A woman wearing a face mask reads a book on a subway in Madrid, Spain, on Jan. 20.Manu Fernandez/The Associated Press
When the coronavirus pandemic was first declared, Spaniards were ordered to stay home for more than three months. For weeks, they were not allowed outside even for exercise. Children were banned from playgrounds, and the economy virtually stopped.
But officials credited the draconian measures with preventing a full collapse of the health system. Lives were saved, they argued.
Now, almost two years later, Spain is preparing to adopt a different COVID-19 playbook. With one of Europe’s highest vaccination rates and its most pandemic-battered economies, the government is laying the groundwork to treat the next infection surge not as an emergency but an illness that is here to stay. Similar steps are under consideration in neighbouring Portugal and in Britain.
The idea is to move from crisis mode to control mode, approaching the virus in much the same way countries deal with flu or measles. That means accepting that infections will occur and providing extra care for at-risk people and patients with complications.
Spain’s center-left prime minister, Pedro Sánchez, wants the Europe Union to consider similar changes now that the surge of the omicron variant has shown that the disease is becoming less lethal.
“What we are saying is that in the next few months and years, we are going to have to think, without hesitancy and according to what science tells us, how to manage the pandemic with different parameters,” he said Monday.
Sánchez said the changes should not happen before the omicron surge is over, but officials need to start shaping the post-pandemic world now: “We are doing our homework, anticipating scenarios.”
The World Health Organization has said that it’s too early to consider any immediate shift. The organization does not have clearly defined criteria for declaring COVID-19 an endemic disease, but its experts have previously said that it will happen when the virus is more predictable and there are no sustained outbreaks.
“It’s somewhat a subjective judgment because it’s not just about the number of cases. It’s about severity, and it’s about impact,” said Dr. Michael Ryan, the WHO’s emergencies chief.
Speaking at a World Economic Forum panel on Monday, Dr. Anthony Fauci, the top infectious diseases doctor in the U.S., said COVID-19 could not be considered endemic until it drops to “a level that it doesn’t disrupt society.”
The European Centre for Disease Prevention and Control has advised countries to transition to more routine handling of COVID-19 after the acute phase of the pandemic is over. The agency said in a statement that more EU states in addition to Spain will want to adopt “a more long-term, sustainable surveillance approach.”
Just over 80% of Spain’s population has received a double vaccine dose, and authorities are focused on boosting the immunity of adults with third doses.
Vaccine-acquired immunity, coupled with widespread infection, offers a chance to concentrate prevention efforts, testing and illness-tracking resources on moderate to high-risk groups, said Dr. Salvador Trenche, head of the Spanish Society of Family and Community Medicine, which has led the call for a new endemic response.
COVID-19 “must be treated like the rest of illnesses,” Trenche told The Associated Press, adding that “normalized attention” by health professionals would help reduce delays in treatment of problems not related to the coronavirus.
The public also needs to come to terms with the idea that some deaths from COVID-19 ”will be inevitable,” Tranche said.
“We can’t do on the sixth wave what we were doing on the first one: The model needs to change if we want to achieve different results,” he said.
The Spanish Health Ministry said it was too early to share any blueprints being drafted by its experts and advisers, but the agency confirmed that one proposal is to follow an existing model of “sentinel surveillance” currently used in the EU for monitoring influenza.
The strategy has been nicknamed “flu-ization” of COVID-19 by Spanish media, although officials say that the systems for influenza will need to be adapted significantly to the coronavirus.
For now, the discussion about moving to an endemic approach is limited to wealthy nations that can afford to speak about the worst of the pandemic in the past tense. Their access to vaccines and robust public health systems are the envy of the developing world.
It’s also not clear how an endemic strategy would co-exist with the “zero-Covid” approach adopted by China and other Asian countries, and how would that affect international travel.
