The Politics of Covid and Healthcare
{ EDITORIAL NOTE – originally written in Jan 2021 }
How is Canada performing?
Unfortunately, on virtually every measure, Canada is under performing — and has been under performing since well before the COVID-recession hit.
Before COVID hit, Prime Minister Justin Trudeau had already set two unfortunate records: spending more money (per person) than any other prime minister in Canadian history; and increasing the federal debt (per person) more than any other prime minister not facing a world war or recession since 1870.
All this spending must mean that Canada was better prepared to weather the COVID-recession, right?
Wrong.
One of our recent studies compared the pre-recession economic performance under the five most recent prime ministers. The findings? Not only did Canada’s economy NOT improve as a result of Trudeau’s spending, but our economic performance pre-COVID is the WEAKEST of the last five comparable periods.
But at least we can fall back on our best-in-the-world health care system that Canadians are proud to have, right?
Wrong again.
The Fraser Institute’s latest comparison of 28 universal health-care systems found that Canada, despite being the second-highest spender on health care, ranks second-last for acute care hospital beds and third-last for the number of physicians available. Canadians also waited longer than ever for medical treatment in 2020: a median wait time of 22.6 weeks!
Surely our government has learned its lesson now and has a plan to recover, right?
Sorry — wrong again.
This year, the Trudeau government plans to run a historic $381 billion budget deficit. In addition to this, they’ve announced several big ticket spending items such as pharmacare, childcare, and ambitious green initiatives. These commitments suggest an even greater acceptance of new debt than has prevailed in the past.
Doctor Burnout
Tragic news broke in early Jan 2021, when a doctor committed suicide in Granby, Que. She was 35 years old, who had been a doctor for 10 years. Family says stress from the pandemic led to her suicide. She was on her second Mental Health leave when it happened. The Canadian Association of Emergency (ER) Doctors says the worst is yet to come. Doctors are made to feel guilty if they take time off, OR, are required to not take any days off - no vacations allowed. Even for doctors who are used to having patients die, it is extremely distressing to see people die without their family able to be around. Similarly, in Apr 2020, a New York ER doctor committed suicide, also attributed to the pandemic.
Dr. Patricia Dobkin, a clinical psychologist and associate professor at McGill University, has been leading wellness programs for physicians and health-care workers for the past 15 years. “The doctors’ minds and bodies are all one and they can’t separate them,” she said. “You can’t put people through 12-hour days for 10 months without a break and expect them to be just well. They’re just human beings like you and I and everyone has a limit.”
This year, there has been increased burnout, and PTSD. Surely this is a once in a lifetime situation because of the Covid pandemic. But, is it?
Months before the pandemic, 86% of emergency physiciansalready met at least one of the criteria for burnout. Physician burnout has been a growing concern within the profession for years. In 2017, nearly a third of Canadian doctorsreported symptoms of burnout and nearly one in 10 had thought about suicide in the past 12 months.
Nursing the Nurses Back to Health
We’re told Hospitals are overloaded, and I should do my part. I’d love to, but, How? What is the problem? What brought us to this point in the first place? How can it be fixed? What can I do to help?
Let's take a look. The Nurse's Union are expecting more nurses to burn out, quit. In the Ombudsman’s report (Dec 10, 2020), she underlines the importance of ensuring a stable workforce and sufficient numbers of staff in CHSLDs (elder care facilities). It says, “It is imperative to act and to tackle the challenges of attracting and retaining staff so that there is a stable pool of workers in CHSLDs and better care and service continuity. Measures must incite and persuade and be concrete and immediate.”
We as a society must prioritize the health-care of seniors and honour our care workers. There has been a lot of lip service paid to our ‘front-line workers’ in the past year, but I’m talking about the last few decades having honour and respect for them. That this has been lacking can clearly be seen by the number of burnouts among these professions; told to do the impossible with less and less. High rates of PTSD are found among Nurses and doctors, similar to police.
A Radio-Canada analysis has found that more than 1,700 nurses working for the province of Quebec’s regional health boards left their jobs between mid-March and August. That’s compared to around 1,300 during the same period in 2019. And nationwide, the Canadian Nurses Association predicts the Canadian nursing shortage will rise with an estimated shortage of 60,000 RNs by the year 2022.
So finding and keeping staff is a problem. Why is that?
Approximately 43% of new nursing graduates report a high level of psychological distress, with as many as 88% of the nursing workforce being exposed to traumatic encounters involving verbal and physical threat. In light of these findings, there is a building sense of urgency to foster an environment within undergraduate nursing programs that acknowledges the presence of traumatic experiences within the nursing workforce.
A 2015 study which examined why newly-graduated nurses in several provinces across Canada left the nursing profession within five years of graduation.
One of the key findings in the survey revealed that newly-graduated nurses felt they required a variety of supports to establish themselves as a nurse and remain in the profession. These supports included: reasonable patient-nurse ratios, receiving a meaningful workplace orientation, respectful inter professional teamwork, and employment under managers who were authentic and understanding in their interactions. They said they required a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as being provided with constructive feedback and emotional support in the face of traumatic experiences to face workplace challenges and bullying behaviours.
