James Somers ended his excellent article on how American engineers responded to the COVID-19 crisis, more particularly, the shortage of ventilators (“Breathing Room: Engineers take on the ventilator shortage,” The New Yorker, 18 May 2020) with a quote from Michael Ryan, the executive director of health emergencies at WHO. Ryan stressed the importance of speed. “If you need to be right before you move, you will never win.”
Commentators have noted with favour the speed at which Vietnam, Taiwan and even South Korea responded to the COVID-19 crisis as a critical explanation of why their infection and death rates were so low in this pandemic. Canada, in contrast, I have suggested, acted with alacrity. One reason given for the speed of the response of the Asian countries is their experience with SARS (Severe Acute Respiratory Syndrome) in 2003. As a result of lessons learned from that new coronavirus epidemic that emerged out of Foshan, Guangdong, China, preparations were put in place for the future.
As Christopher Kirchhoff wrote in a recent issue of Foreign Affairs, “Ebola Should Have Immunized the United States to the Coronavirus.” And even more acutely SARS in Canada, for Canada had its own SARS crisis. A Chinese woman returning from Hong Kong on 23 February 2003 died on 5 March. Eventually, 257 individuals in the Province of Ontario were infected.
The crisis in the ill-prepared Hoping Hospital in Taiwan where the hospital was sealed off with 1,000 patients inside in response to the SARS scare in April 2003 was an example of a panic reaction when there was an absence of preparation. Vietnam had a similar fright. A Chinese-American, Johnny Chen, carried the SARS virus to Hanoi where, when in the French Hospital, he infected 38 members of the staff. He died on 13 March.
The Asian states were determined never again to be caught unprepared. The COVID-19 crisis proved that they were not. Why was Canada seemingly caught unawares when it had its own terrible experience with SARS? Canada, too, had responded to the 2003 crisis with a provincial thorough investigation and a detailed report by Justice Archie Campbell and the federal government with the Naylor Report. The final report of the Ontario independent commission was completed in 2006. The Minister of Health and Long-Term Care made it public on 9 January 2007. The report documented how the SARS virus came into the Province of Ontario, spread and the inadequate response of the health authorities. The report documented the need to isolate and quarantine, to test and track contacts, how to work on treatments and vaccines, but the greatest stress and emphasis of the report was on the measures needed to protect public and health workers. Quality tested masks, gowns and other protective equipment had to be purchased and stockpiled.
Were these lessons learned and applied? What about the public reaction to a new epidemic scare? Were preparations in place. With the outbreak of COVID-129, some racist Canadians attacked Canadians of Chinese ancestry. Attention was also given to the airlift to extract Canadians from Wuhan. At the same time, public health research was referred to as supporting the Government refusal to ban travel. The federal government has decided to follow the WHO’s advice against travel bans. According to Health Minister Patty Hajdu on 3 February, “There isn’t evidence’ that they effectively contain viral outbreaks.”
Imposing a total travel ban on China was viewed as contrary to both Canadian foreign policy and a source of stimulating anti-China sentiment. China, in turn, referred to Canada as a bulwark of calm in response to the crisis. Andre Picard in The Globe and Mail on 4 February even questioned whether Canadians returning from Wuhan, in an unprecedented move, who were quarantined for 14 days at Canadian Forces Base Trenton, needed to be. He had clearly not read the Campbell Report and, it turned out, few had. Picard advised, “Canada hasn’t acted promptly, so at least it can do so smartly.” He argued that medically, quarantine was unnecessary but politically essential. “Politicians and public health officials have to be seen acting, even if their actions are not especially useful.”
However, the problem was not pretence but that officials were not acting sufficiently quickly and implementing what had been learned from prior experience. As Dr. David Butler-Jones, Canada’s first chief public health officer and Deputy Minister of the Public Health Agency of Canada, wrote, in opposition to Picard at the same time, there was a dire need for public health specialists and expertise. “There are few things that focus the mind quite like the fear of contagion. With the emergence of a new coronavirus, the world is once again reminded of the outbreak of SARS in 2003.”
However, Butler-Jones insisted that, “Public health officials and governments across the country are responding quickly and diligently to the current outbreak, applying lessons from SARS.” If this were true, why the failure to introduce a travel ban? Why was there no systematic effort to document the poor state of our protective equipment and, more importantly, take action to redress the problem? Butler-Jones, while mentioning the Campbell Report, focussed on the federal Naylor Report response to the 2003 crisis which stressed communication, coordination and cooperation across jurisdictions.
After all, the Public Health Agency of Canada (PHAC) and Public Health Ontari0 were created in response to SARS in 2003 and that proved crucial in stopping the HiN1 pandemic in 2009. Since then, however, “many governments seem to have forgotten those lessons as changes since 2014 have diminished the capacity of public health to prepare for and respond to new and inevitable threats, as well as to carry out their mandate to protect and promote health and prevent illness and injury.” Government offices have been fragmented and depleted. Generic public servants have replaced specialists. Economic management rather than resource expertise were placed at the forefront.
