Canada’s housing agency tries to slow the exodus from big cities

Canada Mortgage and Housing Corporation (CMHC) is attempting to curb the outflow from big cities.

iamge: HuffPost Canada

Toronto saw a net loss of 50,375 last year as people moved to surrounding small cities; places such as Oshawa where the population increased by 2.1 per cent according.

Municipalities around Montreal also experienced growth with Farnham seeing an increase of 5.2 per cent.

People are migrating out of Vancouver to small Interior cities, as well. In Kamloops, home sales totalled 3,044 units last year, up 6.4 per cent from 2019. Sales were brisk with homes on the market just of 2.6 months on average, compared to 5.8 months the previous year.

The pandemic has resulted in millions of new workers from home. As of December, 2020, 4.8 million Canadians worked from home. For 2.8 million of those, working from home was a new experience.

The influx of highly successful, mid-career professionals and knowledge workers has an effect on the character and culture of a small city. On the plus side, professionals have more to spend and support the arts making small cities more vibrant. Conversely, they drive the price of houses up making them less affordable for low-income wage earners.

CMHC, a Crown Corporation responsible for affordable housing, is promoting big cities. In a two-page ad in The Walrus magazine, they point to the advantages of living in denser communities:

“CMHC is also increasingly recognizing that intensification, or creating denser communities, can play a positive role in addressing not only housing affordability but other challenges — such as access to services, health status, and climate change — that factor into where people choose to live.”

Part of the appeal in moving out of a big city, it seems, is the seemingly lower rates of COVID-19 infection. But most infections in big cities have been among those working in high contact jobs, not home-work environments. And the Kamloops region is now experiencing a spike in infections.

It might seem like commute times are less in smaller cities but Vancouver isn’t much different than Kamloops. In Vancouver, the average commute time by car was 26 minutes last year. While I don’t have averages for Kamloops, most drivers had a commute time of 15 to 29 minutes according to Statistics Canada. And fifteen per cent of Kamloops drivers had commute times longer than 30 minutes.

Big cities attract medical talent to specialized clinics, making health services superior in dense urban centres. Michel Tremblay, VP at CMHC says:  “You simply can’t offer the same level of service in smaller centres; it is just not economically justifiable,”

Everyday needs such as groceries, libraries, and community support services are not only more numerous and varied in a big city, but also easier to get to by walking, cycling, or public transit. People prefer to go on foot, which is the basis for an inherently healthy, active approach to living, CMHC argues.

Personally, I’m not convinced. Despite the disadvantages of living in small cities, Kamloops was a big draw for me when I moved to here from Calgary. I like the slower pace of life and living close to nature.

But I wonder what motivates CMHC, a housing agency, to promote big cities? Is it because they are worried about a collapse in big city housing markets where they insure the mortgages?

The language and mood of the second COVID-19 wave has changed

This second wave of the pandemic feels quite different than the first.

image: Asia Times

In the Spring, shoppers emptied store shelves of toilet paper –a curious indicator of what’s important in people’s lives. A sense of domesticity swept the nation as flour flew off the shelves in a bread-baking frenzy. Canadians became more self-sufficient as vegetables replaced flower gardens in back yards.

Language reflects the change. Google tracts word usage use across Canada. Now no one is trying to “flatten the curve.”  “Flatten the curve” as a phrase peaked in mid-March. Now usage is just three per cent of that. I succumbed to the impulse to use, what had become a cliché, in this column mid-March.

“Novel coronavirus” use peaked in late January and use is now at four per cent of that. The shine has gone off the coronavirus and now it’s just the same old sneaky, deadly disease that has killed over one million globally.

 “New normal” is doing a bit better. Use peaked in May and is now one-half that.

I’m struck by how different normalcy looks now when I watch movies made in pre-pandemic times. People are walking the streets without masks, going to bars and clubs, getting together in large groups at weddings and funerals without a care about whether they are spraying a deadly virus into the air and infecting those around them.

Who’s catching it and dying has changed. Most deaths in the first wave, ninety per cent, were residents of nursing and long-term care residences. The residence death rate is rising again but the source of infections seems to be from young people in the community, not care-givers. Three quarters of infections were in those under the age of 50 as of November 19.

The season plays a role. In the summer, outdoor activities limited the spread. With Fall and Winter approaching, a second wave is sweeping the nation as families and friends gather together indoors.

Fraudsters are cashing in on the second wave as Canadians take advantage of the Canada Emergency Response Benefit. One way is for scammers to relieve us of our benefit is identity theft. They use stolen identity to apply for and redirect benefits. Another scam is to approach an eligible person with an offer to help them apply for CERB, then to use their identity to redirect the benefit.

