Transcript: Protecting Health Care Workers' Lives | Apr 08, 2020

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of George Drew and one of Walter Kronkite. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit and a vertically striped shirt.

A caption on screen reads "Protecting health care workers' lives. @spaikin, @theagenda."

Steve says HEALTHCARE WORKERS NOW MAKE UP 1 IN 10 KNOWN COVID-19 CASES IN ONTARIO, AND NO ONE WANTS TO SEE THOSE NUMBERS GET WORSE. WITH US NOW, ON HOW TO KEEP DOCTORS, NURSES, ORDERLIES, SUPPORT STAFF, LAB TECHS, AND THE MANY OTHERS, SAFE: WE WELCOME: IN STAYNER, ONTARIO: DR. SOHAIL GANDHI, PRESIDENT OF THE ONTARIO MEDICAL ASSOCIATION...

Sohail is in his fifties, with short, receding brown hair and a goatee. He's wearing a checkered blue shirt.

Steve continues AND IN TORONTO FROM HER HOME: DORIS GRINSPUN, CEO OF THE REGISTERED NURSES' ASSOCIATION OF ONTARIO...

Doris is in her sixties, with long wavy brown hair. She's wearing glasses, a red blazer and a black and white necklace.

Steve continues AND FROM HIS OFFICE, ROSS UPSHUR, PROFESSOR AT THE UNIVERSITY OF TORONTO'S DALLA LANA SCHOOL OF PUBLIC HEALTH, WHERE HE SPECIALIZES IN DUTY TO CARE AND MEDICAL ETHICS...

Ross is in his fifties, clean-shaven and bald. He's wearing a blue shirt.

Steve continues JUST THE RIGHT GROUP OF PEOPLE FOR THIS DISCUSSION TODAY. THANK YOU ALL FOR JOINING US FROM YOUR VARIOUS LOCATIONS AROUND THE PROVINCE. DR. GANDHI, I WANT TO START WITH YOU FIRST, AND I WANT TO KNOW HOW CONCERNED YOU ARE ABOUT THE AMOUNT OF PPE, PERSONAL PROTECTIVE EQUIPMENT, THAT THE PROVINCE HAS TODAY IN ORDER TO COMBAT THE SURGE WE ARE EXPECTING TO SEE OVER THE NEXT COUPLE OF WEEKS?

The caption changes to "Sohail Gandhi. Ontario Medical Association."

Sohail says SO UNFORTUNATELY THE SURGE HAS ACTUALLY STARTED, STEVE. AND IN LIGHT OF THAT I'M ACTUALLY QUITE CONCERNED ABOUT THE FACT THAT WE DON'T HAVE A GOOD LINE OF SIGHT ON WHERE THE EQUIPMENT IS. I KNOW THAT THE PROVINCE HAS ORDERED A LARGE SUPPLY OF EQUIPMENT. I THINK THAT'S WONDERFUL. I KNOW THERE'S FEDERAL GOVERNMENT ENDEAVOURS AS WELL TO ORDER SOME EQUIPMENT, AND I THINK THAT'S WONDERFUL AS WELL. BUT THE REALITY IS THAT AT THIS POINT IN TIME, I DON'T KNOW, ON BEHALF OF MY MEMBERS, I DON'T KNOW WHETHER THE EQUIPMENT IS IN A WAREHOUSE, I DON'T KNOW IF IT'S IN A TRUCK, I DON'T KNOW WHERE IT'S GOING, I DON'T KNOW WHAT THE FRAMEWORK IS BEING USED TO DISTRIBUTE THE EQUIPMENT PROPERLY BECAUSE, OF COURSE, WE KNOW THE HOSPITALS NEED SOME. BUT THERE ARE ALSO VARIOUS COMMUNITY CENTRES, FAMILY PRACTICE OFFICES AND OUTPATIENT CLINICS, THAT NEED PPEs AS WELL, BECAUSE A LOT OF THE WORK THEY DO IS TO KEEP PEOPLE OUT OF HOSPITAL AND PREVENT PATIENTS FROM GOING TO HOSPITAL AT THIS TIME. SO IT WOULD BE NICE TO HAVE A LINE OF SIGHT THAT WAY.

Steve says DR. GANDHI, I WANT TO DO A QUICK FOLLOW-UP WITH YOU BECAUSE I'M HEARING ANECDOTAL EVIDENCE AND I SUSPECT YOU HAVE A MUCH DEEPER SENSE OF HOW THINGS ARE, DO YOU KNOW WHETHER DOCTORS ARE REUSING GEAR THAT WAS MEANT TO BE USED ONLY ONCE BUT THAT THEY ARE USING FOR MORE THAN ONE PATIENT AT A TIME?

Sohail says YES, SO I HAVE NOT HEARD THAT DOCTORS ARE ACTUALLY DOING THAT. I'VE SEEN RECOMMENDATIONS COME FROM VARIOUS SOURCES. THOSE SOURCES HAVE NOT BEEN APPROVED, BY THE WAY. SUGGESTING THAT PPEs CAN BE REUSED IF YOU DO THINGS LIKE BAKE A MASK IN AN OVEN AT 70 degrees CELSIUS FOR 30 MINUTES AND USE PEROXIDE AND I'VE HEARD OF ALL OF THIS BUT I HAVE NOT HEARD OF SPECIFIC INSTANCES WHERE PHYSICIANS HAVE USED PPEs YET.

Steve says IS ANY OF THAT TRUE, WHAT HAVE YOU SAID?

Sohail says I WANT TO SEE DATA TO MAKE SURE THIS IS SAFE. I'M JUST TALKING ABOUT RUMOURS THAT ARE OUT THERE RIGHT NOW, I DON'T KNOW IF THIS IS 100 PERCENT SAFE OR NOT, AND WE NEED GUIDANCE THAT WAY.

Steve says DORIS GRINSPUN, LET'S GET THE VIEW FROM THE NURSES OF THIS PROVINCE. HOW IS THE LACK OF PPE CHANGING THE WAY THEY DO THEIR JOB?

The caption changes to "Doris Grinspun. Registered Nurses' Association of Ontario."

