Fears of out-of-town workers spreading COVID-19 in Kamloops are unfounded

Some Kamloopsians worry that the 50 pipeline workers from out of town will bring the Cov2 virus into our community. That number of workers will swell to 600 by August.

Pipe stored in Kamloops. image: National Post

The Site C dam site serves as an example. After concerns were raised in March, several workers went into self-isolation. Even though none of the workers had been tested positive at the time, people in the closest town of Fort St. John worried that the hospital would be inundated. Town councillor Trevor Bolin said the site should be shut down and added:

“If there was an outbreak at Site C, our hospital would be inundated with patients that we could not handle, that our health system couldn’t handle, with the seven ventilators that we have in the community.”

Months later, one case of COVID-19 has been recently indentified at Site C. That person has been isolated before having contact with other workers. Just one case. Fort St. John’s hospital has not been inundated.

No COVID-19 cases have been indentified in Kamloops pipeline workers, despite ongoing work in preparation of the new pipeline near Ord road. This month, crews will start to pull the new pipeline under the Thompson River.

Last weekend saw a dramatic rise in COVID-19 cases in the interior of B.C. So why hasn’t the presence of 50 pipeline workers not resulted in an outbreak in Kamloops?

The answer is precautions. It is not in Trans Mountain’s best interests to have a skilled, expensive workforce out of commission.

After the COVID-19 pandemic hit, Trans Mountain delayed construction in Kamloops for two months to ensure its pandemic safety measures were in place, including temperature checks (Kamloops This Week, June 2, 2020).

In addition, Trans Mountain will implement precautions such as one person per hotel room, spacing for dining, extra cleaning requirements and maintaining spacing during transport to worksites.

The economic benefits to Kamloops are substantial. Seventeen hotels and motels in Kamloops will accommodate Trans Mountain’s workforce. Construction spending in the Kamloops area is expected to be more than $450 million over the next two years. The workforce will spend an estimated $40 million for goods and services at local businesses.

There is no room for complacency when dealing with Cov2. Contagion is an obvious risk with this virus. Kelowna’s experience is a cautionary tale. On the Canada Day weekend an advisory for downtown Kelowna was posted after eight people had tested positive following two house parties involving visitors from other parts of B.C. That number quickly grew to 13 on July 13, then to 35, and now to 60 plus.

According to reports, those parties were not wild free-for-alls like some Texas bar scene.  The parties were mostly done with the right intent with the numbers were kept small. The mistake they made was not the high numbers at any one time but that there were different people every night.

The fact that there are no COVID-19 cases in pipeline workers in Kamloops is no accident. With careful precautions, Kamloops can economically benefit without a COVID-19 outbreak from the workers.

What will cause an outbreak is the assembly of large numbers of people who blissfully don’t practice good pandemic hygiene.

Can B.C. dodge eye-watering, throat-choking wildfires this summer?

Remember last summer when we rubbed shoulders at concerts and live theatre; cheek-to-jowl at our favourite restaurants and watering holes? Remember when we mingled in crowds at Music in the Park, Ribfest, and Hot Nite in the City –outside?

Image: New York Times

Then think of the wildfires of 2017 and 2018, when we huddled indoors, trying to escape the smoke that hung over Kamloops like a grey shroud seeping into every crevice of our homes.

I remember the wildfires of 2017. The skies were clear when I left Merritt after spending a few days camping nearby. I could see a wall of smoke as I approached Kamloops. When I entered it, my eyes began to water and my throat was irritated. Kamloops was right in the path of the Elephant Hill wildfire burning west of the city near Ashcroft. It was like a funnel directed by the prevailing winds right at Kamloops.

The Elephant Hill wildfire was the largest and most destructive wildfires in B.C.’s history. Then came the wildfires of 2018 which was even worse when an area 44 times that of Kamloops kilometres burned. There was no escaping the smoke that year. The province was blanketed with smoke.