On the bright side, Canadians have less debt and fewer bankruptcies than in the first wave. With the receipt of CERB, the debt to disposable income ratio fell remarkably, from 175 per cent in the first three months of the year to just 158 per cent between April and June. The massive wave of support programs rolled out by governments across the country have kept peoples’ heads above water.

Supply chains have become normalized during the pandemic. Even as COVID-19 cases climb, supply chains have been secured so that groceries should continue to be available. 

Of course, government benefits will end, debt will increase, and service workers will be unemployed.

But Spring brings hope that a vaccine will be available and put an end to this nightmare.

Get ready to pay a pandemic premium

In a sneaky move, the Trudeau government has proposed a revised Emergency Response Benefit (CERB) just after they prorogued Parliament. Now the opposition has no opportunity to debate the proposal until after the Speech from the Throne on September 23. It gives the government time to run the plan up the flagpole and see who salutes it.

A $2000 Canada Emergency Response Benefit  image: THE CANADIAN PRESS IMAGES/Lars Hagberg

Conservatives say that while the conversion of CERB to EI is an improvement because it provides incentives for the jobless to accept work, it delays the democratic process. MPs Dan Albas and Pierre Poilievre say the delay in debating the legislation is unacceptable.

“It is unacceptable that the Trudeau government announced these changes days after locking out MPs and shutting down Parliament,” they said in a joint statement.

The revised CERB hands a lifeline to those who have been surviving on it. It extends existing benefits of $500/week until September 26.

The problem with CERB, as some see it, is that the unemployed don’t have to look for work. That’s a disincentive say employers in the service sector: workers would rather stay at home and collect CERB than go to work. “CERB is definitely an issue,” B.C. Restaurant and Foodservices Association president Ian Tostenson told iNFOnews.ca. “We’re hearing things like, ‘Why would I come back to work? I’m making a couple of thousand bucks a month.’ (June 26, 2020).”

B.C.’s restaurant sector has been hit hard: about 100,000 of the province’s 190,000 food and beverage workers were unemployed.

After September 26, when CERB ends, the jobless will have three options to choose from.

If they choose EI, they will have to look for work. Changes to EI mean that they will get a minimum of $400/week. Before the changes, there was no minimum EI and the average was just $312/week. That’s an improvement but some jobless might complain that it’s not as good as CERB.

Gig workers and the self-employed are not eligible for EI. Instead, another program will provide $400 a week for up to 26 weeks. If their annual net income exceeds $38,000, then 50 percent of that benefit will be clawed back.

For those who become ill from contracting COVID-19, or for those who must self-isolate, they can receive $500 a week for up to two weeks. That will be a help. Former University of Ottawa Professor Miles Corak says: “If you get COVID – and trust me, I did – it’s something that lasts longer than two weeks and is quite debilitating,”

Some say the new benefits are too generous, others say they are too frugal –the hallmark of a Canadian compromise.

But where will the money for these programs come from? For those of us who can afford to pay more taxes, it’s what we can do to support fellow Canadians.

And the cost of running the service sector is going to become more expensive. Workers returning to work can reasonably expect to be paid more, given the increased risk they encounter. Restaurants can’t hold as many customers and revenues will decline if nothing is done. The increased costs will have to be passed on to customers.

More taxes and higher costs will result in a pandemic premium. I’ll happily pay it -that’s the price of living in a civil society.

 

 

 

 

 

COVID-19 is more costly to humanity than climate-change

The COVID-19 pandemic has changed the way I regard climate change. Don’t get me wrong: climate change is real and it’s man-made. But it not the “the greatest threat to humanity” that I once characterized it.

image: Dialogue of Civilizations Research Institute

The greatest threats to humanity are the pandemics caused by our violation of the natural world of animals. As we recklessly tear nature apart, we reap the whirlwind of its viral bounty.

World leaders have exploited our fears of climate change. The World Health Organization famously called climate change the “greatest threat to global health in the 21st century.” Leaders of the richest nations gathered in Davos this January and declared that climate accounted for all the long-term biggest risks to the world.

Persistent scare stories have convinced us that the climatic end-of the-world is nigh. One survey of 28 countries shows that almost half of all people believe climate change will likely lead to the extinction of the human race.

The world’s poor don’t see it that way -they rank climate change quite differently. When the UN asked 10 million people, mostly those in the majority world who are poor, what they regarded as the world’s top priorities, they emphasized better education, health care, jobs, government and nutrition. Climate change ranked 16th out of 16 priorities – right after phone and internet access.

Bjorn Leonhard, President of the Copenhagen Consensus and author of False Alarm: How Climate Change Panic Costs Us Trillions, Hurts the Poor, and Fails to Fix the Planet, says:

“Global warming is a real challenge and a problem we need to tackle. But the alarmism makes it difficult for us to think smartly about climate solutions and it diverts our attention away from the many other important global issues (Globe and Mail, July 19, 2020).”

