- Impatience over the unvaccinated may be growing, but most clinicians aren’t conflicted about treating them.
- Federal government knocked for being less proactive on rapid tests than comparable countries.
- Find out how many Canadians took to the skies for travel last month compared to the last pre-pandemic year.
- Explore: Will some COVID infections cause health issues years later?…. With major supply chain conference days away, Conservatives say government’s trucking vaccine mandate will do harm…. Canadian teachers, students trying to be adaptable in another time of disruption…. Stock markets slump over economic uncertainty.
Public outrage over the unvaccinated is driving a crisis in bioethics
The pandemic has triggered a new debate over what used to be a settled principle of bioethics — that you don’t treat patients differently based on past behaviour that may have contributed to their condition. But the nearly two-year-old COVID-19 pandemic — which has overturned so many norms and assumptions — is now testing that principle.
Vaccinated majorities in wealthy Western countries are growing increasingly impatient with a science-denying minority being blamed for prolonging the pandemic and stretching critical care resources to the breaking point. That includes in Canada, where Quebec’s government said it plans to impose a financial penalty on unvaccinated people who don’t have medical exemptions.
There’s some recent opinion research that suggests the public is on board with the idea.
“We know what doctors would say … they would say the same thing that I would tell you,” said Udo Schuklenk, Ontario Research Chair in bioethics at Queen’s University in Kingston, Ont., and co-editor of the journal Bioethics. “However, when you talk to the people that actually finance these health-care systems — the citizens, the people — overwhelmingly, they tell you that you should discriminate against people that are unvaccinated.
“That raises really interesting questions about democracy. It may be that the doctors are the gatekeepers, but the truth is that we pay the bills. So if the vast majority of people in the country think that should happen, should that have an impact?
Canada has a patchwork of triage policies but most follow a fairly standard checklist of priorities designed to maximize benefits and minimize loss of life. Doctors first decide which patients have the best chances of pulling through. If they have to choose between two patients needing treatment and facing roughly equal odds of survival, they’ll usually give priority to the patient they judge to have the most years of life ahead of them.
“If we have two patients with the same level of clinical need, same age, same context, but one is vaccinated and one isn’t, could we de-prioritize the patient who is unvaccinated by choice?” said Vardit Ravitsky, who teaches bioethics at the University of Montreal and Harvard Medical School. “There is a minority of bioethicists who are becoming more accepting of this logic at this point in time.”
That is likely coming to bear because the costs of the pandemic in terms of the treatment of other serious issues has become clear. Research by the think-tank Second Street shows that nearly 12,000 Canadians died while on various medical waiting lists during the period 2020-21. In Ontario, nearly four times as many people died while waiting for CT or MRI scans in 2020-21 than did five years earlier.
But when patients arrive in his Calgary unit, says emergency room physician Joe Vipond, he sees no justification for blaming patients.
“A huge number of people are there because of poor decisions, because of substance abuse, because of other people’s violence. We decided as a profession to treat everyone equally.”
It was a topic the Economist recently dealt with in a memorable, sometimes profane, first-person description from a California ER doctor on dealing with the unvaccinated during the pandemic.
“I can think, ‘You’re a drunk, you’re a stupid meth addict’, but my job is: ‘how can I reach this person?'”
From The National
These three teenagers have stepped up to help others during the COVID-19 pandemic by delivering food, helping seniors with technology and providing homemade air filters. 6:05
As U.S. accelerates distribution of rapid tests, critics call on Ottawa to catch up
Dr. Dalia Hasan is a Kitchener, Ont.-based doctor who started COVID Test Finders, a grassroots social media-led initiative to connect Canadians with the limited supply of rapid tests.
She would actually like to stop performing that function and is among those calling on the federal government to start distributing tests directly to Canadians
“We should be global leaders in the distribution of all public health tools to Canadians,” said Hasan, pointing out that Canada Post, with its network of outlets in virtually every community in the country, is well-equipped to do the job. Rural and remote communities would benefit from such a system, as would people who don’t have ready access to transportation.
“It’s frustrating to me and every Canadian that rapid tests are very difficult to get.”
Earlier this month, Health Minister Jean-Yves Duclos said the government is procuring 140 million more tests from Health Canada-approved suppliers to bolster provincial supply chests that are running low.
“We’re going to make sure every province and territory, and therefore every person in Canada, wherever that person may live, will have access to a safe amount of rapid tests,” Duclos said on Jan. 7.
And while Duclos promised 140 million tests “this month,” provinces aren’t seeing seeing that kind of volume roll in — and the month is almost over.
That contrasts with the U.S., which has also had rapid test supply issues. Washington launched a website this week that allows any American household to order up to four free tests by mail. Half a billion tests will be delivered by the U.S. Postal Service to doorsteps in the next seven to 12 days.
Some European countries long ago went a step further than that, such as Germany and England, with free test kits and a reporting mechanism for test results so that federal health officials can track data.
To be clear, soaring cases in Germany and Britain in December show that rapid tests are not a panacea. And it’s not clear that populations who are averse to getting vaccinated would be more likely to be proactive by testing themselves multiple times a week.
But advocates for rapid tests say they can help break chains of transmission before they start and give people an extra layer for decision-making on whether to venture out to an indoor gathering or crowded space.
Until the supply issue is ironed out, however, most of the provinces have earmarked tests for schools, businesses and long-term care homes, leaving many individuals on the outside.
Hundreds of thousands of Canadians are travelling abroad
It appears that despite Omicron’s fast and furious spread and the federal government reissuing an advisory against non-essential international travel, many Canadians are deciding that hopping on a plane for some down time is an acceptable risk.
Statistics Canada tallied 742,417 Canadian air-passenger arrivals returning home from abroad in December. When adjusted to account for recent changes in tracking air travel, that total is almost six times the number of arrivals for the same month in 2020, and more than half the total for pre-pandemic December 2019.
The increase in international travel is likely to continue: there were 216,752 Canadian air-passenger arrivals to Canada during the week of Jan. 3 to Jan. 9, according to the latest data posted by the Canada Border Services Agency.
“People are saying, ‘Listen, we only have a limited time on this planet.… We’ve put off travel for two years now, I don’t want to put it off anymore,'” says Lesley Keyter, owner of The Travel Lady Agency in Calgary.
Keyter said that since October, the number of clients booking trips has jumped by between 30 and 40 per cent compared with the same time last year. She said popular destinations for her clients, most of whom are aged 50 or older, include Europe, Mexico and Costa Rica. When Omicron cases started to surge in December, Keyter said some clients cancelled their trip, but most kept their travel plans.
“Life is short. We needed to feel some warmth [and] we really missed Mexico,” said Richmond B.C., native Sandy Long, who recently returned from a 10-day trip.
In one sense, many travellers are exercising caution, says Martin Firestone, insurance broker with Travel Secure in Toronto.
“Trip interruption — which used to be a very rarely [purchased product] — is now being added to all the emergency medical plans because clients worry terribly about testing positive,” said Firestone. “That’s the new world we live in right now with the pandemic.”
Canadians are less laissez-faire about the risks of travelling during this wave than Americans. It’s been estimated that U.S. airports, according to screening numbers, saw only 15 per cent fewer people than in the last pre-pandemic December in 2019.
Read more about the numbers, and the obstacles Canadians face returning home should they incur a COVID illness abroad.
First-dose vaccination rates of children in Canada
Vaccination rates of children aged five to 11 in each province and territory.
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