One of the great things about Canada is how most policy decisions are carefully researched with respect to not just its goals but how it will affect others – either in a positive or negative way.
Before such policies are rolled out, expert opinions are sought. Meetings with stakeholders are held. Time is spent trying to reach a consensus. Decisions are evidence-based if possible. If that evidence does not yet exist, it is often waited upon.
This management approach is the gold standard of our society. We expect no less from our politicians and bureaucrats. In almost all cases, this is the correct approach. But for once-in-a-lifetime events such as the COVID-19 pandemic, it simply does not work.
It is time we acknowledge this.
In Ontario, our government and public health leadership are managing the pandemic in the ways outlined above. The messaging is very cautious – as if trying not to scare anyone unnecessarily. Our leaders did not admit the presence of community spread when it was already obvious to clinicians, epidemiologists and local public health units.
They have been very careful in their approach – making great efforts not to economically harm anyone that doesn’t need to be harmed, waiting for overwhelming evidence before acting. Thus, as of this writing, strip bars are closed but bars and nightclubs remain open.
And it took an actual observational study from the Hospital of Sick Children for us to arrive at the rather obvious conclusion that having more than 12-15 children in a classroom is not conducive to required physical distancing. The observations were done in August but the findings were not released publicly until after school started.
The results of this carefulness are crowded classrooms and untraceable infections in young people. The consequences will be rising cases, exponential growth and, ultimately, increased hospitalizations and death.
We can fault our bureaucrats for being too careful but it also reflects on us as a society. It is clear Canadians do not tolerate significant changes in policy or guidelines well once they are set. There was much backlash and frustration when we appropriately were advised to wear masks even though it was somewhat discouraged at the beginning of the pandemic.
Our politicians and public health leadership are aware of this inflexibility, this feedback loop where they are encouraged to be cautious and careful. They are pressured to be correct on the first shot.
Unfortunately, a pandemic with an exponential rise in cases is not the time to be cautious and careful in the traditional sense. Bold and often expedient decisions have to be made based on reasonability and expert opinion – perhaps even with less concrete evidence than we are accustomed to.
Thankfully, our provincial public health leadership did that in March. It needs to do it again now. Reasonable and safe actions should supersede trying to be perfect and blameless. This was exactly the point made by Dr. Michael Ryan from the World Health Organization at the start of the pandemic.
I suggest it is both the decision-makers and the general public who have difficulty with this important concept.
Therefore, we also need expert communicators to explain to the public:
1) We are in unprecedented times and the status quo management style we are accustomed to and expect could actually be a barrier in managing this pandemic.
2) Acknowledge that unfortunately, there will be some who will be economically harmed more than others. But emphasize the risk of not doing enough at the right time would harm them even more.
3) Accentuate that a change in opinion or policy is a reflection of keeping up with new knowledge and not incompetence. Remind everyone this disease did not even exist a year ago.
4) Remind the public that though we may not have indisputable evidence to back up any recommended actions, by the time we get that evidence it could be too late.
5) Lastly, we need to reassure that once this is all over, our traditional management style still holds and remains for non-pandemic issues. It still reflects an important part of what Canada is all about.
Perhaps it is an overwhelming goal to shift societal thinking but we must give it a try.
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Dr Jang can you comment on why the current daily case numbers include BOTH nasal swab PCR positive cases and serology tests which rolled out privately starting August 6th? This is written on public health Ontario websites. We all know serology tests could indicate someone may have had COVId at some point in the past 3 to 6 months but doesnt necessarily have it now. So are these new “second wave” numbers true new cases or are half of them folks who paid for a serology test just to know for fun if they have had COVID. Interestingly serology tests rolled out in France in July, and now they have a second wave….UK is slow to release these tests and they dont quite have the second wave….we release them in August and now suddenly have a “second wave” with record numbers. Hospital admissions from COVID are not really up but we are being blasted in the media like WW3 is coming, the economy is collapsing, mental health cases are skyrocketing. So where is the transperancy? How many of these 900 COVID cases are true currentlt ill people and how many are serology positives who may have zero signs of current illness??
According to David Snowden and his CYNEFIN frame work on decision-making for leaders in simple, complicated, complex and chaotic systems, we need to be as skilled in the complex and chaotic conditions (like we are in now) as in complicated and simple system (where we like to be as experts). A very short, 2 page overview in https://physicianleaders.ca/bulletin2.html
Douglas.. MIKE DROP!
This is exactly the approach that is needed. thanks for articulating in a clear understandable message.