As Canada grapples with rising COVID-19 cases and new, more transmissible strains of the virus, experts in medicine and emergency preparedness say it's worth taking stock and preparing to better meet the next stage of pandemic challenges.
Dr. Shawn Whatley, a past president of the Ontario Medical Association, says that last year in the early days of the pandemic, the government didn’t yet know what it was dealing with, but at this stage officials should be thinking more strategically in several areas.
Whatley, a Munk senior fellow at the Macdonald-Laurier Institute, says that although the vaccine rollout in Canada will provide much-needed relief, it's not a cure-all and governments should adjust their approach in order to save lives in the long run.
“The vaccine is part of an overall response, but the overall response needs to be, protect the vulnerable, isolate the sick, and make sure that our system has enough capacity to meet any demand that comes on it,” he said in an interview.
Some experts also say Canada should investigate and learn from countries that have had more success in dealing with the pandemic.
Protecting LTC Homes, Increasing Rapid Testing
Although steps have been taken to better protect seniors in long-term care homes—where the majority of virus-related fatalities have occurred in Canada—more targeted and effective action could be taken, says Whatley, author of the recent book “When Politics Comes Before Patients—Why and How Canadian Medicare is Failing.”“We have the knowledge and awareness to protect anyone in society, but especially to protect our vulnerable patients. Have we done that? I don't think we have,” he says.
Rather than locking down entire provinces to contain the spread, he says, health officials need to focus on creating protective “bubbles” around care homes, much like professional sports teams have done—with promising success.
Last summer, the NBA and NHL created sealed-off environments in which to finish their seasons, where players and teams were isolated from the rest of the world and lived in self-sufficient communities. Anyone who needed to come into their bubble had to test negative for COVID-19 at least twice. Neither league saw a single positive test result in their bubbles during the remainder of the season.
David Redman, former executive director of the Alberta Emergency Management Agency, says the strategy of quarantining long-term care homes, including staff, is an ideal way to protect society’s most vulnerable.
This could be done by providing government-run hotels so that staff could quarantine in cyclical shifts and get tested before re-entering a care home—which would save lives while greatly reducing demands on hospital capacity, he said in a previous interview.
Dr. Paul Saba, a family physician and writer who advocated for widespread use of masks in the early months of the pandemic, said expanding rapid testing and point-of-care testing at care homes and other hot spots for vulnerable populations is an urgent priority and long overdue in the COVID-19 battle. He says waiting to hear results from PCR tests, which takes one to five days, is causing people to spread the virus unknowingly.
“People visiting nursing homes, they can't wait three days because they'll spread it within three to five days—within the [waiting] period,” he told The Epoch Times.
So far, Health Canada has been reluctant to embrace widespread rapid testing, saying lab-based PCR tests are more accurate. Nevertheless, the health agency has distributed around 3.8 million rapid tests kits to the provinces since November.
Decisions around rapid test strategy and distribution fall to the provinces, however, where many of the tests remain in storage. Advocacy group Rapid Test & Trace Canada has called for a coordinated national strategy to introduce mass rapid testing across Canada.
COVID-19 Tunnel Vision
As governments scramble to contain the spread of the virus, a hyper-focus on case counts and disease eradication is ignoring the broader impact containment measures and restrictions are having, Whatley said.“You have to focus on the whole function of all society,” he says. “We've thrown out all of our disaster plans and we're making up new disaster plans just for COVID-19 that focus on one risk: COVID-19.”
For months, experts have been warning of the tsunami of collateral damage that widespread lockdowns are causing through a rise in phenomena such as suicides, overdoses, bankruptcies, and psychological impacts on children.
Since the early months of the pandemic, Redman has been lobbying provincial and federal governments to set up specialized emergency management teams featuring a cross-section of professionals—including those in the medical, education, and major resource sectors—that could look at all of the areas impacted by the pandemic and work together to minimize the damage to the greatest extent possible.
Learning From Other Countries
Dr. Peter Phillips, a clinical professor of medicine in the Division of Infectious Diseases at the University of British Columbia, says there needs to be a coordinated attempt by the federal government to study and replicate methods of virus containment that have worked in other countries, such as Taiwan.Despite Taiwan’s close proximity to the origin of the virus outbreak in China, it has seen only seven deaths from COVID-19 to date due to a fine-tuned system of early detection as well as intensive contact tracing, surveillance, quarantine, and border controls. As a result, the island has remained largely open with some protective measures in place such as widespread mask usage.
“Ironically, life today in places such as Taiwan, South Korea, and New Zealand is much closer to normal and with far fewer restrictions compared to Canada and other Western countries,” Phillips wrote in a recent op-ed in the Toronto Star.
Timothy Sly, an epidemiologist and professor emeritus at the School of Occupational and Public Health at Ryerson University, says it may be too late to implement some of Taiwan’s measures since the virus transmission is already “out of control” in Canada, but there is much to learn from the island nation.
“For the next pandemic—because there will certainly be more—Canada can follow [Taiwan’s] lead by being prepared ahead of time with facilities, equipment, PPE, procedures, planning, command structures, communication structures, and an up-to-date, 24/7 epidemiological response unit,” he said in an interview.
Taiwan’s success has also been linked to its efforts back in December 2019 to independently investigate early reports of the pneumonia-like outbreak in Wuhan without relying solely on data from Beijing. Saba notes that this type of early-warning system and ability to independently verify information from other countries is crucial in combating the next pandemic.
Canada's auditor general launched an investigation into the government's handling of the country's pandemic early-warning system, known as the Global Public Health Intelligence Network, after media reports in July 2020 revealed that the network partially shut down its surveillance work in May 2019. This cut off the ability of the surveillance unit to raise the alarm about the onset of the pandemic in China. Canada's health minister has also launched an investigation into the matter.
Questions were also raised recently about the way in which Canada informed its early pandemic response. This was prompted by reporting that emerged earlier this January that federal health officials a year ago failed to cite early warnings about the threat of COVID-19 that had been gathered from military intelligence, as reported by CBC. Instead, they relied almost exclusively on advice from the World Health Organization to inform Canadian policy, despite the WHO’s reliance on unverifiable data from Beijing.
Health-Care Capacity
When the first wave of the pandemic hit, the rationale behind lockdowns was to “flatten the curve” in order to protect the health system. But federal and provincial governments have continued to rely on lockdowns to manage spikes in COVID-19 cases, and doing so without addressing many of the underlying capacity issues, Whatley says.Several provinces, such as Ontario, Quebec, and Alberta have returned to more restrictive lockdowns in recent months, saying their health-care systems are already at capacity and threaten to be overwhelmed.
“If this was an issue of capacity, then why haven't we increased our capacity?” Whatley says, noting that a lack of hospital bed capacity in Canada has been an issue for years.
“Every single winter, we're at 100 percent capacity or higher in many, many hospitals across Ontario. I've been saying for 15 years or longer that we do not have the capacity within our current system to deal with any kind of major threat,” he said.
While provinces have made some efforts to increase hospital bed capacity and access to equipment such as ventilators—Ontario, for example, announced funding in November for 2,250 new acute care beds across the province—there hasn’t been the kind of large-scale ramp-up that would be expected during a pandemic, says Whatley.
One thing that could have been done, he says, is retrofitting hotels for medical use, many of which remain empty due to decreased travel.
“The approach to disaster planning is always based on the presupposition that there will always be something that'll happen that we don't know, and that's why emergency services should never be running at maximum capacity," he says.
"You should always build the system so that you have resilience.”