However, changes in the make-up and organization of the Canadian civil service were not the only problems. For why were the experts complacent even in light of past evidence and reports. The University of Toronto by the end of the first week in February had established a steering committee of senior administrators and infectious disease experts who announced that, “the risk in Canada is low.” A more serious concern was stigmatization and discrimination.
There was another problem. Most observers have attended to the economic crisis that followed the COVID-19 crisis. However, even before the crisis in early December, Statistics Canada revealed the loss of a staggering 71,200 jobs, the worst month since the Great Depression. The monthly consumer confidence index slumped to its lowest reading in three years. The fear of a made-in-Canada recession became extant.
Canada faced a real firestorm – fear of an even greater impact on an already endangered economy, especially in the tourist and oil and gas sectors. Fear of domestic tensions with racist overtones. In place, there was a bureaucracy more concerned with coordination and communication than taking action. While China, Taiwan and Vietnam were promoting dedication and sacrifice, Canadian officials were reassuring its citizens that there was little to worry about even as the lucrative Chinese tourist industry (750,000 the previous year) died overnight. The fear was economic, not health. Isaac Bogoch, an infectious-disease specialist and physician with the University of Toronto, advised that. “Travellers need to be aware of where they are going, how they are getting there and know the latest [travel] restrictions, but they don’t need to cancel trips or stop thinking about future ones.”
Canadian tourists consoled themselves: “the decreased volume of tourists was a godsend as we encountered smaller lineups, less traffic and easier access to everything.”
Where was the real crisis in Canada located? – the Wet’suwet’en blockades that had brought the rail transportation system to an effective halt. Bruce Aylward, a renowned Canadian epidemiologist who led a team of experts to China to study the novel coronavirus on behalf of the World Health Organization, was still living in an echo chamber in which Canadians did not or would not listen to his insistence that an aggressive approach to managing and treating the disease was needed. By the end of February, Canadians began to fear that the new virus was past the point of being contained as Italy began collapsing both in terms of public health and in terms of its economy.
A woman in her 60s who recently travelled to Iran became the 5th person in Ontario, the 12th in Canada, with the coronavirus, and was at home in self-isolation. At the end of February, as the pandemic was about to assault Canada, there were still relatively few cases. However, epidemiologists saw what was coming. Instead of reassuring Canadians about the low risk, as they had largely been doing, they now urged immediate action, including:
- Directives for walk-in clinics, policies on patient transfers and guidelines on the appropriate use of isolation rooms and masks.
- Large-scale tests of people who visited clinics and hospitals to determine if and when the virus starts spreading in Canada.
- Ensuring there are enough ventilators, an especially important treatment tool for people over the age of 65, who appear to experience the worst effects.
Federal Health Minister Patty Hajdu changed her tune from reassurance to urging Canadians to prepare by ensuring they have an adequate supply of food and any prescription medications, and be vigilant about hand washing and staying at home when sick.
Why was Canada so complacent and passive as the COVID-19 crisis grew in January and came to world attention? Why did this complacency continue almost through all of February? We noted that the intelligence about contagious diseases had been tucked away in a small unit if the Defence Department. But defence itself as a whole had been grossly neglected. Canada was not only complacent about its security interests related to contagious diseases, but about all security matters, particularly those that arose in the Far East.
In a commissioned research paper by the Canadian Department of Defence, “A MAPPING EXERCISE OF DND AND CF ACTIVITIES RELATED TO ASIA PACIFIC AND INDO PACIFIC SECURITY, 1990-2015,” at a time when security concerns, diplomacy, and governance, non-state and state institution building, security concerns and dialogue, were all bywords, at a time when China was being acknowledged as a major full player in the region, and when Canadian soft as well as hard policy was pivoting to Asia, ”there has been a noticeable decline (my italics) in the Canadian presence, never mind leadership.” By neglecting our interests and opportunities, we undermined Canada’s security interests, now most apparently in the health field. Canada just does not, and did not, sustain or maintain its commitments even in areas central to our security concerns. The authors (David Dewitt, Mary Young, Alex Brouse and Jinelle Piereder) of the report in the article they published in International Journal in 2018 (Vol. 73:1, 5–32) entitled their piece, “AWOL: Canada’s defence policy and presence in the Asia Pacific.” They concluded not simply that Canada was asleep at the switch, but that Canada was just not there. Canada was absent without leave. In other words, complacency in Canada was a trademark rather than an aberration.
“Many factors combined to reinforce Canadian inertia. The lessons from SARS in 2002 had not been institutionalized. The Canadian administration had been hollowed out of expertise; administrators with a primary preoccupation with budgets replaced the experts. Stress was placed on cooperation and coordination rather than action and initiative. Canadian leaders feared Chinese and anti-China prejudice more than COVID-19. They were even more fearful of the already looming economic downturn and did not want to face the economic disaster that would result from the COVID-19 crisis. Diplomatic priorities with China in foreign policy also took priority. Initiative, entrepreneurship and action were effectively undercut until the crisis loomed like a huge monster before Canadian leaders.”