Many countries overwhelmed by the record number of omicron cases are already giving up on massive testing and cutting quarantine times, especially for workers who show no more than cold-like symptoms. Since the beginning of the year, classes in Spanish schools stop only if major outbreaks occur, not with the first reported case as they used to.
In Portugal, with one of the world’s highest vaccination rates, President Marcelo Rebelo de Sousa declared in a New Year’s speech that the country had “moved into an endemic phase.” But the debate over specific measures petered out as the spread soon accelerated to record levels – almost 44,000 new cases in 24 hours reported Tuesday.
However, hospital admissions and deaths in the vaccinated world are proportionally much lower than in previous surges.
In the United Kingdom, mask-wearing in public places and COVID-19 passports will be dropped on Jan. 26, Prime Minister Boris Johnson announced Wednesday saying that the latest wave had “peaked nationally.”
The requirement for infected people to isolate for five full days remains in place, but Johnson said he will seek to scrap it in coming weeks if the virus data continues to improve. Official statistics put at 95% the share of the British population that has developed antibodies against COVID-19 either from infection or vaccination.
“As COVID becomes endemic, we will need to replace legal requirements with advice and guidance, urging people with the virus to be careful and considerate of others,” Johnson said.
For some other European governments, the idea of normalizing COVID-19 is at odds with their efforts to boost vaccination among reluctant groups.
In Germany, where less than 73% of the population has received two doses and infection rates are hitting new records almost daily, comparisons to Spain or any other country are being rejected.
“We still have too many unvaccinated people, particularly among our older citizens,” Health Ministry spokesman Andreas Deffner said Monday.
Italy is extending its vaccination mandate to all citizens age 50 or older and imposing fines of up to 1,500 euros for unvaccinated people who show up at work. Italians are also required to be fully vaccinated to access public transportation, planes, gyms, hotels and trade fairs.
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EDMONTON – Alberta’s nurses could soon find themselves on the picket line as recent talks with the provincial government failed to secure a new agreement.
David Harrigan, with the United Nurses of Alberta, says last month’s informal mediation meetings were productive, but says the gap between the two sides seems too big to bridge.
The union is seeking 30 per cent pay raises spread over two years while the Alberta government’s offer is 7.5 per cent over four years.
Harrigan says the two sides also find themselves far apart on operational issues.
He says while both sides accept that there are serious problems in terms of staffing levels, they can’t agree on what to do about it.
The province says its hopeful an agreement can still be reached.
This report by The Canadian Press was first published Oct. 3, 2024.
Saskatchewan’s New Democrats are criticizing the Saskatchewan Party’s health-care record as the provincial election campaign enters its third day.
The NDP says the emergency room at Saskatoon’s Royal University Hospital reached 350 per cent capacity on Tuesday night, a situation it blames on the Saskatchewan Party and its leader, Scott Moe.
Nurses are set to rally at noon today at the provincial legislature in Regina, with the Saskatchewan Union of Nurses saying the health system is beset by issues including ER overcrowding, hallway beds and staffing shortages.
NDP Leader Carla Beck is set to hold a media availability at the legislature shortly after.
Moe is scheduled to make an announcement in Prince Albert this morning before visiting small businesses and the local campaign office in Warman.
Election day is Oct. 28.
This report by The Canadian Press was first published Oct. 3, 2024.
TORONTO – A new housing project for those who live on the streets and frequently end up in the emergency room is set to welcome its first residents in Toronto this month, supported by one of the largest hospital networks in Canada.
The University Health Network has partnered with Fred Victor, a non-profit housing organization, to provide 51 permanent homes with health and social supports to homeless people who use its hospitals the most. The hope is that the project will ease pressures on hospitals while also providing stable care for vulnerable individuals.
“What we’re trying to build is this continuum of care out from the hospital where people can be discharged to a safe and stable setting that is their home,” Dr. Andrew Boozary, the executive director of the Gattuso Centre for Social Medicine at UHN, said in an interview.
