An over-emphasis on politicians and relative invisibility of medical and scientific advisors has weakened Ontario’s COVID-19 response. An evolving second wave of COVID-19 is on track to collide with the influenza season, straining our healthcare system like never before and worsening our backlog of tests and surgeries.
Normally the slow, methodical nature of political change is an important feature of the checks and balances of a stable parliamentary democracy. When a state of emergency is declared, special powers are given to the government to generate a more rapid response to an evolving situation. COVID-19 represents such an emergency. However, unlike pure socio-political emergencies, COVID-19 is a health crisis.
Non-political public institutions and individuals such as the Public Health Ontario, the Chief Medical Officer of Health and even local Public Health Units should exist to take charge of health emergencies. But these organizations have been slowly defunded over many political cycles, leaving them poorly prepared to lead the response.
Premier Doug Ford during a March 23 COVID-19 update
When the pandemic arrived and a state of emergency was declared, Ontario politicians took the lead rather than our public health leaders and institutions. A Provincial Command Table was established but most of its secret membership is believed to be government officials. Certainly, there has been scientific input but medical science advisors have been relatively hidden from the public. The primary voices of the pandemic in Ontario have been Premier Doug Ford and Minister of Health Christine Elliott.
Separation between political interests and the pandemic response has been lost.
A pressing example can be found in the province’s return-to-school plan. The government has overlooked expert advice and scientific evidence in favour of a political agenda focused on avoiding smaller class sizes.
Let’s be clear: persisting with larger classes will increase the number of school children infected and act as an amplifier of community spread of COVID-19. This is particularly important considering the inability to meaningfully change school ventilation systems.
Recent Ontario modelling suggests class sizes of 30, compared to 15, will increase the number of infections as much as fivefold. Despite the evidence, the government voted down a private motion to reduce class sizes. Paradoxically, Premier Ford restricted indoor gatherings to a maximum of 10 people in Ontario’s hot spots on the same day.
Dr. Dirk Huyer, undated (source: Twitter)
Recently, Ontario’s Chief Coroner, Dr. Dirk Huyer, was asked to help lead Ontario’s testing plan and outbreak response in schools and long-term care homes. The appointment is clearly outside his area of expertise. Meanwhile, our world-class ID/epidemiology/virology experts are completely sidelined.
Testing centres are being overwhelmed with huge lineups and long waits. The strain on our testing system will slow turnaround time, which in turn will delay vital contact tracing. Excessive delays in contact tracing make the process ineffective – speed is essential.
Because of limited new provincial investment in public health units, approximately 50 per cent of Ontario COVID cases still have no known epidemiological link. This is occurring while Ontario Public Health Units have caseloads that should be manageable and a rebound in cases is just beginning. This is a huge cause for concern. Our test-trace-isolate strategy lacks the strength to fight back against the surge of cases on the horizon.
We naturally crave scientific information to make sense of our world turned upside down by COVID-19. Since Ontario’s politically driven response rarely provides scientific rationale for decisions, top experts either have no voice or are relegated to media or social media to express their concerns. Frustration is growing among Ontario’s burned-out healthcare workers.
In the United Kingdom, the government’s disorganized response and lack of transparency led to the formation of the Independent Sage, a group of prominent medical scientists providing non-government, publicly facing advice on the U.K.’s response to COVID-19. While a collaborative model would be preferable, a similar group might be required in Ontario.
As the combination of a second wave of COVID-19 and influenza threatens our healthcare capacity, a single and powerful change needs to be made – recognize the magnitude of the crisis, accept Ontario’s internal deficiencies and bring science to the forefront of our response. Assemble a team of 10-12 of Ontario’s top virologists, epidemiologists and infection prevention and control physicians and add them to the COVID-19 Provincial Command Table. Give this team a direct public voice to restore appropriate balance, transparency and public trust to Ontario’s COVID response.
Many of our shortcomings on timing and depth of lockdown, implementation of a strong test-trace-isolate system, response to long-term care and farm outbreaks, universal masking and, most recently, school re-openings and overwhelmed testing centres could have been lessened with clear, expert-led scientific guidance.
The Ford government’s greatest failing in this pandemic has been to try to keep complete control of the COVID-19 response and the public messaging. True leadership would be stepping back, recognizing areas of weakness and appointing a public-facing COVID advisory committee that is not beholden to the government.
The stakes are high. The second wave of this once-in-a-lifetime global health crisis has already begun in Ontario.
