Jen Gerson: Wishing for a healthcare system that lets me breathe on my children
We're all sick forever now.
Only one memory popped into my head when I saw Ontario's Chief of Medical Health advise parents to wear a mask in their own homes if they have the sniffles.
A few weeks ago, my miserable, stuffy toddler went hunting for a large ball of snot in her nose. Finding one, she put it on the end of her finger and offered it to me as a gift, insisting I eat it. Which, of course, I did (or, rather, I pretended to) because when you're a parent that's just how you roll. Nothing will change your relationship with hygiene and bodily fluids faster than loving a snot-nosed disease vector. Beds and carpets covered in feces, piss and vomit don't merit much more than an exhausted sigh nowadays. My daughter spilled half a bottle of milk onto my mattress the other night and I thought: "That's fine. I'll get to that when I clean the sheets next week."
Hell, it's just milk. I considered myself lucky.
My three-year-old is going to pre-school for the first time after years of COVID isolation. And, no surprise, she's brought home a succession of illnesses; hand foot and mouth disease, strep (twice!), coughs, stomach bugs, fevers, screamy nights of grumpiness for reasons that can't yet be fully explained. I'm still on the mend from a violent bout of diarrhea and vomit and am still coughing up some kind of strange green mucus, but whatever.
Ask any parent of a small child right now and you'll get much the same tale of woe. We're in the trenches, man. The illnesses have been utterly relentless since school began. We've seen nothing like it before; it's as if three years of sicknesses are being crammed into three months.
So while we're stressed out, grumpy, and annoyed, we're not surprised that the shelves are bare of basic children' medications, and the hospitals are overwhelmed. This was all entirely predictable — and was, in fact, predicted.
That’s why Moore's advice, to mask up in the Stage 4 biohazard that is my own home, was responded to with an instant eye roll. It was the type of well-intentioned advice that I completely discounted as out of touch and impractical — which is how we used to regard quite a lot of public health advice in the Before Times. "This is a very fine sentiment, but has no relationship to the world in which people actually live."
Sorry, my little girl just coughed into my mouth.
Moore's announcement felt like a trial balloon for the return of mask mandates in Ontario in the hope of offsetting the effects on pediatric ICUs, which are currently being overrun by sick children. (The government has thus far not imposed a mandate or even hinted that it may, but you know Ford and his sudden reversals.) Federal public-health officer Theresa Tam has already suggested we mask indoors — but has also stopped short of mandates.
I admit, seeing this from afar, I was struck by two entirely contradictory emotions, neither of them positive.
The first, as better articulated by one of my good friends and fellow mom-in-arms was: “Jesus, we shut down the entire world for two years to save the lives of the elderly, and now that the kids are getting sick, it's like pulling teeth to get anyone to accept even the most moderate, least intrusive measure — masking."
The other emotion, equally intense and angry, is the exact opposite of this sentiment: My daughter needs to build an immune system. She needs to be exposed to germs, bacteria, bugs and illnesses. That can’t be avoided. It can only be further delayed.
If the current wave of extraordinary pediatric illnesses is the entirely predictable result of three years of social isolation, lockdowns, school cancellations and, yes, masking, then how will more of any of this help matters in the long run? All we'll be doing is spreading out the pain over a longer period of time. Non-Pharmaceutical Interventions are sometimes necessary, but truer words were never spoken than these: "There are no solutions. There are only trade-offs."
Both of these sentiments are rooted in the same, bone-deep mommy anger. This pandemic, and our response to it, has revealed a profound intergenerational inequity that demands redress. Once again, our kids are paying the bills, literally, figuratively, and physically.
I'm also annoyed that we're all back here, having another fight about masking at all. To be clear, I think the evidence that masking in indoor areas would probably at least help reduce the spread of respiratory illness is perfectly sound. When it comes to mandates, however, this article by the National Post's Sharon Kirkey delves into the nuance. It's not a magic bullet: masking is only as good as the public's willingness to comply with an order to use one, and properly. There are psychological costs to mandates that probably ought not to be dismissed. At the very least, I'm perfectly content with treating masking as a personal decision and don't begrudge anyone who wishes to wear one.
But when we start talking about government-imposed mandates, we will inevitably see polarization on the issue, a division between pro and anti-maskers. And how much of this internecine squabbling gets our government off the hook for failing to foresee the foreseeable? In this case, for failing to prepare with adequate surge capacity? Why is there no flexibility in this system?
