“Those who fail to learn from history are destined to repeat it.”
Let’s get the lessons straight, well documented, and get prepared for the next one, as Bill Gates said prophetically in 2016! Despite the fact that outbreaks seem to come as a big surprise to the population and health officials, they are cyclical! This is the reality of modern times.
After months of media clips showing China dealing with this virus, the World Health Organization declared a pandemic on March 11, 2020, this announcement being based on very early experience and forecasts employing statistical models done by experts. This was after major US media outlets had down-played the seriousness and the U.S. administration was admonished for curtailing air traffic from China.
Within the health and public policy community, there was very little knowledge of the virus and its characteristics.
Sue Rickards, in her commentary on Friday, September 18, 2020, advocated the attack on chronic social and economic problems at their roots. It was a good piece that illustrated the shallowness of much conventional public policy decision-making.
Such has been the case with health care for generations until 1992 when true reform was initiated by the NB government. Taking the first steps to consolidate control and direction of acute care by merging hospitals into regional structures was an important first step. While that was a very difficult, highly-politically-charged step, it was only the beginning. What was to come later would and should make a serious difference for citizens of New Brunswick.
In 1970, as a fledgling Acting CEO at the IWK Hospital in Halifax, I was approached by some persons from upper and western Canada who were Icons in the field of health services organization and management. Dr. Len Bradley, then Medical Director at the great Winnipeg Health Sciences Complex, and Dr. John Phin, formerly professor in the field of health administration in Minnesota. I had graduated just one year earlier from what was the Blue-Ribbon program in Hospital Administration at the University of Toronto. This was a small program available only to 18 persons per year who had had some previous experience in the health field.
My class included physicians, nurses, pharmacists, accountants….all having had just enough experience in the management positions in the health field to understand that they really needed a deeper, more rounded education in health administration. So, with superb professors such as Dr. Burns Roth, Eugenie Stuart, Dr. Peter Ruderman and many others we worked through courses in medical science, economics, human resources, health law, hospital organization and management, public health and much more.
Brunswick News publications carried a lead article on Saturday, August 8, 2020 posing the question: Are We Beginning to Tune Out of Covid-19? The previous day, the Chief Medical Officer of Health, Dr. Russell, posed a similar question in commenting on the latest large gathering of people in celebration at a boating event.
From the beginning, back in late 2019, the risk, scope, etiology, contagion, control, treatment and much else surrounding this virus has been the subject of so much more controversy on the international stage than any other in history. The public can be forgiven for feeling more than a little antsy a full 9 months in!
With previous outbreaks, particularly the worst ones in recent memory (e.g., SARS, H1N1), there was a huge spike, much publicity, much discomfort, and so little controversy because the science seemed less vague. Since the 1970’s we, as citizens, have become accustomed to the promotion of the annual “flu vaccine” which has been helpful but never forced on people. Indeed, the vaccines apparently get adjusted regularly and we typically are at the mercy of the pharmacist or doctor to ensure we are getting the latest vaccine.
So, we are going to the polls! Last week had drama leading to the fact that the parties will not agree to the plan placed before them by the Premier. There are two vacant seats and, according to reports, at least three that want to be vacant!
Those who are seriously interested in seeing the health system get fixed should now start to memorize some lines so that when candidates contact you, you can respond with good questions that will force some response. In just how many elections have you heard the same promises? No more cuts! We will keep your emergency departments intact! No, we will not close rural hospitals. Yes, we will hire more doctors and nurses. We will add more nursing home beds; why we will even put some in your riding.
One of the greatest that comes up in every campaign is: We will place new resources into Health Promotion and Disease Prevention. And sometimes that happens, yet the basic issues of the health system remain.
My book by this title commences with this question on the inside front cover because I wanted readers to understand that making our health system work for New Brunswickers is not about simple improvement but about transformational change.
Being a writer was never in my career path at any time until the opportunity afforded me nearly two years ago by Brunswick News. They asked for a series of commentaries on Health Care Reform and I was only too happy to oblige. It was, in fact, a labor of love for me because I, like thousands of others in the health and long-term care system, have seen so many events happening, policies announced, projects approved for which there seemed often to be a gap in logic! Many days I, and many others, would end the day with many questions about the wisdom of decisions and strategies.
Adam Huras, in a very thoughtful piece in Monday’s Brunswick News, outlined the fact that Premier Higgs has backed off ER cuts and seems to have had second thoughts about the health care reforms announced in February 2020. It is absolutely true that both the Premier’s office, Departments of Health and Social Development and other departments have been pre-occupied by the pandemic.
The pandemic, vicious as it has been internationally, has created huge issues for policy makers trying to keep abreast of the latest changes in forecasts, etiology, transmission methods, mitigation methods and ever so much more. Had the measures announced in February gone forward as outlined, there is little doubt that a health system already beset by major issues would have been in a major state of confusion or pandemonium. That is not the voice of extremism speaking; it is the voice of experience, however!
