Curbing the spread of COVID-19
Quebec and Ontario continue to set new daily COVID-19 case records. Both provinces have been in nearly complete lockdown for weeks. Quebec now will implement for the next month an 8 p.m. to 5 a.m. curfew with fines of $1,000-$6,000. However, all provinces should consider mitigating measures that may well shorten the period of severe restrictions.
Ontario Premier Doug Ford is rightly concerned about the need to better monitor arrivals to Canada. Although Public Safety Minister Bill Blair claimed that only 1.8 per cent of cases were related to travel, according to Brian Lilley (Ottawa Sun, December 23, 2020), some 3.4 – 3.8 per cent of Toronto cases were attributed to international travel. In the past two weeks, Health Canada reported that 69 international and 91 domestic flights carried passengers infected with COVID-19.
To compound the problem, as of Jan. 1, (Elizabeth Cohen, CNN) the new UK variant – thought to be 70 per cent more transmissible - has been isolated in 29 countries. In Canada, so far it is in British Columbia, Alberta, Ontario, and Quebec. The South African variant, meanwhile, has been found in eight countries.
It thus seems very reasonable to require a negative PCR test within 72 hours of boarding any international flight to Canada. We should also avoid unnecessary travel within each province. As incoming CDC Director Dr. Rochelle Wolensky advised, “We need to limit our mobility.”
Brampton, Ontario Mayor Patrick Brown has also advocated for isolation centres and paid sick leave. Toronto, Peel, and Ottawa are indeed setting these up as are Edmonton and Calgary.
Yet for unknown reasons, Ontario and Alberta have failed to follow the lead of most provinces in the granting of pandemic isolation benefits to physicians.
In Canada, as of late July, about 20 per cent of cases were health workers – double the global average. According to the COVID-19 Immunity Task Force, which is studying British Columbia, Alberta, Ontario, and Quebec, rates of coronavirus infection were higher in physicians (especially those in Quebec) than in other health professionals. (Canadian Healthcare Technology, Dec. 2, 2020)
Sadly, two provinces – Alberta and Ontario - continue to ignore the needs of physicians. The Ontario Ministry of Health has refused to engage in discussions with the OMA around “sick pay” for physicians.
Finance Minister Chrystia Freeland asserted last August, “We need people to stay home when they are unwell. Otherwise, we will have another huge outbreak.” Ontario NDP leader Andrea Horwath has repeatedly called for paid sick leave. Her counterpart, Alberta NDP leader Rachel Notley has also urged her province to grant paid sick leave for health workers forced into isolation. She has stressed that the new Canada Recovery Sickness Benefit provides only $450 per week after taxes, which will not cover food and housing for many people. ((Michelle Bellefontaine, CBC News, Nov. 17, 2020) Of interest is that recently the Alberta government pledged an additional $625 after a 14day period of quarantine.
However, even these amounts are inadequate to replace the lost income of physicians, most nurses, and many other health professionals. More is needed if they are to be deterred from working; thus, additional federal support is required.
Most physicians are self-employed and rely on private insurance, but those older than age 65 generally cannot qualify. For even younger ones, there is usually a waiting period of at least two weeks.
Most provinces have recognized this fact. Most British Columbia MDS are covered – up to age 70 – by a governmentfunded disability insurance plan. This now includes quarantine or COVID-19 illness from day one for all BC physicians. Most other provinces (including even Manitoba as of last December) and the Yukon all cover their MDS for lost income from day one of self-isolation or illness. Only Ontario and Alberta have left their physicians totally unprotected.
Although health delivery is within provincial and territorial jurisdiction, clearly there is an urgent need for a better coordinated federal strategy and additional funding.
I agree with Bloc Quebecois leader Yves-francois Blanchet that persons returning to Canada from a vacation abroad should not receive the Canada Recovery Sickness Benefit during their 14-day period of self-isolation. If this has been abused, and saved money were redirected, then the amount for legitimate claims could likely be increased above the current $500 per week, before taxes. Finance Minister Chrystia Freeland should also agree to raise the Canada Health Transfer to the provinces and territories. They in turn should agree to provide pandemic sick benefits to all practicing physicians as well as, if necessary, topping up federal benefits for part-time nurses and other health workers so as to adequately replace their lost income.
As Dr. Thomas Frieden, former director of the US Centres for Disease Control and Prevention (CDC) stated a few months ago, “Paid sick leave is extremely important. If someone has to choose between providing for their family or going to work when sick, they’ll likely go in and infect others.”
Over the next few weeks, a small amount of vaccines will be available, but sadly this will have no immediate effect on the pandemic. Premiers Doug Ford and Jason Kenney should agree as soon as possible to provide adequate paid sick benefits to their physicians. Francois Legault and the other premiers should ensure that nurses and other health professionals also receive sufficient additional benefits to replace their lost income. This will encourage them to self-isolate, if necessary, and help to control the pandemic.
These measures may help to reduce the likelihood of extended, prolonged lockdowns and tighter restriction in other regions. This will lessen the toll on the lives, livelihoods, and mental health of Quebecers and all other Canadians.
Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-chair of the Section on General Internal Medicine of the Ontario Medical Association.
The views here are his own.