H5N1

New findings on pandemic kids. And what they really tell us

The Tyee has published my article: New Findings on Pandemic Kids. And What They Really Tell Us. Excerpt:

A new report by Children First Canada takes a long and detailed look at the state of our kids in this second year of pandemic. Even if you don’t have children, but hope for a decent and dignified old age, you’d better take note the findings of Raising Canada 2021 — and take appropriate action in this and future elections. 

The report finds that COVID-19 has aggravated ten major threats to our children. Those threats have been still more aggravated by “cross-cutting themes”: access to education and child care, access to health care and social services, inequity and inequality, and climate change. 

The report points to a host of threats to children that are also threats to us all. And those threats are unlikely to be blunted short of the kind of social transformation we usually call a revolution. 

Let’s look at the threats first. Some are simply intensified forms of the pre-pandemic status quo. Kids are coming into emergency departments with opioid and other poisonings, and cannabis ingestions. Their parents’ attempts to cope with stress don’t work with the kids either. 

Pre-pandemic Canada was stressful enough, but the report finds that “the effects of school closures have accelerated this threat,” leading to more eating disorders, substance misuse and suicide attempts among adolescents.

Systemic racism and discrimination stress racialized families, and the pandemic has only stressed them more. So it should be no surprise that “status First Nations, Métis, Inuit and Black children are disproportionately overrepresented in the child welfare system.” 

So stressed parents with no support are taking it out on their kids: “In some jurisdictions, clinicians have seen twice as many infants for maltreatment-related concerns, specifically fractures and head trauma.” 

More work for the health-care system 

Meanwhile, even less-stressed parents have skipped routine childhood vaccinations, ensuring more work for our health-care system when kids start coming down with measles and other preventable diseases. While many Canadian and U.S. states try to vaccinate their kids from age 12 and up, the report says, for those under 12 “vaccines may not be available until 2022.” Cuba is already testing its homegrown vaccines on kids as young as three. 

The pandemic has worsened childhood poverty, notably in a third of female lone-parent families, and “households with children are more likely to face food insecurity compared to households without children.” In other words, kids aren’t getting enough to eat. We are “ranked 37th out of 41 countries when it comes to providing healthy food for children.” Failing to nourish our children today will have consequences for the rest of the century. 

Well, not for those who die in infancy. The report says, “Canada’s infant mortality rate has increased. It is now the second highest among 17 OECD countries, at approximately 4.4 infant deaths per 1,000 live births. This is a marked change from 1960, when Canada ranked fifth lowest.”

Violence against health care: Attacks during a pandemic

An interactive report from the UC Berkeley Human Rights Center and Insecurity Insight: Violence Against Health Care: Attacks During a Pandemic. Excerpt:

Atlas of Attacks 

While health care workers worldwide have been lauded as heroes for providing much-needed medical services to fight COVID-19, countless others have faced attacks directly related to their essential work. 

In the midst of a global pandemic, attacks on health workers and services further exacerbate fragile health care systems, highlight weaknesses in resources and equipment, and deprive citizens of basic rights to health, medicine, and protection under international human rights and humanitarian law. 

The UC Berkeley Human Rights Center and Insecurity Insight documented more than 1,100 attacks and threats of violence against health care, including medical personnel, patients, health care facilities, and transport. Some 400 of these attacks appear to be specifically COVID-19 related. 

The Atlas of Attacks maps each report of a violent attack or reported threat of violence against health care, which may include attacks on people or health facilities. Where multiple events are reported, these events will be displayed on the map in clusters, with the number of unique events displayed.

Health care attacks during a pandemic 

Attacks on health care have become more apparent in the midst of the pandemic and impeded the response to COVID-19 in numerous countries. Health workers caring for the infected or sick have been subjected to individual and collective assaults as well as coercion and punishment by security forces for speaking up about their or their patients’ needs. 

While attacks on health care have been prominent in conflict settings, the COVID-19 pandemic has thrown into stark relief the risks health workers face from both the virus and public violence as communities grow fearful, angry, and frustrated. Moreover, health workers have suffered psychologically as a result of these constant threats while having to deal with the trauma of watching patients die.

