Public health cuts risky business for Ontario

We cannot be ‘Open for Business’ without strong public health protections

On Sept. 30, 2014, the Centers for Disease Control and Prevention in the United States confirmed that a 45-year-old Liberian national, recently arrived in the U.S., had tested positive for Ebola virus infection. Unfortunately, this patient died one week later in a Dallas hospital critical care unit. Two nurses caring for the patient developed Ebola and survived following prolonged treatment.

That Sept. 30 was a Tuesday. By Friday of that week, Ontario had developed a plan for managing a potential public health emergency if Ebola was detected in this province. The minister of health and the chief medical officer of health co-chaired a command table that would have ultimate authority for managing a local outbreak of this dangerous illness.

The reason for concern about Ebola was that Toronto’s Pearson airport serves as a port of entry for people coming to Canada from the focal point of the outbreak in West Africa. Although passengers were screened at their departure, the weakness of the screening process was demonstrated by the Dallas patient who denied exposure to Ebola at the time of embarkment.

Canada did not want to close transportation routes to affected West African countries for humanitarian reasons and because Canadian companies and Canadian nationals were working in West Africa.

Screening on arrival in Toronto’s Pearson airport was a federal responsibility. However, it was unlikely that a passenger would develop symptoms of Ebola during the flight from West Africa to Canada.

It was more likely, similar to the Dallas patient, that a traveller exposed to Ebola in West Africa would develop symptoms in the days or weeks after arrival in Canada.

So, it was crucial that arriving passengers from the Ebola zone were carefully followed. If they became ill, they would need diagnosis at a designated Ontario Ebola diagnostic centre. If they tested positive, their contacts would need to be isolated and screened.

The crucial responsibility for following those recent arrivals from West Africa and their Ontario contacts fell to the staff of Ontario’s public health units. These nurses and health professionals were recently described by Premier Doug Ford on a radio interview as “folks that go … into restaurants and put the little stickers on saying its safe to eat here.”

Yes, one of the tasks that public health staff undertake is to ensure that we do not get food poisoning from Ontario restaurants. However, in the case of a public health emergency, our public health workers have a greater and potentially riskier responsibility. They are the front-line workers who identify new patients with a dangerous illness, trace their contacts and limit the spread of infection.

Being “Open for Business” means having open borders for international travel. And open borders require a strong public health system that protects Ontarians from infectious diseases, which can be imported by world travellers. The 2003 Toronto SARS outbreak showed us the tragic consequences of what happens when our systems fail.

The government’s current policies are exposing us to three public health risks. The first is that reducing the number of public health units from 35 to 10 without a firm plan as to future geographic boundaries or leadership damages planning and governance of public health in Ontario.

Second, reducing the provincial commitment from 75 per cent of the costs of staffing municipal public health units to 60 per cent or 50 per cent over the next two years is irresponsible cost shifting. The cost of public health is people and training. Losing trained staff will weaken our response to the next Ebola crisis.

Finally, resilient public health requires close connection with the rest of the health care system. The last government mandated that public health leaders must sit at the Local Health Integration Network (LHIN) senior management table to tighten connections to primary care and hospitals in particular.

With LHINs abolished and potentially years to come before the structure of health delivery under the new Ontario Health board is apparent, public health will become increasingly disconnected from the rest of the health system. Meanwhile, public health governance and leadership are uncertain, and its funding is being cut.

With these policies being implemented, the next dangerous infectious disease like Ebola or SARS will hopefully wait until Ontario recovers from the damage that this government is visiting on public health in this province.