Doris says WE HAVE BEEN SOUNDING THE ALARM BELL FOR OVER A MONTH. WE WERE CONCERNED THAT THE FRAMEWORK THAT THIS PROVINCE WAS USING ALL ALONG WAS LOW RISK, LOW RISK, AND THEN WE MOVED INTO BEST CASE SCENARIO. THERE HAS NEVER BEEN A BEST CASE SCENARIO. THEREFORE, WE'RE ILL-PREPARED WITH PPE AND VENTILATORS AND WITH ANYTHING ELSE. WE ARE VERY CONCERNED TO THE POINT THAT DR. GANDHI MADE, THE HOSPITALS ARE COLLECTING THE PPE AFTER THE SHIFT IN RELATION TO N95 THERE IS RESEARCH GOING ON TO SEE IF ANY OF THEM WILL PROVIDE SAFE RESULTS FOR WORKERS, NOT ONLY NURSES BUT ALL OF THEM. OF COURSE THAT WOULD BE LAST CASE SCENARIO BECAUSE IT'S CONCERNING. IT'S CHANGING THE LIVES OF NURSES AND OTHERS. LET ME SUMMARIZE ONE OF THE STATEMENTS IN THE HUNDREDS OF EMAILS I GET SENT TO ME. SHE SAID BEFORE I WAS ALL FOCUSED WITH MY INTELLECT, WITH MY HEART, AND WITH MY ALL BEING TO TAKING CARE OF PATIENTS TO HELP THEM GET WELL, TO SAVE LIVES, TO BE WITH THEM IN KNOWLEDGE AND COMPASSION. NOW THAT IS ALL TEMPERED BY A PPE. AND THEREFORE THEY CANNOT EVEN USE THEIR WAY OF PRACTISING THE WAY THEY NEED. SO NOT ONLY ARE THEY FACING THEIR SAFETY AND THEIR WORRIES ABOUT THEMSELVES, BUT IT'S AFFECTING THE WAY THEY PRACTICE AND THERE ARE CONCERNS ABOUT ALL ASPECTS OF THESE. THIS IS IN ICU BUT IF YOU LOOK AT NURSING HOMES THEY ARE THE WORST CHAPTER OF THE BOOK THAT WE WOULD WRITE. AND IF WE LOOK AT PSWs, THEY DON'T EVEN HAVE SURGICAL MASKS. I'M TALKING ABOUT SOMETHING AS SIMPLE AS SURGICAL MASKS AND NURSES COME FACE TO FACE WITH PATIENTS AND THEY'RE GETTING SUPPLIES AFTER AN OUTBREAK. IT'S NO WONDER WE ARE AT ABOUT 120 NURSING AND RETIREMENT HOMES
[indiscernible]... THAT ANY ANY OTHER PROVINCE HAS
[indiscernible] AND WE HAVE BEEN ASKING AND ASKING THAT THE SURGICAL MASKS AT THE NURSING HOMES HAVE TO COME QUICKER SO WE CAN PREVENT OUTBREAKS. IT'S DIRE THE SITUATION AND IT MAKES US EXTREMELY WORRIED BOTH FROM A PRACTICE PERSPECTIVE AND FROM [indiscernible].

Steve says UNDERSTOOD. JUST BEFORE I GET DR. UPSHUR TO RESPOND, I DO WANT TO GO BACK TO DR. GANDHI FOR A SECOND JUST TO FIND OUT WHETHER OR NOT YOU ARE HEARING FROM PHYSICIANS RIGHT NOW THAT THEY THEY FEEL UNSAFE AND DON'T WANT TO SHOW FOR WORK. WHAT ARE YOU HEARING?

Sohail says SO I'M HEARING A LOT OF ANXIETY FROM OUR MEMBERS FOR SURE, STEVE. EVERY PHYSICIAN WANTS TO HELP THE PATIENTS OF ONTARIO. THAT'S WHAT WE DO. WE WANT TO HELP THEM AND WE WANT TO PROTECT THEM AND WE WANT TO GIVE THEM THE BEST POSSIBLE MEDICAL TREATMENT THAT WE CAN. BUT I THINK... EXCUSE ME. I THINK THERE'S AN EXPECTATION THAT IF WE'RE GOING TO DO THAT, WE NEED TO BE ABLE TO DO THAT WITH THE RIGHT EQUIPMENT AND PPEs ARE PART OF THAT EQUIPMENT. AND UNFORTUNATELY RIGHT NOW WE DON'T HAVE THAT, AND I KNOW THERE'S QUITE A BIT OF CONCERN ON THE PART OF OUR MEMBERS AS TO HOW WE'RE GOING TO KEEP OUR PATIENTS SAFE, BECAUSE A LOT OF PHYSICIANS ARE CONCERNED SAYING, WELL, IF I GO INTO THIS ENVIRONMENT, I'M NOT PROTECTED. BUT THEN IF I GO FROM THE HOSPITAL TO MY MARKET, YOU KNOW, THAT'S WHAT WE DO IN STAYNER, HOW DO I KNOW I'M NOT SPREADING THIS VIRUS TO ONE OF MY OTHER PATIENTS BECAUSE I DIDN'T HAVE THE RIGHT EQUIPMENT WHEN I NEEDED IT.

Steve says I WANT, DR. UPSHUR, TO READ SOMETHING THAT WAS IN THE CANADIAN MEDICAL ASSOCIATION CODE OF ETHICS AND WRITTEN NEARLY 100 YEARS AGO AND THEN WE'LL COME OUT OF A QUESTION AFTER THAT. THE STATEMENT IN QUESTION GOES LIKE THIS...

A quote appears on screen, under the title "Back in the day." The quote reads "When pestilence prevails, it is their [physicians'] duty to face the danger, and to continue their labours for the alleviation of suffering, even at the jeopardy of their own lives."
Quoted from the Canadian Medical Association, Code of ethics. 1922.

Steve says THAT'S FROM 1922. I WANT TO GET A SENSE FROM YOU ABOUT HOW DIFFERENT OR NOT THE GUIDANCE DOCTORS GET TODAY IS FROM THAT ADVICE FROM NEARLY A HUNDRED YEARS AGO.

