[Caution: This article presents ideas that some readers may find disturbing. Reader discretion is advised.]
Obsessive focus on preventing fatalities by Covid-19 is raising deaths by other causes – all while inept policies and functioning of government fail to protect the vulnerable from dangers of Covid.
With the imposition of yet another round of lockdowns in Ontario & Alberta, the rising sentiment of lockdown-fatigue among Canadians is becoming apparent. While it is amply clear that the course of action taken by our governments has failed to yield the desired outcome, public opinion is sharply divided when it comes to ascertaining the factors leading to this failure. In the meantime, those individuals who want life to return to normal, or even want other approaches to deal with the crisis to be tried, are shouted down with accusations of wanting to ‘kill grandma’. The people throwing this accusation around are unmindful of the fact that over the course of the past 13 months, the expression has lost much of its shock-value.
The irony is that both these opposing camps are convinced that their approach or preferred set of policies would preserve life. I have not come across anyone trying to close the gap in their respective perceptions. But if we think about it, the reason for this gap is pretty clear: while one side defines ‘life’ as ‘a state of not being dead’, to the other side it means ‘acts of living’. Since little (if any) effort has been made to spell out this distinction, the two groups are essentially talking past each other.
In the blockbuster Hindi movie Mr. Natwarlal, there is a song in which the hero, entertaining a gaggle of kids, narrates how he was walking through a dangerous forest, and was chased by a tiger. After describing his desperate attempts to run away from the tiger, he states (at the 3:42 mark in this link) that the tiger killed and ate him.
One sharp kid points out to the man that he was still alive. To this, the man responds:
‘Arre yeh jeena bhi koi jeena hai, lallu? Haan?’
(Is this life worthy of being called a life, my dear? Is it?)
KEEPING GRANDMA ALIVE
When the Covid-19 crisis first arrived on our shores, we (naturally) didn’t know anything about the way the virus would affect us, and so everyone was essentially shooting in the dark. Given the absence of information, a lot of people (perhaps the overwhelming majority of Canadians) were in favor of exercising utmost caution. I was one of them.
As time has passed, we have a better understanding of how the virus behaves, who it affects the most, and what consequences have transpired from our response to the initial assessment of the threat. In my view, that last point is where our policymakers’ Achilles’ heel lies; increasingly, their decisions bear little relation to the data that we now have in terms what it is costing a large number of Canadians to continue to bear the burden of the increasingly harsh restrictions of the various forms of lockdown. If we do not endeavor to arrive at a collectively acceptable threshold at which this cost outweighs the gains (expected or actual) of the current policy, we will be no better than the army generals of World War 1 who kept throwing thousands of soldiers in battle as cannon fodder to achieve whatever objective they had in mind, even as the objective wasn’t achieved while thousands were sacrificed. Just as those generals were unable to step outside the bounds of the paradigm that they were steeped in, our current political leadership is incapable of envisaging a different approach to tackle the crisis even when faced with repeated failure of the approach that they decided upon when we did not have the benefit of experience and data. To borrow a phrase from Michael Crichton, they lack the ‘evolutionary algorithm’, by which living organisms revise (or repeat) their behavior based on the memory and knowledge of their previous actions and their consequences.
It is common to say – and sometimes even believe – that all lives are equally valuable. I have a different view. I believe that each life is uniquely valuable. There is significant difference between the two views. When we say that all lives are equally valuable, we are essentially making a comparison of the worth of any two lives, and arriving at an identical evaluation for each. This still involves the act of comparing one life’s worth with another. My position is that such comparison is, barring extremely rare cases, null. Therefore, each life deserves the same protection as all the other lives.
This is where I think the nub of this discussion lies: our policies of lockdown etc. are aimed at preventing a state of being dead for some Canadians through the instrumentality of constricting many activities that constitute ‘acts of living for a very large number of their compatriots. Crucially, this constriction leads to many of those compatriots ending up in a state of being dead. In a nutshell, an approach that was chosen with a view to preventing deaths ends up causing deaths.
Let us examine where those unintended – even though entirely predictable – deaths have occurred.
There are three main causes of death that are relevant to this discussion: postponement of medical treatment, drugs overdose and suicide. Going by the fundamental premise of the lockdowns that they are needed in order to save lives, all that the lockdowns give us is an exercise in whack-a-mole, where if you beat down death in one place, it just pops up in another spot. Is the incidence of death greater in that another spot? And regardless of the answer, is it up to a government decision – or even a collective decision – as to who lives and who dies?
