Doug Ford hopes to erase our discontent

"When the gap between ideal and real becomes too wide, the system breaks down.”

— Barbara W. Tuchman, A Distant Mirror

Famed American historian Barbara Tuchman is best known for her seminal tome, The Guns of August, a taut retelling of the calamitous events that led to the first great bloodletting of the 20th century, World War 1.

But it was a later book, A Distant Mirror, that resonates today.

The quote used above reinforces the idea that reality sucks and those who embrace kooky ideas and magical thinking, or outright lies and political spin, often have the outcomes of these attitudes turned back on themselves. For someone as ignorant of history as former U.S. president Donald Trump, this is exactly what happened as a result of his preoccupation with an alternative reality.

He was eventually infected in the fall and rapidly developed symptoms of COVID-19, rushed to a military hospital with his presidency and maybe even his very life, teetering on the brink. Some felt it was poetic justice, getting his comeuppance. Thankfully for him, experimental treatments and an instant full-court press by a battery of doctors allowed him to quickly recover. He was given not one, but two monoclonal antibodies that at the time were only being used through clinical research, and there is a good chance that had he been treated like most obese people in their mid-70s who have died from the disease, his fate would have been similar.  

Of course, after he quickly recovered, thanks to immediate care that probably cost a small fortune, he said COVID-19 was no big deal. He didn’t learn one thing.

The man who repeatedly got the facts and the year wrong when referencing the last great pandemic to sweep our world in 1918, is well documented for calling COVID-19, a hoax, a bad flu, and a mere fibble. He is now sitting in his Florida compound, scheming how to steal back power, reduced to being a poster boy for the aphorism, "Those who cannot remember the past are condemned to repeat it."

Tuchman wrote about the awful 14th century and the terrors of the bubonic plague as it swept across the globe, causing so much pain and suffering it still reverberates through the ages. The other thing to know about history is that it rhymes, and libraries and the internet are filled with wise men and women who comment on these past experiences to help us prepare for the future.

This was, of course, lost on the man who oversaw the greatest public health crisis in U.S. history, which has killed almost 4-mllion people around the world and nearly 600,000 in the U.S.

The truth is: one calamity often presages another, as WW1 did the Spanish flu, and Trump’s ill-defined presidency did with the response to the deadly virus.

Which brings us to the focal point of this analysis. Trump’s obscene handling of the pandemic, and his willingness to ignore all personal warnings, seems the opportune time to re-examine arguments that have seeped into the public consciousness over the past year.

While the G7 summit happens in the UK, and global leaders return to the latest concerns over Russia, China, corporate hegemony, public health, in its broadest sense, has already been moved to the backburner. Talk at the conference of progressive, moral decision-making largely revolves around economic interests: removing forced labour from global supply chains is more about reducing labour arbitrage than actual concern for those around the world, often children, who toil at work under inhuman conditions.

World leaders gather at the G7 summit in the UK this weekend (Image: YouTube)

It’s the same with climate change: any substantive policy shifts are now driven by economic interests.

But as we appear to be coming out of the pandemic in many parts of the world (no thanks to anti-vaccination campaigners why pray to the God of Trumpland) what about the future of our collective health? What about our hope that the next crisis won’t be dealt with like the one finally being put behind us? Our curative healthcare model doesn’t really work for many, and is now on life support, and broad-based preventative medicine should be implemented immediately – or in the near future. Seniors now live under constant fear about the future of their long-term care. Who on Earth wants to live in one of the facilities that doubled as makeshift morgues?

The PC government in Ontario led by Doug Ford has shown it has no interest in the long-term care sector or investing in our public healthcare system. Prior to the pandemic, he made cuts to both, and he has since fabricated claims of real change. No, if you live in Brampton or many parts of Mississauga or are staring at assisted care in Ontario, the current government is not your friend.

Ford ended last week by announcing his intention to enact the notwithstanding clause to neuter a provincial court decision at the beginning of the week that protected current rules around third-party spending on election campaigns.

