Health units kept in the dark: report

Ottawa Public Health calling for regular technical briefings

Public health units have been kept in the dark about provincial announcements during the pandemic, making it harder for them to do their jobs, according to a new report from Ottawa Public Health.

The report calls on the province to hold technical briefings for public health units, which largely oversee the COVID-19 pandemic response at the local level, before major announcements are made.

“Finding out about new restrictions and requirements impacting local businesses/sectors at the same time as the general public” has been among OPH's biggest challenges during the past year of pandemic response, the report said.

That lack of communication with public health and officials at the local level became public late last year when Ottawa Mayor Jim Watson said the city had been blindsided by the provincial lockdown announcement.

The OPH report also recommends the province ensure its pandemic rules and restrictions are evidence-based and accompanied by clear rationale, saying there is a perception that “restrictions and requirements were either inconsistent, contradictory or not evidence-based.”

There have been times when residents and businesses became frustrated over what they saw as conflicting guidance and messages from the various levels of public health agencies, “which can erode credibility,” the report said.

Among other things, the report seems to offer a glimpse into a divide between local public health units and the province, something that has been reported elsewhere during the pandemic.

Last month, the issue came up during testimony before the provincial long-term care commission about vaccine rollout in long-term care homes.

Dr. Alison McGeer, an infectious-disease specialist, and Dr. Nathan Stall, a geriatrician, both at Mount Sinai Hospital, were critical of how long it was taking to vaccinate vulnerable long-term care residents.

“Is this problem part of some larger struggle that's going on with public health units?” asked Justice Frank Marrocco, who heads the commission.

“It just seems consistently the case that we'll use any method of dealing with these problems that either duplicates or doesn't involve public health units, and I have some difficulty with that.”

McGeer, who noted that public health units have successfully run massive vaccination campaigns for years, responded that there is a “lack of trust between our current government and many local public health units.”

Sources have told the Citizen that some public health officials have felt sidelined by the province during the pandemic.

In December, Dr. Shelley Deeks, the health protection officer in charge of leading Public Health Ontario's pandemic response, revealed that the provincial government rejected its own public health agency's advice when it set up the colour-coded COVID-19 plan late last year. The province set a significantly higher bar for regional restrictions than public health officials had recommended. That number was later lowered and Deeks has since moved on to another job in Nova Scotia.

Before the pandemic, the Ontario government had announced cuts to public health units and plans for a major restructuring, which have now been paused.

The Ottawa Public Health report and a second one on lessons learned from working with long-term care homes during the pandemic outline challenges and successes over the past 11 months. Among key successes has been a dramatic drop in the size and severity of long-term care outbreaks in Ottawa from the first to the second wave of the pandemic.

In the spring, long-term care outbreaks averaged 43 days, compared to 28 days during the fall. And, crucially, the fatality rate among residents dropped from 38.5 per cent in the spring to 17 per cent in the fall.

The report credits enhanced detection, robust contact tracing and improved infection prevention and control measures for the improvement.

Challenges include communications with the province as well as structural issues involving longterm care.

The long-term care report notes that OPH has been in touch with a worker living in a homeless shelter and those who kept working in long-term care with mild symptoms of COVID -19 “for fear of lost wages required to meet basic needs.”

Among other things, OPH recommends that the province provide working conditions that “support workers in being able to stay home when sick.”

And OPH, which has been frequently lauded for its innovative communications, especially on social media, said it wants to see the province recognize the importance of communicating with the public as a key function of local public health units.

Its communications have contributed to behavioural change and adherence to public health measures, the report says.

“OPH's approach has focused on honesty, empathy, relatability and respect while injecting humour and recommending actions residents could take to restore a sense of control in an ever-evolving situation.”

The report also calls on the province to enhance Public Health Ontario's role as an “independent research and knowledge synthesis and exchange hub to provide scientific, technical, epidemiological and research and laboratory support to local public health units.”

It also calls on the province to make sure local public health units can retain staff brought on during the pandemic, including school

health nurses, who are needed to address mental health and substance abuse issues in schools.

The two reports are on the agenda for the next board of health meeting on Feb. 8.