Canada and COVID-19: January 2020

Where does Canada stand in its handling of the pandemic crisis? The situation clearly is not as bad as America’s. Just past mid-May, Canada had 77,000 cases of COVID-19 with 5,782 deaths.  Two months later, on 11 July, the country had almost 108,000 cases and 8,783 deaths compared to America with 3,236,000 cases and 134,572 deaths, up from 1,520,000 cases and 89,932 deaths on 15 May. The U.S. doubled its cases over the last two months and increased the number of deaths by 50%. The Canadian case load increased 40% and the number of deaths by 52%. Thus, while a great deal of attention has been paid to the horrendous situation in the U.S and Canada has seemed in good shape comparatively, a close look at the figures indicate that Canada is increasing its number of cases at half the American rate but its death toll at roughly the same rate.

The U.S. has a population of 328.2 million people while Canada’s has only 37.6 million. That means that in absolute numbers relative to population, Canada has suffered about half as much from the pandemic as the U.S.

 U.S.Canada
   
Population328,200,00037,600,000
COVID-19 cases3,236,000   108,000
Cases per 1,0001.28
COVID-19 deaths 134,5728,783
Deaths per 100,000         35.623.4
Thus, although our rate of increase in cases is half the American rate, in absolute terms we have less than 30% of the number of American cases though one-third fewer deaths on the basis of population. However, if the American record was not such a complete disaster, Canada’s record would look like a horror show. 

This becomes clear if we compare the Canadian rate to that of South Korea, Taiwan and Vietnam.  

Country Cases Deaths Cases/1000 Deaths/100,000
 
Canada 107,590 8,783 3.3 23.4
South Korea   13,479    299 .27 3
Taiwan        451        7 .04 .004
Vietnam        371        0 .004 0

In my accounts on Taiwan (more than half of Canada’s population), South Korea (1.5 times Canada’s population), and Vietnam (2.5 times our population), the number of cases over almost the same period, was 451 and 371 from Taiwan and Vietnam respectively and 13,479 in South Korea (versus 107,600 in Canada), while the number of deaths respectively were 7 and 0 with 299 in South Korea (versus 8,783 in Canada). There is no comparison between Taiwan and Vietnam compared to Canada. Even South Korea has been far more successful in handling the pandemic. It is only when Canada is compared to the United States that the Canadian record looks reasonably good.  

Why is Canada’s record, as much as it differs from the American one, so much closer to the experience of the USA rather than Taiwan and Vietnam and even South Korea? If we focus on the differences between Canada and the USA, some of the reasons are obvious. Canada was led by a reasonably articulate leader who paid attention to scientists. America was led by a buffoon. By and large, on this issue, in Canada, the ruling party and the opposition generally saw eye-to-eye. Conservative premiers were as rational as the federal prime minister. The United States has a raucous large minority opposed to government. The Canadian public generally trusts government. Canada has a universal health system revered by Canadians; America does not.  

But the differences go much deeper. The American right has a distrust of not only government, but of what it refers to as the deep state. As a result, there has been a much deeper hollowing out of government in America. The resulting chronic structural weaknesses and underinvestment in governance, compounded by Republican Party hostility to a federal bureaucracy, has meant that the capacity of the government to respond adequately to a health crisis had been severely compromised.  

Further, the American media also made a difference. Daily, the media are caught up in Donald Trump’s antics and media distractions, treating his clownish performances as news. Instead of covering the president as a performer, he is covered as a politician when he is simply a corrupt narcissist who is often downright stupid. Except, the American press remains generally obsequious to the office even when the occupant of that office is a fool, all in the name of “objectivity.” The media avoids pressing a case of manslaughter as a result of negligence.  

But none of this tells us why Canada, relative to the Asian country performances already analyzed, has performed so badly. Using my notes I took over the last three months, let me try to reconstruct and analyze the Canadian performance. Was Canada fast off the mark and, if not, why not? Did Canada develop a national strategy and a centralized authoritative agency to deal with the crisis? How did Canada handle the issue of providing adequate protective gear for its health professionals? What did Canada do about testing and about tracing in all its dimensions? Why did Canada opt for a lockdown and a stress on distancing and isolation? What has Canada done to advance treatment and a protective vaccine?  

