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Toronto: Impact of civic walkout of public health workers

Shiloh

Editor, Senior Moderator
At this point, residents are more concerned about the growing piles of garbage in their yards and on the streets rather than the impacts on A/H1N1 preparation...

Source: http://www.thestar.com/news/gta/article/668321

H1N1 crisis: Impact of civic walkout
TheStar.com | GTA | Flu expert: 'More will die' if strike drags on
Flu expert: 'More will die' if strike drags on
TONY BOCK/TORONTO STAR
Dr. Allison McGeer, head of infection control at Mount Sinai, says the public health department can only do limited pandemic planning during a strike.

Instead of picketing, public health staff should be preparing for 2nd wave of swine flu

Jul 18, 2009 04:30 AM

Theresa Boyle
HEALTH REPORTER

Toronto will see more deaths from the global H1N1 pandemic because of the civic workers' strike, warns the head of infection control at Mount Sinai Hospital.

"The bottom line is more people will die," microbiologist Dr. Allison McGeer, a respected authority on pandemic planning who has consulted for all three levels of government on the issue, said yesterday.

On the picket line are as many as 1,800 unionized employees from the Toronto Public Health Unit, which is supposed to be playing a critical role in the battle against the H1N1 influenza virus, particularly in planning for the second wave, which is feared to hit North America in September with a vengeance.

"We are already in trouble. Now we've got 26 days of work that hasn't been done," McGeer said.


Instead of being on the picket line, public health nurses, doctors, epidemiologists and other health unit staff should be providing pandemic management advice to school boards, long-term care facilities, jails, the Toronto Police Service, Toronto Fire Services and other essential services, she said.

They should be tracking the spread and severity of the virus, following up on cases where people have tested positive, and making plans for the establishment of vaccination clinics and flu assessment centres.

They should be organizing ways to help the homeless, shelter residents and people who don't have family doctors. And they should be ensuring that plans are in place to quickly communicate updated pandemic response instructions to the general public and to health-care providers.

"We are expecting them to have spent the summer doing this. ... They are the experts in pandemic planning," McGeer said.

"None of those things are getting done and the longer the strike goes on, the less likely they are going to get done," she warned.

But Toronto's medical officer of health, Dr. David McKeown, insists the strike has had no bearing on the city's response.

"Planning for a pandemic in the context of the current H1N1 outbreak is something we identified as a critical service to be maintained during the strike, so non-union staff have been continuing with our planning efforts," McKeown said last night.

Asked if the same level of service is currently being provided as would have been provided were there no strike, he responded: "I think we're doing what we need to be doing at this point."


McGeer said managers are doing their best, but it's impossible to fill the vacuum.

As for front-line workers, she said: "I'm sure that the people who are out on strike are really unhappy about recognizing that they can't be doing what they know needs to be done."

Privately, senior officials at the city who are not on strike have agreed with McGeer's assessment, expressing concern about the fall when a second wave of H1N1 is expected to hit. Managers are getting burned out, they say.

The health unit is now staffed by about 200 non-union employees and managers. They are also contending with health issues arising from piling-up garbage.


Sources say restaurant inspections are being done only on a complaint basis.

Ontario's pandemic plan calls for the province's 36 public health units to play a central role in containing spread of the virus and minimizing illness.

With Toronto's health unit hobbled by the strike, not only will the city see more deaths, but there will also be more infections and hospitalizations, McGeer said.

"The whole goal of the (pandemic) plan is that fewer people die. It's very simple," she said.

Public health should be declared an essential service, like police and fire, so that employees are not able to strike, McGeer argued.


"I really struggle with our Toronto Public Health not being an essential service," she said.

Her comments come days after the World Health Organization warned that the virus is spreading faster than any other pandemic in history, that production of a vaccine has been delayed and that one may not be ready until the end of the year.

Of all the province's public health units, Toronto's has by far seen the most H1N1 activity. Latest numbers show that there have been six related deaths and 85 hospitalizations.

What the second wave of the pandemic will bring is still a big question mark. At the very least, it's expected to surpass the impact of regular seasonal flu, which has a role in 50 to 70 deaths in Toronto annually.


But there is a fear it could mimic the 1918 Spanish flu, which infected one-third of the world and contributed to the deaths of more than 50 million.

McGeer said the public health unit was already behind the eight ball before the strike.

Public health, in general, is woefully underfunded and under-resourced, she said, noting that the H1N1 outbreak was a challenge to deal with even with the full complement of staff.


"In terms of pandemic planning, it's causing a terrible problem because we know that the amount of pandemic planning that the Toronto Public Health Department can do when it's on strike is very, very limited," McGeer said.

She pointed out that five royal commissions in the past 12 years have warned that public health is substantially underfunded.

"When I have been part of stakeholder groups and focus groups about what our goals should be for a pandemic and what we are aiming to do in Canada ... Canadians tend to talk about being sure that we have protected the most vulnerable people.

