We are all affected by the COVID-19 pandemic; however, we have not and should not let the virus define us. Decision making during pandemics often calls to mind how great decisions have been made historically. If you think we have problems, consider the first week or two of Winston Churchill’s term as Prime Minister of Great Britain. He was put in place as prime minister just as Belgium, Holland and France fell to Nazi Germany and as Britain’s entire army, over 300,000 troops, was trapped in Europe. There were huge pressures on Churchill to concede to the enemy and many pointed out the risks of fighting. Needless to say, Churchill chose to fight. His first step was to articulate a compelling case to the people of Britain. He famously stated, “We shall go on to the end. We shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender.“.
Churchill galvanized the people by reminding them of their historical strength and successes. He then basically got informed consent; telling them the truth (mostly) so that they could weigh in on the choice to fight or concede. As we begin to emerge from the COVID-19 pandemic our choice is how to fight the invasion of our country by an enemy virus. We too must offer information to inform and hopefully galvanize Canadian society to accept the risks that will inevitably accompany reopening society. We should not just recreate the past. We need to learn from what went well (and more from what did not) during this pandemic. We need Canada to emerge in a more innovative, nimble and prepared state than we were before adversity hit. Learning lessons from the past is the responsible thing to do and is not a criticism of the many correct and well-reasoned responses that the provincial and federal governments have put in place or the good governance we have experienced at KHSC and within the Faculty of Health Sciences at Queen’s University. However, we do need to learn lessons and reinvent our country to ensure we are better prepared for the future.
How we choose to respond to COVID-19 is critical and must be done strategically in partnership with the local authorities (city, region, hospital, and university). We have recently seen an entire round of CIHR research funding canceled or delayed, medical students removed from clinical rotations across the country, elective procedures canceled and some doctors’ offices closed, making it hard to get care and prescription referrals. Schools and daycares are closed and it is estimated there will be a 1% decrease in global gross domestic product (GDP). We are already seeing the early consequences of delayed care for the 99% (those patients who have diseases which are not COVID-19). Delays in cardiac surgery, interventional procedures, cancer surgery, ophthalmologic procedures etc. predictably have adverse consequences. If, as COVID-19 curves flatten, we are too slow to ramp up procedures we may precipitate more morbidity and more mortality than the virus can itself wreak.
In planning our way forward epidemiology (and the experiences of countries that were infected earlier) should be our guide. This epidemic will not likely have an abrupt end date. Rather I anticipate that we will enter a new normal, one with mass COVID-19 testing, selective quarantine of infected people and hopefully a vaccine and effective drugs so that COVID-19 becomes more manageable. Therefore, the correctness of a response how to reactivate education, research, and provision of healthcare should likely be viewed not from the perspective of a 2-3 month delay but from the perspective that we will be dealing with this challenge for months or years to come. True, none of us have a crystal ball and the longer term disease ramifications will no doubt be different than those of the first wave.
Like Churchill we need to display courage and take calculated risks. We also owe the public a clear explanation of what the risks are both of ongoing shut downs versus phased activations of business and health care. Canada has, or will soon have, the ability to bring back, health care students (medical, nursing, rehabilitation, occupational health and physiotherapy) into training, even if their roles are more focused for a time on service than on education. We can offer patient care opportunities in clinics, by video visits, and on our clinical teaching units. The consequences of not getting our future healthcare colleagues back to the coal-face could be huge for their self-image and career trajectories, as well as for Canada’s healthcare human resource supply. I cannot help but note that last week it was the military, not civilian medical personnel, that was called in to deal with health care concerns in Quebec nursing homes. The Universities and Medical Schools cannot be on the sidelines at time of crisis like these.
The good news is that we have already become more creative with fewer face to face meetings and more ZOOM meetings, more e-health and video visits and a renewed spirit of high-minded cooperation, marked by fewer bureaucratic barriers between government, universities and hospitals. There is much more to do however. Canadian and Ontario governments must continue to be innovative and consider bold uses of stimulus funding, such as forgiving student loan debt, extending funding for all CIHR-funded researchers for an additional 1-2 years year to keep laboratories open, investing in a domestic health care supply chain that is not so dependent on the United States and China. The spirit of our response to the epidemic should be optimistic. We should view this pandemic not only as a challenge but as an opportunity to do things differently and better. Let’s channel the late President, John F. Kennedy, who when making the case for the American space program, identified the benefits to society of taking on difficult challenges, in this case going to the moon.
Kennedy said, “We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win, and the others, too.“
Rice University, Houston Texas, Sept 12th, 1962
So over the coming weeks, months and year…let’s do what is right for KHSC, Queen’s and Canada knowing that if it is done right change will be hard but will yield enduring benefits. Let us reactivate our healthcare system and schools, let us forgive student loan debt, let us bring workers back to work as soon as safely possible, let us build a more robust national public health core, let us ensure Canadian research is funded in a stable and robust manner, and let us spend on aspirational projects, like vaccine development, and creation of a Canadian pharmaceutical supply chain and proper national repository for PPE and other biomedical supplies.
In summary, we all need to show courage in the face of this unseen enemy and when this pandemic has ended (as it will), let it be said Canada responded with courage and innovation!