It was the latest move by a Conservative leader, part of the global trend away from democratic governance in favour of authoritarian-style decision making. Ford wants to set aside protections under the Charter for five years. Why? To win an election.

He does not want the business community, and healthcare workers and many public sector unions reminding Ontarians of his failures during next year’s Ontario election campaign. Curtailing third-party spending is his way of erasing all the bad decisions during the pandemic. The move, if successful (if the majority PCs want to force the notwithstanding clause, they will) could backfire, but only if the public takes matters into their own hands.

The government cannot control basic forms of expression and it’s impossible to curtail broad communication, especially now that social media can singlehandedly change the results of elections.

But is the public ready to take its own health and its own well being into its own hands?

Battling a pandemic begins by believing in science and taking individual responsibility. It also demands policy be enacted not around economic concerns or profit motives, but in response to our fundamental right to basic care. There will be no return to norms, because norms are what got us here in the first place. Swimming in place will only lead to more suffering.

The past 16 months exposed a system chronically outdated. Our endgame on treating a disease but not preparing ourselves for it (even if it is a novel virus) has to be the driver for future moves. Yes, it’s time to implement a full-scale progressive model of care, especially for the most vulnerable.

Ford has already moved to protect his friends including Mike Harris and Hazel McCallion, who both profit from privatized long-term care because of their work directly with companies in the sector. The PCs have curtailed the ability to sue these entities, despite his claims of ensuring the protection of those who have suffered in care settings. His hypocrisy would be comical, if not for the deaths of so many whose families cannot seek justice, thanks to the man who claims to be fighting for them.

If the private sector continues to operate with impunity, placing profits over care, good luck preventing the next disaster. Ford wouldn’t even make changes to the sector during the pandemic, even after the Canadian military was forced into action and wrote a damning report complete with a roadmap to fix the broken system after the first wave. The provincial leader ignored it and subsequent waves of devastation serve as proof that as long as the PCs remain in power, profits and protection of private commercial interests will always be the priority.

Brampton Mayor Patrick Brown, another authoritarian-styled Conservative leader obsessed with holding political power, is no different. He put private interests over public health throughout the pandemic, even fabricating claims that there were zero infections caused by bars and restaurants. Only after healthcare groups, labour unions and other politicians screamed for protections for essential workers, did Brown, months later, jump on the bandwagon.

While trumpeting his consecutive tax freezes, which hurt the most vulnerable (most who don’t own property) the mayor has failed to invest one cent into the local share of costs for healthcare. He will be long gone from Brampton by the time the next crisis hits (he spent much of last year campaigning and directing City resources for the federal Conservative leadership bid of Peter MacKay, a clear signal that Brown is simply using Brampton to get back into party politics in one of the higher levels of government).

So who will guarantee the well being of residents? Who will pursue decision making to prevent all the suffering and death next time?

Preventative care means “all” policy is health policy, everything from safe housing, to income security, to a healthy social safety net, to urban design, green initiatives, and the day-to-day stuff like eating right, watching your weight, exercising, eliminating smoking and what’s needed to bolster your overall mental and physical well being.

We are in this pandemic together, but under the current system, we have responded to it differently, based on our life’s experiences. As we hopefully beat COVID-19 back to a manageable point, will societies collectively lose themselves in revelry and celebration of life, without reserving a small corner of our consciousness to guarantee a better response next time, so such celebrations won’t be necessary? Or will there be a global shift away from the way things were?

Finding long-term success in the realm of public health, means taking an “upstream” approach. The  “downstream” one kicks in once the damage (injury or sickness) has settled in. The Band-Aid solutions offered by our reactive system do not factor in how the local labour force, race, gender, education and socioeconomic factors can be underlying reasons why some get mild symptoms while others die, or why some environs make it through unscathed while others, like many parts of Peel, are devastated.

