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Inside Canada's frayed pandemic early warning system and its COVID-19 response – CBC.ca

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As COVID-19 quietly incubated in Wuhan, China, last fall, public health officials in Canada were looking for gaps that needed to be closed in their long effort to upgrade this country’s online pandemic early warning system.

Few people outside of a tight circle of highly-specialized epidemiologists and federal bureaucrats had ever heard of the Global Public Health Intelligence Network (GPHIN) before the novel coronavirus became a global pandemic.

That’s probably going to change now.

Information about the coronavirus outbreak is spreading fast, but what do we actually know about the illness? CBC News medical contributor and family physician Dr. Peter Lin breaks down the facts about what it is, where it came from, how it spreads and what you can do to protect yourself. 5:10

The online, multilingual monitoring and analysis unit, which scours the Internet for media reports of infectious diseases, has been a crucial pandemic tripwire for both Canada and the World Health Organization (WHO).

The network delivered its first report about COVID-19 on Dec. 31, 2019 — one day after a similar online monitoring network known as ProMED issued its notification.

CBC News has obtained a series of internal public health agency documents and slide-presentation decks — including one given by a senior epidemiologist from the Public Health Agency of Canada (PHAC)  last November on the eve of a pandemic that has since killed tens of thousands and crippled the world economy.

Network needed a tech upgrade

The documents bring into sharper focus the kind of information key decision-makers had at their fingertips as the outbreak started in China and raise questions about how seriously global pandemic preparedness was being taken within the federal government.

The records show GPHIN was in the middle of a long-overdue technology upgrade as the virus was spreading.

Despite almost four years of work with the National Research Council of Canada, the early warning system was — as of last fall — still in need of “improvement in the geographical and time tagging algorithm,” according to a Nov 12, 2019 presentation to a WHO conference in Seoul, South Korea by senior epidemiologist Florence Tanguay.

That algorithm is crucial to the system’s ability to sort through as many as 7,000 online articles per day to spot disease outbreaks around the globe.

The network also was awaiting an “expansion to new data sources,” such as social media feeds. From its inception in the late 1990s, GPHIN had relied on news wire services and later local media articles posted online.

Network’s first alert came from a media report

At the time when GPHIN and ProMED issued their COVID-19 notices, little was known about how deadly or contagious the outbreak might be — but the early signs were ominous.

The International Society for Infectious Diseases, which runs ProMED, cited multiple urgent notices from official Chinese sources. One came from the Wuhan Municipal Health Committee, which warned that “multiple patients had been isolated” and medical institutions in China should be on the lookout for respiratory infections “and improve emergency plans for medical treatment.”

But the GHIN’s initial notice to its 800 subscribers, which include the WHO as well as the health ministries in Canada’s provinces and in 85 countries around the world, cited an Agence France-Presse report.

Chief Public Health Officer Theresa Tam speaks during a news conference in Ottawa April 15, 2020. (Adrian Wyld/Canadian Press)

Chief Public Health Officer Dr. Theresa Tam said last week GPHIN was one of the intelligence sources she relied on, crediting it with detecting the outbreak in Wuhan “right at the end of December.”

It wrote daily reports on the progress of the virus, she said.

The Canadian government most likely would have been aware of the ProMED reports and has, according to senior health officials, also had personal contact with agencies in other countries, notably the U.S. Centres for Disease Control.

Earlier this month, the military’s health intelligence unit acknowledged it also had been writing regular briefings on the novel coronavirus since early January.

The medical intelligence cell within Canadian Forces Intelligence Command began producing detailed warnings about the emergence of the deadly novel coronavirus in Wuhan, China in early January, CBC News has learned.  2:09

‘Critical warning task’

Another major source of intelligence for the Canadian government, naturally, was the World Health Organization — although the documents show up to 20 per cent of that institution’s open-source intelligence comes from GPHIN.

It is difficult to understate the importance of the Canadian network, said one of the country’s leading intelligence experts.

“The Global Public Health Intelligence Network was meant to perform a critical warning task with regard to the COVID-19  … outbreak. This was its job,” said Wesley Wark, a University of Ottawa professor.

“It should have been at the heart of a Canadian and indeed a global early warning system.”

Created in 1997, GPHIN is credited with helping spot the SARS and H1N1 outbreaks.

Did world governments get GPHIN’s warnings?

During those previous outbreaks, the network issued rolling email alerts to those governments and the WHO as the viruses it was tracking appeared in new countries.

