Ep. 33: Covering COVID with Journalist André Picard
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Health columnist André Picard has been at the Globe and Mail newspaper since 1987. Covering the coronavirus has made him the most closely-read pundit of the pandemic. Here, Picard speaks with host Shaun Francis about his belief that we have to learn to live with COVID-19, the disastrous effects of the virus on long-term care, and what the pandemic reveals about our health-care system overall.
LINKS AND HIGHLIGHTS
André Picard is on Twitter @picardonhealth.
Find a compilation of Picard’s Globe and Mail columns here.
Picard’s personal website is here.
One of the many columns Picard penned about Canada’s failure during COVID to protect those in long-term care homes is here.
Picard’s bio: André Picard is a health reporter and columnist for The Globe and Mail, where he has been a staff writer since 1987. He is also the author of five bestselling books. André is an eight-time nominee for the National Newspaper Awards, Canada’s top journalism prize, and past winner of prestigious Michener Award for Meritorious Public Service Journalism. He was named Canada’s first “Public Health Hero” by the Canadian Public Health Association, as a “Champion of Mental Health” by the Canadian Alliance on Mental Illness and Mental Health, and received the Queen Elizabeth II Diamond Jubilee Medal for his dedication to improving healthcare. André is a graduate of the University of Ottawa and Carleton University, and has received honorary doctorates from six universities, including UBC and the University of Toronto.
Please subscribe and rate us on your favourite podcast platform. Eat Move Think host Shaun Francis is Medcan’s CEO and chair. Follow him on Twitter @shauncfrancis. Connect with him on LinkedIn. And follow him on Instagram @shauncfrancis. Eat Move Think is produced by Ghost Bureau. Executive producer is Chris Shulgan. Senior producer is Russell Gragg.
Journalist André Picard in conversation with Medcan CEO Shaun Francis final web transcript
CHRISTOPHER SHULGAN
Eat Move Think executive producer Christopher Shulgan here. The media has been a key part of the way we’re understanding the pandemic. Kelly Grant and Wency Leung at the Globe and Mail, Sharon Kirkey at the National Post, Theresa Boyle at the Toronto Star. But the ultimate conscience of the nation has been columnist André Picard. Through his columns for the Globe and Mail and with his posts on Twitter, he encouraged us all to take this seriously—and lately, he’s been taking a more moderate tone. He’s our guest in this episode, which also sees the return of our host Shaun Francis, back from his summer hiatus.
CHRIS
Shaun talks to the Montreal-based André Picard about the evolution of his thinking on the coronavirus. "We have to learn to live with the pandemic, rather than live in fear of it," Picard says. They also discuss how Canada’s managed things relative to other countries and how, despite a sometimes depressing news cycle, Picard maintains his mental wellness. Hint: It involves time on Mont Royal. Here’s Shaun talking with the Globe and Mail’s André Picard.
SHAUN FRANCIS
Andre, great to have you on the show and great to be back on the show after a brief summer respite. I was actually in France, André, so I have the first-hand experience of what's going on over there. And you would appreciate, I actually sadly on my very first day, full day there, I had a road bike accident and fractured my femur at the hip. So my—I have a trainer there, he drove me to the emergency of the local hospital in Aix-en-Provence. That's where they diagnosed the hip fracture.
SHAUN FRANCIS
The health system there, the private sits side by side with the public. But even the public—I mean amazingly, I walked into the ER not having paid anything, and they took my passport, but there was no charge or request for anything. So I was able to book at the hospital a CT scan, that cost me 170 euros of my hip. And the hip surgeon who was operating—I guess he does both private and public, charged me, I want to say 80 euros for the consult. So yeah, I had some good experience with actually a really first class system. Welcome to the show. Great to have you. Thanks for all that you're doing. How's the journey been for you since February when we first heard about COVID?
