keep going deeper in debt without dire consequences.
A good comparative model would be the approach used in radiation safety. Radiation doses to the public, patients, and staff are kept as low as reasonably achievable, taking social and economic factors into consideration (i.e. the ALARA principle). Control measures to keep COVID-19 numbers as low as reasonably achievable taking "social and economic” factors into consideration. Such consideration should be transparently be made public.
Given the anecdotally reported economic and social consequences of COVID-19 it will become progressively harder for people to comply with Public Health orders to control the epidemiology of COVID-19.
Public Health Ontario published a rapid review on the “Negative Impacts of Community-Based Public Health Measures During a Pandemic (e.g., COVID-19) on Children and Families” (2020). They specifically commented on the negative impacts on mental health in children and the importance to monitor for other adverse effects (e.g. help line calls).
There are a few specific areas that need immediate attention by the MB Government.
Given the shocking revelations reported by Canada’s military of substandard care in Ontario long term care facilities you would think the government would want to reassure Manitobans that their loved ones are being treated with care, dignity and respect. This is especially true as visiting MB Personal Care Homes (PCH) had been totally suspended.
The province inspects all PCH but the inspection reports are not publicly available. It is disturbing that both the former NDP, and current Progressive Conservatives, have talked about disclosure of PCH inspection reports since 2013 without doing anything about it.
Select PCH inspection reports, accessed by CBC through freedom of information, were less than complimentary.
If the government is going to limit access to PCH they have to do more to ensure that Manitobans feel that their vulnerable loved are safe. Suppression of the PCH inspection reports does the opposite.
Concerns have also been raised about adverse mental health impacts of COVID-19 imposed social isolation.
The government invested $4.5 million on a Mental Health Virtual Therapy Program (i.e. an internet based cognitive behavior therapy-based program). They also provide contact numbers for province wide crisis lines on their COVID-19 support web pages.
What are the statistics on crisis calls or use of the Mental Health Virtual Therapy Program?
What measures have been put in place to ensure Manitobans have gotten value for money for the on-line therapy program?
Well packaged COVID-19 impact information on crime, child protection services, homelessness and street drug use should be prospectively and transparently provided. Access to such information should not be left to anecdotal analysis or freedom of information requests.
As a physician I was particularly troubled hearing news stories about people dying in acute or long-term care institutions without their loved ones being by their side. If we can protect health care staff with PPE (personal protective equipment) we can take surely take measures, herculean if needed, to provide PPE to a small number of family members so they can be with their loved ones as they pass. Yes, there will be a small risk of COVID-19 transmission but not beyond that we currently expose our doctors, nurses, gas station attendants and grocery clerks to.
I’m confident that if you informed relative of the risks of COVID-19 transmission, with PPE on board, most would accept this risk and be with their loved ones when needed.
To paraphrase Gandhi, we are judged by how we treat our most vulnerable. For some social isolation, in and of itself, makes life not worth living.