The caption changes to "Ross Upshur. Dalla Lana School of Public Health."

Ross says STEVE, FIRST I WANT TO HOPE AND WISH THAT YOU AND YOUR FAMILY AS WELL AND THE SAME FOR DORIS AND SOHAIL AND THANKS FOR THE OPPORTUNITY TO SPEAK TODAY. SO AFTER SARS AND IN THE INTERIM PERIOD WHEN WE WERE VERY CONCERNED ABOUT AN EVOLVING POTENTIAL INFLUENZA PANDEMIC, I HAD THE GREAT FORTUNE OF CHAIRING A WORLD HEALTH ORGANIZATION WORKING GROUP CALLED DUTY TO CARE IN THE HEALTH PROFESSION. SO IT'S IMPORTANT TO CONTEXTUALIZE OUR THINKING ABOUT THIS BOTH HISTORICALLY AND CURRENTLY. HISTORICALLY A PHYSICIAN DID NOT HAVE ACCESS TO PERSONAL PROTECTIVE EQUIPMENT AND UNTIL SUCH TIME AS IT WAS ESTABLISHED THAT HAND HYGIENE WAS IMPORTANT IN REDUCING TRANSMISSION OF INFECTION WITHIN HOSPITALS, PHYSICIANS ACTUALLY LARGELY PRACTISED IN SITUATIONS WHERE THEY SUCCUMBED AT FAIRLY HIGH RATES HISTORICALLY THROUGH THE PLAGUES OF THE PAST TO INFECTION, AND IN FACT IN TORONTO, BOTH WHERE I LIVE IN KEW GARDENS, IT'S A MEMORIAL TO PHYSICIANS IN BEACH PARK, HE WAS A COMMUNITY PHYSICIAN WHO DIED IN 1918 PROVIDING CARE FOR HIS PATIENTS IN THE EAST END OF TORONTO.

Steve says HE DIED FROM THE SPANISH FLU?

Ross says YES, HE DID. IN FACT, A LARGE PROPORTION OF... THERE'S AN INTERESTING ARTICLE IN THE GUARDIAN BECAUSE PEOPLE ARE SENSITIZED TO HISTORY AROUND DUTIES OF CARE WHERE USUALLY THEY AREN'T IN INTRAPANDEMIC PERIODS. I'VE BEEN DOING RESEARCH ON THIS FOR ABOUT 20 YEARS. SO THERE IS A GUIDANCE GAP. AND WHAT WE POINTED OUT IN OUR LITERATURE REVIEW IN SYNTHESIS IN 2007 CODE OF ETHICS WAS SILENT ON THE DUTY OF CARE IN AN EPIDEMIC. THE AMERICAN MEDICAL ASSOCIATION, AFTER THE 9=11 EVENT, DID SHARPEN AND FOCUS THEIR GUIDANCE TO PHYSICIANS ON THEIR OBLIGATIONS IN PUBLIC HEALTH EMERGENCY. HOWEVER, I THINK IT'S FAIR TO SAY THAT THE ANXIETY THAT PHYSICIANS AND NURSES AND OTHER HEALTH CARE PROFESSIONALS ARE FEELING ABOUT THEIR DUTY TO CARE IS REAL AND NEEDS TO BE ADDRESSED. THERE ARE REAL CONSIDERATIONS... SORRY. DID YOU WANT TO JUMP IN?

Steve says WELL, I WAS GOING TO JUMP IN WITH THIS BECAUSE, I THINK PEOPLE CAN UNDERSTAND THE NOTION OF HEALTH CARE WORKERS OBVIOUSLY BEING CONCERNED ABOUT THEIR OWN HEALTH RIGHT NOW. I MEAN, WE'VE SEEN SOME SHOCKING NUMBERS COME OUT OF ITALY WHERE, FOR EXAMPLE, I THINK AS MANY AS 75 DOCTORS HAVE GIVEN THEIR LIVES IN ORDER TO HELP FIGHT THIS VIRUS. BUT WHAT DOES ONE SAY TO A DOCTOR WHO SAYS I WANT TO HELP, I WANT TO BE THERE FOR MY PATIENTS, I WANT TO GET PEOPLE BETTER, BUT I DIDN'T SIGN UP TO DIE?

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."
Then, it changes again to "Ross Upshur. Lunenfeld=Tanenbaum Research Institute."

Ross says WELL, THEN THAT MEANS THAT WE'VE KIND OF FAILED IN OUR EDUCATION PROCESS BECAUSE IT'S ALWAYS BEEN THE CASE, AND IT STILL IS THE CASE. SO, FOR EXAMPLE, DURING SARS, THE FIRST PHYSICIANS WHO RECOGNIZED THE SERIOUSNESS OF SARS CORONAVIRUS IN VIETNAM, DR. CARL ORBANI WHO WAS WORKING FOR THE WORLD HEALTH ORGANIZATION IN VIETNAM ALERTED THE WORLD TO SARS AND UNFORTUNATELY HE SUCCUMBED TO SARS HIMSELF. HEALTH CARE PROVIDERS DO GET EXPOSED TO INFECTIOUS AGENTS, AND GLOBALLY THERE ARE MANY HEALTH SYSTEMS WHERE THEY HAVE LIMITED TO NO ACCESS TO PERSONAL PROTECTIVE EQUIPMENT AND THERE ARE HEALTH STATIONS AROUND THE WORLD THAT BARELY HAVE FUNCTIONING RUNNING WATER AND SOAP. SO I WAS THINKING ABOUT THESE PROBLEMS FROM A GLOBAL POINT OF VIEW. OF COURSE, YOU REALIZE THAT THERE'S DIFFERENTIAL CHALLENGES THAT WE FACE. SO ULTIMATELY, BECAUSE OF THE GUIDANCE GAP AND AS THE CANADIAN MEDICAL PROTECTIONS ASSOCIATION GUARD DANCE DOCTORS, THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO'S GUIDANCE, THEY'RE A BIT CAGEY IN THE SENSE OF SAYING PHYSICIANS HAVE AN OBLIGATION TO CARE FOR PATIENTS, IT'S PART OF THE FIDUCIARY OBLIGATIONS TO THE PATIENTS THAT THEY SERVE. THEY ALSO HAVE A SPECIAL PLACE IN SOCIETY BY VIRTUE OF THEIR TRAINING. THERE'S A SOCIAL CONTRACT, AN EXPECTATION ON BEHALF OF THE PUBLIC THAT WE WILL ACTUALLY BE THERE TO WORK. AND FINALLY, THERE IS AN IMPLICIT OR EXPLICIT RECOGNITION, I WOULD SAY, THAT YOU DO FACE EXCESS RISK, AND YOU SIGN UP FOR THAT WHEN YOU BECOME A PHYSICIAN. NOW, I'VE NOTICED SOME PEOPLE SAYING WE DIDN'T SIGN UP FOR A SUICIDE MISSION, BUT I THINK THE WAY IT IS CURRENTLY IN THE REGULATORY AND OTHER ADVICE IS THAT YOU'RE GOING TO HAVE TO MAKE... LOOK IN THE MIRROR AND DECIDE AS A PHYSICIAN OR AS A NURSE OR AS A HEALTH CARE PROFESSIONAL WHETHER YOU ARE WILLING TO PROVIDE CARE IN THE ABSENCE OF PERSONAL PROTECTIVE EQUIPMENT...

