Opinion piece

In advancing the idea of a ‘balanced approach’, commentators should recall that the other extreme of getting the balance wrong is surrendering to uncontrolled viral spread. 

By Lawrence Loh, MD, MPH, FCFP, FRCPC, FACPM

It’s a strange day when a former conservative political leader and a former public health executive are seemingly singing from the same song sheet. The shared perspective advanced in their recent writings seem to present a question: “What happened to balance in the pandemic response?”. Their commentaries soon make clear that they are asking the question rhetorically, advancing their belief that the implementation of disease control measures have supposedly not accounted for unintended consequences along the road to saving lives and protecting the healthcare system from COVID-19. 

Nothing could be further from the truth.

The reality is that Canada’s pandemic response has thread a needle between two extremes: uncontrolled viral spread versus harsh, draconian lockdown measures. What’s most interesting is that those calling for a ‘balanced approach’ make three fundamental errors.

The first is that they anchor current measures as one extreme; that they are draconian, overbroad, and not necessary since “it never got that bad.” Suggesting that the measures are an overreaction based on the success of control efforts to date represents the famously flawed thinking of the prevention paradox. Leaving that aside, data and evidence demonstrate that Canada has painted a middle path by any objective measure. Measures seen elsewhere have never been deployed here; movement control restrictions, curfews*, even welding people into homes

( * This post was written before curfews were in place in Quebec, Canada.)

Even in countries that are considered success stories, the response has stayed steadfast to Canadian values and principles in balancing transparency and privacy. Canada’s response has balanced arming the public with information about high-risk economic sectors, geographic distribution, and inequities with a careful understanding of the stigma associated with the disease and a respect for the longstanding medical concept of confidentiality. This has stood differently from other national responses that have broadly shared details on cases and clusters that could potentially identify an individual’s status, sometimes with tragic consequences

The second error advanced by these commentators is one of attribution—blaming the measures for unemployment, impacts to mental wellness, and disruption. This speaks to two key considerations around the global pandemic. 

Firstly, it’s easy to forget that COVID-19 is a disaster much like any other disaster. If a nuclear power plant was melting down, or a giant earthquake levelled Vancouver, it’s unlikely we would be sitting around questioning whether emergency measures are necessary. Any rational government would act to address the immediate threat to life and limb. Considerations around unintended consequences and long-term impacts would persist, but there would be an understanding that keeping the community open would lead to further losses. Disaster relief would be designed to get people genuine financial assistance and resources according to their need.

Because it has been so long and insidious, and the suffering so circumscribed to already marginalized communities and in public health call centres and hospitals, people forget that COVID-19 is itself a disaster. As a disaster that spreads from person to person, that means the emergency measures are simple: collective action to reduce contacts in order to save lives and keep our first responders, essential workers, and vulnerable safe. Hence, the measures are being taken in response to the emergency, rather than being taken in and of themselves.

The final fundamental error that these commentators make, in talking about balance, is they don’t talk about the other extreme—which is letting COVID-19 run completely loose and the resultant impacts seen, direct or otherwise. 

Fortunately, we have a long list of countries that have gotten that side of the balance wrong.

Wuhan. Lombardia. New York City. Guayaquil. Manaus. Madrid. Mumbai. Jakarta. Rostov. Port Elizabeth, South Africa. Liège. Prague. Winnipeg. El Paso—and most recently, Los Angeles.

The places that have seen viral misfortune see many of the same impacts, but with death and dismay from COVID thrust on top. When viral spread spirals out of control, hospitals are overwhelmed, mental health is impacted, and consumer confidence and the economy still collapses

In essence, failing to balance on the COVID side of the equation results in much of the same harms.

Where the virus is spreading rapidly, a trip to the movies is weighed carefully when the fear of contracting the virus is even more tangible. Few people are holding dinner parties or going to the shops if it feels like ICU roulette. Of course, in the end, it is still the most marginalized and vulnerable among us that are least able to protect themselves, bearing the brunt of suffering and death. 

Perhaps as illustration, I can offer an alternative image to that recently proposed in this very blog’s opinion piece section.

I too have a picture in my head of a family: two partners, a mangy dog, and several dishevelled kids. They’re at the front door, one partner holding an eviction notice as the snow comes down outside, having just returned home from work. The other is in the kitchen, opening soup tins from the food bank for family dinner. Their children are struggling as they watch cartoons in the living room. 

Coming into the house, the returning partner removes their coat and sits down heavily, sighing. The unspoken question lingers, answer even known before they speak up.

“We turned one table today.”

“Just one?”

 “There’s more people than ever coming down with it. No one wants to go out.”

“Yeah. I heard Katie across the road passed today. Two months on a vent. Got it from work and she didn’t even know until it was too late—and now her shop’s gone bankrupt, anyway.”

“God. Just terrible.”

 “I don’t know. You know Angie says the hospital is crazy. They’re treating people in the gift shop. Seem it’s spreading everywhere. Gym class, holiday parties, construction sites. Nowhere seems safe.”

With a nod, and pain in their eyes, the partner preparing dinner puts some soup in the microwave. “I wonder what might’ve been if we’d done better at controlling this.”

“Would have been nice if we got some support or assistance, and had the chance to stay safe,” the other partner agrees. “We could have closed up, stayed home, and stopped the spread.”

This story illustrates a clear reminder: when the balance tips towards needing to control COVID, then acting quickly and judiciously to stay on the middle path helps prevents essentially the same set of indirect harms—on top of the deaths and disability brought on by COVID itself. 

Putting in measures and counterbalancing their impacts by providing meaningful support can help guarantee success in the challenge to preserve livelihoods and lives to the extent possible. Seeking genuine balance is about finding the narrow path between two very stark realities; while we can discuss exactly where to draw the line, hopefully all can agree that the extremes of opening it all up or shutting it all down have impacts and costs that are similar and equally undesirable. 

Blog photo by Edwin Hooper on Unsplash

About the author

Dr. Lawrence Loh is Medical Officer of Health at the Region of Peel, and Adjunct Professor, Dalla Lana School of Public Health, University of Toronto.