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Fahad Razak, Arthur Slutsky and David Naylor are physicians and professors in the Department of Medicine at the University of Toronto. Katharine Smart is president of the Canadian Medical Association; Alika Lafontaine is the designated president.

We are now more than two years into the pandemic and Canada’s health care systems remain in crisis. Across the country, from British Columbia to the Atlantic provinces, emergency services are operating at reduced capacity. Some are completely shut down. And that’s only August – traditionally a slower time for hospitals and an opportunity for healthcare workers to recuperate before the generally higher pressures of winter.

This unprecedented situation is just the latest pandemic-triggered crisis, each of which has exploited pre-existing vulnerabilities in our healthcare systems.

During the first wave, the long-term care sector experienced devastating viral spread and severe staffing shortages. The result? Canada had one of the highest death rates among LTC residents of any wealthy country.

At the start of 2021, thousands of seriously ill patients were transferred between hospitals to balance the load of admissions and the demands for ventilators. No surprise: on a per capita basis, Canada has one of the lowest acute care capacities in the Organization for Economic Co-operation and Development.

Starting in late 2021, the huge Omicron BA.1 surge resulted in some of the highest vaccine-era death rates among the elderly and other vulnerable groups, as well as disruption to staff at health due to personal and family illnesses. The current wave of Omicron BA.5s has only made this staffing crisis worse, with shortages of thousands of healthcare professionals, unsustainable amounts of overtime, accelerated retirements and worsening Professional exhaustion. It’s a depressing cycle: shortages breed burnout, burnout breeds staff shortages.

The BA.5 wave also reinforced a central lesson of the pandemic: even without an increase in COVID-19-related intensive care unit admissions, massive disruptions can occur in healthcare delivery. This situation is exacerbated by the pent-up demand for services that the pandemic has disrupted. In Ontario alone, the estimated health care backlog — from routine checkups and childhood vaccinations to diagnostic tests and surgeries — has grown to nearly 22 million services.

Health system leaders are rightly rushing to find solutions wherever possible, but the problems are long-standing, systemic and disheartening. Structural and human resources challenges that have been in the works for decades will take years to overcome, even in the most optimistic scenarios. In a protracted pandemic, there is little chance – and no ethical justification – to attempt the mass importation of medical professionals. In addition, it will take years to meet infrastructure needs for acute and long-term care. Temporary capacity building may be feasible. However, with health systems perilously close to the brink, it is totally foolish to ignore the reality that this winter may well see new waves of COVID-19, as well as the resurgence of seasonal viruses such as influenza. We need to redouble our efforts on the simple public health measures that can reduce the burden of respiratory viruses and keep our healthcare system functioning, right now.

For example, high-quality masks are an effective, low-cost intervention to slow the spread of all seasonal viruses. Masks should be used in indoor public places wherever extensive mixing occurs. Effective and affordable technologies are now available to dramatically improve indoor air quality and need to be deployed wisely and widely.

Current limited testing for COVID-19, meanwhile, has left Canadians navigating the pandemic in the dark. In the coming months, sewage testing to track community spread should be standardized, intensified, and transparently reported. Rapid tests for multiple viruses should also be widely available to monitor the individual spread of COVID-19 and other viral pathogens. Special attention is needed to detect the presence of COVID-19 and seasonal viruses in high-risk settings such as long-term care.

We also need to somehow recapture the magic of early vaccine deployment in Canada to address our now deplorable booster dose rates and rapidly deploy all next-generation vaccines that provide lasting benefits for protect Canadians as much as possible.

More importantly, leaders must stop minimizing both the consequences of COVID-19 and the problems of the health care system. The first step in crisis management is to recognize the problem. An understandable increase in public frustration, fatigue and discord must be addressed with clear messaging about what needs to be done and, importantly, why.

Winter is coming. Without clarity and candor from leaders, and without some urgent, low-burden measures to mitigate the spread of several viruses in the near future, Canadians face the real prospect of more disruption to their health care services. health and long-term damage from a continued exodus of demoralized health care workers.

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