Steve says IF I CAN TALK TO DR. GANDHI ON THAT, IF I CAN. DR. GANDHI, YOU'VE HEARD THIS EXPRESSION, THE GUIDANCE GAP. WHAT GUIDANCE ARE YOU IN FACT GIVING THE DOCTORS OF THIS PROVINCE RIGHT NOW?

Sohail says SO WE'RE ASKING OUR DOCTORS TO ADVOCATE FOR THEMSELVES SO THEY HAVE THE RIGHT EQUIPMENT. NOW, I WANT TO BE CLEAR ABOUT THIS. THE PHYSICIANS ACROSS ONTARIO HAVE STEPPED UP TO THIS CHALLENGE TO THE BEST OF THEIR ABILITY, AND MORE SO. AND I COULDN'T POSSIBLY BE MORE PROUD OF OUR PROFESSION RIGHT NOW. IN THE PAST FIVE DAYS, 1300 PHYSICIANS HAVE SIGNED UP FOR A SERVICE THAT ALLOWS HOSPITALS AND LONG-TERM CARE HOMES TO HIRE A PHYSICIAN TO GO INTO THESE DIFFICULT ENVIRONMENTS. OUR PHYSICIANS IN HOSPITAL CONTINUE TO PROVIDE CARE, SOME OF THEM WORKING 18-HOUR SHIFTS. SO IN TERMS OF PUTTING OURSELVES AT RISK AND GOING INTO THESE DIFFICULT AND DANGEROUS ENVIRONMENTS, I'VE GOT TO TELL YOU, I'M 100 PERCENT PROUD OF MY DOCTORS. THEY'RE DOING A WONDERFUL JOB OF DOING THAT. THE ONLY CONCERN IS THAT A REASONABLE EXPECTATION... AND I THINK THIS IS A VERY REASONABLE EXPECTATION... THAT IF YOU'RE GOING TO SEND SOMEONE INTO HARM'S WAY TO HELP SOCIETY, YOU NEED TO SEND THEM WITH THE PROPER EQUIPMENT, AND THIS IS PARTICULARLY THE CASE FOR A VIRUS THAT CAN INFECT OTHER PEOPLE. SO AS A YOUNG PHYSICIAN WHO IS REASONABLY HEALTHY, HE'S LIKELY NOT GOING TO GET A SERIOUS COMPLICATION. BUT HE OR SHE COULD SPREAD IT TO SOMEONE ELSE IN SOCIETY, AND THAT'S WHERE WE NEED MORE GUIDANCE AS TO WHAT THAT RIGHT LEVEL IS BECAUSE WE NEED TO PROTECT SOCIETY AS WELL.

Steve says SO LET ME MAKE THE ANALOGY HERE AND YOU TELL ME IF THIS WORKS. IN THE SAME WAY THAT A CONSTRUCTION WORKER, FOR EXAMPLE, CAN COME TO A CONSTRUCTION SITE AND SAY, "THIS PLACE IS UNSAFE. THERE'S NO WAY YOU'RE GETTING ME UP IN THAT ELEVATOR TO GO 50 FLOORS UP GIVEN THE LACK OF SAFETY I SEE, THEREFORE I'M NOT GOING TO WORK," DO YOU FEEL DOCTORS ARE ENTITLED TO HAVE THAT SAME VIEW WHICH IS I'M HAPPY TO GO AND TRY TO SAVE LIVES, BUT IF YOU DON'T GIVE ME THE PPE I NEED, I'M NOT GOING.

Sohail says IN FAIRNESS, THAT ANALOGY HAS SOME MERIT. BUT WHAT'S NOT INCLUDED IS THE FACT THAT OTHER PEOPLE ARE BEING PUT AT RISK, RIGHT? BY GOING INTO ENVIRONMENTS LIKE THAT... SO A CONSTRUCTION WORKER CAN SAY I NEED A SAFETY BELT IF I'M GOING TO CLIMB UP THAT GRID, AND THAT'S REASONABLE. YOU HAVE TO HAVE A SAFETY BELT IN CASE YOU SLIP. THE PROBLEM IS IF THE CONSTRUCTION WORKER SLIPS, AND I HATE TO USE AN ANALOGY LIKE THIS, IF HE OR SHE SLIPS, IT'S ONLY HIMSELF THAT'S GOING TO GET HURT. OUR PHYSICIANS, THEY MAY NOT GET SICK BOUGHT OF COVID, BUT BECAUSE THEY DON'T HAVE THE PPEs, THEY'RE GOING TO TAKE THAT VIRUS AND THEY'RE GOING TO GIVE IT TO SOMEBODY ELSE THAT THEY SEE. AND THAT'S THE PART THAT AS A PHYSICIAN I STRUGGLE WITH BECAUSE I DON'T WANT TO HARM ANYONE, RIGHT?

