THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 3: Pandemic

Medical professionals conscripted

    Hospitals suffered high attrition rates during the Pandemic for a number of reasons. Sometimes, healthcare providers got sick. Sometimes, they couldn’t take the stress and needed a break. Sometimes, they simply walked off the job.
    The day after Mountain View General Hospital instituted quarantine measures, for example, four percent of its workforce did not show up the next day. More than 80 people simply stayed home——about 20 among the clinical staff, about 60 among the non-clinical staff such as clerical workers and computer technicians.(43)
    Simply put, they didn’t want to catch the flu, but more importantly, in many cases, they didn’t want their families to get it from them.
    Every such loss hurt the health system, even attrition among non-clinical staff. While receptionists and computer technicians played no direct role in saving lives, they performed critical functions during the Pandemic, such as helping the hospital to communicate with the public. Later, they would be trained to help with meals, move patients for treatment, and provide child and pet care for clinical staff members.
    An exception: pregnant women. Avian Flu inflicted a higher mortality rate in pregnant women and also presented an increased risk of miscarriage, premature birth and stillbirth. As a result, pregnant healthcare providers were transferred to duties involving giving flu and homecare advice over the phone.(44)
    Every day, the hospital lost a few more people. They cracked under stress and exhaustion, or stayed home to care for children or a sick family member.
    Sometimes, they got sick themselves because of stress and lack of sleep: common colds, seasonal flu, bronchitis and, occasionally, H5N1.
    New recruits entered the hospital workforce——retirees, Health Link nurses, students, volunteers——but many of the volunteers didn’t last long and consumed resources for their training. By the end of the Pandemic, Mountain View would lose about one-third of its clinical staff and most of its supplies, barely functioning as a hospital.
    In the beginning, people had a right to quit and walk off the job regardless of how valuable their job was. It was their legal choice. But the flu changed that, just as it changed everything. Soon, refusal to work would be against the law. The government saw to that.

    The Public Health Act granted still more important powers to medical officers to help it fight the epidemic. They would use these new powers to seize private property for public use and conscript workers.
    Once the public health emergency had been declared, the public health system received the power to acquire or use real or personal property. For example, when the Calgary RHA needed space to house volunteer workers, they simply took over a downtown hotel. The owner would be reasonably compensated in accordance with the law, but could not refuse or set their own price. If the owner didn’t like the compensation, they could dispute it. As of the time of writing of this book, there are 256 such cases in arbitration in Canada. For example, the Capital RHA, which covers Edmonton, seized a fleet of refrigerator trucks from a freight company. At the time, the mortuaries had filled to overflowing, and the RHA needed the trucks to store corpses until they could be buried. The company wanted to charge the RHA more than the RHA thought reasonable, so the case is now in arbitration. The outcomes of these cases are critically important as they may determine government’s ability to respond to future epidemics.
    The public health system also received the power to require any qualified person to render aid that the person was qualified to give, and to conscript workers for any needed services. This mostly applied to healthcare workers, first responders, firefighters and policemen——anybody labeled an essential worker. Some of them had walked off the job. Now the government said: If you aren’t sick, you have to work.
    Government not only compelled people to continue doing the jobs they already had, but also conscripted students, retirees and anybody else with medical expertise or training that would be needed during the crisis. Licenses got pushed through for those who lacked them but had some training. At the time of the Pandemic, more than three million people lived in Alberta, of which one-fourth of them, or about 750,000, became clinically ill; 7,500 doctors and 35,000 nurses were there to care for them, a workforce that steadily dwindled over time due to its own casualties. Similarly, some 600,000 healthcare professionals would have to address 7.9 million clinically ill across Canada, half of them needing hospital care. The numbers of the sick ended up far exceeding the capacity of the health system, and so the system needed more people, space, equipment and supplies to treat the growing tide of infected.
    Meanwhile, the workforce of other essential services—garbage pickup, water treatment, electric utilities, food distribution——suffered an attrition rate of about 25 percent over the course of the epidemic, causing significant disruptions.(45) Sometimes, cities would lose power and water for hours. Cities became snarled, with some neighborhoods shutting down entirely for days at a time due to a slower pace of snow removal, which actually acted positively to reduce the spread of disease. Rat populations became a problem in larger cities where trash accumulated without removal. Government conscripted any workers with needed skills to beef up these basic services.
    Not that the workers always minded, even if they preferred to have a choice. During the Pandemic, civic organizations and charities throughout Canada received more volunteer applications than they could even process. The Canadian Red Cross, for example, saw donations skyrocket; as increasing numbers of non-severe cases were turned away from hospitals later in the epidemic, Red Cross volunteers accepted assignments to enter communities and provide homecare to families that needed help.(46) A pizzeria in Ottawa began delivering free hot food to first responders. A dry-cleaning service in Halifax offered free laundry services for healthcare workers. People opened their homes for daycare for children and pets of healthcare workers. Teachers began taping lessons for children, which TV stations aired as a supplement to daytime programming. Civic groups, quietly providing some services during the first weeks of the epidemic, were given more responsibility, and were recognized by the government. People agreed to look after each other’s children, bartered foodstuffs and household items such as light bulbs and batteries, took in elderly neighbors who needed assistance, traded books and games to keep their kids occupied.
    The list is endless, and proved that a major crisis brings out both the best and worst in people.
    But not everybody volunteered, particularly for dangerous work with a high level of exposure of infection. Many left their jobs for a variety of reasons.
    In response, the health regions started a medical draft.