ANDRÉ PICARD
Yeah, so it's kind of been nonstop. I kind of started in mid-January, I wrote my first story about this. And it's just been ongoing since then, and sort of escalating. You know, if you look at the pandemic curve, that's sort of the journalism curve of busy-ness, and then it dropped down a bit, and now it's taking off again. So we kind of follow the news pretty closely. So it's just been crazy busy.
SHAUN FRANCIS
Yeah, I know. It's really been life changing for all of us. I mean, I think Canada got off pretty well. I mean, our hospitals never did overflow, as they predicted they might. And while it sadly got into long-term care, which is where we saw most of our deaths here in Ontario, at least, it seems like we fared better than most. Do you think that was through happenstance, or do you think there were certain public policy measures that we made that other countries didn't?
AF: I don't think it was happenstance, I think it was a reflection of our system. we have this very hospital-centric system. Our hospitals have all the resources. The hospitals were scared because of SARS. You know, SARS was a hospital-based disaster. So the hospitals did exceptionally well this time, but there was a collateral damage. The price we paid is we ignored everything else. I think, you know, to me, the big disaster of COVID in Canada is what happened in nursing homes, long-term care. There's at least 7,500 deaths of seniors. And that's, to me, just a totally preventable tragedy. And it's a reflection of the system that elders are just neglected generally, and they paid the price for it in this pandemic.
SHAUN FRANCIS
What's fascinating to me is, you know, I've read here in Ontario, the average life expectancy in long term care, let's call it 13 to 14 months. So once you enter, you have, on average, 13 to 14 months, before you may pass away. And often, you do so not necessarily because of your disease, but from some contagion like influenza or pneumonia. But why did it take COVID? I mean, I'm assuming that every year we have—influenza rolls through long-term care, and you don't read about it, don't talk about it, we don't do testing for it. That's really my impression. Yet it takes COVID to illustrate, you know, how poorly we've been managing our aging population.
ANDRÉ PICARD
Yeah, I think that's what COVID has done in many instances is just shone a light on long-standing failures. And one of them is long-term care. You know, this notion that we have four people to a room, four 90 year olds with no immune systems in a room, it's just a recipe for disaster. And yes, the flu hits every year, at least we have a flu vaccine, so that protects some people, we have flu protocols. So they're used to it. And COVID is just the flu on steroids, if you will. It's just much more deadly, and that they paid the price. It's true that people don't live very long after they go into long-term care, but that's because it's just become this disaster relief place. It's just where we stick people when they're going to die. And it's not where they should be. If we're going to stick people where they're going to die, they should be big, beautiful palliative care homes, and we should take care of people instead of just warehousing them and letting them die of horrible infections.
SHAUN FRANCIS
Right. And you and I could talk about this probably at length about where we spend our money in Canadian health care, right? And where it sort of disproportionately goes versus where maybe it should go, right? I mean, to your point, you know, if we have the money, we seem to disproportionately pay for things that people might be able to afford, and then disproportionately don't invest in these sorts of circumstances which are horrifying and undignified.
ANDRÉ PICARD
Absolutely. You know, we have a sickness care system, and we wait for people to get sick, and then we spend an inordinate amount of money when it's hopeless. It doesn't make any sense.
SHAUN FRANCIS
Now let's fast forward. So we go into lockdowns, which is a public policy remedy or public health remedy that I think few people had known of previously, which was this quarantining of the healthy population. And then we come out of it based on case counts. And then we predict as we come out of it, we rightly so should see more cases increase. But it doesn't seem like there's necessarily an end in sight at the moment. It seems like we have sort of perpetual uncertainty. Is that how you're seeing it?
ANDRÉ PICARD
Yeah, I think there's a lot of uncertainty. I think that's almost inevitable with a pandemic with a new disease, where we're just learning about it and how it operates. I think what I've said all along, is that we have to learn to live with it rather than live in fear of it. And I think that's what we haven't quite grasped. We're still in this reactive mode every day and every week, and we have to be a little bit more, I think, realistic about what's going to happen and how to react to it.
