Debt....Deficit....Darn it.
When we talk about health care, we talk in the billions, and in some cases trillions, of dollars and in time spans of decades and in physicians and nurses per 100,000 population. Numbers are really, really big in health care-- REALLY big.
Planning that utilizes statistics both past and present and then attempts to extrapolate this information to the future is tried, but with significant error, because the world isn't static and neither is science or technology or the economy.
Just a year or two ago, there were suggestions and even insistence that growth in Canada's GDP would be sufficient to offset the rising costs of health care. A great deal has changed since then and no matter how we wish things could be different, we really do need to face reality.
An excellent article recently in the National Post by Terence Corcoran pointed out some significant facts:
* The federal deficit (not debt) for this year, originally estimated at $50 billion is now pegged at $55 billion
* According to Finance Minister Jim Flaherty, by the year 2015, the series of deficits expected over the next few years will run up the national debt (not deficit) by $170 billion
* Ottawa's total net debt will rise to $628 billion meaning about $19,000 per capita which isn't much different from 1997, the peak year for federal debt.
* Provinces and local governments are also running deficit budgets.
*Ontario is heading for a deficit of $18 billion this year with deficit budgets likely for years to come.
* BC, Alberta, Quebec, New Brunswick and Newfoundland....all riding deficits....to the tune of about $31 billion this year alone.
* Canada's provinces are likely to add close to $100 billion in total new debt over the next five years.
* Added to the provinces' net debt of $274 billion as of the end of 2008, this additional $100 billion will bring the provincial net debt to $375 billion by the end of 2015.
* Add $375 billion in provincial net debt to the projected federal net debt of $628 billion by 2015 and you are looking at $ 1 trillion (TRILLION) in debt...about $30,000 per man, woman and child.
So...the message is likely that to turn this trend around, cuts to government spending will be needed and possibly more taxation. Either one on its own is painful. Together they are even more concerning.
With health care being the biggest portion of all provincial budgets and with federal funding for health care already having been dished out fairly lavishly to the tune of billions and billions only back in 2004 (remember, the "fix for a generation" by Paul Martin) one wonders where anybody gets the idea that we are going to get the funding to shorten wait times, add a national pharmacare program or adopt new and increasingly expensive diagnostics and treatments let alone contribute to improved education programs and environmental initiatives or to withstand the economic blast of a serious pandemic.
No doubt about it: The public is going to have to be more self-reliant when it comes to their health care whether through monitoring their own chronic illnesses, using social networking sites to connect with others who share the same illness or through funding their own procedures or preventative care.
Merrilee Fullerton
97 Comments
Reader Comments (97)
All in all, a great show.
http://www.thestar.com/Opinion/Editorials/article/695615
Granted, overseeing large ministries is difficult but the tone is set at the top and needs to reflect the ideals that we hold important.
Maybe the real problem is the ideals of honesty and integrity have slipped rather desperately or that in the name of transparency and openness we find there is rot below the surface.
Either way, it isn't pretty.
http://prescriptions.blogs.nytimes.com/
Now compare that to Ontario where we pay a health care premium up to $900 per person plus significant sums toward health care via taxes.
I hazard a guess that for my family of five, we have paid well over $13,000 a year toward health care in Ontario through a variety of mechanisms.
"even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny. " - Jefferson
"The NHS administration has made numerous service cuts and bed closures which have lacked transparency and accountability. The latest blow specific to the emergency physicians at the GNGH has been the administration’s forced dismantling of a stable staffing schedule. In August, the NHS administration unexpectedly announced a take-over of the emergency physician schedule with plans to bring in contract physicians beginning September 15th, 2009. The NHS has also maintained a private for-profit temporary physician staffing agency on retainer, at a cost of $20,000 per month. This company would provide physicians at a significant additional public cost should the current emergency physicians not comply with NHS forced restructuring. Physicians are being replaced, ostensibly to reduce wait times with no proof of benefit and at great cost to the region. Staffing more physicians per time period may appear to benefit wait times but in practice this will not be effective. Of course, the real issues of bed and nursing shortages are being ignored. Most long wait times do not currently result from the number of available doctors, but are due to the number of patients held in emergency departments, awaiting a bed in the hospital."
and eklimek...it seems Jefferson's comment is timeless.
It is about finding balance and when politicians are not held accountable we get what we deserve.
