We’ve been living with restrictions caused by the COVID-19 pandemic for over two months now. I recently lost a patient due to COVID-19, and this loss caused me to reflect on the effects of the disease, and it’s impact on society. There really is only one word to describe it.
This disease is unrelentingly, unwaveringly and inexorably cruel.
This has nothing to do with the actual pathology (the conditions and processes) of the disease. That in itself, is in line with a bad viral illness. You (mostly likely) get a fever,cough muscle aches, etc. In people who are predisposed (elderly, those with immune compromise) COVID-19 is more likely to get into the lungs and cause inflammation. There is, of course a much higher rate of death for those who have multiple other medical conditions.
Doctors have seen viral illnesses throughout the years, and this pattern of the weakest among us been more adversely affected is one that we are all aware of. Indeed, my patient was elderly and had a number of medical problems. Truth be told, it would not have been unexpected for my patient to have died anyway from any of the other conditions they had. While tragic and sad, the fact that COVID-19 took them when infected, is no real surprise.
Instead, however, the cruelty of this disease is manifested in how my patient, and the grieving family spent the last days. My patient was in hospital, isolated, and alone. No family could visit. No comfort in their last days and no ability for the family to say goodbye, which I know will haunt them for a long time to come.
But it is not just the patients with COVID-19 who are dealt this cruel fate at the end of their lives. Another patient recently died in hospital due heart disease and was COVID-19 negative. Didn’t matter, the new restrictions in place to increase physical distancing and reduce spread (all of which make sense on a population level), meant that they too, died alone, with no contact from family, and the grief of not saying goodbye will haunt their loved ones as well.
This doesn’t apply just to hospitals either. The local hospice (my community is fortunate to have one of these) has new, stringent guidelines in place for their palliative patients. Only one visitor per patient at a time. A maximum of two people allowed to visit at all (what happens if you have more than two children who want to say goodbye). Common area not to be used, so no sharing your grief with other families (which is often therapeutic).
Yes, I know, communication via online tools and phone is encouraged. But we humans are social creatures. We need to see each other in person. We need to hold hands. We need to hug each other. We need physical contact. Yet we can’t have it. Of course, this is necessary and appropriate. But that doesn’t make them any less cruel.
The further medical victims of COVID-19 are of course, the patients whose care has been delayed while waiting for the acute stage of the pandemic to pass. My patient who has a growth on her ovary, and has not been able to get a repeat scan (and worries daily about what it could be). My patient with chronic hip pain who was already waiting for 12 months for their hip replacement surgery before it got cancelled since it was “elective”. Numerous patients with cancer who have had their treatments delayed. The 35 (minimum) whom the Health Minister herself said may have died due to the care that was delayed by this pandemic.
Then of course, there are economic victims. The 44% (!!) of Canadians who lost work due to the pandemic. They now struggle with finding ways to pay the bills and provide shelter and food for themselves and their families. The toll as they struggle is heartbreaking.
We are also seeing an increase in domestic abuse, more people with alcohol and drug problems relapsing, and warnings of Post Traumatic Stress Disorder in physicians and allied health care workers who treat patients with COVID-19.
All of the above are victims of the cruelty perpetuated by COVID-19.
But in all that, there is, to my mind, hope.
There has also been this year an explosion of gentleness, kindness and decency amongst Canadians. Whether it is a grass roots group like ConquerCovid19 (which has, to my mind saved an untold number of lives and reduced morbidity), or simple acts of gratitude like shining a light for doctors, these acts make a difference. Whether you provide PPEs, or grocery runs, or other support to health workers, you are making a difference. Whether you call your friend to check on them after they have lost their loved one, or check on isolated seniors, you will make a difference. Whether you sing songs like these students or these doctors, you will make a difference (seriously, click the links, those songs are great).
Or if you are the unknown (to me) person who left this on the front lawn of my office building…
… you made a difference.
“Gentleness is the antidote for cruelty.” – Phaedrus
Indeed, while it seems that COVID19 is inexorably cruel, the gentleness and kindness that has been exhibited by so many people proves that we will get through it, and we will succeed. It will not be easy. And we will need more kindness and gentleness than we thought possible, but we can do it.