COVID-19: A heavy toll on health-care workers

An important comment in The Lancet Respiratory Medicine: COVID-19: a heavy toll on health-care workers. Excerpt:

Health-care workers are known to be at risk for anxiety, depression, burnout, insomnia, moral distress, and post-traumatic stress disorder. Under usual working conditions, severe burnout syndrome affects as many as 33% of critical care nurses and up to 45% of critical care physicians. Extrinsic organisational risk factors—including increased work demands and little control over the work environment—and the trauma of caring for patients who are critically ill have been heightened by the COVID-19 pandemic and represent important exacerbating factors for poor mental health among health-care workers. 

Following the outbreak of severe acute respiratory syndrome in 2003, health-care workers reported chronic stress effects for months to years. Among health-care workers treating patients with COVID-19, a Chinese study reported high rates of depression (50%), anxiety (45%), insomnia (34%), and distress (72%). These findings were supported by a systematic review of 13 studies including more than 33 000 participants. 

Studies from Italy and France reported a high prevalence of depressive symptoms, post-traumatic stress disorder, and burnout; risk factors for adverse psychological outcomes included younger age, female sex, being a nurse, and working directly with patients with COVID-19. The long-term effect on the health of those working in health care remains to be seen. 

The COVID-19 pandemic is a stark reminder of racial and socioeconomic disparities, with disproportionate infection and death rates among migrants, the poor, and racialised groups. COVID-19 has also had a disproportionate effect on women health-care workers. Women comprise 70% of the global health and social care workforce, putting them at risk of infection and the range of physical and mental health problems associated with their role as health professionals and carers in the context of a pandemic. The pandemic exacerbated gender inequities in formal and informal work, and in the distribution of home responsibilities, and increased the risk of unemployment and domestic violence. 

While trying to fulfil their professional responsibilities, women had to meet their families' needs, including childcare, home schooling, care for older people, and home care. Burdened by these obligations, women had reduced academic productivity relative to men, as evidenced by fewer women being part of the cohort producing new knowledge about the pandemic. There was a disconnect between the demands of parenting and the expectations of the scientific community, as shown by ultra-short timelines for COVID-19-related grant proposals, which further deepened the divide between women and men. 

During the pandemic, there have been glimmers of hope and solace. We were buoyed by support from institutional and government leadership, the spirit of teamwork, the celebration of lives saved, and the acknowledgement of our value by the public. Social media was a venue for health-care workers to share their anxiety, insomnia, and fatigue, which reduced the sense of isolation and normalised conversations about mental health. 

To effectively support health-care workers—the greatest assets of our health-care systems—we must understand their challenges and needs. Burnout and other forms of work-related psychological distress are unavoidable occupational health issues. By acknowledging the commonality of psychological distress related to caring for patients with COVID-19, we can destigmatise work-related mental health issues and appropriately attend to the mental health needs of all health-care workers affected by the pandemic. 

Finally, we hope that the COVID-19 pandemic will prompt a redefinition of essential support workers, with recognition of the contribution of all health-care workers and appropriate education, protection, and compensation.

COVID-19: Quebec doctor’s death by suicide sends shockwaves through Canada’s medical community

This Global News report makes explicit what the study just below only hints at: mental health issues are as widespread as ever, but it's not being noticed and dealt with. Coronavirus: Quebec doctor’s death by suicide sends shockwaves through Canada’s medical community. Excerpt:

The death of a Granby, Que., emergency physician has sent shockwaves throughout the Canadian medical community.  

Dr. Karine Dion, 35, who was also the mother of a young son, died by suicide earlier in January. Her family said it was the stress of the COVID-19 pandemic that led to her death. 

“Her family and her husband have gone public with this death to let the public know the immense distress that health workers are experiencing on the front lines of this pandemic,” said Dr. Naheed Dosani, a palliative care physician and a health justice activist.

“Throughout this pandemic, our health workers on the front lines, my colleagues, have experienced significant mental stress, losses, trauma, grief, and a burden that is really hard to put in words.”  

The burnout rate of doctors practicing emergency medicine is estimated at around 86 per cent, according to a recent survey by the Canadian Association of Emergency Physicians (CAEP), the national organization representing emergency physicians across the country. 

The same survey found “frontline staff will be adversely affected by COVID-19 both during and after the pandemic.”

Around 14 per cent of those surveyed had contemplated suicide during their staff career in emergency medicine, and of those physicians almost six per cent had actively considered suicide in the past year.  