I find it intriguing that physicians in the US are touted as being in support of a public program when most of the stats that I read indicate the US physicians generally support a public/private option and not exclusively one or the other.
This is unfortunate.It will only contribute to a decrease in morale and more physicians will look elsewhere for work.
It will also contribute to a system that is not sustainable.
Short term solutions meant to coerce physicians into doing what they are told to do for political reasons.
The squeeze on ER docs has been for at least the last decade. Medemerg, the outside contracting agency, has been used to encourage ER doc to sing from the hospital song sheet on several occasions.
Deteriorating ER conditions is evidenced by the youthful naivete of ER docs. It takes about 10 years for a forehead to flatten from banging against the wall. Some then move on quietly. Some don't. But they generally move on, or don't care.
You know the aphorism. If you are young and not a socialistm you have no heart. If you are old and are still a socialist, you have no brain.
If you look at the directors who left the big EDs in the 90's like Dubinsky, Merrel, and Jones they had lasted about 15 years plus in the system. Now you are lucky to get a decade out of them before the forehead is flat.
Actually very sad to see the loss of talent from the system over the years, but a rational person can only take so much abuse.
Of course the public is going to get the system they deserve.
As I recall, the combined governmental debt in Canada at the end of WWII was about 125% of GDP. According to OECD figures, even with new debt added over the next few years as reported, Canada will remain well below 25% debt:GDP ratio.
This is not to say that spending controls and constraints are not warranted in order to improve the ratio. It is just that we need not panic and suggest that massive cuts and/or tax increases must materialize any time soon. If these such developments do emerge it will be due to ideological drivers and not economic history.
Ever wonder how Canada (and other developed nations) overcame that 1945 level of debt burden? Worth considering.
In fact, I'm planning an exit strategy as we speak and I'm only 48 years old.
If there is an exodus of physicians and administrators around the age of 50-55 in the next few years, there will be a relatively inexperienced talent pool to draw from.
Of course, this won't be isolated to health care. It will affect all areas as the boomers who have managed to build and maintain a nest egg leave to do other important activities that they find worthwhile.
It is important that those in the trenches, whether they be front line or administrative, are appreciated for what they can provide.
Having said that, I don't mean that the big egos should be stuffed full of empty praise but that those who do good work and have been loyal and persistent in the face of adversity should be recognized and appreciated for what they provide.
Demographics were very different after 1945. The boomers where born and a young, healthy creative and energetic population contributed to the economy.
We had 25 pretty good years and then in the 70s things got bumpy.
Our demographics heading into 2010 are grossly different as is the economic reality and the change in global political power from the USA to others.
We are looking at very uncertain times and although Canada has managed to hang on to the coat tails of the USA as it rode with its economic prosperity, the same cannot be said for the current situation.
The US has its own massive problems economically and Canada depends significantly on this partner.
Very different circumstances now compared to 1945.
Canada's GDP looks to be on rather shaky ground. Much depends on what happens to oil and energy prices. Ontario is going to flounder for some time until it develops a better education strategy. Our manufacturing base just isn't likely to come back anytime soon and if we are counting on creativity a la Richard Florida school of thought, we are a long way off from recovery.
Definitely a fine balance to be had.
http://www.conferenceboard.ca/hcp/details/economy/income-per-capita.aspx
The most important determinant of a country’s per capita income, over the longer term, is productivity. This is because there is no limit to productivity growth. There is a limit to how many hours an employee can work, to how low the unemployment rate can fall, to how high the labour force participation rate can rise, and to how large the proportion of working-age people within the total population can be. But innovation and technological change can sustain productivity growth indefinitely. In the equation below, productivity is the only component with no upper limit. Improving productivity in Canada is the only sustainable way to reduce the sizable gap between Canadian and U.S. income per capita that has emerged in recent decades."
Do we have a single one of these machines in Ontario?
http://news.bbc.co.uk/2/hi/uk_news/8257686.stm
Any guesses that Canada will be trying to get ventilators from the US or attempt to send patients to the US to access ventilators?
Some of these blog posts go back to the avian flu (H5N1) but still very pertinent info regarding dealing with shortages of personnel and equipment.
http://www.mayoclinic.com/health/school-closing/AN02001
It is highly unlikely that health will collapse. The system is stable with most people getting needed care in a timely fashion. It is agreeded , at the margins, things are worse, but our rationing system is relatively good.
