TL;DR What we should do, but probably won’t; Give two choices, accept the treatment offered without harassing (or worse) those treating you or acknowledge one’s choice to go home and managing on one’s own against doctor’s advice (and lose the right to emergency medical care when, not if, it doesn’t work). If you can’t make a choice, you’re not competent to make a decision, so you are on a Form 1 (declared temporarily incapable of managing one’s affairs) and evaluated for mental health (or other impairment) issues.

The idea at it’s core is that if you are unwilling to accept the best efforts of the medical professionals who are treating you, you have have a choice; go home and manage on your own, but forgo the right to getting bailed out when you are proven wrong by COVID-19. What you don’t get to do is try to force medical professionals act against what their training and expertise tells them is the most effective, often the only, thing to do (or conversely to do that which they understand to be harmful or useless).

At the same time, the best person to handle giving a belligerent patient the choices available to them is probably not an exhausted, frustrated and/or angry professional with little or no psychiatric or de-escalation training (or headspace).

In this kind of situation, the choice above needs to presented by an on-site psychiatric professional (backed up by security, if necessary). If the patient is unwilling to make a choice, or presents in other ways that suggest mental health issues or impairment, said patient should be subject to the laws for mental incapacity (Form 1) and evaluated in a psychiatric facility which has been provided the resources to manage and treat COVID-positive patients with mental health or impairment issues.

It probably won’t happen for two major reasons. The first is that most people without exposure to mental health issues don’t understand them or even necessarily believe they are a disease and not a choice, including those in government and authority that would need to decide to do this. The second reason is that governments have been unwilling to even close to adequately fund mental health treatment, and are unlikely to start now.

Which means that the when triage time comes (and it’s on its way), the systemic choice is likely to be accept treatment peacefully, or go home and die.

This is not the fault of the medical profession, nor of those with genuine mental health issues or impairment. Year of underfunding, and historical reasons to distrust governments and politicians who claim to ‘follow the data’ but somehow don’t give the medical professionals and scientists freedom to speak openly in public about the data and models (and one wonders how much pressure (implied or otherwise) there is to ’tweak’ certain parameters of the model to produce a more politically favourable outcome).

The truth is that the only thing that is going to get us out of this is worldwide herd immunity, which requires effective long-term vaccines not just temporary prophylactics, which is what we seem to have.

Those of us who can, still need to do our part and get the shots available to us, but we also need to hold our governments to account for selling ‘Covid Snakeoil’. The idea that this can be ‘made to go away quickly’ is a line of rubbish, at best. We need to have to fortitude to lockdown harder and longer, and accept that we can’t do business as usual with a killer virus that will continue to be a problem. That is until we stop being selfish and self-centered countries that think we can solve a global pandemic while only caring about vaccinating ourselves.

For the duration, we need to be willing to accommodate and support means of doing business, work, and leisure that limit the spread of the virus and accept that this is going to be a long haul, not a quicksilver fantasy.

Ultimately by failing to understand the hard objective reality we are faced with, our politicians and ‘political class’ have fed and magnified the degree to which there is distrust and resistance to getting herd immunity.

And that’s even without the pre-existing anti-vaxxers and various malicious actors ‘stirring the pot’.

This isn’t a case where a ‘big stick’ and/or shame and brow-beating those who don’t trust the situation is going work. What is needed is honesty and transparency on the part of the government and business. We also need the ‘big stick’ for those who want to use this to stir up division and trouble.

I suspect the reality of how this is going to play out, is that it’s going to be some years yet of similar nonesense as we’ve seen so far, and that the only thing that might save us is if the virus mutates to be as or more transmissible, but significantly less deadly. I have my doubts about the ability of our ability to collectively do more than ride this out, given the political, business, and social realities of the day.

Now there’s a happy thought for the holidays!