“We know whenever there’s stress with the added pressure, and the stress becomes prolonged, we feel there is a sense of powerlessness, helplessness. It does increase or can increase the risk for psychological risk conditions, physical risk conditions, and also burnout as well,” explained Dr. Katy Kamkar, a Toronto-based clinical psychologist.  

Dosani said the pandemic has increased the pressure felt by frontline health-care workers exponentially.

UK: ‘We don't have enough nurses to keep all our patients safe,’ says RCN leader

Now, this is frightening. Via The Guardian: ‘We don't have enough nurses to keep all our patients safe,’ says RCN leader. Excerpt:

There are not enough nurses to safely care for patients in the UK, according to the body that oversees the profession, and many of those who are working are suffering from anxiety and burnout after a gruelling nine months treating Covid patients.  

A year after the prime minister pledged during the 2019 election campaign to add 50,000 nurses to the NHS, the Royal College of Nursing has accused Boris Johnson of being “disingenuous” for claiming the government is meeting this 2025 target.  

Johnson claimed last week that the government had “14,800 of the 50,000 nurses already” during prime minister’s questions in the Commons. 

Yet the latest NHS figures show there were 36,655 vacancies for nursing staff in England in September, with the worst shortages affecting mental health care and acute hospitals. Staff in some intensive care units (ICUs) have quit since the pandemic, with those whom the Observer spoke to choosing to work instead in supermarkets or as dog-walkers.  

Dame Donna Kinnair, the RCN’s chief executive and general secretary, said: “The simple, inescapable truth is that we do not have enough nursing staff in the UK to safely care for patients in hospitals, clinics, their own homes or anywhere else.” 

She said that even before the pandemic, “heavy demand” was rising faster than the “modest increases” in staff numbers. Last week the Health Foundation thinktank said there were 5.5% more nurses in English acute hospitals compared with last year, but some of these were nurses who had previously retired or left the profession, and had returned to help during the pandemic. 

The thinktank said that even if the government met its target, 50,000 nurses would not be enough to recover from the pandemic. 

“With tens of thousands of vacancies in the health and care system right now, any suggestion by politicians that a small increase equals success is disingenuous,” Kinnair said. “We know many returned to support the pandemic, and 35% of our members surveyed this year said they were considering leaving the profession.”  

She said the solution was “honesty and investment” from the government.  

With Covid-19 surging in Wales, Northern Ireland and London, many senior NHS leaders around the UK are concerned about the strain on medical staff, who have worked in full PPE and stressful conditions for nine months.

Quebec health system headed for massive burnout in pandemic, expert warns: 'We will not last until Christmas'

Via The Sudbury Star, a Montreal Gazette report: Quebec health system headed for massive burnout in pandemic, expert warns. What Dr. Liu says about Quebec is likely true of every healthcare system in North America—not to mention Europe, Latin America, and South Asia. Excerpt:

As Quebec is poised to declare a tally of more than 100,000 COVID-19 cases over the weekend, the province’s foremost pandemic expert who accurately predicted the second wave would target the regions is now warning of a potential breakdown of the health-care system in the months to come.  

Dr. Joanne Liu, who in her former role as president of Doctors Without Borders led the fight against cholera epidemics in Haiti and Yemen and against Ebola in West Africa, said the sight of nurses blocking bridges this week follows a pattern she has observed in nations struck by chronic health catastrophes. 

“There is something that I call the behaviour of epidemics,” explained Liu, who was appointed last month to an independent panel of the World Health Organization that is evaluating the WHO’s response to COVID-19. 

“One of the things I remember with Ebola is people were going on strikes in the streets because the government was not giving them their allowances for danger work. I don’t want to criticize the (Quebec) government, but we have to acknowledge that having staff doing compulsory overtime over and over again, at this rate we will not last until Christmas.”  

On Friday, the province’s largest nurses’ union called off a weekend overtime strike after Treasury Board president Sonia LeBel pledged to address the issue in negotiations. 

“What you start to see is a general fatigue in the population,” Liu said. “I’ve seen that in every single epidemic in my life. It’s always what hits us after six to nine months. The general population gets tired, but the medical staff who work day in and day out in a hospital, it’s the constant stress of, ‘Am I going to bring this back home? Am I going to expose all of my family?’  