There are funding issues, highlighted by the non existant economy right now. Ontario has particularly been affected by these changes.
There is room for more taxation. The overall increase in tax derived resources could proabaly rise by at least another 30% without a fundamental uprisng by the taxpayers based on other OECD countries experiences.
In health, our biggest issues is our inefficiency is providing our "free" health care dollar. Compared to most other jurisdictions using similar core resource structure it costs us more money to deliver our "free" dollar, and there remains debate as to whether our health care dollar is as good as other countries health care dollar (not enough high tech stuff in our health care dollar). Based on the crude indicators, infant mortality and life expectancy, we aren't doing badly.
Thus, it appears our best approach is to track down why we waste some much to deliver our services. Much of this is realted to our bureacratic structure and the issues exposed by eHealth - how we politically run our system.
Front line health care must either occur in that it is needed (looking after strokes); or because it is wanted (tattoo removal). One can reasonably design a "system" that balances those two. The absolute seperation in Ontario (no buying declared government services) is needed to control and manage health care as the government reads it should be provided. It can only be provided by redistributing wealth. We require management costs to control that redistribution.
Reversing the pyramid by giving management control to patients (money moves as patinet care moves) is so deeply in opposition to central controlled global funding, we seem not to be able to move. We have entrenched and internalized our control to a limited oligogarchy but, in fairness, can't move to anarchy which each makes an independant action.
All in all, we are not badly off but we need to strive to a higher level - we really haven't move far in the last 7 years.
To be fair, neither you nor I are economists. However, I think you rely here too heavily on the importance of demographics in terms of debt reduction post 1945 vs now.
Yes, the market place demands and type of economy that energed post WWII were different than today but the fact remains that todays Canadian economy is much bigger and much more diversified not to mention global.
In the end, we have to concern ourselves with the economy's ability to carry a given debtload and that picture is much better today for Canada than it was post 1945. No question.
As for the problem and proffered solution to waste in health care spending, I find it somewhat amusing how often posters return to the idea that the size (and thus waste) of the 'bureaucracy' is a big dealand major savings lie there.
Surely all but the most rabid anarchist among us agrees that some level of bureaucracy is needed in order to support what must get done. The question then becomes 'what size'.
One tends to think that the required size of bureaucracy a needwed might relate to the size of population, geographic nature and complexity of program offerings. One might also think that political orientation would dictate the size in many cases. One would be wrong.
The right-wing dominated province of Alberta has a civil service almost twice as large per capita as Ontario. Why might that be?
There are no doubt civel servants sitting around being less than productive any given day in Ontario but that is not where the efficiencies we need in HC are to be found.
We need to begin attaching dollars to patients in trems of proceedures and we need to have a more evidence-based approach to treatment and investigation choices. The big bucks are here.
We will get to this when the US reforms and does likewise I think
“Today's approval is good news for our nation's response to the 2009 H1N1 influenza virus,” says FDA commissioner, Margaret A. Hamburg, M.D. “This vaccine will help protect individuals from serious illness and death from influenza.”
All four firms manufacture the H1N1 vaccines using the same processes, which have a long record of producing safe seasonal influenza vaccines. “The H1N1 vaccines approved today undergo the same rigorous FDA manufacturing oversight, product-quality testing, and lot-release procedures that apply to seasonal influenza vaccines,” says Jesse Goodman, M.D., FDA acting chief scientist.
Based on preliminary data from adults participating in multiple clinical studies, the 2009 H1N1 vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, as occurs with the seasonal influenza vaccine, FDA explains. Ongoing clinical studies will provide additional information about the optimal dose in children. FDA will accordingly update dosing recommendations. Sanofi Pasteur is reportedly the only provider of the vaccine for populations as young as six months.
The agency says that it is working closely with governmental and nongovernmental organizations to enhance the capacity for adverse-event monitoring, information sharing, and analysis during and after the 2009 H1N1 vaccination program.
I have been polling patients and the problem really seems to lie with small to medium businesses which often have no plan, and at this point in time without a raging epidemic in the community still resist having the patient remain at home if sick.
