Many may not know that following the deadly SARS outbreak in Canada in the early 2000’s, an inquiry was held to determine what went wrong ( and quite a bit did ), how to fix it, and to learn from those mistakes in order to ” give a legacy of betterment to those who died, those who fell ill, those who suffered so much and those who fought it with such courage.” 13 essential questions were asked. http://www.archives.gov.on.ca/en/e_records/sars/report/v1-pdf/Vol1Chp2.pdf While the report focused primarily on events in Ontario, the lessons learned were critical for the reform, preparation and decision making of all officials across Canada.
Because of past and ongoing concerns and criticisms voiced by ER docs, nurses, infectious disease specialists, journalists and people like myself, I wanted to go back and see exactly what happened and what was learned during SARS, to see if the recommendations and learned experiences have been applied by government officials, both elected and appointed. In the middle of a global pandemic, it makes for both compelling reading, and it provides a critical lens with which to view the current timeline of decisions made in handling Covid-19…and there is much to be critical about.
One of the best and ongoing timelines of the unfolding crisis management at the federal level has been given in this piece in the Edmonton Journal. https://edmontonjournal.com/news/national/the-road-to-canadas-covid-19-outbreak-timeline-of-federal-government-failure-at-border-to-slow-the-virus/
This timeline is a stunning read, made even more so because of how provincial counterparts parroted the federal messaging, telling citizens the risk to Canadians/ British Columbians etc, was low… until very quickly they all had to do an about face. (I posted a very small timeline of key moments here in BC, in this post https://lailayuile.com/2020/03/17/covid-19dont-let-hindsight-be-the-most-astute-advisor-measures-we-need-to-keep-our-communities-safe-and-operational/)
Why the Precautionary Principle has been ignored repeatedly by officials who hesitated to close borders, hesitated to order the public to stay home, hesitate still in closing down work camps and constructions sites, is surely going to be a matter considered by another inquiry down the road.
From page 3 of the Executive Summary of the Sars Commission report:
In The Commission of Inquiry on the Blood System in Canada, Mr. Justice Krever said:
‘Where there is reasonable evidence of an impending threat to public
health, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat.’
The importance of the precautionary principle that reasonable efforts to reduce risk
need not await scientific proof was demonstrated over and over during SARS. The
need to apply it better is noted throughout this report.
One example was the debate during SARS over whether SARS was transmitted by
large droplets or through airborne particles. The point is not who was right and who
was wrong in this debate. When it comes to worker safety in hospitals, we should not
be driven by the scientific dogma of yesterday or even the scientific dogma of today.
We should be driven by the precautionary principle that reasonable steps to reduce
risk should not await scientific certainty.”
Despite being in a state of emergency in BC, and requests for citizens to stay home and limit excursions from our homes, we have heard repeated assertions and mention of the economy as a reason why places where people work and live in close quarters have not been shut down.
From Page 4 of the same summary:
“The Commission therefore recommends:
• That the precautionary principle, which states that action to reduce
risk need not await scientific certainty, be expressly adopted as a guiding principle throughout Ontario’s health, public health and worker
safety systems by way of policy statement, by explicit reference in all
relevant operational standards and directions, and by way of inclusion,
through preamble, statement of principle, or otherwise, in the
Occupational Health and Safety Act, the Health Protection and Promotion
Act, and all relevant health statutes and regulations.
• That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of procedures, guidelines, processes and systems for the early detection and
treatment of possible cases.
• That in any future infectious disease crisis, the precautionary principle
guide the development, implementation and monitoring of worker
safety procedures, guidelines, processes and systems.”
If these recommendations should be applied to health care and disease control within health systems, is it not prudent to assume they be applied to actions taken in all venues where disease transmission may occur rapidly?
How is it that the risk is great enough to consider releasing some non violent offenders from prison early, yet men who live, eat and work in close quarters in work camps, are not in the same category of risk?
Where isn’t the precautionary principle applied there? A serious question for the powers that be, particularly since we are now all defined as essential and non essential workers, to try and keep everyone who isn’t essential at home to break the chains of transmission.
There are photos circulating online of workers being taken to and from the Kinder Morgan work camp in buses. There are photos of men all working shoulder to shoulder on construction sites in downtown Vancouver. We know men were in isolation with flu like symptoms at the site C work camp. Mayor Lori Ackerman declared a local state of emergency over the concerns of what might happen, and was quickly reined in when Farnsworth then declared a provincial state of emergency which nullified her actions. The site C camp remains open as do others, yet one builder said the guidelines were too little, too late and shut down his sites, urging others to do the same. https://www.nanaimobulletin.com/news/construction-company-shuts-down-all-job-sites-says-new-b-c-guidelines-are-too-little-too-late/
Which brings me to a key recommendation from the SARS Commission:
“1. Medical Independence and Leadership
Public confidence requires that the fight against infectious disease be driven by
medical expertise, free from bureaucratic or political pressure. The Commission, in its
first interim report, recommended more independence for the Chief Medical Officer
of Health. The government has made significant progress in that direction, by
amending the Health Protection and Promotion Act to give the Chief Medical Officer
of Health a greater measure of independence.”
