This column is an opinion by Dr. Hance Clarke, the director of pain services at the Toronto General Hospital (TGH), and Imran Abdool, president of Blue Krystal Technologies and Business Insights. For more information about CBC’s Opinion section, please see the FAQ.
In the short-term we are fighting COVID-19, but eventually the dust will settle. It always does. However, pandemics will happen again. We must win this battle and ensure we win the broader war on pandemic preparedness.
For too long, health-care experts have warned of under-funding and a lack of resources in the sector. Sadly, those chickens have now come home to roost.
A healthy population builds strong economies, but too often those strong economies under-invest in their health-care sectors. Case in point: after the Global Financial Crisis of 2007-2008, Canada emerged as one of the stronger economies. Despite this enviable position, repeated calls for health care investment and news clips of over-capacity hospitals received only a lukewarm response from policy makers.
Hallway medicine became the accepted norm as patients waited days in the ER for hospital beds. It was a warning sign Canadians failed to heed.
The current toolbox of government initiatives now being deployed to cope with a pandemic that is already underway is a poor solution for a system under stress. Given the lack of a vaccine or a cure for COVID-19, society is scrambling to build ventilators and calling upon every physician and health care worker to shore up the front lines — at best, a desperate reaction.
It’s frustrating to know that Canada could have been much better prepared for this outbreak.
Prime Minister Trudeau recently acknowledged Dr. Joe Fisher, a professor in the department of anesthesiology and pain medicine at Toronto General Hospital in the University Health Network (UHN), in his daily address to Canada, for example. Dr. Fisher’s company, Thornhill Medical, created a novel portable intensive care unit, operated by battery power, which has a ventilator and can perform vital signs monitoring. This is a technology that should have been procured long before we were in the midst of a pandemic.
However, there was little interest in health care investment during times of plenty. Instead of being in a position to implement these devices seamlessly during this immense surge in the need for ICU ventilator care, the next months will be spent scrambling to build them as a potential band-aid solution.
We didn’t learn from SARS, and we didn’t make the investments we should have in health care before this crisis hit. So we must start to assemble the lessons being learned again during this time of stress – or else they will be quickly forgotten for the next pandemic.
First, health care research and development is a space that the Canadian government must invest in as a routine policy. We cannot leave this task only to profit-seeking companies. Since the 1990s, for example, relatively few radical new medicines have come to market – in contrast with the so-called “golden age” of antibiotics during 1940 to 1960 (which coincided with higher investment in public research at universities).
Second, the COVID-19 crisis has shown how easily the supply chain can be disrupted. But it’s not just toilet paper hoarding and grocery shortages, some prescription medications appear to already be on back order. Again, we’ve come to rely too much on for-profit companies to manage the drug supply.
For chronic pain patients on opioid medications, for example, various long-acting formulations are already on back-order without a clear indication of when that might be lifted. This shortage can have severe consequences, both physical and social — some patients may suffer in isolation as they cope with significant opioid-related withdrawal, others may not be able to tolerate this distress and turn to illicit means in an attempt to mitigate their distress.
Our fear is that Canada will see a spike in opioid-related deaths during the current pandemic as a result.
Third, we need to establish surge-capacity in health care. When our economic times are good, that is the moment to invest in the growth and sustainability of our health care capacity — not reduce or stagnate those budgets, which has been the path taken by government in recent years.
Finally, we need to realize that as our population ages, this requires a re-calculation of the health care-productivity nexus. Aside from preparing for crises such as COVID-19, funding of routine services such as hip and knee replacements must remain a priority to keep our citizens healthy and productive long into the future. That productivity is the basis of a strong economy.
Ultimately, ensuring we are able to cope with surges such as COVID-19 needs to be balanced with a targeted annual approach to health care investment that optimizes system dynamics and reduces wait times. As patients see needed medical procedures delayed or cancelled by hospitals right now, it means even more lost productivity reverberating through the economy, and for a full economic recovery post COVID-19 we will need a workforce at maximum capacity.
While COVID-19 is a tragedy, we should not let it become a double tragedy by repeating our mistakes. We must learn, assemble the best practices as we go, and act on them.
The old phrase “don’t miss the forest for the trees” means we must keep our eyes on the big picture: a properly funded and managed health care system that can provide for regular daily needs, as well as pandemic preparedness for exceptional times.