The outlook for last year looked bad. Experts forecast more of the same because of a build-up of combustibles on the forest floor. But contrary to predictions, 2019 turned out to be wonderful.

Again this for this summer, the forecast appeared bad. Now I’m holding my breath, hoping the forecast is not true. Things look promising with long-range forecasts for the remainder of July being relatively cool and damp according to theweathernetwork.com.

And the Meteorological Service of Canada predicts the same:

“Summer is currently on hiatus it would seem. It will ‘return’ (was it ever here?) at some point in the future. Certainly today and looking into next week even, we are not seeing any signal, or sign that the weather will significantly change. Normally, by this time in the annual calendar, we would have seen one, perhaps two, dominant ridges of high pressure. This would have brought about long stretches of hot, dry weather (July 10, 2020.”

To lament the absence of a summer with hot, dry weather displays poor memory of what those tinder-dry conditions can bring. Cool, damp weather needs to be celebrated.

The isolation brought on by the COVID-19 pandemic had us huddling indoors earlier in the spring but at least now we can go outdoors and enjoy nature’s beauty, albeit with physical isolation.

It would be unbearable if we were physically isolated by the pandemic and driven indoors by wildfire smoke.

Every week of relatively cool, damp weather is one week less of the potential wildfire season. Bring it on.

Kamloops has a reputation of delivering hot, dry summer days. That’s something I enjoy. But I would like to see Kamloops promoted as a place where you can safely breathe in the summer.

And next year, when the pandemic hopefully abates, my wish is that we can crowd together to and enjoy each other’s company in the smoke-free air as we did last year and with a bit of luck, this year as well.

 

This is the way the pandemic ends

This is the way the pandemic ends. Not with a bang but a whimper.*

The novel coronavirus, SARS-CoV2, is sweeping the globe like wildfire killing hundreds of thousands in its wake. But its months are numbered. In a year or so, it will become part of the suite of viruses that regularly infect us –it will become endemic.

image: pingtree.com

It will be demoted to a common coronavirus, one of the seven known human coronaviruses. Four are part of the regular group that cause one-third of common colds.

But this virus will be remembered as being distinct from its older brother, SARS-CoV which caused the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003. This new coronavirus is sneaky.

The older coronavirus was conspicuously clumsy. Infected people became infectious after they became sick. They were flagged with the disease before they passed it on. Infected people with serious problems breathing and a fever showed up at hospitals where the disease was largely contained. Epidemiologist Benjamin Cowling of the University of Hong Kong says:

“Most patients with SARS were not that contagious until maybe a week after symptoms appeared (Scientific American, June, 2020).”

When sick people are not contagious, they can be quarantined before spreading the disease. Containment of SARS worked so well that only 8,098 cases were reported globally with 774 deaths, mostly in Toronto and Hong Kong.

SARS-CoV’s evil younger brother, this one that causes COVID-19, uses stealth. Infected people spread the disease before they show symptoms. You can be asymptomatic and feeling fine, all the while shedding the deadly virus. No warning signal until after the damage is done.

Hospitals are particularly vulnerable. When I went to the emergency section of the Royal Inland Hospital in Kamloops to get stitched up, I was intercepted at the entrance and asked if I had any of the COVID-19 symptoms. I didn’t but I could have been infected and spreading the virus. They took a chance on treating me, for which I’m thankful.

Political leaders can play a part, or not. Trump twiddles as the pandemic wildfires rage across the land of the free. Beachgoers merrily flock together in Florida and California. As protesters defend their constitutional rights to carry guns and not to wear masks, the novel coronavirus revels in the merriment.

While SARS-CoV-2 enjoys its killer notoriety now, soon it will be just another garden-variety nuisance.

The most famous example of a virus’s fall from infamy is the Spanish flu pandemic caused by the H1N1 virus from 1918 to 1919. In over two years and three waves of assault, the pandemic infected 500 million and killed nearly 100 million.

