We all know the disastrous direct effects of COVID-19; as of 2020 June 06 worldwide there were 6,844,705 cases and 398,141 deaths according to www.worldometers.info/coronavirus/. Nevertheless these were only the direct effects of the virus. COVID-19 has affected the world negatively in many other ways, and goal of this entry is to raise awareness of some of the major problems and the extent to which they affect us. Briefly, is our response to COVID-19 worse than the disease? I don’t have the expertise and resources to put a human or monetary price tag on the effect of COVID-19. I hope that a body such as the Parliamentary Budget Office will take this on and publish its findings. Nevertheless, I can describe some of the things that should concern all of us.
Economic downturn: The impact on jobs in this country has been disastrous; we lost approximately 3 million jobs in March and April before receiving a small recovery of about 300,000 in May. It has been said that the total number of hours worked by the labour force has decreased by ~30%. Any long term restriction of our economy will negatively impact all aspects of Canadian life including our health care because all such services require money.
Opioid pandemic: Even before COVID-19 arrived in Canada, we were dealing with a crisis in the abuse of opioids. This has had immeasurable social costs and personal impacts on the families affected. The opioid pandemic has been made worse by our response to COVID-19 because many affected individuals have not accessed safe injection sites and other sources of help. Moreover one would suspect that more people are abusing opioids as a result of the viral pandemic.
Cancer: In the UK, the National Health Service estimated that 24,000 cases of cancer have gone undiagnosed. Due to COVID some 12,750 fewer cancer surgeries have been done, 6,000 fewer chemotherapies have been started and 2,800 fewer radiotherapy treatments have occurred. This surely will result in increased numbers of early deaths in the UK. Undoubtedly a similar situation holds for us; unfortunately I have not found similar data for Canada.
Mental health: COVID-19 per se and our response to it have taken a toll on the mental health of Canadians. Certainly it has decreased the quality of life for virtually everyone in Canada. The stresses imposed might have been as little as the loss of a hug to as much as murder. Various levels of government have estimated that family violence is now 20-30% higher due to the corona virus.
Education: Schools and post-secondary have closed. Some of the coursework has been accomplished using on line technology, thanks to the efforts of conscientious instructors. On the other hand there are huge portions of students’ education that have simply not been addressed. The cost to individuals and the country have not been quantified.
Regular Health Care: A lot of normal health care has gone unattended. This ranges from elective surgeries to vaccinations to normal checkups. One of the major international concerns is the effect of COVID-19 on usual vaccinations to measles and other viruses. The World Health Organization has estimated that 117 million children may not receive measles vaccination due to the way in which COVID-19 has interrupted international vaccination programs. This is of particular interest because the widely used measles-mumps-rubella (MMR) vaccine has been identified for potential protection against SARS-CoV2, through a retrospective analysis.
MMR against COVID-19: Young et al have released their retrospective analysis of observations relating MMR vaccination to possible protection against COVID-19 https://www.medrxiv.org/content/10.1101/2020.04.10.20053207v1.full.pdf
This document has not yet been subjected to peer review and must be appreciated as being preliminary. Briefly, they present three arguments to support the idea that MMR could provide protection against COVID-19. Firstly, the basic science information on the structure of SARS-CoV2 shows analogies with the protein structures of the components of MMR. Accordingly antibodies formed against MMR may have the potential to recognize and thus bind to analogous parts of the SARS-CoV2 virus. This gives me a plausible basic mechanism for their proposal. Secondly, they have reconstructed the time lines of relevant vaccination programs for females and males in Germany, Italy and Spain and compared them to the age profiles of deaths due to COVID-19. The associations are consistent with the idea that these vaccinations provided some protection against COVID-19. For example the ages at which the death rates to COVID-19 start to rise coincide quite well with end of projections for rubella protection in females. It should be noted that males did not receive rubella vaccinations per se but later received MMR, and the death rates for males was higher than females in all three countries. Thirdly, COVID-19 appeared to reinvigorate the formation of antibodies formed against the rubella virus, which implies similarity of antigenic sites of the two viruses. Given that the delivery of an effective vaccine for COVID-19 is still many months away, MMR may be useful in reducing the burden of COVID-19 in the meantime.
The MMR situation seems to be the epitome of irony because vaccination programs are being compromised just as such vaccinations are being touted as possible treatments to mitigate COVID-19.
The Way Forward. Given that the our present response to COVID-19 now seems to be somewhat excessive, I suggest that we open up Canadian society much faster so that the adverse effects described above are at least mitigated. This is in no way a criticism of the direction our leaders have taken through the initial months of this pandemic; the steps they took then were perfectly appropriate for the existing knowledge. But now that so much more is known about the COVID-19 pandemic, we should change our practices to reflect this new knowledge.
We know that the hardest impacted locations have been in nursing homes of large congested cities, particularly Montreal. Therefore we have to protect the residents of these homes. We also know that work places such as meat packing plants have also been hot spots because employees work in close proximity for long periods of time. Accordingly we should ensure that employees have adequate protection including good work space and perhaps more importantly ventilation.
It is also well established that COVID-19 is unevenly distributed across our huge country. As of June 7, there were 7800 deaths in Canada with 4978 in Quebec and 2426 in Ontario. Of the Quebec total Montreal had 3067 deaths, and Ontario's Toronto (city) had 928. With this heterogeneity of disease, our focus should be on Montreal and to a lesser extent the greater Toronto area. The reins on the rest of Canada should be relaxed substantially to reduce the adverse effects of our COVID-19 response to a minimum.
A practice that should be adopted is ensuring vitamin D sufficiency in residents of nursing homes, and front line workers. Given that a specific vaccination against SARS-CoV2 is not imminent, MMR vaccinations for most vulnerable should be considered on a case by case basis.
PS There is a TVO Agenda video addressing this at https://www.youtube.com/watch?v=d9wEYz7jlu4&t=1398s
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