My point of reference for COVID-19 is SARS.  Admittedly, the two are almost 20 years apart: I was a Toronto hospital CEO in the thick of the SARS outbreak, but I am much more removed from the COVID-19 pandemic. I am, however, struck daily by some of the similarities as well as the significant differences.

The magnitude of COVID-19, and its implications both current and future, make SARS look like a minor blip on the radar screen.  I worry about how we, as a country and globally, are going to pay for this. The rate of spending on anything even remotely related to COVID-19 seems unlimited and almost unquestioned. How long can this continue unabated? Where is the money coming from? I don’t remember this being a big issue during the SARS pandemic although I am aware that the negative economic implications of SARS led to a downgrade from Code Orange sooner than some health sector people felt appropriate. SARS 2 reared its ugly head a few weeks later. Some would argue it was worse than SARS 1.  I hope there is a lesson to be learned from that.

One of the strengths I see in the way Canada and individual provinces are handling COVID-19, similar to SARS, is the reliance on scientific and fact-based evidence, as contrasted most obviously with our neighbour to the south. Medical Officers of Health, both nationally and provincially, are front and centre in the public discourse. Our politicians are out there, but the focus is on what is being done or needs to be done. Our politicians are not questioning scientific evidence or advice. There is consensus on the health and wellbeing of our citizens being paramount; there is agreement that this is not the time to descend to partisan politics. And thank the heavens for that. I also give thanks for our healthcare system, with all its warts and blemishes. Can you imagine living in a country during a crisis like this, where you may not have any healthcare coverage because you cannot afford it, or you may not receive needed support because your political stripes are different? These are huge advantages we often make light of.

Returning to the SARS pandemic for a moment, there are a couple of lessons from that experience I don’t think we learned very well. Firstly, everyone involved marched to the same drummer. Recommendations from scientific committees and working groups were implemented uniformly and expeditiously. During the present crisis, I find almost the opposite to be true. This is most notable when I watch what is happening in Ontario where different hospitals are making decisions resulting in different policies among institutions and in some instances, publicly funded institutions are even competing with each other for such things as acquisition of supplies. This is unacceptable.

More broadly, there are differences among provinces on such things as social distancing guidelines, implementation of rules around size of group gatherings, and so on. Of course, in a country the size of Canada, differences are to be expected but to the average citizen trying to make sense of everything, it is not always clear why one province has suddenly decided to limit the size of group gatherings to three individuals while another has gone with five.  The same can be said for the determination of essential services. There is considerable variation across the country. This is confusing and can result in some skepticism about whether we actually know what we are doing.

My final point relates to Canada’s health system capacity. Following the SARS pandemic, comments were made about the inability of an already maxed out system to cough up more acute and critical care beds during a crisis. Some twenty years later, I would say the problem is even worse. What other industry considers regularly using 100% or more of capacity as being efficient? Most industries actually plan to use less than full capacity, so they are able to respond to unexpected events such as the present COVID-19 situation. Yet, in healthcare anything other than full occupancy is deemed inefficient. A vacant bed is actually considered bad. What does that say about us? I am pretty sure there will be another COVID-19 scenario in the future.  Let us hope we do not continue to be victims of the old adage, “Those who fail to learn from history are doomed to repeat it”.

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