Kaitlyn Kuryk, a student in health sociology at the University of Manitoba, wrote about these issues in The Conversation: “Now is the time for integrative policies over reactive measures; public programs over privatization; and embracing preventive measures to avert illness. Now is the time for change. We should never go back to normal.”

The new normal has a retro vibe and spins all the way back to Greek times. The Journal of Medical Ethics and History of Medicine reminds us that Asclepius and Hippocrates focused medical practice on the natural approach and treatment of diseases, highlighting the importance of understanding the patient’s health, independence of mind, and the need for harmony between the individual, social and natural environment, as reflected in the Hippocratic Oath.

In other words, medical treatment starts with awareness, and the goal is to nip sickness in the bud. A reimaging of the time-worn war maxim about winning the battle before it ever gets to the battlefield, certainly applies here.

Donald Trump lost re-election because of his pandemic response, Doug Ford is trying to avoid the same fate (Photo: Wikicommons)

This might be disorienting to some, but when a major crisis hits – like economic depressions, wars, or a pandemic – it forces us to take a 30,000-foot focus on the flaws that were desperately in need of an overhaul, long before the pandemic struck.

Let’s start with hospitals. Ontario is stymied by its healthcare payouts, well over 40 percent, and the largest expense on its budget. Matthew Anderson, the newly named president and CEO of Ontario Health, previously headed the William Osler System which manages Brampton Civic Hospital and the Peel Memorial Centre for Integrated Health and Wellness. He once asserted that hospitals had to engage in the proactive process of managing disease – making sure people don’t get sick in the first place. He said the fate of the healthcare system in Ontario is based on sustainability. With costs rising, and gaps in the primary care model emerging, the ways of doing business must change.

Peel Memorial’s model would prevent sickness, he said, and put people back into their homes quicker, saving the province a bundle. Health Minister Christine Elliott says Anderson will play a key role in helping to transform the current public healthcare system and solve the problems with hospital overcrowding.

None of this can happen in places like Brampton until the provincial government funds healthcare based on population. The city currently cannot provide its residents with an adequate standard of care because its lone hospital, Brampton Civic, simply does not have the capacity. Local leaders have utterly failed their constituents. While the three current NDP MPPs have demanded a second full-service hospital and at least double the number of hospital beds, the two PC MPPs in the city, Prabmeet Sarkaria and Amarjot Sandhu have done absolutely nothing. Fifteen years of Liberal leadership inside Queen’s Park was equally pathetic.

To gain an understanding of the suffering this pandemic has wrought, we have to unpack past practices, and see healthcare in broader terms, both physically and sociologically. For a disease to become a pandemic, four questions need asking, and in each case, except the last one, the answer is “very”: How lethal is it? How good it is at finding victims? How difficult it is to contain? And how susceptible is it to a vaccine? (This will take time to know)

In Bill Bryson’s 2019 bestseller, The Body, he quotes Harvard Professor Daniel Lieberman who notes that in 90 percent of all rare disease cases, there are no known treatments. That means if you are ignorant of the dangers awaiting you, it’s time to bone up. The professor believes 70 percent of the diseases that could kill us – like Type 2 diabetes, cardiovascular disease, respiratory ailments, and cancers – are preventable, “if we would just live more sensibly.”

Michael Kinch, a Washington University professor, echoes his sentiments, saying, “The fact is, we are really no better prepared for a bad outbreak today than we were when the Spanish flu killed tens of millions of people a hundred years ago. The reason we haven’t had another experience like that isn’t because we have been especially vigilant. It’s because we have been lucky.”

When luck runs out, science should take over, and our healthcare system must be put in a position to better meet the challenges. But most jurisdictions around the world are falling short, tragically so.

A curative health system (caring for the sick when the illness strikes) caused our hospitals to be overrun during the first wave of the pandemic and then again during  the third wave. ICUs were overwhelmed 24/7, and frontline healthcare workers faced incredible stresses, and ended up exhausted – like the system itself.

