SARS helped, but still lots to learn
Now is best time to study crisis response, says Canada’s former top doc
“My gut feeling now is everybody is doing a bloody good job.”
DR. MICHEL BERGERON FOUNDER OF INFECTIOUS DISEASE RESEARCH CENTRE AT LAVAL UNIVERSITY
OTTAWA— It’s never too late to learn what went wrong and how to fix it. But is it too soon?
Dr. David Butler-Jones, Canada’s former and first chief public health officer, says no.
Butler-Jones says the federal government should do what a previous Liberal government did smack in the middle of the 2003 SARS outbreak: appoint an independent review of the COVID-19 response.
“If it gets underway now” or in the near future, even though the coronavirus pandemic is still unfolding, Butler-Jones told the Star “there may be some things that will help advise the current thinking, because it’s going to go on more than SARS did.”
Every other day, there are revelations about what critics say is a slow response by the Liberal government and the purposebuilt Public Health Agency of Canada to a rapidly developing crisis. The World Health Organization declared a global public health emergency on Jan. 30 (three travellers to Canada had tested positive) and a global pandemic on March 11.
Government documents released to the Commons health committee show that up to March10, officials were still telling Health Minister Patty Hajdu the risk of COVID-19 to Canadians remained low, a statement she repeated to reporters later that day, because “we don’t have incredible community transmission.”
The next day, Ottawa unveiled its first $1 billion COVID-19 response package and, days later, moved to shut borders and recall all Canadians from abroad.
Prime Minister Justin Trudeau defended his government’s actions Friday, saying it acted “quickly” and always on the advice of health officials, to ensure there were “no panics” among Canadians while taking increasingly strong measures to curb the virus spread in Canada.
All governments learned sobering lessons after the 2003 SARS epidemic, acted on many of them, and changed the course of how we responded five years later to the 2008-’09 H1N1 influenza crisis, said Butler-Jones. There were more lessons learned after the H1N1outbreak.
Butler-Jones, who sat on the 2003 SARS review panel led by Dr. David Naylor, and some of his fellow panellists say Canada is, on balance, managing the COVID-19 crisis well.
“At each stage that the epidemic has unfolded, I have underestimated the magnitude of this pandemic,” says Dr. Robert Brunham, director of B.C.’s Centre for Disease Control’s research laboratory, who also sat on the Naylor SARS review panel.
Brunham said the rebuilding of Canada’s public health system that occurred post-SARS “has really resulted in Canada not being like Italy.” Where Brunham thinks Canada and the agency could and should be moving faster is on vaccine development, saying 12 to 18 months is too long. “My main critique of that is we need it sooner.”
He fears a second, more deadly wave of COVID-19, as happened during the 1918 influenza epidemic, and says the country needs a made-in-Canada solution and supply.
Dr. Michel Bergeron, founder of the infectious disease research centre at Laval University, said, “This is day and night versus how we managed the SARS epidemic … We were not prepared.”
“My gut feeling now is everybody is doing a bloody good job.”
Public health authorities in Ottawa and the provinces are clearly collaborating and co-ordinating their responses in a way that is effective, Bergeron and the others said.
The 2003 SARS review led Ottawa to carve out public health services — the broad population-based things like disease and infection control — from the sprawling Health Canada bureaucracy and create the Public Health Agency of Canada or PHAC.
Ottawa beefed up the Quarantine Act, pandemic preparedness plans (meant for an influenza pandemic), and the national emergency stockpile (intended as a backup f or influenza and other emergencies).
A formal federal-provincialterritorial public health network was created. The provinces spent more on labs and public health services and everybody vowed to be ready for the next crisis. It didn’t work out that way. As COVID-19 shot around the globe in a few short months, Canadians have witnessed a worldwide race to get hands on critical medical supplies, different rates of testing across the country, a lag in real-time data sharing and surveillance of the disease trajectory, different orders about when to stay at home, sometimes confusing guidance on travel restrictions, on wearing masks, on the permissible size of public gatherings, on whether asymptomatic people transmit the virus, and on interprovincial border closures.