I suspect the economic disruptions and drop in provincial GDP will be as important as the medical issues once we see the H1N1 ball starting rolling very shortly in the next few weeks. Hold off on buying those Halloween costumes for the kids this year unless it is a gown, N95 mask, and safety glasses. ;)
Without an election to distract the public this fall at least now they will be able to focus on the performance of our health care system when stressed well beyond what it has been designed for.
"The novel H1N1 influenza is rapidly morphing into its second wave assault. Within eight to 10 weeks, every organization will confront how to cope with sick employees and stay in business," said Michael T. Osterholm, an international authority on pandemic influenza and business preparedness and director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.
"We're beyond theory and onto execution. The pandemic is here. And we need every business to recognize the impact they can have. It's not too late, but time is of the essence," Osterholm said.
http://www.healthcarefinancenews.com/news/university-experts-warn-h1n1s-impact-businesses-healthcare-providers
http://www.newswise.com/articles/study-details-pathways-to-flu-virus-exposure-validates-preventative-measures
updated 12:55 p.m. ET, Wed., Sept . 16, 2009
WASHINGTON - The death rate from the pandemic H1N1 swine flu is likely lower than earlier estimates, an expert in infectious diseases said on Wednesday
http://www.msnbc.msn.com/id/32877953/ns/health-swine_flu/
It won't be health care or business as usual.
http://ca.news.yahoo.com/s/capress/090916/business/oecd_jobs_canada
http://healthcarereform.nejm.org/?p=1785&query=TOC
September 16, 2009
President & CEO of Cambridge Memorial Hospital terminated
Cambridge, ON (September 16, 2009) – Ms. Julia Dumanian has been terminated from her position as President and CEO of Cambridge Memorial Hospital, effective immediately. This announcement was made today by Murray Martin, who was recently appointed by the Ministry of Health and Long-Term Care as Supervisor of the hospital.
"I have taken this action to start us down a path of restoring confidence in Cambridge Memorial Hospital," said Mr. Martin.
Mr. Patrick Gaskin has been appointed Acting President and CEO of the hospital. Mr. Gaskin has been a senior level health care administrator for the past 17 years. Most recently, he was Integrated Vice President, Planning & Operational Improvement at London Health Sciences Centre and St. Joseph’s Health Care, London. Prior to that, Patrick worked for Grand River Hospital in Kitchener for nine years in various roles including Vice President, Executive Vice President and Acting President & CEO.
Cambridge Memorial Hospital's Board of Directors remains in place and will function in an advisory capacity to the Supervisor. They will re-assume their full governance responsibility and accountabilities when the Minister of Health and Long-Term Care decides it is appropriate to end Mr. Martin's appointment.
College sold fake diplomas
http://www.thestar.com/news/gta/article/696939
Don't get me wrong: I think it is appropriate for a hospital to engage more QUALIFIED PSWs for taks not requiring a highly skilled regulated health professional. But you have to think that their professional colleges and organized labour representatives are going to milk this investigative report for all its worth and more!
Needless to say that it is yet another lapse in the system that has happened on Dalton's watch. This will definitely diversity the Question Period beat down.
The actual number of deaths requires that governments remain transparent and honest with their reporting however in many regions of the world this is not the case. At last check Germany had 15,000 cases and not one death reported which many have questioned. China as well had no deaths reported at last check. This suppression of deaths would lower the numerator and underestimate the true CFR.
In the end though even if the pH1N1 does have a CFR similar to seasonal influenza the absolute number of fatalities will be very large as the entire population is susceptible to infection. The attack rate in Argentina which has a winter climate more similar to ours than Australia was about 20 percent. Apply that to the GTA with a seasonal flu CFR and we still will have serious health and economic issues based on the absolute number of cases. And in Ontario the average age of hospitalization at last check was 25 years so very different demographic than we see in seaonal flu. Having grandpa on a ventilator near the end of his life is not as anxiety provoking as having a kid in first year university or a single mother of three ventilated for one to two weeks.
The winds of the second wave have started to blow in the office as of Tuesday. We were running about 1 to 3 percent of patients with influenza-like illness (ILI) prior to school starting and looking at the numbers from Tuesday and Wednesday this week those with an ILI has jumped to 5 to 6 percent.
