Toronto infectious disease specialist Allison McGeer has tackled all manner of viruses and bacteria over the years, including SARS in 2003. Yet her favourite story to share when discussing pandemic preparedness has nothing to do with pathogens. Instead, Dr. McGeer likes to tell people about the history of Winnipeg’s Red River Floodway.
Built after the devastating flood of 1950, Manitoba’s worst in nearly a century, which forced 100,000 residents to evacuate and destroyed roughly 10,000 homes, the floodway was a costly and highly unpopular project. Premier Duff Roblin faced vehement opposition and public ridicule for spearheading its $63-million construction.
Yet, derided as it was, the floodway, nicknamed “Duff’s Ditch,” has since paid for itself multiple times over, regulating the amount of water that flows through the city during annual spring thaws and preventing tens of billions of dollars in flood damage to Winnipeg.
“Duff Roblin had to be willing to destroy his career to do that,” said Dr. McGeer, a member of the Emerging and Pandemic Infections Consortium (EPIC) and professor at the University of Toronto’s Temerty Faculty of Medicine.
To Dr. McGeer, this story stands out because leaders and the public aren’t always inclined to go to such lengths to mitigate disasters in the unknown future. But before Canadians move on from worrying about COVID-19, some disaster management experts say taking unpopular and arguably mundane measures now – investing in the social and public health equivalent of “Duff’s Ditch” – can help us prepare for the next infectious disease crisis and avoid making the same mistakes again.
In recent days, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, has said while the world must continue its fight against COVID-19, “we have never been in a better position to end the pandemic.” And U.S. President Joe Biden said, during an interview on 60 Minutes, “the pandemic is over.” Yet the lack of a clear public health strategy, combined with an epidemic of misinformation and a health care system more fragile than ever, leaves us vulnerable to future pandemics – not to mention potential further waves and long-term health repercussions of COVID-19.
“We tend to ignore the actual existence of risk, to ignore the fact that we have to mitigate [disasters] before they become reality,” said Ali Asgary, an associate professor of disaster and emergency management at York University. “This is the big lesson that is hard for us to learn.”
Amid the enthusiasm for returning to a sense of normalcy, societal problems that amplified and were exacerbated by COVID-19 have also largely retreated from the public’s attention. The health gap between affluent and poor Canadians has widened, as deaths and disability among those living in crowded homes have left many with lasting trauma and families without breadwinners. Employees in meat-processing plants and factories, who already faced occupational hazards like exposure to toxic chemicals and injury from dangerous equipment, were subject to massive outbreaks. And in woefully understaffed and underfunded long-term care homes, many succumbed to not only the raging spread of COVID-19, but dehydration and neglect.
Although many have hoped past waves of COVID-19 would provide the impetus for the kind of changes that would make the country more resilient to future disease outbreaks, history suggests otherwise. Social inequalities, discrimination against men who have sex with men and a lack of urgency to address the spread of disease in poorer countries, which all played a role in the HIV/AIDS crisis, have now fuelled the rise of monkeypox. With both viruses, the distribution of medical expertise and prevention tools has been far from even, with patients in poorer countries left behind.
After the 2009 outbreak of H1N1 swine flu, Canada’s stockpile of personal protective equipment and medical supplies went neglected, leaving the country’s health care workers scrambling, with nurses in long-term care homes wearing garbage bags over their uniforms because they lacked proper gowns, when COVID-19 emerged.
Pandemics historically leave little in the way of a lasting imprint on society, said Mark Humphries, a history professor at Wilfrid Laurier University. Even the oft-cited notion that COVID-19 can bring forth mass improvements in indoor air quality, akin to the advent of wide-scale water sanitation systems after the discovery that cholera is water-borne, may be overly ambitious. Dr. Humphries explained after cholera was first linked to water in the 1850s, the illness was not traced to bacteria for another two decades. And it took another several decades before modern water treatment facilities were introduced.
When it comes to pandemics, “people forget about them relatively quickly and they move on. And I think that’s partly what we’re seeing happening here too,” Dr. Humphries said in an interview in July.