When I hear appointed health officials talk about keeping the economy going, mentioning the economy repeatedly, I’m not hearing a doctors concern, I’m hearing a politicians. It doesn’t matter if its a provincial official or a federal one, the economy is a politicians concern and that concern should not drive public health policy or decisions in a time of crisis, where it has been shown time and time again that early and aggressive intervention and restrictions work. We are not under draconian restrictions. We need essential services only during this time.
Should we be worried about the economy? Of course. But breaking chains of transmissions takes precedent above all. Or it should. Jacinda Arden had it right and continues to have strong support for her early and strong actions. Justin Trudeau might want to spend some of his alone time to take notes. https://www.straitstimes.com/asia/australianz/new-zealand-pm-ardern-declares-national-emergency-as-country-reports-47-new
This is where I veer off into another issue: differing and contradicting experiences and opinions between medical professionals. Having read the full SARS Commission reports, I understand better perhaps, her rationale of testing on health care professionals and care homes and contacts.
As detailed in the SARS reports, their concerns were often ignored and negated during the SARS outbreaks and many became ill because proper precautions were not taken early on in the outbreak with regards to PPE, )personal protection equipment).
Instead of assuming the worst and taking the biggest protections early on, nurses and doctors only increased the protections as the risks became better known and bigger. This resulted in transmissions that should have been avoidable. This is directly mentioned within the report, as was the recommendation to require whistleblower protection for health professionals who come forward and speak out. But Covid 19 isn’t SARS, and the infectious viral shedding periods are reportedly different.
In my last post, I brought the message from Dr. David Forrest, a calm but powerful message of caution and warning to practice physical distancing and self isolation and why. Many said he was over dramatic.
Last weekend Royal Columbian ER doctor Sean Wormsbecker posted a video to youtube, sharing his concerns that he was not allowed to test people who were sent home to self isolate. He said the province was lowballing numbers of postives by not testing people with symptoms who are in self isolation, and expressed concerns those people didnt take it seriously.
Dr. Bonnie Henry disagreed publicly yesterday in her daily update, saying she and her colleagues on the front lines were talking to people who self isolated. And maybe the people she has spoken to are, but many people are not being followed up on who have symptoms at home.
I don’t doubt that Dr. Henry is correct in her opinion. But I also don’t doubt that an ER doctor on the very front lines is correct in his either. Both have very different perspectives and experiences inherent to their positions right now. And its not hard to find news reports of doctors being threatened or fired in other jurisdictions for speaking out. It is prudent to point out that whistleblower protection was also a key recommendation in the SARS report to ensure those who speak up do not suffer employment loss or reprisals.
We are in a period right now with Covid-19 research, in which many different studies are already out and will continue to come out. It’s very common for different doctors and scientists to hold different views even in the face of scientific evidence. An example of this is the appearance by Dr. Patrician Daly on CBC yesterday, which is causing a lot of concern online today, because of what she said in a segment with respect to self isolation of foreign travellers, and with respect to transmission of the virus.
You can listen at this link, select the March 30th segment, and fast forward to the 54 minute mark: https://www.cbc.ca/listen/live-radio/1-4-bc-today
In her response to the senior calling in to report a couple who refused to self quarantine after travelling, in a building of seniors, she says:
Then we get to another caller Randall at the 1:01 mark, who also asks about asymptomatic people spreading virus. She says:
This is showing to be inaccurate and gives mixed messaging to public who had many questions below a facebo
The CDC in the US is now saying the opposite, and in fact stating asymptomatic people are spreading it. That up to 25% may be capable of doing so.
And again, If we learned anything from the SARS Commisions, it is that the precautionary principle dictates we do not wait for science to prove it, we must treat everyone as though they may have it, except those in our family bubbles who have not been out or about. This is a key guiding principle that must be followed in health and in dealing with the economic consequences of this pandemic.
Dr. Patricia Daly creates confusion when she says not to be concerned. This is why we wash our hands, it’s not just symptomatic people who can spray droplets. An asymptomatic person with virus can sneeze too, or touch their mouth or nose and then transfer that onto a doorknob. Seriously.
I’ve gone on too long, but this is important. This needs to be said. We are not seeing spikes yet but we are not through the next incubation period yet. We already know its spreading through our communities by community transmission now. We see the idiots having parties and gathering to pass a joint around between friends. And the order that gatherings of 50 people or less is ok, is still causing confusion. The messages must be simple numbered orders front page of every paper.
It’s incredibly important to stay home and stay safe. More than ever, anything that’s not essential shouldn’t be happening. In the end, it will be better to have looked like we went too far, rather than not far enough.Especially if it saves one of your friends or family.
Until next post, here is the link to the full SARS reports. A compelling read right now.
Dr. David Forrest is an infectious disease specialist at NRGH and in the mid-island.
He has a history of being a strong patient and medical advocate for care and process, and has a strong powerful message to share. I strongly support our medical professionals in the best of times, but we have to come together as citizens to make sure as few people as possible get this virus. And Dr. Forrest explains in no uncertain terms why.