In order to probe for these answers, let us see how this exercise has manifested in real life.
Collecting data on deaths caused by postponement of medical treatment is difficult; if a cancer patient dies because the needed treatment was not given to them owing to lockdown measures, the death certificate is going to specify the cause of death as cancer – and likewise for other life-threatening ailments. So there is no way to arrive at the number of deaths caused by curtailment of treatment.
However, early on in the lockdown-era, there were multiple media reports about the possible toll of delaying treatments for those who were at risk of dying, including this one in the National Post which said that ‘almost 200,000 surgeries and other procedures were shelved indefinitely, as hospitals braced for a deluge that never quite materialized’. The report also said that after the suspended operations were resumed, catching up with the backlog could take up to two years in British Columbia, according to the provincial Health Minister Adrian Dix.
I don’t have the technical knowledge to assess the unfortunate situation of cancer patients, but as a layman, my simple question is: How does a delay of two years in a life-saving operation affect the patient’s chance of survival? And what happens to their quality of life in the interim? My concern is confirmed by this report from Ontario’s Financial Accountability Office, which also informs us that:
- In 2018-19, the average occupancy rate for Ontario’s hospitals was 96%, with 28 hospitals (or 20% of the total) having average occupancy rate of over 100% in the year, and (more crucially)
- Ontario’s rate of total hospital beds per 1,000 people is among the lowest in the Organisation for Economic Co-operation and Development (OECD) and Ontario’s occupancy rate is the highest.
In other words, in the province with roughly 40% of Canada’s population, healthcare was already in dire straits before the pandemic, and the unthinking postponement of already scarce treatments has left it in tatters.
Now, throw in the factor that some of these affected patients are children. As I mentioned in my earlier article Fighting The (Previous) Civil War, wait times in Ontario for the first surgical appointment for pediatric patients tripled due to the lockdown (when target time was 30 days, the average wait time was 90 days). As many as 61% of children did not receive the recommended surgery within the target time.
Coming to adults, for breast cancer, the number of patients whose surgery was completed within the target time dropped from 88% to 62% as a result of the pandemic measures.
One can compile similar figures for other ailments, demographics and provinces.
The main question here is this: Is any effort being made to capture the data that can show us the deaths caused by postponing medical treatment? I haven’t come across any. Until we have this data, it becomes impossible to ascertain the crushing cost in lives that Canadians are paying in order to save lives from Covid-19. Of course, they are paying a high cost in terms of suffering also – but here I am trying to reduce the equation to lives saved versus lives lost. Admittedly, that is a woefully insufficient measure, but I believe that it is the bare minimum on which we should be able to agree on a threshold to ascertain if the bargain is worth it.
LEAVING ON A HIGH
When it comes to death by overdose of drugs, the situation is equally grim – if not more so.
This report by Public Health Ontario analyses the data for drug-overdose deaths over 7 months, divided equally between three and a half months each immediately preceding the first lockdown on March 16, 2020, and after, up to June 30, 2020. It paints a grim picture.
Opioid-related deaths went up by nearly 36% (or in absolute terms, 186 more people died). The highest increase (37.5%) was in the age group 45-64, followed by the 25-44 age group at 34.60%. In raw numbers, 66 more people in the 45-64 group died, and an even 100 more people in the 25-44 group.
Based on the data in the report, here is a twin challenge for the Social Justice Warriors and assorted do-gooders:
- In the 5th quintile of neighborhoods with ‘material deprivation’ (a.k.a. highest poverty), deaths by drug-overdose was the highest of all quintiles in both the periods, at 45% and 42% respectively.
- And the 5th quintile of neighborhoods with the highest ethnic diversity (read: fewer white people) was the only quintile that registered a rise in overdose-deaths as a percentage of the overall deaths, from roughly 18% to 23%. Considering that the overall number of deaths itself rose, this is a whopping increase.
There is one more datum in this report that we will revisit in the next segment: suicide by drugs-overdose. On Page 8 of the report, the chart shows the manner of death (accidental, suicide, and undetermined). While the number of suicide-deaths by overdose is down (from 21 pre-lockdown to 9 in the lockdown period), the footnote to the graph says that “There were 88 suspected opioid-related deaths where manner of death has not yet been determined, and therefore the observed decrease in deaths determined to be intentional (suicide) may not be reliable as investigations for potentially intentional deaths may take longer to complete.”
