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'It matters to families': Canada does not keep track of probable cases of COVID-19 – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


When Vicente Perez was admitted to a Toronto hospital for suspected COVID-19 on May 2, the first question he asked his family was about Florencia, his wife of 70 years.

“Where is she? I don’t know how to call her,” his granddaughter, Cindy Perez, remembers him saying over the phone. “She doesn’t know where I am.”

His family didn’t have the heart to tell him that she had died just hours before.

Florencia and Vicente lived at home in Toronto with their adult son, who had fallen ill just two weeks earlier from what their family doctor thought was a sinus infection.

The couple in their 80s took care of their son, who had not been instructed to self-quarantine, bringing him food and tea as his condition failed to improve. 

But when Florencia came down with a sore throat on April 28, they worried it could be COVID-19.

Her symptoms quickly worsened, and four days later she died in bed next to Vicente.

“It all happened just very quick,” Cindy said. “It went from nothing to all of a sudden symptoms, and she died that Saturday morning.” 

Vicente was extremely disoriented when paramedics arrived, and they quickly determined his oxygen levels were low.

He was immediately taken to Humber River Hospital in Toronto, where he tested positive for COVID-19 that night. 

“They admitted him into the hospital that very day,” Cindy said. “And what was really, really sad is that because he was already very disoriented, he never knew that my grandma passed.” 

Vicente had bone marrow cancer and Parkinson’s disease, and his condition worsened over the following weeks. 

He died alone in hospital on May 21. 

After seven decades together, Vicente and Florencia passed away just weeks apart. 

The stark difference between their deaths is Vicente tested positive for COVID-19 before he died and so was included in Canada’s national case count. But Florencia wasn’t tested, so her death wasn’t reflected. 

Canada only records lab-confirmed cases nationally

Canada does not record probable COVID-19 cases and deaths across the country despite international guidelines to do so, and experts say we may never know how many cases have been missed.

The World Health Organization released a set of guidelines in April calling on countries to track both confirmed and suspected cases of COVID-19 as a way to monitor the total impact of the disease worldwide.

“The WHO has issued very clear guidelines that you don’t need a test to be able to diagnose a COVID death,” said Dr. Prabhat Jha, professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto.

“The bad news is that Canada is too slow in reporting that second type of death.”

Both Ontario and Quebec said in statements to CBC News that the case numbers they release information on are based entirely on lab-confirmed tests.  (Evan Mitsui/CBC)

Unlike Canada, countries like New Zealand, Portugal and the U.K. have routinely released information on these probable cases throughout the pandemic. 

A spokesperson for the U.K.’s Office for National Statistics told CBC News it records a doctor’s declaration of COVID-19 on a patient’s death certificate, even when a test isn’t available, and that the data could be useful for future research. 

But most Canadian provinces haven’t publicly released data on these probable COVID-19 deaths and cases, even separately from the confirmed ones, instead focusing solely on people with positive test results.

A spokesperson for the Public Health Agency of Canada said in a statement to CBC that without a positive test for COVID-19, a probable case does not meet its national surveillance reporting criteria. 

That means if someone dies of COVID-19 before testing positive, even when it’s marked as the cause of death on their death certificate, that case isn’t necessarily reflected anywhere in our national numbers. 

And that’s exactly what happened to Florencia Perez. 

B.C. tracks probable COVID-19 cases, deaths

Ultimately, it’s up to the provinces and territories to decide if they should report those numbers publicly — and at least one does. 

British Columbia not only counts probable COVID-19 cases and deaths, but it conducts antibody and post-mortem testing to find those who may have been missed. 

“This is something that we felt was important early on to try and get a good sense of the overall impact and who’s been impacted,” B.C.’s Provincial Health Officer Dr. Bonnie Henry said in an interview with CBC. 

“That helps us understand deaths in the community that we might not have recognized.” 

The BC Centre for Disease Control has made data on probable cases public, while the BC Coroners Service said it has so far identified five additional cases of COVID-19 from people who had been tested after their deaths.