Once again, we're shifting the blame, and putting the responsibility for managing a collective crisis onto individual choices in order to cover for systemic failures. To put it another way, we need a health-care system that can handle the fact that I'm going to breathe on my children.
It's much easier to turn this into a debate about "mask vs. anti-mask" than to ask very hard questions about why a wealthy province of 15 million people only has 112 intensive care beds for children. It's not just Ontario. There are versions of this story playing out everywhere; Ontario, which closed its schools for a longer period than any other jurisdiction in North America, seems to be bearing the brunt of this combined RSV and flu wave, though it has company in its misery. Alas, the short-sightedness is endemic; pediatric illnesses are swamping hospitals in Canada and the U.S. B.C., for all its wealth, has only 22 pediatric ICU beds.
COVID, it should be noted, isn’t the major driver of the current challenge. The majority of the pediatric beds are filled with kids suffering the entirely not-novel illnesses of RSV and flu — illnesses that have long been endemic. RSV, for example, is responsible for about a fifth of all child deaths among kids who are otherwise healthy. The death toll is most horrific in developing countries without access to advanced care. However, even in Canada, deaths are not uncommon. This study, for example, found 79 RSV-related deaths across 11 pediatric centres over a 10-year period between 2003 and 2013. Many of those children suffered from severe co-morbidities, but in 40 per cent of those deaths, RSV was deemed primarily responsible. Even in Canada, a handful of otherwise healthy children die of this disease every year.
The numbers for the flu are also terrifying for any parent to behold. Between 2016 and 2020, an average of 20 Canadian children between the ages of 1 and 14 died every year of influenza and pneumonia, according to Statistics Canada. That number trended down during COVID when the kids were masked up, isolated, and sent home.
These are awful killers. They always have been, and they always will be.
Our COVID protocols gave us a few years' reprieve from RSV, as an unintentional but welcome side effect of the measures we took to limit the spread of the new, novel virus. The same was true of influenza. But those infections weren’t prevented, they were just delayed, at enormous financial and societal cost. We are now paying that bill, with interest.
And our response to this?
I don't know what it ought to be, but I think most parents fall broadly into one of two camps. One of them would rather rip off the Band-Aid, to move back to normal and accept that this is going to be a shit year. We're all going to get sick as our immune systems re-acclimatize to social interaction and the very young children suddenly get caught up on three years of the once-routine exposures they missed. Tragically, a few of these children will die — the awful unknown is whether the strain on the health-care system means more will die than otherwise would have in a pre-COVID “typical” year.
In the other camp, we get those individuals and parents whose risk tolerance has been permanently lowered as a result of the pandemic. The argument is essentially that wearing masks during the fall and winter may simply be our new normal, that we should resign ourselves to some shut downs and social distancing during flu season and routine masking for at least a few months a year. This is something we ought to simply get accustomed to in order to backstop a chronically fragile health-care system that is never going to be able to keep up with a world filled with more transmissible diseases, fewer per capita resources, and a rapidly aging population.
Most of the people making this argument aren’t really coming out and saying so — they’re still talking about this as an emergency measure, a temporary necessity, probably because they fear the public backlash to being upfront about it being a new annual routine. But this is indeed a slippery slope — in a country where flu reason routinely drove hospital occupancy beyond 100 per cent even before the pandemic, when would the logic behind a mask mandate not apply? A notable exception to the evasion is Marsha Lederman, who wrote in the Globe and Mail this week that said, “We need to normalize wearing masks, as is the practice in parts of Asia. Not just as a pandemic measure. Not all the time; not all year, even. But at this time of year, what used to be called cold-and-flu season, when we typically see increases in respiratory viruses — including COVID — masks need to return to our lives annually, brought back out along with the puffy coats, hats and mitts.”
Lederman is being open and honest about what is actually being proposed. She’s said the previously unsaid. Personally, I don't think that latter argument is going to fly with the general public, because I think most people want to return to pre-pandemic norms. I don't think most people like masks, and the notion of an annual "mandate season" just rings awfully dystopian. I would prefer we didn't manage our systemic health-care capacity issues with widespread social restrictions and expectations that were considered neither normal nor necessary prior to 2020.
But, then, I'm only four illnesses into winter. You may wish to ask me again in January.
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