"That we can have that sense as a society and not fund pubic health is a complete mystery to me," she said.
 
Re: Toronto: Impact of civic walkout od public health workers

Re: Toronto: Impact of civic walkout od public health workers

I would think that public health workers would have a higher moral obligation to set aside employment disputes during a time of crisis.
 
Re: Toronto: Impact of civic walkout of public health workers

Source: http://www.torontosun.com/comment/columnists/lorrie_goldstein/2009/07/26/10264236-sun.html

H1N1 virus could be our Katrina

Toronto is woefully unprepared to handle a major swine flu outbreak

By LORRIE GOLDSTEIN, TORONTO SUN

Last Updated: 26th July 2009, 3:39am

If you want to know whether Toronto is prepared for the resurgence of the swine flu (H1N1) pandemic this fall, think of New Orleans just before Hurricane Katrina hit.

On the one hand, maybe we'll be luckier than New Orleans. Maybe we won't sustain a direct hit.

Maybe this fast-moving virus will remain in its current, relatively non-lethal form -- although, make no mistake, a bad flu is nothing like a bad cold. It's much worse. If you get it, you'll know it.

Maybe the H1N1 vaccine, whose development is taking longer than predicted, will be ready in quantities sufficient to cope.

Maybe there'll be enough Tamiflu (a treatment, not a vaccine). Maybe there'll be some way of distributing it in the first 48 hours to people showing flu symptoms, because after that, it's not effective.

Maybe the train wreck that is our lack of preparation for the resurgence of H1N1, partly caused by the strike of Toronto civic workers, which has virtually shut down the city's public health unit -- won't turn out to be important.

Maybe, as some predict, we'll soon all be chuckling about how we panicked over nothing. Maybe.

But maybe not. Maybe H1N1 will morph into something like the Spanish Flu, a global killer of tens of millions of people 90 years ago. Odds are it won't happen. But it could. And if it does, we're not ready. Not by a long shot.

Even if we dodge this bullet, as New Orleans dodged decades of direct hurricane hits until Katrina -- while experts knew all along the city's levees weren't capable of protecting the public -- maybe we'll fool ourselves into thinking everything's okay. Like they did in New Orleans. Until it was too late.

Because things aren't okay. Not when Dr. Allison McGeer, head of infection control at Mount Sinai Hospital, says more people will die of H1N1 because of the civic workers' strike, which has gutted the city's public health unit, which by now should be fully engaged in preparing for the resurgence of H1N1 in September.

That warning from McGeer, who, along with Dr. Donald Low, also at Mount Sinai, were the experts the media relied upon during the SARS crisis because of their knowledge, honesty and integrity, included another frightening observation.

McGeer told the Toronto Star our governments have ignored five warnings from royal commissions that public health is woefully underfunded, even in normal times.

JUST THE BEGINNING

But that's just the start. Coping with a pandemic isn't about how many pages there are in the health ministry's emergency response plan.

It's about how many doctors and nurses can actually respond, the capacity of hospitals to absorb a higher-than-usual number of patients, the number of intestive care rooms and respirators available for treatment.

Make no mistake. Our medical professionals will do the best job they can under the circumstances.

But any claim Toronto, or Ontario, is prepared for a serious flu pandemic, when hundreds of thousands of people can't even find a family doctor because of a politically and deliberately engineered physician shortage that was supposed to "save money" a generation ago, is absurd.

Not when our ambulance service and hospital emergency rooms and wards are overflowing with patients even in normal times.

Not when Ontario's health ministry has told doctors that, except in hospitals and for high-risk cases, they shouldn't test their patients for H1N1 because "laboratory testing is not recommended to determine if treatment with antivirals is indicated" and "treatment decisions should be based on clinical features only."

That's like telling a physician water's wet. Doctors always treat for flu based on the patient's symptoms, because by the time they get the lab results, it's too late to do any good.

KEEPING TRACK

But the reason a doctor will test for H1N1 is, first, it's helpful for the patient to know once they've recovered whether they had it -- say, for a mother with a respiratory-compromised child at home, who now knows she's immune. Second, it helps track the progress of the disease in the population, so health authorities can prepare and respond appropriately. Assuming anyone's preparing.

Instead, doctors have been scolded for ordering too many H1N1 tests compared to other provinces, meaningless since Ontario has the largest population of any province. The relevant figure is the ratio of tests to population, not the number of tests.

All this sounds like the actions of a government that knows it doesn't have the resources to deal with a serious flu pandemic and doesn't want to know how bad things could get.

Finally, remember those headlines about how Premier Dalton McGuinty's government (and the Conservatives before that) wasted hundred of millions of dollars on a botched plan to introduce eHealth computer records for patients?

Well, this is what happens when money earmarked for health care is spent irresponsibly as opposed to wisely and effectively.

More people die.

LORRIE.GOLDSTEIN@SUNMEDIA.CA
 
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