Henry said because there is a lag in processing the death certificate data, it can take several months before those cases can be found. 

“That’s our system, unfortunately,” she said. “It’s unfortunately one of those things that we can only look at retrospectively, but we do want to be able to determine the overall impact of COVID on the province.”

WATCH | Dr. Bonnie Henry shares her views on a grim milestone:

‘Each of those people who have been ill reflect the pain on their entire family, their community,’ says B.C.’s provincial health officer. 1:33

Henry said identifying these missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure.

“The impact on our seniors and elders has been so profound — particularly people in long-term care,” she said. 

“Finding that balance of trying to protect that community but also give people who are in the important final stages of their life the respect and the care that they need — that’s the most challenging part of this whole outbreak for sure.” 

Hardest-hit provinces release no data

But in Quebec and Ontario, Canada’s two hardest-hit provinces, this type of surveillance isn’t being publicly recorded. 

Both Public Health Ontario and the Quebec Ministry of Health and Social Services said in statements to CBC that the case numbers they release are based entirely on lab-confirmed tests. 

Dr. Michael Gardam, an infectious disease specialist and chief of staff at Humber River Hospital, who is a veteran of the SARS and H1N1 outbreaks, said he doesn’t think that approach goes far enough.

“We clearly know there were more cases. This is an underestimate,” he said. 

“I just in general would like more transparency from the numbers, more transparency from public health — just put all the information out there.” 

Gardam said the daily lab-confirmed case numbers should have a “big asterisk” beside them that indicates “we know there are more cases than that.” 

Dr. Bonnie Henry said identifying missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure. (Ben Nelms/CBC)

Dr. Michael Warner, medical director of critical care at Michael Garron Hospital in Toronto, has personally diagnosed patients with probable COVID-19 despite negative test results or those that were unable to get tested before dying. 

“Unfortunately, many cases I think have already been lost because it was at the beginning of the pandemic when we lost so many patients in long-term care homes, and it’s unclear whether we can go back,” he said.

“It matters to families because they want to know how or why their loved one passed away, and I think we owe it to them.”

Dr. Allison McGeer, an infectious diseases specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003, said one reason the data isn’t recorded is because officials feel the numbers could be taken the wrong way. 

“The one thing that public-health people don’t want to do is be seen to be inflating the number of cases,” she said. 

“They tend to be conservative because it’s always tempting to accuse them afterwards of inflating numbers and making it look worse.” 

Slow reporting systems partially to blame

Tracking these cases through death certificates is also more work for an already slow reporting system, especially in Ontario, which relies on outdated technology like fax machines and the manual reporting of cases. 

In response to ongoing criticism, the province announced Thursday it would finally be overhauling its antiquated system of reporting diseases. 

But while Ontario may soon be able to track confirmed cases faster, there appears to be no plan for the province or other parts of the country to release data on probable cases and deaths any time soon.

For Cindy Perez, that adds more pain to an already painful situation. 

“The fact that she’s not accounted for in the numbers, it’s unfair because she did suffer from the disease,” Cindy said, referring to her grandmother. 

“People should know that there have been so many people that have gone unaccounted for that have been victims to this.”


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The great PPE panic: How the pandemic caught Canada with its stockpiles down – CBC.ca

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This is the fourth in a series of articles looking at some of the lessons learned from the first months of the COVID-19 pandemic and how Canada moves forward.

To hear Minister of Public Services and Procurement Anita Anand describe it, Canada’s effort to supply frontline workers during the pandemic has been a significant — if uneven — success.

“We did procurement like it has never been done before,” said Minister of Public Services and Procurement Anita Anand. “We are in an urgent scramble to secure personal protective equipment and we will not let up until that task is accomplished.”

The federal government, she said, has conducted just under a hundred flights to Canada carrying Chinese personal protective equipment (PPE) and bringing supplies from the U.S. and Europe.

It was a remarkable, last-ditch effort. But could it have been avoided?

