We need to protect health workers in the COVID-19 battle
SARS crisis showed vulnerabilities we can fix, says Dr. Charles S. Shaver.
In 2003, SARS caused 774 deaths worldwide, with 43 in Canada. Nearly half of cases involved health workers. COVID -19 has spread to 115 countries with more than 4,000 deaths — more than five times more than SARS, in less time. We must look for short-term and longer-term mitigating measures, including for those persons who live “paycheque to paycheque” and have no sick leave. They may be working part-time or are self-employed. How can they be induced to remain in quarantine?
There’s also a specific set of workers we should focus on. As Dr. Tedros A. Ghebreyesus of the World Health Organization notes: “We can’t stop COVID -19 without protecting our health workers.” About 43 per cent of nurses are casual or part-time; many work in multiple institutions. They have no sick benefits and must rely on EI — if they qualify.
Physicians placed in quarantine would have to wait 30 and often 90 days or more before collecting private insurance benefits. If elective surgery were cancelled for weeks to make room for COVID -19 patients, this would have major economic effects on surgeons and anesthetists too. Their disability insurance would not cover them.
In June 2003, Ontario offered $500 to $6,000 to persons who lost income due to SARS for more than five days. It also set up the Income Stabilization Program. Eventually MDs, nurses and paramedics received a total of $190 million.
To minimize patient visits to physician offices and walk-in clinics, each province should pass legislation waiving the requirement for signed “sick notes” by MDs. They should set up free-standing COVID-19 testing centres, such as in Nova Scotia or Michael Garron Hospital in Toronto, or offer home-testing by paramedics. In addition, to minimize patient visits to offices, provincial health ministries should collaborate with medical associations to establish — at least for a few months — new fee codes so that MDs could be paid by government to manage patients over the telephone.
In the longer term, we should begin to build new chronic-care beds across Canada. Excluding Quebec, the rest of Canada has 73,000 acute hospital beds, but we rank 26th out of 27 in beds per thousand persons among countries with universal health care. Many operate at more than 100 per cent capacity, with patients lying in hallways.
Meanwhile, COVID-19 has halted production of products in China, and supply chains for components of automobiles, computers and so on have been disrupted. This may well affect our drug supply. For many months, drug “back orders” had been worsening for a number of reasons. Last summer, Kelly Grindrod of the University of Waterloo estimated that 1,800 of 7,000 prescription drugs were shorted. The
Food and Drug Administration estimated last spring that at least 80 per cent of the active ingredients in all of America’s medicines came from abroad — mainly China. India is the leader in generic drug manufacturing, but China provides it with 80 per cent of its raw ingredients. How can we ever expand our pharmacare program if we do not have a secure supply of drugs? As Dr. Jacalyn M. Duffin of Queen’s University asked, “Why doesn’t Canada … begin making the drugs we need with generic companies of its own?”
Both of these long-term suggestions cannot be implemented in time to affect COVID-19, but might help us prepare for subsequent pandemics. Of note is that they could also create thousands of jobs.
Unfortunately, Canada, like the United States, has been running up deficits and has not been saving during “good times.” Our federal debt has increased by 5.6 per cent over the last five years. This year, the total federal/provincial debt is nearly $1.5 trillion. Oxford Economics estimated that COVID-19 might slash global domestic product by $1 trillion. In Canada, this would be further exacerbated by the recent rail blockades. This week, oil prices and the stock markets have dropped precipitously. Thus we have very limited room to go even deeper into debt if we become victims of a severe global recession.
Federal Finance Minister Bill Morneau has offered assistance to protect businesses and workers affected by COVID-19. So far, he has not given details. The first ministers are meeting in Ottawa on Friday. Canadians are justifiably apprehensive. They urgently need to hear not platitudes, but concrete plans for action.
Ottawa physician Dr. Charles S. Shaver is past chair of the section on general internal medicine of the Ontario Medical Association. These views are his own.