Elder Advice – Thinking Inside the Box – Week 8
I digressed.
What I really wanted to address last week is our present response to the challenge of COVID 19. I didn’t because, apart from being Tim, I was timid. The subject is uncomfortable. The language is charged. The correctness police are ever ready to pounce. But I am among friends here – so here goes.
The starting premise is that the COVID-19 response is without historical precedent in terms of its interference with the social and economic order. For centuries, custom and common sense required that the yellow flag be raised to warn the healthy of where the sick were under quarantine. But never before - not even in wartime - have the healthy been confined. House arrest of the healthy has, until now, been reserved for convicted felons.
We can, I think, justify the early restrictions in the face of what was great uncertainty over the potentially overwhelming effects of COVID-19. But whether because that response flattened the curve or because the predictive models were wrong, outside of retirement facilities, there is no overwhelming health care crisis.
The questions which must now be asked - and considered without all the hyperbole, hypersensitivity, and emotive evasions that have characterized virtually all public statements on the subject since this crisis began - are:
1. On what do we base the plans (municipally, provincially and federally) to move forward; and
2. What will we do when this happens again?
And the trouble I am having is that every answer disclosed to date bases all decisions solely on health concerns. Why is that wrong? Because it allows governments to abdicate their responsibility and avoid making needed political decisions by sheltering (read: cowering) in place behind their medical and scientific advisors. It allows them to avoid confronting the equally important economic, constitutional and even moral questions which medical and scientific advisors are not equipped to answer – and do not pretend to be - either fully or at all.
Somehow, we have to be able to acknowledge that the real balance is between lives that might be lost against those other things of value that will be lost. I can hear you squirming in discomfort. But we really need to stop allowing others to shut down debate with the bromide: “life is priceless; saving lives is the only thing that matters”. Because that is empty rhetoric - verbal comfort food - emotionally filling but of no real value. And it is not even credible given the known consequences of the everyday lives of those who drive, fly, or create waste. The everyday lives of all of us which causes untold numbers of global deaths annually. Not to mention the unvaccinated children we tolerate. And don’t get me started on the wars, the famine and the mortality rates from unhealthy behaviors like obesity, to which we collectively and routinely turn a blind eye.
Consider the economic issues. It is not just about the Mt. Everest of public debt we continue to create which will deplete needed resources for decades and place a financial burden on our children and likely grandchildren for which we have not equipped them. A functioning economy is the foundation for their future and the source of security for every Canadian. Even if you insist on considering economics only as it relates to health, financial crises are notorious for their long-lasting, negative downstream health effect. Financial hardship equals overcrowded and unsafe living conditions, malnutrition, serious physical and mental health problems and death. When it is not busy maiming them, poverty kills people. A single example; the economic crisis of 2008-10, and the rise in unemployment that accompanied it, was associated with more than 260,000 excess cancer-related deaths in the 34 OECD member countries. That’s not me talking; that’s a blunt conclusion of the 2016 study put out jointly by Harvard, Oxford and Imperial College London.
Consider the constitutional issues. Another single example. It is one thing to ban travel into Canada by foreign nationals, or even travel within Canada by COVID- infected Canadians. It is another thing entirely to restrict healthy Canadians from travelling freely within their country. Maritime provincial governments have been enforcing a ban against ill-defined “non-essential” travel into their provinces. Police authorities are stopping vehicles, and demanding identification and purpose of visit. It does not appear that they are keeping data on how many are refused entry. Never mind section 6(2) of the Charter, which expressly provides Canadians and permanent residents with the right to economic mobility - “to move to and take up residence in any province” and “to pursue the gaining of a livelihood in any province.” And that right includes the inter-provincial provision of services. Never mind that travel for non-economic purposes is arguably protected under the right to liberty in section 7. Interprovincial transportation falls under federal jurisdiction. See s. 92(10)(a) of the Constitution Act, 1867, which, among other things, says that a province “must not prevent or restrict interprovincial traffic.” There are some things that totalitarian regimes like China do that liberal democracies don’t. And for good reason. Because we don’t want to be like China. We need to be exquisitely careful that responses we elect to make do not enable our governments to erode fundamental rights by trading on public fear.
Consider the moral issues, by all means, but start with acceptance of the fundamental truth that: “life is more than not dying”.
And consider even the direct adverse health consequences of the lockdown itself - like the suspension of surgeries for other medical conditions. B.C. reported this week that it will take two years to clear its backlog of even elective surgeries. For many, elective will become life-threatening over that period. What governments have done has, or will, compromise the health of those patients affected by the delay – up to and including what would have been preventable death.
Saving lives is valuable, but it is not the only value we need to consider and weigh in the balance as we work to minimize the consequences of our response to COVID-19 and plan for the next time. Hindsight will tell us whether Sweden was prescient.
Of course, even someone as elderly, experienced and plainly eminent as I am cannot pretend to have ready answers. But I want all the right questions asked and debated by government, with advice from more than doctors and epidemiologists, in a transparent, full and dispassionate way. Because we cannot sustain this for 12 -18 months, socially or economically. And we cannot respond this way the next time. And there is going to be a next time, either as a consequence of governments forcibly preventing herd immunity this time, or because another Chinese wet market bat-shit crazy bat consumer is incubating COVID-20 as we speak. And we need to be much better prepared for the sequel with much more widely considered, narrowly targeted, and effective responses.