Many homes in Toronto have a sign in the window that says, “You are there for us. We’re here for you, ”expressing the city’s support for healthcare workers. Ontario was taken into custody in mid-March to ensure that COVID-19 cases did not overwhelm hospitals.
But do we still have to be locked up? Provincial officials, who extended Ontario’s emergency orders until June 30, would say yes. Some doctors, epidemiologists and public health economists would say no. Many fear that the remedy is worse than the disease.
“I am not questioning the need for a lockdown in March,” said epidemiologist Martha Fulford, chief of medicine at McMaster University Medical Center. “But now we have more information. And two months later, we are at a point where the damage from the lockout begins to appear to be greater than the damage from COVID.
“And this is the conversation I think we should be having. “
Fulford is not talking about the fiscal harm of a tattered economy. It refers to the so-called “social determinants of health” or to the health impact of millions of low- and middle-income Canadians – most of them women and newcomers – who have been kicked out of work because of of the closure.
“We know there is a correlation between poor health and poverty and deprivation of rights,” said Fulford in an interview. “And if we have massive unemployment and massive job losses, it will lead to poor health, which will lead to premature death. “
Public health officials say Ontario has managed to smooth the curve and spare its health care system.
“But there doesn’t seem to be an exit strategy to deal with the worsening collateral damage from non-COVID mortality that we are seeing,” said Fulford. “And it is not tracked or clearly documented. “
Vivek Goel, a professor at the Dalla Lana School of Public Health at the University of Toronto and the university’s vice president of research, innovation and strategic initiatives, is also concerned.
“Shutting down your economy is like cutting your two feet – or maybe a better analogy would be your head – to try to save the rest of your body,” he said. “It was never intended as a long-term strategy.”
Goel is leading a team of researchers from the University of Toronto who are studying the health consequences of prolonged layoff in various sectors of the economy and trying to quantify the risk of non-COVID mortality.
“So often closure is presented as a debate between health and the economy,” said Goel. “But the economy is also health. “
For example, studies of past economic downturns have shown that unemployment increases the risk of dying by around 1.7%, Goel said in an interview.
“If we compare the deaths of people between the ages of 25 and 60 due to COVID and the deaths in the coming years of unemployment, I certainly think we will have a lot more” because of unemployment, he said. “Death is just the hardest thing. But there will also be other effects on the health of these people. “
Goel’s team includes colleagues from the University of Toronto, Laura Rosella, Canada Research Chair in Population Health Analysis, and economist Kevin Bryan, Assistant Professor at the Rotman School of Management. Together, they aim to have their analysis ready by mid-July to help policymakers reopen the economy.
“I would say we need to carefully assess the types of (public health) consequences we are talking about,” said Goel. “And then let’s think about how we will reopen the sectors safely, starting with the ones that are most important to the economy.
“Can we get the right protections? Can we work with unions? And can we reassure people that we will make them work safely? ” he said.
Epidemics are inevitable with the opening of the province, he said. Therefore, hospital capacity, testing and contact tracing will be crucial. Hospital admissions, rather than the number of new cases, should be the number to watch, added Goel.
As of 5 p.m. Wednesday, health units had reported a total of 30,807 confirmed and probable cases of COVID-19, including 2,373 deaths.
About 97% of deaths from COVID-19 in Canada have occurred in people 60 years of age and older. Seventy-two percent of deaths have occurred in people over the age of 80.
Meanwhile, approximately 2.2 million Ontario workers have been directly affected by pandemic-related closings, including job losses (1.1 million), temporary layoffs or severely reduced hours of work (1 , 1 million), according to the Financial Accountability Office of Ontario (FAO).
Health Minister Christine Elliott acknowledged on April 28 that about 35 Ontarians have died while waiting for treatment for heart disease, according to modeling, while hospitals have freed up space to treat the new coronavirus.
More than 52,000 hospital procedures had been canceled or avoided by April 22, and each week the pandemic continues, up to 12,200 more procedures are delayed, according to the FAO.
Hospitals began a gradual return to elective surgery in late May, but medical researchers estimate that it will take 11 months to clear the backlog.
An Elliott spokesperson did not explain how provincial officials weigh the risk of death from COVID versus the risk of death without COVID during the pandemic. But in a statement, Hayley Chazan said the government has introduced measures to help vulnerable populations, including funding to improve access to food banks and other supports.
“We understand how important it is for people to return to work, especially for those whose lack of employment has led to mental health problems and poverty,” she said in an email.
“As we gradually open up our economy, continuous protections for vulnerable populations must be put in place, as well as the continued practice of physical distance, hand washing and respiratory hygiene, and important mitigation plans to limit health risks, “added Chazan.