“The treatment for the homelessness crisis is housing and, beyond housing, there needs to be these health and social supports in place.”
The project, named Dunn House, is officially opening Thursday, with residents expected to move in over the coming weeks and months.
UHN has earmarked all 51 apartments in the building for those who use its hospitals frequently and were willing to move there, Boozary said. The homes are set to help unhoused individuals with complex medical and social needs.
Some people who were set to move in have died before the project’s opening, which highlights the need for such a space, Boozary said.
“We lost a number of people who’ve been coming in and out of the hospital at UHN in hopes of trying to help them move in, but they didn’t live to see this day,” he said.
“But this is the reality of the mortality and morbidity facing people who are unhoused.”
Toronto, like many communities large and small across the country, is dealing with a surge in homelessness, driven in part by the high cost of living, mental health struggles and the opioid addiction crisis.
The city’s shelters are full, with some 12,000 people. There are also several hundred people living on the streets, in parks or in encampments across Toronto.
Boozary will be one of the physicians working in the new space, which was built on a hospital-owned parking lot.
The modular, four-storey building will have fully furnished studio apartments with a kitchenette, living area, bedroom and bathroom. And 15 of the units will be barrier free for those who use mobility devices. There will also be a health clinic inside the building, Boozary said.
The residents will have a variety of community-based supports available in addition to doctors, including psychiatric help, case management support, justice help, harm reduction resources, and prepared meals.
The melding of health and housing is badly needed, said Keith Hambly, CEO of Fred Victor, an organization with experience in shelters and supportive housing.
“I think we all in some ways recognize the vital need of health and housing,” he said.
“Making that absolute link between the two for this particular population was in a way a no-brainer, but also one that is something that should have happened a number of years ago.”
The building will be staffed 24 hours a day, including by those with extensive experience dealing with ingrained trauma.
There is also a large community space for the residents to make of it what they wish. Hambly said they’ll likely have art classes, cooking classes and perhaps pottery classes.
The hospital network and Fred Victor partnered with all three levels of government to get the project done, something that has been in the works for about five years.
The city helped construct the building, the province is providing funding for health care and the federal government provided funds from its rapid housing initiative. United Way is providing food support while Inner City Health Associates will provide doctors and nurses. The Parkdale Queen West Community Health Centre will also be involved.
Boozary and his team have long looked at the number of visits and time spent in emergency rooms and in-patient beds by those who are homeless. The data triggered an idea for him: the hospital must get into the housing game.
At UHN, 100 patients without fixed addresses accounted for 4,309 emergency department visits over the past year, Boozary said. That represents about three per cent of all emergency room visits.
Over a recent six-month period, just one per cent of such patients accounted for 15 per cent of emergency room visits and 32 per cent of all visits to in-patient units.
One patient set to move into the new building had 249 emergency department visits and spent nine total days in hospital over the past year, which accounted for about $120,000 in hospital costs, Boozary said.
Another patient had 156 emergency department visits and spent 260 total days in hospital over the last year, a cost of more than $400,000.
“This is not that people want to be in the emergency department, it is that they have nowhere else to go and they just are sicker,” Boozary said.
Long-term homelessness is bad for health. Life expectancy plummets by half with chronic homelessness, Boozary said.
Rates of cancer and chronic disease are also significantly higher for those without homes compared to the general population, he said.
The housing project should also help the hospital free up beds used by so-called “frequent flyers.”
“You’ll see a real benefit to the individuals that can ensure human dignity and improved health outcomes while also helping it address some of the system pressures that are in place,” Boozary said.
He realizes 51 new homes will not solve the homelessness crisis, but hopes the project becomes a model for other institutions to emulate.
“The hope is that this can provide somewhat of a playbook for other jurisdictions or other partnerships between every level of government, between hospital and community, to try to advance concrete solutions for people,” Boozary said.
This report by The Canadian Press was first published Oct. 3, 2024.
