Covid-19 & HRM economy

[OldDartmouthMark]

Regarding COVID and the economy, there's one thing I've noticed that perplexes me a little. This isn't about HRM specifically as I think it applies to most of the country. I can already think of some reasons why it is this way, but would be interested in what others think.

With all the service industry layoffs, that has pretty much devastated the industry and put many many thousands of people out of work, plus other industries stating that they are experiencing hard times because of the difficulty of bringing in foreign workers, why hasn't there been some effort for government to play matchmaker and create some incentive for unemployed restaurant workers to help out farmers who need hands to harvest crops, for a specific example?

To my way of thinking, there will be some challenges in that, perhaps logistical or otherwise, but it seems like a no-brainer to match many people who are out of work with many people who need workers. Instead we are bringing in workers from out of country, where much of the wages paid will end up, while draining money out of Canada's reserves to subsidize people out of work.

Don't misunderstand my point, I do applaud the government's work to try to help people who have fallen on hard times from the restrictions put in place, but it just seems like there could be more done to help people earn wages (which will also be better for their self esteem) while helping industries that need workers, with the side effect of helping the country's financial position.

[q12]

Originally Posted by eastcoastal

Cool - what's your image source?

Globe and mail

https://www.theglobeandmail.com/cana...map-explainer/

[Phalanx]

Could more be done? Sure. Is it likely to make much of a difference? Probably not. Most people don't want to work that hard for that little pay. Look at the US as an example... their social safety net is far weaker than ours (so not something that can be used as an excuse) yet there's still unemployment AND a huge demand for economic migrants.

Farm labourers could be paid more, of course, but then the trade off is that the consumers would end up paying more at the checkout (I mean, this isn't necessarily a bad thing in some ways, ideally it could lead to things like less food waste, but it would also make things more difficult for other people on the lower end of the political spectrum).

[eastcoastal]

Originally Posted by q12

Globe and mail

https://www.theglobeandmail.com/cana...map-explainer/

Thanks!

[someone123]

Originally Posted by OldDartmouthMark

However, I thought it irresponsible for the organizations involved to create a narrative that young people would essentially not be affected and old people would almost certainly die from the illness. IMHO it supported an idea among many young people, who already by nature think they are virtually immortal (we all did when we were young), that they don't need to worry about the consequences of catching the virus because it wouldn't affect them, and that old people were going to die anyway, so no need to be concerned.

I agree completely. Nobody wants this virus and the fatality rates in older people are probably something like 2-20%, which is far from guaranteed death. We're seeing now that infection rates in Canada are low so might be a big mistake to assume everyone will eventually be exposed.

One misconception is that you either die or you are fine after an infection. But it's possible many people will have organ damage that will affect them for years or the rest of their life, and it's possible it will have effects during pregnancy. There are a lot of patients who don't have a clear "death/survival" outcome but rather end up on ventilators for many weeks in a miserable deteriorated state and it's unclear whether medical intervention is helping or simply extending the suffering.

[OldDartmouthMark]

Originally Posted by someone123

I agree completely. Nobody wants this virus and the fatality rates in older people are probably something like 2-20%, which is far from guaranteed death. We're seeing now that infection rates in Canada are low so might be a big mistake to assume everyone will eventually be exposed.

One misconception is that you either die or you are fine after an infection. But it's possible many people will have organ damage that will affect them for years or the rest of their life, and it's possible it will have effects during pregnancy. There are a lot of patients who don't have a clear "death/survival" outcome but rather end up on ventilators for many weeks in a miserable deteriorated state and it's unclear whether medical intervention is helping or simply extending the suffering.

Yes, you bring up a very good point - potential long term effects from organ damage (and etc.?).

Perhaps forever, but at least for a very long time it has seemed like we look at potential health risks in far too simplistic terms. Usually a judgement is based on the live/die binary viewpoint whereas the actual situation is so much more nuanced than that.

Like when talking about car accidents for example, you typically only hear if somebody dies in an accident, but you never hear whether somebody was laid up for 6 months in extreme pain, or had permanent physical or mental damage from the situation. It seems like the general attitude is that as long as they didn't die, it's OK. Forget about the guy who lost a leg, or suffered a brain injury that means they will never be able to live their lives as they did before the incident, etc.

The talk surrounding COVID seems to follow this line of thinking, as you have so aptly pointed out. I really hope that, as research continues, the 'in-the-middle' scenarios between surviving unscathed and dying are brought to light so people can all understand the risks and implications of contacting this virus.

Great points. Really appreciate the discussion!

