WHAT WILL LIFE LOOK LIKE IN FULL GRIP OF COVID-19?
As if fear isn’t already in the air, if not in the grocery store lineups, then grim plans for a significant influenza pandemic in Canada are a jolt of panic infused with sobering reality of worst-case scenarios as COVID-19 continues its alarming spread.
Stockpiling body bags, choosing a central place where people bring corpses of family members and identifying hockey and curling rinks cold enough to be temporary morgue sites are among the government’s planning guidelines.
The surge capacity of crematoriums, running out of coffins and church space for holding funerals and recruiting temporary grave diggers are all outlined in the “Management of Mass Fatalities: Canadian Pandemic Influenza Preparedness,” a planning guideline prepared by the Public Health Agency of Canada in 2009.
“There are currently no plans to recommend mass burials or mass cremations. This would only be considered in the most extreme circumstances,” the guidelines reassuringly offer.
It warns of six months’ worth of deaths compressed into six weeks.
“Most crematoriums can handle about one body every 4 hours and could probably be run over 24 hours to cope with increased demand. Cremations have fewer resource requirements than burials and, where acceptable, this may be an expedient and efficient way of managing large numbers of deceased during a pandemic,” it reads.
“Refrigerated trucks can generally hold 25-30 bodies without additional shelving.”
What is happening around the world and beginning across Canada makes this contagion of novel coronavirus the most worrisome health scare in generations.
Many Canadians seem stuck in the stage of thinking the most important thing is to hoard toilet paper or else laugh at people hoarding toilet paper.
The reality, however, is sinking in.
As the virus jumps from country to country, each nation reacts in its own way. A mix of surprise and dark humour greeted the curtailment of national passions: Iran cancelling public prayers, an end to kissing in Italy, closing of pubs in Belgium, shuttering soccer in Spain, cancelling basketball in March in the United States, the end of Tim Hortons’ Roll-up-therim contest in Canada.
Perhaps the NHL suspending the hockey season was the shock that woke you up, or closing of schools; maybe it was U.S. President Donald Trump’s speech cancelling most travel from continental Europe or Prime Minister Justin Trudeau’s wife, Sophie, testing positive for COVID-19.
Patty Hajdu, the federal health minister, said COVID-19 could infect between 30 and 70 per cent of Canada’s population. That would mean somewhere between 11.3 million and 26.3 million people in Canada could get sick, with varying severity.
Life, for weeks, months or more — no one is really sure — will be so very different.
What is happening in Italy offers a strong warning.
The Italian government ordered a nationwide lockdown. All shops except food stores, pharmacies and stores selling essentials were closed and all travel sharply restricted. More than 1,000 people have died with more deaths inevitable.
In the region around Milan, one of Italy’s wealthiest areas, COVID-19 is breaking the health-care system.
“It’s as if you were asking what to do if an atomic bomb explodes,” Dr. Antonio Pesenti, head of Lombardy’s intensive crisis care unit, told the Washington Post. “You declare defeat. We’ll try to salvage what is salvageable.”
Dr. Michael Warner, medical director of critical care at Toronto’s Michael Garron Hospital, said Italy’s crisis must spark an aggressive reaction in Canada.
“That could very easily happen here in very short order,” Warner said.
“The COVID-19 situation is dire and may soon be completely out of control. Health-care resources are finite, and thus we will not be able to provide care for all who become ill.
“We already run at 100 per cent capacity on most days in the intensive care units in Ontario and if we get a (surge) of patients all at once … there is no system that can handle that. It’s impossible.
“I don’t want to have to be in the position, which is something people are planning for, to have to triage resources. That’s something we haven’t really experienced in Canada but that is the reality in Italy today — decisions are made as to who gets access to critical care and who doesn’t and people who don’t are dying.
“If we can spread out the number of people who get infected over time, maybe the system can adjust,” Warner said.
What Warner and public health agencies are urging is simple behaviour everyone should take to slow the rate of transmission.
Hand washing, covering coughs and avoiding contact with others will likely slow its spread; “social distancing can save thousands of lives,” said Warner.
The hubris of modern life made the simple ask of washing of hands as our salvation seem laughable, an ode to snowflakes or witch doctors or hand-wringing.
The reality is these public measures may be crucial.
“Given that there is currently no effective vaccine or specific treatment for COVID-19, public health measures will be the only tools available to mitigate the impact of the virus,” the Public Health Agency of Canada (PHAC) said Friday.
It’s a strategy known as “flattening the curve,” based on the graphs of potential peak infection rates. Reducing the peak burden on the health-care system caused by new cases and spreading that peak out allows for better treatment for everyone who is ill. And also buys time for a vaccine.
What might our lives look like when Canada is in the full grip of COVID-19? The government has plans and recommendations on measures for individuals, communities and governments. It’s a balancing of risk versus reward, personal freedoms and cultural and religious needs, along with who is most impacted by actions on a sliding scale of possible responses.
PHAC notes in its guidelines the ethical debate of “societal versus individual interests” and comes down on the side of society: “When a health risk like a pandemic affects a population, public health ethics predominates, and a higher value is placed on collective interests.”
Some possibilities are more invasive than others, such as closing public transit and schools.
“Widespread school closures as a control measure have the potential of coming at a high economic and social cost since school closures would impact the many families that have one or both parents working outside of the home,” PHAC says.
Other things, like going to church, theatres, sporting events and concerts could be risky.
“Restrictions on non-essential gatherings could pose a barrier to accessing group support and personal freedoms (e.g., cancelling church services, closing community centres). It may also have cultural or religious implications (e.g. funerals, religious services, weddings).”
Businesses should consider staggered work hours to avoid crowding, allowing work from home and relaxing sick leave policies. Businesses may need to be closed all together depending on local situations, PHAC says.
Mass gatherings, such as concerts, sporting events, religious services and conference should be reconsidered or avoided.
Self-serve buffets, PHAC notes, should be off the menu.
If things get as bad as they could, such trivial concerns will be absent for a long time.