Dear VCH Leadership,
It’s been nearly two years since the harsh reality of COVID-19 entered our lives here in British Columbia. Since then, there have been nearly 300,000 confirmed cases and we are closing in on 2,500 lives lost. Our case count has never been higher, and any perceived control we had over the pandemic in mid-2020 has vanished.
Outbreaks in our Long-Term Care (LTC) facilities continue to occur, our hospital system is on the verge of collapse and our children have returned to school to almost certain exposure to the SARS-CoV-2 virus. As a concerned employee of Vancouver Coastal Health, I am continually disappointed with our reactive response to the pandemic and our inability to incorporate new evidence into our policies. I cannot think of any defensible excuse to continue to ignore the calls by a multitude of infectious disease doctors, aerosol engineers and epidemiologists urging VCH to listen to the science and take active steps to manage this pandemic.
After last week’s VCH Town Hall, it appears we have thrown up our hands in defeat, despite not having attempted any meaningful airborne mitigation strategies to address how the pathogen actually spreads. Instead, we plod ahead with out-dated and inadequate droplet precautions, cancel surgeries, and actively deny aerosol transmission while thousands more of us and our families get infected by a preventable illness. The only actions taken recently by VCH are to move the goal posts even wider on mitigation and suppression efforts, which will only serve to accelerate cases. All the while, VCH seems unwilling to acknowledge the likelihood that along with these hundreds of thousands of acute infections, there will be the unlucky 10-30% that will now have to live with a new chronic disease.
It appears to me that VCH has thrown the Precautionary Principle out the window and prefers to roll the dice with a novel coronavirus that can infect your brain, liver, kidneys, lungs and heart. At the time of writing, I have seen nothing in VCH’s approach to managing the pandemic that demonstrates our stated values: “We Care for Everyone. We are Always Learning. We Strive for Better Results.”
We care for everyone?
In March 2020 when I listened to the first VCH Town Hall, I felt pride knowing I worked for such a great organization that was going to do everything in its power to protect its workforce and the community we serve. Nearly two years later, frontline staff are fighting for the most basic of protections, children are being sent into schools without meaningful mitigation strategies, the disabled and immunocompromised are being ignored and VCH leadership still doesn’t seem to understand how COVID-19 spreads. Do we really care for everyone when we tell families with vulnerable children that COVID is “mild” in most cases? Do we really care for everyone when we send care team members back to work in LTCs only 5 days after a positive test? Do we really care for everyone when we send community health care workers into several homes a day with only a medical mask? Do we really care for everyone when we say most people will have nothing more than the sniffles? ―it’s clear the most vulnerable in our society are not included when VCH speaks of “everyone.”
We are always learning?
How can we expect to get this pandemic under control if we don’t accept the basic way in which it transmits and the most effective methods for preventing transmission?
How can the community we serve have faith in VCH when we continue to hold onto droplet dogma? How can staff maintain morale when VCH refuses to change our approach despite our failure to prevent cases amongst our own colleagues and our patients?
Certainly, in the face of the ongoing failure of current precautions, this should have led to some reflection, if not a complete overhaul of VCH’s pandemic approach. The BCCDC guideline that VCH is basing their policies on is dated September 8th , 2021. This guideline does not acknowledge aerosol spread outside of AGMPs or encourage use of N95s. It was already obsolete by the time it was published. We learn by acquiring new understanding, knowledge and behaviours. This inability of VCH leadership to learn, even with the collective knowledge and intelligence of global experts at its fingertips, is failing all VCH staff and the communities we serve.
We strive for better results?
VCH has had every opportunity to look to other jurisdictions such as New Zealand or Taiwan that have been able to successfully implement effective countermeasures for the spread of COVID-19. Instead of adjusting their approach in light of what most would consider poor and worsening results, VCH stays the course. VCH continues with the same ineffective policies and instead of striving for better results, simply changes our goal. Instead of closely monitoring community spread to limit rising case counts, VCH pushes for endemicity. We are now forced to give ground on prevention measures as the consequences snowball from our previous failures to act with swiftness and effectiveness. Instead of preventing infections in children, VCH says most children will experience a “mild” illness. Instead of keeping hospitalizations down, VCH cancels surgeries. Continually moving the goal posts in order to keep up the appearance of “better results” doesn’t count for much. VCH MHOs are openly stating the Omicron variant is mild in most cases and we shouldn’t be concerned with tracking or managing it going forward. VCH MHOs are justifying sending infectious workers back to LTC because they have medical masks on―the same medical masks that didn’t prevent the spread of COVID in the first place! VCH MHOs are being called out on social media by internationally prominent experts for spreading health misinformation.
The purpose of this letter is not to demonize VCH, its leadership, or the people that work for it. It’s an easy thing to state core values, this is a plea for us to do the hard work to honour them. Too often we’ve been told by leadership that VCH is simply following Ministry of Health guidelines so there’s nothing to be done, but VCH policies affect every VCH staff member, their families, and the communities we serve. That is where VCH owes its allegiance. It is unethical to continue employing ineffective droplet precautions when dealing with an aerosol/airborne pathogen. It is unethical to allow a novel disease to rip through our communities when we have effective tools to limit its spread but refuse to use them. It is unethical to refuse to change course when the situation is continuing to worsen. It is unethical to ignore how our actions affect our most vulnerable, our young children, and our elders.
I am writing this letter in the hope it triggers change. If you are reading this as a VCH representative in a position of power and you are thinking, “We need to find out who wrote this and nip this in the bud,” you are the real problem.
I don’t know of any VCH employee that does not want to make a positive difference. Every day, people are putting their own well-being on the line to go to work and provide care in our communities, our hospitals, and facilities. These literal heroes deserve to have leadership that follows the science to keep them and their patients safe. Lack of strong, effective, and responsive leadership has placed a tremendous burden on frontline VCH employees and the community in general. It has been most baffling to see VCH leadership not leading, but being dragged along, well behind the science and public sentiment at a time when what they most need to do is lead.
The strongest leaders are accountable for their mistakes and demonstrate they can learn and grow. So let's live up to those core values. Let’s prove we care for everyone, we are always learning and we strive for better results.
A concerned British Columbian, clinician and parent