What Wuhan lacks, Alberta already has: a coordinated health system

What Wuhan, China Needs During its Novel Coronavirus epidemic

Imagine living in Wuhan, China during the Novel Coronavirus (2019-nCoV) outbreak. The street outside your apartment is eerily quiet, but you see a City worker in protective equipment walking down the street. The worker is rather gracefully spraying disinfectant on benches and railings. Looking out your window, you smell the disinfectant and feel a bit nauseated as your stomach growls. Pangs of hunger are setting in. You boil a pot of water and prepare the last of your noodles from the pantry with some leftover fish from the fridge.

As you contemplate going to back to the local supermarket to again forage for scraps of food, a loud speaker in the street can be heard in the distance echoing warnings to stay at home. The Wuhan local government is urging you to stay inside. Meanwhile, you see that there is much needed nutritious food and supports being delivered to a Downtown district of Wuhan. There is nothing to support a normal life in your part of the city. Against your own wisdom, you make the trek to a more centralized part of Wuhan that is rife with essential resources but also unknown risks.

Fear is a funny thing. While fear can encourage people to take appropriate precautions to protect their health, the emotion can also activate our survival instincts. In these cases, sick patients will congregate around trusted institutions (like hospitals) to gain a sense of control over their health. Fear is partly why humans do not easily comply with quarantines and travel bans. So, how do we work with fear?

Wuhan’s Unspoken Risk Factor

You may assume that Wuhan lacks basic resources to control the spread of 2019-nCoV. However, that is simply not true. Health insurance is mandatory for most Wuhan residents and directly financed by local government (REF). As a result, public hospitals are very accessible to almost all Wuhan residents. There is also a good supply of clinics across most of Hubei province. While Wuhan’s healthcare system is vastly different from Canada, the city apparently does a pretty good job providing illness care. Where Wuhan fails is around coordinating community services, like home care. These community-based services are unfunded, and in many major Chinese cities (like Wuhan) they hardly exist at all.

“The definitive factors in determining whether someone is in good health extend significantly beyond access to care and include the conditions in their life and the conditions of their neighborhoods and communities.”

— John Auerbach, U.S. Centers for Disease Control and Prevention

Imagine going back to Wuhan. You feel lightheaded and have some muscle aches, but you don’t actually know if you need to go to a hospital. You need to speak with a nurse or doctor and get their opinion about your health condition. Better yet, if a community nurse could take your temperature and assess you at home, your worst fears would be allayed without spreading the virus throughout the streets of Wuhan. Without any access to basic services in your immediate neighborhood, you have no choice but to make the trek to a centralized Wuhan hospital to be assessed. Here you will likely wait for hours in a crowded hallway alongside thousands of other Wuhan residents, waiting for an exhausted health professional to assess your condition.

As “the Chicago of China”, Wuhan is a major urban center that operates on a centralized model of illness care. Sick residents, therefore, are expected to present at a outpatient clinic or hospital to be assessed. In some instances, this centralized model of care can increase the spread of viral diseases and chaos in the face of disease.

Photo of Wuhan, China prior to Coronavirus outbreak
Wuhan is the largest city in Hubei province and the most populous city in Central China. The city of over 11 million people is sometimes referred to as “the Chicago of China” by foreign sources.

Alberta’s Unspoken Protective Factor

Enter Alberta, Canada. A province currently rated at low risk of exposure to the Novel Coronavirus (2019-nCoV), partly because we do not have direct flights or travel routes to areas currently affected by the virus. But, even in the event that new cases crop up in Toronto or Vancouver, Alberta is not likely to have the same response. Why?

Alberta’s health care system is perhaps the greatest gift to residents in times like this. In the unlikely event that multiple cases of 2019-nCOV are detected in our province, the level of system integration here allows health professionals to openly share information and coordinate a unified response. China might be able to build a hospital in 10 days, but Alberta can transform its entire health system in 10 days.

Aside from obvious differences in both urban density and environment, Alberta has spent over a decade integrating all levels of it’s health response. And, while the province is perfectly designed to respond to a Coronavirus outbreak, its very design may prevent an outbreak from happening in the first place. That is because Alberta is well-positioned to mobilize its entire health sector to form a coordinated response plan. The province can also rest assured that this has already be done before. For example, Alberta efficiently evacuated all the patients from both Slave Lake and Fort McMurray during rather unexpected forest fires. The same system that worked then is the same one that will work now.

In a nutshell, conservative Alberta has achieved a level of government control over its health system that Communist China could only dream of. Imagine the worst case scenario of a 2019-nCoV outbreak in Alberta. The government could easily alert all residents to call 8-1-1 if they have any symptoms of disease. From this point, people would access standardized assessments and information overseen by Registered Nurses… from the comfort of their own home. This telephone service could also provide real-time surveillance data to the health system, providing health care managers with a birds-eye view of emerging cases in the community. Public health teams would be activated early, primary care networks could support family doctors manage patients in the community, home care could assist vulnerable patients before transfer to hospital, and hospital managers could prepare specific units to safely contain the influx of patients. The province has the capacity to deploy an entire workforce to tackle 2019-nCoV with existing resources.

I would argue that Alberta has a precious public health resource that Hubei province could only envy. Since the advent of SARS in 2002, Canadian provinces (like Alberta) have already prepared extensively for epidemics and pandemic events. Alberta, in particular, has spent the last decade building a provincial backbone for a coordinated community response.

So, while 2019-nCoV is nothing to gawk at… Alberta residents shouldn’t worry too much. Your provincial health care system is built for this. Even more reassuring, Alberta’s health care system will likely to prevent an outbreak before it even starts.

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