“They say the mark of insanity is doing the same thing again and expecting different results,” Dr. Noah Ivers writes. From clean air to changing the culture of working sick, here are lessons from the pandemic we must consider.
If we’re going to live with COVID-19, what lessons should we take with us?
They say the mark of insanity is doing the same thing again and expecting different results.
With Doug Ford’s announcement to speed up reopening, as well as the removal of vaccine passports by March 1, politicians and some public health authorities are emphasizing a need to learn to live with the virus. But it’s important to clarify what exactly this means.
If we are learning to live with this virus, it can’t happen without addressing past failures. Learning to live with the virus should not mean returning entirely to normal life as we knew before the pandemic. This would dishonour the memory of the more than 35,000 Canadians killed by the virus, and be a disservice to those who made sacrifices of all sorts.
With these restrictions loosened, what lessons will we apply when new variants arise causing new waves of COVID-19? Will we avoid devastation to our economy and our wellness? There have been many lessons to take from the last few years, but I propose here that we must act upon a few immediately: breathing clean air, staying home when sick, proactive planning for health care surges in demand and rebuilding trust in public health authorities.
As a physician, I’ve been amazed at how few of my patients in the last couple years ended up in hospital due to influenza or due to exacerbations of chronic lung disease. It’s been amazing to see how beneficial breathing clean air can be. If we try to “return to normal” we must apply solutions that we now know can prevent people dying due to poor air quality. That means upgrading required standards on ventilation and filtration everywhere that people gather. This is especially crucial in spaces that are crowded or where vulnerable people might gather.
We also want people who may be vulnerable due to disabilities to feel safe so they can actively contribute to society. As a physician, I have learned how it is possible to protect my patients with compromised immune systems, and also how little is in my power. Investments to improve the quality of the air we breathe — prompted by legislation governing safety in these spaces, similar to how we addressed lead in the past — could both create new jobs and keep people healthier. Learning to live with the virus means making those investments.
Another lesson to learn from is changing the culture of “showing up” to work when sick. We’ve always known that it’s impolite (at best) and potentially dangerous to show up to school, work, or social events when unwell, but the pandemic has clearly illustrated our ability to stop doing this. We can choose to value a “tough it out” approach that puts others at risk or to value a “compassion first” approach that keeps others safe. Learning from this pandemic means that workplaces and schools should reset expectations and rebuild cultures around the idea of limiting sickness amongst employees and students. Obviously sick pay and sick leave policies are needed to enable this positive culture change, along with flexible work or learn from home policies.
As a family physician, I don’t want to be assessing every mild cold nor writing notes to confirm them or their resolution. My time is better spent focusing on patients who may require investigations or management. Sick pay and sick leave policies must be crafted in a manner that does not burden the health workforce.
It is also crucial that we understand that the public health decisions in Canada were required due to inadequate health care capacity. As a nation, we have relatively few staffed hospital beds per capita and we cannot handle surges in demand. We must learn ways to manage the challenge of inadequate hospital capacity without using lockdowns. We must also learn how to “catch up” so that all my patients waiting for cancer biopsies or hip replacements or other procedures can be taken care of quickly. This has also illustrated a need for more home care so people can avoid needing these facilities and also so that their family members can stay in the workforce. We have seen the ability for multiple parts of the health sector to work together to address urgent regional needs. We must apply those lessons on an ongoing basis.
The health care workforce has been flexible during the pandemic. In many areas, family physicians like myself have built new relationships with public health and hospitals to help vulnerable communities. But these efforts have left other work undone. Will we learn about the investments we need to make in health care to protect our economy? Or will we go back to ‘normal’ with hallway health care an indelible feature of our hospitals?
Public health has, in many ways, lost the trust of the average Canadian due to policies that sometimes haven’t made sense, such as closing up outdoor play spaces. At the same time, when evaluating our performance overall, Canada has done fairly well, losing fewer lives per capita than many comparable jurisdictions.SKIP ADVERTISEMENT
However, this will ring hollow to those family members who have experienced losses and to those people suffering with disability. We must also consider those who have lost their livelihoods and suffered economically due to inadequate support from the government. We need messages from leaders about what has been learned and how we can make things better going forward to create new economic opportunities. Those who have been careful will feel betrayed if the message suddenly shifts to “return to normal” rather than returning with new realizations.
Finally, we need to urgently learn how to rebuild trust. Whether it’s knowing that as a physician, I’ll have access to protective equipment and evidence-based guidance on testing and treatment when needed or implementing a new vaccination program. We have learned that these things will not be possible without trust. And we have learned that trust cannot be rebuilt without regular, transparent and empathic communications — ideally from a non-partisan, trustworthy source with legitimate expertise and without conflicts of interest.
We need not wait for that to act upon what we have already learned. Canadians have in the past faced great battles with passion to protect fellow Canadians. We must do that again now. Not by forgetting, or wishing to return to days of yore, but by acting now upon what we have learned.