At the end of December, the Wuhan Municipal Health Commission in China reported a cluster of cases of pneumonia and soon identified a unique virus. The World Health Organization (WHO) went on an emergency footing. At the beginning of January as the news of the pandemic was creeping out of China, and the day after the U.S. Centers for Disease Control and Prevention (CDC) had already created an “incident management system” and issued a travel notice for travelers to Wuhan, Hubei province, the Canadian media was understandably focused on the 63 Canadians among the 176 people killed when Ukrainian International Airlines flight UIA 752 was shot out of the sky by the Iranian military just after the plane took off from Tehran Airport on 8 January 2020. Justin Trudeau’s suggestion, implying that the plane crash was partially the result of escalating tensions in the region between America and Iran, though undiplomatic, was perhaps understandable.

However, the existence of a possible very virulent virus was already extant. I have not written about Hong Kong or Singapore, but on 4 January, the head of the University of Hong Kong’s Centre for Infection, Ho Pak-eung, insisted that the city implement the strictest possible monitoring system for a mainland mystery new viral pneumonia expecting a surge in cases during the upcoming Chinese New Year. The Singapore Ministry of Health on 4 January reported the first suspected case of the “mystery Wuhan virus” in Singapore, involving a three-year-old girl from China who had traveled to Wuhan.  On 7 January, the U.S. Centers for Disease Control and Prevention (CDC) had already created an “incident management system” and issued a travel notice for travelers to Wuhan, Hubei province.  

Further, media interest in Canada could have been expected since there were reports that China was silencing its scientists. Chinese authorities censored the hashtag #WuhanSARS. They began investigating anyone who was allegedly spreading misleading information about the outbreak on social media. On 10 January 2020, Li Wenliang, a Chinese ophthalmologist and coronavirus whistleblower, started having symptoms of a dry cough. He was summoned to the Wuhan Public Security Bureau and forced to sign an official confession promising to cease spreading false “rumors” regarding the coronavirus. “We solemnly warn you: If you keep being stubborn, with such impertinence, and continue this illegal activity, you will be brought to justice—is that understood?” Li signed. “Yes, I understand.”  On 12 January 2020, he started having a fever and was admitted to the hospital on 14 January 2020. He died on 7 February.  Only then did the Canadian press take notice.  

Why in mid-January was the Canadian media preoccupied with whether the Queen in Britain would allow Prince Harry and Meghan Markel to live part time in Canada and reporting virtually nothing about the virus? On 5 January, WHO had already published its first Disease Outbreak News for the world community on the new virus named novel coronavirus-infected pneumonia (NCIP), although, as yet, there was no risk assessment. By 10 January, WHO had issued a technical package of guidelines to countries on how to detect, test and manage potential cases. Based on experience with SARS and MERS and known modes of transmission of respiratory viruses, the guidelines covered infection and prevention controls to protect health workers, recommending droplet and contact precautions when caring for patients, and airborne precautions for aerosol generating procedures. Two days later, China published and shared the genetic sequence of COVID-19.   

On 14 January, based on the experience with SARS and MERS, WHO’s technical team suggested that among the 41 confirmed cases, some limited human-to-human transmission of the coronavirus, mainly through family members, could be expected. WHO warned that there was a risk of a possible wider outbreak. Very significantly, over a week later a small specialized Canadian military intelligence unit (MEDINT) began producing warnings and analyses. There was no indication that the intelligence reports were being widely distributed within government at the time. I could find no evidence that these reports were distributed to the media.  

America was much further ahead. On 3 January, Dr. George Gao from China was on vacation in the U.S. with his family and briefed US CDC Director Dr. Robert Redfield on the severity of the virus. Redfield was rattled. By contrast, in Canada, other “more serious” items appeared in the press which in retrospect are the height of irony. Several items stand out. Boeing very reluctantly stopped its production of the 737 Max jet and probably saved billions. Trump appeared before the World Economic Forum in Davos calling climate change advocates “prophets of doom” while he celebrated American oil and gas production that would soon enough result in over-production and a drastic drop in prices. Meanwhile, the Canadian government had won its case before the Supreme Court against B.C.’s rejection of pipeline expansion.  

By the time President Trump’s impeachment trial had opened in Congress on 22 January, two days earlier the U.S. had confirmed its first cases of COVID-19, then called the Wuhan coronavirus. While Canada was preventing Meng Wanzheu of Huawei’s return to China and holding her for possible extradition to the U.S., the U.S. Centers for Disease Control and Prevention had an emergency response system and activated it. America authorities were advised to step up airport health screenings and Trump stopped all flights from China.  