It sounds like a reasonable expectation to me, for a new graduate entering any profession. But, what many new nurses experienced instead was bullying, humiliation, blame, and criticism. Not surprisingly, over time, newly-graduated nurses lost the joy of nursing practice which was compounded by the accumulation of negative effects without these adequate supports. And so, we've lost them forever, and I for one, can't blame them.
Help! Nurse!
I want to make clear at this point that I am in no way condemning any of my friends, or strangers for that matter, in the health-care systems who are doing their best under extremely stressful situations. I am merely suggesting that some political decisions may have made their job way tougher than it should have been.
I’ve heard complaints that the government had all summer to fix the problems in the health-care system and did nothing. To be fair, it is something that would take at least 5 years to fix, not 5 months. They need now to start treating hospital staffing they way they do the army or the fire station. Nobody says we only need to hire 3 firemen because that’s all it takes most of the day. As intense as fire fighter training is, it takes years to train a doctor or a nurse. And even then, you don’t want only first year grads on a floor.
Before you start that, you need to adjust the numbers in schools, so maybe adding teachers, and some sort of a plan. That can’t be done over night. Before all that can happen, you need to convince people to go into health-care as a profession. I know many who are already trained, experienced and would not go back for any amount of money. It’s not worth risking their health. And they’re talking mental health, not MRSA, or Covid, As a citizen, I say we need more nurses and assistants. But, as a friend, I couldn’t recommend it as career. Not the way it is right now. So it would take quite some marketing plan to get places filled in nursing programs. So the government can’t just hire double the staff over the summer; they aren’t just sitting around waiting to be hired.
Vaccine Questions
There are many scientific questions to be pondered in regards to vaccination programs. They will have to tread carefully in their roll out of vaccines to nurses if they don't want to make the staffing shortage situation even worse.
Do they need to take the vaccine if they already had Covid? If they have tested positive, presumably they already have developed immunity, which is usually better that from a vaccination.
If a nurse gets the vaccine, will they have to self isolate when they are exposed to the virus? Pfizer is not promising that their vaccine will make the virus less transmissible from a vaccinated person who gets the virus. So getting or not getting this vaccine will not change distancing, mask protocols, etc.
Is it worthwhile continuing with testing? A Portuguese court studying PCR recently concluded that the PCR test (especially at cycle threshold of 35–40) is unable to determine that a positive test corresponds to a Covid infection in the person. It depends on # of cycles used and the viral load in the person at the time. In my region, they stopped testing people in hospitals for MRSA years ago because eventually everybody was testing positive for it, even without outbreaks. The test just doesn't provide any useful information. There are still people dying of it though. Hospitals have had to learn to live with that fact. I expect the same will be true in time for Covid.
What Could Have Been Done Differently
As of November 15, there were apparently 166 deaths from Covid outside of Long Term Care homes, across Canada. For whatever reasons, TV stations ‘silent edit’ out this information in subsequent versions of their newscasts.
A former Critical Care Director at Guelph Hospital suggests that the
$350billion Canada spent on Covid response could have been better spent to help chronic under-staffing of elder care in our country. Help the most vulnerable, not help everybody in the country to make sacrifices that aren’t paying off. It would have also avoided the many unintended secondary effects that these people wouldn’t have had if they were not thrown out of school, or work, locked down, etc.
And these are not conspiracy theorists making some wild claims. A research team published in Nov. that they found no correlation for Jan-Aug 2020 between the stringency of government Covid protocols and decreased death rate due to Covid-19. Countries with high incomes, higher obesity, high non-communicable disease rates and a slowdown of life expectancy increase had the highest death rates, regardless.
A World Health Organization (WHO) Writing Group, concluded that “forced isolation and quarantine are ineffective and impractical.” In October 2020 the World Health Organization’s special envoy on COVID-19 urged world leaders to stop “using lock-downs as your primary control method.” Small gatherings could be allowed with the usual precautions.
In a study published by the Center for Disease Control (CDC) in October 2020, there was an increase not only in COVID deaths compared to the previous year but also about 100,000 non-COVID deaths. In the 25–44 year-old group, which has an extremely high chance of recovery of COVID, there was a 26.5 per cent increase in deaths in this group. Many of these deaths can be attributable to “deaths of despair.”
The American Medical Association in December 2020 released “Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic” and set out measures to deal with this crisis.
In addition, people who need vital health-care services have seen their right to life and security violated. A survey released on July 14, 2020 by the Canadian Cancer Survivor Network (CCSN) reveals that “the disruption of cancer care due to COVID-19 has triggered another public health crisis. In fact, more than half (54 per cent) of Canadian cancer patients, caregivers and those awaiting confirmation of a cancer diagnosis report having had appointments, tests and treatment postponed and cancelled.” According to the same survey, “most affected by the disruption in cancer care during the pandemic are those awaiting confirmation of a diagnosis and recently diagnosed patients (74 per cent and 73 per cent respectively), who are at a critical time in their cancer journey.”
Long term, we need to re-build health-care capacity after many years of harmful cost-cutting
What Nurses Really Need to be Vaccinated Against
Hospitals have had to learn to live with that fact that viruses continue to live; in this world, in us. Can we learn to live with this fact?
Can we find a better way for nurses to live? Surely in our society, we can find a way for nurses to have a life and a career, with reasonable supports in place, and without risking their mental health. We can't let governments off the hook for this. But in the meantime, give a nurse a hug, virtually, if need be, for now.
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