SHAUN FRANCIS
Yeah, I totally agree. As I've read or heard, you know, we've never had a vaccine for a coronavirus. Never had a vaccine period for anything under four years. Even the flu vaccine is only partially effective. And we shouldn't expect COVID to go away, no matter how good a job we do at dealing with it. So this notion that we are going to get rid of it somehow, as opposed to living with it, you know, that seems to be where there's almost two camps emerging globally?
ANDRÉ PICARD
Yeah, so I think there's no question there's no magic bullet. Even if we have a vaccine, we don't know how effective it's going to be. It's going to take, the last I read, at least four years to vaccinate everyone in the world, even if we have the best vaccine imaginable, which we probably won't. So there's all these barriers. So it is going to be here for a long time. I think the big unknown, and to me the one that I really struggle with and that scientists struggle with, is we haven't figured out the immunity part of this question. You know, we thought the best case scenario of this is we thought lots of people would get infected really quickly, and we'd develop immunity, and then we'd have these immunity passports and we'd live happily ever after. And that doesn't seem to be the case. We don't even know if the immunity to this is lasting, which I think is a real barrier to a good vaccine. So I think that's the really frightening aspect of this virus is we don't know how the immunity part works.
SHAUN FRANCIS
What I've also read is we don't understand what that herd immunity threshold might even be, right? Is it 80 percent?
ANDRÉ PICARD
Yeah. And even that term, "herd immunity" is such a loaded term that, you know, the reality is there is no herd immunity to most viruses. So we have to—I think we have to not put so much stock into that idea.
SHAUN FRANCIS
Some though have said that the only way out of a virus, so in fact when you vaccinate people, that's what you're getting is herd immunity. And it either happens through vaccination, or for a virus like this, it happens naturally. If you listen to a couple professors out of Harvard and a couple out of Oxford, you know, they've recently been doing a lot of European television where they've said it's nuts, you know, if our strategy is to keep the kids home and to keep the healthy people home, and let's assume that herd immunity threshold is even 50 percent, you're by definition then kicking the can down the road and keeping the aged and the sick more at risk for a longer period of time. And so they're articulating really an age- and risk-based strategy versus a total population strategy.
ANDRÉ PICARD
Yeah, think that is our strategy now is to kick the can down the road and hope that we have a better response so we have more understanding. So I think that's been the philosophy all along. It's certainly imperfect. I don't like this notion where people are essentially saying—now this is oversimplifying what you said but, you know, saying, "Yeah. Well the old people, let’s lock them away to keep them safe." I don't think that's realistic either, nor do I think we can keep kids in the basement and out of school. I think we have to get on with our lives, but try and do it in a different way that minimizes interactions, but allows us to get on with life.
SHAUN FRANCIS
Let's run that thread down a bit. How do you live with it? And how do you kind of minimize it? I mean, because you say with some physical distancing. Are you talking—I know you're not talking lockdowns. No one likes lockdowns. You know, what's that happy medium of how society actually gets going again while living with it?
ANDRÉ PICARD
Well, I think that's the million-dollar question is where do we find a happy medium when there's such a wide diversity of views, right? I know people who have not left their homes since February. They're living in fright, even though they're young and they're healthy. And I know 90 year olds who are, like, out shopping. Ah, I'm fine. I think that's a real almost impossibility in a democratic society is to please, I was gonna say everyone, but even please half the people is impossible. I think politically, this is an unmanageable, so I just don't know. I don't know how we're going to find that solution. I think we're just going to sort of putter along until we get it sort of semi-right and people can bear it. But on the idea of lockdowns, I think the future of lockdowns is—you know, it's a very blunt instrument. We had these massive lockdowns. I think it gets more difficult each time. So I think massive lockdowns are pretty well off the table, I think we have to do much more focused ones, like maybe this community for a week, where there's a big outbreak, and then move onto another community and sort of try and herd people that way. And I think that's the future, is more specificity.