[someone123]

I think it's becoming a bit more common to talk about quality-adjusted life years instead of just survival or death. Of course, it's hard to know how to equate losing a finger to losing some lung function or dying, but it's a better starting point.

We should be looking at QALY lost due to COVID-19, not just deaths. It is sad when anybody dies but it's significant whether it's a healthy 17 year old or a 93 year old with terminal cancer who had a life expectancy of 2 months and poor quality of life. I suspect the covid death counts are hugely exaggerating the loss of QALY.

Also, we should accept that we can lose QALY due to other life factors like lost income. I believe that the shutdown was important and I think a lot of people are underestimating how bad widespread infection would have been, but we will need to find a good balance in the future, and accept that somebody pays when the government hands out money even in areas like health care.

[OldDartmouthMark]

Originally Posted by someone123

I think it's becoming a bit more common to talk about quality-adjusted life years instead of just survival or death. Of course, it's hard to know how to equate losing a finger to losing some lung function or dying, but it's a better starting point.

We should be looking at QALY lost due to COVID-19, not just deaths. It is sad when anybody dies but it's significant whether it's a healthy 17 year old or a 93 year old with terminal cancer who had a life expectancy of 2 months and poor quality of life. I suspect the covid death counts are hugely exaggerating the loss of QALY.

Also, we should accept that we can lose QALY due to other life factors like lost income. I believe that the shutdown was important and I think a lot of people are underestimating how bad widespread infection would have been, but we will need to find a good balance in the future, and accept that somebody pays when the government hands out money even in areas like health care.

I always cringe when I hear people talking about judging the quality of life of others, it always seems a little cold and calculating and really just rubs me the wrong way. Everybody has one life, just one (varying religious beliefs notwithstanding), and nobody has the ability or the right to judge whether one is more valuable than the other.

Sure, most people would likely agree that a healthy 17 year old has a better quality of life than a 93 year old suffering from cancer. But you only have to start changing some variables around before you are making some truly questionable (and perhaps unconscionable) judgements. How do you compare a 17 year old with terminal cancer vs a healthy vibrant 93 year old? A 20 year old hopelessly addicted to hard drugs vs an 80 year old with some health conditions living a happy life and involved with a loving family? A 45 year old who has been incarcerated for murdering an innocent person vs an 85 year old who has always lived an honest hard-working life?

QALY seems like a slippery slope that is embraced by statisticians or people who must turn life experience into data for some reason. I understand these concepts are important in the health care world when impossible decisions must be made over who lives and who dies, but really I cringe when I hear it in casual conversation.

That said, I agree with your points that QALY should be considered when assessing the effects of pandemics like COVID-19, but to illustrate the serious consequences of the disease to people who blow it off because in their opinion "it's just a virus that kills old people". Perhaps if they thought that they, themselves, could suffer permanent damage that could decrease the enjoyment of the rest of their lives, they would take it more seriously.

I don't know that I'd use it in the context of the economy or financial loss. Of course those are serious factors, but honestly if people have their health, they have the ability to recover from financial loss and come out stronger and wiser for the experience. The economy always recovers to some extent, and people have virtually infinite abilities to adapt to financial hardship. Not so much to serious lung or heart damage...

[someone123]

Originally Posted by OldDartmouthMark

I don't know that I'd use it in the context of the economy or financial loss. Of course those are serious factors, but honestly if people have their health, they have the ability to recover from financial loss and come out stronger and wiser for the experience. The economy always recovers to some extent, and people have virtually infinite abilities to adapt to financial hardship. Not so much to serious lung or heart damage...

I am not sure I agree with this. People trade prime hours of their life for money. Lots of people will spend a day doing a job they don't want to do for $15 an hour. When we take tax dollars from those individuals we're taking their life away from them to some degree.

Thinking about it another way, most people would auction off time from their own life. Let's imagine you knew for certain you'd live to be 100, and you could sell 1 year of that and live to 99 instead with absolute certainty. Would you accept $1 for your year? $10 billion?

[OldDartmouthMark]

Originally Posted by someone123

I am not sure I agree with this. People trade prime hours of their life for money. Lots of people will spend a day doing a job they don't want to do for $15 an hour. When we take tax dollars from those individuals we're taking their life away from them to some degree.

Well, my point of view is that I don't think it's necessarily a good measure to compare financial wellness to quality of life, at least over the baseline of being able to afford basic food and lodging.

Yes, many people do jobs they don't want to do for $15 per hour, or $30 or $50 per hour. That's a fact. But many people also have made the choice to make $15 an hour doing a job that they find satisfying and enjoyable over a $30 an hour job that they hate. Some people are able to see past our consumer based lifestyles and realize that life's journey can be more important than the number of digits in our bank accounts.

