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Nov. 29, 2021 | Monday
Editorials and Opinions
Dr. Brown: Isolation and shrinking boundaries in the COVID era
Dr. William Brown.

It wasn’t so long ago that some were upset by women wearing the niqab. Now, nearly two years into this pandemic, distancing, social bubbles and face masks have become the norm and the niqab is just another face-covering mask.

We’ve become comfortable with half-hidden faces in grocery stores, pharmacies, banks and the post office, and along the way, more wary of strangers.

Business towers in Toronto and other big cities are half-empty because most employees now work at home. That’s the case with my accountant.

A week ago, when I met him for breakfast, I was his first face-to-face client in a year and a half. His firm’s offices from Toronto to Niagara were all but empty and there was little enthusiasm among the company’s managers and staff for returning to the office.

The same holds true for the large banks, investment firms and most government services, which greatly expanded their online services, while cutting back on face-to-face service during the pandemic.

Throughout my 50-year career practising medicine, I saw all my patients face-to-face. That was until I began to provide consulting services to Thunder Bay and region and had my first encounter with tele-medicine as the only way to see patients and families in remote areas.

It worked but not nearly as well as in-person get-togethers where it was easier to get a sense of what was going on and, of course, examine the patient. So, helpful, and even lifesaving as tele-medicine can be, medical assessments are much better where patients and physicians occupy the same physical space.

That applies to a whole range of professional services and personal relationships. After all, we are social animals, where reading the intentions and feelings of others often comes from body language, as much as speech. That’s where masks and distancing, however necessary, get in the way in pandemics.

Masks were certainly a problem in this pandemic for severely ill patients in intensive care units, where they were surrounded by staff wearing several layers of head and face gear through which their voices were muffled.

This challenge was compounded by the tragedy that many COVID patients in their last days and hours were unable to touch their family members, or even see them, because of the risks involved and overworked staff.

Just as heart-wrenching were the many patients with moderate to severe cognitive and memory problems in long-term care facilities who struggled to understand what was going on when the staff wore head and face gear.

Confused patients were even more confused when they were isolated in their rooms for several weeks for fear they might become infected or infect others. The cognitive and social costS to those isolated patients were real, lasting and, in retrospect, probably not worth the cost, given that more than 80 per cent of the patients developed COVID anyway, despite isolating them.

There’s another challenge in long-term care facilities. In the late stages of most dementia, many patients become incapable of forming and sustaining meaningful relationships with other patients and staff.

In that sense, they become self-isolating, many content to wander corridors or sit in rooms with others with little to say to one another. Here staff and family can help patients connect when they are incapable of doing so themselves.

That’s the tragedy of dementia and the miracle of transformative, hands-on personalized care, if only for moments.

On a brighter note, there was a lovely piece written by Anna Russell in the New Yorker magazine on Oct. 4 about how Jane Goodall, now 87, was managing the pandemic.

Goodall is a world-renowned expert on primate behaviour in the wild and a passionate, tireless, mesmerizing advocate for animals, nature writ large and the future. Russell reported that before the pandemic,

Goodall travelled 300 days a year to deliver lectures and attend meetings around the globe. However, once the pandemic struck, she settled into her childhood home in Bournemouth accompanied by her sister Judy, July’s daughter and her grandchildren, and an aging "whipper, named Bean."

But if you imagine Goodall retreated from the world, think again. Travel was out, but she continued to travel virtually and maintain a punishing schedule of meetings promoting what she most cares about and along the way, her views expressed in her most recent book, "The Book of Hope: A Survival Guide for Trying Times."

Impressive, but perhaps no surprise, given Goodall’s determination and energy. The only hint that fatigue and perhaps age might be catching up with her was Russell’s closing observation that Goodall climbed the stairs to her attic bedroom slowly.

Thanks for people like Goodall and the staff at long-term care facilities for doing what they must, in the best possible way, despite a nasty pandemic.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the InfoHealth series at the Niagara-on-the-Lake Public Library.  

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