“Human kindness has never weakened the stamina nor softened the fibre of a free people. A nation does not have to be cruel to be tough.” Franklin D. Roosevelt.
Canadians have shown COVID19 what we are made of this year. We have shown it that its cruelty is no match for our kindness. We have shown it that we will beat it and all it’s complications, though it will take time and continued effort.
So continue to be good to one another. And together, we will win.
6 thoughts on “The Cruelty of COVID-19”
Thank you Sohail for your work, and your eloquent writing.
Thanks for the great post Sohail. Cruel really does sum it up.
I do feel a need to defend the stringent visitor policies for hospices you alluded too.
Most people are not familiar with how hospices are run.
Hospices are built and run using donated funds. While each hospice gets some govenment funding, it is estimated that most hospices still need to fundraise ~50% of their operating budget. As such many rely on volunteers for services such as housekeeping, meal prep, landscaping, reception, vigils, etc.
When COVID hit, fundraising dried up over night and volunteers either needed to stay home due to risk (age or medical conditions) or fear of the novel virus. Hospices have no idea when they will run fundraising events again or will be able to welcome their volunteers back. It is unclear what fundraising will look like with record levels of unemployment in the months/years to come.
The additional costs of PPE falls squarely on the hospice organization. My hospice has 19 N95 masks (one more than 18, one less than 20). None fit our physicians and they fit less than half our nurses. While we eventually got adequate amounts of gloves and surgical masks, we had to resort to sewing cloth gowns since none were available in our LHIN, reusable or disposable.
When COVID hit, there were no additional funds provided for hospices. No emergency funds, no directives to redeploy staff to hospices. Hospice would have been completely invisible if not for the great advocacy of Rick Firth and HPCO. Our organization relied on voluntary layoffs and internal redeployment of staff just to keep the lights on and keep patients cared for.
Hospices needed to restrict visitors due the fact that they could not guarantee the safety of patients, families and staff without proper funding and adequate PPE. Just one case of COVID would have drained a hospice of most of their stock and anticipated use of PPE. Hospices faced the same challenges as hospitals and LTC with none of the same resources.
Most hospices had to restrict to one essential visitor out of sheer necessity. The policy allows for additional visitors at EOL but still cannot contravene the provincial directive prohibiting gatherings greater than five.
Hospice have leveraged technology (virtual visitation) and made use of window and patio visits whenever possible. Hospices regularly take pressure off acute care services by reducing EOLC in hospitals. Most hospices are supported by community-based programs that also manage patients in their home, also relieving stress on hospitals. Hospices are now slowly relaxing their restrictions but one single case of COVID in either a patient or staff would be considered an outbreak and lead to a prohibition on admissions until the outbreak was cleared. For a hospice to shut down, it would mean greater numbers of patients dying in acute care or at home. While many patients request home palliation, hospices provide a backstop for burnt out families and caregivers. Losing that option would be devastating.
I agree with you one hundred percent. COVID has forced us all to make cruel choices that we would never otherwise make. I am thankful we never had to implement a provincial triage process for the allocation of ventilators and ICU beds.
At least, not yet anyways. The choice to restrict visitors to hospices, however, could have been be mitigated proavtively by appropriately funding these organizations appropriately (decreased reliance on fundraising) and adequate access to PPE for all staff and visitors/family.
Thanks for another emotional and thought provoking post Sohail.
Hey – I agree with you on this Darren. Hospices had no choice – I even mentioned that as being necessary – although I didn’t have time to outline all the reasons that you eloquently state above. We need hospices open and they provide great care. It’s just awful they are put into the position they are in to have to restrict visitors they way they are (which is necessary)
Just venting 🙂
Thank you for all you do and all you are enduring through this cruel pandemic.
As two of your at risk patients we appreciate all that you are doing more than words can say. Kindness and understanding are hallmarks of your care for your patients.
We are honoured to call you not just our Family Doctor but also our friend.
Stay safe. Stay well. Bless You
Cynthia and Gord Culbert