Controversial push to ease restrictions draws sharp criticism
It's been a tough two years in the intensive care unit of Dr. Kwadwo Kyeremanteng's Ottawa hospital.
The hours have been horrendous and burnout among staff widespread, not least due to a unique characteristic of the COVID-19 sufferers who have flooded the ward.
While the typical ICU patient is unconscious for much of his or her stay, those with COVID often arrive awake and can chat with the doctors and nurses, which makes it all the harder when some grow desperately ill and succumb to the virus, said Kyeremanteng, the unit's head.
“That was a very under-recognized source of stress.”
But despite the pressures of grappling head-on with the world's worst public-health crisis in generations, Kyeremanteng has a perhaps surprising take on the pandemic and its impact.
As some of his colleagues balk at any easing yet of public-health restrictions, the critical-care specialist is pushing for schools to move more quickly toward open, pre-pandemic norms, and questions the need for some of the other limits still in place.
“The approach moving forward with COVID needs to be more sustainable,” he said. “What we're doing right now — closing economies, restaurants, gyms, schools — that is not a sustainable solution.”
He is one of the leaders of a controversial new U.s.-based group — the Urgency of Normal — that's pushing for a rapid return to unrestricted in-person learning for children, whom they argue have suffered unduly because of pandemic lockdowns.
The organization's 400 or so signatories include 32 other Canadian physicians and health-care professionals, among them four infectious disease or medical microbiology specialists, emergency medicine doctors, university professors and a hospital chief of medicine.
Fringe groups of physicians have popped up throughout the pandemic, denying the virus's seriousness, advocating for discredited antiviral drugs and spreading misinformation about vaccines.
The Canadian MDS backing the Urgency of Normal, while still likely in the minority, are different: Those interviewed by the National Post tout the power of COVID vaccines, have been on the pandemic's front lines and voice respect for the science.
But they also argue there's scant evidence to support closing schools or keeping students in masks and say it's hard even to justify the vaccine mandates that brought hundreds of truckers to Ottawa in a mass protest.
Though restrictions are easing in most provinces as case counts drop, the possibility of imposing further lockdowns again has not been ruled out.
“We're doing a lot of harm to the fabric of society,” Dr. Martha Fulford, a pediatric infectious-disease specialist at Mcmaster University and chief of medicine at a Hamilton hospital, said about the measures. “We need to understand what the endpoint is, what the rationale is, for any of this we're doing.”
Still, the group has come under some stinging criticism from other physicians and scientists, who complain that the advocacy “tool kit” it posted online for parents and school boards is rife with incorrect or misleading science.
The statement in its Powerpoint slides that child suicides have been increasing in the U.S. during the pandemic is simply wrong, said Dr. Tyler Black, a University of British Columbia clinical professor of psychiatry and suicide expert. The rate was actually higher in 2018, before the pandemic, he wrote on Twitter.
“Your slides on mental health are beyond bad,” concluded Black. “By being unscientific and biased in your selection and presentation of data, you are part of the misinformation crisis of this pandemic.”
Emily Smith, a public health professor at George Washington University, accused the group of lying about data by saying, incorrectly, that more children have died of the flu than COVID.
Kyeremanteng says the group welcomes all such input and sees the document as “iterative,” with some changes already made. He and the other signatories, though, say there is still ample evidence of the harm suffered by young people during the pandemic.
A recent review in the Canadian Journal of Public Health said there's a shortage of rigorous studies comparing rates of youth mental-health problems before and during the pandemic — but that there's “reason to believe” the pandemic could leave long-term impacts.
A sharp increase in eating-disorder cases has been well-documented. And the Quebec public-health institute reported this week that while actual suicides have remained stable, emergency room visits by teenage girls for suicidal behaviour jumped in 2021. “The distress remains very palpable,” it said.
Kyeremanteng said school closures and online learning have been a particular challenge for already marginalized communities. “Mom has to choose between going to work or educating the kids,” he said. “Those impacts can be lifelong.”
The Urgency of Normal tool kit, citing the relatively mild impact of COVID on children, recommends maintaining in-person learning regardless of where case counts move and eliminating school mask mandates by Feb. 15.
But the Canadian supporters say return to pre-pandemic life should go beyond just classrooms. With the large majority of Canadians now vaccinated and protected against serious COVID disease, the harms of public-health restrictions need more attention, they argue.
“We have a vaccinated population that should be largely protected from severe disease. So what else do people want before you have the conversation about going back to normal?” asks Dr. Ari Bitnun, a pediatric infectious-disease specialist and University of Toronto professor. “We are going to have to live with it, basically.”
The focus should shift beyond only combating the coronavirus, echoed Dr. Jocelyn Srigley, a clinical professor of medical microbiology at the University of British Columbia.
“We need to keep in mind that health is about more than just COVID-19 and look at the bigger picture,” she said.
The four Canadian doctors also said it's hard to justify vaccine mandates when evidence points to the shots doing little now to prevent transmission of the Omicron variant, even as they continue to be a potent defence against serious illness. Meanwhile, they acknowledge their views face sometimes-sharp pushback from colleagues.
Since his role in the Urgency of Normal was revealed, even Kyeremanteng's family has faced attacks, he said.
“This is a heated time and there are a lot of emotions when it comes to COVID response,” said the ICU physician. “I won't lie to you, it's been a tough week.”