Health officials didn’t have the control measures we have today, simple measures like school closures and physical isolation. It ended only when enough people survived the pandemic with immunity.

Governments have demonstrated their worth during the pandemic, or not. Canada is doing a good job but our neighbours to the south, not so much.

Sarah Cobey, epidemiologist at the University of Chicago, says: “The question of how the pandemic plays out is at least 50 percent social and political.”

The other 50 percent comes from science in the development of a vaccine. Only then will CoV-2 be completely vanquished.

Until, vigilance is the adage. CoV-2 will sneak up on you when you least expect it.

* My apologies to T. S. Eliot, author of the poem “The Hollow Men” (1925).

This is the way the pandemic ends

This is the way the pandemic ends. Not with a bang but a whimper.*

The novel coronavirus, SARS-CoV2, is sweeping the globe like wildfire killing hundreds of thousands in its wake. But its months are numbered. In a year or so, it will become part of the suite of viruses that regularly infect us –it will become endemic.

image: bbc

It will be demoted to a common coronavirus, one of the seven known human coronaviruses. Four are part of the regular group that cause one-third of common colds.

But this virus will be remembered as being distinct from its older brother, SARS-CoV which caused the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003. This new coronavirus is sneaky.

The older coronavirus was conspicuously clumsy. Infected people became infectious after they became sick. They were flagged with the disease before they passed it on. Infected people with serious problems breathing and a fever showed up at hospitals where the disease was largely contained. Epidemiologist Benjamin Cowling of the University of Hong Kong says:

“Most patients with SARS were not that contagious until maybe a week after symptoms appeared (Scientific American, June, 2020).”

When sick people are not contagious, they can be quarantined before spreading the disease. Containment of SARS worked so well that only 8,098 cases were reported globally with 774 deaths, mostly in Toronto and Hong Kong.

SARS-CoV’s evil younger brother, this one that causes COVID-19, uses stealth. Infected people spread the disease before they show symptoms. You can be asymptomatic and feeling fine, all the while shedding the deadly virus. No warning signal until after the damage is done.

Hospitals are particularly vulnerable. When I went to the emergency section of the Royal Inland Hospital in Kamloops to get stitched up, I was intercepted at the entrance and asked if I had any of the COVID-19 symptoms. I didn’t but I could have been infected and spreading the virus. They took a chance on treating me, for which I’m thankful.

Political leaders can play a part, or not. Trump twiddles as the pandemic wildfires rage across the land of the free. Beachgoers merrily flock together in Florida and California. As protesters defend their constitutional rights to carry guns and not to wear masks, the novel coronavirus revels in the merriment.

While SARS-CoV-2 enjoys its killer notoriety now, soon it will be just another garden-variety nuisance.

The most famous example of a virus’s fall from infamy is the Spanish flu pandemic caused by the H1N1 virus from 1918 to 1919. In over two years and three waves of assault, the pandemic infected 500 million and killed nearly 100 million.

Health officials didn’t have the control measures we have today, simple measures like school closures and physical isolation. It ended only when enough people survived the pandemic with immunity.

Governments have demonstrated their worth during the pandemic, or not. Canada is doing a good job but our neighbours to the south, not so much.

Sarah Cobey, epidemiologist at the University of Chicago, says: “The question of how the pandemic plays out is at least 50 percent social and political.”

The other 50 percent comes from science in the development of a vaccine. Only then will CoV-2 be completely vanquished.

Until, vigilance is the adage. CoV-2 will sneak up on you when you least expect it.

* My apologies to T. S. Eliot, author of the poem “The Hollow Men” (1925).

Should B.C. bubble-up with neighbours?

Canada’s four Atlantic Provinces have agreed to open their borders to each other on July 3, creating a regional pandemic bubble. What are the opportunities for B.C.?

image: Britannica

The Atlantic bubble means that travellers within the region will not be required to self-isolate after crossing the borders. Travellers will have show proof of residency with a driver’s licence or health card.