Steve says UNDERSTOOD. DORIS GRINSPUN, LET ME GET YOU IN HERE. IS THERE A SITUATION THAT YOU'RE AWARE OF WHERE A NURSE IN THE PROVINCE HAS GONE TO WORK, MAYBE A HOSPITAL, MAYBE A HEALTH CARE CLINIC... WHO KNOWS?... AND HAS FOUND THEMSELVES TO BE IN A SITUATION WHERE THEY THOUGHT, THIS IS NOT SAFE, AND THEREFORE LEFT AND GONE HOME?

Doris says SO LET ME TELL YOU FIRST A COUPLE OF THINGS. IN ITALY, 75 PHYSICIANS SUCCUMBED TO COVID-19 AND 120 NURSES ALREADY AND TWO OF THEM COMMITTED SUICIDE BECAUSE ONE OF THEM WOULD HAVE BEEN WITH DIRTY HANDS, EITHER WAY. DIRTY HANDS AND THEY STAY AND THEY DIDN'T HAVE PPE, THEY LEFT AND THEY LEFT PATIENTS UNATTENDED. SO THE SITUATION IS NOT THAT SIMPLE AS A CODE OF ETHICS. THE SITUATION NEEDS, AND THIS IS WHAT WE HAVE BEEN SAYING PUBLICLY, A DUTY TO CARE NEEDS TO BE MATCHED BY A DUTY TO PROTECT. AND THIS PROVINCE WAS ILL-PREPARED TO START WITH. I MEAN, YOU CAN SEE THE PRESS RELEASE THAT WAS SENT IN MAY, WHAT WAS DISCOVERED THAT THE EQUIPMENT, THE PPEs, WERE ACTUALLY PAST THE DUE DATE. SO THE DUTY WITH CARE GOES TO A DUTY TO PROTECT. NO DOUBT NURSES WILL CONTINUE TO GO TO WORK. THE ISSUE IS BOTH I HAVE HEARD FROM DOCTORS AND NURSES THAT... CLOSED OFFICES. THAT'S THE PERFECT EXAMPLE. AND IT'S VERY EASY TO GET BEHIND A CODE OF ETHICS AND JUDGE BASED ON THAT. I WANT TO SEE ANYBODY THAT IS BEHIND THE CODE OF ETHICS IN OFFICES LIKE ME OR YOU OR... TO GO TO THE FRONT LINES OF CARE AND GO INTO THE PROCEDURES THEY DO WITHOUT PPEs. PEOPLE ARE ABSOLUTELY COMMITTED TO PROVIDE CARE. BUT WE HAVE THE IMPERATIVE AND WE STILL ARE NOT DOING, STEVE, ALL WE NEED TO ENSURE THEY HAVE PPEs. I DO NOT BELIEVE WE'RE DOING ALL WE CAN FOR THEM.

Steve says WELL, WHAT ELSE SHOULD WE BE DOING?

Doris says WELL, FIRST OF ALL... AND I CAN SEND YOU THE LIST THAT I SENT TO THE PREMIER AND THE MINISTER ABOUT A MONTH AGO OR MORE, AND THEN WE SENT IT TO THE PRIME MINISTER, WE SAID AT THE TIME, LET'S INCREASE THE IMPORTS BEFORE THINGS GET CLOSED UP...

Steve says OKAY. DORIS, WE ARE WHERE WE ARE. THAT WAS GOOD ADVICE AT THE TIME BUT WE ARE WHERE WE ARE NOW...

Doris says BUT WE DIDN'T DO IT. AND WE DIDN'T START FACTORIES. SO LET'S RAMP UP THOSE FACTORIES. 24 BY 7 HEALTH PROFESSIONALS ARE ALSO 24 BY 7 WITH THEIR PATIENTS ACROSS ALL THE SECTORS. THIS IS NOT ONLY ICU, IT'S ACROSS ALL THE SECTORS. STEVE, IF PEOPLE... ARE NOT ALLOWING NURSES TO GO INTO THEIR HOMES BECAUSE THEY DON'T HAVE SURGICAL MASKS. THESE ARE PEOPLE WITH CANCER. IT'S NOT ONLY PATIENTS WITH COVID, IT'S PEOPLE WITH CANCER, PEOPLE WITH WOUNDS, WHO NEED THE CARE BUT DO NOT ALLOW HEALTH PROFESSIONALS...

Steve says FORGIVE ME, DORIS. WOULD YOU AGREE THE PRIME MINISTER AND THE PREMIER, THE HEALTH MINISTERS, THEY SAY AT THEIR BRIEFINGS, AND I WANT YOUR VIEW ON THIS, THEY SAY AT THEIR BRIEFINGS WE'RE DOING EVERYTHING WE CAN TO LIBERATE MASKS FROM THE UNITED STATES, FROM 3 M, TO RETOOL LINES IN THE PROVINCE OF ONTARIO SO WE CAN MAKE OUR OWN. DO YOU AGREE WITH THEM?

Doris says I AGREE WITH THEM TO A CERTAIN EXTENT. I AGREE WITH THE POLITICIANS ON THAT SENSE. I HAVE A FEELING THAT IN THE CIVIL SERVANT LEVEL THOSE DEALING WITH PROCUREMENT ARE STILL BOXED INTO MORE USUAL CASE SCENARIO OF WHO YOU DEAL WITH, THE THREE LEVELS, ET CETERA, I DO NEED... BUT WE NEED TO FAST-TRACK THE APPROVALS. THERE ARE TONNES OF PEOPLE AND PROBABLY OTHERS DO THAT THEY ARE IMPORTING AND NOBODY HAS LISTENED TO THEM. I'M NOT SAYING FOR FREE. LET'S TEST MORE AND BRING MORE AND MORE PPEs SO WE ARE NOT CONFRONTED WITH PEOPLE GOING TO WORK AND NOT HAVING THE PROPER MINIMAL PROTECTION IN MANY SECTORS AND THEN NOT THE PPEs TO TAKE CARE OF COMPLEX AND [indiscernible].

