Winnipeg Free Press

Winnipeg Free Press (Newspaper) - April 17, 2020, Winnipeg, Manitoba C M Y K PAGE A7 THINK TANK PERSPECTIVES EDITOR: BRAD OSWALD 204-697-7269 ? BRAD.OSWALD@FREEPRESS.MB.CA ? WINNIPEGFREEPRESS.COM A7 FRIDAY APRIL 17, 2020 Ideas, Issues, Insights CHAD HIPOLITO / THE CANADIAN PRESS FILES B.C. Premier John Horgan introduced strict new measures to ensure returning Canadians adhere to self-isolation requirements. Pandemic highlights need for reform L AST week, British Columbia Premier John Horgan rolled out a tough new plan to ensure that those Canadians who arrive home via the Vancouver International Airport and land crossings would take the mandatory 14-day isola- tion period seriously. The hope is that new meas- ures will prevent those Canadians being repatri- ated from other countries or cruise ships from undermining progress at "flattening the curve" here at home through social distancing and other measures such as shutting down schools. Under the new directive (with authority derived from the Quarantine Act), travellers landing in Vancouver must give provincial officials detailed information about how they will self-isolate for 14 days. This includes where they will isolate themselves, how they will get from the airport to the location, and any arrangements for obtaining groceries or drugs during their isolation period. Horgan's new order has teeth: if officials reject travellers' "isolation plans," those travellers will be dispatched to a provincial quarantine facility for 14 days. Similarly, travellers will be screened for flu-like symptoms at the border and people exhibiting any will be moved into isolation. Those whose self-isolation plans pass muster can expect provincial health officials to follow up to ensure they are abiding by the directives. We have come a long way since the federal government simply accepted the World Health Organization's recommendation that countries not close their borders or even screen travellers from coronavirus-stricken states. Which brings us to the most remarkable aspect of this news from British Columbia: that these tough new border control and screening measures were introduced by a province rather than the federal government. In his announcement, Horgan was at pains to emphasize that the federal government was in agreement with the proposal and that federal officials would join in the efforts roughly a week later. But the nature of the announcement and rollout leave little doubt that it was B.C.'s NDP government, not the feds, that was pushing the plan. Indeed, Horgan's health minister, Adrian Dix, had been expressing frustration about a lack of federal quarantine enforcement for some time prior to the announcement. For weeks into the pandemic, the federal gov- ernment refused to impose border restrictions or any real screening on travellers arriving in Canada. Canadian airports became coronavirus sieves. Once the virus had well and truly arrived on our shores, the responsibility for grappling with COVID-19 fell largely to the provinces, which have responsibility for health care. Several premiers, including Horgan, have risen to the challenge. Ontario Premier Doug Ford has received praise from unexpected quarters for his sober, empathetic handling of the crisis. He has almost always deferred to public health officials and avoided partisan politics or bashing the federal government. While he is likely benefit- ing from low expectations, Ford has adapted his own brand of partisan politics to the crisis by, for example, showing up in a mask to help workers load medical supplies into trucks. Similarly, Alberta Premier Jason Kenney recently raised eyebrows when he announced the government of Alberta had excess personal protective equipment and so would be donating that equipment to provinces that were experienc- ing shortages. The temptation to hold on to that equipment must have been intense. Kenney has not held his partisan tongue as successfully as Ford, but he deserves credit for his contribution to the greater Canadian good. Even with strong provincial leadership, the provinces are under intense pressure to cope with the skyrocketing costs of handling the epidemic with limited revenues. In some cases, provincial governments have responded with layoffs. This week, Manitoba Premier Brian Pallis- ter announced he would seek a reduced work week for some public-sector workers in order to save money. While the federal government has provided some assistance to the provinces, it is unlikely to be of much help. The pandemic has exposed other flaws in how our federation works. Municipalities, which largely depend on property taxes for revenue, have essentially been hung out to dry. Winnipeg Mayor Brian Bowman has sounded the alarm on the drying up of municipal revenues. And, this week, Vancouver Mayor Kennedy Stewart announced that B.C.'s largest city is facing the prospect of bankruptcy if it does not receive assistance. Since cities exist under provincial jurisdiction, it will be up to the provinces to solve these