I’d planned to write a post without any mention of the on-going pandemic, but obviously that’s not going to happen. It has been such a prominent feature of our lives for over a year now, with restrictions still in place across many areas of the world – and while new variants take hold at the same time as mass immunization efforts are being rolled out.
Here in Montreal, for example, we still have a daily curfew from 8 PM until 5 AM. Don’t ask me what the scientific basis is for this; our local healthcare professionals and researchers have confirmed there is none. The politicians feel that an evening curfew somehow limits large social gatherings in people’s homes, but it’s not working.
Most of neighbours have simply switched from large dinners with family and friends to large weekend brunches or lunches. Meanwhile, these same politicians have just re-opened movie cinemas, arenas, and other indoor ‘activity’ centres in Montreal for spring break this week. Our schools’ spring breaks occur much earlier than in other areas, which was one of the explanations given for why Montreal was long the epicentre of COVID-19 in Canada; spring break travellers returning to this city brought the virus with them – before it arrived elsewhere in Canada.
Now, of course, Montreal-area healthcare professionals and science journalists are concerned that the government decision to loosen pandemic restrictions specifically for spring break will again put this city at the forefront of yet another wave of COVID-19. This time, though, an even more dangerous and contagious third wave of variant strains of the virus.
As you can see, concerns about the pandemic haven’t yet been allayed by our current mass-vaccination program. At this point, we’re still only vaccinating people aged 80 and older. We have at least, finally, gotten residents of long-term care facilities (nursing homes) vaccinated against this coronavirus though. That was good news.
And as far as I know most of the people living in official ‘retirement homes’ in Montreal have also been offered the opportunity to receive the vaccination; including my father-in-law.
Individuals working within healthcare and social services, who have direct contact with patients, were also given priority access to the vaccine – as well they should. Another priority was people living in “isolated and remote communities” (1) across the province.
The balance of Quebec’s immunization program is solely age-based, which is arguably inequitable on a number of grounds. Cancer specialists and patients groups are advocating for priority vaccination for those in treatment or remission with cancer. Cardiologists and heart disease associations are arguing for faster access for their patients, and so on.
Shelters for those without homes or for victims of violence should perhaps have been considered as a priority, along with immigration centres, organizations working with the disenfranchised and poorest among us.
As it stands, this is the age-based vaccination roll-out plan for Quebec, with Montreal being given first access within certain categories because of the significantly higher rates of COVID-19 within this city as compared to the rest of the province:
People 80 years of age or older;
People 70 to 79 years of age;
People 60 to 69 years of age;
Adults under 60 years of age who have a chronic disease or health problem that increases the risk of complications of COVID‑19;
Adults under 60 years of age who do not have a chronic disease or health problem that increases the risk of complications, but who provide essential services and have contact with users;
The rest of the adult population.” (1)
It will be a while before we begin vaccinating patients with chronic illnesses, categorized as being at similar risks of severe COVID-19 as people aged between 60 and 69. As an arbitrary cut-off age, this seems fair to me. If you’re 22 and taking immunosuppressant medications due to an organ transplant, I feel that you should move up the line for a vaccination. But perhaps not before someone who’s 68 or 69 years old.
My own rare disease, CRPS, might put me at greater risk of complications from COVID-19 because it’s two conditions in one; both autoimmune and neuro-inflammatory. Then there’s my asthma, my old buddy since adolescence, and the reason for which I’ve already been on a ventilator three (yes, 3!) times. But I’m not clamouring for more rapid access to the vaccine, because I believe the current cut-off to be fair.
From a bioethics perspective, it seems equitable and just. Our most at-risk elders were prioritized, including those living in isolated communities and often without access to pandemic-appropriate healthcare facilities. Also granted more rapid vaccination were all the individuals who put their lives on the line to care for others within our healthcare and social services – including ambulance technicians.
It would be impossible to roll out an immunization program rapidly while trying to take into account every possible disease and to evaluate risks of COVID-19 infection for specific categories of patients. As the World Health Organization’s Dr. Mike Ryan phrased it so eloquently, over a year ago and relatively early on in this pandemic:
Speed trumps perfection. Perfection is the enemy of good when it comes to emergency responses.” (2)
Also fair, and equitable, is the fact that throughout Canada – in line with our Prime Minister’s pledge last year to all Canadians – COVID-19 vaccination is free no matter which province you happen to live in. (3) This seems to be a distinct advantage over our American neighbours, even though our immunization programs are being delayed in some instances by provincial ineptitudes.
