Report’s lessons not learned
‘Gaps’ in data gathering hold ‘potential to delay’ early outbreak detection
A clear picture of the fight against COVID-19 is being hampered by lack of consistent data about the virus across the country, Canada’s Chief Public Health Officer Theresa Tam said Wednesday.
But the problem of sharing such data among provinces was flagged four years ago in a report commissioned by the nation’s top public health officers. Failure to put in place a mechanism for data surveillance across the country would have negative consequences for people’s health, said the 2016 report.
Despite that report, inadequate data sharing information has been a problem during the COVID-19 crisis, Tam admitted Wednesday.
“Data is extremely important obviously to any outbreak,” she said. “There’s obviously some gaps, particularly in reporting to the national level, that we do have to address.”
The 2016 report was commissioned by the Pan Canadian Public Health Care Network, a group designed to coordinate the work of the nation’s top public health officers. It flagged that Canada’s public health surveillance system was inadequate, with inconsistent data sharing between provinces, a lack of common standards and gaps that could hamper a response to a virus like COVID-19.
The network’s report was a blueprint for how to create a more unified system for public health, one where all provinces looked for similar problems and collected data in a similar way. It found provinces collected data differently and didn’t have consistent standards when it came to monitoring for disease outbreaks.
“The lack of a mechanism to align surveillance standards across Canada is a missing pillar of surveillance infrastructure that holds the potential to delay the early detection of outbreaks and is a barrier to better understanding chronic diseases and injuries, resulting in negative consequences for the health of Canadians,” reads the report.
Since the outbreak began, not only have Canadian provinces counted their COVID-19 data in different ways, they have also switched their methodologies during the outbreak.
While some provinces use fully electronic systems to report new cases and trace the contacts of people who are infected, it has been revealed that others still use fax machines to report the information.
THERE’S OBVIOUSLY SOME GAPS, PARTICULARLY IN REPORTING TO THE NATIONAL LEVEL.
The network’s report found data sharing was done on an ad hoc basis with informal agreements, but no consistent rules. Tam said that has been a barrier during this crisis and policy-makers at all levels are trying to address it.
Before the pandemic, the network aimed to bring together public health agencies across the country into a common set of standards by 2022. Health care is a provincial jurisdiction and provinces have consistently resisted any efforts for the federal government to regulate any part of their systems.
Tam said some of the issues around information sharing have been addressed, food-borne illnesses as an example are well-tracked, with good information sharing between provinces. In the case of COVID-19, a respiratory illness, she said there are still barriers.
“It is absolutely recognized also at the first ministers level that this is another chance for us to improve on what we are doing,” she said. “Capitalizing on the crisis that we have, we need to give it another good go for the next piece.”
She said the data on COVID-19 now comes from a wide array of sources.
“It’s the complexity of the Canadian landscape of data, some data has to come from hospitals, some comes from labs, some comes from local public health units.”
The network’s report noted that the European Union had managed to pull together a more uniform surveillance system over a five-year span, creating the European Centre for Disease Control, despite having to merge 27 countries and 23 official languages into one system.
A report into the SARS crisis in 2003 made similar recommendations about sharing information, arguing that a disease outbreak required a federal response and it should have all the necessary data to make decisions.
It called for a stand-alone public health agency with the authority to gather data from the provinces, which led to the creation of the Public Health Agency of Canada.
Testifying at the House of Commons health committee on Wednesday, Amir Attaran, a law professor at the University of Ottawa, said this jurisdictional issue should be tossed aside.
“It is good for the federal government to let provinces run their show, and that’s normally how it should work,” he said. “But I’ll suggest that a pandemic is not normal times, and there comes a point where the federal government must step in — the point where provincial actions are killing Canadians.”
Attaran said the federal government has the power to step in and demand sharing of data and it could also use that authority to demand better testing from the provinces. He said both these steps should be taken despite the jurisdictional challenges because lives are at risk.
“If our country cannot show that once-in-a-century flexibility, then, yes, we are turning the Canadian Constitution into a suicide pact.”
Tam said where good data is most needed, the local level, it is available and accessible to decision makers. Local public health officials are able to track the virus in their communities and use it to do contact tracing and make other decisions. She said what is missing is the bigger picture on how the virus is spreading across the country.
“It is important to get the national picture and to be able to provide that to policy-makers as well.”
“We have the basic information, but I think what people need, and are asking for now is for what we call this aggregation, more in depth analysis,” she said.