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Fahad Razak, Arthur Slutsky and David Naylor are physicians and professors in the University of Toronto’s Department of Medicine. Katharine Smart is the president of the Canadian Medical Association; Alika Lafontaine is its president-elect.

We are now more than two years into the pandemic and Canada’s health care systems remain in crisis. Across the country, from British Columbia to the Atlantic provinces, emergency departments are working at reduced capacity. Some have ground to a complete halt. And it is only August – traditionally a slower period for hospitals and an opportunity for health care workers to recover before the typically higher pressures of wintertime.

This unprecedented situation is just the latest pandemic-triggered crisis, with each one having exploited pre-existing vulnerabilities in our health systems.

In the first wave, the long-term care sector experienced devastating viral spread and severe staff shortages. The result? Canada had one of the highest mortality rates among LTC residents of any wealthy country.

In early 2021, thousands of acutely ill patients were transferred between hospitals to balance the load of admissions and ventilator demands. No surprise there: On a per-capita basis, Canada has among the lowest acute-care capacity in the Organisation for Economic Co-operation and Development.

Starting in late 2021, the huge Omicron BA.1 wave resulted in some of the highest vaccine-era death rates among the elderly and other vulnerable groups, along with health care staffing disruptions from personal and family illness. The current Omicron BA.5 wave has only deepened that staffing crisis, with shortages of thousands of health care professionals, unsustainable amounts of overtime, accelerating retirements and worsening burnout. It’s a depressing cycle: Shortages beget burnout, burnout begets staff shortages.

The BA.5 wave has also reinforced a central lesson of the pandemic: Even without a surge of intensive-care unit admissions related to COVID-19, massive disruptions can occur in health care delivery. This is exacerbated by the pent-up demand for services that the pandemic disrupted. In Ontario alone, the estimated health care backlog – from routine checkups and childhood immunizations to diagnostic tests and surgeries – has grown to almost 22 million services.

Health system leaders are rightly racing to find solutions wherever possible, but the problems are long-standing, systemic and daunting. Structural and human-resource challenges decades in the making will take years to address, even under the most optimistic scenarios. In a sustained pandemic, there is little prospect – and no ethical rationale – for attempting the mass importation of health care professionals. Moreover, the infrastructure needs for both acute and long-term care will take years to address. Some temporary shoring up of capacity may be feasible. However, with health care systems dangerously close to the brink, it is utter folly to ignore the reality that this winter may well see new COVID-19 waves, along with the resurgence of seasonal viruses such as influenza. We must double down on simple public health measures that can reduce the burden of respiratory viruses and keep our health care system working, right now.

For example, high-quality masks are a low-burden and effective intervention to slow spread of all seasonal viruses. Masks should be used in indoor public settings wherever broad mingling occurs. Effective and affordable technologies are now available to greatly improve indoor air quality, and must be wisely and widely deployed.

The current limited testing for COVID-19, meanwhile, has left Canadians navigating the pandemic in the dark. In the months ahead, wastewater testing to track community spread should be standardized, intensified and reported transparently. Rapid testing for multiple viruses should also be widely available to monitor individual spread of COVID-19 and other viral pathogens. Particular attention is needed to detect the presence of COVID-19 and seasonal viruses in high-risk settings such as long-term care.

We must also somehow recapture the early magic of Canada’s vaccine rollout to address our now woeful booster-dose rates, and rapidly deploy any new-generation vaccines that offer durable advantages to keep Canadians maximally protected.

Most importantly, leaders must stop minimizing both the consequences of COVID-19 and the problems in the health care system. The first step in crisis management is recognizing the problem. An understandable rise in public frustration, fatigue and discord must be addressed through clear messaging on what needs to be done and, most importantly, why.

Winter is coming. Without clarity and candour on the part of leaders, and without some low-burden and urgent measures to mitigate the spread of multiple viruses in the near future, Canadians face the real prospect of more disruptions to their health care services, and long-term damage from a continued exodus of demoralized health care workers.

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