55 million face masks, just gone
Ontario had all the top-grade face masks it needed for doctors and nurses in an unforeseen medical crisis of hellfire proportions.
That was the lesson learned from the 2003 SARS epidemic in Toronto: Stockpile. Be prepared. Protect health-care workers.
Twenty-six-thousand pallets of supplies, $45 million worth, including N95 respirators, face shields, needles, disinfectant wipes and disposable thermometers. Fifty-five million face masks. Then the province began methodically destroying the goods. They’d reached their best-before date, which for most N95s — it varies among manufacturers — was five to 10 years.
By 2013, according to the annual auditor’s report, Ontario had disposed of 80 per cent of the stockpile because they were deemed not up to 100 per cent par. Elastic bands had degraded and were susceptible to snapping. The crucial filtering material had deteriorated.
Now the U.S. Centers for Disease Control has changed its protocols, its National Institute for Occupational Safety and Health branch concluding from controlled testing that expired N95s remain effective beyond the manufacturer’s expiry date if they’ve been stored properly. Indeed, in a crunch — and this is a crunch — health-care workers should try bandanas and scarves.
Whether the health ministry ever replenished that cache or to what extent is unclear. But obviously not to the level of acute preparedness, or frontline workers wouldn’t be issued two ordinary surgical masks a day, as one nurse told the Star, and the government wouldn’t be scrambling to outbid for massive replacement delivery — at least five million masks on order, Premier Doug Ford said Wednesday. But they’ll take weeks to get here, even with production cranked up by manufacturers globally. By which time, who knows what havoc will have unfolded in Ontario hospitals, as the peak of the coronavirus pandemic rolls across the province.
“That’s appalling, incomprehensible,” says Mario Possamai, frustration evident in his voice down the phone line as he discusses the mystery of the vanishing stockpile. “I don’t know how we can face our health-care workers who are so brave and committed and tell them that we didn’t have their back as we should have. They should have all the N95s that they need and they should have them right now.”
Possamai, a forensic investigator by profession, was senior adviser to the SARS Commission that produced three massive volumes on the what and the why and the how of the epidemic that struck Toronto in two waves 17 years ago, ultimately killing 44 in the province and sickening at least 330 others with serious lung disease. Of the infected, 72 per cent contracted the virus in a health-care setting. Forty-five were health-care workers, including two nurses and a doctor who died.
And SARS was relatively tame as a contagion — highly infectious, certainly lethal, but not community spread, unlike the increasing numbers of Canadians who’ve tested positive for COVID-19 without ever having left the country or being in contact with known infected. Most of the SARS cases were linked to two Toronto hospitals and one 78-year-old woman who’d returned from a trip to Hong Kong, where she’d stayed at the same hotel as an infected doctor from Guangdong Province in China.
She died at her home here. Her son, feeling ill, waited 10 hours in a crowded emergency ward waiting to be seen, contaminating two other patients and sparking a chain of infection.
“We laid out an important blueprint to make sure that if and when a pandemic came, we’d have enough N95s respirators, we’d have the lab testing capacity that we’re ramping up now, but that we didn’t have in place at the time.”
In the forward to his final SARS report, the late Justice Archie Campbell wrote: “SARS taught us that we must be ready for the unseen. That is the most important lesson of SARS. Although no one did foresee and perhaps no one could foresee the unique convergence of factors that made SARS a perfect storm, we know now that new microbial threats like SARS have happened and can happen again.
“However, there is no longer any excuse for governments and hospitals to be caught off-guard and no longer any excuse for health workers not to have available the maximum level of protection through appropriate equipment and training.” Yet here we are. Alarm bells began ringing in the public health community about China even before the regime admitted to the world what it had lied about earlier — that they were in the grip of a voracious viral epidemic.
Canada, like many other countries, responded to China’s crisis. In early February, after the World Health Organization declared coronavirus a pandemic, the federal government, in collaboration with the Canadian Red Cross, sent 16 tonnes of personal protective equipment — clothes, face shields, masks, goggles and gloves — to China.
It was an appropriate humanitarian gesture at the time, born of urgency. But was nobody thinking, maybe something evil this way comes?
A spokesperson for the Ontario health ministry was unable to tell the Star how many N95s had been destroyed, how many were left, and whether the stockpile had been rolling replenished.
“The ministry was in the process of destroying expired stock prior to the start of COVID-19,” said Travis Kann, in an email. “Once the situation in China was known, the ministry paused all destruction activities. They remain paused.” Well, one would hope so. Kann added that the ministry is consulting with experts to evaluate how or if the remaining expired stock may be used, in training or in lieu of surgical masks, with the unexpired N95s reserved for patients.
Another former health official during the previous Liberal regime told the Star, on background, that the N95s were deliberately not got rid of, so they could be used for training and testing purposes as part of emergency planning and preparedness activities.
The problem, as the 2017 auditor’s report discovered, was — ministry officials told them — that it had the budget for these supplies “only around the storage and not the management of them.” Most of the supplies were not put into circulation before they expired — just trashed.
Ontario had been woefully unprepared for SARS. But we’ve been there, we should have gained wisdom. Certainly the knowledge is now readily available. And just as certainly China paid attention, applying those lessons to their pandemic. Italy apparently did not.
“Italy did not have SARS,” points out Possamai. “We did. And we didn’t spend enough time looking at the China experience.”
In late January, Possamai sent a letter to the federal health ministry, warning about what might lie ahead and steps to be taken. No response.
“The government, federally and provincially, has not been transparent about how many of these N95 masks are still around. They didn’t move in an expeditious fashion. They’ve been flat-footed. We should be on a war footing, to see how many of these expired respirators can still be used and get them out the door.
“Weeks ago, as soon as they realized something pretty awful was coming, they should have confiscated all the supplies of N95s that were in the marketplace. Why could an ordinary person walk into a hardware store and buy an N95 when we needed those for health-care workers. Now they’re begging for them. Did nobody realize, hey, we might need these.”
He adds: “Both at the provincial and federal level, there was huge funding of pandemic planning, workshops and committees. They took on the knowledge of the SARS commission and other best practices. But the fact that there’s such a shortage of N95s and lab testing and respirators tells me nobody really thought about the practicalities of what we’re going to do during a pandemic.
“The central message of the SARS commission was the precautionary principle. Which is that you err on the side of precaution when there’s no scientific certainty.”
Justice Campbell wrote: “Things happened that should never have happened: deaths, unspeakable loss, untold suffering. Where should we direct our outrage, our anger?”
It was systemic failure. And now, unforgivably, deja-vu.
Possamai: “We’re so late to the game. We’re bloody late to the game.”