Public Services and Procurement Minister Anita Anand listens to a question during a news conference in Ottawa, April 16, 2020. (Adrian Wyld/The Canadian Press)

Dr. Sandy Buchman, president of the Canadian Medical Association, gives Ottawa credit for pulling every lever it could when the need for PPE became critical. “But they wouldn’t have had to scramble to do that if we had adequate stockpiles, and the same goes for medication,” he told CBC News. “We should have maintained and had them available.

“We had a pandemic plan in place but we didn’t actually have things ready. We didn’t have adequate personal protective equipment for frontline health care workers.”

In fact, Canada still doesn’t have the PPE it needs to keep those essential workers safe.

Read more from the series:

Just take a look at the nation’s capital. Thirty out of some 600 Ottawa paramedics are currently reassigned from front-line duties because of a lack of N95 masks, according to their union.

CUPE ambulance rep Jason Fraser told CBC News that when he began as a paramedic during the SARS epidemic in 2003, he and his co-workers were fitted out with state-of-the-art respirators. 

“For 17 years, the gold standard of mask has been the N95 masks,” he said. “And due to a global shortage or difficulty obtaining proper PPE, all of a sudden surgical masks are OK protection.”

Fraser said his members don’t want to work with anything less than N95s and don’t believe they’d be asked to do so were it not for preventable shortages.

He points the finger of blame mainly at the Ontario government. But a shortage of N95s has been an issue in many places across the country.

PPE stock in poor shape

Canada’s pandemic response got off to a rocky start when it came to the basic tools: masks, gowns, gloves and other products.

Canadian PPE stockpile levels were woefully low when the pandemic hit; materials were allowed to expire without being used or even donated, and then ended up in landfills. The Trudeau government was widely criticized for sending 16 tons of PPE to China at a time when the novel coronavirus was still mostly a Chinese problem, and the Public Health Agency of Canada was still mistakenly assessing the risk to Canadians as “low.”

A cargo aircraft delivers medical supplies and protective equipment to Montréal–Mirabel International Airport. (Daniel Thomas/Radio-Canada)

Anand said her department responded to those shortages by fostering the creation of a Canadian PPE industry from scratch.

“Forty-four per cent of our contracts by dollar value are made with domestic manufacturers,” she said.

“This is an incredible effort on behalf of Canadians themselves to protect Canadians. So that is a heartening story and it’s also an important lesson learned.”

It’s a lesson nearly everyone involved in fighting the pandemic agrees has to be learned — if Canada wants to avoid the same experience when the next pandemic hits.

The preppers weren’t prepared

One nation that hasn’t had to worry about PPE is Finland. Its history of Soviet invasion left it with a siege mentality that manifested itself in the construction of a secret network of bunkers stocked with supplies to carry its people through times of war or disaster — including a huge stockpile of masks.

Canada also has a National Emergency Stockpile System (NESS), launched in 1952 at the height of the Cold War and originally intended to help Canada survive a nuclear attack.

Lately, the system’s rationale has changed somewhat. “We began to move away from beds and blankets and increased our holdings of antiviral medications and key treatments,” Sally Thornton of the Public Health Agency of Canada told MPs at a committee hearing in May.

“We do not focus on PPE and that wouldn’t be a major element, because we count on our provinces, within their respective authority, to maintain their stockpile.”

Some MPs found that answer highly unsatisfactory, given that the NESS last year threw out two million N95 masks that had been allowed to expire.

Stockpile ‘completely unready’

“The stockpile system proved completely unready for COVID-19, and the degree of unreadiness goes well beyond the explanation that COVID-19 was was unexpected in terms of its impact and scale,” said Wesley Wark of the University of Ottawa, an intelligence expert who studied the NESS’s response to the pandemic.

“It was clearly underfunded. Cabinet ministers and senior officials have admitted that fact.”

Health Minister Patty Hajdu said in April that “federal governments for decades have been underfunding things like public health preparedness, and I would say that obviously governments all across the world are in the same exact situation.”

