Canada and COVID-19: March to May 2020

On 3 March, my wife and I were scheduled to fly to Portugal and Spain for five weeks and then continue onto Israel for another two weeks to visit my grandchildren and great-grandchildren. The trip did not take place. Not because we were aware of the coronavirus pandemic. At the end of February, we were even more oblivious of the threat than Canadian officials.

Fortunately, my youngest sons who live in British Columbia were not. Daniel insisted that we not go. He forbad us to go. “But,” we protested, “there are only two cases in Spain.” “Do you know what is going on in Italy? Do you know the rate at which it is spreading? Do you know how virulent it is?” His insistence wore us down. We finally, and most reluctantly, agreed to cancel the trip as we felt it was not fair to allow our children to worry about us.

We had not been convinced by the evidence they put before us or the arguments they offered. We were even in greater denial and less able to absorb the extant evidence than even the Canadian leadership. Besides, the main story was still the protests by the Wet’suwet’en Nation over the pipeline. There was a breakthrough and a proposed deal. The federal and B.C. governments agreed to recognize the hereditary governance system of the Wet’suwet’en Nation.

In the meanwhile, we were receiving requests to sign petitions to urge the government to take action. “Coronavirus is spreading rapidly across the world. So far, it has killed over 3,000 people and infected more than 90,000. Several countries have already implemented safety measures to protect against the spread of the deadly disease, including tightening border control and screening new arrivals for signs of the virus. Almost 10,000 people have signed this petition urging the Canadian government to step up prevention methods now to keep Canadians safe — will you add your name?” We did not sign. We should have. But we did cancel our trip.

Canadian health professionals had started issuing warnings. “Person-to-person spread of the coronavirus within Canada unrelated to travel to an outbreak region is inevitable,” experts said as they called for more aggressive testing. “You can slow it down, but you can’t stop it,” said Gardam, chief of staff at Toronto’s Humber River Hospital. “Local transmission is coming.”

However, the general context was not one in which the authorities were primarily concerned about our health. As they would be again in May, the major concerns were economic. This was true internationally as well as locally. “As the coronavirus’s effects on the economy continue to mount, political leaders and central bankers were starting to take action. The finance ministers of the G7 countries issued a joint statement saying, “they would ‘use all appropriate policy tools’ to try to contain the virus and its effect on the economy. (The virus has jittered markets, slowed manufacturing in China and put a dent in international travel.)”

By 4 March, the U.S. Federal Reserve cut its interest rate by 50 basis points. The Bank of Canada quickly followed the American lead. Dozens of Canadian businesses included new disclosures in their financial reports that outlined the impact coronavirus could have on their operations and the growing risks that could affect profits. Media reports carried warnings of a coming coronavirus recession. Health reports from around the world enhanced the growing panic.

In Washington state, six died. Reports suggested the virus has been circulating for at least six weeks. There were fears that the virus would spread to British Columbia. Ontario initiated “pilot” sites testing patients with flu-like symptoms for COVID-19. By early March, there were 27 confirmed Canadian cases – 18 in Ontario, 8 in B.C. and 1 in Quebec. Canadians abroad, specifically ones on the cruise ship Diamond Princess, tested positive for the virus. Hope had been abandoned that health authorities could contain the epidemic. Isolation and separation, testing, and tracing, new treatments and a new vaccine would help mitigate, slow and eventually stop the disease. But the possible devastation was incredible. Harvard University epidemiologist, Marc Lipsitch, forecast that without adequate interventions, an infection rate of 20-60% might result.  At a mortality rate of 1%, that would mean 30 million deaths.

The story had switched from complacency to near panic. On 7 March, B.C., Provincial Health Officer Dr. Bonnie Henry, who would soon become a household name because of her TV appearances, announced a COVID-19 outbreak at a long-term care home in North Vancouver after two residents were diagnosed with the virus. What a difference a week makes. As Thomas Homer-Dixon in a Globe and Mail op-ed observed, “What a difference seven days make. Shopping for groceries at a big box store near Victoria during the last week of February, I found nothing amiss. Shelves were well-stocked, people’s carts contained the regular assortment of necessities and goodies, and everyone seemed to be happily going about their daily lives. A week later, I stood in front of the same shelves, expecting to find them filled with the usual staples – flour, pulses, sugar and the like. But they’d been stripped bare. Now, shopping carts were groaning under giant bags of potatoes, stacks of packages of frozen chicken and large jugs of water. People kept their distance from each other in the aisles. No one was smiling.”

Neither was I. But for a very different reason. For the next three weeks at this crucial time when the worldwide total of coronavirus cases first exceeded 100,000, when many were being asked to stay home from work, when schools were closed, when large gatherings and events were cancelled, when face masks became a common sight and when 3,400 people across 90 nations had died, I was unable to follow the development of the COVID-19 story. I had suffered a heart arrest. Normally, less than 10% survive. Many who do have serious mental deficiencies. I was lucky. My wife was present. So was a stranger nearby who knew CPR. My wife called 911 and the ambulance happened to be two blocks away. Speed and action – and luck – can radically alter history, individual or collective.

A 4.5 hour operation rewired my heart. But my body had become infected – not with the virus, but with a bacterium that was never identified. It took three weeks to get the infection under control. My two youngest sons flew in from BC. They took turns being at my side as I whined about my pain and insisted that I would rather die. My eldest daughter flew in from India but had to spend two weeks in quarantine. However, by 26 March I was home in bed watching TV and obsessed with the coronavirus story. Finally, on 23 March the federal government announced a lockdown. But testing? Tracing?

