Differential Impact

June 04, 2020

By Geoff Frost, UBC Physiatry Resident

Another day in our post-Covid-19 world

The Covid-19 pandemic has been many things: at times isolating, at times terrifying. At all times unfair. What is has not been is perhaps more surprising. When this all started, I wrote a blog post suggesting that Covid would affect all people equally – with some caveats. It seems like the caveats were not the subtext, but rather, the content.

How has it changed the way you work?

The most shocking part of this pandemic for me, which in retrospect was perfectly foreseeable, was its impact on work. Certain workers have been able to maintain their work habits, and crucially, their income. Happen to be a computer programmer? You are most likely still working. Did you pursue a career in event planning? You are almost certainly out of work. This has created an asymmetrical burden. Those who were unable to work find themselves in a financial death spiral. Imagine you were that aforementioned events planner. You had been doing a bang up job at work, building out your client base, planning ever more efficient and worthwhile events for local charities. Things had been going well, so you decided to buy a condo in Vancouver. You are now responsible for mortgage payments in the $2000 a month range. Forget living expenses like food, now everything is trouble. And yes we’ve all heard the financial planner’s advice: always have 3 to 6 months savings stashed away in a rainy day fund. We are approaching the limit of most rainy day funds, even with financial help offered by governments and banks.

Some benefit, while others do not

And let’s say you were still working during the pandemic. Everything suddenly, for lack of a better word, went on sale. You decreased your discretionary spending while the stock market crashed, possibly leaving you with money to invest in the market. Low and behold, within a few months it rebounded, leaving you with a windfall. And while I personally was not in this position, this is not merely theoretically. I know plenty of personal acquaintances who financially benefitted Geoff quote.pngfrom the pandemic.

The tale of two pandemics

And the tale of two pandemics starts to become startlingly clear. The politics surrounding this mess are far beyond my expertise. I won’t pretend to know the difference between Universal Basic Income and the Canada Emergency Response Benefit. I won’t pretend to know who should receive an income top up vs. who shouldn’t. What I do know though, is that sustained poverty is bad for your health.

Poverty and healthcare

Numerous studies globally have shown the deleterious impact of poverty on health. The Code Red study done in Hamilton, Ontario, is perhaps the most stark and shocking example in the Canadian context. In brief: there was about a 20 year difference in lifespan in Hamilton based on whether you lived in a wealthy or poor neighbourhood. Simply put, being poor is bad for your health.

What are the long-term impacts?

I’m not tilling new soil with these reflections. We have all known these harsh facts since perhaps the Victorian era. But as we sit in the eye of the Covid storm, I cannot help but wonder what things will look like 5 to 10 years from now. Some solid research has shown that college graduates that matriculate during a steep recession or depression have negatively impacted wages for their entire lives. This is not just a two to three year blip we all get to laugh about in hindsight. This is a real social problem with big financial and health impacts.

Wave of a Pandemic.jpg

There have been many interesting graphics floating around on the internet about the different waves of a pandemic. There’s the first wave, which we are all living through now. Then there’s the second wave, when the virus makes a return as we ease restrictions. But have you heard about the third, fourth, or fifth waves? (Graphic care of Dr. Evan Kwong via Twitter). And now I’m wondering about whether we should be thinking of a sixth wave: the long term increase in mortality associated with chronic poverty. And more heartbreakingly, how deeply unfair the sixth wave will be.

The impact on outpatient fee for service family practices 

This is something even physicians have experienced on a deeply personal level. Do you run an entirely outpatient based fee for service practice? I’m guessing you feel like our events planner, financially smashed. Are you an inpatient specialist? You are our computer programmer, and suddenly everything is on sale. Even physicians are seeing differential impacts on their livelihoods. I do not mean to generate conflict between physician groups with this observation. I do mean to highlight this important difference which so many of us are living through.

Diversified portfolio

And I wonder how that difference will affect future work patterns. As a resident about to graduate, am I suddenly looking much more carefully and seriously at inpatient work? Of course. I would be foolish not to. As one of my staff recently said: this pandemic is a great example of why you should build a mix of inpatient and outpatient services into your work life. Like any good portfolio, never put all your eggs into one basket. I cannot help but wonder, how many other residents or early career staff, are having these same thoughts. How many careers will be forever changed in course as a result of a virus that originated on the other side of the world four months ago? Whenever I stop to think about it, I cannot help but notice how deeply Covid has changed every aspect of our lives.

Geoff Frost.jpegGeoff is a fourth-year Physiatry resident at UBC. He currently serves as the Director of Communications at the Resident Doctors of BC and is the host of the Pulse Podcast. Geoff is a professional engineer in Ontario, and prior to entering medicine, he worked as a biomedical engineering entrepreneur.