The medical repercussions of infection with this virus are manifold, complex. We can’t afford any government that glosses over this fact.
“I’m sorry, but it is likely COVID-19 again.” These are words we say daily to our patients, in May 2022. Parents of young children in day care or kindergarten, not yet eligible for COVID-19 vaccine, respond, “But they told us COVID-19 is over,” or, “How can they let this happen?”
Meanwhile, our patients who are still struggling with long-COVID from infections in the spring of 2021, are tired, short-of-breath when they go for an easy walk, suffering from headaches, struggling with cognitive deficits, are mad as hell that they are back in bed, isolating from their loved ones. Ninety-year-olds and our patients with disabilities who live in the community and those who live in group homes, retirement homes, or long-term care residences heart-wrenchingly ask, “How has the world forgotten us?”
Indeed, how have we forgotten the body bags, mass graves, pyres of bodies? How have we forgotten more than six million people who have died from COVID-19, globally? Researchers acknowledge that the number of deaths is likely a gross underestimate, as deaths in many parts of the world are underreported, due to poor record-keeping and testing. The true death toll from COVID-19 may be between 14.1 million and 23.8 million. The same countries that are less likely to have an immunized population because of poverty, war, lack of medical resources and basic infrastructure, lack of access to vaccines, lack of access to medical care, and distrust of western biomedicine, are also less likely to have accurate records of COVID-19 deaths.
But we cannot be smug as Canadians. We do not have to look beyond our own backyards to witness preventable tragedy. At least 41,000 Canadians (13,000 people in Ontario) have died from COVID-19 since the pandemic began. And, although we no longer see it as headline news, people are still dying every day from COVID-19 in our own cities and rural and remote areas.
Enter now, like a chorus in Greek tragedy, the inevitable voices chanting, “Aha, so the vaccines didn’t work!” Yes, they did. Vaccines (thank you, science!) did exactly what we said they would: reducing serious illness, hospitalization and death. Death rates in Canada and worldwide are highest among people who are unvaccinated, or only partially vaccinated.
You may not want to hear it, and politicians (especially in the midst of election campaigns) may not want to address it, but COVID-19 is not over.
“Return to normal,” they said. Who are “they,” and how do they define what is normal? It is politically convenient to forget about the people who lost family and friends and colleagues to COVID-19.
It is medically and socially irresponsible to focus on mortality and gloss over the serious issues of morbidity (illness) and long-term disability. In Canada, 3.88 million cases of COVID-19 (1.33 million in Ontario) have been recorded. Those cases aren’t just data points, they are people. Doctors, nurses, personal support workers, dentists, social workers, educators, child-care providers, grocers, long-haul truck drivers, taxi drivers, high school students, kindergarteners, newborns. Many of us were sick for weeks, during which time we couldn’t work (or we were pushed back to work while still contagious, because of inappropriate public policy). The stress on the health-care system is serious. There is nothing “mild” about emergency departments that are understaffed and over-crowded.
Epidemiologists and infectious disease experts, cardiologists, respirologists, endocrinologists and neurologists warn that the medical repercussions of infection with this virus are manifold, complex. Just because your week or two of isolation are over, does not mean that Covid-19 is done with you. Just because you had your COVID-19 vaccine, and/or you made it through an infection a year, or six months, or six weeks ago, does not mean that you are immune. You can be reinfected. You can (re)infect others.
What should we be doing, then? Well, we should be using the knowledge and tools that we have. For example, every region of Canada could and should ensure that citizens have all the preventative tools at their disposal (masks, ventilation, supports for people to adequately isolate). Every public health unit and school boards could and should require masks indoors. They should test and report and trace cases. Ignorance is not bliss.
We know that COVID-19 is airborne, we know that it wafts through classrooms and offices and restaurants and gyms, leaving people sick in its wake. We know that opening windows and installing HEPA filters, and tracking carbon dioxide levels as a gauge of ventilation, are helpful measures. We know that for masks to be most effective, everyone needs to be masked, that respirators such as N95 and KN95s are more effective than surgical masks (because they filter out large and small particles and are better-fitted than surgical masks, even if they aren’t fit-tested). Surgical masks are much more effective than cloth masks (respirators and surgical masks trap viral particles using electrostatic properties of their fibres).
Politicians around the world, pandering to a small but vocal group of anti-maskers, encouraged people to “move on” because it was politically expedient, not because it was safe to do so. “Let’s see your smiles,” they said. They literally do not care what happens to you, short-term or long-term. Ask a person who lives with chronic illness or cares for someone with a disability, ask a person who lives in poverty, ask a senior who cannot afford a retirement home, or ask the families of anyone who died in long-term care of neglect. Your health/safety is not the primary concern of any of the leaders who lead you to believe that wearing a mask is a hardship. It is a hell of a lot easier to wear a mask than it is to convince those leaders to care for you when you need it.
So, as a family doctor who has stood up for my patients and vulnerable people in the Ottawa community throughout the pandemic, I am here to remind you, to beg you, to take care of each other. I am here as an antidote to collective amnesia, even if it means I’m putting myself out there to be criticized and harassed. Here are some concrete things you can do, if you have any sense of being in this together:
Think about people beyond your immediate circle. Put on masks any time that you are indoors. “Oh, doctor, stop with the virtue signalling,” the trolls will say. How about, dear public, think more about shared responsibility.
How much longer will you need to wear masks? None of our infants and children under 5 have had their first doses of COVID-19 vaccine yet. That’s one metric, if you need a reason to wait. Just because you don’t have an infant at home, doesn’t mean you won’t end up giving COVID-19 infection to a parent at the grocery store, whose infant will end up in hospital. If that isn’t a risk you care about, how about your staff not being able to show up to work? How about the local hospital or the paramedics or the doctor at your clinic not being able to respond to your emergency because their staff are away with COVID-19?
Get all the doses of vaccine you are eligible for, and demand that our public health authorities open eligibility for booster doses of COVID-19 vaccine to the entire population. In Quebec, anyone 18 and over is eligible for a fourth dose (second booster). As the interval of time extends beyond five months, the protective benefits of earlier doses wane. Most of our essential workers, all parents, are in the under-60 age group whose third dose was in December or January. They are asking us to give them their boosters, but instead public health units are throwing out doses. It makes no sense.
In Ontario, we are in the midst of an election. When you vote on June 2, vote for a candidate who cares about the health and well-being of children, seniors, people with disabilities, women, marginalized populations. Make sure you understand each of the political platforms and demand to know what political parties stand for when it comes to public health care, mental health, family medicine, children’s health, the crisis in nursing, environmental determinants of health, social determinants of health. There are many organizations that highlight health platforms, including the Ontario Medical Association.
The inequities we witnessed and moral injuries that we experienced between March 2020 and June 2022 stem from a health-care system that was already fragmented, dysfunctional, fundamentally flawed before the pandemic began.
I’m asked on social media, “When will you shut up about masks and vaccines?” The answer is, never. It is literally part of my job to advocate for your health and safety. As long as marginalized and vulnerable populations are at risk, as long as there are political decisions that adversely affect your health, as long as key players are absent at decision-making tables, the advocacy cannot end. Systemic misogyny, racism, ageism and ableism were key issues that played out at every level of the pandemic, with catastrophic consequences. We cannot afford to forget this. So — with many colleagues across Canada and around the world — this is your wake-up call.
Dr Nili Kaplan-Myrth, MD, CCFP, PhD, is a family doctor and anthropologist who writes about health policy and politics. She co-hosts a podcast, Rx:Advocacy.ca . Twitter: @nilikm
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