It is time to promote our top medical scientists and truly listen to the experts.
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It is both deeply ironic and shocking that Dr. Fallis’ perfectly legitimate comments in a publication entitled “healthy debate.com” has lead to his removal from the William Osler Health System. This is an affront to everything our country is supposed to stand for. The executive team at Osler who made this decision should be ashamed.
Thank you for your excellent paper, Dr Fallis. This morning I read about your mission to insist that the Scientific and Medical communities be major voices in the pandemic response. Many Ontarians have been concerned about the poor political messaging and leadership in this crisis.
It was more important to have bars and indoor restaurants open before schools against all evidence from communities which successfully reduced cases!
It appeared to be an effort to keep the Buck a Beer crowd on board.
At a tv show in September, the premier appeared ignorant about the arrival of the second wave… “Who would have thought.. “ when recognizing an upsurge in cases..
This province needed and needs an Independent Sage. I am appalled at the penalty you have paid for your leadership. The Incompetence of this government has not only led to failure to prevent Covid through testing and tracing, the collateral damage for our kid’s education, the care of patients outside the Covid wards and to our economy is enormous.
We are finally hearing and reading more urgent advice and pleas from doctors and scientists. Why not organize into a Scientific Pandemic Advisory Team with an independent face and press. Independent Sage may be too subtle a title. Covid is not our last pandemic!
Carolyn,teacher, mother, grandmother,
Toronto
I’m late to this particular link. Sadly, logic and reason has continues to be ignored while so-called non-experts like us remain appalled by outrageous government actions.
Various experts around the globe have cited the success of using treatments such as Ivermectin or hydroxychloroquine in combination with azithromycin and zinc to improve outcomes. Additionally, sufficient levels of D3 and B1 are also important. to support immune systems. It confounds me why this is not pursued by the medical community here in Canada.
Agree entirely with this “bring science to the forefront of our response.” But what science? Traditional science and epidemiology, like evidence, which is emerging with this novel Corona virus, are necessary but not sufficient.
There are dynamics and complexities involved, and the science of complexity is being used by the Santa Fe Institute, its founding home, the New England Complex Systems Institute, and others to help stop this virus. Too bad it is superseded by politics there and elsewhere.
Complexity is the science for the 21st century according to Stephen Hawking and well suited to dealing with the novel features and complex dynamics of Covid-19. In addition to the usual science, we should tap into those resources to see what they are advocating, add complexity scientists to the list of other scientists, and each of us learn some complexity and think complexity when making policy decisions and actions for Covid-19. It requires a few simple ideas to frame thinking, and adaptive action with feedback and change as needed.
Can look at the websites mentioned above and Google complexity Covid for more, as well as “What is complexity science” and “Complexity Explained.” As it turns out, traditional science and complexity science tend to converge with Covid-19, but it is still useful to explore, to understand and plan for a future unknown. There is also some writing that a lack of complexity thinking is what got us to where we are at with this virus (The damage we are not attending to – Santa Fe Institute, and Who dropped the ball – BMJ post), and what we need to stop it.
I do not dissagree with anything but I come from a problem-solving perspective. I saw Covid as two problems. The medical challenge was the first. The second is the challegne of changing the behaviour of people. We invested billions in the first and very little money or expertise into the second. We needed teams of communication, advertising, service design, design thinking, cognitive style, and so on to shape solutions (translating medical recommendations into designs of schools, solutions in all aspects of society or fun and engaging messages for communications). One aspect is communication and social media strategies. Ontario failed to engage society. Where is its advertising to reach 20-year-olds? Where was the plan in Aug to reach parents and teachers that schools are safe? It was amateur. I also lived in NZ. Imagine…if we hired Schitts Creek to produce 20 short vidoes on the behaviour changes we needed. This would be fun, and support social media. The Kiwis hired actors to do so. They also started Creative Genius to get people to produce their own covid videos to help others. About 600 videos were submitted. This includes videos to support the use of its app (which is a tracking app, not an exposure app) 42 per cent of Kiwis have the app compared to 6 per cent of Canadians. While I support what you are saying, we will fail again unless we make a distinction between the challenges we face. Here are a couple of articles I wrote on what the NZ did. https://www.linkedin.com/pulse/covid19-wicked-problem-solving-did-your-country-change-ed-bernacki/ https://www.linkedin.com/pulse/do-countries-ignore-elderly-covid19-apps-simple-needed-ed-bernacki/
I completely agree with Dr. Fallis. It is high time for the Ontario government to listen to scientific advice.