SHAUN FRANCIS
And you're certainly seeing different countries too with different policies and measures, which is pretty fascinating as well, because you can—I guess, you know, it's like a grand global experiment on what appears to be working best. You know, Sweden has been this outlier. I think it's been mis-advertised as having had no lockdown. But on the other hand, you know, I don't think they're anywhere near as stringent as other countries have been. And if you look at them now, it's not like they don't have cases, but they're flatlined versus other European countries. There's no masks, people seem to be living a pretty normal life. Have you been following Sweden?
ANDRÉ PICARD
Yeah, I think we all follow Sweden, because it is an outlier. But I think as you said, it's not as black and white as it's often made out to be. There are restrictions there. I think the really difficult thing when we compare countries is culture matters so much in health and politics. And, you know, the people's risk tolerance is a very, very different way of viewing life in Sweden than in Canada or than in Hong Kong. And we can't just say, "Oh, there's no COVID in Hong Kong. We have to be like them." We're never going to be like them. It's a very, very different society. So I think we have to be careful to learn lessons, but not think that we can magically import what others are doing. The other thing I'd say about Sweden is I think the lesson we're getting from Sweden is that we all sort of have the same challenges, and they're just coming at different times, right? So we all have this curve that—I don't believe in this first and second wave, I think it's a big wave with a bunch of ripples. We all have the ripples, and Canada and Sweden's ripples are happening at a different time. But in the end, we're pretty well ending up at the same end point. I think that's ultimately what will happen.
SHAUN FRANCIS
Sunetra Gupta, who's an epidemiologist at Oxford, talked about, she was quoted as saying it's crazy to be comparing countries like it's some sort of competition for an Emmy or an Oscar. We're dealing with a virus, right? And it doesn't know borders. It just, you know, does what it does among humans. And it's very, very dependent on, like you said, local populations and culture and pre-existing immunities and the age base. I mean, what's fascinating about Africa, for example, is that, you know, now they say they're not seeing the mortality that we're seeing, but, you know, that may not be surprising, because you wonder, well, is the data just terrible? Which it probably is. But on the other hand, there's very few people over 65, right? So their experience with this will be completely different than our experience will be or Northern Italy will be.
ANDRÉ PICARD
Yeah, absolutely. And in Africa, you know, there's so many other causes of death that come and blur the picture. We're not comparable in any way,
SHAUN FRANCIS
Right. Yeah. Tuberculosis, a million and a half people a year die from tuberculosis.
ANDRÉ PICARD
800,000 kids die of measles. That's unthinkable here.
SHAUN FRANCIS
Yeah, right. I mean, I guess this is an example of what the first world considers problems, right? Because those infectious diseases don't get any in the sort of in the first world with respect to attention. But when COVID rips through, we can't not read about it every moment of the day.
ANDRÉ PICARD
Yeah. And, you know, and we in the media are part of that problem. But we love new stuff, right? New stuff is easier to write about and things that have been killing people for millennia, well, like tuberculosis, they've always killed people. We don't really pay much attention, for better or worse.
SHAUN FRANCIS
And part of this debate about the measures we should be taking, seems in some part to emanate from this dichotomy where the infectious disease experts are solely looking at COVID and its contagion and its mortality and measures to mitigate it. Whereas the public health experts are—now there's epidemiologists among them, but from a true public health perspective, you're looking at the overall health of society, and that there seems to have been a real bifurcation there in how we're looking at it. You know, every country seems to be operating slightly different. I mean, the UK I watch closely, and Boris Johnson, I mean, it's almost every other week, there's a new policy, and they make them overnight. And I was just asking someone the rule of six, is that the same six? Or is it—in other words, do you just travel with your bubble when you go to a restaurant, which you’re still allowed to do? Or is it—you know, can you meet friends but never have a group larger than six? And they didn't know the answer to it. I mean, there's so much confusion.