The documents obtained by CBC News raise questions about whether that practice of issuing specific alerts was followed in the case of COVID-19. The decision to issue those warnings would have been up to the Public Health Agency of Canada.

Wark said those warnings and alerts would have been crucial to other governments — and likely would have been taken more seriously than others because they’d be coming from GPHIN, a trusted source.

“It was the institution that was meant to have the technical tools, meant to have the expertise that governments and health experts around the world would look to as the most reliable source of open-source medical intelligence during an outbreak,” said Wark.

‘Dismaying reality’

But to date, he said, he’s seen no indication of how GPHIN daily reports were used, or if they even made their way into government risk assessments.

“The dismaying reality about the Canadian threat assessment of COVID-19 is — from the record we have available — it appears that for some reason or another, Health Canada, the Public Health Agency of Canada, was not able to generate … consistent, daily reporting from its key sources of information, like the Global Public Health Intelligence Network,” said Wark, who pointed to the absence of the reports in documents tabled before the House of Commons health committee.

“The risk assessments referred to in some of the documents made available to the House committee suggest there were only periodic assessments that were done.”

The creator of the Global Public Health Intelligence Network says that, despite the network’s accomplishments in flagging SARS and H1N1 before they took off, successive Canadian governments have had to be convinced of the need to invest in a global disease early warning system in the age of globalization.

Money problems

“Governments, [in] Canada and elsewhere, do not invest in preparedness,” said Ron St. John, a former director general at the Public Health Agency of Canada who once served as the country’s quarantine officer.

“GPHIN, although it had proved itself, was never fully financed.”

Former Public Health Agency of Canada official Dr. Ron St. John speaking to the Pan American Heath Organization in Washington in 2014. (World Health Organization)

The network was conceived in 1997. Throughout St. John’s time in government, he said, GPHIN was on budgetary life support. He said the Centre for Emergency Preparedness and Response routinely had to use a portion of its budget to keep the network “alive” because it never received enough federal money.

A spokesperson for the Public Health Agency of Canada insisted the network produced quality information for the health agency and the government as a whole.

“From the start of the COVID-19 outbreak, GPHIN was, and continues to be, an important source of public health intelligence for PHAC,” said Natalie Mohamed in an email.

Technological hurdles

Aside from funding, one of the recurring challenges faced by GPHIN has been the speed of technological change and the importance of keeping the network modern, said St. John.

In the presentation Tanguay gave to the WHO last fall, she told delegates the network had undergone a reboot in “collaboration with the National Research Council of Canada” (NRC) which led to the development of a “new, enhanced web-based platform using emerging technologies” powered by more automation.

She was referring to artificial intelligence systems.

Built on late-1990s technology that had been only partially refreshed, the aging network was by 2016 in need of a major overhaul.

The federal government had known for a long time about GPHIN’s antiquated system. A 2013 evaluation of epidemic intelligence systems red-flagged trouble that the Global Health Security Initiative had in sourcing information for an ongoing evaluation.

The GPHIN “system design did not allow the extraction or collection of data in a format compatible” with the security initiative analysis, the report read.

In a report posted online early this month, NRC suggested the project was a success.

Even so, the federal government recently put out a request for help from industry to address certain functional aspects of the GPHIN system, including search and location extraction.

In addition, the public health agency has formed a partnership with the University of Toronto’s Brain Alliance big data research centre to improve aspects of the network.

Mohamed said the renewal project is in its final stages and has met key objectives.

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Federal government to provide $14B to provinces, territories to 'safely' restart economies – CBC.ca

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The federal government is providing $14 billion to the provinces and territories to help them “safely and carefully” reopen their economies.

Prime Minister Justin Trudeau made the announcement at his daily news conference outside his residence at Rideau Cottage this morning.

Trudeau also announced that Canadians with disabilities will receive a one-time payment of up to $600 to help offset the higher costs of living during the pandemic.

The government has announced emergency aid for unemployed Canadians, students, businesses and seniors, but advocates say that people with disabilities were falling through the cracks.

Many face increases in the cost of living, such as higher grocery bills and delivery service fees.

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Bouncing back? Canada added 290,000 jobs in May – CBC.ca

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After losing more than three million jobs in March and April, Canada’s economy added 290,000 jobs in May, Statistics Canada reported Friday.

The data agency reported that 290,000 more people had paid employment in May than in April. The surge means May was the best one-month gain for jobs in Canada in 45 years, although it happened from an admittedly low bar. It also  means the labour market has bounced back by about 10 per cent of the hit it took from COVID-19.