As we know from creating bubble families, picking who you want to bubble up with is tricky -a bit like asking someone to dance. Who is desirable? Are they available? Do they practice safe social intercourse?

For the Atlantic Provinces, it was easy. Not only are they attractive because they form a natural geographic area but also there are no active COVID-19 cases, with the exception of New Brunswick and that was caused by a doctor who was infected upon returning from Quebec. They form a natural regional bubble that’s desirable, available, and safe.

Countries can bubble up with neighbours as well. While not quite bubbles, the European Union has loosened border restrictions this week to 15 countries including Canada but not the U.S. Russia, or Brazil. The loosening includes countries that have controlled the spread of COVID-19.

But while some countries are desirable, they are not available. New Zealand makes an appealing partner because they have largely contained the virus. But they want nothing to do with bubbling after three new travel-related cases were reported.

Canada’s travel and tourism industries want to bring more countries to the dance floor. In an open letter to Prime Minister Trudeau in the Globe and Mail, they say 14-day quarantines and travel restrictions are “no longer necessary” and are “out of step with other countries across the globe,”

Trudeau objects, saying that lifting travel restrictions now “would lead to a resurgence that might well force us to go back into lockdown.”

Epidemiologists agree with Trudeau. Lauren Lapointe-Shaw, general internist and clinical epidemiologist says: “Travel is the one segment of the economy that probably has the greatest potential to derail our ability to stay out of lockdown.”

The problem is not just being in a metal tube hurtling through the sky with dozens of other passengers, it’s the dangers that await you on landing. “When people travel, they don’t travel to stay indoors with their close travel companion at their arrival destination,” Dr. Lapointe-Shaw said. “Travel does have an outsized effect on the ability of outbreaks to grow quickly.”

When B.C. is stares across the dance floor at potential partners to bubble with, there are Alberta and Washington State.

B.C.’s relations with Alberta are a bit prickly. Last month, travelers with Alberta plates have received nasty notes and had tires slashed. One Alberta traveler had a note attached to his windshield reading: “F-ck off back to Alberta! Supposed to be not doing non-essential travel.” Soon after, he also noticed a large scratch on the side of his car.

The love with Alberta just isn’t there.

Washington State forms a natural geographic area with B.C. It’s part of Cascadia, a loose association of bioregions along the West Coast. While appealing, Washington is off limits as the U.S. spirals into an every-growing deadly pandemic.

It looks like B.C. will have to sit out this dance.

Emergence of Canada’s economy from a coma must be done carefully

Canada’s economy has been placed in an induced coma since it was infected with the novel coronavirus. Arousal from the coma must be done carefully to avoid a devastating setback.

The Dirty Thirties. Image: Canadian Encyclopedia

Keeping the comatose economy on life support has been expensive. We’ve blown the wad on the first wave of the pandemic to the tune of one-quarter trillion dollars. We can’t afford an expensive relapse.

Canada’s debt, manageable now, could lead to consequences worse than that of the Dirty Thirties if the recovery is not done right.

Royal Bank of Canada CEO Dave McKay puts it this way: “We can’t screw this up because we don’t have enough fiscal firepower. We can’t fail the re-entry. We don’t have enough money for a massive step back.”

Bringing the economy back to life is as much an art as a science; a little wakefulness here, a few stimulations there. Hurry up and wait to see what happens. The patient’s urge to run must be tempered with the pitfalls that lie ahead.

Deep thinkers are at work. We need to listen to the advice of health professionals, who understand the mortal dangers of this virus, and to economists who appreciate the long-term social and economic costs of tanking the economy.

Unemployment already exceeds anything in the past century, except the Great Depression. The sheer number of people affected is staggering. A projected 8.5 million Canadians will receive $2,000 monthly from the Canada Emergency Response Benefit (CERB). That’s nearly 40 per cent of Canada’s work force.

Unlike Employment Insurance, the CERB does not require recipients to look for work. It doesn’t require them to accept a job offer. Recipients can only earn up to $1,000 a month, anything more and the CERB is lost.

