Dian Cohen
Local Journalism Initiative
The scientific and medical wins that came out of the pandemic are clear – vaccine development and virtual care most prominent. Of course, they aren’t without detractors – we’ll get to them as well.
The COVID-19 vaccines were the fastest vaccines ever created. From identifying a new pathogen — the novel coronavirus formally known as SARS-CoV-2 and colloquially called COVID-19 — to discovering an immune response against it to developing and testing a safe and effective vaccine for it, all in less than 12 months. Typically, vaccine development is 5 to 10 years or more because the process is so rigorous: first find something that works, then test whether it’s safe and effective in clinical trials, then pass the regulatory approval processes, then manufacture enough doses for widespread distribution and finally roll it out to the population. Before this spectacular cooperative win, the fastest vaccine to go from development to deployment was the mumps vaccine in the 1960s — it took four years.
It’s hard to identify a public health tool that has had a more positive impact than vaccination, or one that has done more to promote health equity. Vaccination coverage for COVID-19 is high in Canada, with more than 80 per cent of the population having received at least one dose. Coverage for other preventable childhood killer viruses is high too — 77 per cent for diphtheria, whooping cough and tetanus to 92 per cent for polio and measles.
Still, a palpable downside has emerged. Before the pandemic, 70 per cent of survey respondents agreed that before children attended daycare or school, they had to be vaccinated. Now 38 per cent of respondents say vaccination should be the parent’s choice and fully 17 per cent say they are “really against” vaccinating their children. Regionally, support for mandatory vaccination is highest in Ontario and lowest in Quebec. This anti-vaccination movement poses a threat to public health and could help trigger an outbreak of preventable diseases that were once thought to be all but eradicated in much of the developed world – for example, we have seen 29 cases of measles this year, compared to 3 cases last year.
‘Long COVID’ is another downside. More than a million Canadians are still waiting for a medical advance to provide relief for their symptoms. One in nine people who contracted COVID-19 still suffers from cognitive impairment, fatigue, shortness of breath and other ailments that affect their health and ability to pick up their lives from before the pandemic. The medical community is still working to understand it — there is no agreed-on definition of the condition or its diagnosis and few if any clinical practice guidelines.
Increased accessibility to healthcare through telehealth — predominantly by telephone, but also by video and text messaging has been a significant win. Before the pandemic, fewer than 1 in 4 primary care doctors offered their patients online appointment scheduling or the ability to ask a medical question through a secure website. And with good reason – Canada’s healthcare system had no fee codes that allowed doctors to be paid for virtual consultations. That changed quickly. By early 2021, all Canadian jurisdictions had instituted a variety of fee codes to support virtual care. The rate of virtual consultations rose from 20 per cent to 60 per cent. Half of all Canadians reported to the Canadian Institute for Health Information (CIHI) that they had been offered a virtual visit alongside other non-virtual modes.
The benefits of virtual care are crystal clear — improved access to healthcare services anywhere, but especially for those who live in rural or remote areas.
Virtual care, however, is not without resistance and concerns. Some downsides require that healthcare providers learn to practice in different ways: they may not be able to palpate an abdomen as they do in an in-person physical exam, but they can take vital signs and listen to the heart and lungs over a virtual platform. Of course, they have to invest in the technology — only 5 per cent of physicians outside hospitals have done so. In addition, virtual consultations lack the personal touch that comes with in-person visits, so healthcare providers have to find other ways to build a relationship with their patients.
Other downsides are significant: patients who don’t have a reliable internet connection, a computer, and a camera may be excluded, raising equity concerns. Storage and sharing of personal health information raises privacy and security issues. Then there are issues surrounding private companies offering virtual care services outside of the publicly funded health care system. If you visit a doctor virtually through a commercial app, there is no continuity of care — you know neither the doctor nor the quality of his/her competency. Moreover, the information you submit in the app could be used as a promotional tool.
For whichever of these reasons, our uptake of telehealth has been significantly less than other G7 countries, and the proportion of visits that are virtual today has decreased from the days when many in-person health services were unavailable. It is not a stretch to believe that the healthcare system itself is a victim of COVID: it is in worse shape and less universal than it used to be.
When COVID-19 was scaring us all, virtual formats almost overnight became a dominant means of delivering care. With the waning of the pandemic, the “virtual first” approach was challenged in favor of delivering care the old-fashioned way — in-person. Only a few provinces have indicated that the virtual consultation fee codes in the public system are permanent. New data shows that we are still struggling to clear surgical backlogs created during the pandemic, with Canadians needing joint replacements and cancer surgeries facing some of the longest wait times. The doctor shortage is worse — health professionals who are suffering from pandemic-related burnout and/or low-grade PTSD are retiring early. New graduates are shying away from family medicine. The aging population, along with its younger relatives face fast-degrading access to and quality of healthcare.
Yet the possibilities of telemedicine and virtual care are endless. Our mindsets are simply not yet attuned to embracing the wins that accompany it. Incorporating telehealth permanently into the Canadian health sector requires a champion. The federal/provincial/territorial governments and national organizations need to embrace its positive features to relieve the strain of people without doctors going to emergency rooms. They need to agree on the principles of virtual care design, deployment and governance across all jurisdictions of the country. Without question, it would be an improvement over the system we have now.
Tomorrow, wins, losses and lessons learned four years later.
