Ontario wants doctors to shut up and diagnose

When you put it all together, it makes perfect sense. Dr. David Fisman’s specialty is epidemiology. Dr. Nathan Stall’s is geriatrics. Dr. Michael Warner works in critical care, as does Dr. Brooks Fallis.

In other words, they are each experts in areas where Ontario has made poor decisions in its COVID-19 response: the spread of infectious disease, how to best care for the elderly, and how to run ICUs with the sickest patients. And they have been the subject of an effort to discredit vocal critics of the province’s pandemic response.

And in Ontario, the COVID-19 pandemic has resulted in a high level of viral spread, which in turn has been deadly in long-term-care homes, and has threatened to overwhelm its ICUs. It’s simple, when you think about it.

So perhaps it was predictable that as the pandemic has worn on, some of the Conservative government’s most vocal critics have been targeted by conservative media. The firing of Fallis as medical director by William Osler Health System — a move that prompted 23 ICU doctors, or nearly the entire critical care staff, to write a protest letter — was something different, but sung in a similar key. He said he was told, “the hospital was under pressure from the provincial government, leading to concern about the possible loss of funding for the hospital.”

The official denials, by the way, were less than convincing. Osler said, in a statement, that “at no time has the provincial government given any direction or advice bearing to HR matters,” which is not what Fallis alleged: he merely said the government was applying pressure. The premier’s office, meanwhile, simply said it had never heard of Fallis, the lead critical care doctor directing one of the hardest-hit COVID hospitals in Canada. The denial, if true, would seem like carelessness.

The context for the idea of provincial pressure may be that early in the pandemic the province told hospitals to spend whatever was necessary, and assured them they would be made whole later, which was the right thing to do. In a flood, go ahead and put the life rafts on a credit card.

Quietly, some hospital administrators have wondered when the money will come. And that is not all.

“I think it’s complicated and very subtle,” said the highranking hospital source. “Hospitals rely on government for not just base funding, but all kinds of priority funding, onetime funding, capital plans, etc. Plus, CEOs are beholden to their boards, who are community members of all political stripes. Pressure can come in multiple ways.”

All of this is an outgrowth of the fact that the province has not listened to the people whose predictions tended to come true. None of these experts have been perfect, because nobody is. But they have been warning that what has happened would happen, for months. In most senses, they have been right.

This is all the result of a basic dynamic: a province doesn’t listen to the people who could have helped guide the pandemic in a better direction. That list extends far beyond Fisman (from the University of Toronto), Stall (at Mount Sinai), Warner (at Michael Garron Hospital), and Fallis (at the William Osler Health System).

“We have a government that doesn’t care about advocacy,” said a medical source not named in this column who is familiar with the response and is not among the government’s vocal critics. “It’s not that there’s only one approach, but you have to do something. They did nothing. The plan was to do nothing and then lock down.”

“We were going 100 miles per hour in the middle of the night with the headlights off, and we swerved at the last possible second to avoid an oncoming truck,” said another source familiar with the province’s pandemic response, on the province-wide restrictions that finally bent the COVID-19 curve, and were implemented on Dec. 26.

Both sources asked for anonymity in order to speak freely, without repercussions.

It’s been a pattern. When Dr. Shelley Deeks recommended thresholds for the framework that was eventually introduced to guide restrictions in the province, the province quadrupled her numbers, rendering the framework a car without seatbelts, and only clambered down after heavy media pressure and terrifying modelling from the province’s independent volunteer science table. Deeks has since left Public Health Ontario for a job in Nova Scotia.

These critics are far from alone, because this province hasn’t often listened to its best experts.

So you get one doctor stripped of his leadership position and alleging government pressure, three doctors publicly targeted by conservative media, and possibly a chilling effect on those who would like to criticize this government.

Meanwhile, the pandemic remains. Ontario is finally, belatedly, laudably bending the curve, but according to the science table briefing Thursday, at our current rate of case count decline Ontario will still be between 1,000 and 2,000 by the end of February, at which point our ICUs would be back into something resembling normal operations.

That is without the more transmissible U.K. variant catching fire: that would require still more stringent public health measures. You’d have to take this thing truly seriously, which Ontario has only done when the hospitals were on the verge of real disaster.

Which is why they have been so roundly criticized, which has led us here.

“If we are able to keep our reproduction number down far enough, as the B.1.1.7 variant becomes the dominant variant, we may be able to do things like keep schools open and maintain the reduction in cases,” said Steini Brown, the dean of the Dalla Lana School of Public Health, and the cochair of the science table. He added, at one point, “you see reports regularly of (healthcare workers) suffering from burnout, exhaustion and leaving the profession.”

Essentially, the province has relied on health care to handle the province’s choices, and has preferred health care be quiet about it. It’s a lousy way to run a pandemic, but that’s the way it’s been.