COLUMNS

Our post-pandemic future

By Vanessa MacDonnell, Sophie Thériault and Sridhar Venkatapuram

What will our post-pandemic future look like? This is a question on the minds of many these days. Indeed, in the weeks and months ahead, politicians, policy experts, academics, businesses, non-profit organizations and the broader public will have to make important choices as we rebuild our lives, societies and the international order.

Around the globe, governments at all levels are developing a range of recovery plans. Some of these plans will tilt toward austerity, tacitly accepting that some people can be left behind. Health care budgets may not see significant cuts, but other crucial public goods and services, such as education, could see their funding slashed.

Alternatively, some governments will spend their way out of the economic downturn. These governments will invest significant funds to support businesses and their populations and build new infrastructure in the hope of stimulating the economy. These investments will take different forms. In Canada, for example, there continues to be pressure to bail out the oil and gas sector and to loosen environmental protection measures. But there are also calls to convert the Canadian Emergency Response Benefit, the $500 weekly payment to people who became unemployed as a result of the pandemic, into a universal basic income program.

In short, whether through cutting back or spending more, governments will be faced with choices. And what COVID-19 has shown us all is that the choices governments make can have immediate life or death impacts.

It is essential to acknowledge that the pandemic is the outcome of policy choices made by governments and not a natural disaster or an “act of God.”

The fingerprints of governments and their choices are everywhere, whether at the international level in the regulation of animal-transmitted disease threats and outbreak reporting, the regulation of international trade and travel, or how quickly and what kind of policies were implemented to contain the virus.

The devastating effects of COVID-19 are equally the result of choices: to tax and spend in ways that benefit some and disadvantage others; to intervene or not intervene in the economy when market forces prevent individuals from meeting basic needs; to view health as the product of a combination of luck and personal choices rather than the result of colliding social, economic and political factors; and to adopt particular foreign policies on international cooperation, including foreign aid.

Defective government policies created the pre-conditions for the pandemic as well as the extent of the devastating outcomes. Choosing austerity as the path forward is just a continuation of bad choices and social injustice. Cutting back government programs and social common goods are likely to further entrench existing inequalities rather than strengthen the economy or protect us from future pandemics and health shocks. Slashing essential programs like education and incomes supports is more likely to create new vulnerabilities than to remedy old ones. Continued on page 19

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Researchers to study inhaled sedatives as solution to COVID-19 drug shortages Inhaled sedatives could reduce lung inflammation, shorten the duration of ventilation and potentially improve survivalsolution to COVID-19 drug shortages

By Robert DeLaet

Ateam from Lawson Health Research Institute are being funded by the Government of Ontario’s COVID-19 Rapid Research Fund to study whether inhaled sedatives can replace those that are delivered intravenously in COVID-19 patients requiring ventilation. The multi-centre clinical trial aims to address a global shortage of intravenous (IV) sedatives while improving patient outcomes.

“When COVID-19 patients develop severe respiratory failure and need to be ventilated, they require sedation. While IV sedatives are currently used, there is concern about global drug shortages, particularly if there’s a second wave of COVID-19 in the fall,” explains Dr. Marat Slessarev, Scientist at Lawson and Critical Care Physician at London Health Sciences Centre (LHSC). “Even if we have enough ventilators, we won’t be able to ventilate patients without sedatives.”

The clinical trial, being co-led by Dr. Slessarev and Dr. Angela Jerath at Sunnybrook Health Sciences Centre, will study the replacement of IV THIS IS THE LARGEST TRIAL OF ITS KIND. IF INHALED SEDATIVES CAN SHORTEN THE LENGTH OF VENTILATION OR IMPROVE SURVIVAL IN PATIENTS WITH RESPIRATORY FAILURE, THIS COULD CAUSE A PARADIGM SHIFT IN THE WAY WE SEDATE PATIENTS IN INTENSIVE CARE UNITS (ICUS) AROUND THE WORLD

sedatives with inhaled sedatives. Inhaled sedatives, also called volatiles, are widely available due to their use in operating rooms to sedate patients during surgery. While they have not been routinely used to sedate patients needing ventilation, early studies suggest they could be safe and even more effective than IV sedatives.

“Preliminary studies in non-COVID patients with severe respiratory failure suggest that inhaled sedatives can reduce lung inflammation, shorten the duration of ventilation and potentially improve survival. Inhaled sedatives could therefore reduce the pandemic’s strain on ventilator capacity while improving patient outcomes,” says Dr. Slessarev. “Since these drugs are safe, cheap and readily available, they can easily be used to address IV sedative shortages if found effective.”

The researchers will recruit approximately 800 patients from across Canada and the United States including patients from LHSC. Each patient will be randomized to receive either IV sedatives or inhaled sedatives. Patient outcomes such as survival and length of ventilation will be compared between the two groups to determine which method of sedation is most effective.

Given many survivors of critical illness experience cognitive impairment for months or even years after an intensive care unit (ICU) stay, the team is also planning a sub-study to assess whether one method of sedation results in better cognitive outcomes after treatment.

In addition to funding from the Government of Ontario, the study is being supported with funding from the Canadian Institutes of Health Research (CIHR), London Health Sciences Foundation and Sunnybrook Health Sciences Centre.

Robert DeLaet is a Consultant, Communications & External Relationsat Lawson Health Research Institute.

“This is the largest trial of its kind. If inhaled sedatives can shorten the length of ventilation or improve survival in patients with serve respiratory failure, this could cause a paradigm shift in the way we sedate patients in intensive care units (ICUs) around the world,” notes Dr. Slessarev. ■ H

Robert DeLaet is a Consultant, Communications & External Relations at Lawson Health Research Institute. F RE E www.hospitalnews.com SEPTEMBER 2020 HOSPITAL NEWS 5