Further in the article, the Premier, who was committed to major reforms in the health system long ago, acknowledges that the reforms as announced perhaps were not well conceived and raises the rhetorical question: “what was that going to accomplish anyway?”
“Mental illness is one of the leading the leading disabilities in the world with 4 of the 10 leading disabilities being mental disorders!” So says the Action Plan for Mental Health in New Brunswick published in 2011. The plan was a visionary document and has a wealth of statistical and historical information regarding Mental Health in New Brunswick.
Twenty percent of Canadians suffer with some mental disorder while 80 percent are said to have someone in their family or close circle of friends suffering from one of many mental disorders. Mental Illness is referenced in the report as “The Orphan of Health Care” which suggests that it does not receive the priority that it deserves.
Time was when the family doctor knew each patient, each family, their idiosyncracies, pressures, distress and pressure points. That was in the days when medicine was considerably less complex and doctors worked 70-80 hours per week. Office visits were not limited to 10-15 minutes and there was no such thing as “only two things per visit; if you have other issues to discuss with the doctor, you will need to book another appointment”.
That was also in the days when housecalls were common which served to render urgent in-home care but gave the doctor some insight into living conditions and family dynamics. The thousands of drugs that have an impact on the body and the moods just were not available so treatment of known mental challenges was pretty limited.
There has been a good deal of concern within the public, the media, and advocacy groups about the Covid-19 outbreak in Region 5. For the provincial leadership team, it was akin to the opposing team hitting a game winning home run in the bottom of the ninth after a stellar pitching duel. It was a big disappointment. And the doctor who was thought to have been the carrier and whose life has been badly scarred will deal with the aftermath for years to come, no doubt.
People had a right to be frightened; it is a wicked virus made even more wicked by the fear that the warnings starting with the WHO and many others in regulatory and advisory roles play. The fear of this awful virus has ensured that businesses closed, that commerce came to a halt, and that our lives have been put on hold as we “stay the blazes home”. And just when we see light at the end of the tunnel and we think we can get back to the golf courses and Tim Hortons, we get broad-sided.
The discussion at the Horizon Health Authority Virtual AGM this week suggested that even though the Premier has not been able to conclude the consultations with municipalities that he promised, thanks to the Pandemic issues and distress, the CEO remains convinced that the plan needs to go ahead as originally announced. This, now, has raised the hackles of persons in rural communities and has now created strong pushback from some.
Having now had 5 months to ruminate on what was announced and how it was announced, and having consulted with some knowledgeable people in the field, what appears obvious is the classic stalemate! Rural Health Care thinking versus Urban Health Care thinking. What appears obvious is that the rurals were handed a plan that took them by surprise and did what they should do…push back!
That was the headline of a CBC story carried on the news on June 5, 2020; the story went on to discuss the issue of inadequate home care in New Brunswick as illustrated by the case of Paul Ouellet’s sister, Lorette. And the issues of inadequate funding of home care in New Brunswick were well documented in the Council on Aging Report.
In the story, the health authorities’ position of “move long term care to health” was recited again by Karen McGrath, CEO of Horizon, in which it was noted that she has been asking for structural change for two years. The structural change referred to is to move long term care to the Department of Health or to the health authorities, the theory being that somehow that would improve the flow of persons requiring long term care more smoothly and expeditiously. This is also a position taken strongly by unions.
Oh, that it was all that simple. However, achieving reform of long-term care in New Brunswick requires significant change at deeper levels; otherwise, we are just “moving the chairs on the deck of the Titanic”. New Brunswick has wasted countless tens of millions of dollars in executing “restructurings” that were not well thought out. Ask any veteran of NP Power for a few illustrations!
The Telegraph Journal editorial in the June 6 edition is “bang on” in terms of issues in Health and Long-Term Care. Recent publicity in response to the unanticipated outbreak in the Campbellton Region drives home the issues of the need for health and long-term care reform much documented and written about for a decade in New Brunswick.
At the heart of this is leadership and communication. New Brunswick has many stellar health and long-term care professionals; people like Jennifer Russell, Linda LeBlanc, Cindy Donovan, Chris Goodyear and thousands of others. Each wonderful professional that I know is dedicated to utilizing the terrific training and experience that they have had over many years and decades.
But as our late Chief of Staff at DECRH, Don Morgan, used to say: “we all see the health world from where we stand.” That observation was made as we were in the midst of one of several major controversies during the regionalization of hospitals in 1992.