ANDRÉ PICARD
Yeah. No, I think the politicians are in an unenviable position. They're trying to please everyone. And they really want to open up the economy because they need that, but they don't want people to be infected. And they worry about perceptions, I think they're in an impossible position. And I think actually, the countries that have done the best have sort of kept the politicians out of it for the most part and said, "Listen, we're going to let public health run this." You know, the more independent public health is, I think those countries have had better outcomes, because they don't have that dilemma and the being pulled two ways at once or 10 ways at once.
SHAUN FRANCIS
I mean, that seems to be the Swedish model, where this guy Tegnell is, people are tattooing him. I mean, I'm sure some people hate him, but some people love him so much, apparently he's been tattooed on their bodies. What are the long-term consequences? How does this change healthcare? Let's just start with that, healthcare in Canada. Does anything change because of this?
ANDRÉ PICARD
Well, hopefully. Hopefully, it's, you know, what we talked about earlier is I think this has exposed the weak points in our system, and hopefully we address them. Now that's when I'm on a good day, I feel that. That's the best-case scenario. On a bad day, I look back at, you know, other disasters we've had, and we kind of just fall back into our old ways. And that's what I fear. For example, I'm really interested in the elder care part of this, you know, because that's where the disaster has been, right? So I think to me, the worst-case scenario would be we just build more long-term care homes, right? Well, lots of people have died there, so let's build more of them. I'm hearing that, and I think that's not the solution. The solution is we have to rethink this fundamentally. Should people be living there in the first place? Maybe we should be investing half that money in home care, which is what other countries who are doing much better have done. You know, they don't have these homes. And then if we're going to have these homes, as I said before, maybe they should be palliative-care facilities, or hospices rather than pretend they're someone's home. It's not someone's home if you're just there dying for a year. So I think we have to allow ourselves to fundamentally rethink things. And if we do that, I think we'll come out of this much better.
SHAUN FRANCIS
And are there other longer-term societal implications from your perspective?
ANDRÉ PICARD
Well, I think again, the other thing it's really shone a light on is inequalities in society. So, you know, who's getting COVID? It's frontline workers, immigrant workers, people, racialized workers. And, you know, I think we have to rethink that. How are they—in the health system, they are the people in our health system everyday too, not just with COVID. So I think we have to rethink how we deliver care. I think in Canada, this hospital-centric system, I think has served us well, to a certain extent during COVID. But I think we should also think, well, how did it fail us? It failed us with all these seniors who died by—you know, we stopped delivering home care in Canada when COVID came along. That makes no sense. We should have been doing the exact opposite, because people are much safer in their homes. So we literally took people out of their homes and sent them to nursing homes where people were dying by the hundreds. And, you know, crazy policies like that. So hopefully, we can learn from this to reshape the system a little bit. And again, all stuff that we've known we should be doing for 50 years, maybe this will give the impetus to actually do it.
SHAUN FRANCIS
If you are king of Ontario, for example, given it's a provincial system in Canada, and you have finite resources, which of course we all do, how would you reapportion them in our health system? Because, you know, I've heard you, right? More for our aging population. But given the scarce resources, what would you do?
ANDRÉ PICARD
Yeah, so I think—I've written about this for many years, I could give you a book-length answer on it. But the short answer is, I think, we just have to think more in a holistic way rather than this—we have a very siloed system. So I think what I would do is mostly structural stuff. I know that's boring, but I think the structure really matters to how we deliver care. So I think we have too many hospitals, I think we have too many institutional homes where old people live. So I think we have to invest more in community care. I think we have to make the system we have more seamless, you know, so that the money follows the patient rather than the money going to stuff, doing stuff to people. The money should follow keeping people healthy. That should be rewarded in our system. So lots of pretty fundamental stuff. You know, it sounds like a massive amount of stuff we have to do, but to me, the good news is we do all this stuff in Canada, we do it in these little islands of excellence all over. And we just have to—I think we have a real problem scaling up success. We just like to perpetuate stuff that's kind of working, mediocre, because that's easy. And I think we have to just take that next step and take all our little success stories, our land of pilot projects, and make them the norm. So I think we have all the elements and all the money we need for an excellent health system, but it's just putting the pieces together.
