The Globe and Mail - 03.04.2020

FRIDAY, APRIL 3, 2020 | THE GLOBE AND MAILO A

OPINION

NEWS |

T

he coronavirus pandemic
caught the world by sur-
prise, advancing at a speed
and magnitude beyond most peo-
ple’s initial imaginations. Misin-
formation about causes and treat-
ments has already led to tragic
outcomes. In their desperation,
doctors and patients have been
using an array of antimicrobial
products in a manner that will

lead to more harm than good.

U.S. President Donald Trump

has now taken centre stage, giving

medical advice after first dismis-

sing the virus. Recently, he used

his pulpit to recommend wide-

scale treatment of COVID-19 with

hydroxychloroquine and azithro-

mycin based on a “feeling.” The

implications of these recommen-

dations are dangerous. Like any

pharmaceutical product, these

drugs should not be used without

actual medical advice. Now there

are reports of overdose deaths of

people who have followed his ad-

vice and deaths of others who

cannot access essential medica-

tions for existing conditions.

But it could get worse.

The widespread, inadvertent

use of antimicrobial drugs in this

pandemic could leave us with an-

other, more dangerous legacy: a

dramatic increase in drug-resist-

ant infections.

Drug-resistant infections (of-

ten referred to as “superbugs”)

emerge through a complex inter-

play of humans, animals and the

environment. Excessive and in-

creased use of antibiotics over

several decades has led to a grow-

ing list of organisms that no long-

er respond to treatment. It’s called

antimicrobial resistance, or AMR.

It costs us $1.4-billion annually

and, before this pandemic, it was

predicted to cause the loss of

256,000 Canadian lives by 2050.

Today, we are watching the

alarming spread of the new coro-

navirus. With no proven treat-

ment, it marches, unbridled,

across the globe. In the same way,

drug-resistant bacteria could lead

to the frightening spread of bacte-

rial infections that would no long-

er respond to currently reliable

antibiotics.

For example, Canadians may

recognize azithromycin – one of

the drugs recently highlighted by

Mr. Trump – as a common treat-

ment for bacterial pneumonia.

There are now reports that it is be-

ing stockpiled and arbitrarily pre-

scribed. Misuse of antibiotics such

as this can lead to AMR, leaving us

without options to cure common

conditions that are currently

treatable.

Because COVID-19 is a viral in-

fection that appears as either a

mild cough or cold, a pneumonia

or even severe sepsis, most pa-

tients will receive antibiotics dur-

ing their treatment, often unnec-

essarily. As the documented glob-

al burden of coronavirus infec-

tions nears one million cases (and

counting), the consumption of

antibiotics will likely rise propor-

tionately. We can safely predict

that this will lead to a rise in anti-

microbial resistance, which will

affect all aspects of health care

long after COVID-19 has left us. If

there is no secondwave ofthis

drug-resistant virus, there will al-

most certainly be a secondwave

of drug-resistant bacteria.

It doesn’t have to be that way.

First, we need to return to the

core principles of antibiotic stew-

ardship: Use antimicrobials to

treat infection based on science,

not emotion, and don’t use anti-

biotics to treat viral infections.

Second, we need to revisit in-

vestment strategies for anti-infec-

tive drug discovery and develop-

ment, not based on current need,

but based on an informed view of

what we are likely to need in the

future. We needed funding for ef-

fective coronavirus treatment

yesterday, just like we need fund-

ing now for effective treatment of

other important drug-resistant

infections.

In the meantime, we’re assem-

bling a network to help bring AMR

into the public discourse. We in-

tend to keep surveillance, public

health and infection prevention

and control in Canada’s collective

conscience well after this pan-

demic is over. Because if we don’t,

we may just find ourselves in a

similar situation not too far down

the road.

ThedangerouslegacyofCOVID-19:Ariseinantimicrobialresistance

ANDREW MORRIS
GERRY WRIGHT

OPINION

AndrewMorrisisaninfectious
diseasesphysicianatSinaiHealth,
UniversityHealthNetworkandthe
UniversityofToronto.

GerryWrightisthescientificdirector
oftheM.G.DeGrooteInstitutefor
infectiousdiseaseresearchandthe
D.BraleyCentreforAntibiotic
DiscoveryatMcMasterUniversity.