I’m pretty sure SAGE in the UK was well in place and offering advice before and during the UK government’s disorganized and ineffective response to the pandemic–one of the worst in Europe. From what I’ve heard and read, the experts in SAGE had great difficulty coming up with anything like a consensus, and there’s been lots of speculation that the chief scientific and medical officials felt–and gave into–pressure to give the advice the government wanted to hear.
I suspect there are much better examples than the UK for what you are calling for in Ontario.
May I nominate Drs. Elizabeth Richardson ,Dominik Mertz, Neil Rau, and Martha Fulford?
Respectfully, our response to COVID has various implications that are beyond the scope of expertise of infectious disease specialists.
With respect to the specific examples of reducing class sizes for example, I suspect that the government heard the advice the author references loud and clear but had to contend with the sheer logistical challenges of cutting class sizes in half within a short time frame. Ultimately infectious disease specialists are not experts on the logistics of upscaling an education system. So the government had to make a decision to either switch to part time attendance or go forward with overcrowded classrooms. They may have even put this dichotomy to their own internal public health experts who had to weigh in.
That is just one example of a situation where expert advice clashes and someone has to make a difficult decision.
This is so true.
Just because someone is an excellent clinician or scientist, does not automatically mean they are a good leader, or should be charged with policy decisions.
In fact, school boards presented feasible and affordable options to the Ontario government for reducing all class sizes without needing to hire many teachers. TDSB proposed a plan that would have required only 200 additional teachers at a cost of $20 million, and would have placed all Kindergarten-Grade 8 students in classes of 15-20. The Ministry of Education rejected this plan. It appears they do not wish to reduce class sizes, despite clear evidence and expert advice that it is a crucial public health measure.
While I basically support your comment, I also see this as a failure of the public service in Ontario to innovate the solutions it needed. I have an international specialization in public service innovation. I was struck by the lack of engagement of innovation teams or the use of behaviour insights to shape solutions. Ontario knew schools had to reopen in April. Did you see teams of innovators come together with skills in HVAC, service design, cognitive style, communication, education, architecture and change come together to translate medical recommendations into practical solutions? No. There is a bigger issue here as well. I would suggest Canada missed so many opportunities to engage citizens to change behaviours. Our communication is mediocre at best. Here is an overview of what NZ did – they made people laugh. https://www.linkedin.com/pulse/covid19-wicked-problem-solving-did-your-country-change-ed-bernacki/
Thank you for the well written & thoughtful article. It is important that physicians speak to these issues. I appreciate all those that have done that- it’s not easy. I’m not sure the general public knows how much better Ontario could have done in this pandemic if politicians had not turned it in to an election campaign style forum. We desperately need medical leadership to be the lead role in this. Having a “secret” command table is as worrisome as is having a coroner involved during a pandemic in a province rich is medical experts. It’s shameful that Ontario is in this position.
Excellent and clearly presented info. Thanks.
Would this be like the science critically evaluating the Sweden response such that their country is back to normal? Science was politicized the minute Trump shut down most travel from China. Since then, masks are silly and don’t work, masks might work, masks are mandatory. Since then HCQ is has absolutely no value and is toxic and completely unsafe (despite 500 million people probably taking there usual dose today, despite the American Association of Physicians and Surgeons suing the FDA for its arbitrary restriction to its use ie. your American colleagues). Since then (as of Jun 2020 in Canada), 1 person under 20y with other comorbidities has died secondary to covid – yet all our grade-schools are on some wonky 25% onsite and 75% at home schedule…which science might you be suggesting? BTW how overwhelmed was WOHS in March, April, May, June – funny that this metric is never reported anywhere but for Italy when they were in the thick of it.
Scientists are political!
Pretty sure the ID specialists are, on some level, happy to give media interviews and have a spotlight on their role. The exception to me is Dr Allison McGeer – she is truly a trustworthy expert that we should be hearing more from. I always appreciate her interviews.
I had heard that one ID specialist has a financial stake in technology around a COVID app.
That said, the clinicians are obviously “less political” than politicians. But to suggest that scientists don’t have biases or vested interests can be an issue.
On a side note, some docs seem to spend a lot of time on Twitter, and perhaps effort in curating their social media presence. It makes me wonder why they aren’t spending that time on patient care.