“We’re seeing this across the (Quebec network) and that’s why there are demonstrations now. People are not machines. It’s this emotional wear and tear, an accumulation of that, and we have to factor this in.” 

One veteran nurse, who agreed to be interviewed on condition of anonymity for fear of professional reprisals, confirmed the burnout among colleagues.  

“Despite an average of 1,000 (new pandemic) cases per day — virtually the same number as the first wave — nurses are now expected to handle the virus just like we handle everything else,” the nurse said. “I don’t see any efforts by management to get us food or free parking or anything like that. We are no longer (Premier François) Legault’s guardian angels. Instead, it feels like we’re chopped liver.” 

In her experience, Liu noted that the phase of anger and frustration among medical staff during a lengthy epidemic is followed by one during which the health system starts to fall apart. 

“I call it the burnout of the health system,” she said. “It’s real. I’ve worked in war zones, and it has gotten to shape my way of thinking. This is not what we’re trained for in Canada. What we’re going to see is all the indirect impacts of COVID-19 that have been lasting for so long, all the indirect stress on the health-care system that is not caring for its population.”  

Liu was alluding to delays in cancer treatment and elective surgeries, as well as growing mental health problems. On Wednesday, the Montreal public health department released a survey that found nearly one in two young adults was experiencing symptoms of generalized anxiety or major depression.  

“I think mental health (issues) are going to be big, big, big,” Liu added. “It’s always big in epidemics and it’s always overlooked.”  

For those reasons, Liu, who works in the emergency room of Ste-Justine Hospital, urged Quebecers to avoid going to ERs unless absolutely necessary.  

“If there is one message I can give, it is to keep asking yourself as a citizen, ‘Do I really need to go?’ If people do that, it might make the difference of the one extra bed I’m going to have in my ICU for your child when he’s going to be really sick.”

UK: Calls for mental health help double in Manchester under Covid-19 restrictions

Via The Guardian: Calls for mental health help double in Manchester under Covid restrictions. Excerpt:

Calls to police and specialist services about mental health have almost doubled in Manchester while people have been isolated at home, prompting the leader of the city council to call for a more balanced and proportionate approach to lockdown.  

Sir Richard Leese, who heads Manchester city council and is also deputy mayor of Greater Manchester, said the government needed a new strategy to tackle outbreaks which “brings into play mental health and other health risks including those caused by poverty and economic inactivity, and one that allows the economy to fully function”. 

Greater Manchester has one of the highest Covid-19 infection rates in the UK. Calls to three crisis helplines set up in response to the pandemic have increased significantly in the last few months. The Greater Manchester Mental Health Foundation’s helpline received 2,168 calls in July compared with 1,187 in April. 

Greater Manchester police (GMP) said they too had experienced a significant increase in “mental health demand”. Ch Supt Umer Khan said: “We are grateful to the majority of people within Greater Manchester who have followed guidelines to help reduce the spread of Covid-19, however these restrictions have had an impact on many people’s mental health, both those with pre-existing conditions and those who have not struggled with their mental health before.  

“Police officers are often the first point of contact for people going through a mental health crisis. Since February 2020 we have seen a 42% increase in mental health demand coming into GMP. It is important that these people have immediate access to the right help and support.  

“GMP has worked with partners to train thousands of officers in how to deal with people with various mental health conditions and help direct individuals to the support they need.” 

Manchester recorded 47.3 coronavirus cases per 100,000 people in the week of 10-16 August, the seventh-highest infection rate in England. Nearby Oldham had more than double that rate, with 103.1 cases per 100,000 in the same time period.  

Leese said very few people were dying of Covid in the region, but “presentations of people with mental health issues … have soared, as has the number of people suffering from the state of the economy”.

Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020

Via MMWR: Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. The summary:

What is already known about this topic?  

Communities have faced mental health challenges related to COVID-19–associated morbidity, mortality, and mitigation activities. 

What is added by this report?  

During June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.  

What are the implications for public health practice? 

The public health response to the COVID-19 pandemic should increase intervention and prevention efforts to address associated mental health conditions. Community-level efforts, including health communication strategies, should prioritize young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.

Hollowed-out public health system faces more cuts amid COVID-19 pandemic

Many thanks to Lauren Weber for sending this major report by Kaiser Health News and The Associated Press: Hollowed out public health system faces more cuts amid virus. Here's an excerpt and then a comment, but you should just click through and read the whole long, grim story. Don't let it depress you, but do let it enrage you.