U

ndoubtedly, the coronavi-
rus will bring transforma-
tional change to all aspects
of our lives, but the impact on
global politics will be dire. This
week we got a glimpse into how
populist-nationalist govern-
ments, which continue to be on
the rise, will respond to the pan-
demic. The policy responses
from leaders such as Hungary’s
Viktor Orban are on script and
foretell a dark future. More pres-
cient perhaps, is the coming
clash of ideologies in many liber-
al democracies.
Populist-nationalists have a
disdain for representative poli-
tics, courts, media, international
bureaucrats and scientific ex-
perts that all make up “the elite.”
According to their narrative,
these elites have slowly tried to
move hard-working people away
from traditional conservative
values, industrial self-sufficiency
and loyalty to a unified ethnocul-
tural state. “Elites,” according to
populist-nationalists, promote
divisive cultural and identity
wars, dependency on cheap off-
shore production under interna-
tional pressure in favour of free
trade and porous borders that
undermine national unity.
This global pandemic has
been perceived by populist-na-
tionalists as a validation of their
views and as justification for
their latest draconian policies.
The coronavirus, an outside
force that is propelled by open
borders, hyper-globalization,
and carried by “others” such as
immigrants or cosmopolitan
world-travelling urban elites, is

vindication to populist-national-

ist calls for sturdier borders to

prevent people from bringing

the virus into their country. It al-

so validates their notions that

national production of goods

and services should not be de-

pendent on global supply chains

and that liberal media give too

much credit to international sci-

entific experts and global offi-

cials.

No wonder then, that Mr. Or-

ban has responded to the global

pandemic by introducing an in-

definite state of emergency,

which effectively suspended par-

liament, put future elections on

hold and gave the Prime Minister

wide national powers.

Not only is Hungary closing its

borders, blaming refugees and

students from the Middle East

for bringing the virus to Hungary,

it is using the virus to implement

wide surveillance of individuals’

mobile phones to track their

movements and jail terms of up

to three years for those who defy

lockdown orders.

Mr. Orban, like other populist-

nationalist leaders elected to

power – Turkey’s Recep Tayyip

Erdogan, India’s Narendra Modi

and the United States’ Donald

Trump – have worked for years

to intimidate, shut down and ef-

fectively silence liberal media

who question their policies. Un-

der the pretext of stopping fake

news about the coronavirus,

Hungary has instituted jail terms

of up to five years for those who

spread misinformation that “dis-

torts” thegovernment’s present-

ation of approved facts. The cor-

onavirus has presented an op-

portunity for Hungary to clamp

down on free speech, silence po-

litical opposition and shape pub-

lic debate and news.

Liberal democracy has been

under attack by populist-nation-

alists for several years, but the

coronavirus will sharpen their

knives and their base of support

will cheer them on along the

way. With fear of the virus at an

all-time high, the draconian pol-

icies will be justified by the guise

of public health.

But there is a deeper challenge

being posed for the future of pol-

itics in liberal democracies.

As progressives look at the

coronavirus as a reaction to cli-

mate change and animals who

have been forced from their nat-

ural habitat into city markets,

populist-nationalists see this as

just another attempt to deindus-

trialize the heartland, stop peri-

phery communities from being

self-sufficient in their pursuit of

harnessing their natural re-

sources including oil and gas,

and effectively using the envi-

ronmental cause to undermine

hard-working people.

When progressives call for

stronger international co-oper-

ation and co-ordination through

institutions such as the World

Health Organization, populist-

nationalists see international bu-

reaucrats trying to undermine

the power of the nation-state. As

progressives in Mr. Trump’s U.S.

look at this pandemic and call

for the introduction of universal

health care, populist-nationalists

see scheming liberals who want

to expand the welfare state to

give health care to undocument-

ed workers and migrants at the

expense of blue-collar workers.

For every policy idea that pro-

gressives want to bring in to pre-

vent another pandemic, pop-

ulist-nationalists seebig govern-

ment trying to expand its pow-

ers. For populist-nationalists in

Hungary, biggovernment is the

European Union in Brussels and

for Rust Belt U.S., it is the swamp

in Washington.

The coronavirus will indeed

transform our lives. We need to

prepare for illiberal democratic

governments who will use this

pandemic to push through their

policy preferences, but we also

need to prepare for further siloed

public debates on how best to

address our collective situation.

InHungary,ViktorOrbantakesadvantageofapublic-healthcrisis

BESSMA MOMANI

OPINION

AprofessorattheUniversityof
WaterlooandSeniorFellowatboth
theCentreforInternational
GovernanceInnovationandtheArab
GulfStatesInstituteinWashington

Hungarian Prime Minister

Viktor Orban has used

the coronavirus to further

his agenda and tighten

the country’s borders.