Sea level rise is very real problem but it’s often portrayed in apocalyptic terms. We are told by the UN climate change panel that 187 million people will be displaced. Bloomberg News declared that coastal cities such as Miami may “drown in 80 years.”

But that number assumes that we do nothing in the meantime. In fact, people don’t just sit around while the water laps at their feet. The same UN climate change panel shows that with adaptation, such as protection with dikes or seawalls, the number of people in the world who have to move by the end of the century is just 305,000. For comparison, four times that number of immigrants now live in B.C. according to the 2016 census. B.C. could accommodate all the world’s water refugees.

The economic effects of climate change are serious but not fatal. The UN Intergovernmental Panel on Climate Change found that the economic effect of climate change would reduce the average person’s income in the 2070s by 0.2 per cent to 2 per cent. The reduction means that we will “only” be 356 per cent richer today instead of 363 per cent richer without the impact of climate change. That’s a sombre finding but not as bad as the economic fallout of the COVID-19 pandemic from which we may never fully recover.

The impact of climate change is real but it pales in the light of the economic impact of this global pandemic.

 

 

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).

Money spent on public transit could be better spent elsewhere

Equality, not density is responsible for the spread of COVID-19 says UBC Professor of Architecture Patrick Condon.

image: Humantransit.org

“The issue of transfer of this disease doesn’t seem to be density itself, it tends to be the inequalities that are associated with living in a major metropolitan area … both in terms of the jobs that [poorer] people are working and the additional need they have to use public transit to get around,” he told CBC Radio’s Spark (April 24, 2020).

In New York, for example, the hardest-hit neighbourhoods were not wealthy Manhattan but poorer boroughs like Queens, Brooklyn and the Bronx. In Canada, condo buildings in central Toronto or Vancouver aren’t COVID-19 hotspots because the people who occupy these higher-end rentals have the “luxury of jobs that can be done from home,” says Professor Condon.

Others in the service industry such as grocery store workers aren’t so lucky. They have to work in public spaces and need to take public transit to get to work.

Commute times have increased over the last decades as affordable housing is pushed further away from where people work. Longer commute times increases the exposure to pathogens.

Environmentalists, such as David Suzuki, have indentified some solutions to urban planning but miss one important one. Suzuki says:

“During the COVID-19 pandemic, cities worldwide have been repurposing streets to create more room for walking and cycling. In some, temporary measures to help people maintain physical distancing, like lower speed limits and limited car access, are providing impetus for permanent changes that prioritize healthy mobility choices over cars (armchairmayor.ca, June 17, 2020).”

What Suzuki misses is the fact that most people don’t live where they work. Walking and bicycling is great for getting around near where you live but many workers live in distant suburbs and rely on public transit.

However, the use of public transit has declined during the pandemic and its future is in doubt because people have found other ways to get to work.

Money spent on public transit could be better spent elsewhere, like affordable housing near where people work.

Public transit has long been promoted as a reasonable alternative to cars. However, that’s only true when busses are full. Mass transit vehicles use up roughly the same energy whether they are full or empty, and for much of the time, they’re more empty than full.

“Subsidized transit is not sustainable by definition,” says Wendell Cox, a transport policy consultant in St. Louis, and former L.A. County Transportation commissioner. “The potential of public transit has been so overblown it’s almost scandalous.”

Professor Condon’s alternative to public transit is to move people closer to work rather than have them commute long distances. Once workers don’t have to sit in cars and public transit, they can get around in the ideal communities that Suzuki imagines.

Condon agrees with Suzuki on one point: city streets take up a lot a space and would be better used purposes suitable to humans.

Post-pandemic urban planning that has people living closer to work meets the goals of reduced commute times, less pollution, and the avoidance of future pathogens.

 

Pandemic exposes failings of long-term care facilities in B.C.

In 2002, the BC Liberals had a grand plan to provide seniors with home-like settings. Added to that, they promised that the new residences would cost the government about half as much. Who wouldn’t want that?

image: WebStockReview

Home-like residences would be financed through public-private partnerships (P3s). Reduced costs to the government would result by attracting private-sector investors to finance new residences.

However, the plan hasn’t worked out that well.

Sure, the government reduced their costs but it was by shutting down existing facilities. Between 2001 and 2004, the government closed 26 long-term care facilities, resulting in the loss of 2,529 long-term care beds according to a report prepared for the Canadian Centre for Policy Alternatives called Assisted Living in British Columbia, Trends in access, affordability and ownership.

The fallout of the grand experiment is fewer, unaffordable housing units.

According to Statistics Canada and the Canada Mortgage and Housing Corporation (CMHC), the cost of Private-Pay assisted living exceeds the financial resources of seniors with average or low income.

Affordable housing is defined as rent less than 30 per cent of income. While wealthy B.C. senior couples can almost afford rent according to that definition (39 per cent), seniors living alone in a bachelor suite require over 80 per cent of their income for rent, which is clearly unaffordable. At rents that high, seniors will be doing without basic sundries, medications, transportation, and entertainment.

