The Biggest Problem With COVID-19? The Patients Who Don’t Die.
Alberta is the latest jurisdiction to be crushed by a tsunami of COVID patients — but it didn’t have to be this way.
Newly married in 1951 and pregnant with anticipation, my folks joined the great post-war exodus from Europe to North America, emigrating by ocean-liner from Holland to Canada in search of opportunity.
Their straight-laced version of Protestant religion crossed the Atlantic with them. Soon they had a brood of children (by 1968 they’d generated an iteration of Cheaper By The Dozen), dutifully shepherding them to church twice each Sunday to be properly schooled in the tenets of the faith.
The church’s Reverend, himself a Dutch immigrant and as fond of cigars as he was of sermonizing, had but a nodding acquaintance with the English language. To get himself through sermons in his adopted tongue he drew heavily on a store of pet phrases committed to memory; there were, to put it mildly, a few slip-ups.
His favoured descriptor for the elderly and sick was “the weak and the feeble”. Hands laced together on the pulpit, he led the congregation one Sunday morning in thickly accented prayer: “Shine your mercies, O Lord, on the feak and the weeble among us.” I’m sure the good Lord knew what he meant, but my brothers and I doubled over in our pew, stifling snorts of laughter and earning a stern glare and sharp dig in the ribs from our father.
The dear Reverend is long-departed; if there are stogies in heaven he’s doubtless shrouded in a cloud of pungent smoke.
But “the feak and the weeble” remain with us, and they’re the subject of much attention (and controversy) in the present day. The good Reverend would have much to pray about: the greatest number of deaths — by far — from COVID-19 has been amongst the elderly and infirm.
As of yesterday (November 28), as a second wave of COVID-19 infections gathers steam with alarming speed, the death toll from the virus in my province of Alberta stood at 524; the average age of death is 82. The average age of death in Alberta before the pandemic? Also 82.
Much hay is made from those numbers by those staunchly opposed to virus-fighting restrictions on our freedoms. In a scathing indictment last week of Premier Jason Kenney’s most recent moves to curb the virus’ spread, John Carpay — president of the Justice Centre for Constitutional Freedoms — noted that 27,000 Albertans die every year from various causes. That translates to roughly 520 deaths each week — equivalent to the number of deaths from COVID in the past eight months.
“Why and how,” Mr. Carpay lamented, “Is this a crisis that justifies the lockdowns we have been suffering under — to various degrees — since March?”
Mr. Carpay and many others — including the authors of the Great Barrington Declaration — are (rightfully) alarmed by the tragic destruction of businesses, livelihoods, mental health, and education engendered by lock-down measures. They advocate strongly for protecting the old and the infirm; but otherwise for keeping society wide open, given the tiny risk of death from COVID-19 for those who are younger than 75 and otherwise healthy.
Life is full of risks, goes the argument. COVID is but one risk among many; we had best learn to live with it rather than ruin the global economy with all the misery that entails. To be born is to die one day, after all. Buck up, people.
And I get it. I know a lot of great doctors; but even the best doctors lose 100% of their patients — everyone dies in the end. And the causes of death are many. So why this intense focus on COVID-19? Why are we turning the world upside down to save the elderly and “the weak and the feeble”?
Let’s set aside the fact that no jurisdiction has successfully protected long-term care residents and the infirm without taking significant protective measures that apply to everyone.
Let’s focus instead on the key fact that Mr. Carpay and his like-minded colleagues consistently fail to properly apprehend; this crisis isn’t only about those who die from COVID-19.
It’s just as much, or more, about those who don’t die from the virus: those who become infected with COVID, get sick, and require hospital care in order to survive.
The average age of Albertans in hospital is 61, and most do survive, thanks to the skill, tenacity, and ingenuity of health care professionals; and the good news is that, proportionately, more survive now than in the spring, due to better understanding of the disease and improved treatments.
But they wouldn’t survive without hospital care. And there’s the rub: we won’t be able to handle the coming crush of patients. And patients who would have survived will die for lack of care.
Hospital beds in Alberta are filling rapidly. As of yesterday, more than 400 Albertans were in hospital with COVID, 88 of them in intensive care. At the moment we have the capacity to accommodate more patients; but there are limits as to how much and how fast we can expand our resources before hospitals are swamped. Hence the point of the spring initiative: to “flatten the curve” to allow hospitals time and space to absorb the inflow of sick patients.
Today’s count (November 29) was 1608 positive COVID tests, drawn mostly from symptomatic people and their close contacts. We know, based on earlier Alberta numbers, that at least 3.3% of these people will end up in hospital (in roughly a week), and that 0.6% will land in ICU: that translates into 53 additional patients in hospital and 10 more in ICU from today’s case tally alone. That’s likely an underestimate, since in contrast with earlier this year we’re now testing mostly symptomatic people, a cohort more likely to end up in hospital.
And once in hospital, those patients don’t leave quickly. Bed turnover is excruciatingly slow. Average length of stay for a COVID patient is just under two weeks; average ICU stay is more than 10 days.
As the patients pile up we’re hurtling to a place well beyond capacity, even if we manage to hold the line at 1600 cases per day. And we have no certainty that we’ll do that — case counts are at record highs, and we no longer have much grasp on what’s going on with community transmission — our vaunted contact tracing system has collapsed under the weight of all the new cases. We’re flying blindfolded at 100 km/h straight into a brick wall.
Alberta Health Services is working feverishly to create additional spaces to care for patients and to expand ICU capacity to 400 beds. But from whence shall come the staff? It takes more than a “bed” to successfully care for patients, particularly in the ICU. The highly specialized personnel required to properly look after these patients can’t be conjured out of thin air. Not only that, at any one time a portion of staff are sick or isolating because of COVID. And, recruiting help from other jurisdictions is a non-starter, as much of North America is in the throes of the second wave.
An over-taxed health care system will lead inevitably to increased deaths from all causes, not just from COVID. Beds occupied by COVID patients can’t be occupied by patients with strokes, heart attacks, sepsis, or trauma. Tough choices loom: who decides who gets the bed, who gets the ventilator, who lives and who dies?
It needn’t have come to this. We had ample warning that the second wave was coming, and we had stark lessons on how to prepare from other jurisdictions who experienced the disaster presently unfolding in Alberta.
We wouldn’t be in this pickle if we had collectively adhered to the simple dance — the COVID three-step of mask-wearing, careful hand-washing, and sensible social distancing. But too many Albertans failed to comply, aided and abetted by foot-dragging on the part of our political leaders, rampant misinformation, inconsistent messaging, and distorted perspectives.
So here we are, perched on the cusp of catastrophe.
And yet, even as the COVID tsunami bears down on us, the naysayers and deniers were out in full force yesterday, braying nonsense at anti-mask rallies across the province.
Their arguments are feeble, and their rationale is weak. But too many Albertans are listening to them.
And they’ll continue to listen, I’m afraid, unless they get personally nailed by the virus — if, for instance, it’s their loved one who is denied a bed in an understaffed, overwhelmed hospital and dies for lack of care.