Fulford, who works primarily in pediatrics at McMaster, is particularly concerned about the impact of the judgment on children.
“It is not a pediatric disease anywhere in the world,” she said, noting that fewer than 100 people under the age of 20 in Canada have been hospitalized due to COVID-19 and none have died . (In Ontario, less than 4% of people who test positive for coronavirus are under the age of 20.)
In comparison, 1,372 people under the age of 20 were hospitalized with influenza in Canada last year and 10 died.
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“So if we’re looking for an exit strategy and trying to improve the damage, why haven’t we reopened playgrounds, schoolyards, camps, swimming pools?” ” she asked. “Depriving a child of his education or socialization will do nothing to prevent COVID but will do a lot of damage to these children.”
Keeping camps and daycares closed further disadvantages adults and single parents who cannot afford alternative care, added Fulford.
As mental health experts sound the alarm, Fulford is already seeing the impact of his practice.
One of his patients, a former injection drug user who had been clean for six or seven years, became so depressed by self-isolation that he started using drugs again, she said.
“These are the lives that will deteriorate if this continues,” she said. “We have not had a COVID tsunami, but following (the lockout), we are all preparing for a tsunami of mental health issues. “
Doctors in the United States are also speaking out. Last month, a letter to President Donald Trump, signed by 600 American doctors, called the lockout a “mass incident” with “increasing negative health consequences” for millions of people who have not contracted COVID- 19.
“The millions of victims of continuous arrest will hide in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke or kidney failure,” said the May 19 letter. “Among young people, this will be called financial instability, unemployment, despair, addiction, unplanned pregnancies, poverty and abuse.”
“It is impossible to overestimate the short, medium and long term damage to the health of people with continuous cessation,” said the letter from Los Angeles emergency medicine specialist Dr. Simone Gold.
Gold, who has been criticized in the American media as a supporter of Trump, said the letter was a popular effort on the part of doctors and was not politically motivated.
“Losing a job is one of the most stressful events in life, and the effect on a person’s health is not mitigated, as it has also reached 30 million (today 38 million) other people, “says the letter. “Closing schools and universities is immeasurably detrimental to children, adolescents and young adults for decades to come.”
Richard Schabas, who was Ontario’s chief medical officer of health between 1987 and 1997, said it is unfortunate that the issue of reopening the US economy following COVID-19 has become so politicized.
“It really muddled the debate in the United States, and I think it affected some of our thinking in Canada,” said Schabas, who was chief of staff at York Central Hospital during the epidemic of SARS from 2003. He retired as a medical officer of health for Hastings Prince Edward in 2016.
Politicians must establish “non-negotiable,” he said in an interview.
“They have to say things like: children have to go to school; people have to go to work; there must be optional medical care. Once we have laid the foundation necessary to protect our public health, we can discuss what we can do to control COVID beyond that, “he said.
“So far … everything has been: what should we do to control COVID, and the rest can go to hell,” said Schabas. “And it’s a big mistake from a public health perspective.
“If, in our attempts to end deaths from COVID, we end up causing far more deaths from other things – deaths that will haunt us or damage to our health that will haunt us for decades to come – it is not a good business. “
Canadians are “scared” by the deaths from COVID-19 because they are broadcast daily in the absence of any context, said Schabas.
Nearly 300,000 Canadians will die each year from cancer, heart disease, stroke, traffic accidents, suicide and a multitude of other causes, he noted. Since mid-March, for every Canadian outside long-term care who died from the new coronavirus, 50 have died of something else, he added.
The vast majority of people in Canada are at very little personal risk of dying from COVID-19, said Schabas. For most people under the age of 60 and for the elderly without serious health problems, the risk of dying from coronavirus is about the same as that of dying from the flu, he added.
“We are two populations: the frail elderly for whom COVID is a deadly disease and the vast majority for whom this is not the case,” he said.
In an appearance before the House of Commons health committee on May 20, Schabas said the country was facing both a tragedy and a crisis.
The tragedy is COVID-19, a respiratory virus that has the potential to kill tens of thousands of Canadians who are overwhelmingly elderly and infirm, he said.
The crisis is our attempt to control this virus which has the potential to cause “serious and lasting damage” to the country’s economy, education, social and cultural institutions and mental health which will have repercussions on the public health for decades, said Schabas.
“The tragedy is a natural disaster that saddens and saddens us all,” he said. “The crisis is a self-inflicted injury that really scares me.
“It offends social justice because the burden of the crisis is disproportionately heavy on children, young families and blue-collar workers,” he said. “The more we focus exclusively on COVID, the greater the danger to our public health.”