Peter Brindley: Covid’s third wave—another wake-up call for a complacent world?

It’s generally fine to be ignored if everything is going to plan. My nation, Canada, and my profession, intensive care medicine, is usually happy with this arrangement. The current worldwide attention on both is because of Canada’s woeful covid-19 vaccination performance, and a growing third covid-19 wave. [1,2] Our national “sages” (and I accept my portion of blame) continue to shuffle papers and lecture dispassionately about “staying the course.” Meanwhile, your average Canuck tries to make sense of it all despite weary resignation and significant despair.

It’s not easy fighting an unprecedented novel mutating virus. Regardless, the attention on Canada and its ICU’s is because we have all the variants, too few vaccines, and excessive fatigue. Our current response might also reflect that we have had life too good for too long. Regardless, I am committed to the cause and grateful that, even at our worst, we are luckier than most. It even feels indulgent to complain while inhabiting a rich nation, and plying a lucrative trade, but, I want to leverage the attention to encourage a third-way between denial and panic. I just want Canada and its patient care to be so quietly competent that the world focuses its attention elsewhere.

My profession has done well on the covid-19 frontlines, but one of covid’s many lessons is that we need to do better in the backrooms. After all, meaningful change requires sustained engagement, not just polemicizing. It’s tough to know the right dose of fear, but, in terms of disaster preparedness we needed to waft the smelling salts long ago. Instead, I just read incredulously that Canada was named the top country in the world for 2021, despite ranking below 20th for administered covid-19 vaccine jabs. [3,4] This is hardly the time to encourage complacency.

Our national story (it is just as often a myth) is that Canada just gets the job done with minimal fuss. Regardless, like all rich industrialized nations, we can be smug and prone to virtue-signalling. Our particular brand usually includes unwarranted superiority, especially when comparing ourselves to our “excitable” American cousins and “stuffy” British parents. Our lower early death rates from covid-19 (under 25,000 to date) fed that bias and complacency. However, the top three issues in Canada are now vaccination, vaccination, vaccination. This is a large part of why Canada’s per-capita rates of covid-19 are now higher than the UK and US. [4] Covid-19 highlights that “well-done” matters more than “well-said.”

Canada’s vaccination performance also shows the world that minimal preparation cannot be overcome, even with eye-popping expenditure. In just one year, my once thrifty nation has already spent more on covid-19 than any other project in its history: 380 billion Canadian dollars have been spent for a population of approximately 38 million. This is 50 times Canada’s overseas aid budget, and enough for at least a hundred new hospitals. My take home: never equate cost with value, and never believe any official who says there is simply no money.

Canada is a G-8 country, but currently has zero—I repeat zero—ability to make its own vaccine. Instead we tried to bogart more vaccine than any other nation: at least four doses for every citizen. This nation routinely lectures others on social justice, but, along with other rich nations, we also withdrew vaccines from an international vaccine sharing pool (COVAX), intended primarily for poorer nations. [6] In other words, are we really “all in this together” or are we just better at slogans. Even if the entire world is facing the same storm, the industrialized nations do not seem to want to share the lifeboat. So, what to do? We could start with the most clichéd of Canadian responses: an apology.

Canada loves apologizing so much that this is the punchline to why our national chicken crossed the road (i.e. to say sorry). So where is the vaccine apology, or meaningful acceptance of responsibility. I have only heard blame: “It’s those that aren’t wearing masks” say those charged with getting vaccines; “It’s the federal government not us” says the provinces (the Canadian version of a US state) and vice-versa.

Which brings us to Canada’s myth of national unity. Notably, Canada’s coronavirus response has been mostly provincial (i.e. regional) not national. Canadian parochialism even includes our provinces competing for healthcare workers. [6] Even if doctors and nurses had the time to help out, Canada’s medical practitioners still do not have national licences. As such, we can’t work elsewhere because our national bureaucracy is as thick as maple syrup, and there are more restrictions than you can shake a nasal swab at.

Just to get a license in another province currently costs each individual thousands of dollars and days of paper work. To put this in UK terms, imagine re-applying and re-paying the General Medical Council every time you moved county. The result is that Canadian healthcare workers cannot be flown into hot spots even though our firefighters routinely are. There are also major provincial travel restrictions during covid-19. Presumably, one week of working elsewhere could necessitate five weeks away from your home hospital: if you quarantine 14-days upon both arrive and departure. Sure, Canada comes together when we play Russia at hockey, but for covid-19, hell no.

Like most countries, Canada has a complex history: most of it grand, some of it not. Regardless, we were previously known for tackling big challenges. We left footprints because we put work boots on. I love this country, but I am tired of unwarranted halo-polishing. Similarly, I used to think that healthcare was too big to fail; I now worry we are too big and too frail. If the best predictor of future performance is current performance, then I am no less concerned about the post-covid world. Unfortunately, those discussions will be ignored until we accomplish something as seemingly banal as getting enough vaccines into enough willing arms.

Peter Brindley, Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. Scholar, Peter Wall Institute for Advanced Studies. Twitter @docpgb

Competing interests: none declared.

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