IMHO, much of it revolves around one's viewpoint and perceived purpose of life... and how you seek and obtain a good sense of wellbeing.

Taking tax dollars from a population to provide services and benefits to all is a complex issue, and again, viewpoint-dependent. I don't think it's easy to quantify the value of paying taxes to receive the confidence of knowing you will have healthcare, emergency assistance, infrastructure and other services to support your lives, vs paying no taxes and not having those benefits.

Originally Posted by someone123

Thinking about it another way, most people would auction off time from their own life. Let's imagine you knew for certain you'd live to be 100, and you could sell 1 year of that and live to 99 instead with absolute certainty. Would you accept $1 for your year? $10 billion?

I suspect if you were 99, in good health and state of mind, you would have a different viewpoint on the monetary value of that one year of life than you would from the perspective of a 30 year old.

As you move through life, your opinion of the value of 1 year, or 10 years, changes dramatically as you come to terms with your mortality and how precious your time actually is. And this is precisely why 30 year olds shouldn't be making decisions on the quality or value of life of an 80 year old. No matter how old you are or what you are able to do, whatever life you have is precious to you, and nobody has the right to make that decision for you.

[Keith P.]

Originally Posted by OldDartmouthMark

As you move through life, your opinion of the value of 1 year, or 10 years, changes dramatically as you come to terms with your mortality and how precious your time actually is. And this is precisely why 30 year olds shouldn't be making decisions on the quality or value of life of an 80 year old. No matter how old you are or what you are able to do, whatever life you have is precious to you, and nobody has the right to make that decision for you.

Yet we have ceded exactly this sort of power to our health-care system where we ration vital services. Those in the system make these decisions every day. I am not talking about those with serious injury brought into the ER for repair. I am talking about those with chronic conditions that severely impact their quality of life. In our system the 35 year-old former runner and extreme sports enthusiast who has wrecked their joints as a result will get those things fixed or replaced far more quickly than a 70 year-old with similar ailments due simply to wear and tear and a lifetime of physical labor.

[OldDartmouthMark]

Originally Posted by Keith P.

Yet we have ceded exactly this sort of power to our health-care system where we ration vital services. Those in the system make these decisions every day. I am not talking about those with serious injury brought into the ER for repair. I am talking about those with chronic conditions that severely impact their quality of life. In our system the 35 year-old former runner and extreme sports enthusiast who has wrecked their joints as a result will get those things fixed or replaced far more quickly than a 70 year-old with similar ailments due simply to wear and tear and a lifetime of physical labor.

You speak the truth, Keith. Sometimes when I hear these discussions I think I've somehow been dropped into an episode of the Twilight Zone, but I haven't been - it's the reality we live with.

In other cultures the elderly people are respected and revered for their life experience, but in our 'culture' elderly people are considered worthless and 'in the way'. It's sad, really.

You would almost think that many younger people don't realize that they, themselves will someday become older, and want or need the care they wish to deny older people today. It boggles the mind.

I can relate personal experiences with elderly relatives that I have provided support for, which would make your head spin from the total lack of regard due to their age, but will refrain as I don't want to discuss personal issues on a public forum. Let's just say that there are clear directives in the health care system to deny healthcare to anybody who fits a certain age criteria - I've witnessed it personally and have had lengthy conversations about it. Yet these people have been productive their entire lives and have paid into the system for many years, but it means nothing to some.

OK... sorry. I've strayed off topic again. Carry on...

[eastcoastal]

Originally Posted by Keith P.

... In our system the 35 year-old former runner and extreme sports enthusiast who has wrecked their joints as a result will get those things fixed or replaced far more quickly than a 70 year-old with similar ailments due simply to wear and tear and a lifetime of physical labor.

Perhaps it's because we've decided to value to potential future production of capital from the 35-year-old over the 70-year-old who has already produced the bulk of their capital. That's what happens when you value people for the $$ they can pump into an economy or the pockets of the ruling class. We are seen as investment-and-return mechanisms.

[someone123]

Originally Posted by eastcoastal

Perhaps it's because we've decided to value to potential future production of capital from the 35-year-old over the 70-year-old who has already produced the bulk of their capital. That's what happens when you value people for the $$ they can pump into an economy or the pockets of the ruling class. We are seen as investment-and-return mechanisms.