Inventory analyst Olivia Ivey organizes a stack of boxed personal protective equipment inside the massive warehouse in Langley, B.C. where the Provincial Health Services Authority receives and distributes millions of pieces of PPE. (Glen Kugelstadt/CBC)

What Hajdu said is true — although her own government closed warehouses and left the stockpile even smaller than it found it. NESS’s annual budget is only about $3 million and both the Harper and Trudeau governments routinely spent even less on it. It has a regular staff of just 18 people.

“But beyond its underfunding,” said Wark, “it basically lacked any kind of strategy as far as I can tell to prepare for an emergency …”

“There was really no planning done to integrate the federal government’s stockpile system with those held by the provinces and territories. It’s not until February — a month into the COVID-19 crisis — [that] the federal government wakes up to the fact that they don’t even know what is held in provincial and territorial stockpiles, nor do provinces and territories know what’s held in the federal stockpile. That points to a basic strategic failure.”

The come-as-you-are pandemic

When March arrived, Wark said, “the stockpile system had to transition into being a kind of portal for trying to get supplies hastily mobilized from domestic suppliers or international sources into Canada and passed on to provinces and territories.

“You know, I think the whole thing was just a desperate scramble. And it didn’t need to have been that way, if proper attention had been paid to the important role that the stockpile system was meant to play.”

A pandemic is a bad time to start shopping for emergency supplies. With COVID-19 engulfing one country after another, Canada found itself competing with dozens of other countries, as well as private U.S. hospital networks, to acquire the most sought-after items. 

Anand said the government has learned that lesson and will ensure that stockpiles of PPE, medicines and other essentials are maintained in future.

Stockpiles alone won’t solve the problem, she said, because PPE products have expiry dates and a major pandemic would at least start to exhaust any stockpile.

“Another part of the puzzle is also to make sure that we’ve got relationships with a diverse range of suppliers who can produce these goods so that we have priority when it comes to making sure that we have that product,” she said.

Unreliable suppliers

Canada’s two main markets for acquiring PPE supplies — the U.S. and China — have been problematic.

China’s PPE market quickly flooded with new companies that previously had been making things like baby toys or auto parts. They began to churn out PPE of wildly varying quality.

In the U.S., President Donald Trump ordered 3M to stop fulfilling contracts to provide N95 masks to other countries, and halted a shipment to Ontario in April. Thanks mainly to dogged resistance to that order by 3M executives, the threat was averted.

Dr. Deborah Birx, White House coronavirus response coordinator, holds a 3M N95 mask as she and U.S. Vice President Mike Pence visit 3M headquarters in Maplewood, Minn., March 5, 2020. (Glen Stubbe/Star Tribune via AP)

But it it all served as a reminder of the risks involved in depending on other countries for essential supplies in a global emergency. Ontario Premier Doug Ford vowed to make his province self-sufficient.

“I’m not going to rely on President Trump,” he said. “I’m not going to rely on any prime minister of any country ever again. Our manufacturing, we’re gearing up and once they start, we’re never going to stop them.”

Anand said she is working to end Canada’s dependence on foreign sources. 

“The strategy from procurement has been to diversify our supply chains to make sure that we are not reliant on one country or one jurisdiction alone,” she said.

“We would very much aim to have domestic production of every item here in Canada.”

That would mean persuading the Canadian manufacturers that switched production over to medical equipment — such as clothing maker Stanfields in Nova Scotia — to stay in the game once the crisis passes.

Mixed messages on masks

The government’s early advice against wearing masks confused many Canadians, who suspected (correctly, as it turned out) that the guidance defied common sense.

That confusion also affected people in the medical field.

“I have been astounded that we are not being told to wear masks,” one occupational therapist told CBC News on March 31, describing conditions at the rehab hospital where she worked. “We are even being told we can’t wear our own masks and will be reprimanded and potentially disciplined for doing so.”

Some Canadian hospitals even had security guards order people to remove masks before they could enter.