SHAUN FRANCIS
And could that ever happen in our political system? Or is it just grind along somewhat hopelessly until, I don't know, something happens?
ANDRÉ PICARD
Well, I think there's no reason it shouldn't happen. You know, it happens in other countries. We have much better health care systems in Europe, in the Nordic countries, and they don't spend more money than us. They're not that dramatically different from us. They're just better managed. I think our fundamental problem is our system is micromanaged by politicians. To me, the best health systems in the world aren't the ones that spend the most, they're the ones that have professional managers who have the power to manage, and the politicians mind their own business. That's to me what distinguishes Europe from North America is they're just well-managed corporations that run this and they happen to be publicly funded.
SHAUN FRANCIS
Yeah, and again as I articulated, that was my experience in France. I don't know how they do it, but I took a 170-Euro CT scan within 24 hours. I thought that was pretty fantastic. So André, you've written in a recent column about the—really, the endless loop of bad news and its effect on the medical community and the community at large. I mean, you can't turn it off as some people try to. How do you deal with that?
ANDRÉ PICARD
Yeah, I think lots of people are suffering from this, quote, "COVID fatigue." You know, it just seems endless, especially depressing right now, because we see the numbers climbing back up. You know, we thought the worst was behind us. So it is hard. Now I don't personally like to complain. I think I know I'm in this position of privilege. I'm someone who has a job during this. You know, I know a lot of people who are suffering because they don't work, etc. So I don't like to complain. But it at times it becomes overwhelming, right, for everyone. And I think what you have to do is, at some point, you have to turn off the news. You have to just sort of go out there, and I luckily live right beside Mount Royal in Montreal, and I go up there at dawn every morning for my morning run. And that's my time to unwind and to forget about the news for that hour or so a day. And we all have to find that balance in our lives. There's not a lot of balance these days, but we have to find these outlets to protect I think our—not only our physical health, but our mental health. I, last year, did an event with Jon Kabat-Zinn, the sort of the guru of mindfulness. And I have a collection of his books. And I've been reading those in these times sometimes to remind me—you know, he has this great quote saying, you can't control the waves, but you can learn to surf. And I think that's sort of become my motto for this pandemic is learning to surf with what comes along each day.
SHAUN FRANCIS
Yeah, I know. It's probably never been a time of sort of greater uncertainty for our generation. And yeah, those experts and philosophers of old, right, we can really live by some of those words.
ANDRÉ PICARD
Yeah. I think I think the other people we can learn a lot from is kids. Kids are infinitely resilient. And they've been amazing during COVID, right? So it's all this, like, kids are going back to school. I live right beside this primary school, and I'm kind of amazed. You see the kindergartners come in and they've got their masks and stuff. And it's just normal for them, right? Like, us old people are all freaking out. There's never been anything like this. And for them, it's like, hey, this is the new normal. And, you know, school is something dramatically new for them. And a mask? So what. In the grand scheme of things, that's nothing. So I think I get some hope from that too, seeing the kids having fun and going about their lives, and they adjust.
SHAUN FRANCIS
Yeah. No, they definitely do adjust. André, thanks very much. Really, really enjoyed speaking with you, you do an immense service for the media, for being sort of a calm, informative voice on so many topics and a great advocate and relentless advocate for Canadian healthcare. So I really appreciate your time and everything you're doing. And looking forward to getting back on when COVID—when we've all agreed COVID actually is over.
ANDRÉ PICARD
Thanks, Shaun. And I hope you heal well.
SHAUN FRANCIS
Yeah. Thank you. Yeah, I'm working on it.
CHRIS
That’s a wrap for this episode of Eat Move Think. André Picard maintains a thriving Twitter feed at @picardonhealth. Check out the podcast website for highlights and full episode transcripts at eatmovethinkpodcast.com. Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg. Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow Shaun on Twitter and Instagram @Shauncfrancis—that's Shaun with a U—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.