As the weeks and months have dragged on and as the public becomes increasingly anxious about basic issues in our society, it is increasingly important to sort out reality from perception. The outbreak in Campbellton is disturbing, aggravating, and disappointing. It illustrates clearly that the best laid plans often can get sidetracked by undisciplined behavior.
Nationally and internationally, the attention has turned to Long Term Care and legitimately so. Chris Selley, in his National Post article of May 27, “Shameful Nursing Home Report Shows How Canada’s Lockdown Strategy Went Wrong”. In the article he refers to recent reports from the federal government, Ryerson University’s Institute on Ageing that make it clear that the Covid-19 risk is very high amongst those of us over 60 who live in long-term care.
Based on analysis, his conclusion is that “Canadians who aren’t elderly or in long-term care homes have faced a risk of death that’s no worse than the 2009 H1N1 outbreak.” His article goes on to underscore that the vast majority of people infected by the virus do, in fact, survive and do well.
We have known from the beginning that it is a powerfully contagious virus and for those with underlying medical conditions, it is lethal. We know that and it is said that the vast majority of those dying during the pandemic have been persons with one or more co-morbid situations. In Italy, a major hot spot earlier on, it was 99.2% of persons who died that had at least one other illness. That makes frail elders and persons living with Chronic diseases vulnerable targets.
To the astute observer, information and knowledge seems to change almost daily as experience and research combine to help us understand what we have experienced and will yet experience. Pharma companies and university research labs around the globe are racing to be the first with a drug and first with a vaccine. The rewards for success are enormous.
In late 2019 the world heard about the outbreak of a strong virus but its seriousness on the world stage was not felt to be so serious. That led some of the major news outlets in the US to use terms like “pandemic panic” in assuring the public that this was nothing to worry about.
The first rule of politics: don’t ever waste a good crisis! In exercising the need to continue to cultivate voter support, times of crisis present a magnificent opportunity to curry favor with voters and potential voters. The longer the “crisis period”, the more opportunity for elected officials to raise the level of their political capital or spend it.
Such has been the case with the Covid-19 pandemic. In Canada we have been spared the drama that seems to play out in some jurisdictions; in some of these situations the stakes are enormous and competition for air time and influence is beyond anything we can fathom in New Brunswick.
But clearly, as the Canadian version of pandemic drama unfolds we see where “the ship is leaking” and the best that can be done now is to mitigate the risk and damage. In Canada, the eyes are clearly on Long Term Care. Covid-19 has brought deaths amongst seniors and residents of long-term care facilities to the fore. Thankfully, New Brunswick has been spared this drama in long term care.
The Prime Minister, in his Tuesday message, invested good air time assuring Canadians of Canada’s commitment to supporting the provinces in improving the system of Long-Term Care. His words of commitment and assurance constitute a message that seniors advocates have wanted to hear for decades: It is our seniors who built this country, who helped to get Canada to where it is today, and we need to see that their care is good and safe (a paraphrase).
In New Brunswick, that message has been communicated for many years by the Senior Citizens Federation, the Nursing Home Association, the Special Care Home Association, the Coalition of Seniors and Nursing Home Residents Rights, the Home Care Association, and others. Over 40 years ago, health planners and professional leaders were trying to prepare Canada for the day when Senior Care would need a higher priority.
The health and long-term care systems in Canada, however, are influenced strongly by the forces of the status quo, that being hospitals, emergency departments, professional interests, funding crises, and construction of superb facilities. In times leading up to elections, it seems that the public gives more credit for ribbon-cuttings and promises of new initiatives and funding than in the substance of what is behind those announcements.
Our lives have been forever changed with Covid-19, so say just about every informed observer of human behavior and public institutions. Just imagine….90 days ago our lives were moving blissfully along, snowbirds enjoying the south, New Brunswick political people debating an attempt to reform health care, rural communities upset, unions also not so happy.
And south of the border the press was wondering why people were concerned about a virus in China. The virus had already established itself firmly in Wuhan but United States media downplayed it as did prominent health authorities.
Please enjoy this presentation that was initially scheduled for March 26, 2020 and was cancelled due to social distancing recommendations.
Senior health executives of my vintage would tell you “this is not my first rodeo”! We have seen major outbreaks of highly infectious diseases for as long as I have been alive which is 75 years! Polio was alive and not well when I was a kid with iron lungs as the way to save lives of thousands of people. Then Jonas Salk invented a vaccine which we, as school kids, took without any choice. Our family knew only one thing: with the vaccine the likelihood of tragic illness was all but eliminated; avoiding it left us with a great chance of getting a dreaded disease. So Rotary Club and Bill Gates Foundation have now made strides in the near elimination of polio worldwide.
Then measles, chicken pox, and influenza. Now, at our age and for good reason, we are doing the Shingles Vaccine because it is such an awful disease; vaccine is not a guarantee but lowers the risk enough to make it worth the $400 we pay!
