Jane Philpott is a medical doctor and former Member of Parliament. Beginning July 2020 she will be dean of the Faculty of Health Sciences at Queen’s University. From 2015 to 2019, she served as federal Minister of Health, Minister of Indigenous Services and President of the Treasury Board. She currently works in the Markham Stouffville Hospital COVID-19 Assessment Centre.
As we pass 40,000 COVID-related deaths worldwide, we have not yet seen the worst of this pandemic. The Governor of New York is pleading for a million more health workers. Every country needs more health resources on the front lines. Canada is no exception.
A public health emergency calls for public health solutions. Canadians know about the important measures we must all take—physical distancing, handwashing, and staying at home except for essential—food and health—reasons. Other health solutions are just as critical, but they are harder to scale up: human resources; testing and tracing, health infrastructure and supplies; vaccine and treatment trials.
Health human resources are, not surprisingly, the most vital. Even if we had 50,000 ventilators across the country (which we don’t) to help keep the most seriously ill patients alive, they require trained operators. They require doctors and respiratory therapists who know how to intubate. These happen to be the clinicians most at risk of acquiring the COVID-19 infection themselves. They must be kept safe.
Public officials in the country should be obsessed with protecting the health workers who will keep people alive. That means ensuring that the right personal protective equipment (PPE) is available to all front-line workers, everywhere, always. This must be orchestrated centrally. The volunteer donation drives and drop-offs are well intentioned but not every community has those kinds of contacts. The military doesn’t depend on goodwill donations for its equipment. Health workers shouldn’t either.
I see political leaders working tirelessly to intensify the manufacturing and procurement of PPE and other acute care equipment. But on the ground, workers are nervous about whether it will get to them and whether their safety needs will be met. In my work at the COVID-19 Assessment Centre at the Markham Stouffville Hospital, we have the PPE we need to do the job right. It grieves me to hear that is not the case everywhere. That’s not fair and it’s certainly not smart. Protecting the workforce is job one.
The recruitment and retention of health workers hasn’t been this important in Canada for at least a century. We need to expand the health workforce and this requires some creativity. Regulatory colleges are looking at options to license doctors who have essentially finished their residency programs but aren’t able to write their final exams because of COVID-19. Now is also the time to expedite the national licensure of doctors and nurses that we’ve wanted for decades, so health workers can quickly be deployed to the province or territory that needs them most. International medical graduates are eager to be put to work. Health professionals who are currently underutilized (physiotherapists for example) are ready to stretch their scope of practice to provide virtual home care and public health screening.
We could also create an army of community health agents. I first met Dr. Tedros Adhanom Ghebreyesus (now Director General of the WHO) in 2008 when he was the minister of health in Ethiopia. He had just completed an ambitious plan to build 4,000 new community health centres and to train and deploy 30,000 health extension workers, showing how rapidly it can be done. In India, smallpox was eradicated with a force of 150,000 surveillance workers who made a billion house calls in the 1970s. The COVID-19 pandemic similarly requires an intentional focus on community-based diagnosis and home-based care.
The other area that still needs scaling up is testing. We’ve seen improvement in Canada, though there are more than a dozen other countries who are doing it better. This is one place we could deploy our army of community health workers to facilitate aggressive testing, in and out of hospital settings, prioritizing settings with vulnerable populations, including nursing homes, shelters and correctional facilities. Using expanded testing criteria, we can search out and isolate positive cases. The same team can support contact tracing and education. We’re already seeing medical students used for this role in some provinces.
As more information becomes available to support the best decisions and projections, we need timely reporting of data, with consistent and radical transparency. This is not the time to hide bad news.
Regrettably, the Public Health Agency of Canada’s ability to produce timely, accurate national surveillance is severely limited due to the lack of strong federal public health legislation. The agency lacks the legal authority to compile data from provinces and territories. Thankfully we’re seeing reasonable cooperation in the sharing of data, but it’s inconsistent and not always comparable. Regional health authorities vary in the content of their data reports and these are not always compiled with others in a way that allows us to spot regional trends and outbreaks.
Good data analysis is the only way to predict how long this will last. We must not rush to believe the situation is getting better or worse based on the number of cases reported. The number of cases is dependent on the number of tests being done, which is shifting and patchy. If we want to know when the curve is flattening, the best numbers to follow are COVID-19 hospital admissions—specifically ICU admissions—and the number of COVID-19-related deaths. Only in recent days are we starting to see some provinces reporting daily ICU admission rates, but there is not yet a place to find this data nationally.
Beating back this virus so our lives can return to a new normal is our urgent collective purpose. Our country has a boundless supply of creative, ambitious and compassionate citizens. By harnessing their spirit of solidarity and organizing their collective energy, we will get to the other side.