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The Peter Lougheed Centre hospital in Calgary on April 9, 2020. The Canadian Medical Association is calling for circuit-breaker lockdowns in Alberta and Saskatchewan to protect 'crumbling' health-care systems.Jeff McIntosh/The Canadian Press

Alberta is now confronting what Ontario and Quebec faced in earlier waves of the COVID-19 pandemic as doctors warn of soon being forced to choose which patients get life-saving care at the province’s overburdened hospitals.

Nothing strikes fear into the hearts of Canadians more than the prospect of triage protocols being implemented in the country’s intensive care units. We have long been lulled into assuming that, despite its numerous shortcomings, our public health care system will be there when we need it. The pandemic has challenged that assumption in bone-chilling ways.

“Albertans’ hospital system, especially ICUs are under more killing stress than at any time in the province’s history,” the province’s former chief medical officer of health, James Talbot, and critical care specialist, Noel Gibney, wrote in a weekend letter asking Premier Jason Kenney to reinstate stricter public health measures to slow the rate of COVID-19 transmission.

The head of emergency medicine for the Alberta Medical Association, Paul Parks, warned last week that a form of triage was already being implemented in some of the province’s hospitals. Alberta Health Services insisted that all patients in need of mechanical ventilation were receiving it. But it acknowledged that overwhelmed hospitals were “operating at a reduced standard of care” with more than 1,000 COVID-19 patients overall, including more than 250 in ICUs.

Thousands of Albertans have seen treatments or surgeries postponed as hospitals scramble to free up staff to deal with the onslaught of COVID-19 patients. A similar situation exists in Ontario and Quebec, which also postponed thousands of surgeries and diagnostic tests during earlier waves of the pandemic. The backlog will take years to clear, leaving our already under-resourced health care system playing an endless game of catch up that threatens the quality and quantity of care Canadians expect and deserve.

Our health care system was under severe strain before the pandemic. COVID-19 has exacerbated its multiple problems and added a slew of new ones to the pile. Provincial governments eliminated thousands of acute care and ICU hospital beds after Ottawa slashed health care transfers to the provinces in the 1990s. Many provinces cut capital spending on health care infrastructure, including hospitals, after the 2008 recession and never restored it.

The consequences of those moves came home to roost when the pandemic struck. While this country has experienced milder waves of COVID-19 than most other developed countries, our hospitals – first in Quebec, then in Ontario, and now in Alberta – have come closer to reaching the breaking the point with proportionally far fewer COVID-19 patients than elsewhere.

As CIBC economists Benjamin Tal and Andrew Grantham point out in a new study, COVID-related hospitalizations per one million of the population were four times higher in the United States, and five times higher in Britain, than in Canada in early 2021. “Yet, as we all surely recall, the hospital system in Canada during the second wave was at its wits’ end,” they write. “Simply put, we reached capacity at levels that many other countries consider to be acceptable.”

Even now in Alberta, which has become the poster province for how not to manage a deadly pandemic, COVID-19 hospitalizations remain far below the peaks reached in most other developed countries when controlling for population size. And yet, doctors warn that the province’s hospitals are on the verge of collapse and wave the t-word before a frightened populace.

No one is suggesting that Canada should emulate some U.S. states in their willingness to tolerate much higher COVID-19 hospitalizations and deaths just to keep their economies open and avoid the wrath of citizens opposed to public-health restrictions. But the inability of our health care system to handle the comparatively milder waves of COVID-19 that Canada has experienced until now begs the question of what might happen if a more transmissible variant of the coronavirus emerges in coming months, or another pandemic hits us in coming years.

“If hospitalization rates are the main factor influencing COVID-related government policy, then a lower health capacity threshold means quicker and longer [public-health] restrictions, resulting in a lower rate of economic growth,” Mr. Tal and Mr. Grantham note.

Canada is paying the price for having both underinvested in its health care system and poorly allocating resources within that system. More money alone will not fix what successive cohorts of health care bureaucrats have mucked up. But the $6-billion the federal Liberals have pledged to help provinces reduce surgery backlogs, on top of the $3.2-billion promised to help hire 7,500 doctors and nurses, amounts to a rounding error in a public system that cost $185-billion to run in 2019 – before almost anyone outside China had even heard of COVID-19.

The country needs an honest discussion about what kind of public health care system it wants – the rickety one we have, or the robust one we could have – and how much it is willing to pay for it. Ideally, that should happen before the next pandemic strikes.

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