In some provinces, the head of epidemic response is obvious. Ontario needs a coronavirus czar.
The COVID-19 pandemic has burned along in Ontario: rising, dipping, rising again and now settling in at a still significant number of daily cases. In recent weeks, a question has been asked in the Ontario medical community: not just who is in charge, but who should be in charge?
In some provinces, the head of epidemic response is not just obvious, but their faces are painted on murals. Dr. Bonnie Henry rules B.C.; Dr. Deena Hinshaw has taken the lead in Alberta. Here in Ontario we have Dr. David Williams, the chief medical officer of health, and a man whose communication style can be described as hospital tranquilizer beige. It’s been confusing.
On Monday, it was announced Williams would no longer give a daily update, and will instead befuddle the cameras just twice a week. There is some speculation the premier may also cut back his appearances.
And, while public communication isn’t everything, it’s an admission that public communication from the top public health official in Ontario stopped being useful, if it ever was. It’s hard to even criticize the move because Williams is such an impenetrable communicator. It has been an exercise in confusion, in that regard.
But the pandemic isn’t over in this province, and we’re stuck between two worlds. The Greater Toronto Area is still in the grips of COVID-19, and much of the province is relatively COVID-free, and neither epidemic success nor economic success are being achieved.
So, with Williams half-sidelined, do the next thing. Appoint a coronavirus czar, even this late in the game. A public health leader.
“If there was a single person whose sole responsibility was to efficiently address the issues facing the province, I think we would be in a much better position,” says Dr. Isaac Bogoch, an infectious diseases specialist with the University of Toronto and Toronto General Hospital.
“It should be a small group, not a major committee, that can just act and cut through all levels of bureaucracy to get the job done. It would be people who have experience in epidemic management. That’s what this is. A huge part is communication, because you need buy-in from the people and communities you’re working with. This is a new virus, yes, but the same principles apply to all communicable diseases.”
Ontario isn’t out of control. We have averted a catastrophe. But it’s been said over and over: the case numbers won’t consistently fall, and the underlying infrastructure to control the epidemic haven’t been adequately built. Ontario has dropped under 300 new daily cases twice, on May 26 and 27, and then popped back up; the surge Monday was partly driven by migrant workers in Windsor and HaldimandNorfolk districts.
But we’re not there. When the province’s 34 medical officers of health offered a data-based set of thresholds that will allow individual areas to hold restrictions at their own pace, it was among the most comprehensive and helpful displays of public health leadership at an Ontario-wide level that we have seen in the pandemic. The fact Doug Ford is now considering a regional reopening strategy is a credit to local public health officials.
But which expert is in charge of Ontario’s actual pandemic response? Williams? Ontario Health head Dr. Matt Anderson, who has been given the testing portfolio? The provincial health table, which may not include a single doctor who still sees patients, and is light on infectious disease expertise? Who is aligning Ontario’s overlapping pieces? Who could give Ford advice that would lead to something other than a partial lockdown, a reopening that happened too soon, and a one-size-fits-all strategy?
And who is setting up the architecture to fight this longer-term? Can you test in the right places? (Ontario finally has a testing program that doesn’t send away people with symptoms, but it requires implementation.) Can you keep the virus out of vulnerable settings? (The migrant workers, often crammed into bunk bed shacks, are an indication we can’t, as are the skyrocketing numbers in homeless shelters.)
Can you trace contacts? (Ontario’s contact tracing starts, on average, five to seven days after the onset of symptoms, rendering it ineffective as often as not.)
Can you isolate people who have the virus, and don’t have the ability to self-isolate from their families? (Largely, no.)
“You need methods to detect COVID-19 early on, before it spreads out of control,” says Bogoch. “Can you detect an ember before it becomes a forest fire?”
We are still not in a position to stamp out this virus, while the jurisdictions who have done so are the ones hugging their parents and drinking on patios. Maybe a czar.
“The key in these jobs is somebody who can tell truth to power: who is respected enough by the (health) sector and by the system that, at the end of the day, they can absorb the information, communicate that information back, and have the ear of the premier,” says Dr. Sacha Bhatia, the chief innovation officer at Women’s College Hospital, and its chief of cardiology. “So you know that when you communicate with them, it will get to the premier.
“The positives would be someone who isn’t beholden to structures, or bureaucracy, but can integrate those two worlds together. But the danger is, if you’re to do a czar, the czar has to be A, super-respected, and B, the role has to be clearly defined by the province.
“It’s a high-risk play, but it could be effective if it’s the right person brought into the right circumstance.”
So who would it be? Anderson? Ontario Health is already taking more control, in testing and medical procedure restarts. Dr. Jane Philpott? She is a Liberal, but an excommunicated one. Dr. Allison McGeer? She is one of our most decorated epidemiologists, but isn’t seen as a politician.
Ford probably wouldn’t appoint anyone he couldn’t control, so it may be a pipe dream. But it would be nice to have someone truly credible to whom Ontario could look to for guidance on public health, all together. Because we don’t have that right now.