The disincentives to find work are part of the induced coma. Rest and relaxation is the prescription. Workers must stay home to avoid contagion. To encourage workers to help wake up the economy, they should be allowed to keep a larger portion of the benefit as they return to work with a gradual clawback as earnings rise.

This would be a step towards a basic annual income for all Canadians –an idea supported by both the right and left ends of the political spectrum. Sheila Regehr, chair of the Basic Income Canada Network, is urging just such a change. The group issued a policy paper in January that proposed a $22,000 annual benefit for a single adult. Under that proposal, benefits would be reduced by 40 cents for each dollar of earnings and would be eliminated entirely after a person’s income rose above $55,000.

Child care is another knotty problem. Parent returning to work need affordable child care, but they need to assured that they are not sending their children into harm’s way. Any uncertainty about public-health risks at daycares and schools will prove to be a significant disincentive for many Canadians to return to work.

The next decade may well be known as the Dark Twenties. The economy that awakes from the induced slumber might not recognize its former self.

Stop the misinformation about the COIVID-19 vaccine now

In an information vacuum, all kinds of thoughts flourish.

image: WION

Canadians generally favour vaccines but doubts persist. In a recent survey, 15 per cent of Canadians and 20 per cent of Americans said they would not get a COVID-19 vaccine if it were available.

Why would you not get vaccinated against a deadly disease? Let’s count the reasons.

Some of it is simply “needle fear.” A study published in the Journal of Advanced Nursing found that 16 per cent of adult patients avoided the flu shot because of needle fear (Globe and Mail, May 22, 2020).

Then there is the fear from rushing to produce the vaccine. Political pressure is being put on researchers in the U.S. and China to come up with the first COVID-19 vaccine. Will such a vaccine be thoroughly tested for efficacy and long-term side effects?

There is the politics of choice: “Why should I be forced to get a vaccination if I don’t want to?” Well, public health is not a personal choice. In a universal health care system like we have in Canada, we all pay for the careless choices of individuals.

The psychology of “fear transfer” is a factor. Once we have exhausted our fears about the actual virus, fear of the vaccine becomes the greater threat.

In the U.S., presidential election politics are at play. President Trump has whipped up anti-lockdown sentiments in states that are reluctant to open the economy too quickly which would result in more COVID-19 deaths. Anti-lockdown protestors have also been pushing the anti-vaxx message.

Some Canadians are reluctant to have vaccinations too but they are not necessarily anti-vaxxers. They just want more valid information. In the absence of valid information from reliable sources, parents will turn to dubious sources such as those found on Facebook.

Anti-vaxxers tend to be concentrated in private or religious schools, or in home-schooling, and they live in a rural area or a community with a small to medium-sized population.

Another source of reluctance is irrational reasoning. “Why should I get a vaccination for a disease that doesn’t exist?” Of course, the disease, such as measles, has been suppressed because of vaccinations. Without vaccinations, they come back.

More wishful thinking is that: “if enough people are exposed to the COVID-19 virus, they will develop herd immunity and vaccinations won’t be required.” The problem is that we don’t know whether exposure to the virus develops resistance or for how long.

A federal agency, the Canadian Institutes of Health Research, has recently funded research into the psychological factors of the pandemic. Researchers will monitor social media for concerns and for conspiracy theories being raised about the pandemic, including those about a future vaccine.

The researchers, Eve Dubé, of Laval University and Steven Taylor of The University of British Columbia argue that rational, science-based messaging about the vaccine needs to begin early, especially at a time when the public is saturated with health information about the pandemic.

“It is important to be pro-active, instead of leaving an empty space for vaccine critics to fill the information void,” said Eve Dubé, “Once the trust in vaccination is weakened, we are vulnerable to crisis.”

Reliable messaging about the COVID-19 vaccine has to start now.

