These are the front lines of a deadly, global fight.
Today, as Canada is in the throes of a second wave of the COVID-19 pandemic, those words conjure images of doctors attending to people on ventilators in hospitals, residents in long-term care homes visiting family through windows and lines of people at test centres snaking around the street.
They also hold a special meaning for Canada’s veterans and their families, who urge Canadians to observe Remembrance Day safely this year. 2020 marks the 75th anniversary of the end of the Second World War, and Remembrance Day celebrations will be markedly different this year as the COVID-19 pandemic rages on.
“Wear a poppy, pay tribute to the legions,” Doug Munroe, a navy veteran who has been involved with legion branches across the country, told HuffPost Canada. “The legions are suffering because the closures of the legion are affecting the monies that are collected for veterans and for veterans’ families.”
Munroe, who will be 78 in December, said he plans to watch Remembrance Day services online and will miss going to the national ceremony in Ottawa.
Changes to Nov. 11 ceremonies are just one of the ways the pandemic has impacted Canada’s veterans. Amid the pandemic, whether they’re in long-term care or living at home, veterans say they are also dealing with mental health challenges, shifts in access to health-care services and increased isolation.
‘We know the pain is out there’
After serving as a health-care administrator in the Canadian Forces from 2001 until his medical release in 2010, Walter Callaghan ended up returning to school to focus on veterans’ issues. The University of Toronto PhD candidate has now added a chapter on COVID-19 to his dissertation, writing about how veterans, like himself, with post-traumatic stress disorder (PTSD) and other mental health issues are coping with the pandemic.
Callaghan said generally veterans seem to be coping well — they’re used to following orders, especially the COVID-19 orders and guidance that are in everyone’s best interest. Some veterans who have PTSD were also accustomed to being isolated before the pandemic, so it was validating to see the general public understand how difficult it is to live like that, he added. Some veterans also found a purpose in educating people about isolation and what it entails.
But Callaghan said he’s noticed a number of veterans who are struggling but don’t want to seek help because they fear taking away resources from other people who need them.
“November and December tend to be really, really rough times for a lot of veterans, especially those with PTSD,” he said. “If you add into it the COVID isolation aspect, we are seeing a number of individuals hurting.”
“We know the pain is out there. We’re not seeing them come forward in the same numbers as in previous years.”
The reason these two months are more challenging, Callaghan said, is because of the holiday season and the constant reminders around Remembrance Day that can be hard to avoid. The messaging around Remembrance Day can often focus on older, male veterans, not reflecting the lives and experiences of other veterans.
In Canada, it’s estimated up to 10 per cent of veterans, both those who served in war-zones or peacekeeping forces, will experience PTSD, according to the government.
A spokesperson from Veterans Affairs Canada said the department is extending coverage to include virtual and telehealth services to ensure veterans have access to the services they need and is also adjusting coverage to include personal protective equipment equipment like non-medical masks and gloves if veterans require them to receive in-person treatment.
Veterans Affairs staff have been “proactively reaching out” to vulnerable veterans, including those who are case managed or have health-related issues, the spokesperson said. They said staff have made over 18,000 calls to clients to date.
“... an act of remembrance itself could be following the health guidelines.”
Callaghan said one of the reasons he wanted to return to school was because it forced him to be social and start finding his place in society. When the University of Toronto campus closed because of the pandemic, he felt the same toll of a lack of social interaction that he said other Canadians also experienced. The initial months in lockdown also meant cancelled physiotherapy and massage therapy appointments, necessary to manage his chronic pain.
He and other veterans feel angry, he said, when they see people not following physical distancing or other COVID-19 guidelines, because they know those actions could cause the pandemic to be prolonged.
“We’re hopeful that if people follow the example that we’re trying to set out, an act of remembrance itself could be following the health guidelines,” he said. “They’re not pleasant. Some orders are never pleasant. But if we work through this together, we will get through this.”
Canadian politicians spoke about some of the challenges facing veterans when they paid tribute to the country’s veterans in Parliament last Thursday to mark the beginning of Veterans Week.
“Our veterans served Canada with honour and valour right across this country and all around the world. They stepped up for us, and now it is time for us to do the same for them,” Prime Minister Justin Trudeau said.
Canadians are rising to the moment, Trudeau said, whether by purchasing groceries for older veterans or by being on the front lines of the pandemic and working to protect “the last members of the greatest generation.”
Conservative leader Erin O’Toole, who is also a Canadian Armed Forces veteran, acknowledged the challenges the pandemic poses around Remembrance Day.
“I know there are veterans across Canada who may be struggling with the invisible wounds of service during this unique remembrance week. I know they may feel alone when thinking of their laughing comrades,” O’Toole said. “This pandemic has put a pause to the traditions that bind us.”
Pandemic affecting health-care access
Munroe, the navy veteran, said he hasn’t been able to see a doctor in person for over a year. He’s been able to get a flu shot at a pharmacy, and blood work done at a lab, but said he wishes he was able to have in-person appointments at his family doctor. He believes other veterans may be having the same issue with accessing health-care services during the pandemic.