China had reported 453 cases and 9 deaths. Health authorities in China were given sweeping powers to initiate lockdown and quarantine prevention efforts. On 22 January, the World Health Organization (WHO) convened an Emergency Committee to assess whether the outbreak constituted a public health emergency of international concern. By 30 January 2020, after a meeting in China to better understand the context and international implications as well as exchange information, upon their return, the Executive Committee of WHO reconvened and advised the Director-General that the coronavirus outbreak constituted a Public Health Emergency of International Concern with 7,818 confirmed cases, dubbing the risk assessment very high for China and high for the rest of the world. By then at very least, Canada should have stood up and taken notice.  

On 16 January, Japan’s Ministry of Health, Labour and Welfare reported its first case. Researchers from the German Center for Infection Research (DZIF) at Charité – Universitätsmedizin Berlin developed a new laboratory assay to detect the novel coronavirus allowing suspected cases to be tested quickly. On 17 January, US CDC sent 100 border officers to three American airports to screen travelers coming from Wuhan, China. However, when Donald Trump was briefed by US HHS Secretary Alex Azar about the virus, Trump was more concerned with the question of when flavored vaping products would be back on the market. When US CDC learned from the Chinese on 10 January of the genetic sequence of the virus, it developed its own testing kit using three small genetic sequences instead of two used by Germany. Within weeks, the test kits were found to be defective because the third sequence, or “probe,” gave inconclusive results. CDC lost five weeks in developing its testing program.  

By the time of Trump’s impeachment, and after 300 confirmed diagnoses and 6 deaths had been reported in China, the Chinese cover up the spread of a new coronavirus ended. On 21 January, the Communist Party’s Central Political and Legal Commission called for the public to be kept informed and warned that deception could “turn a controllable natural disaster into a man-made disaster.” In the U.S., on the day the impeachment trial began, Dr. Anthony Fauci, America’s foremost infectious disease expert, gave video news report on Voice of America.  

Data was quickly accumulating on the rapid spread of the disease, human-to-human transmission and a rapidly increasing rate of transmission. China shut down Wuhan with a total quarantine on 23 January and suspended its public transportation. But while the American experts were issuing alerts, at the Davos Forum Trump assured everyone that America had the problem under control and that “its going to be just fine.”  

The sense of the enhanced riskiness of this disease was growing by leaps and bounds. On 24 January, in Lancet, Chinese scientists established that people could be symptom free for a few days after being infected, thereby greatly increasing the rate of infection. Personal Protective Equipment (PPE) ws strongly recommended for front line health workers. The disease had spread to Thailand, Australia, Malaysia, Sri Lanka, Japan and Singapore when Canada reported its first case in Toronto on 25 January.  

Governments should have been in panic mode. Gabriel Leung, Dean of the University of Hong Kong medical school, a world expert on SARS and viruses, offered nowcasts and forecasts of the coronavirus projecting that the true number of coronavirus infections was likely 10 time more than the official reported numbers and that draconian measures were needed to slow the progress. He predicted that the number of infections would exponentially peak in late April or May when there could be up to 100,000 new infections per day. The disease had spread to Austria, Romania, Ecuador, Fiji, Samoa, Poland, Mongolia, Switzerland, Germany, France, United Kingdom, Russia, Tibet, UAE, Brazil and who knew where else.   

While senior officials in the U.S. were on top of the crisis with dire warnings from its intelligence agencies, Trump’s acting chief of staff, Mick Mulvaney, initiated regular meetings and briefings on the virus, but Trump himself was dismissive. A senior medical adviser at the Department of Veterans Affairs, Dr. Carter Mecher, emailed public health experts in government and universities that, “The projected size of the outbreak already seems hard to believe.”  

As of 30 January, finally there was some substantive action in Canada. Air Canada halted direct flights to China following the federal government’s advisory to avoid non-essential travel to the mainland. In contrast, Trump’s economic adviser, Peter Navarro, even as Trump downplayed the crisis, warned that the virus could evolve “into a full-blown pandemic, imperiling the lives of millions of Americans.” Azar, Redfield and Fauci supported the travel ban because it could buy some time to put into place prevention and testing measures. Little did they know or recognize that the time bought in February would almost entirely be wasted.  

Meanwhile, in Canada, an op-ed appeared fearing the transportation cut-off to China would disrupt our agricultural trade with China. And the Canadian Health Minister, Patty Hajdu, not Donald Trump, was reassuring Canadians at the end of January that the risk to Canadians remained low. David McKeown, former medical officer of health for Toronto, advised Torontonians not to “let the coronavirus mutate into an epidemic of fear and panic.”  

However, on 29 January, the House Committee on Health began to discuss the threat. Better late than never. But was Canada just late? (to be continued)

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