Bubble families emerge from pandemic

Provinces are allowing the expansion of family units to include friends and family. The selection of who’s in and who is out is tricky.

image: Money Crashers

B.C.’s provincial health officer, Dr. Bonnie Henry, said last week: “I believe that we are at a point where we can increase our social contact, and we can have more people in our close circle of family and friends.”

Singles can pair off with another single or with a couple and socialize exclusively with them.

Families can also pair off with other families. But it has to be done carefully. As soon as you add others to your circle, you add all the people which they are connected to which amplifies the risk.

Before you extend your bubble family, sometimes called a cohort family, you need to check with them to ensure that their degree of virus avoidance matches yours. It would be a mistake to extend your circle to a family just because they’re “cool” as Professor Lucia O’Sullivan found out.

O’Sullivan wasted no time inviting her “best friend family” to join forces after New Brunswick allowed bubbling. The families lived nearby, traveled together, spent Christmas Eve together and have children of a similar age (Globe and Mail, May 2, 2020).”

“Saturday morning,” said O’Sullivan, “I was gardening and I thought, uh oh, I better contact them and see. I felt rushed because I thought everyone’s going to ask them. They’re like the coolest family in town. It’s like asking someone to the prom: Were they already taken?”

It turned out that they were taken. Instead, the “best friend family” had bubbled up into a group of eight: two husbands, two wives and four kids.  O’Sullivan’s parents paired up with her sister. Her best friend family’s parents decided not to break their quarantine. Bubbling can leave you feeling left out.

Bubbling requires commitment, like going steady or being in a monogamous relationship. For instance, the chances of contracting a sexually transmitted disease is extremely low in a monogamous relationship, but increases sharply if one or both partners cheat.

You can’t play the field. Dr. Henry says: “What you can’t do is see two people one night and four different people the next.”

Bubbling reduces the isolation of singles. Daycare and work-time access improve.

An Edmonton couple, both who work and have a two-year old, bubbled with another working couple with two-year old forming a makeshift family of six.  They care for the children on alternate days: While one parent goes for walks, or does arts and crafts with the kids, the other three parents can work a full shift uninterrupted. They rotate a biweekly grocery run, one person shopping for both families. As a courtesy, they text message each other whenever anyone leaves the house for errands, a walk or a drive.

Mental health improves with socialization. Some sense of normalcy returns to these crazy times.

However, what legacy will remain once the pandemic is over. Will you remain close to those in your bubble?  Will those not included feel slighted or shunned?

And how will you feel about the “others’” outside your circle? The stain of disease is deeply engrained in the human psyche. If they didn’t meet your standards of hygiene, can they ever be trusted?

 

Ageism contributes to poor care in long-term facilities

The COVID-19 pandemic has made it clear the disparity of care for residents in long-term care compared to that in hospitals. An indicator of that disparity is the fact that 80 per cent of COVID-19 deaths have been in long-term care homes so far.

image: mybetternursinghome.com

I’m avoiding the label of “the elderly” for these residents for reasons I’ll explain later.

The reduced long-term care is not for lack of dedication by workers but for political reasons. Barb Nederpel, President of Hospital Employees’ Union, told me:

“The pandemic has brought the problems in how we treat seniors and those who care for them into sharp focus. Twenty years ago, workers in long-term care earned the same wages and benefits regardless of their employer. Through privatization and contracting out, the BC Liberals forced thousands of these workers into lower paid jobs. Many took second or third jobs to make ends meet. To keep seniors and workers safe during the pandemic, public health officials are limiting workers to single sites and we’ve secured agreement from government to increase those wages back to the industry standard.”

For ideological motives, the BC Liberals argued that private care facilities could operate more efficiently. Privatization created a multi-tiered system where those who could pay more got better treatment.

The trouble with this model is that in this market where there is a labour shortage, workers will go to where they are paid more -leaving places that pay less short-staffed. The residents who call those places home suffer.