I could not yet read about it since I still had difficulty comprehending, but I followed the tale obsessively on TV. It was certainly an escape from my own discomfort and pain. On 25 March, the Province of Ontario had announced an emergency plan. I got used to Justin Trudeau emerging out of his home in Ottawa and announcing a new economic relief initiative for Canadians. If my memory serves me correctly, when I began to follow the coronavirus story in detail, Ottawa had announced wage subsidies of up to 75% for small businesses.

At the same time, the Province of Ontario passed Bill 188, the Economic and Fiscal Outlook Act which was primarily about amendments being made to the Personal Health Information Protection Act which focused on personal privacy when information was being collected. In this effort to protect individual rights, there was nothing about individual responsibilities to the collectivity to protect our health. If the federal government concentrated its efforts on “welfare” programs, the largest provincial government was focused on privacy issues as organizations were permitted to collect personal data, but only with permission and with a system to prevent and detect unauthorized snooping.

Privacy protection is fine. However, was this a priority as a pandemic was about to take off? Was this a priority when “we were not doing well at all in the efforts to mitigate the disease itself,” when “testing was rare,” when “there was no tracing of those who came in contact with a person diagnosed with the disease”? Most embarrassing of all was “the severe shortage of Personal Protective Equipment (PPE) for frontline health care workers.” Anyone with N95 masks was asked to donate them to Toronto hospitals. There were shortages of gowns, gloves, disinfectant and visors. At the end of the first week in April, the race was on to obtain the necessary protective gear for Canada’s front-line health workers. “It is really a Wild West when it comes to buying medical supplies right now,” Deputy Prime Minister Chrystia Freeland said.

By the first of May, reports documented that Canada’s emergency stockpile of personal protective gear was ill-prepared for the pandemic and constituted a fraction of what was required. “The federal agency did not have a target for the levels of personal protective gear it should maintain in the stockpile, did not know what level of stockpiles the provinces and territories had and did not advise lower-level governments about how much should be stockpiled.” (Globe and Mail)

At the same time, it had become clear that a large number of coronavirus deaths were taking place in long-term care facilities, such as the Camilla Care Community nursing home. “Nursing homes account for 81 percent of the country’s covid-19 deaths,” according to Theresa Tam, Canada’s chief public health officer. However, Canadian officials were insisting that there were encouraging signs that the spread of the virus was slowing in many parts of Canada.

The problem is that Canada over April and May remained relatively complacent. On 23 May 2020, Nathaniel Basen published an interview in TVO.org with David Fisman, a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health (“COVID-19: The week in review with epidemiologist David Fisman – May 17-22”) in which he emphasized the necessity of testing aggressively as a key to a healthy province that could also enjoy a reasonably rapid economic recovery. When asked why the same discussion recurs over and over again, he responded, “I am completely baffled. I’ve expressed some frustration over the past couple of days with some of the contacts I do have with the province, saying I’m not playing this game anymore. Various people reach out and ask for your opinion or ask for your work, and it disappears down a black hole.” That pithily sums up what has happened from the end of March through April and May.

The PPE crisis may have been resolved, but this had yet to be tested if another spike in infections emerged. But the issue of testing had not been resolved. Ontario repeatedly set a target of 16,000 tests per day – nowhere near the recommended number – and repeatedly missed that target. There was no tracing program or one under development where tracers were being hired and trained. There was, of course, no effective treatment or preventive vaccine. As Fisman said, “there doesn’t seem to be any clear strategic planning at the provincial level.” Instead, we had “dysfunctional messaging” and a failure to recognize that Toronto was the hot spot in the province.

Why was Canada stuck in second gear? Part of the problem is that our bureaucrats are trained for repeated routine behaviour and not trained to take action in the face of a crisis. Fisman suggested that, “if you’re surrounded by folks who are in the most important public-health fight of their careers, and they are proving again and again that they just cannot get the job done, then I think he has to find people who can get the job done.” But the problem may be systemic and not a matter of a choice of individuals. We did not, and still do not, insist that the responsibility of out leaders is to lead dynamically, with initiatives and sanctions that penalize those who endanger the health of the community. Rights. Privacy. Voluntary compliance – all these are part of the dysfunctional system of communication.

It is not as if we do not have a plethora of lessons from history going back to the second wave of the 1918 flu epidemic. Why has wearing a mask become a symbol of a culture war, much more in America than in Canada, but with plenty of evidence that there exist a significant minority of Canadians who believe that the requirement to wear a mask is an imposition on their individual freedom just as they once insisted that wearing a motorcycle helmet was as well? But wearing a mask is sensible and protects others. That is not difficult to grasp. Why should wearing a mask be a matter of individual volition? Because it offends our sense of independence and even masculinity? Because we do not want to be identified with “political correctness”? But the vast majority of Canadians and even Americans concur that wearing a face mask is a matter of public health rather than a matter of personal choice.

However, there was a huge gap between what we knew and what we did. Further, the extent of our ignorance was amazing. In mid-April, at the height of the disaster and the evidence of Canada’s poor performance, the approval rates for the Prime Minister and the provincial premiers soared. 74% of Canadians approved of Prime Minister Justin Trudeau’s performance, the highest level of approval ever recorded for the prime minister, at least 30 points higher than he received in last year’s election and 20 points higher than his best rating after first being elected in October 2015.

Rob Ford who was elected in Ontario with minority support and who enjoyed only a 25% approval rating at the end of 2019, enjoyed a 60% approval rating with only 15% disapproving of his performance. The Ontario government’s performance responding to the pandemic, its communication with the people, and its handling of the economy got the most positive reviews. And the federal Liberals and the provincial Conservatives were by-and-large operating out of the same play book. Was this result because we favour our leaders in a crisis or because Canada looks great compared to the Americans to the south of us? After all, on 22 May, the federal government said it would do more to help the provinces ramp up testing and tracing.  This could have been done four months earlier.

It was not.

(To be continued)

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