After all this time then, have we learned nothing? Not exactly, according to Dr. Asgary. The problem isn’t that we fail to learn from crises, but that we often fail to implement what we learn, he said.
Even though the lessons themselves differ, depending on whether the crisis is a natural disaster or a fast-spreading disease, there are certain patterns that reoccur at the individual level, among organizations, and at a societal level, Dr. Asgary explained.
For starters, individuals often get it wrong when it comes to preparing for emergencies, he said.
How they respond to a crisis varies greatly, some overreacting and some underreacting, depending in part on their own psychological attributes, the influence of what others around them are doing and how frequently they encounter similar events, he said. For example, individuals have had no previous personal experience dealing with a pandemic on the scale of COVID-19 to help them get through it. And some of the behaviours people have adopted over the past couple years, like staying home when sick or keeping up to date with vaccinations, may not stick once they sense the threat has passed.
Some who have felt abandoned by public health officials and governments may feel it is futile to take any personal action, said Etsuko Yasui, an associate professor of applied disaster and emergency studies at Brandon University in Manitoba. This reaction may explain why some racialized people with a history of experiencing discrimination from the health care system have been hesitant to receive vaccines. Or why certain individuals who have felt public health rules infringed on their rights and hurt their livelihoods are vehemently opposed wearing masks and insist COVID-19 is over.
“People who do not want to learn from the past or adopt the remedial approaches are not necessarily skeptics or conspiracists,” she said. Rather, she explained, this may be a response to their experience of vulnerability; “our society did not understand them, rejected them, and let them down.”
Among agencies and organizations tasked with responding to crises, organizational and staffing changes mean institutional knowledge about how to best handle a situation is often lost, Dr. Asgary said.
At a societal scale, the way the political system works is also not conducive to implementing lessons from past crises, Dr. Asgary said. Politicians tend to offer promises or promote expectations “that may not really align with the reality of the risk of the situation,” he said. Meanwhile, there may not be continuity in how governments deal with threats of emergencies and disasters. In the context of climate change, for instance, newly-elected political parties often scrap the policies of the previous government and start again from scratch.
Continuity in training and education is also important for passing on information and best practices about how to deal with various threats to new decision makers within organizations and governments, Dr. Asgary said. Whenever a crisis occurs, he explained, people often write up reports or hold talks on “lessons learned,” but fail to implement them and transfer them systematically and objectively into the training of others.
Even now, countries still lack co-ordination to universally and equitably distribute resources, like vaccines and antiviral drugs. An unwillingness or inability to fight misinformation, cited as one of the major failures during this pandemic in a new Sept. 14 report from the Lancet COVID-19 Commission, persists and threatens the ability to control future outbreaks.
Hubris in scientific solutions continues to lead to a heavy reliance on the development of new treatments and medications, while social and political solutions, like protecting wildlife habitats to prevent viral spillover from animals into humans, fall to the wayside. Meanwhile, underfunding and the problem of having too few staff care for too many in shared living spaces that made long-term care residents vulnerable to the spread of disease and neglect remain unresolved.
Banal and costly but impactful measures may just be the “Duff’s Ditch” that is needed to protect us in the long-term: paid sick days for hourly workers; ventilation upgrades in schools, workplaces and congregate living settings; labour-law changes to make factories and meat-processing plants safer; support for burned-out health care workers; alternative models to long-term care and structural changes in how governments and organizations prevent crises.
The recovery phase of a crisis is an important time for figuring out what went right and what went wrong. But unlike in a flood or earthquake, where the damage is physical, much of the struggles and suffering people have been experiencing during the pandemic has been internal, and therefore a lot of the damage is intangible, Dr. Yasui said.
This makes it harder to perceive as a threat than other types of disasters, and its damages and social costs are less obvious, she said.
Thus, as the country now looks toward rebounding, Dr. Yasui suggests it’s important to listen to and take stock of the impact it has had on those who have been, and continue to be, most greatly affected.
“The reality is that we feel urged to fix the damage and get back on to be productive and successful again,” she said. But, first, she advised, a moment of reflection. “If we don’t spend the time to look at what happened and how we can avoid repeating the same mistakes, we will not learn the lessons.”