Based on the May/June experience it took about a month for the number of cases in the office to ramp up to the point that one saw absenteeism rates in that schools above 10 percent. Watching a pandemic unfold is not like watching an incoming hurricane, but is rather a slow process and not for those with ADHD. I'd still hold off on the Halloween costumes at least in the Peel/Halton region.
http://www.bmj.com/cgi/content/full/339/jul14_3/b2840
If any of you are over the age of 65 you might think about donating a sample for this study which will indicate whether or not you have been exposed to pH1N1.
http://h1n1study.oahpp.ca/Pages/Who%20are%20we%20recruiting.aspx
A lot of hard questions need to be asked of Health Canada as to why it chose to take the adjuvanted vaccine route and is this the reason why there will be a 3 to 4 week delay in the vaccine's rollout here? What was in it for GSK to go the adjuvanted route in Canada? Who was responsible for the vaccine choice decision at Health Canada? If there are safety concerns regarding the use of adjuvanted vaccine in pregnant women which necessited a switch by PHAC/HC to use unadjuvanted vaccine in this risk group then why do these concerns not also apply to young children?
"Glaxo initially concentrated on development of its vaccine with an adjuvant, said Sarah Alspach, a Glaxo spokeswoman, in an e-mail. Adjuvants are ingredients used by some countries in vaccine formulations to boost effectiveness. U.S. health officials said they favored a swine flu shot that didn’t use the extra ingredient and their clinical tests are being conducted on vaccines without adjuvants."
http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aL1RsswD_C44
Don't know, no testing is happening.
It is pretty much the only strain of influenza circulating now across the country. You can check the flu watch sites in Canada and the US to verify. I'd tell your son and his friends to enroll in the study above as they are very short on young adults. He will then find out if he has antibody to pH1N1.
"This week, 96.8% of the positive influenza A subtyped specimens were Pandemic (H1N1) 2009."
Look under laboratory surveillance summary:
http://www.phac-aspc.gc.ca/fluwatch/09-10/w35_09/index-eng.php
Thanks as always for your informative and timely comments.
As for the question above, a very valid one. I think one MPPs in opposition to the government might like to soon start posing as agitation games are once again in season.
....from an educated blogger in the US:
http://mjperry.blogspot.com/2009/07/top-10-ways-uk-rations-healthcare-to.html
Ken Deane, Board Member eHealth
Ken Deane is Assistant Deputy Minister of the Health System Accountability and Performance Division at the Ministry of Health and Long-Term Care. Prior to this, he was chief operating officer of the London Health Sciences Centre and St. Joseph's Health Care in London, Ontario. Deane has also served as president and CEO of St. Joseph's Health Centre in Toronto, president and CEO of Hotel-Dieu Grace Hospital in Windsor, vice-president of finance and chief financial officer of Hamilton Health Sciences Centre, and executive vice-president and chief financial officer of Grand River Hospital in Kitchener.
He has served on various boards, most recently on the board of directors of the Workplace Safety and Insurance Board where he was the chair of the human resources and compensation committee.
from info@healthedition.com
September 18, 2009
Volume 13 Issue 37
Alberta Health Services closing 350 hospitals beds
Alberta Health Services is planning to close 350 hospital beds in Edmonton and Calgary over the next three years. This corresponds with the number of so-called “alternate level of care” or ALC patients currently in hospital in the two cities who are ready for discharge but waiting for a place in community care.
Alberta Health Services, the agency that runs health care in the province, announced plans Wednesday to open 775 community living options, including assisted living, home care and long-term care, “to ensure patients across the system are getting the right care in the right place.”
However, the head of the Alberta nurses’ union says the bed closures will only exacerbate pressures on Edmonton and Calgary hospitals. “I would suggest to you that there’s more than 350 people waiting for an acute care bed,” United Nurses of Alberta President Heather Smith told Sun media Tuesday, after attending an AHS briefing on its plans.
It has also been mentioned that the inclusion of assisted living in the community care options will saddle patients with more of the costs. Assisted living facilities have recently been allowed to hike their rents to as much as much as $1,650 a month.
Edmonton is losing 140 beds and Calgary 150, with another 60 beds between the two of them being set aside to ease ER pressures. Health authorities in each city will invest about $13 million in expanded community care programs but they are projected to end up saving a total of $52 million a year by the time the plan has been fully executed.
The 290 vacated hospital beds will be kept in the system but not staffed. Instead, they will be used for surge capacity such as in the event of a serious H1N1 flu outbreak this fall.
