As omicron spreads throughout North America, the US and Canadian reactions could not be more unique. US states are largely open for business, while Canada’s greatest territories are closing down.
The difference between them partly comes down to arithmetic: The U.S. medical services framework, which focuses on free markets, provides more hospital beds per person than the government-dominated Canadian system does.
“I’m not advocating for that American market-driven,” said Bob Bell, a physician who ran Ontario’s health bureaucracy from 2014 to 2018 and looked at Toronto’s University Health Network before that. “But I am saying that in Canada, we have restricted hospital capacity excessively.”
The results of that are being felt all through the economy. In Ontario, restaurants, concert halls and gyms are shut while Quebec has a 10:00 p.m. curfew and restricted in-person church services. Funeral receptions and indoor weddings have been suspended by British Columbia.
The limits on hospital capacity also include intensive care units. The US has one staffed ICU bed for every 4,100 individuals, according to the data from thousands of hospitals reporting to the US Health and Human Services Department.
Ontario has one ICU bed for about 6,000 occupants, based on provincial government figures and the latest population estimates. Obviously, the hospital capacity is just a single method for estimating the success of a wellbeing framework.
Overall, residents of Canada have better access to medical services, live longer than Americans and rarely go bankrupt due to medical bills. Canada’s death rate from Covid-19 is 33% of the US rate, an impression of Canada’s widespread use of health restrictions and its better approach to health care.
Still, the pandemic has exposed one trade-off that Canada makes with its universal system: Its medical clinics are less fit for taking care of a surge of patients.
The situation is especially stark in Ontario. Broadly, Canada has fewer medical clinic limits than the US has, as a proportion of the population. Ontario fares the worst among Canadian provinces. It had one intensive-care or acute-care bed for every 800 inhabitants as of April 2019, the most recent period for which information is accessible, as indicated by the Canadian Institute for Health Information.
During the same period, the average ratio in the rest of Canada was around one bed for every 570 inhabitants. (About one inpatient hospital bed per 420 residents in the state of New York).
“The math isn’t on our side,” Ontario Premier Doug Ford said Monday as he announced new school and business closures this week to alleviate pressure on the province’s hospitals. Nearly 2300 people are hospitalized in the province with Covid-19.
No Surge Capacity
Brampton’s mayor, Patrick Brown, tweeted: “We need a national conversation on inadequate health care capacity and staffing”, as an emergency was declared by Brampton Civic Hospital due to the shortages of beds and workers.
The greatest bottleneck in the framework is the staffing required by acute care, especially in the emergency departments and intensive care units, Bell said. The personnel crunch becomes outrageous during Covid waves when huge quantities of staff are forced to isolate at home as a result of contamination or openness.
“We haven’t done an adequate job of developing capacity that will serve the needs of Ontarians,” Bell said. “There’s just no surge capacity available.”
The head of the medicine department, Stephen Archer, at Queen’s University in Kingston went through twenty years working in hospitals in Minneapolis and Chicago. He strongly believes that the Canadian system is better and provides more equitable care.
He still calls it “embarrassing” to see Toronto’s hospitals having to move virus patients to smaller hospitals around the province, as happened the previous year. The Kingston Health Sciences Center, where he works, took in excess of 100 patients affected by Covid from Toronto prior to the pandemic, which was no surprise, Archer said, because Ontario’s hospitals get overburdened even by a busy flu season.
“I think a very fair criticism of the Canadian system and the Ontario system is we try to run our hospitals too close to capacity,” he said. “We couldn’t handle mild seasonal diseases like influenza, and therefore we were poorly positioned to handle Covid-19.”
Beyond hospital capacity, Archer and Bell cited other reasons for the disparity in the way that the US and Canada respond to new outbreaks. Canadians put more trust in their government to act for the larger collective good, and they will not tolerate the degree of death and serious sickness that America has suffered from Covid, they said.
Physician and former University of Toronto president, David Naylor, who drove a government audit into Canada’s reaction to the 2003 SARS epidemic, said hospital capacity probably plays a bigger role in Canadian decision-making than in the US because Canada’s universal system means “the welfare of the entire population is affected if health care capacity is destabilized.”
But he also argued that prioritizing only on hospital capacity could be misleading. “Both Canada and the US have lower capacity than many European countries,” he wrote by email.
The significant difference between the two nations’ reactions to Covid flare-ups is social, Naylor argues. In Canada, more than in the US, strategy is directed by a “collectivist ethos” that tolerates prolonged shutdowns due to covid and other public health restrictions to keep hospitals from collapsing.
“America’s outcomes are almost inexplicable given the scientific and medical firepower of the USA,” Naylor said. “With regret, I’d have to say that America’s radical under-performance in protecting its citizens from viral disease and death is a symptom of a deeper-seated political malaise in their federation.”