problems, putting even greater pressure on provincial treasuries. In 1937, the Rowell-Sirois Commission was formed to consider changes to Canada's federal arrangements in light of failures during the Great Depression. In short, the problem the members of the commission confronted was that the federal government had all the revenue, but the provinc- es had all the problems that had to be paid for. Sound familiar? Hopefully, at the end of this pandemic, leaders at both the federal and provin- cial levels will agree that Canadian federalism was ill-prepared for this crisis and that new ar- rangements must be developed. Royce Koop is head of the political studies department at the Univer- sity of Manitoba. Our health-care system is our health workers IN country after country, members of the public are clapping from their doorways and balconies to show their appreciation for health workers. It's clear our health system is largely our health workers. Ventilators do not work without health workers; testing does not happen without health workers. All forms of care required to respond to this crisis will require health workers. Health-care system capacity - of which health workers are a key component - is often repre- sented as a flat line on epidemic curves. The main aim of flattening the curve is to keep demand below the upper limit of health-care system capacity. This flat line gives the impression that health-system capacity is static. It is not. Social distancing is a way for us to help moder- ate the demand side of the equation, but how are we to bolster the capacity side of the equation to keep ahead of that curve? Ongoing analyses of health-care system capacity are modelling increased capacity of physical resources. What is unclear is whether these analyses are modelling health-workforce capacity, and if so, how. Health-workforce capacity is not simply the number of doctors, nurses, respiratory therapists or other essential health workers that are actively registered. What health workers are allowed to do (their scopes of practice) and how they do it (their prac- tice patterns) can vary substantially, depending on the populations they care for, the settings in which they work and the regulations by which they are governed. But health-workforce modelling should not only model how work is typically done. In times of cri- sis, when systems are called upon to demonstrate resilience, responsiveness and surge capacity, models need to take into consideration how work could be done and demonstrate what capacity could be mobilized through more optimal use of available resources. That is, how could we better use the whole of the health workforce to turn the capacity line upward? Responding to this crisis will require shifting tasks and leveraging the full scope of skills avail- able within the health workforce. These innova- tions are often employed in low-resource settings, out of necessity, but even high-income countries are quickly shifting tasks and redeploying avail- able human resources. In the United Kingdom, for example, anyone with skills in sedation, including dental nurses who are part of the National Health Service, are being recalled to help respond to the COVID-19 crisis. In Australia, physiotherapists are similarly being redeployed to work in acute respiratory teams. Additional pools of health workers, such as trainees and retirees, are being mobilized. To best accomplish this, we need to know who is in the health workforce, where they are, and what skills they have. Sounds straightforward - and yet, in Canada, these basic data are often frag- mented, out of date or hard to access. With better data infrastructure and co-ordinat- ed health-workforce planning, we could proac- tively address inadequacies in the system and de- velop the flexibility necessary for the workforce to respond effectively to pandemic situations. We need to be building this infrastructure now. It is time for custodians of health-workforce data - regulatory authorities, insurers, employ- ers, health professional associations, educational institutions and all levels of government - to co- operate in the collection and sharing of informa- tion about the health workforce. Processes and pathways that emerge out of ne- cessity should be maintained and developed after the crisis has passed in order to leverage this crisis as an opportunity for system strengthening. The performance of our health system - during this pandemic and beyond - depends upon high-quality and timely data to support decision-making. By prioritizing health-workforce data and infrastructure, we will be able to better maintain the well-being and productivity of our health workers. We will be able to protect their physi- cal safety by predicting who is going to need personal protective equipment and ensuring that this critically important equipment gets to work- ers when and where they need it. We will also be able to promote their psychological health and safety by planning for sustainable workloads and appropriate supports. Now more