Canadian Medical Association

For years, physicians, nurses and other health care professionals across the country have expressed deep concern for the state of the health systems. A shortage of providers, lack of resources and an aging population combined with systems that have not seen meaningful change or upgrades in decades was leading us to the brink of failure.

Many of us assumed it would be demands resulting from Canada’s aging population that would eventually push us over the edge. When the country’s health systems were designed in the 1960s, we set out to address the needs of that generation. Fewer people had chronic conditions and life expectancy was shorter. Health systems were designed to serve, first and foremost, acute or urgent needs. Those requiring urgent care received it, but others were often left behind.

And then came COVID-19.

Today we have health systems across Canada continuously and desperately pivoting to meet the urgent needs of COVID-19 patients. Surgeries, procedures and other non-COVID care continue to be sidelined. Hundreds if not thousands of health care workers are off the job after contracting COVID-19, needing to isolate or simply burning out from working under the intense pressure of the pandemic.

A recent report commissioned by the Canadian Medical Association showed that delayed or missed health care services may have contributed to more than 4,000 excess deaths not related to COVID-19 infections between August and December 2020. Two-thirds of Canadians living with chronic diseases reported having difficulty accessing care in 2020. Routine cancer screenings were paused during waves of the pandemic and remained 20% to 35% below pre-pandemic levels as of January 2021 in Ontario.

A similar picture can be found in provinces and territories across the country. A newly released survey of 188,000 residents by the BC Centre for Disease Control reports that one in three respondents found it harder to access health care during spring 2021 than in the first year of the pandemic. The survey also shows that 40% of those affected said their health had worsened, either significantly or somewhat, as a result. Doctors Manitoba estimated last week that the total pandemic backlog for diagnostic and surgical procedures has grown to 153,320 cases as of November–December 2021.

We often hear warnings that “if” health care systems become overwhelmed, triage protocols will be used to determine who receives care and who does not. I would argue that when we are cancelling thousands of surgeries and procedures — as we have seen happen across the country since the beginning of the pandemic — triage is already happening.

Our hospitals are again filling up with patients with COVID-19. While there is a lot of focus on the unvaccinated in our hospitals, as physicians our duty will always be to take care of those who need us, regardless of their personal choices. We will continue to do so. However, this commitment does not lessen our distress at watching the impact of these choices on the health systems and on Canadians overall. As provinces and territories continue to explore ways to educate, encourage and entice those remaining to get vaccinated as soon as possible, we must remember that this is not a homogenous group. Many of the unvaccinated are from marginalized groups or are individuals misled by the plethora of misinformation spread online. Encouraging vaccination requires a multifaceted approach.

Governments and policy-makers have few levers left to pull to get us through the pandemic. We can increase health care resources to accommodate the surging need, or we can adjust population behaviour to bend the curve and ease the strain on health systems with local lockdowns, restrictive public health measures and other tools. Given that we have no additional health care resources to deploy, we are left only with the latter option. Critical to our success will be using available means to increase vaccination rates, including third and potentially fourth doses. The data are clear on vaccines: they are safe, and they are the best tool available to protect ourselves and the health systems.

All Canadians count on functioning health systems. The pandemic has laid bare, wave after wave, the impact of inadequate investment and innovation and — most of all — the need for open and honest discussion about the state of the health systems. We knew the country’s health systems were cracking and the foundation was leaking with a rapidly aging population pushing them closer and closer to collapse. COVID-19 just got to them first.

The reality of this conversation is nothing new to anyone working in health care or discussing health care over the past few decades. “Health care transformation” has been punted about by successive federal and provincial governments, with commissions and think tanks creating detailed, ambitious road maps designed to evolve the health systems. Those reports — from the Kirby report to the Romanow report and everything in between — currently sit tidily on shelves, occasionally cited for the sake of an argument. Meanwhile, Rome burns.

There are no simple answers for Canada’s beloved yet long neglected health systems. We all have a right to systems prepared to respond to our needs today and tomorrow. How we get there should be our top priority.

Dr. Katharine Smart

President, Canadian Medical Association

This commentary was originally published in the Toronto Star

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