COVID-19: Hard choices

November 26, 2020

Dear Members: 

Since I wrote to you earlier this week, additional public health measures have been announced to slow the COVID-19 pandemic. There has been a lot of debate on the probable effectiveness of these plans and what needs to happen next. There is no question that tight lock downs are effective in reducing spread; we experienced it in the spring and results from other jurisdictions speak for themselves. However, these strict measures were not without consequence and the health of our community paid a price. Statistics Canada reported 402 additional deaths over a seven-week period in the spring, and COVID accounted for only 40 of these deaths. These excess deaths were in part related to people not seeking care when they needed it or presenting late for medical attention to problems that should have been readily treatable. Some were related to substance abuse and overdoses due to the strain on mental health brought on by economic hardship and social isolation. That being said, letting the virus run rampant through our communities is not the answer. 

The debate over public health restrictions has become politicized. In my opinion, this misses the point. The fact is that there are no simple answers, and we face a complex situation. It is not a case of choosing between the health of Albertans and the economy. They are inseparable. 

When managing patients in the ICU, I often need to make difficult decisions that are not always based on perfect information. I weigh the pros and cons of all courses of action, and choices are rarely clear-cut. All decisions are balanced against the risk to my patient if I’m wrong. Once the call is made, it is my duty to closely monitor the situation and be ready to change course if the desired results are not achieved. That’s the kind of thinking we need in wrestling with this pandemic. 

Prior to this week, the measures put in place have not been effective in controlling the rising case numbers and a different path was chosen. We must now remain vigilant, assess what is happening and be ready to act with more stringent measures if needed, accepting the consequences that those measures will no doubt bring. We all recognize that there will be a lag before we see the effects, but there is very little room for error if case numbers continue to climb at current rates. This province can ill-afford to see another doubling of daily cases.  

We must continue to trust our public health experts and count on them to relentlessly monitor and assess what develops. If more stringent measures are needed, we expect government to take them. I am confident that Dr. Deena Hinshaw, the Chief Medical Officer of Health, is bringing the latest evidence and best public health advice to the tables where decisions are made. If there is debate about those recommendations, then I know she will participate actively, professionally and ethically. She is an amazing resource for Albertans who is providing extraordinary service. 

Along with every professional on the front lines, physicians are doing what we can to prevent the system from being overwhelmed. We are all stressed, tired and worried about the days ahead. As we care for our patients, we must not forget to appropriately recognize and address our own need for personal safety, mental health and resilience. Take care and be safe. 

I want to say “Thank you” to all our colleagues who have been in the public advocating and expressing the level of concern we all feel. Your advocacy is so important to the profession, our patients and the community. I, myself, have written to the Minister, Premier and Dr. Hinshaw to express my concern with the rising numbers. I have offered the support of the AMA in messaging to the public and the profession and in further mobilization of community care beyond what we have achieved in the Pandemic Community Supports Working Group (or in other collaborative undertakings). 

President’s Letters are public documents, so I will take the opportunity to make a plea to Albertans: I know many of you are tired and fed up with the pandemic, but please listen to what the experts are saying. Wear masks, wash your hands, social distance and avoid social gatherings – as hard as that is at this time of year. It is only by following these requirements that we will slow COVID-19 before the health care system becomes overwhelmed. Every decision that you make to the contrary places others at risk. I hope you will agree that getting through this pandemic at the expense of our seniors, our most vulnerable and the less-fortunate is not the Alberta way. This problem is here. This problem is now. The decisions you make will shape the days ahead.

You can reach me in the usual ways. 

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org  
• Comment publicly on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

Sincerely,

Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association