than ever, we need to show our valuable health workers our support by explicitly including them in the capacity-planning equation, and implementing protective policies and practic- es. Otherwise, we're left with one hand clapping. Ivy Bourgeault, Sarah Simkin and Caroline Chamberland-Rowe are investigators with the Canadian Health Workforce Network and the University of Ottawa. Social connection crucial for seniors MANY Canadians have been in total lock- down for several weeks. This includes seniors, who are the most vulnerable to COVID-19, but are also vulnerable to the negative health effects of social isolation. Most long-term care facilities have banned all group program- ming, as well as visitors and volunteers, for fear of spreading the coronavirus throughout care homes. Several provinces have asked community-dwelling seniors to self-isolate for their own safety. Why? Data out of China suggest that the older you are (especially if coupled with frailty), the more likely you are to die if you contract the virus. The mortality rate is 15 per cent for those aged 80 and over, and eight per cent for those aged 70 to 79. In Italy, these numbers are even higher. Physical isolation is imperative to keep Canadian seniors, especially those living with frailty, healthy. But this does not mean we must socially isolate. Extensive research supports that remaining social is vital to support both our physical and mental health. This can be especially chal- lenging for community-dwelling seniors, who are accustomed to leaving home for regular visits and activities. It can even be more dev- astating for community-dwelling seniors who were already fighting loneliness and social isolation. So, what can we do to keep our seniors from suffering deeply from social isolation during COVID-19? Many Canadians are getting in- novative. Arbutus Walk, an independent living com- munity home in British Columbia, has been scheduling regular dance parties where resi- dents get together to dance on balconies. The National Institute for Caring for the Elderly and CanAge suggest creating a photo-board for seniors with favourite family pictures, setting up a virtual book club, or watching a TV show or movie together virtu- ally. This can allow seniors to share experi- ences with others by engaging in the same activities at a scheduled time while maintain- ing physical distance for safety. Research shows that maintaining a routine is important for physical and mental health - especially during a time of so much uncer- tainty. Here are a few tips for seniors to avoid social isolation: For those with a tablet, computer or smart- phone: 1. Create your family tree This could be the perfect time to start researching your family tree. This allows you to reach out by phone to speak to relatives you might not have seen for a while. Listen to the stories of their youth, about their work or other relatives. Record your findings to share with others. Many great websites exist for developing a family tree such as Ancestry.ca (a paid sub- scription is required) or FamilySearch.com (a free service). 2. Have a video chat Platforms such as FaceTime, Skype and Zoom allow for free video connections for two or for small groups using a smart phone, tab- let or computer. Just like being at the coffee shop, schedule a call, grab a coffee and stay in touch. Don't worry about your hair or outfit - it's a strange time, no one is judging! 3. Get some exercise It's important to get some exercise to help keep your muscles and bones strong and challenge your balance. The National Bal- let School has made their virtual resources available for older Canadians to safely bring dance into your home, including chair ballet. Incorporate exercise into your daily routine to support your physical and mental health and avoid frailty. For those without technology: 4. Call friends and family Schedule regular calls to stay in touch. An old-fashioned phone call can be worth its weight in gold. Set time aside to call two people you enjoy every day. 5. Get outside once a day if you can Go for a walk or sit on the porch. If that isn't an option, sit by an open window to get some fresh air. Incorporate this into your schedule to create a daily routine. 6. Be creative - paint, draw, sing, write Everyone has a story to tell - maybe this is the time you've needed to write your book, paint that masterpiece or do some sketches. Pull out those crafts and art supplies and remember how creative you used to be when you had the time. Set aside time each day to use your creative side. Social isolation and loneliness are not good for our health. But while we can't be together physi- cally right now, we can still stay connected. John Muscedere is the scientific director of the Canadian Frailty Network (CFN), a critical care physician at Kingston Health Sci- ences Centre and a professor of critical care medicine at Queen's University. ROYCE KOOP IVY BOURGEAULT, SARAH SIMKIN AND CAROLINE CHAMBERLAND-ROWE JOHN MUSCEDERE A_07_Apr-17-20_FP_01.indd A7 2020-04-16 10:48 PM ;