Lessons not learned from the SARS inquiry: The Precautionary Principle be expressly adopted as a guiding principle

A question of hindsight: Why did officials wait so long?

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/)

 

Risk Management 101: The Precautionary Principle

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:

“Precautionary Principle

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/

How much did we actually learn from the SARS Commission? 

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.

Different professional opinions: Don’t kill the messenger and listen to the front lines.

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:

  1.  that returned travellers in mandatory quarantine are allowed to go out to do their essential services ( whats the point of quarantine if they go out into public ?)
  2.  travellers  that are supposed to be in self isolation with no symptoms pose no risk to others
  3.  repeats that if they have no symptoms they pose no risk
  4. Vancouver coastal health is not going out to enforce orders and relying on good will, or following up on federal quarantine orders.
  5. repeats again that people who have no symptoms pose no risk to the caller

Then we get to another caller Randall at the 1:01 mark,  who also asks about asymptomatic people spreading virus. She says:

  1.  We do not believe people who are asymptomatic spread the virus before they have symptoms or if they have no symptoms, again, there is no evidence asymptomatic people spread the virus.

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.

More on this here:

https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us

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.

 

http://www.archives.gov.on.ca/en/e_records/sars/report/v1.html

 

40 Comments on “Lessons not learned from the SARS inquiry: The Precautionary Principle be expressly adopted as a guiding principle

  1. The Precautionary Principle is the right initiative to ensure the health and safety of the most number of people.
    This same principle also applies to financial aid for all the shut down small businesses now on the brink of failure.
    The government has suggested a number of initiatives to provide partial funding to retain employees, business loans, partial grants, and aid for self employed operators who do not qualify for EI.
    This is a good start, but how on earth will any of the business loans be repaid with the debt just piling up? How will they catch up? Without significant support, their staff will have no work to go back to.

    What is needed is a complete stop to all residential and commercial rents, property taxes and mortgage payments RIGHT NOW. For at least 3 months.

    This would be immediate life support. It would cost little to implement, with no financial hoops to jump through, no long waits for essential funding, and would benefit everyone across the spectrum. The ripple effect will be a huge boost to the economy in the aftermath of the pandemic with healthy people, shops and services, and vibrant communities.

    Stopping these payments is a Precautionary Principle in action for Small Businesses, and their staff by providing relief at a time when it is most critical. It will be the vaccine essential for the strength of our economic and social recovery. It would inject goodwill to the most number of people to keep shops and services open in the wake of these forced closures, and enable all the staff to have jobs to go back to once this crisis abates.

    • I agree. I was disappointed to see banks deferring for up to 6 months but still charging interest and then making payments higher at the end. And some banks are reporting this to Equifax, which will impact your credit, others are not.

      People are still going to get evicted. Landlords are being merciless in many cases. And if people dont pay for sure they will get evicted the second the eviction ban is up.

      Rent and mortgage forgiveness for 3 months is needed. Govt did not have the balls to follow in others footsteps for the people but seem very willing to bail out those who can and will come through this only slightly scratched.

      Small businesses are being lost already. My neighbour closed his restaurant. Another friend had to close their physical storefront and is selling online but likely wont make enough to make it through. These businesses cant take on that much debt with so much uncertainty.

      Thanks for posting this. Great ideas. And I hope you and yours are healthy and managing through this tremendous stressful time 🙏🏼❣

      • Thanks Laila – we think of you often, and thank you for this excellent work you continue to do.
        Hope you all stay well, too. Small shops and services need to be meaningfully supported immediately to prevent a tidal wave of business failures, unemployment and vacant storefronts. This can be prevented!

  2. Laila – almost always anything in a URL after a question mark is meant to track you and your response (did you click on it or not). The biggest exception is YouTube videos. You can always test the shortened URL by opening a new tab, window, or browser, pasting the shortened link into the address window, and pressing the Enter key.
    All the best,
    Marc Erickson

  3. Awesome job Laila playing a huge part in exposing the truth about the reckless hypocrites. Politicians and lead Health officials playing on the political teeter totter. Life on one seat and economy on the other seat. Especially when there is some economy that could still be shut down at least for this couple weeks at least. It would be great if this story of yours was everywhere as much as possible. Your truth is sure a good nemesis to some out to lunch media. Hope you feel better soon. God bless you.

  4. But Bonnie Henry and Dix right up to the Federal level are still allowing construction all over the place, normal cross country travel, and non essential workforce infrastructure to stay going and still to this day allow Drive Thrus for god’s sake! What am i missing here. These politician/health officials and negligent hypocrites are completely messed up if they think there’s a decent chance to stop the virus earlier when they are allowing this to continue during a critical time frame. They are doing the big normal things we would all expect like border shutdowns, mandatory isolation stuff restuarant dining etc. etc. If stuff is still allowed like what i mentioned then people are going stay enabled and not take care. I would rather not hand out too much credit to the leaders,when they have avoided the precautionary principle so much, for so long and are still allowing big things to fall between the cracks. Even Minister Patti Hagdu said if we all stayed still for two weeks we would beat thing. What hypocrisy when so much enabling is being allowed by her the governments. Sorry but i will pass on too much cudos to them lest I might sound like a hypocrite or toy with it in that space. It’s an either or for me. No grey area.

