REGIONAL MEDICAL EXPERTS JUGGLE SCIENCE, POLITICS.
CANADA'S REGIONAL MEDICAL EXPERTS JUGGLE SCIENCE, POLITICS AND PUBLIC PERCEPTION
POSTMEDIA IS TAKING AN IN-DEPTH LOOK AT THE SOCIAL, INSTITUTIONAL AND ECONOMIC ISSUES THE PANDEMIC HAS BROUGHT TO LIGHT — AND, MORE IMPORTANTLY, HOW WE CAN SOLVE THEM.
In 2003, the panel of experts in Ontario looking into the SARS response recommended the province make the chief medical officer of health report directly to the legislature, not the health minister.
There was “a perception that the lines between public health management and political considerations during certain stages of the SARS outbreak appeared blurred,” the preliminary report said. “We are ill-equipped to definitively challenge or confirm this perception. However, perceptions matter.”
That recommendation was never implemented.
The perception of public health officials is again being tested, this time at a scale not contemplated 18 years ago. Amid the COVID-19 pandemic, many of the top doctors from each province and territory have experienced periods of near-superhero status followed by skepticism and public pressure as the months dragged on and their roles became muddled with political decisions.
Last March, companies created T-shirts highlighting public health officials. In Alberta, one artist designed stickers and prints of chief medical officer of health Dr. Deena Hinshaw fashioned as a warrior, while people on social media suggested renaming Edmonton's Corona LRT station in her honour.
In British Columbia, local musicians produced songs praising provincial health officer Dr. Bonnie Henry and a limited-edition “Dr. Henry” shoe was so coveted it crashed the company's website.
Angus Reid Institute surveys found that the top provincial public health officials had approval ratings in the 80- and 90-per-cent range in the early days of the pandemic.
“It was brand new. People were turning to experts in ways that they had not done in a generation, if not longer, arguably probably since the end of the Second World War in this country, because you were dealing with something that was new and unknown, but also very urgent and very scary,” said the institute's president, Shachi Kurl.
But pressure, politics and the passing of time have tarnished some of that shine. Public health officials have been criticized by some who feel restrictions are too harsh and others who feel they aren't harsh enough. In the best cases, that has led to harder questions. In the worst, threats of violence.
By September, Henry acknowledged she was getting death threats and had boosted security at her house. In January, protesters showed up at the home of Saskatchewan's Dr. Saqib Shahab. Around the same time, in the Northwest Territories, an Alberta man was charged with making threatening statements over the phone toward chief public health officer Dr. Kami Kandola.
Former Alberta chief medical officer of health Dr. Jim Talbot has spoken with some of the officials and says they worried about the pedestals they had been placed on.
“One was that it was unrealistic. Nobody can be that good, that popular, without triggering some kind of disappointment later on,” he said.
“And the second concern that they had was that the work that they were doing, they were the most visible part of it, but there were literally thousands of other people who were part of the team making a difference at the provincial ministries and within the provinces themselves. And so they felt quite awkward about it, because they're team players, first and foremost, and it seemed like they were being singled out for the kind of attention that Connor Mcdavid would get.”
Initially, Canada's governments responded to the pandemic in similar ways and speeds. Patrick Fafard, associate professor of public and international affairs at the University of Ottawa, said the early messaging was clearly rooted in public health: wash your hands, keep six feet from others, and stay home.
As the pandemic progressed, provinces began to make different choices as to when, how and to what extent to implement and ease restrictions. Months dragged on and governments were hit with questions about mental health and the economic impact of their decisions.
“The governments' chief medical officers' work began to take divergent positions, which makes people understand that this was much, much more complicated than simply following the science,” Fafard said.
Provinces have options in how they respond to the pandemic, including the Public Health Act, Emergencies Act or special legislation. All relate to the chief medical officers of health and, depending on how they are presented, can lead to different impressions of how much power they have.
In Alberta, for example, restrictions are signed by Hinshaw and styled as orders of the chief medical officer of health.
“Other provinces, depending on the legislation they're using, more often the legislation is styled as `today, the government of pickyour-province announced,' ” Fafard said.