Despite the job gains, Canada’s official unemployment rate rose to 13.7 per cent, as 491,000 more people were looking for work in the job market, notably students, whose search for summer work isn’t normally recorded in the months before May.

In February, Canada’s jobless rate was 5.6 per cent. It increased to 7.8 per cent in March and 13 per cent in April. The number of unemployed Canadians has more than doubled since February.

Blows away negative expectations

The job gains came as a pleasant surprise to economists, most of whom were expecting more job losses for the month.

The average expectation for the job numbers from economists polled by Bloomberg was for a loss of about 500,000 more jobs. But not all of them thought the number would plunge again.

Economist Benoit Durocher at Desjardins was one of just two to forecast the adding of jobs — 400,000 to be precise.

That was his call before the numbers came out, and his optimism proved prescient.

His reasoning was simple: as many Canadian provinces cautiously reopened in May, some of those people who were laid off temporarily in March and April would trickle back to work and show up in May’s employment numbers.

“Employment should rebound and return to positive territory in May, but the extent of the rebound remains unclear,” Durocher said ahead of the numbers coming out. “Under these circumstances, the unemployment rate should begin trending downwards. However, the return to pre-COVID-19 levels could be fairly slow.”

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Should everyone be tested for COVID-19? Most Canadians think so, poll shows – CTV News

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TORONTO —
Experts say widespread testing for COVID-19 is one of the most effective defences against a second wave of infections, a measure most Canadians support according to a recent poll.

More than three in five Canadians say they are in favour of testing every Canadian for the novel coronavirus, according to a Nanos Research poll commissioned by CTV News.

The random survey of 1,009 Canadians, which took place between May 26 and 28, revealed that 28 per cent of respondents support and 33 per cent somewhat support widespread testing measures, while more than one in three opposed the idea.

Polling data shows that residents of Atlantic Canada and Ontario have a higher intensity of support for universal testing than residents in Western Canada.

As the COVID-19 pandemic continues, provinces are working to expand their testing criteria to include people with very mild or even abnormal COVID-19 symptoms, an effort Canada’s Chief Public Health Officer Dr. Theresa Tam says will help spot possible community cases that would otherwise go undetected.

Officials are also working to roll out the country’s first antibody test as rapidly as possible to help determine how much of the population may have been infected.

But some provinces, including Ontario and Quebec, have routinely fallen behind their diagnostic targets. The criteria for who can get tested also ranges widely between each province.

Nanos polling also shows that Canadians are more likely to say they are confident that there will be a vaccine available to fight COVID-19 within the next 12 months. However, four in ten respondents are not confident in that timeline.

Tam has noted that officials are working to understand how administering an eventual vaccine would be prioritized to certain segments of the population while considering “the maximum number of Canadians who may wish to be vaccinated.”

 

MOST CANADIANS HAPPY WITH PROVINCIAL RESPONSE

According to the poll, more than three in five Canadians are confident that their public health authorities have an accurate count of the number of COVID-19 cases in their province.

However, Ontario residents were less confident in the province’s data, with the majority of respondents doubting the official case count.

Ontario, one of the hardest hit provinces, has had several instances of reporting errors since the beginning of the outbreak.

On Thursday, the province recorded a spike in the number of deaths due to COVID-19 after days of relatively lower numbers. However, officials said the increase may have been due to a lag in reporting from local public health units. This comes just days after officials revealed nearly 500 COVID-19 patients were not flagged to local public health agencies for contact tracing due to a reporting error.

When it comes to the economic ramifications of the outbreak, nearly eight in ten Canadians say the opening up of the economy in their province is being done in a safe (33 per cent) or somewhat safe (46 per cent) way.

Residents in B.C. and Atlantic Canada were the most confident in the safety measures being taken to reopen the economy.

However, when asked which approach Canada should take to opening its border with the U.S., 40 per cent of Canadians say Canada should keep the border closed to non-essential traffic until the end of the summer. Thirty-one per cent say Canada should keep the border closed until there is a vaccine.

Twenty per cent of Canadians say the border should open to non-essential traffic once businesses are allowed to open, even if social distancing is still in place, with residents of the Prairies the most likely to be in favour of reopening.

 

METHODOLOGY

Nanos conducted an RDD dual frame (land- and cell-lines) hybrid telephone and online random survey of 1,009 Canadians, 18 years of age or older, between May 26 and April 28, 2020. Participants were randomly recruited by telephone using live agents and administered a survey online.

The margin of error this survey is plus or minus 3.1 percentage points, 19 times out of 20.

The research was commissioned by CTV News and was conducted by Nanos Research. 

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