This is the clear, simple and powerful message every British Columbian needs to hear.
Full appreciation for this messaging. Because as I said yesterday, you don’t get to put others at risk https://lailayuile.com/2020/03/22/you-do-not-get-to-put-others-at-risk/
I have a lot of friends in law enforcement and health sciences who can’t speak out right now. Some have, despite risk to employment. Yesterday a group of doctors warned BC officials we are going to be just like Italy if they do not enforce stricter measures. https://vancouversun.com/news/covid-19-doctors-urge-b-c-government-to-take-more-drastic-measures/
I have not been silent over my ongoing concerns and it’s more urgent than ever people understand why.
The photo above is from a friend who is a paramedic who like most others, has had to plan for alternative arrangements in the very likely event he may be unable to see his family for a period of time during this pandemic, including his little son who was recently given an all clear from cancer. His wife and kids need him, and he is at risk for impacts of Covid, but he does not have a choice. Nor do our nurses, doctors or any other essential service worker right now.
Hes risking his own health, for others.
I’m beyond livid at the complete and utter thoughtlessness being displayed all over social media by people posting group pics on Quarry Rock in North Van which is now closed, on beaches and yes, getting together with other couples and families in their back yards.
This is all, a hard NO. Full stop.
You don’t get to put me or my family, and other people in danger simply because you don’t think it’s that serious. We are in a state of emergency. Hospital wards are starting to fill. People have died.
There has been a great disservice in the mixed messages being given out by officials contributing to this blatant lack of regard. The language isnt clear. So let me be clear.
Stay the fuck home.
Officials stated this is the time to remain only with your family group. Lay low.
There is far more information and clarification for citizens in the questions that follow these daily updates than in the actual official releases. But that information is being lost.
It is ok to go for a short walk, but you can’t go for walks with a group of friends. You should limit it to 1 or 2 family members if that.
You can not hang out in your backyard with all your friends over. You can’t have other couples, or teens or neighbours over.
You can not meet in a parking lot and then go walking together. Your cars are a foot apart. Did someone sneeze on your door handle? Cough on that park bench?
You can not go for bike rides with others in a group 2 feet apart from each other. You are exerting your lungs and inhaling each others breathe.
You shouldnt be parking right beside each other.
This virus lives on surfaces for varying degrees of time and it remains in the air after someone coughs or sneezes for an amount of time.
If you must go out for groceries, keep it to once a week, one family member only.
You must assume everything is contaminated and act accordingly. The gas pump for example. You pump your gas then touch your vehicle handle. You drive off. Boom your personal space is now an issue . Use hand sanitizer before you get back into your vehicle.
Those of you stupidly gathering in groups will regret it when you get sick or make someone else sick. They talk about deaths, but not enough is being talked about how horrific many survivors feel who have been severely sick but live. Lungs like glass. Feeling like you are slowly suffocating. This is a painful illness if you develop it severely. Some have long term lung damage from fibrosis.
And this is not just affecting seniors. This chart from the BC govt on Saturday, shows the ages.
Use your damn judgement and recognize that *you do not have the right to put your family and others at risk.*
And to all the officials out there dancing around the subject? Please stop giving mixed messages.
When you tell people to ‘stay home’, but then also say ‘gatherings up to 50 are ok so long as you practice social distancing’, you are giving a mixed message.
When you fail to close worksites where men and women work in close quarters or work camps who have men and women who have been travelling back and forth in BC and elsewhere, it gives the impression to a large number of the public this isn’t as serious as it actually is.
This is appalling. It is confusing to many who don’t understand why it’s ok to expose construction workers but not our families and friends. It doesn’t even make sense to keep mentioning the economy in the same breathe you are asking people to stay home!!
The federal health minister said she was briefed in January on this, and yet here we are in March *hoping* people will take the warnings seriously.
And they are not.
We do not have endless beds in our hospitals to manage numerous sick Covid patients and all the rest of the people who are sick, or hurt or injured. This is a fact, and why doctors and nurses are pleading with the public and officials to act now. We owe them all much better than what is bring presented by officials in their communications.
Well, I’m tired of officials ‘hoping’ people will do the right thing, and then expressing their disappointment when they continue to ignore it.
We need stronger actions and we cannot wait.
We need clear concise orders, not ambiguous statements. Even today, people are picnicking and letting their kids play on surfaces no one cleans.
Every day officials fail to enforce this, is another day the virus spreads further and faster, because it’s an invisible opponent and we dont know where it is.
Cases announced today, are from test results days ago if not longer. Todays true numbers are much higher.
You must assume anyone and everyone might have it, because many people dont show symptoms at all and other may look like they have allergies. You may not get severely ill…but your mom or dad or sibling might.
I don’t want to believe anyone would intentionally be so thoughtless. But some of what I have seen online is inexplicable.
To all of you with the power to do something who are not doing it, or choosing to ignore it, you don’t get to endanger my family or friends, nor do you get to disregard the growing pleas of our doctors, our nurses, our officers and paramedics.
Do. Your. Jobs.
We will support you to keep us all safe, because in this battle the only way we can fight it, and fight it successfully is if we all do it at the same time ❣