Are we ready for the big one?
Here it comes. The next big pandemic. Not necessarily the “Wuhan virus.” But someday, from somewhere, another Spanish flu or worse. How ready are we?
We are not fearmongering. Whatever may become of Wuhan, or SARS, mass urbanization and mass travel create ideal conditions for viruses to spread and mutate. And while some are relatively benign bugs, like the common cold, others are lethal, especially in the early stages.
Even in a far less mobile world, things like the “Plague of Justinian” or the Black Death wreaked havoc. And while the ghastly Ebola virus has periodically frightened us without going quite literally viral, something will, eventually. We are not immune and cannot be. But we can try to be prepared.
In one sense we are “ready.” We have an advanced health- care system with sophisticated facilities, effective diagnosis, skilled doctors and nurses and a population far healthier than, say, European peasants suffering early 14th- century famine. And shortly after Wuhan hit in the bungling and secretive People’s Republic of China, we had reports and were monitoring the situation.
Unfortunately that response also shows that we are not ready at all. Despite a few amateur worriers outside government and a few professionals within, each potential pandemic like MERS is basically treated as a strange one-off episode. Thus our response to Wuhan, far from being co- ordinated and decisive, was to saunter into action, starting next week to ask people arriving in our biggest airports if they’ve physically been in Wuhan and feel so sick we should detain them, before giving them a leaflet when they cough “No.”
We also had the prime minister say “Obviously, we take very seriously this issue of the coronavirus.” But the press releases churning through the Parliamentary Press Gallery concern “the appointment of Marc Gold as Government Representative in the Senate” and “Motoneigistes disparus : le Bloc Québécois exprime sa solidarité” and “Minister Champagne concludes visit to Mali, continues on to Morocco” and “Liberals Must Put the Needs of Canadians Ahead of Big Airline Companies.” Very seriously indeed.
Which brings us to the biggest “preparedness” problem. Canada’s entire health system is not set up to deal effectively with a pandemic. Or much else. We are forever assured we have world-class health care. But we all know it’s overloaded, from waiting lists to patients in corridors. So if Wuhan, or something similar, hits hard, people will stagger into overburdened ERS and doctors’ offices and wait for hours, making everyone else there sick, including providers. Exactly how you’d set it up if you wanted to spread disease.
According to the CBC, of 163 acute- care hospitals in Ontario over half were more than 100 per cent full for at least 30 days in the first half of 2019. Nearly 40 hit 120 per cent at least once. And 40 were over 100 per cent the whole time. Add one pandemic and, experts say, we’ll have patients in tents in parking lots in mid- winter. Dying.
The dedicated people who work in our health-care system somehow provide outstanding acute care. But for chronic conditions it’s a nightmare because it’s set up all wrong. We certainly can’t change it in the next month. If Wuhan is the big one we’ll just have to weather the storm. But there’s no excuse going forward.
The big problem with our health- care system is grotesque over- centralization. Crucial resource- allocating decisions about prices and budgets are made deep within government bureaucracies and even “decentralizing” measures like healthcare teams come from the centre, with no feedback mechanisms and no interest in any.
This Soviet- style “bigger is better and markets are worse” mentality means a major city like Ottawa has only a handful of hospitals, including Canada’s largest. And the problem isn’t just that, say, St. John’s, N.L., has only two main hospitals for adults and the whole province just one for children, “attached” to one of the St. John’s adult ones, so a viral outbreak could deprive everyone of urgent care. It’s that routine surgeries are routinely performed in hospitals, too, meaning they’re not available anywhere else.
Vancouver General Hospital, Canada’s second- largest, includes an eye clinic, arthritis centre, domestic violence centre, skin care centre, Alzheimer’s centre, hip centre and much more. If a pandemic shuts it down, all those services become unavailable, too. If we had a properly responsive system, patient driven through market mechanisms with public funding, we’d have many more smaller specialized facilities and much more resilience.
When the big one hits, we’re going to need it. So what are we waiting for?