Ageism is at the heart of deaths in long-term care homes. The reduction in worker wages reflects the degree that we care about the residents of those facilities. The death of “the elderly” is seen as no big deal. People get old and die. The meme “Boomer Remover” that has been circulating reflects the dark humour of ageism.

To dismiss residents as “the elderly” robs them of their dignity as fathers and mothers, grandfathers and grandmothers, brothers and sisters. Let’s call them persons; persons who love and are loved, who laugh and cry, and make a difference in the world. Age should be just one aspect of anyone’s life, not a defining attribute.

Hospitals are relatively well-prepared for the pandemic in contrast to long-term care homes says Rona Ambrose, former Conservative minister of health and minister during the Ebola crisis in 2014:

“Our hospitals are ready. Doctors and nurses have been properly trained and are waiting to be called in for COVID-19 duty. Personal protective equipment is available, and, if not, it’s on its way.

“Meanwhile, caregivers in many long-term care homes are underpaid, lack training and don’t have PPE. How could this have happened when we knew from day one that long-term care homes would be centres of COVID-19 infection? How could we have failed our care-home residents so badly? There are hundreds of these facilities dealing with outbreaks across Canada (Globe and Mail, April 13, 2020).”

Post-pandemic, we will need to reset our values so that workers’ wages coincide with the value that we place on them. It’s too bad that it takes a pandemic for that disconnect to sink in. There has been an outpouring of appreciation for workers who have put their lives on the line to serve us. Let’s back up that appreciation for long-term care workers with a living wage.

Ventilator treatment for COVID-19 leads to questions of end-of-life

Now is the time to talk to your friends and family about your prospects of survival should you become deathly ill. But if you’re like me, you’d rather not start the conversation.

image: The Conversation

If you are unfortunate enough to catch the new coronavirus and are placed on a ventilator, the odds are two-to-one that you will die. And if you survive, your quality of life could be seriously compromised.

The numbers are still coming in, but they don’t look good. One review conducted in China said that 86 percent of COVID-19 patients put on ventilators eventually died. In the UK, about two-thirds of ventilated patients died.

From an optimistic perspective, you have a chance of living so why not take it?

In the most serious cases, COVID-19 takes over the respiratory system and leads to pneumonia. Your lungs fill with fluid and you can no longer capture oxygen; you begin to suffocate and are left literally gasping for air.

A ventilator seems like the obvious choice but it’s extremely invasive. You are sedated and muscle-paralyzing drugs are given -the procedure is so aggressive that you would not tolerate it otherwise. A 10-inch tube is inserted into your lungs with the hope is that the oxygen will prevent you from suffocating to death before the body’s immune system is able to rally, overwhelm the virus and return you to health. That’s the hope.

Kathryn Dreger, an internist and professor of medicine at Georgetown University, describes a common result:

“The amount of sedation needed for Covid-19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.”

Given that prospect, you will have to make the agonizing decision to ventilate or not. And you will have to decide at a time when you are least able to do so, when you are very sick and perhaps not thinking clearly.

Your doctor can help you decide but it’s not a purely medical decision. These are highly personal decisions affecting your future quality of life.

As difficult as it may be, you should give advance directions regarding invasive treatments.

As I watched my wife die of breast cancer seven years ago, the need for such directions became painfully clear. She had signed a “do not resuscitate (DNR)” order. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if her breathing stopped or her heart stopped beating. She died without any of those interventions.

When I talked to my doctor shortly after her death about a DNR order for me, he was concerned; worried about my apparent preoccupation with imminent death when I seemed perfectly healthy.

The best chance that a DNR will be honoured is if you have talked to your doctor and family. But kids have trouble dealing with their own mortality, let alone yours.

In our culture where talk of death ends a conversation, it’s easier not to start the conversation.

I would not consider a life hooked up to tubes, or bed-ridden with recurrent infections, worth living but I procrastinate in getting a DNR order.

One day when I’m least capable making the decision, I’ll probably regret my procrastination.