The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. 

Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed more than 126,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money, state and local government health workers on the ground are sometimes paid so little, they qualify for public aid.  

They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs.  

Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and Associated Press analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems. 

An Associated Press-KHN investigation has found a skeletal workforce facing more possible county budget cuts. KHN, also known as Kaiser Health News, and AP interviewed more than 150 public health workers, policymakers and experts, analyzed spending records from hundreds of state and local health departments, and surveyed statehouses. On every level, the investigation found, the system is underfunded and under threat, unable to protect the nation’s health.  

Robert Redfield, the director of the Centers for Disease Control and Prevention, said in an interview in April that his “biggest regret” was “that our nation failed over decades to effectively invest in public health.”  

So when this outbreak arrived — and when, according to public health experts, the federal government bungled its response — hollowed-out state and local health departments were ill-equipped to step into the breach.

Over time, their work had received so little support that they found themselves without direction, disrespected, ignored, even vilified. The desperate struggle against COVID-19 became increasingly politicized and grew more difficult. 

States, cities and counties in dire straits have begun laying off and furloughing their limited staff, and even more devastation looms, as states reopen and cases surge. Historically, even when money pours in following crises such as Zika and H1N1, it disappears after the emergency subsides. Officials fear the same thing is happening now. 

“We don’t say to the fire department, ‘Oh, I’m sorry. There were no fires last year, so we’re going to take 30% of your budget away.’ That would be crazy, right?” said Dr. Gianfranco Pezzino, the health officer in Shawnee County, Kansas. “But we do that with public health, day in and day out.”

This is not just a Republican failure; the Democrats are equally to blame. Both parties, since about 1980, have presided over an enormous project of social engineering: the transfer of wealth from working people and the middle class to the 0.1%.

"Government is the problem" was Reagan's mantra, and as people began to notice that their incomes couldn't quite cover all their bills any more, they were taught to blame government spending for their suddenly heavy taxes. (Never mind that Americans were already among the most lightly taxed citizens of any industrialized country.)

 

So tax cut after tax cut came from Republican and Democratic administrations alike, on all levels of government. Somehow the taxes were always too burdensome, the government spending too wasteful. Universal health care was for those overtaxed "socialist" Europeans and Canadians, and a little grudging support for public health came only to provide symptomatic relief—to provide a Band-Aid, not to prevent the cut in the first place.

 

"We're all in this together" rings hollow in a country that's been taught for 40 years that everyone is personally responsible for his or her success or failure, health or sickness. And now that the consequences of 40 years of wealth transfer are manifest, 126,000 rugged American individualists are dead, 2.6 million have been sickened (so far), and everyone but the 0.1% have been further impoverished. (The 0.1% have been doing just fine, thanks.)

 

It will take more than yet another transfer of power from Republicans to Democrats to roll back COVID-19. It will take a rollback of 40 years of systemic theft from the 99%.

COVID-19: Front-line health workers 'at tremendous risk' of mental health consequence, expert warns

Via The Washington Post: COVID-19: Front-line health workers 'at tremendous risk' of mental health consequence, expert warns.

Front-line health-care workers “are at tremendous risk” of developing mental health problems because of their service amid the pandemic, Joshua A. Gordon, director of the National Institute of Mental Health, said Wednesday. 

“They’re working long hours and don’t have a lot of time to build themselves back up before they have to go on their next shift,” he said in an interview on C-SPAN. “So we know from previous disasters and epidemics that they are at high risk.” 

Officials and experts have warned that a historic wave of mental health problems is fast approaching because of the pandemic, something the system is ill-equipped to handle.  

Gordon said researchers need to know more about how to help front-line health workers and that this also extends to grocery store clerks, hard-hit communities and others.  

More research is needed, he said, on “interventions to help reduce the mental health impacts of disasters and pandemics."  

He said experts need to look at methods that have worked before and try to figure out how to utilize those to help communities in need. 

“We’ve got a number of fast-tracked research proposals that we’re working on to try to encourage the field to understand how best to respond,” Gordon said.  

Previous disasters and pandemics suggest some share of people will “develop chronic mental health conditions as a result of exposure to the pandemic,” he said. But, he added, given how different the coronavirus pandemic is from previous emergencies, that ultimate toll is still unknown.