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In the years that followed the 2003 SARS outbreak that infected over 400 Canadians and killed 44, an independent inquiry was launched in Ontario to investigate the response to the outbreak and learn from the mistakes made.
Some of the experts involved in that inquiry say there was one key lesson learned at the time — which Canada failed to apply when the coronavirus pandemic hit.
At the helm of the 2007 SARS Commission was Justice Archie Campbell, a superior court judge with an “insatiable curiosity,” who colleagues say was determined to ensure the lessons from the outbreak were never forgotten.
As Campbell met with advisers in the library of a federal building in downtown Toronto, he noted how decades of previous royal commission reports were there just collecting dust on the shelves.
“We would look around the room and he’d point out a royal commission and he’d say, ‘As far as I know, that is as far as the recommendations of that royal commission got. They’re sitting on the library shelf,'” remembers lawyer Doug Hunt, chief counsel for the commission. “And he said, ‘I do not want ours to end up that way.'”
WATCH | Health-care workers put at risk as lessons from SARS not applied in COVID pandemic:
Lessons learned from SARS in 2003, including ensuring the availability of personal protective equipment and access to sick leave, were not applied to the COVID-19 pandemic, and that put the lives of health-care workers at risk, a report commissioned by Canada’s nurses’ unions says. 2:01
That was the driving force behind the inquiry, which aimed to thoroughly investigate the outbreak and make clear recommendations that governments would want to follow in the face of future infectious disease outbreaks.
“We had great hope at the time,” said Hunt. “But I think in the end, from a government standpoint, it did end up just on the shelves of that library.”
Canada didn’t ‘err on the side of caution’ early in pandemic
Canada has faced a much more dire situation in the coronavirus pandemic, with more than 190,000 COVID-19 cases and 9,700 deaths in the eight months since it began.
But experts who worked on the SARS Commission say if the lessons from SARS had been better applied early on, the country could have fared much better.
“Canada, China, Hong Kong and Taiwan had more than 90 per cent of all SARS cases and deaths, so they’re the ones who we should be comparing ourselves to,” said Mario Possamai, a senior adviser to Campbell on the SARS Commission. “Canada now has more COVID-19 deaths and cases than China, Taiwan and Hong Kong combined.”
He said the most important lesson from the SARS Commission was a concept called the “precautionary principle,” a strategy that future governments could apply to ensure the situation didn’t get out of control.
Mario Possamai, a senior adviser on the 2007 SARS Commission, said the precautionary principle was not successfully followed by the federal government at the beginning of the coronavirus pandemic. (Craig Chivers/CBC)
The basic tenet of that principle is to always take the safest approach in an outbreak and not wait for all of the scientific evidence before acting.
“What Justice Campbell said was that when there is scientific uncertainty, err on the side of caution and protect health care workers and protect Canadians,” said Possamai. “And we didn’t do that.”
“In case after case, a precautionary approach would have made a difference,” said Possamai. “We were not only late in moving in that direction, but there was a real lack of transparency.”
Time and time again the Public Health Agency of Canada assured Canadians it was using the best guidance available, but declined to cite the specific scientific evidence behind its decisions, like its reluctance to acknowledge asymptomatic transmission and the possibility of airborne spread of the virus — something Possamai said caused confusion.
“What were the studies? What was the science?” he asked. “It’s completely opaque.”
Hunt said the lack of personal protective equipment available to frontline health-care workers at the beginning of the pandemic was “inexcusable,” and called the decision to destroy millions of expired N95 masks last year “mind-boggling.”
The federal government was widely criticized early in the pandemic for failing to maintain an adequate supply of personal protective equipment in the National Emergency Strategic Stockpile (NESS), and for sending 16 tons of PPE to China, leading to a scramble to procure supplies. Canada has since become almost entirely self-sufficient in producing its own PPE, and China has repaid the donation.
Canada’s Chief Public Health Officer Dr. Theresa Tam finally conceded this week that the science is “evolving” on whether COVID-19 can be transmitted via aerosols — or microscopic airborne particles — yet PHAC’s guidelines still make no mention of it.
“In key areas, we just didn’t take a precautionary approach,” Possamai said. “The kinds of arguments that the federal government made at the time didn’t make sense then, and make even less sense now.”
Canada ‘must do a lot better’ at protecting elderly in 2nd wave
Prime Minister Justin Trudeau responded to questions last week about whether Canada’s lessons from SARS had been followed, after the release of a report Possamai authored that alleged Canada put health-care workers at undue risk of COVID-19.
“As we look back on those first months, there are a lot of things we could have done differently, we should have done differently, and things we’re learning from,” Trudeau said during a news conference on Oct. 5.
“At the same time, many of the things that we were able to do successfully in those first months of the COVID-19 pandemic were based on lessons learned from SARS.”
WATCH | Dr. Theresa Tam reflects on Canada’s early COVID-19 response:
Part 1 of 3 of Rosemary Barton’s exclusive interview with Chief Public Health Officer Dr. Theresa Tam about Canada’s response to the COVID-19 pandemic. 9:44
Tam said the government did “learn a lot” from the SARS outbreak, noting that both PHAC itself and her position were created because of the inadequacies that were identified in the aftermath.
“Every outbreak or pandemic is different,” she said. “This one is magnitudes bigger than SARS itself, so I know we will learn even more from this than we did the last time around.
“We need to broaden pandemic preparedness going forward.”
Tam said that includes expanding beyond hospitals into long-term care homes, adding that the government “must do a lot better” at protecting elderly residents and health-care workers who work in them.
“The precautionary principle, this time, is a disgrace,” said Doris Grinspun, the head of the Registered Nurses’ Association of Ontario who worked on the front lines of SARS in 2003 and called for an inquest into the outbreak.
“We should have known that we needed to be better prepared.”
Grinspun said while communication and co-operation between different levels of government has improved since SARS, she feels Canada needs to learn from the mistakes of the first wave to contain the spread of COVID-19 more successfully in the second.
“This time, we are better prepared than the first wave,” she said, adding that following the precautionary principle for residents of long-term care in the second wave would mean hiring more staff.
“We have been saying ‘hire, hire, hire,’ because come the fall with the twindemic — the flu and COVID — we will be in trouble.”
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