I hate to use this expression here, but on this front, we at least have the silver lining in the form of actual data of excess deaths in the lockdown era in Ontario. That number is 186 over three and a half months. On an annualized basis, that means 638 excess deaths.
Coming to Alberta, CBC reported in September 2020 that the rate of overdose-deaths more than doubled in the period April to June 2020, compared to period from January to March 2020.
Over in British Columbia, the situation is equally grim. As the CBC reported in December 2020, the number of overdose-deaths in November was 89% higher compared to a year ago. Furthermore, as per the report, compared to 456 deaths related to Covid-19 between January and November of 2020, the number of overdose-deaths was a whopping 1,572.
The long and short of this is that the problem of people losing lives to drugs overdoses, which was already severe in many parts of the country, has got worse in the lockdown era. At least in Ontario, this worsening has disproportionately affected the poor and the ‘diverse’ people. Is it the case that more of them are driven to suicide-by-drugs owing to the isolation and financial ruin caused by the lockdowns?
As the era of lockdowns began (which none of us imagined would last for so long), the Canadian Mental Health Association issued a warning about the increased risk of people committing suicide, in June 2020. This was a reasonable apprehension to have at the time. Thankfully, as reported by CBC in February 2021, the data points in the opposite direction, at least for parts of the country. This data from British Columbia, Alberta, Saskatchewan and Nova Scotia shows a decline in suicide numbers in those provinces in 2020, with a combined reduction of 10.80%. So at least on this front, the situation does not appear to be worrisome. Or does it?
Firstly, the CBC report does not include data from the two most populous provinces of Canada, Ontario and Quebec, which together account for roughly two-thirds of Canadian population. Next, let us loop back to the point about the undetermined manner of death in relation to drugs-overdose in Ontario. The obvious question is: Does a similar situation exist in the other provinces also, whose data is linked to in the CBC story? There is a good possibility that it does. The conclusion is that we don’t know if suicides are up in the lockdown era.
Thirdly, as reported by CTV in December 2020,
“Distress Centre Calgary says suicide-related calls, texts and chats were up 66 per cent in October compared with the same month in 2019.”
The situation across Canada is similar, and perhaps worse. As this report by CBC in November 2020 states, ‘Canadians in quarantine (are) as twice likely to have suicidal thoughts’.
I frankly don’t know what is worse – being driven to commit suicide, or being desperate enough to consider it. Life (in the sense of the state of not being dead) is our most precious possession, and all animals including humans instinctively make all efforts possible to preserve it; indeed most would go to any extreme to preserve it. Should we be relieved that fewer people took the terminal option of suicide to exit out of their troubles in 2020, or should we be worried that more people were desperate enough to consider it because the lockdowns had made their life unbearable?
And finally, let us factor in euthanasia, which in political legalese, is ‘medically assisted death’. As CTV News reported in November 2020, a 90-year-old woman was considering ending her life due to the fear of another imminent lockdown in her retirement home. I don’t know if she carried through with this thought, but if someone does, what would the death certificate show as the cause of death? I don’t think it would show ‘Covid-19’ as either the immediate or the underlying cause.
While I am always adamantly in favor of forming my opinions based on data rather than on anecdotes (which this woman’s case is), the uncomfortable fact is that collecting such data is not even on the radar at any level of our government. Reading the story about her, I was left with the painful conclusion that in our officials’ efforts to keep her alive, they had driven her to choose death instead. Recalling the song from the movie Mr. Natwarlal,
‘Arre yeh jeena bhi koi jeena hai, lallu? Haan?’
(Is this life worthy of being called a life, my dear? Is it?)
BABY & BATH WATER
The sum total of all our governments’ bumbling efforts is that in pursuit of their goal of ‘keeping grandma alive’, they have made her life desolate enough to be no longer worth living. Apart from the elderly, other at-risk groups have also seen their welfare (in terms of lives, health and finances) being reduced to ashes. These include:
- the poor,
- those in precarious / low-paying occupations,
- those suffering from mental health issues (including drug dependency) and
- ‘racialized’ communities (Note: I detest the term ‘racialized’, but am using it here for its familiarity value).
How much worthwhile is it to impose these devastating costs on vast numbers of people, and keep grandma in desperate isolation, deprived of human contact (including, crucially, contact with family and even her spouse)? She may be breathing, but she is definitely not living.
Have we lost the plot entirely? I am inclined to believe that we have – or at least the government, its officials and their supporters have.