Neglected No More: Hard pandemic lessons

THE WRITERS' TRUST BALSILLIE PRIZE IS AWARDED ANNUALLY FOR A BOOK OF NONFICTION THAT ADVANCES AND INFLUENCES POLICY DEBATES ON A WIDE RANGE OF TOPICS RELEVANT TO CANADIANS. HERE ARE EXCERPTS FROM THE FOUR FINALISTS.

When I first wrote about AIDS in 1981, the acronym had yet to be coined; the strange new illness, which seemed to affect only gay men, was dubbed grid — gay-related immune deficiency. In the four decades since, AIDS has become, arguably, the most deadly pandemic in human history. At least 36 million people have died of AIDS, and another 40 million are still living with HIV, the human immunodeficiency virus that causes aids. (Of course, nothing compares to the Black Death. The bubonic plague killed somewhere between 75 and 200 million people between 1346 and 1353. But that was long before the advent of medicine or public health measures such as sanitation and clean water.)

AIDS has not only described the arc of my career in journalism, it has spawned in me a long-standing interest in pathogens more broadly: the viruses, bacteria, fungi, parasites, worms and prions that have been the scourge of humanity since the dawn of time. I have written about all manner of infectious micro-organisms, from the obscurely rare to those that casually kill millions a year, everything from sleeping sickness to tuberculosis, chicken pox to Ebola, polio to influenza.

Outbreaks rarely generate much media attention. The exception was Severe Acute Respiratory Syndrome (SARS). In 2003, SARS-CoV killed forty-four Canadians, devastated the economy and exposed gaping holes in our public health infrastructure. It was a dress rehearsal for a real pandemic.

The formal name for the pandemic virus that causes Covid-19 is SARS-CoV-2. When it arrived in our midst, someone (I wish I could remember who) said, “You've been training for this moment your whole life.” That's true. For me, infectious diseases are fascinating not because of their biology, but because they almost always have wide-ranging social, economic and political implications.

We are only beginning to get a sense of the earth-shattering fallout from Covid-19. In Canada, the pandemic has, among other things, exposed the fault lines in our institutions—political, public health, judicial and more. But no sector has been more brutally unmasked than eldercare, the hodgepodge of long-termcare homes, home care and affordable housing for seniors that lurks on the margins of health and welfare systems. We have long deluded ourselves into thinking our elders were well cared for. Now the norm has been shown to be horribly inadequate. We have been forced to confront the fact that the old way of doing things—dispatching our elders to live in holding-on-bya-shoestring nursing homes — is not working.

AIDS forced journalists to write about all manner of issues that were largely taboo until then: homophobia, intravenous drug use, sex work, institutionalized misogyny and more. It made us confront uncomfortable socio-economic realities such as how poverty, marginalization and disempowerment are pathogens' best friends. Covid-19 is reminding us that we need to relearn many of those lessons.

It is hard to imagine a population that has been more profoundly neglected for an extended period than elders. The responses to the sickening incidents cited at the outset of this introduction exposed multiple “systemic vulnerabilities” — the treatment of elders as disposable, understaffing, poor regulation and a total absence of accountability — that were never corrected. If anything, they grew worse. That set the stage for what happened in care facilities during Covid-19: thousands upon thousands of deaths, most of which were preventable.

What is perhaps most shocking is how little was done to raise the ramparts around nursing homes.

Anyone with even a passing knowledge of infectious diseases would know that frail seniors living in congregate settings are sitting ducks for pathogens, especially respiratory viruses. As soon as the word “pandemic” was uttered, alarm bells should have gone off and protective measures put in place.

That elders were at high risk was no secret. By February 2020, there was extensive coverage describing how coronavirus was hitting seniors particularly hard in China and in Europe, and warning that this phenomenon could soon hit North America. Among people over the age of 80 who had contracted coronavirus, the death rate was 22 per cent; in those aged 70 to 80, it was 8 percent.

The headline on a column I wrote in the March 8 edition of the Globe and Mail — before a single nursing home death had occurred — read: senior care facilities are especially vulnerable to covid-19 outbreaks. Not long after that, I wrote another column saying “if you can get your relatives out of seniors' homes, try to do it as fast as you can.” That commentary triggered many angry responses, but, in retrospect, my only regret is not having said it sooner.