Steve says I'M GOING TO READ SOMETHING THAT AN EMERGENCY PHYSICIAN WROTE FOR THE ATLANTIC MAGAZINE. HE WROTE THIS LAST MONTH AND THEN I'LL GET EVERYBODY TO COMMENT ON THIS, DR. UPSHUR I'LL GET YOU TO GO FIRST. HE WRITES...

A quote appears on screen, under the title "Hanging over the cliff." The quote reads "I am afraid a tipping point could happen with little warning. The loss of providers will come from many causes -quarantine, sickness, caring for their own family, cohorting- but it will be the creeping fear and feeling of abandonment that eats at us the most. A slow drip, drip, drip of attrition. Having colleagues sharing the burden is a crucial predictor for clinicians' willingness to work despite the risk.
But when the cascade starts, when you are forced to reuse your disposable face mask for the third day in a row, and another nurse doesn't come in, because of her concern for her daughter, and you know that two of your colleagues are being treated in the I.C.U. and another 10 are home infected... sooner or later, you look around and see so few standing with you. At some point, the system could break, and we will all be gone."
Quoted from Thomas Kirsch, The Atlantic. March 24, 2020.

Steve says OKAY, DR. ROSS, LET'S GET SOME COMMENT ON THAT, IF YOU WOULD?

Ross says THAT'S I THINK A VERY STARK REMINDER THAT WE'RE IN EXTRAORDINARY TIMES WITH EXTRAORDINARY CIRCUMSTANCES. SO AS I HEAR THAT, I'M PREPARING TO GO BACK ON CLINICAL SERVICE. I WORK WITH THE PALLIATIVE CARE SERVICE HERE AND WE'RE EXPECTING EXTRAORDINARY DEMAND. AND ONE OF THE KEY PRINCIPLES... I LIKED WHERE HE TALKED ABOUT THIS NOTION OF ABANDONMENT. BUT ONE OF THE KEY PRINCIPLES IN PALLIATIVE CARE IS NON-ABANDONMENT. SOMEBODY HAS TO PROVIDE CARE FOR OUR PATIENTS, AND IF IT MEANS WRAPPING A BANDANA AND GRABBING WHATEVER BARRIER IS IN THE WAY IN ORDER TO PROVIDE CARE, I THINK OUR COLLEAGUES AND I WHO ARE STANDING ARE GOING TO BE THERE TO TRY TO PROVIDE THAT CARE. I DO FEAR ABOUT THE TIPPING POINT, AND I'M WORKING WITH THE WORLD HEALTH ORGANIZATION, I CO-CHAIR ONE OF THE ETHICS WORKING GROUPS, AND WE'RE HEARING SIGNS... THIS IS A GLOBAL PANDEMIC. WHAT WE'RE EXPERIENCING IN CANADA IS HAPPENING ALL AROUND THE WORLD, AND HEALTH CARE PROVIDERS AND ALL HEALTH SYSTEMS ARE FEELING THE SAME SENSE OF ANXIETY AND DREAD. IT'S TRULY DREADFUL. I TOTALLY AGREE. THERE'S A RECIPROCAL OBLIGATION ON HEALTH SYSTEMS TO PROVIDE HEALTH CARE SUPPORT, PROTECTIVE EQUIPMENT, IF POSSIBLE. THERE ARE OTHER WAYS WE CAN THINK ABOUT ORGANIZING AND DEPLOYING HEALTH RESOURCES. AND MY BIG COMPLAINT IS THAT THE TIME TO FIGURE ALL THIS OUT ISN'T WHEN THE PANDEMIC IS BURNING THROUGH POPULATIONS AND HEALTH CARE PROVIDERS. WE ARGUED AND URGED TO HEALTH SYSTEM THINKERS TO THINK ABOUT THIS IN THE INTRAPANDEMIC PERIOD.

Steve says WHY DIDN'T THEY LISTEN?

Ross says IT'S NOT JUST DUTY TO CARE, IT'S RESOURCE ALLOCATION. HOW DO YOU FIGURE OUT THE... THERE IS A SUITE OF ETHICAL ISSUES THAT WE HAD DOCUMENTED AND CAREFULLY PUT OUT RECOMMENDATIONS FOR CONSIDERATION. I THINK WE DODGED A BULLET IN H 1 N 1, EVERYBODY THOUGHT IT WAS THE BIG ONE AND IT WASN'T. YOU KNOW, PEOPLE LIKE TO LIVE LIVES NOT THINKING ABOUT PESTILENT DEATH AND DISEASE. YOU'RE REQUIRED TO FOCUS YOUR ATTENTION ON THESE EXTRAORDINARY POSSIBILITIES THAT ARE NOT IN FRONT OF YOU. I REMIND PEOPLE THAT ARE OTHER PANDEMICS AHEAD. WE HAVE HAD SEVEN SINCE 2003 THAT HAVE HAD A HEAVY IMPACT ON HEALTH CARE PROVIDERS. LET'S NOT FORGET THE EBOLA OUTBREAKS IN WEST AFRICA AND DEMOCRATIC REPUBLIC OF CONGO, H1N1, ZIKA, AND CORONAVIRUS. IF WE'RE NOT THINKING ABOUT IT NOW AND, STEVE, I'M GOING TO ASK YOU AS A MEMBER OF OUR ESTEEMED PRESS CORPS, TO HOLD OUR FEET TO THE FIRE AFTER THIS IS OVER. COME BACK AND SAY, YOU KNOW, YOU HAD THE WALKERTON CRISIS, YOU HAD THREE COMMISSIONS OF INQUIRY AFTER SARS, AND EVERYTHING IN THE CAMPBELL COMMISSION, WHICH WAS ABOUT THE IMPACT OF SARS ON HEALTH CARE WORKERS, IS GERMANE. SO LET'S NOT HAVE FORGETFULNESS SET IN ONCE WE'RE OUT FROM UNDER THIS AGAIN.