The 35 year old has a 45.6 year life expectancy while the 70 year old has a 15.2 year life expectancy.

https://www150.statcan.gc.ca/t1/tbl1...pid=1310013401

But this story is kind of misleading since it's not clear that the 35 year old really would bump the 70 year old off the list under normal circumstances. Both should get treatment. The need to make trade-offs comes into play in extreme cases like ventilators that are used to capacity during a pandemic. And the differences are even starker than the life expectancy tables suggest because survivability drops off. If you've got a 90 year old with other conditions, their 5 year survivability odds are poor on or off a ventilator, while an otherwise healthy 20 year old might have 30% odds of living another 50 years if given a ventilator.

There are other side-effects too. What do you do if you don't try to give patients scores? First come, first served? FCFS was used for organ transplants for a long time and it means that the mildest cases got the transplants because everybody else died before they got to the head of the list.

[OldDartmouthMark]

You are dealing with statistical averages there, and people are anything but average. The healthcare system already does take into account a person's condition and likelihood of survival of a procedure, but if age is the only factor and limited space is available, the younger person will always get preferential treatment.

As the healthcare system becomes even more stressed (as it already was before COVID-19) this will become more prevalent. You will probably experience this more as you move through life's stages, and unfortunately some day you will probably find that you no longer value this statistical data as much as you do now. You will then understand whether this story is 'misleading' or not. Experience is sometimes the only way to learn certain lessons, unfortunately.

[someone123]

Originally Posted by OldDartmouthMark

You are dealing with statistical averages there, and people are anything but average. The healthcare system already does take into account a person's condition and likelihood of survival of a procedure, but if age is the only factor and limited space is available, the younger person will always get preferential treatment.

The life expectancy figures reflect the unavoidable fact that we have imperfect information about the future. The 70 year old could live to be 102 and the 35 year old might get hit by a bus in 1 month. But the averages are nevertheless a good way to guide decisions when more precise information is unavailable.

I guess the biggest issue I have with your criticism is that you don't seem to propose a better alternative. In cases of acute resource contention in the health care system, a decision must be made, and there will always be a downside.

[OldDartmouthMark]

Originally Posted by someone123

I guess the biggest issue I have with your criticism is that you don't seem to propose a better alternative. In cases of acute resource contention in the health care system, a decision must be made, and there will always be a downside.

I don't feel I have to propose a better alternative to recognize that there are significant flaws in the current system. As it's not my field of expertise, I think that others more capable than I should be able to devise a better system than that which currently exists, but I am also suspect that these decisions are being made on the contention raised by eastcoastal, which I feel is a flaw in philosophy and not methodology.

You actually don't have to promote the method you are presenting as the best solution either, unless you believe it is the absolute best method that is possible for any entity to create. History tells us that often this is folly, though - better methods are often devised to replace less-good methods, but it just takes a person with imagination and ability to devise it and some systemic will to implement it.

[someone123]

Originally Posted by OldDartmouthMark

You actually don't have to promote the method you are presenting as the best solution either, unless you believe it is the absolute best method that is possible for any entity to create. History tells us that often this is folly, though - better methods are often devised to replace less-good methods, but it just takes a person with imagination and ability to devise it and some systemic will to implement it.

I'm not promoting it, I am just talking about pitfalls while trying to be concrete about different systems (like first come first served). I am completely open to people coming up with better solutions. I realize there are experts who have studied this a lot although I think good systems will be easily supported in open rational debate and there is no need to rely on appeals to expertise or life experience.

My points are based on what I've heard from experts about ventilator utilization and organ transplants. Here's one podcast episode called "Who gets the ventilator?": https://freakonomics.com/podcast/covid-19-ventilators/

It's good food for thought.

[OldDartmouthMark]

It is good food for thought, and to be clear, I'm feeling some resentment towards anyone who tends to value people less because of their age, whether they choose to arrive at that place using data or just personal opinion.

I understand you are just trying to explain how the system works from what you've read, and I appreciate that. I am only saying that I've had experience with the system not wanting to give treatment to a healthy person in her 80s purely due to her age (age was explicitly given as the reason). We fought hard and advocated for her and she is still doing well over a decade later. Had we followed the 'advice' of the medical people involved, she would have lost, at minimum, a wonderful decade of her life. :twocents:

[eastcoastal]

Originally Posted by OldDartmouthMark

... I am also suspect that these decisions are being made on the contention raised by eastcoastal, which I feel is a flaw in philosophy and not methodology...

You have a point. The more I think about it, the more I feel like decisions "on the front line," or in the hospitals aren't made based on capacity to produce, rather that it's systemic. We are conditioned to place value on production, so the systems we design make it feel natural.