Another early promise from our Prime Minister was that Canada would purchase sufficient numbers of vaccines for each Canadian to be vaccinated – and that any leftover doses would then be donated to other countries. Canada’s strategy was to invest early in products which were still in development, and to pre-order vaccine doses in case they would later receive regulatory approval.
After a career in bioethics, particularly in clinical or medical research, I’d never have imagined that a federal healthcare bureaucracy could move so quickly and with so little information available! This has been one of the high points of the pandemic response, in my view:
Canada has made deals to buy more doses per capita than any other nation, according to researchers at the Duke Global Health Innovation Center in North Carolina.
It is among a handful of wealthy nations that reserved billions of doses between them before late-stage trial data came in, ensuring they would get access even if only one or two vaccines worked.
Canada could donate extra doses through the World Health Organization-backed COVAX facility, which would distribute them among recipient countries…
a COVAX source confirmed discussions were going on between Canada and other governments and organizations involved with COVAX, a facility created to ensure equitable access to COVID-19 vaccines.” (4)
The other high points, for me? These all relate to front-line teams and individuals, including our military personnel who were brought in to relieve suffering and horrific conditions in our nursing homes. Although this report details the situation in Ontario’s long-term care homes, military personnel were also deployed to these centres in Quebec; called CHSLDs here, after their French name. The situations were similar in these centres, in both provinces:
Conditions in some of Ontario’s long-term care homes during the COVID-19 pandemic were so upsetting that the military immediately brought in mental health supports for soldiers deployed there, a senior officer who oversaw part of the mission told the province’s commission on the facilities.
The potential psychological harm of witnessing atrocities later detailed in a military report was apparent almost as soon as officials walked through the doors, the medical director for the teams sent to the facilities told Ontario’s Long-Term Care COVID-19 Commission.
“As we were walking through…and starting our work within the long-term care facility, we very, very quickly recognized that this had a high risk for either mental health struggles or long-term impacts on our clinicians,” Maj. Karoline Martin said. “It was – it was very traumatic. It was very devastating”. (5)
With many Canadians now receiving COVID-19 vaccinations, there is already talk in bioethics circles about whether vaccination passports or passes should be implemented here. This isn’t a new concept; if you’ve travelled internationally you may already be aware of the “signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”)” (6) that is required for Yellow Fever in many countries.
Stay tuned for another post on that topic… or just watch your local news – it’s bound to come up fairly soon! As always, thanks so much for stopping by.
Stay safe, keep well, and let’s all hope for a brighter future…
References
(1) Integrated Health and Social Services University Network for West-Central Montreal (CIUSSS West-Central Montreal); Government of Quebec. COVID-19 vaccination. Government of Quebec. Undated. Webpage.
Online. Accessed 01 Mar 2021:
https://www.ciussswestcentral.ca/programs-and-services/lifestyle-habits-and-prevention/vaccination/covid-19-vaccination/
(2) Dr. Mike Ryan of the World Health Organization (WHO), quoted by the United Nations Office at Geneva (UNOG). Tweet (on Twitter) by @UNGeneva. 14 Mar 2020. Online. Accessed 01 Mar 2021:
(3) Katya Slepian. All Canadians will get COVID-19 vaccine for free, Trudeau confirms. Abbotsford News (Black Press Group Ltd.). Newpaper website. 07 Oct 2020. Online. Accessed 01 Mar 2021:
https://www.abbynews.com/news/video-all-canadians-will-get-covid-19-vaccine-for-free-trudeau-confirms/
(4) David Ljunggren, Allison Martell, and Stephanie Nebehay. Canada in talks to donate extra COVID-19 vaccine shots to poorer countries – sources. Reuters. News website. 18 Nov 2020. Online. Accessed 01 Mar 2021:
https://www.reuters.com/article/uk-health-coronavirus-vaccines-covax-exc/exclusive-canada-in-talks-to-donate-extra-covid-19-vaccine-shots-to-poorer-countries-sources-idINKBN27Y2UW
(5) Canadian Press. Military deployment in long-term care homes called ‘traumatic,’ report says. CityNews; a division of Rogers Digital Media; Rogers Communications. News website. 11 Nov 2020; updated 12 Nov 2020. Online. Accessed 01 Mar 2021:
https://toronto.citynews.ca/2021/03/02/its-back-ontario-lcbo-locations-to-reopen-on-mondays-province-hours/
(6) Centers for Disease Control and Prevention (CDC). Yellow Fever. U.S. Department of Health & Human Services (HHS). Website (Travelers Health; Disease Directory; Yellow Fever). Updated 30 Nov 2020. Online. Accessed 01 Mar 2021:
https://wwwnc.cdc.gov/travel/diseases/yellow-fever