“So that led to this bizarre situation in Alberta, where Deena Hinshaw was even more closely associated with the decisions of the government that she works for, because of the technical nature by which the decisions were announced.”
Although Hinshaw is the face of COVID-19 announcements in Alberta, she has repeatedly said she is a government adviser who makes recommendations, not decisions. The government has rejected calls to release all of Hinshaw's proposals. As a result, nobody knows to what degree the government has acted on her advice.
In November, as Alberta battled its second wave, CBC reported that secret recordings of meetings showed Hinshaw disagreed with decisions made by the government's emergency management cabinet committee.
Hinshaw said she felt betrayed by the leak, and reiterated that elected officials make the final decisions.
Former Manitoba chief provincial public health officer Dr. Joel Kettner said there may be a false impression that chief medical officers of health are the decision-makers. “On several occasions a premier has said, `Well, I'm just doing what my chief medical officer of health tells me to do' and that's convenient, I guess, but for these kinds of things, I doubt if that's really true.”
As for who should have final say, Kettner said the complex decisions made during a pandemic need to come from elected officials.
“These big decisions should be made by the elected leaders who should take accountability for them. They should be transparent in terms of how they decided and what they weighed up, including input from the chief doctor,” he said. “The doctors should be there to explain things to the public about how the disease is spread, and what symptoms you get, and how sick you can get, and what the consequences are.”
Provinces have taken different approaches to sharing information publicly. In Ontario, Premier Doug Ford has almost-daily press conferences with medical officials, so it's easier for the public to determine whether a decision is political, Fafard said, whereas in Alberta and B.C., Hinshaw and Henry are often on their own at the podium explaining and defending government choices.
“So when people don't like the decisions that (those) governments have taken, they are inclined in those situations to blame the chief medical officer of health,” he said.
Both Hinshaw and Henry's offices declined interview requests for this story.
Despite having similar profiles, the two top doctors had markedly different 2020s. While Henry has managed to maintain high approval ratings in Angus Reid's surveys — in early January she was at 80 per cent — Hinshaw's popularity has steadily declined. At the beginning of this year, her approval rating was 54 per cent, the second lowest in the country, above only Ontario's Dr. David Williams.
One reason for the discrepancy between Henry and Hinshaw could be that opposition to restrictions is not as high in British Columbia as it is in Alberta. An August survey by Angus Reid found that Albertans are more likely to think their
government is going too far when it comes to COVID-19 restrictions; however, almost half of the Alberta respondents thought the measures were just right and 27 per cent said they didn't go far enough.
Another factor could be how effective each province was in managing the virus.
On Nov. 7, two and a half weeks after Henry confirmed the province was experiencing a second wave, she announced a regional lockdown in hot spots. Later in the month, that was expanded to the whole province in an effort to slow B.C.'S transmission rate.
Alberta's major shutdown of businesses was announced Dec. 8 after ICU capacity hit record highs and the province was examining contingency plans for beds. Health experts had been calling for stronger restrictions for weeks.
“The government of British Columbia, for the most part, was ahead of the curve. Whereas in Alberta, particularly in November, the government was behind the curve, and was criticized roundly for it,” Fafard said.
Even so, Hinshaw has had success Ontario's top doctor has not.
Jessica Mudry, associate chair of Ryerson University's School of Professional Communication, says Williams hasn't been able to connect with people. “I remember zero messages, zero interviews. There is absolutely nothing about him that I remember, aside from the fact that perhaps he has a moustache.”
Despite popularity ups and downs, Talbot thinks most people still trust their public health officials enough to follow the rules in the event of a third wave as new variants of COVID-19 rapidly spread across the country.
“(The public will) do it for the best reasons, because they want to look out for one another.”
Lorian Hardcastle, an associate professor in the Faculty of Law and Cumming School of Medicine at the University of Calgary, said once the post-mortem is done on Canada's COVID-19 response, provinces may want to consider updating their legislation to clarify responsibilities in a crisis.
“When it's coming from the government, the public knows that's a balance between political, economic and health considerations,” she said. “Whereas if the chief medical officer of health is saying something, we think it's good science.”