At times, it seemed there was no endgame to this downstream response.

It’s upstream (preventative care) where the real work is being done to put us in a better position to respond to the far-reaching effects of a pandemic.

The Black Death flourished because mankind lived in closed quarters with animals, and what they carried. When the beasts got sick, and their disease jumped to humans, these invisible microbes wreaked havoc. They flourished in unsanitary conditions, the Black Death and the Dark Ages were aptly named. Life was short, and brutal. The consolations of religion didn’t help, either, nor did the alternative answers offered by the mystics.

Mankind didn’t have the capacity to understand microbiology and searched for other solutions to improve chances for survival, to extend mortality rates. Ponce de Leon explored the Florida swamps in search of the Fountain of Youth. Mary Shelley created a Frankenstein monster, and wrote about pumping electricity into dead body parts in hopes of creating the immortal man. The search goes on today. In 2017, Tad Friend wrote a New Yorker article entitled, ‘Silicon Valley’s Quest to Live Forever’ which talked about people living in California (where else?) who gathered to learn the secrets of longevity, and how the health of the cell was the key to an extended life. Apparently, glutathione was a powerful antioxidant that protected cells and their mitochondria, which would provide energy. Some disciples believe this could be “the God molecule.”

Extending life was simply a ‘medical problem’ and mankind would eventually find a “cure” for aging – like it did for cuts, or a broken leg.

In 2017, the Peel Memorial Centre opened in Brampton, a decade after closing the full-fledged hospital that once sat on the Lynch Street site. The Liberal government bragged that this wasn’t a hospital, but a new-style preventative medicine model. It would extend outwards in its Phase 2 and 3 stages – which never happened because the liberals allowed massive cost over-runs in the construction of Brampton Civic and the incoming Doug Ford government refused funding, and didn’t buy into its original mandate: a shift in focus from treatment to prevention. Earlier this year it committed to the bare minimum, 250 beds for Memorial’s Phase 2 expansion, about a quarter of what the city needs.

Preventative care is about creating a new normal, giving all of us access to services, and positive measures to avert illnesses. However, during the dark days of the COVID-19, The William Osler Health System temporarily closed the Urgent Care Centre (UCC) at Peel Memorial, shifting these responsibilities to Brampton Civic, which was already overrun.

Naveed Mohammad, president and CEO of Osler, said at the time, “This pandemic has challenged us in ways none of us could ever have imagined.”

Trillium Health Partners – Mississauga Hospital, Queensway (Etobicoke) and Credit Valley – has also embraced a preventative medicine model, which is under the direction of Dr. Robert Reid, a leader in the field. He was also attached to the Dalla Lana School of Public Health at the University of Toronto Institute of Health Policy, Management and Evaluation. Reid was Trillium’s chief scientist and senior vice-president science, “with a passion for healthcare transformation.” He is internationally recognized for his research developing and testing population-based innovations in primary care delivery, prevention services and chronic care. He once co-authored a paper “on the patient-centered medical home movement.”

The Peel Memorial model irked the Brampton electorate from the get-go, especially because they raised millions to fund it, and didn’t understand the facility’s limited usage, or the fact it closed at night. Why wasn’t it called a hospital? What was this hybrid? The public outcry continued when the UCC temporarily shut down.

The question going forward is this: can the preventative care model practiced at Osler and Trillium, be expanded over time to a full-blown delivery system to prepare us better for the next battle in this pandemic, or subsequent ones?

Yes, said Stuart Butler of the famed Brookings Institute in an article written in the JAMA Forum entitled, After COVID-19: Thinking Differently About Running the Health Care System. “The enormous pressure on hospitals because of the COVID-19 pandemic should bring about a re-examination as to whether these institutions should be the first resort when people are sick.”

He said one urban scholar points out how reconsidering the best settings for different patients could mean appropriate infection control practices. Thousands of skilled nursing homes and inpatient rehabilitation facilities could be available for patients with COVID-19 and for other patients currently being sent to hospitals.