Seniors who can’t find lower cost Publicly Subsidized residences are turning to Private-Pay residences as a last resort, even though they can’t really afford them.

And while the number of Private-Pay and Publicly Subsidized units has increased marginally, it hasn’t kept up with demand. The net new Private-Pay units have only increased by 1,130 in all of B.C. from 2010 to 2017. In the Interior Health region, the net new Private-Pay units only increased by 243.

The number of Publicly Subsidized assisted living units added in the same period is even more dismal -only by 105 for all of B.C. and by 26 for the Interior Health region.

The labels “Private-Pay” and “Publicly Subsidized” are misleading.

Private-Pay suggests that these residences are built independently and rented at market prices, like a hotel. However, the government pays the operator of these facilities a daily resident rate and BC Housing, a crown corporation, pays for housing costs.

Publicly Subsidized is equally misleading. It suggests that the residences are owned and operated by the government. They are not: 63 per cent are owned by a non-profit organization, 33 per cent are owned by a for-profit business, and only 4 per cent are owned by a public health authority. Unlike Private-Pay facilities, renters are subsidized according to their ability to pay.

As the pandemic unfolded, it became apparent that some Private-Pay residences did not meet the legislated standards of care for residents. As a result, health authorities seized control of a number of residences owned by Retirement Concepts, British Columbia’s largest chain of for-profit care homes.

Long-term care facilities in B.C. didn’t meet the needs of most seniors before the COVID-19 pandemic and now the outbreak has focussed a spotlight on those failings.

More Publicly Subsidized residences need to be financed by BC Housing and operated by non-profits and for-profit businesses. The housing may not be grand but when well-designed, they can be comfortable, affordable, safe, and profitable.

China’s response to COVID-19 cover-ups should be to speak softly and carry a big wallet.

China has been accused of covering up the start of the COVID-19 pandemic for months, giving the virus time to spread globally.

Lu Shaye. Image: National Post

China’s response has been to come out swinging, angrily reacting in a manner not fitting a superpower. While irrational outbursts have been characteristic of the leader that other superpower, China should take the higher rhetorical ground.

China has lashed out at a number of countries critical of its handling of the crisis, including Australia. After Australian Prime Minister Scott Morrison called for an independent review of the spread of the virus, China’s ambassador to Australia questioned whether a country that is so “hostile” to China is the best place to send Chinese students for education, or whether Chinese consumers would want to buy Australian wine and beef, (Globe and Mail, May 1, 2020).

Canada has felt similar peevishness from China after the arrest of Meng Wanzhou, the chief financial officer of Huawei Technologies after the U.S. had requested her extradition. The shrill tone of China’s ambassador in Canada was followed by the blockage of our exports of pork and canola to China. Lu Shaye, China’s ambassador to Canada was decidedly undiplomatic last May in Toronto when he harangued Canadians and said that we have a “psychological imbalance towards China’s economic and technological development” caused by “West-egotism.”

Lu Shaye is now spouting familiar rhetoric in France. He has released a series of attacks on the “malevolence” of the French media, calling them lapdogs of the U.S.: suggesting that Le Figaro was trafficking in “lies,” and “Some Westerners are starting to have no confidence in liberal democracy,” with one of his favourite themes that the French were “psychologically fragile.”

It’s all so unnecessary. To call us psychologically imbalanced is an obvious insult.  There is no need to mimic Trump’s childish outbursts to demonstrate your status as a superpower.

The mature reaction of a superpower to accusations is to calmly carry on with global dominance and be diplomatic in areas of dispute.

China’s global influence needs no psychoanalysis of critics. That rising superpower is spreading its influence globally with the Belt and Road Initiative with projected spending on infrastructure of $1 trillion in 71 countries. The initiative involves one-half the world’s population and one-quarter the global GDP.

Sure, China’s worry is that its soft power being eroded by accusations of a cover-up. But that will pass, especially if China can clean up the breeding grounds of pandemics, the disgusting “wet markets” of slaughtered wild and domestic animals.

The U.S. superpower’s foreign policy hasn’t always been characterized by a whiney leader. Theodore Roosevelt’s foreign policy in 1900 was: “speak softly and carry a big stick; you will go far.” The components of the policy were the possession of a strong military, never to bluff, and to strike only when prepared to strike hard.

China’s foreign policy should be “speak softly and carry a big wallet.” China has chosen to dominate the world through the investment in infrastructure.  That policy will deliver the resources needed to keep their industrial machine rolling out the world’s goods in a peaceful, albeit colonial, way.

China should resist the inclination to feel grieved at perceived historical humiliations over the past century. Lashing out is unbecoming of a rising superpower.

 

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.