It would take almost two months before politicians officially acknowledged the severity of the long-termcare crisis, by calling in the troops, literally. Canadian Forces health specialists were deployed to the hardest-hit homes in late April 2020. By then, thousands had already died. Quebec, the hardest-hit province by far, created “swat teams” to dispatch to care homes in October 2020, but did so only after a second round of deaths in institutional care was well under way.

The way elders died — almost always alone, their family care-givers locked out, without palliative care, and often with little care at all — was the greatest horror of all. Nihilism reared its head in our public policy response, an underlying ageist “they're going to die anyhow” attitude. The proponents of “herd immunity” — let the coronavirus run rampant and if vulnerable elders die en masse, too bad, that's the price of getting the economy running at full steam — openly reflected this crude philosophy.

There are those who will be looking for villains — politicians, care home operators, workers who walked off the job. But the real villain in this tragedy is society's profound and long-standing neglect of elders. A reckoning is in order.

Thousands of deaths, millions of people at risk, billions of dollars in potential damage: the numbers associated with earthquakes are overwhelming. For many of us who live in a seismic zone, the initial reaction is shock or surprise at the potential devastation. But that often gives way to a form of devastation fatigue. Not knowing what to do or think, we simply stop thinking about the risk at all.

My interest in earthquakes precedes my move to Victoria. I've been thinking about them ever since I first arrived in Vancouver in the 1990s, largely because I'm a journalist who's interviewed many quake survivors, scientists, and engineers. I've also had a close look at a lot of the innovation: watching engineers shake buildings, ducking under desks with school kids, and squeezing my lanky six-foot-five frame inside North America's first tsunami-survival capsule. So the interest has been professional. But it's also personal. As interesting as the scientific and engineering challenges are, what really fascinates me is our response to the risk — or, in many cases, our lack of response. I suspect millions of us are largely indifferent because we've never lived through a deadly earthquake and don't know what it's like. To be clear, I've never been in a major earthquake. But when I was 12 years old, my family was in a car crash that killed my dad and nearly paralyzed my sister. I've never forgotten the catastrophe that came without warning and shattered my family in seconds. I get a similar sense from every survivor of deadly earthquakes I've ever interviewed — they never saw it coming and can never forget it.

Jim Reimer, a pastor from Nelson, B.C., was in Haiti in 2010. “The floor literally lifted up about three feet into the air and threw me across the floor,” he says. “It just threw me!” The horror of mangled bodies piled up after the quake traumatized Jim deeply. “I thought I should be pastoring, but I didn't have it in me. I was broken.” Jim rallied and has since helped raise hundreds of thousands of dollars for Haitians.

But along with a heavy heart for the victims, he's been left with a deep sense of anxiety that whatever building he enters might collapse. “I go into a building and the first thing I do is look for an exit.”

Haley Westra was 18 when she flew to Nepal on a volunteer school-building project — and landed in a giant earthquake. “You'd look over to your left, and there's a building coming down on a family, and you'd look over to your right, and people are just running away from the buildings. And there's screaming and chaos, and you're just frozen.” Thousands were buried and millions left homeless in the

Himalayan kingdom. The aftershocks continued, but Haley stayed and helped the people of a small mountain village rebuild. When she returned to Victoria, she tripped in the airport a few times because she wasn't accustomed to the ground under her feet remaining still. Haley went on to study nursing, and now she wonders if her hometown is prepared. Apart from physical infrastructure, she questions if we'll have adequate mental health resources. “It's a trauma, so people will need emotional support and psychological support for what they've seen, and the fact that you cannot trust the ground,” she says. “I don't trust the ground I walk on anymore.”

On a sunny summer day in 2017, I received a copy of a comprehensive seismic report commissioned by the City of Victoria — a thorough examination of the building stock in British Columbia's capital city.

The study considered several different scenarios, and in the worst crustal and subduction earthquake scenarios, the damage it predicted was staggering: two out of every three buildings in the city of Victoria could either collapse or face demolition.

These are the homes of teachers, doctors, police officers, firefighters, professors, scientists, journalists, managers, ministers, and midwives. What will happen to our city if two out of every three of us are left homeless in a single day? What will happen if many of us die and even more are injured?

“If you're going to worry about earthquakes,” one person told me, “you should probably just move somewhere else.”

For many people who live in an active seismic zone, that looks like the only real choice: leave, or refuse to think about it. But a growing number of people have been thinking about earthquakes in recent years; they have discovered that there are other choices, and we can reduce the risk.

REBECCA CRAIGIE PHOTO