A B.C. Ambulance Service paramedic wearing a face shield, an N95 mask and gloves is seen in the ambulance bay outside the emergency department at Royal Columbian Hospital in New Westminster, B.C., April 12, 2020. (Darryl Dyck/The Canadian Press)

Calgary ER physician Joe Vipond told CBC News the government’s position on masks struck him as irrational from the beginning.

“And I see that changing, but boy it’s slow!” he said.

He said that his own province of Alberta was “pretty late to the PPE bandwagon”.

“I know in B.C. on March 25 every single hospital and every single long term care facility were mandated to wear masks in all situations, in order to avoid pre-symptomatic and asymptomatic spread,” he said.

In Alberta, he added, that decision came “a good three weeks after. And so I think a lot of ways we were quite lucky to avoid a lot of transmission within our acute care facilities. That didn’t work out so well for our long term care facilities.

“I know there was one outbreak at the Lloydminster hospital and also in Winnipeg that were blamed on lack of universal masking. There was always a concern about N95, and we were told to be very cautious in our use.”

Vipond blamed the relentless search for cost efficiencies, cheaper vendors and just-in-time delivery for the shortages.

“There is value in having stockpiles and there is value in having your own domestic control over things,” he said. “I’m hoping that we recognize the value of being a masters of our own domain.”

Mike Villenueve, CEO of the Canadian Nurses’ Association, agrees with Vipond about the patchwork nature of PPE access across the country.

“It’s been a story of great success in many places … and the complete opposite in others — you can’t seem to get it, or it’s locked up, or I’m encouraged to not use it because it’s expensive,” he said.

“Our view is that we should err on the side of protecting people, and whatever the cost of an N95 mask is, [it’s] small compared to the cost of a life.”

‘A sense of mistrust’

Villeneuve said the fact that rules on PPE use varied from place to place led nurses to suspect PPE policies were being driven not by the best science but by harsh realities of supply and shortage.

“How come that filters down so differently across 13 jurisdictions, hundreds of employers and different practice settings and so on, when a nurse in a practice setting in Alberta is doing the same thing as a nurse in the same setting in Manitoba?” he said.

“That sort of sets up a sense of mistrust.”

Anand said that it’s up to provinces to set such policies — but she doesn’t rule out the federal government making uniform recommendations. 

She said her department soon will be rolling out new PPE supplier competitions on its supply hub website.

“We have had 26,000 businesses respond to our call out to suppliers, 26,000 businesses wanting to step up and assist in the Team Canada effort,” she said. And while only about 17,000 of those companies are Canadian, Anand argued it “suggests is that there is capacity in the Canadian economy to become self-sufficient in the area of PPE.”

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A third of Canada's foodservice workforce is still unemployed: survey – CTV News

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TORONTO —
New data from Statistics Canada’s Labour Force Survey revealed that 164,000 foodservice and accommodation jobs were recovered in June. Despite these gains, at least 400,000 people who were previously employed in the foodservice sector are still out of work.

Restaurants Canada, a national non-profit association representing Canada’s diverse foodservice industry is calling on the federal government to make changes to the Canada Emergency Wage Subsidy program (CEWS) to aid businesses in their effort to rehire workers as they continue to recover.

The program was implemented at the height of the pandemic to help businesses subsidize their employee’s wages for up to 12 weeks, initially. Restaurants Canada is urging the government to keep the subsidy available for as long as pandemic restrictions are in place and to gradually reduce the subsidy as businesses achieve manageable levels of revenue.

To qualify, businesses must have experienced a 30-per-cent decline in revenue. The association is asking the government to scale the 30-per-cent threshold to support restaurants in their recovery.

“Reforms to the federal wage subsidy are urgently needed to help foodservice businesses bring more Canadians back to work amid ongoing restrictions,” said David Lefebvre, Restaurants Canada Vice President, Federal and Quebec in a press release. “Forty-four per cent of restaurant operators who responded to our latest survey said they did not apply for the subsidy for at least one of their establishments because it would not meet the requirements.”