We have to be flexible, and embrace all options, he concluded.

Tele-medicine, and virtual care at Osler have greatly expanded since the pandemic began and have been available in over 20 outpatient clinics and services. Patients who participated could confidentially access health care services through their phone, mobile device or computer via secure video call. This is also the case at Trillium.

Said Butler: “It is also time to consider some hospitals as possible hubs for a wider range of services related to wellness, rather than providing only clinical services. Many managed care organizations and community clinic systems are already diversifying in this way, with some even providing education and employment training through partnerships.”

Matching patients with healthcare practitioners (whether at a hospital, or off-site) is just one way of reviving our system, which some think is itself on life support. The movement to build flexible facilities that can change according to evolving circumstances (like a pandemic) is a trend finding favour in urban design. In normal times, hospitals take up to four years to build, after plenty of fundraising drives in the city where they will be located.

But the pandemic has upped the ante, closed the timelines, and propelled the world to think and build outside the box. In Wuhan, China, they used modular construction to build two hospitals (2,600 beds in total) in just two weeks. The Javits Centre and the Arthur Ashe tennis grounds in New York City, quickly morphed into field hospitals during the height of COVID-19, and were quickly converted back after the worst of the virus had passed. The advancements in medical infrastructure will be one of the big takeaways from this pandemic.

Most people have a sharp mind for changing plans according to developing circumstances – especially in a crisis. And then there’s Trump, the unstable genius. His daily briefings in the midst of the first wave were pure theatre, messy and mind-numbing, and tragically filled with misinformation. His denialism, rejection of basic facts and promotion of miracle cures, was thoroughly unmodern, and took us back to a bygone age.

President Joe Biden inherited a disaster and it wasn’t hard to look down right Herculean after his predecessor’s tragically incompetent behaviour. But even with America’s impressive pledge to send half a billion vaccine doses to countries that cannot procure enough on their own (the rest of the G7 has committed another half billion) the pandemic has revealed public health inequity on a global scale. It’s a generous act, but it raises questions around how a globally connected economy can truly function if the fundamentals of societal well being can not be looked after. Where will the next virus emerge from? And will the countries of the world be better equipped to prevent widespread transmission?

The argument by many is that Canada’s current “curative” healthcare system is ill-suited to these troubling times. We couldn’t even prevent a second and third wave, and without a vaccine we would almost certainly be heading toward a fourth wave, instead of an open summer.

Doug Ford claims to be 'For the People' but his policies have favoured corporations (Photo: Government of Ontario) 

Hemson Consulting’s growth forecasts were issued last June and said the Greater Golden Horseshoe will grow to 13.5 million by 2041. Ontario is facing a staggering $407 billion debt, the largest sub-national amount in the world. The annual deficit to service this mammoth line of credit is untenable. As the population skyrockets and the debt moves alongside, something has to give. The Ford government has proven inept in dealing with a problem that was started by Mike Harris and compounded by 15 years of Liberal rule. The current premier has shown he is clueless when it comes to growing the economy, the only way of reducing the crippling number on the balance sheet.

His big idea is to hand over land to developers (actually, that’s their idea) who want to build more single-family houses and low-return commercial structures for retail and warehousing. 

We are all dreaming if we expect the order of magnitude investments in healthcare and long-term care needed to pandemic-proof Ontario, unless the PCs are either defeated or fundamentally change their priorities for spending.

Donald Trump lost his bid for re-election because of his inept pandemic leadership. Doug Ford is now trying to suppress freedom of expression heading into next year’s provincial election. He hopes we forget what has happened.   

For now, as the lockdown is lifted, we have been quickly lulled back into a false sense of security, thanks to the country’s impressive vaccination roll out.

As you revel in your summer joy, freed from the shackles of this horrible disease, set aside some time to think about how to avoid a repeat performance.

We need a system of care that is far more enduring than our present-day model.

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