​Health and Long-Term Care Reform: lessons from the pandemic

By now we are all sick to death of the pandemic!  People are restless, depressed, frustrated, tired of following what often seem to be illogical rules, pushed to get vaccinated, never knowing if they can see loved ones, and more.

​Let me be clear:  my wife and I have been loyal subjects, following every rule that is imposed on us without public complaint and taking every vaccination made available.  I am no anti-vaxxer, not even close.  But I do respect the rights of those whose opinions differ from mine to express their opinions in a mature, controlled manner without shouting and without nasty language.  We are a population of persons, all of us from different cultures, educational backgrounds; some of us steeped in science, some very suspicious, some having become amateur virologists during the pandemic.

The many, many “talking heads” of media outlets have contributed to some increased knowledge but much public panic.  One of my very informed friends told me recently: “I just have to shut off the TV when the Covid messages come on!  It is too depressing.”

Then comes Omicron, the latest variant, said by the South Africans that it spreads rapidly, as we are seeing in New Brunswick, but does not make people very sick.  So, another “kick in the head” for people exhausted from the emotional distress of pandemic.

The lessons that we are already learning from this terrible journey have been numerous and growing each day.  As the science and awareness has evolved, not much of what we experience nearly two years later resembles what we were told in March 2020.  Remember the first pronouncements from WHO and CDC and other authorities?  These are some that registered with me:

1. Masks probably are not too helpful! Fauci
2. Dr. Birx, two months into the pandemic, acknowledged on International TV that the WHO statistical modelling was probably not solid.
3. Masks may be of some help:  Tam
4. The virus spreads over anything you touch:  so, people were washing their carrots, potatoes, and wiping down all groceries.
5. When we get over this, the virus will mutate and there will be other forms in the population.
6. The Covid-19 virus is lethal and a killer
7. Social distancing, even in home settings?!
8. Then:  yes, masks work and must be worn, HazMat suits were visible on the media stories, and PPE was essential in care situations.
9. When we get the vaccine administered to 70% of the population, we will have herd immunity and the population will be basically safe.
10. We can do Operation Warp Speed and get the vaccine out in record time; then oh, how that became politicized.
11. Aside from respirators and other respiratory meds, the vaccine is the only salvation for the population.
12. Great nasty controversy when non-mainstream clinicians found some treatments that worked for their patients.
13. Announcement by a prominent German pathologist that in a number of autopsies on persons diagnosed with Covid, the main cause of death was underlying, chronic conditions; so, he introduced the distinction of “dying with Covid or dying from Covid”, also acknowledged recently by Dr. Fauci.
14. Many of us, including political leaders, were thrilled when the commencement of vaccinations took place; but then it became clear:  no, not just one but two doses; and now it is three doses as the emerging standard, with Dr. Fauci suggesting a fourth dose may be necessary and one of the drug companies was suggesting a specific Omicron virus.
15. Now in Israel the first case of fluorona has been reported which is a combination of the flu and corona virus!
16. CDC has said that the PCR test does not distinguish between flu and Covid.  Yet flu has almost vanished, a disease that used to kill hundreds in New Brunswick every year and made thousands sick enough to be out of school or away from work for a time!
17. The world-wide death rate does not seem to have changed despite the fear that Covid is a strong and lethal virus.  It has remained at 0.17 per cent of population for years.
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What have we learned from the journey thus far in New Brunswick?  Many lessons, and here are mine:

1. Hospitals and health care workers have experienced unprecedented stress for many reasons.  But hospitals and Emergency Departments have been front page news since the 1990’s with overcrowding, huge and unconscionable wait times, all attributable to larger issues of public policy.  Fix those issues and do it fast because the next outbreak is coming.
2. Long term care, across the country, has been a focal point because Covid, Influenza and many other infectious/viral diseases attack the most vulnerable.  Persons with multiple underlying co-morbid conditions will always die from something:  influenza, general decline, acute episode with the cardiac system.   The Council on Aging, in January 2017, presented government with the basics of a plan to fix the long-term care system and to date there has been no apparent energy directed at essential reforms.  Consequently, amongst other things, NB has a huge proportion of hospital beds occupied by elders awaiting long term care placement. 
3. Pandemic preparedness:  in the health and long-term care system, in which I invested over a half century of my life, emergency preparedness was always a condition of Accreditation and was a high priority.  The warnings of a pandemic (they come in cycles) have been clear since 2015 but New Brunswick was apparently caught flat-footed.
4. Primary Health Care:  it is unconscionable that 40,000 (or more) New Brunswickers still live without access to effective primary care.  The calls for reform of primary health care have been heard in New Brunswick for nearly 20 years yet here we are!  Good news is that virtual care, just a bit better than no care, has sprung into action and doctors have responded well.  But nothing beats sitting in the office of a knowledgeable, caring service provider who will take the time to fully understand the issues; not just two issues but all of them!  Much of good diagnostics involves listening and visualizing patients and their condition.
5. Motivated by fear and a sense of urgency, the health system can change quickly.  But the direction to change has to come from the top.  Initially, the unity shown by political parties with Covid seemed a refreshing alternative to the criticism that takes place along with no real discussion of real issues in the legislature.  Political parties in NB must learn:  the health and long -term care system is in crisis and has been since the late 1990’s, and all parties are to blame for the current state, and that a seriously improved system will happen only when the posturing stops and commitment to reform is made priority.
6. Government, and its servants, must learn new methods of listening to the public.  The Civil Service does not have a corner on knowledge and information and must reach out to sources of insight that may not be resident in the system.  To quote a prominent leader in NB in a recent publication:  stop treating us like we are stupid!  There are some smart people out there; there are some smart people in the civil service.  The trick is to figure out a way to create a productive method of mature, respectful collaboration.
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Whether this virus came from a fish market or was a release from the research lab in Wuhan may never be resolved.  What we do know is that this will not be the last major systemic crisis that we will face and we will deal with the next one if we learn the lessons clearly, stop vilifying those who do not readily accept a particular point of view, and modernize our health and long-term care systems without any further delay.
Ken McGeorge is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is [email protected]