Submitted by Dr George Harpur
As this pandemic and the ensuing deluge of information continues, confusion still reigns supreme. For a clear concise overview of the situation I recommend going online and listening to an interview with Dr. David Katz at the following link. https://youtu.be/Lze-rMYLf2E
As Dr. Katz points out, this virus is not going away. Our present measures have been successful in buying us time to find tools with which to fight the disease and get a beginning on the development of a vaccine but we have yet to succeed with any of this which means that most of us are still vulnerable and the commendable effort most of us have made, needs to continue.
One of the big problems today has to do with conflicting reports that are immediately seized on and promoted as support for the “soup de jour” theory. Scientific evidence to either support or counter a particular theory must generally be demonstrable by reproducible experiment to be considered valid for good reason. In a situation like this, wishful thinking can exert a powerful influence. Verifying evidence is time-consuming and in circumstances such as we face at the moment, hard to come by with the result that a great many untested theories have been given more credence than they deserve by an anxious, desperate public and a good many politicians. The truth is that while there is an absolute frenzy of investigation underway, we have far more questions than answers to most of the critical questions. So what to do?
Our current measures have successfully slowed the progress of this disease but will never subdue it. If continued they will provide time needed to complete some of the trials already underway that may result in the discovery of an effective tool with which to treat this virus in the short-term and within a year or less, to a vaccine that’s effective.
One of the many things which is still uncertain about this infection is the question of immunity. Does it reliably induce immunity, the current information is confusing. Part of the difficulty lies with the development of a reliable assay for the antibody and there are hopeful developments in this area. Some of the trials with serum from those who have recovered strongly suggests that effective antibody development does occur and may be transferable but the information to date does not constitute proof. At the other extreme there are several reports of people who seem to have acquired reinfection after successfully overcoming this disease so the puzzle remains.
The test for infection, which is the one being reported on daily, remains seriously flawed with a significant false-negative incidence as high as 30% in some series which can leave a number of people who may be asymptomatic or have only mild symptoms falsely reassured and unwittingly spreading the virus. This test can also err in the opposite direction with a false positive rate of approximately 15% and you can imagine the panic such a result would cause in a resident of a nursing home as occurred in Lucknow.
Advice Provided by Public Health Agencies
The advice being provided by public health agencies, while it may not be based on the highest levels of scientific evidence, can largely be grouped in the category of things we can do which possibly are having a very big positive effect and even if we’re not 100% certain of that, we can at least be sure have little if any negative effect. Frequent handwashing is in this category and is backed by a very strong body of evidence. Wearing masks in public places is another with a growing body of information that supports its effectiveness. The same could be said for social distancing although there have been a few instances of apparent failure. Stepping back from any of these may result in a flare that will not become apparent until 2 to 3 weeks after practices change. This sort of setback is a big concern as we move toward attempting to reopen safely and has occurred to a limited degree in South Korea.
Socioeconomic status (SES)
There is another side to the story that is not as readily apparent but being talked about more in the media as the duration of the restrictions on business continue. I’m not talking about the very direct economic impact on many people, I’m referring to the secondary consequences for the health of a large number of people that will result from this recession. Socioeconomic status (SES) is a major determinant in health outcomes including mental health, lifestyle related diseases, which include heart, stroke, cancers and the degenerative disorders, all of which result in reduced quality of life and shortened life expectancy.
So how do we ease back into full employment? What number of excess deaths due to economic factors is a reasonable trade off for the lives saved by the shutdown? A good crystal ball would come in handy. As we rush to return to “the good old times” we need to think carefully and hard about just what it was made the old-times so good.
As we struggle to move forward it may be possible to make some changes that address some of the problems that have been exposed by the crisis so that the good times lie ahead.
Visiting the Cottage
There’s been a lot of talk lately regarding visits to the cottage. In much of this discussion the fact that a major part of the concern is about the safety and well-being of those coming up to their cottages is being lost. While it’s true that residents in these rural areas are not thrilled by the idea of contact with people coming from centres that might be considered hotspots, most of the health workers in these areas are far more concerned about what would happen in the event that this virus suddenly begins to spread in areas with extremely limited resources. Should you start to become ill at your cottage it would be prudent to pack up and immediately get back home to your own health care provider and an area where more resources for your care are available. If there were a large number of patients requiring medical attention in a small rural community, not only would the local facilities rapidly be swamped, additionally, the ability to effect transport of those requiring the services of a major centre would become saturated, leaving the victims stranded in an area unable to provide needed care.
There is a long list of things that someone planning to come to the cottage for a weekend or a prolonged stay needs to consider. An outline of many of these is being provided in the joint communication from PFHT & MNBP in their Joint Statement of Tuesday, May 12
HEALTH CARE NEEDS IN A PANDEMIC WHILE COTTAGING
* Draft Version of MNBP/PFHT May 12, 2020 Joint Statement *
Principle: the health care system in a small place like the NBP develops to support its local population and then stretches in summer to support an expanded population. This is a pandemic, people can become ill quickly and in large numbers. It is not predictable. Come prepared.
1. “In a pandemic, start with your Own Doctor/Nurse Practioner when it isn’t an emergency” by phone/video where possible instead of using the emergency deptartment.
2. RX meds – bring enough and ensure you have a means by which you can get more if you plan to stay for long periods of time.
3. Bring first aid, sunscreen, acetaminophen, good supply of medications, thermometer!!, etc. (Health Canada first aid/emergency kit).
4. Ensure adequate clean water for drinking, brushing teeth, etc.
5. Bathroom needs and hand-washing when outside of your accommodation – be prepared to bring these items with you to protect yourself/your family.
6. Masking advice: (per Health Canada).
7. DO NOT TRAVEL DURING A PANDEMIC IF YOU OR YOUR FAMILY MEMBERS ARE SICK or your health is unstable – even a runny nose but including sneezing, coughing, fever, etc! You may transmit a potentially lethal virus to an area with a fragile health and public health system.
9. DO NOT travel back and forth between the cottage and your primary residence until the Chief Medical Officer advises it is safe to do so. Choose a location and stay there. Travel can spread virus during a pandemic.
10. Note that case contact-tracing will be very difficult. If you have symptoms that may require covid testing it is advisable that you return to your primary residence, but keep track of places you’ve been and people you’ve interacted with.
11. If you become suddenly unwell with COVID-19 your care will be provided locally/within the Grey Bruce Health Services system. We do not have transport options to get you back to your primary city. We simply do not have the ambulance and staff capacity. PHONE FIRST.
-Grey Bruce Health Unit 1-800-263-3456 Extension 3000
-Assessment centre: Owen Sound Regional Hospital, Grey Bruce Health Services portable facility just outside the entrance to the Owen Sound Hospital Emergency Department. Hours of Operation: 12:00 PM – 4:00 PM, 7 days per week. For more information, visit https://www.gbhs.on.ca
14. Limit risk-taking behaviours – never a good thing but during a pandemic this is particularly difficult because it puts you into a health system that could be infected with a virus.
15. Gear, footwear, etc. to prepare to be here.
16. Be prepared to change your plans – surges in cases can result in unexpected lock-down alterations.
