Mental silos risk patients’ lives

Tom Moore died on Tuesday.

Ironically, the 100-year-old succumbed to the coronavirus that made him famous.

Last April, Moore set out to do 100 laps of his back yard, pushing his walker, to raise funds for the British medical system struggling to deal with the COVID-19 pandemic.

Captain Sir Thomas Moore, as he is more officially known, raised some $43 million and earned a knighthood.

It’s hard to realize that the first COVID-19 case showed up in Canada just over a year ago. A patient came to Toronto's Sunnybrook Hospital after returning from Wuhan, China, where the disease apparently originated.

COVID-19 was a brand new disease. We didn’t know how it started, how it was transmitted, or how to treat it. We had to learn as we went. Initially, we feared the virus was transmitted by physical contact. So disinfect, disinfect, disinfect. No handshakes, no doorknobs, no handrails.

And, of course, no sex.

Masks were only for medical staff. Because masks might encourage people to touch their faces with un-sanitized fingers.

Then we learned the virus is transmitted by breathing. By invisible micro-droplets, floating in the air. Masks became the first line of defence. (Presumably, sex was safe, if neither person breathed.)

Then they become mandatory. And now double-masking is recommended.

Initially, too, we saw ICU patients propped up in beds. Now I sometimes see then lying face down. It looks awkward, but apparently it helps to drain the fluid building up in their lungs.

At that point, I wondered if anyone in the COVID-19 camp had contacted the cystic fibrosis community about postural drainage.

Because nobody, but nobody, knows more about getting fluid out of lungs than the people who treat cystic fibrosis.

Granted, the fluid in CF lungs is thicker, more sticky, than the fluid in COVID-19 lungs. But it’s still a fluid, and the face down posture implies that there are ways of helping it drain, safely.

I write from personal experience. Our son had CF. When he was diagnosed, we received a posture board which could be adjusted to, I think, three different positions. We did “clapping” — slapping our cupped hands on his bare chest as he lay on the posture board, mostly head down — to jiggle the mucus clogging the tiny airways in his lungs so that it would drip into larger passages where he could cough it out.

It was a primitive process. But it worked. Therapy gave him 20 years of life that he wouldn’t have had otherwise.

Postural drainage techniques have changed since then. We used to do 20 minutes, in each of six positions, every day. I gather that five or six minutes can now accomplish as much. Also that there are new -- and very expensive -- vests that can deliver something like ultrasound impulses to produce the same effect as clapping.

But it is still all about draining those fluids.

So naturally I wondered if COVID-19 treatment centres had utilized any of the knowledge that CF doctors had accumulated over the last half-century.

Apparently not. Off the record, I was told that the CF community has had no connections with the infectious disease physicians treating COVID-19 cases.

None.

I don’t claim any medical expertise, just experience. But I fear that people may be dying because specialists are unwilling to think outside their professional silos.

I can understand that people dealing with the pandemic are being run ragged. By stress. By overwork. By despair.

And I can understand that their specialty is infectious disease, which CF is not. It’s genetic.

But I still argue that the silo mentality may be costing lives.

A silo is, of course, a vertical cylinder. In agriculture, it holds a single kind of cattle feed — not to be mixed or adulterated with anything else.

The same principle holds for ideas. Within their own silo, professionals share information willingly. But they rarely venture into anyone else’s silo.

As a writer and a journalist, I’ve seen too many silos. In mining, in forestry, in social work — even in churches that lock out anything related to evolution.

An examination of COVID-19 treatment in long term care homes in B.C., by Ernst & Young, specifically identified the silo mentality as leading to unnecessary deaths.

The Canadian Press report referred to “longstanding staffing shortages and … issues surrounding information being kept in silos and not shared with the wider community.”