Steve says WE ACCEPT THE CHALLENGE. THANK YOU FOR THAT, DOCTOR. I WANT TO GO TO DR. SOHAIL GANDHI, THAT WAS A PHYSICIAN IN THE STATES THAT DESCRIBED A DESPERATE SCENARIO. WE DON'T WANT TO BE OVERLY DRAMATIC HERE BUT I WANT TO KNOW YOUR SENSE OF HOW CLOSE YOU THINK WE ARE TO THAT SCENARIO IN THE PROVINCE OF ONTARIO TODAY?

Sohail says I AM TRYING NOT TO BE DRAMATIC BUT I HAVE TO TELL YOU I'M EXTREMELY CONCERNED ABOUT A SITUATION LIKE THAT. THERE ARE MULTIPLE REASONS WHY PHYSICIANS MAY NOT WORK, THEY MAY NEED TO ISOLATE THEMSELVES, THEY MAY BE OVERWORKED. WE TALK ABOUT ITALY A LOT. ONE THING WE HAVE BEEN ADVOCATING FOR AT THE ONTARIO MEDICAL ASSOCIATION FOR YEARS IS THAT YOU LOOK AT A COUNTRY LIKE ITALY. ITALY HAS ABOUT FOUR DOCTORS FOR EVERY 1,000 PEOPLE IN THEIR POPULATION, AND DESPITE THAT NUMBER OF FOUR DOCTORS FOR EVERY 1,000, THEY WERE STILL OVERWHELMED BY COVID-19...

Steve says IS A THOUSAND A LOT OR A LITTLE?

Sohail says CANADA HAS 2.4 FOR EVERY THOUSAND. SO WE WERE ALREADY STARTING OFF AT OVER 50 percent LESS PHYSICIANS ON A PER CAPITA BASIS THAN ITALY DID, AND THAT WAS A COUNTRY THAT WAS COMPLETELY OVERWHELMED. SO WE'RE STARTING OFF BEHIND THE CURVE TO BEGIN WITH. SOME OF OUR PHYSICIANS WILL NEED TO ISOLATE TO PROTECT OTHER PATIENTS. SOME PHYSICIANS UNFORTUNATELY ARE GOING TO GET SICK. I BELIEVE THERE ARE 22 HEALTH CARE WORKERS RIGHT NOW, AS OF THIS MORNING, WHO ARE IN INTENSIVE CARE UNITS BECAUSE OF COVID-19. I DON'T KNOW THE BREAKDOWN, HOW MANY PHYSICIANS, NURSES, LAB TECHNICIANS, RTs, I DON'T KNOW THAT BREAKDOWN. SO WE KNOW SOME PHYSICIANS ARE GOING TO GET SICK. AND I CAN TELL YOU THAT IT WILL PROBABLY HAPPEN VERY QUICKLY IF THERE'S A CRISIS. NOW, THAT'S WHY AT THE OMA WE SET UP SERVICES FOR PHYSICIANS TO WORK EXTRA. WE'VE GOT A MATCHING SERVICE NOW, AND THAT'S WHY, AGAIN, I CAN'T TELL YOU HOW PROUD I AM OF OUR DOCS BECAUSE 1300 HAVE ALREADY SIGNED UP FOR THIS SERVICE TO GO TO DIFFERENT AREAS AND HELP OUT IF THEY'RE NEEDED.

Steve says LET ME JUMP IN WITH THIS FOLLOW-UP QUESTION THEN. YOU MAY HAVE SEEN YESTERDAY THE MAYOR OF BRAMPTON, PATRICK BROWN, HELD A PRESS CONFERENCE WHERE HE WAS SURROUNDED BY PEOPLE WHO ARE DOCTORS BUT NOT PERMITTED TO PRACTISE IN ONTARIO BECAUSE THEY HAVE THEIR ACCREDITATION AND CREDENTIALS FROM SCHOOLS OUTSIDE THIS COUNTRY. THEY SAID THEY WERE PREPARED TO WORK. THE PREMIER HAS CALLED FOR ALL HANDS ON DECK. IF THE NUMBERS OF PEOPLE HOME-GROWN IS BECOMING A PROBLEM, SHOULD WE IN FACT GET ALL HANDS ON DECK AND ALLOW THOSE FOREIGN-TRAINED DOCTORS AND NURSES TO PARTICIPATE AS WELL?

Sohail says YEAH, SO THERE ARE MANY WAYS THAT THEY CAN PARTICIPATE. THE PREFERENCE FIRST IS WE HAVE A NUMBER OF RECENTLY RETIRED PHYSICIANS WHO HAVE VOLUNTEERED TO COME BACK INTO THE WORK FORCE. SO OBVIOUSLY THEY KNOW THE SYSTEM VERY WELL. THEY KNOW CANADIAN MEDICAL NOMENCLATURE WELL. IT'S IMPORTANT TO GET THEM BACK FIRST. WE HAVE A NUMBER OF RESIDENTS WHO ARE IN THEIR FOURTH OR FIFTH YEAR OF TRAINING WHO COULD GET TEMPORARY LICENSING. WE NEED TO GET THEM LICENSED. CERTAINLY A LOT OF THE FOREIGN-TRAINED GRADUATES, WE WELCOME ANY HELP. THEY COULD BE A PHYSICIAN EXTENDER OR PHYSICIAN ASSISTANT INITIALLY TO TRY AND HELP TAKE SOME OF THE LOAD OFF THE PHYSICIANS. THEY MAY NEED GUIDANCE OF THE PHYSICIAN. OBVIOUSLY WE MAY BE IN A POSITION TO USE EVERY ONE WHO IS WILLING TO HELP.

Steve says DORIS GRINSPUN, MAYBE I COULD GET YOU TO SPEAK TO THIS. IF WE GET INTO A CIRCUMSTANCE WHERE NURSES AND DOCTORS AND MANY OTHERS ARE FALLING ILL TO THIS VIRUS, YOU KNOW THIS HEALTH CARE SYSTEM AS WELL AS ANYBODY, YOU'VE BEEN ON THE JOB FOR A LONG TIME, HOW WILL THIS HEALTH CARE SYSTEM OF OURS RESPOND TO A SITUATION WHERE WE DON'T HAVE ALL HANDS ON DECK AND IT'S A PROBLEM TRYING TO GET ENOUGH PEOPLE TO COME OUT AND TREAT PEOPLE?

