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.
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.
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.