Myopic Focus on Covid Isn't an Abundance of Caution

Ever since Covid first disrupted our lives, I've been struggling to understand why governments all over the world have so utterly failed to weigh the benefits and harms of the responses taken.

As said harms are becoming harder to ignore, it is past time to have the conversation most seem totally unwilling to have - what did we get wrong?

A comparison between my partner's experience with cancer in his early 20s fifteen years ago and that of my cousin's good friend now battling the same cancer, at the same age, crystallizes what I see as wrong with our response to Covid.

I thought a lot about my partner’s experience - and my experience supporting him through it - when all non-urgent health services were shut down in Ontario in March 2020. I remember the feeling that everything was in suspended animation once we knew he had cancer; reading about people having their cancer surgeries or treatments postponed indefinitely gave me pangs of the cold, numb and anxious feeling I remember keeping me up at night in 2006. I could very easily viscerally imagine what these people were going through. To have what already felt like a life on pause further interrupted, with not even a plan as to when you may expect treatment, must have felt like torture.

During that time, I wondered why they didn't keep everything going as long as possible rather than completely canceling it all? I would of course understand why you wouldn’t want vulnerable cancer patients in hospitals that were, in fact, overwhelmed with Covid. But that never happened here during the spring of 2020. This was all done just in case. The idea was that this was the cautious, careful way to go - as though there would be no consequences to doing this. As though the only danger left in the world was Covid.  I wondered how different my partner’s outcome might have been, had something like this happened when he had cancer.

Unfortunately, I now have a very close parallel to relate, in my cousin’s friend.

My partner noticed a lump under his arm in the fall of 2005. He asked me what I thought of it, and I said I thought he should ask a doctor. He did - and by the end of that year, he had surgery to remove it. At that point, we already knew from a prior core biopsy that it was cancer. I remember being very annoyed that more specific diagnosis on the type and stage of cancer would be delayed until after the holidays. Isn’t this more important, I thought at the time? Cancer doesn’t stop growing over Christmas - and his doctors had emphasized to us how important his early detection and quick treatment would be. 

My cousin’s friend noticed a lump on his neck this spring, 2021. He too went to the doctor. They assumed the lump to be due his recent Covid vaccine - lymph nodes, including those in the neck, are a part of your body’s immune system, and can often swell up after an immune response. It took noticing another, larger lump under his arm - and him following up quite a few times - to get to the point my partner was at in just a few months. My cousin’s friend only got there very recently, after almost six months.

In the spring of 2021 in Ontario, healthcare was all anyone could talk about. Unlike the first wave in 2020, during our third wave, our hospitals did come pretty close to being overwhelmed (though they still never actually were). Much fear was spread that doctors would be forced to pick and choose who would get life-saving care and who wouldn’t. We were told triage protocol could mean that some of the oldest and sickest patients may not receive the highest level of care available.

I found the idea that there may not be space in the ICU if you needed it to be genuinely terrifying, much more than I ever found Covid itself to be. I started worrying that my partner shouldn’t go for his daily downtown bike ride, worried that if he got in an accident and didn’t have the best prospects, they wouldn't even bother to try to save him. At the same time, I also remember thinking - haven’t we already been picking and choosing who gets life-saving care since March 2020? Would we really call the care anyone has been receiving, due to Covid, the highest level of care available?

Since the first wave in Ontario, many family doctors have only taken virtual appointments with patients - to the extent emergency physicians have called them out for leaving the ER as the only option some patients have for in-person care. This has contributed to issues with late diagnosis and treatment of illnesses that have progressed further than they may have, given a better standard of care - including childhood cancers that are being found at a much later, and harder to treat, stage. 