In May, Finance Minister Bill Morneau announced that the federal government would extend the CEWS by an additional 12 weeks until the end of August. 

When asked about any future changes, the minister’s office pointed to the Economic and Fiscal Snapshot released on Wednesday, which states: “As economies reopen and business activity resumes, the government will soon announces changes to the CEWS to stimulate rehiring, provide support to businesses during reopening and help them adapt to the new normal. In anticipation of this forthcoming announcement, the government has set aside additional funding as part of the 2020 Economic and Fiscal Snapshot.”

The minister’s office declined to share specific details about future changes to the program, but advocates remain hopeful as more businesses begin to reopen. 

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COMMENTARY: Canada and the U.S. are neighbours but miles apart when it comes to COVID-19 – Globalnews.ca

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The COVID19 pandemic has shone a light on the core strengths of Canada’s health-care system while at the same time laying bare the serious shortcomings of the American system.

In this country, we have started to flatten the curve. Ontario and Quebec are not quite as far along as other provinces, but their spread rate of the virus has slowed considerably.

If we stick to adhering to public health protocols – keeping our physical distance, wearing a mask in many situations, not congregating in large crowds – there is every reason to think the curve will continue to flatten while the pandemic continues.

Read more:
B.C. reports 25 COVID-19 cases, most since May 8

Not so on the other side of the border.

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The COVID-19 situation in the United States is almost out of control in many places. States like California, Arizona, Texas and Florida are getting steamrolled by the deadly virus that is rampaging through them.

Even neighboring Washington, which thought it had the virus almost under control mere weeks ago, has seen a resurgence in case numbers, hospitalizations and deaths.

There seem to be many reasons for the stark differences between the two countries’ experience in fighting off the virus.

Perhaps the most important difference is that Canada’s response to COVID-19 is being driven and determined by public health officials, and not by politicians.

Read more:
President Donald Trump playing politics with the pandemic: experts

People like B.C. Provincial Health Officer Dr. Bonnie Henry and federal Public Health Officer Dr. Theresa Tam have been in charge for the most part and they are being guided by science rather than politics.

Canadian political leaders, meanwhile, have primarily been responsible for devising financial aid packages for the millions of people hit hardest by the virus and have stayed out of the health side of the response.

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Contrast that to the United States where, in some cases, elected officials (notably President Donald Trump) publicly clash with public health experts and ignore or override their advice.

Dr. Anthony Fauci, the respected U.S. infectious disease expert, has almost disappeared from public view. Evidently, that is because the Trump administration does not want him offering the country expert advice.

Can you imagine if the B.C. government tried to muzzle Henry? A pitchfork-waving mob would instantly materialize in the streets.

Read more:
British Columbians snapping up Dr. Bonnie Henry merchandise

Another key difference is that Canadians tend to follow rules created for the benefit of the larger community. We don’t chafe under state controls and when someone like Dr. Henry says, for example, that there will be no mass gatherings of people there generally is not (the public protests against racism are notable exceptions).

Americans, on the other hand, love to boast about their constitutionally protected personal rights and have been thumbing their noses at things like crowd limits since the pandemic began. In fact, the current surge in COVID-19 cases in the U.S. can be traced back to the Memorial Day long weekend in late May, when huge crowds gathered to celebrate.

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Finally, it cannot be a coincidence that a country with a public health-care system is doing so much better fighting COVID-19. It allows us to take a centralized approach to taking on the virus.

The U.S., on the other hand, has a private system that has led to a decentralized approach. The result is a hodge-podge of results (within states, some neighboring counties have differing “lockdown” rules; some hospitals do not even report case numbers or deaths).

Two countries side-by-side, yet we could not be further apart in this pandemic.

Keith Baldrey is the legaslative bureau chief for Global BC, based at the Legislature in Victoria, B.C.

© 2020 Global News, a division of Corus Entertainment Inc.

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