Health-care leaders need to step it up too
For more than a month, the World Health Organization's special envoy on COVID-19, Dr. David Nabarro, has been warning that “circuit-breakers” should not be a “primary measure” for tackling the spread of the virus.
He told The Guardian:
“You don't want to use those as your primary, and I stress that, primary, means of containment. Because in the end living with the virus as a constant threat means maintaining the capacity to find people with the disease and isolating them.”
Indeed, if COVID is going to be a “constant threat,” we can't keep using lockdowns as a measure of first resort.
Premier Jason Kenney held on as long as he possibly could before coming through with extreme restrictions — and, make no mistake, they are extreme. While he avoided closing down retail, restaurants and bars, for now, our homes are going to be regulated as harshly as in Quebec. After many of us have followed the rules and whittled down our social cohorts — mine was down to eight people — it's now illegal for us to go to each other's place for drinks or even see each other socially for dinner.
The problem I see is that jurisdictions that do these kinds of measures seem to have no other strategy. In Toronto, when the 28-day circuit breaker was up, they just added 28 days more. After that? Who knows?
It should be increasingly clear that a vaccine is not a panacea either. Prime Minister Justin Trudeau admitted this week that unlike other countries, Canada doesn't have the capacity or the permission to manufacture vaccines locally. So we are relying on other nations to produce it for us and we will have to wait our turn. What's more, if COVID mutates every year, as it may, there will continue to be people who contract it and need to be hospitalized. Then what? Another lockdown? More restrictions?
If the primary goal is to take the pressure off hospitals, it's time for the premier to ask his health-care administrators for a better strategy. Here are some ideas:
1. Develop an outpatient treatment protocol. I have had several doctors express frustration that they have no clear direction on what to do with a positive patient other than telling them to rest, drink lots of fluids, take Tylenol and hope they don't need to be hospitalized. Doctors need a better prophylactic and outpatient protocol. The East Virginia Medical School has developed one, while acknowledging there is no silver bullet, they say there are strategies “we found to be highly effective in damping down the hyperinflammatory cytokine `storm' that is the cause of mortality and morbidity in COVID-19.” If we want to keep the pressure off hospitals, we need to treat more patients effectively at home.
2. Use charter hospitals. If large full-service hospitals are going to be busy treating COVID patients, we need to rely more on the private sector to do the rest. The premier should fast-track approval for chartered surgical facilities that can perform elective treatments and surgery to keep the pressure off hospitals.
3. Use hotels for longterm care. Many front-line nurses have told me that “bed-blocking” — acute care beds filled with patients who are awaiting placement in long-term care — remains a huge problem. Meanwhile, long-term care facilities have unfilled spaces because some don't want to risk accepting a patient who might be COVID positive from a hospital with an outbreak. The premier should investigate contracting with a hotel to provide temporary transition beds for NON-COVID long-term care patients to free up acute care hospital beds.
4. Educate the public on their true level of risk. The Alberta COVID statistics website reports 87 per cent of deaths are in patients over age 70 and 92 per cent of deaths have two or more comorbidities, with hypertension, dementia and cardiovascular diseases being the most common. Before easing restrictions, Florida Gov. Ron Desantis held a roundtable with doctors that included
Dr. Jay Bhattacharya, one of the authors of the Great Barrington Declaration, to explain to the public why lockdowns cause excessive harm and advise on how to shift to a strategy of focused protection for the elderly and infirm.
The premier has told us to shut ourselves in for three weeks. I'm prepared to do that. But I'm not prepared for this to be the only strategy. He's asked us to do better. We will. But he needs to ask his health-care administrators to do better too.