A recent report from Deloitte, prepared for the Canadian Medical Association, highlighted more than 4,000 excess deaths in Canada for the period of August to December 2020 that are not attributable to Covid. Contributing factors listed for these deaths include significant decreases for in-person visits for chronic disease care and cancer screenings, as well as significant increases in food insecurity and opioid related deaths. These all represent problems likely to continue to get worse for a long time. The consequences of delayed or cancelled procedures and tests alone will include illnesses that have been allowed to progress and require more aggressive care that may not ultimately be successful. People will continue to die due to the measures we chose to take in response to Covid for a long time.

In this context, I can’t help but think - raising fears about triage in the third wave wasn’t really about not wanting to make decisions as to who lives and dies. It was about wanting to be removed from these decisions. It was about giving a nice, comfortable distance for the politicians and health bureaucrats who decided to shut things down - so that they could tell themselves they did the best they could, and none of the consequences were their fault. 

If it isn’t the fault of those making healthcare decisions that our healthcare system is in shambles - then whose fault is it?

Popular sentiment has placed the blame on the unvaccinated. When people tell stories of their delayed treatments, these are often accompanied by pleas to take action on unvaccinated people who are filling hospitals. Though I empathize with where the urge to blame the unvaccinated comes from - I find it misplaced. Vaccines weren’t even available in the first few rounds of healthcare cancellations - certainly not in the period with excess deaths outlined in the report between August to December 2020. Placing the blame on an issue that didn’t exist at the time initial shut down decisions were made seems more than a little disingenuous. I feel we need to address that initially, treatments were cancelled for the unknown - not because of any actual imminent threat (given healthcare was never actually overwhelmed in Ontario). We also need to address that this was not, actually, the “safe” choice. The backlog caused by initial shutdowns made all subsequent strains on our healthcare system much worse than they had to be.

I have been against lockdowns since it was clear they were not being used for ”just a few weeks”, to give the healthcare system time to prepare to deal with Covid - they were going to continue to be used because our healthcare system couldn’t handle any additional strain, and we had no real plans to do anything to address that. In fact, the plans we did follow - to keep so many hospital services shut down for so long that many physicians were “downright bored”, in the spring of 2020 - greatly contributed to the cumulative deterioration of healthcare access in all subsequent waves.

It is important that we admit if we have done the wrong thing, so that we know not to do it again. Placing all of life in suspended animation in deference to Covid concerns was not without costs. There needs to be an honest and balanced analysis of the costs versus benefits of each and every draconian measure we allowed to be taken. The level of disruption all of us have been put through should never be allowed to be taken lightly.

My partner’s concerns, fifteen years ago, about a lump under his arm were met with quick testing and referrals from his family doctor. His cancer was diagnosed at stage one. He didn’t need to have too many chemotherapy treatments, and he was able to have lots of time in between treatments to rest, recover, and maintain as much of a normal life as he could. We’ve often referred to his cancer experience as the best you could hope for in a bad situation

During Covid, my cousin’s friend's concerns about a lump on his neck were initially dismissed (due in no small part to his doctor being distracted by Covid-related concerns). This and subsequent delays in accessing testing and referrals meant it took a lot longer for him to get a diagnosis. When he finally did, only recently - it was stage four. He will need far more treatments, with pretty much no time to recover in between, for far longer than my partner did. His chances of survival are now far less than my partner’s were. Though he started in the same place my partner did - going to the doctor as soon as he noticed a problem - he was not given the best of anything. 

None of us will be able to expect the highest level of care available from our healthcare system for quite some time. It’s tapped out. Canada currently has a backlog of 327,800 procedures that will take at least $1.3 billion in additional funding to address. There is also a shortage of nurses and staff burnt out from the strain of the last 20 months, adding to the challenges in working through the backlog.

Some of this, it needs to be said, should really be attributed to chronic underfunding and mismanagement of our healthcare over decades, that led to our system being totally unprepared to deal with relatively small surges of Covid patients. We also need to ask - how much of this is really due to Covid itself, versus the initial measures to shut so much of healthcare down in deference to Covid?

Every time we talk about shutting down anything again, we need to remember this. Shutdowns don't save lives - they sacrifice some lives to save others.