In his TED talk in 2015, Bill Gates warned the world: there will be another pandemic soon. He warned governments to get prepared by developing good plans and doing “Germ Games, not War Games”. He said no need to panic but we need to get going to be ready for the next epidemic. Using the problems with combating the Ebola outbreak in 2014 he showed that the world is not ready, that the WHO is not the body to mobilize resources and systems, that there is a need for an overall global health system to respond to outbreaks.
As our Emergency Measures Leaders will attest, proper planning is a tough discipline and it is often difficult to get busy people to take emergency preparedness seriously. It is difficult to mobilize political support because it has little electoral appeal. For those of us in the health professions, it is much more satisfying to look after sick people, frail elders, accident victims and those with terminal illness than to invest hours in planning for the unimaginable.
How much relevant pandemic planning has taken place since 2015? None that would be recognized.
New Brunswick has been the envy of the continent for the rapid response of our political leaders and the Chief Medical Officer of Health, Dr. Russell. And by now they must be exhausted. The risk is still present and we are not out of the woods yet, but it is manageable apparently.
The toll on the public, however, has been larger than it might appear. The fiscal toll is measurable with businesses struggling or going under, loans and mortgages deferred, rental deferral being required in places. The larger fiscal toll is felt by our provincial government; remember prior to COVID-19 the strategy, based on sound counsel from respected economists, was to balance the provincial budget. Remember that informed people such as Les Smith, the Coalition of Concerned Citizens, and Professor Richard Saillant were calling for government to reduce deficit spending in order to restore fiscal health to the provincial government.
Despite the huge impact on provincial revenues and expenses caused by the pandemic strategies and limitations, the province seems to be performing better than it might. But much of the fiscal distress is felt in the long-term care system where their unavoidable costs due to Covid-19 are only now becoming recognized.
Of major concern to Canadian taxpayers now must be the runaway growth in deficit spending at federal level. There have been so many bail-outs required and more in the pipeline: airline industry crippled; major corporations, transportation, universities, education, individuals with job loss. At last estimate, the spending deficit seems to be closing in on three-quarters of a trillion dollars!
Let your mind go back 2-3 years prior to the pandemic. How often have we heard of the need for a national pharma care program? A national Dementia Strategy? A National Long-Term Care Strategy? In cost-sharing in health care the provinces have maintained for years that the federal government has failed to honor its obligations to properly support the National Hospital and Medicare Programs.
Always with these issues the debate ends with “no more money to give the provinces”. Then very, very quickly, in the Spring of 2020 the coffers seem to be full to overflowing with rescue programs such as CERB being announced with great regularity. Economics 101 would suggest it will require decades to get the federal government back to anything even close to a balanced budget unless the proposed global economic reset takes place.
Equal to the fiscal challenge is the toll that lock-downs and regulations are exacting on our society. In previous outbreaks, society returned to “normal” in a few weeks with limited emotional toll taken. Such is not the case with Covid-19. Universities have been turned on their ears and to assume that virtual learning is even remotely close in quality to on-campus learning is a sad dream. Gone is the dialogue, the exchange of views, the relationships with talented faculty, the mental stimulation that can never be achieved on Zoom.
Students often report discouragement, disillusionment while doing their best to get assignments done and submitted. Talented faculty are attracted to teaching because they enjoy the mental stimulation of interacting with students, mentoring them, watching them grow in their intellectual pursuits. Career satisfaction must be suffering with these great people.
Distress on families is, admit it or not, enormous. To the extent the family lives together in a single bubble, day to day stress may not be so huge. But when the family is separated, as is the case with thousands of people, the distress is real. The heartache of facing Christmas knowing that the years are ticking away and the emotional power of having the family together is to be sacrificed is real and huge.
The family unit, despite many assaults on it over decades, has been the bedrock of civilized society for generations and the distress being caused should never be under-estimated. Indeed, it may take years for the damage to be undone.
More distress has been injected by the rampant politicization of the pandemic. New Brunswick has avoided that, to our leader’s credit in all parties! But never a newscast or look at social media goes by without seeing leaders or would-be leaders in other jurisdictions adding distress to the system with inconsistencies in practice, regulation, and behavior.
New Brunswick, though, has had its share of regulatory inconsistency which adds to distress and disillusionment. The recent publicity about a young couple getting a $295 ticket for removing their mask in a parking lot with no one in sight except the officer. More tragic was the report of the young businessman from Saint John who, on a return from a routine business trip, tested positive, then received a large volume of anger-driven hate messages from people who had no facts nor did they know him. Then, of course, there is the acceptability of large retail outlets functioning while churches close!
Those are but three of the inconsistencies that are leading to distress in the system, probably unnecessarily.
The New England Journal of Medicine, in September 16, 2020 described Intimate Partner Violence as “a pandemic within a pandemic!” The New York Times described it as another public health crisis worldwide.
One key reason for the distress on workers, the public, and those playing even a small role in the regulatory process is the fact that all this COVID-19 appeared with no warning. Not only was there little understanding of the virus at the outset, but the litany of conflicting reports, conflicting directions, changes in regulations at the levels of the WHO, CDC, Federal government have led to multiple levels of confusion. This was best born out last week in the CTV survey on public attitudes toward the proposed Covid-19 vaccine; in this survey some 22% said they would not take it while another 28% said they would be in no rush but would wait a few months to be sure the vaccine is perfectly safe.
And why not; after all, vaccines normally require years to get to market safely. In this case, there has been an unprecedented rush to market because the mantra has been: controls will be relaxed when we get the vaccine! In rushing the process, some speculate that shortcuts in the processes of trial and approval.
It would be very wrong to simply label those 50% as “anti-vaxxers”; on the contrary, they need to have their concern for safety respected. Follow the science means, above all, ensure that the product has been proven to be safe and will have no undesired side-effects. The film Challenger: The Final Flight, aired in 2013, showed the worst of what can happen when short-cuts are taken in the science.
The Second major lesson from Covid-19, then, is: Pandemic Planning and Pandemic Drills must be part of our public policy priority.
Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He is author of Health Care Reform in New Brunswick: lessons from a socialized system. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.