AHS has also announced that 246 beds will be closed at Alberta Hospital Edmonton, the province’s major psychiatric facility, arising from the decision not to proceed with redevelopment plans for the aging facility. Patients will be transferred to continuing care spots and other hospitals.
While cost savings are important for AHS, as it deals with a projected $1.3 billion deficit this year, CEO Stephen Duckett insists the plan primarily addresses the needs of ALC patients who do not need to be in a hospital bed. He promises that no beds will be closed until new community care options are up and running. “There is no room for doubt on that commitment,” he says.
Part of Dr. Duckett’s performance pay this year is also riding on the community care plan. His compensation package allows for a bonus of up to 25 per cent of his $575,000 salary which amounts to $144,000.
According to his performance agreement with the AHS board, released this week, he has to meet 10 targets this year to get the full amount. This includes reducing the number of ALC patients provincewide from 700 currently to 550 this year with a three-year target of 350.
Other access targets, worth 40 per cent of his bonus overall, involves reducing wait times for hip replacement patients and routine and complex ER cases.
Quality improvement is another component of his performance agreement worth 30 per cent of the bonus. It includes the completion of an incident reporting system, and improved influenza vaccination rates for seniors. Sustainability is the third element. To get anything, he has to achieve the board’s budget target. HE
from info@healthedition.com
Hansard Highlights
On Monday, Nova Scotia Finance Minister Graham Steele revealed that the province is facing a $590 million deficit this year that could grow to $1.3 billion in two years if nothing is done. He told the CBC that change is ahead for the government’s biggest spending item, health care. “We will never get a mastery of the books of this province if we don’t find ways to deliver health care differently,” he said. However, the Speech from the Throne that opened the Nova Scotia legislature Thursday gave no hint of the government’s plans to make health care sustainable. The Speech promised improvements to mental health care, self-managed care allowances and legislation to “recognize the right of couples to be placed together in the same nursing home.” ER closures at rural hospitals are a perennial issue in the province, and the Speech said the new NDP government will keep its election promise to hire an emergency room advisor.
The fall sessions of the House of Commons, as well as the Ontario, Manitoba and Quebec legislatures also started this week.
In the Ontario legislature Wednesday, NDP Leader Andrea Horwath questioned Premier Dalton McGuinty about the closure of the Fort Erie hospital ER at the end of this month. “Fort Erie's 30,000 residents will join those in Port Colborne who have already lost their ER, and face long travel times and waits in the overburdened ERs in Welland and Niagara Falls,” she said. Mr. McGuinty acknowledged that “we all have a tremendous attachment to our local hospitals” but the Local Health Integration Network recommended the ER be replaced with an urgent care centre and “We think that overall it presents a step forward in improving the quality of care that's available to patients in the community.” He cited a third-party review that said the hospital ER lacks the necessary diagnostic equipment and specialist back-up required.
so the "step forward" is to mask the real problem which is lack of human resources and funding for diagnostic equipment and instead to create urgent care centres where the void won't be seen.
This is certainly a very interesting "step forward" and clearly a sign that inadequate resources within Canada's public health care system will just be hidden away....errr...should I say "transformed" .
A step forward? Really??
http://www.theglobeandmail.com/news/technology/science/dr-kumanan-wilson-on-the-vaccine/article1282172/
"In 2008-09, 147 of the 393 Ontario patients sent to the United States for care were neurosurgery patients.
Jensen said he doesn't know exactly how many neurosurgery beds there are in the province, but did indicate there are a relatively small number.
He said OHIP would pay a U.S. hospital an average of $8,100 a day for neurosurgery patients."
“What they need to do is make the ask of physicians, and the physician needs to make a request for the resources in the facility (to care for the patient).”"
oh...so if you don't have someone to advocate on your behalf for access back to the Canadian system, you won't get care? Really??
Of interest, I attended another flu-pandemic planning session at one of the biggest hospitals in all of Canada and was told there are no plans to ship seriously ill H1N1 patients over the boarder in the case of inadequate resources here ie beds or ventilators or human resource. It hadn't occurred as a possibility apparently. Also there could be issues of transporting patients with this sort of highly communicable disease from one country to another and they could be refused entry.
I am hoping that this pandemic is not going to be as serious as others that have occurred in the past 100 years.