We need a permanent surge in prevention spending to avoid the next pandemic

Wars are adrenaline surges, especially at the beginning.

COVID-19 is a crisis often described in the language of war. We shall fight it at the border. We shall fight it in the ICU. We shall never surrender.

Wars mobilize huge numbers of people and generate massive solidarity. A war is a crisis, and a crisis simplifies our priorities.

The First World War was supposed to be the war to end all wars, but humans don't always heed the lessons of history or address the issues that destroyed the peace in the first place.

When you're in the middle of a pandemic, it serves no purpose to lament the failures of prevention and early intervention. But when the crisis has passed and the bars are reopened, it will be a self-inflicted disaster if we remember only the adrenaline rush and the camaraderie, and resort to old patterns.

Sask. modelling seems pessimistic

To their credit, governments have begun to publish models of the pandemic's potential impact on health and health care, in a sense an assessment of enemy strength and the state of our military.

Saskatchewan released a three-scenario model, as summarized in the table below:

Even good models are sophisticated guesswork and this pandemic is fraught with uncertainty.

That said, even Saskatchewan's low-range scenario seems pessimistic. Italy, severely battered and with 50 times the population of Saskatchewan, still has only 140,000 cases and 18,000 deaths, the equivalent of 2,800 and 360 here. Neither figure is rising ominously.

Saskatchewan's low estimate would translate to an eventual 150,000 deaths in Italy (probably more because Italy's population is much older) which, if not impossible, seems improbable.

Alberta, with four times Saskatchewan's population and slightly more cases per capita as of April 8, estimates from 400 to 3,100 deaths under the most probable scenario, with as many as 32,000 in a worst-case situation.

No reason to fear the worst right now

A pandemic is like a 40 C January night that creates a surge in demand on the power grid. The health care system doesn't know if the temperature will drop to 10 or 80, so it has to gear up for a wide range of possibilities.

The planning is impressive: old ventilators found and new ones ordered, hundreds trained to staff phone lines, designs for a pop-up field hospital, hundreds of physicians suddenly aboard the virtual care train. It's amazing how the gridlock disappears in the face of an external menace.

Nonetheless, the high-end estimates would swamp the health care system and there are limits to how much surge capacity can realistically be created.

The mid- and low-range estimates are manageable. So far there is no reason to fear for the worst.

As things stand on April 8, we should be all right. Then what?

Global economic system to blame

For decades, health experts have tallied up avoidable harms and deaths. They've pleaded for policies, investments, and infrastructure that would either prevent communicable disease outbreaks or diminish their impact.

During a crisis, governments suddenly have time for public health and hand the microphone to the experts. After the worst is over, public health and prevention tumble down to their usual bottom rungs on the priority ladder.

The problem is global, the product of political and economic arrangements that are intentional designs, not laws of nature. The neo-conservative ideology of small government, low taxes, me-first and here-and-now thinking has allowed critical infrastructure to crumble and left people especially poor people exposed to avoidable threats.

We've seen it during Katrina, climate change and viruses. The big money lies in cleaning up the mess, not preventing it.

'A staggering negative return on non-investment'

Was the COVID-19 pandemic preventable? Probably.

China failed to regulate its clandestine animal markets and lied about the virus during the crucial emerging stages.

A co-ordinated global approach to test kit development, production and analysis would have delivered better information on the prevalence of infections and the impact on sub-populations. Investments in surveillance, quarantine protocols and case monitoring would almost certainly have reduced transmission rates.

It would have cost a fair bit to achieve optimal preparedness on all fronts, but not doing it has already cost trillions, a staggering negative return on non-investment. Had global leaders collectively done what experts have called for all along, it may not have been necessary to invoke the blunt instrument of economic paralysis to limit the damage.

We should give thanks daily to the health care and other essential service workers who bear risks to lessen ours, but governments and citizens alike should also apologize to them for being accomplices in the chain of events that conscripted them into their roles and left holes in our capacity to keep them safe.

Will COVID-19 prove to be a game-changer? Only if it's a mind-set changer.

This column is part of CBC'sOpinionsection. For more information about this section, please read thiseditor's blogand ourFAQ.

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