Alot of that amounts to minor variations in public health messages, dished out as federal and provincial authorities scramble to analyze and respond to the rapidly evolving science, and is not a reason to criticize those officials or politicians, said Butler-Jones.
However, he added that some of Canada’s difficulties might have been avoided had other lessons not been forgotten or gone unheeded.
Some provinces have split up their public health programs and expertise, for instance, and spread them across several departments or shuffled publichealth professionals aside in favour of “generic public servants.” Butler-Jones says it’s reduced their ability to co-ordinate planning, make key organizational decisions on policy and resources, and to be responsive.
Alberta Premier Jason Kenney made clear this week he’s unimpressed with certain federal steps.
He said Alberta will do more mass testing, along with much more rigorous screening of international arrivals and stricter enforcement of quarantine orders, and will encourage and facilitate safe use of masks in crowded spaces.
It was another slight crack in an otherwise united front that federal and provincial leaders have maintained. Ontario Premier Doug Ford differed with Ottawa on how quickly to release projections of how bad things could get. He briefly mused about wanting to see a “stronger” national strategy on interprovincial travel limits, before quickly joining ranks again and praising the feds.
Trudeau said this week the SARS review had helped Canada put measures in place that are helping now, but he again made clear Friday he’s not ready to start second-guessing his officials, or publicly rehashing decisions, and for now an independent review will wait.
“With hindsight, I’m sure there are lots of things that we would have done differently, could have done differently, but I can tell you that every step of the way we took the advice of our medical professionals and our public health experts seriously and did as best as we could.”
For some, that’s not good enough.
Many front-line doctors and nurses are furious that there is no slack in the hospital system to deal with a possible surge of coronavirus patients, and angry at gaps in supplies that mean they are short of personal protective equipment.
Linda Silas, president of the Canadian Federation of Nurses’ Unions, said stopgap measures like urging nurses to clean and reuse soiled masks is “sick, sick, sick. It goes against all our training in disease training.”
Other health and medical experts say the Trudeau government, the federal agency and its chief public health officer, Dr. Theresa Tam, have responded as well as possible to a virus more infectious and deadly than initially thought.
To health workers and educators like University of Toronto’s Dr. Anna Banerji, a pediatrician with expertise in infectious disease and public health, the federal government and the federal agency handled the early stages well, but the urgency is escalating fast.
“We’re in a crisis. We don’t have enough personal protective equipment for health-care workers,” she said.
“You’re asking me to go into a hospital and risk my life and risk the life of my family because the preparation is not there.
“We really need more national strategies for vulnerable communities, especially Indigenous people,” she added, suggesting the military needs to get involved. “I don’t see them looking into the future that far,” she said.
Professor Kelley Lee, who holds a Canada research chair in global health at Simon Fraser University, said “clearly this outbreak is just overwhelming people,” including those at the federal agency who are trying to absorb an onslaught of information about epidemic, then roll it out to provinces, who must roll it out to local jurisdictions.
“We’re just not moving fast enough. It might be because of the sheer volume and maybe we haven’t made the public health agency big enough. We need to invest more. The scale of the need is much bigger than we expected.”
Lee emphasized the importance of clearer and consistent data gathering and analysis — a job that is much bigger than the public realizes, she says.
Anne McLellan, the former Liberal health minister who appointed the Naylor review of the SARS response, agrees on that much. She says any review that does get underway should examine the feasibility of a greater role for the federal government, “at least around building the information systems across the country,” that could report to the federal level so that information can be shared “in real time if possible and then shared with the WHO and others when you’re dealing with a global pandemic.”
But she does not share the view of Butler-Jones about the need for a review right now.
She said it’s way too soon in the middle of an all-consuming global pandemic that is unlike SARS.
“We did not have an economic crisis with SARS, we did not have an economic crisis with H1N1. The dimension of this crisis is so much greater, now is not the time to ask someone to put in place a lessons-learned.”