Preliminary results of an ongoing study assessing how Canadian veterans and their spouses have been impacted by the pandemic indicate about 54 per cent of respondents have had difficulty accessing care, Dr. Don Richardson, the study’s primary investigator, told HuffPost.
Richardson, who is also the scientific director of the MacDonald Franklin OSI Research Centre at Lawson Health Research Institute, noted while certain health-care services were quick to pivot to virtual appointments during the pandemic, other physical procedures need to be in person.
“... if you are already an at-risk population with higher rates of depression, PTSD and anxiety, we want to know, is the pandemic worsening those conditions?”
But there seems to be support for moving forward with virtual care where possible.
Early results also suggest 76 per cent of respondents would prefer telehealth to in-person appointments after the pandemic. Richardson said this might be because of the convenience of virtual care, but also because veterans who have significant anxiety or PTSD may prefer to stay home where they feel safe.
“It’s probably going to force innovation in health care as to what can be delivered virtually and what actually needs to be delivered in person.”
The study, which researchers hope will involve responses from 1,000 veterans and 250 spouses through a series of surveys over 18 months, also examined other issues like mental health.
Those preliminary results indicate 57 per cent of veterans have reported worse mental health functioning compared to before the pandemic. Almost the same amount (54 per cent) also reported their spouse has worse mental health functioning.
“It’s important to monitor mental health in veterans and the impact the pandemic is having, because if you are already an at-risk population with higher rates of depression, PTSD and anxiety, we want to know, is the pandemic worsening those conditions?” Richardson said.
With the pandemic causing people to be isolated and, in some cases, away from their support networks, it’s important to understand how veterans are coping since they’re also at higher risk of problematic drug or alcohol use, he added.
Callaghan said for veterans who already used telemedicine, the pandemic didn’t present any additional challenges. But for anyone who wasn’t already in treatment, starting out on a virtual platform can be difficult because “there’s a physical presence that’s missing there, when you’re dealing with trauma,” he said.
COVID-19 and veterans in long-term care
Nov. 11th has always been a special day to George Branchaud — even before he served in the navy for 25 years and then spent over 25 more as a civilian and engineer with the department of national defence. He recalls watching the ceremonies as a child and celebrating the day with his family.
“[I] always watched and celebrated Remembrance Day. It was always something special to me, from when I was a boy to today,” Branchaud, now 79, said in a video filmed by Sunnybrook, where he’s a resident, and shared with HuffPost.
Sunnybrook recorded Branchaud and other veteran residents talking about what Remembrance Day means to them in advance of Nov. 11 this year.
The pandemic has had a devastating impact on Canada’s long-term care homes, with over 2,000 residents dying during the pandemic in Ontario alone and 80 per cent of Canada’s deaths during the pandemic’s first wave traced back to long-term care.
The Veterans Affairs Canada spokesperson said while long-term care falls under provincial jurisdiction, when the department is aware of confirmed COVID-19 cases, it works closely with veterans, their families and the facility management “to ensure Veterans’ needs are being met.”
At Sunnybrook hospital’s Veterans Centre in Toronto, the largest veterans’ care facility in the country, the pandemic has been a “very challenging time,” Dr. Jocelyn Charles, the centre’s director of care, told HuffPost.
A few residents tested positive at the beginning of the pandemic, but the centre, home to 375 veterans, hasn’t had any cases since then, she said. Family visits have mostly been allowed, outdoors during the summer and indoors now, and virtual visits are also an option. It’s been “very, very challenging” for veterans to, at times, not be able to hug their families, but Charles said staff have been doing their best to create meaningful interactions for residents through a range of small group programs like art and horticultural therapy.
The centre has arranged to broadcast a pre-recorded ceremony for its residents, which they’re “thrilled” about, she said. Sunnybrook will also continue its “Operation Raise a Flag” initiative, which will involve 37,500 mini Canadian flags planted on the grounds around the centre. The flags are typically planted by volunteers but this year will be placed by staff and Canadian Armed Forces members. A bagpiper will also play outside the facility on Nov. 11.
Amid the pandemic, it’s important not to forget the sacrifice of veterans, Charles said.
“I think most importantly during the pandemic is that we remember their sacrifice and it doesn’t get lost,” she said. “With all of the distractions that are happening now in our society, their sacrifice was huge for Canada and we must remember it.”
If you or someone you know needs help in Canada, contact Crisis Services Canada at their website or by calling 1-833-456-4566. You can also find links and numbers to 24-hour suicide crisis lines in your province or territory here. This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you’re worried about. Veterans Affairs Canada has a 24-hour assistance service line for veterans and their family members: 1-800-268-7708.
CORRECTION: An earlier version of this story incorrectly stated the MacDonald Franklin OSI Research Centre was located at Western University. It has been update to say it is located at the Lawson Health Research Institute.