Hats off to New Brunswick and its leadership. During this dreadful time of pandemic, with the cooperation of most of the population, but not all, the numbers seem to be favorable relative to the rest of North America. Thankfully, while frail elders and residents of long term care are prime targets, there have not yet been serious issues. The thanks for that can be given not only to provincial leadership but also to the rapid response of Nursing Homes and Special Care Homes. And the fact that 4 political parties are pulling together is a model for North America!
Have there been problems of execution of procedures? Yes indeed. Have employees and administrators responded with determination? You bet they have. Listening to operators share their experiences thus far shows the determination, dedication to residents, focus on safety that families would want to see and hear.
Well over a month into the journey ....
Prominent Wesleyan Pastor John Symonds and his wife, Willo Ann, created a song that is making the rounds on Facebook expressing the spirit of the proper response of the public to this pandemic: “Cough if you want to, sneeze if you will but I came here to stay…………it’s a battlefield, brother, not a recreation room, it’s a fight and not a game…..cough if you want to, sneeze if you will but I came here to stay”, sung by the piano in their living room! This folksy little song expresses the spirit of what officials are trying to get us to understand as the key method of preventing the spread of this disease. Just stay home!
But it is not entirely that simple for sick people need to be cared for, essential services provided, policing to be done, groceries to be on the shelves and secured, electricity needs to be generated and distributed, elders in homes and care facilities need to be cared for, fed, clothed, bathed and entertained.
Premier Blaine Higgs and Dr. Jennifer Russell have been the calm, factual, steady face of the battle against this awful virus in New Brunswick and thankfully it has not gotten to the level that it could have at this stage were it not for rapid response.
The world continues to adjust to new and different times, many in shock, many experiencing the distress that always comes with such a crisis, many inflamed by what they hear or read either on social media or television or wherever is their source of information.
That the disease is dreadfully serious is well beyond question. It is taxing the energy of the wonderful health care professionals who provide care to those stricken with the virus. That health care facilities are distressed is beyond question, many having been at a point of crisis long before Covid-19!
Covid, and each of the viruses and infectious diseases that have preceded it, follows a familiar cycle: discovery in the country of origin, early management in that country, notification to the World Health Organization, alerts to other countries, and the international war on the disease commences. The war is always complicated because in the early days, little is known about the virus, how it behaves, how it is transmitted, what drugs and treatments are effective, if any, what the incubation periods are and much, much more that engaged thousands of brilliant people around the globe in research laboratories and regulatory centres.
The world has been torn apart in just a few days; the growth of cases in various countries is alarming while some countries report no incidence of the virus whatever. In North America, New York seems the hardest hit and we hear daily briefings from the White House, various governors, our Prime Minister and increasingly our premiers. The briefings each day seem to ramp up the intensity and seriousness of the Covid-19 issue, and in New Brunswick the faces of Premier Higgs and Dr. Jennifer Russell have become welcome sights to a concerned public.
Floating hospitals and military field hospitals are being activated in the United States and hospitals are being directed to vastly increase their capacity.
In the short time since early February the world has been brought to a virtual standstill due to one miserable little bug, Covid-19. Universities shut down, graduations cancelled, meetings postponed, vacations cancelled, much normal social and economic activity grinding to a halt. Millions of people worldwide will receive no paycheque until the dust settles!
The stock market went crazy requiring the Fed and Bank of Canada to restore confidence, a rare intervention significant of the seriousness of this bug and its potential impact on human health and the economy.
Dreams are being dashed for millions of people due to this one, little bug whose impact on humans can, albeit rarely, be lethal. As one physician pointed out, 99.9% of people less than 50 years of age who contract the virus will recover. But for those in my age group who have compromised immune systems and other co-morbidities, the prospect is serious and often lethal.
Premier Higgs has announced a health summit in June 2020 at the conclusion of a 3-month period of consultation with people in the province on health care issues. John McGarry, Chair of the Horizon Health Authority Board of Directors, has appropriately said that the summit must concentrate on more than rural health care issues and he is absolutely correct. Since the province started down the road of a planned approach to health care in 1992, there has been a long drought! Instead of rain in response to the drought we have seen for decades now a series of unrelated initiatives leaving the health system resembling a patchwork quilt.
There have been many health summits in recent years. During the term of David Alward, the Canadian College of Health Leaders and the Institute on Public Administration, both New Brunswick Chapters, held a summit in Moncton with Minister Flemming and Jeffrey Simpson. Not much has happened. Then the NB Medical Society sponsored really well-organized event involving some national leaders early in early 2015. What is aggravating to those of us close to the scene is that hopes get built up when these events are held and supported by our leaders. At both of these events, and there have been more, many of us walked away with a new spring in our step expressing hope and optimism.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.