MICHALCIZEK/

AFP/GETTYIMAGES

P

rime Minister Justin Tru-
deau says he would consid-
er stricter border measures
with the United States depend-
ing on the evolving situation
there with respect to the corona-
virus pandemic.
But given that the epicentre of
the disease has now moved to
U.S. shores, one wonders how
much longer the federalgovern-
ment can wait before imposing
even stronger sanctions at our
border to safeguard the health of
all Canadians.
Without doubt, closing the
border to all non-essential travel

on March 21 has had a huge im-

pact, according to the latest fig-

ures from Canada Border Servic-

es Agency.

During the week of March 23

to 29, for instance, the number of

people coming into Canada from

the U.S. over land was down 82

per cent, and nearly 85 per cent

lower at airports, compared with

the same time last year, accord-

ing to a report that the CBSA pro-

vided me.

However, in that same week,

more than 88,000 truck drivers

from the U.S. were allowed into

the country, along with nearly

100,000 “other travellers” – a

group I suspect largely consisted

of Canadian snowbirds returning

from sunny southern getaways. I

would expect that number will

decrease dramatically in the

coming weeks. But that still leav-

es us with 88,000 truck drivers,

which is, by the way, a decrease

of nearly 24 per cent from the

same week a year earlier.

We all understand and accept

that the movement of goods be-

tween Canada and the U.S. is vi-

tal. These trucks supply us with

fruits and vegetables, among

many other types of goods and

supplies. Shutting off the border

to this traffic is not an option.

But if a country is only as

strong as its weakest link in its

fight against COVID-19, what

does one do about tens of thou-

sands of people arriving from a

country that has now become

ground zero of the pandemic?

The government has now or-

dered, by law, all Canadians re-

turning home via the U.S. to

quarantine for 14 days. This is be-

ing done for a very good reason.

Unfortunately, the options at the

government’s disposal regarding

trucks coming into the country

are not many, nor particularly at-

tractive.

Border agents are asking driv-

ers basic questions about the

state of their health, while look-

ing for any signs that the driver

might be suffering from the vi-

rus. But given the high estimated

numbers of asymptomatic cases,

this is a very hit-or-miss process.

Some countries are using in-

frared guns to take the temper-

ature of travellers arriving for en-

try. But experts have questioned

the accuracy of these devices.

Many jurisdictions have decided

they’d do more harm than good.

Hong Kong, meanwhile, has

taken what many consider fairly

draconian measures when it

comes to people returning there

from another destination. They

are made to wear tracking brace-

lets, which allow their move-

ments to be monitored by a

smartphone app. This is to en-

sure they abide by the terms of

the 14-day quarantine they are

put under after they return

home from out of country.

The city of Denver has experi-

mented with drive-through test-

ing stations. They proved so pop-

ular they had to be shut down.

But they show that the technol-

ogy exists to provide testing that

can produce quick results, in

about 15 minutes.

I’m not sure how truck drivers

from the United States would

feel about any of these measures.

I’m certain none would welcome

tracking bracelets that monitor

their activities inside our coun-

try, and some would surely re-

sent a health worker sticking a

giant Q-tip down their throat or

up their nose. On the other hand,

given the lack of testing in many

parts of the U.S., some might ac-

tually welcome it.

But if we’re going to try and

seal off all portals from which

the virus can gain entry into Can-

ada, I don’t know how we can’t

look at the traffic that continues

to come into our country from

the U.S.

The government can put its ci-

tizens in quarantine and self-iso-

lation, but if we have infected

people regularly coming into

Canada from the U.S., efforts by

citizens here to defeat the virus’s

spread are going to be under-

mined.

Mr. Trudeau, his deputy

Chrystia Freeland and Treasury

Board President Jean-Yves Du-

clos have all hinted at “further

restrictions” at the border if the

COVID-19 situation in the U.S.

continued to spread rapidly.

They have not indicated what

they might be.

Mr. Duclos told Maclean’s

magazine recently that while the

work of truck drivers from the

U.S. is important, “the health and

security of Canadians is the most

important.”

Hard to argue with that. The

question now: How far will the

federalgovernment go to uphold

that statement?

Ourcoronavirusweakspot:theU.S.border

WhileCanadians

returninghomefrom

thesoutharebeing

quarantined,truck

driversdoingtheir

vitalworkcontinue

topourinunfettered

GARY
MASON

OPINION