Doris says YEAH. SO LET ME TELL YOU WHAT WAS THE MAJOR FALLOUT ACTUALLY IN ITALY. THE MAJOR FALLOUT IN ITALY ENDED UP BEING THAT THEY DIDN'T HAVE NURSES FOR ICU, END OF STORY. AND IN CANADA, LET'S NOT COMPARE TO ITALY, ONTARIO IS THE LOWEST
[indiscernible] YOU HAVE HEARD ME SAY THAT. IF THE SITUATION IS THAT HEALTH PROFESSIONALS BECOME ILL IN BIG NUMBERS OR THAT THEY ARE SELF-ISOLATED FOR REASONS OF COVID, THE SYSTEM SIMPLY WILL CRUMBLE. THE GOOD NEWS IN NURSING IS THAT WE ALREADY, FOUR WEEKS AGO, LAUNCHED WHAT'S CALLED A
[indiscernible] NURSE. WE HAVE 8,000 REGISTERED NURSES OF WHICH ABOUT 900 ARE CRITICAL CARE NURSES READY TO GO IN RESERVE. WE STARTED THAT BECAUSE OF OUR EXPERIENCE WITH SARS, STEVE. AND AS YOU KNOW, I WAS IN THE POSITION ALSO DURING SARS. BUT THE PROVINCE, THE HEALTH SYSTEM IN ONTARIO WAS DEFICIENT... AND IT'S NOT JUST THIS GOVERNMENT. PREVIOUS AND PREVIOUS. WE HAVE THE [indiscernible]
JUST WITH NURSES
[indiscernible] IN THE ENTIRE COUNTRY. AGAIN, WE DON'T SEEM TO HAVE LEARNED ALL THE LESSONS OF SARS THAT WE COULD HAVE, NOT IN RELATION TO PPE, NOT IN RELATION TO THE HEALTH CARE WORKERS IN GENERAL [indiscernible] IN NURSING. SO I HOPE [indiscernible] I CAN TELL YOU WE'RE ALREADY SENDING DOZENS, DOZENS A DAY OF NURSING STUDENTS, WHICH IS IN ADDITION TO THAT LARGE NUMBER I MENTIONED OF 8,000, NURSING STUDENTS [indiscernible] AFTER THE FIRST YEAR. SO WE HAVE SENT HUNDREDS OF THEM...

Steve says I KNOW. WE HAD SOMEBODY ON THE PROGRAM THE OTHER NIGHT TALKING ABOUT IT AND SHE TOLD US THAT THEY'RE ALTER TIED... ALL TERRIFIED. IT'S GOT TO BE SCARY.

Doris says NOT TO ICU, NOT TO ICUs. WE WILL NOT SEND NURSING STUDENTS TO ICUs. THEY'RE GOING TO NURSING HOMES. AND THEY'RE TERRIFIED BECAUSE THEY DON'T HAVE THE PROTECTION. BUT SOMEHOW THESE YOUNG PEOPLE ARE VERY, VERY CLEAR ON WHAT THEY'RE THERE FOR. THEY DON'T MANY TIMES ALSO HAVE THE TREMENDOUS RESPONSIBILITY OF GOING BACK HOME TO A FAMILY. SO THAT ALLOWS THEM A DIFFERENT LEVEL OF LEVERAGE...

Steve says DORIS, I'M GOING TO JUMP IN HERE IF I CAN. WE'RE DOWN LITERALLY TO OUR LAST MINUTE AND I WANT TO ASK ROSS ABOUT THIS. WE ARE SEEING PICTURES ON THE NEWS AND ANECDOTAL EVIDENCE, PEOPLE COME OUT TO THEIR FRONT PORCHES, THEY BANG POTS AND PANS, THEY APPLAUD. WE'RE HEARING THE PREMIER OF ONTARIO CALL PEOPLE WHO ARE DOCTORS AND NURSES AND ORDERLIES OUR HEROES TODAY. DO YOU THINK THAT'S THE RIGHT WAY TO DESCRIBE THE PEOPLE WHO ARE WORKING IN OUR HEALTH CARE SYSTEM TODAY?

Ross says WELL, I THINK IT'S COMFORTABLE AND LAUDABLE AND APPRECIATED WAY TO DESCRIBE WHAT HEALTH CARE PROFESSIONALS ARE DOING, BUT WE ARE PROFESSIONALS, WE DO HAVE A JOB TO DO, AND, YOU KNOW, I'D LIKE TO SEE WHAT I DO AS DOING MY JOB. THAT'S WHAT I SIGNED UP TO DO AND I'VE BEEN DOING FOR OVER 30 YEARS. THE SUPPORT IS ENTIRELY APPRECIATED, AND WE WILL DO OUR LEVEL BEST TO LIVE UP TO THE EXPECTATIONS AND DISCHARGE OUR DUTIES AND OBLIGATIONS TO THE PATIENTS. THE PEOPLE OF ONTARIO DESERVE THE BEST POSSIBLE CARE AND THEY'RE FORTUNATE TO HAVE SOME OF THE BEST HEALTH CARE PROVIDERS IN THE WORLD AT THEIR SERVICE.

The caption changes to "Producer: Harrison Lowman, @harrisonlowman."

Steve says AMEN. I WANT TO THANK THE THREE OF YOU FOR COMING ONTO TVO TONIGHT AND HELPING US OUT WITH THIS AND OBVIOUSLY WE ENCOURAGE ALL OF YOU WHO ARE WORKING INSIDE HOSPITALS, INSIDE COMMUNITY HEALTH CENTRES, STILL STAFFING YOUR DOCTORS' OFFICES WITH NURSES AND SO ON, TO BE SAFE BECAUSE IF YOU'RE NOT SAFE, THE REST OF US AREN'T GOING TO BE EITHER. SO THANKS FOR JOINING US AND TAKE CARE, ALL.

Ross says YES. TAKE GOOD CARE. I HOPE YOU AND YOUR FAMILY [indiscernible].

Steve says THANKS SO MUCH.

Ross says BYE.

Watch: Protecting Health Care Workers' Lives