Everything has changed now

The pandemic has adjusted our ideas about what we owe our fellow citizens and what costs we’re willing to bear

April 8, 2020

By Tristan Bronca

Tristan Bronca

Tristan Bronca

It feels much longer ago than it actually was, but I remember when China imposed cordon sanitaire in Hubei province, locking down a population of 17 million. One of the first headlines that came over the wire read: “Quarantine of an entire city would be inconceivable, unenforceable and illegal in Canada: expert.”

It was a kind of thought experiment: “What if it got that bad here?” It was probing the edges of what we could imagine—the scale and speed of the spread of the virus in Hubei, the extremity of the measures to contain it, the incomprehensible mobilization of resources (a hospital built in a week). Italy’s health minister told the New York Times that Italy looked at the example of China not as a practical warning, but as a “science fiction movie that had nothing to do with us.” It might as well have been happening on the moon.

It’s not just about the cultural gap either. It has more to do with the seriousness of the outbreak, and the totality of the takeover of life and society. When the case count exploded in Italy, the same health minister said the rest of Europe “looked at us the same way we looked at China.” It was still too much for them to imagine.

This is amazing in itself, but especially when you consider that anyone with even a cursory understanding of epidemiology would be able to explain how this infection could spread, the exponential curve, etc. There were no surprises, no secrets as to the causes and effects. It happened exactly how experts warned it could happen.

Yet the idea that it would come to that—that the chain wouldn’t be broken along the way, that China wouldn’t be able to bring the virus to heel, that it would rampage through so many other countries—was, even among experts, difficult to square with modern experience. We knew we could be facing something unprecedented. We definitely knew what we had to do to protect ourselves from it. Yet, it is axiomatic that nothing in our experience could prepare us for the worst pandemic of our lifetimes. Nothing could guide any of us through decisions we never really expected to make, or the costs of trying to avoid them, if just for a little while longer—whether cancelling a trip, closing a business, or shutting down a border.

Italy looked at the example of China not as a practical warning, but as a ‘science fiction movie that had nothing to do with us.’ It might as well have been happening on the moon.

Dr. James Hamblin, a physician and editor for the Atlantic magazine, said: “The thing is if shutdowns and social distancing work perfectly and are extremely effective it will seem in retrospect like they were totally unnecessary overreactions.” Any rational person with a functioning sense of empathy who has seen what is happening in the world will read that and think “at least American leaders won’t have to worry about that anymore.” But then I would have to tell you to turn on the news, and you will see men of legendary callousness saying things like “we can’t let the cure be worse than the problem itself” without any possible conception of how great the cost of the problem itself could be.

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Canadians, for our part, have begun to make peace with the unthinkable. We are beginning to do what, only a few weeks ago, we thought we would never have to. Prime Minister Justin Trudeau and other leaders have said that they are going to listen to the science and craft policy accordingly. That’s exactly what you want to hear, but in retrospect, their actions, based as they were on the best available evidence, have also been inadequate considering the generation-defining dimensions of this pandemic.

For example, infectious disease experts have long told us that travel bans aren’t effective for controlling the spread of coronaviruses, and so, in keeping with that evidence, Canada opted to invest its efforts in community testing, by tracking and isolating cases.

That worked initially. But we knew it was probably only a matter of time until there were enough cases to overwhelm those measures. When that happened, it took too long to realize it was happening. It took too long to convey the importance of quarantine for returning travellers. It took too long to begin scaling up testing. It took too long to begin equipping healthcare workers with the protections they would need. It took too long to stop asking people what to do and start telling them what needed to be done.

The next step will be compelling them, which has already begun with the announcement that there will now be fines for those who break quarantine. The effectiveness of any public health response requires walking a line, balancing mandates that force people to act a certain way, and directives that ask them to, voluntarily. With the mandates, push too hard or too early and it could backfire. People lie for fear of consequences, they sabotage other public health efforts, and they circumvent bans. But as the crisis escalates, relying entirely on voluntary buy-in can be devastatingly ineffective. For all our appeals to civic duty and our responsibilities to the health of our fellow Canadians, some percentage of the population can’t or won’t ever buy in. A recent national poll found that 20% of Canadians thought this pandemic was blown out of proportion.

As of this writing, the Canadian government has yet to deploy the military for assistance or enact the war measures act to lock down travel or compel companies to produce essential equipment like respirators and masks for healthcare workers. In New York, nurses posed for photos with garbage bags tied around their body. In Spain, a staggering 14% of the nation’s cases are healthcare workers. In Canada, hospitals have set up charity drives for face masks, and there are daily reports of rationing. Doctors and nurses wear protective gear that is supposed to be changed between patients for up to 12 hours.

It cannot be said or stressed often enough: We have to protect the healers first and foremost. If governments exist to protect people, its first obligation during this extraordinary time is to the people protecting the rest of us.

(Our leaders’) actions, based as they were on the best available evidence, have also been inadequate considering the generation-defining dimensions of this pandemic.

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I’m not even going to bother quoting case counts or deaths because by the time you read this it will be different. All I know is that however bad it is as I write this, there is a mathematical certainty that it’ll be worse when you’re reading it. Doctors have an entirely different vantage point as we walk headlong into this hurricane, and as a result, they—you—will have to give more in this fight.

It is impossible for people who are not doctors to conceive of this sacrifice, myself included. After a few weeks of not leaving our houses, some of us are still deliberating whether to take up jogging or bread-making or some other long put-off self-improvement project; some of you are shacked up in a hotel between shifts so you don’t bring the virus home to your family. Some of us are wondering whether a case of pinto beans and nine packs of pasta is enough or whether we should grab a few more “just in case”; some of you are worried you aren’t going to have enough ventilators.

Still, there’s a newfound sense of civic duty among those who probably won’t see the inside of an ER during this pandemic. They understand that they play a role in staving off this virus and preventing the collapse of our healthcare system. They understand healthcare workers need help.

You can see it in the images of deserted subway cars and platforms in Toronto. You can see it in the unprecedented number of people who answered the call to donate blood, despite the initial cancellations because of concerns over the virus. You can see it in Vancouver, and other cities, where coordinated cheers have erupted from apartment balconies in appreciation for doctors and nurses. For every person who still thinks it’s okay to meet up with their friends at the park because “it’s outside, man” there are several who are doing their part.

I don’t know whether the level of public buy-in at this stage will curb the spread. It helps I’m sure, certainly relative to some other countries. But whether it is enough seems to be a target that’s moving by the day. In a New York Times column, David Brooks wrote that pandemics induce a feeling of “enervating fatalism.”

This has always been true in the sense that you could be struck by the virus in the streets, or sealed away from the outside world by the powers that be. But there’s also a contemporary brand of this feeling. It comes when doing your part means doing nothing. It comes when you’ve shut yourself in your house for weeks obsessively watching the case count climb in real time on those menacing charts, graphs, and tickers. It comes when watching television or doing anything else becomes the part of your life between reading or talking about the thing. As one healthcare professional told the New York Times, “there is nothing else right now.”

We’re all trying to flatten the curve, but “flat” is a matter of perspective, oriented solely around a single fixed axis: the capacity of our healthcare system. From where we currently sit, the curve looks not flat at all. We need to hope that as weeks and months pass, and we remain consistent in our efforts and the government ramps up its support, that we will eventually find our way over the crest having minimized the toll this pandemic has taken around the globe. Things, I think, will look different on the other side.

Tristan Bronca is the senior editor for the Medical Post.

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