    I will give my utmost thanks though, too all the essential front line people out there keeping the necessary things going and burdening themselves with such a great amount on their shoulders and to many doctors and staff for having the courage to speak out about things they feel is not good enough from our politician/ heath officials trying to play both sides in a dangerous time. I do hope I’m wrong in my doubts about planking this thing

    • We shall see how this all pans out.

      There is a new website created by some university students that’s mapping reports of Covid symptoms in a heat mapping style.

      Cumberland is a hot spot locally here right now. Not surprising considering a well know local herbalist did an Instagram story recently asking if physical distancing was more harmful than the virus and should be be putting aside people for safety and how it was better to die at home with a loved one.

      I was livid and fired off a response.

      https://flatten.ca/heat-map

    • It was with no surprise many noticed how Horgan washed his hands of anything happening at site c with workers in isolation with flu like symptoms but no confirmed positives ( most likely because they did not do testing, I’m guessing)

      He has no firmly placed all culpability in Dr.Henrys hands. Is Dr. Henry aware many if not most workers are required to sign non disclosures barring them from discussing anything on site?

      Is Dr.Henry aware there have been demonstrated examples over the life of this project of nondisclosure,obfuscation and covering of workplace accidents and safety?

      I dont believe this work is essential and I would ask if there has been pressure out on Dr.Henry to maintain these work sites in opposition to the orders she has given in general.

      https://vancouversun.com/opinion/columnists/vaughn-palmer-horgan-says-work-at-site-c-will-continue-unless-dr-henry-says-to-stop/wcm/1ffa8db7-e3f7-4a9f-b0bb-e9b2263d8c93/amp/?__twitter_impression=true

  5. Of course Bonnie Henry hands aren’t completely on the steering wheel. Horgan’s are. It’s been obvious for a while now. Workers at Site C have now become infected as should have been forseen. I figured it was a only a matter of time. The hypocrisy and recklessness is astounding. Not shocking though. The only thing that I can figure out with Bonnie Henry is that she is completely tangled up in the political weeds and must go along with the negligent political masters while doing what she can and is aloud to do within certain parameters for the public safety and healthcare which would be expected in a crisis such as this.
    I wonder if she is speaking to her truth amid all the NON ESSENTIAL things that are aloud to continue. We are all asked to do our part and MOST OF US are doing that along with the ESSENTIAL services and Supporting Services and the brave front line health care people. But politicians keep kicking out a chair leg that hinders the flattening of the curve much sooner.
    It is my strong opinion that Bonnie Henry may not be speaking to her truth. But let us repeat what was sadly expected. Infection of Site C workers now. What possibly comes next and may continue should not shock us when such madness from leadership is at play. I can only state again. These microscopic monsters don’t give a shit us, our economy, our projects, our money, or anything else except for it’s own survival.

  6. The Order of Chain of Command maybe. ???
    Corporate H.Q.s, John Horgan and Premiers Office, Health Officer. ???

  7. As long as it’s only for essential travel or extenuating circumstances for people and family. I read it as more for essential. Anything different is going against all that what is trying to be achieved for flattening the curve at least in this two to three weeks. Just like the infections of some Site C Workers that wouldn’t have happened if it weren’t for Horgan deeming big projects essential.
    Bonnie Henry in charge and under no pressure to keep those bigger things like construction, mines and the big government pet projects going. My opinion. It’s bullshit. She has told us to do no non essential travel around the province and avoid going to smaller towns especially to avoid overwhelming those small communities but all those other things are aloud. Her power is limited and now look whats happened with Site C workers.
    When I hear our Health Officer say it’s dangerous to shut down big projects because of safety of environmental concern and this and that, then I just shake my head. She just can’t be in charge when it comes to the Horgan’s big special interests. Those things could have been scaled down too bare essentials for monitoring of safety and security. I was involved in a range of big industry for decades, and have half a brain cell too have a fairly good idea how things work and be done.

  8. Isn’t it amazing the number of infected Site C workers keeps going up. Hopefully Fort St. John is going to be okay. Infection at the LNG Canada site. Alaska Highway News is sure putting out the details in the past few days. Good reporting from them. No use in me printing the site code for Alaska Highway News when it’s all there easy to load. Horgan’s people are such dangerous hypocrites. Typical when politicians run things in front of Health Authorities power in a crisis such as this. They get a whole lot more people sick and worse. They make me just plain sick.

    • Trudeau sure hasn’t. Here in BC negligent Horgan hasn’t learned either. His non essential pet projects like site C and other big industry is just to damned important to be derailed. Life and safety comes second to those kinds of bastards. Sorry but I despise those kind of politicians.We all know whats taking place at those sites and the lies that are being told by the government officials to the public about how everything is okay, compared too what’s really happening, as told by the locals, families, workers, mayors, councilor’s and community and northern region leaders.
      I am glad that these things are being told and investigated, by the good concerned real news reporting from the CBC, Alaska Highway News, Narwhal, your blog etc. and all the other good fighters and places. Too bad there’s not enough of them unlike some useless biased sterile local big media rear end licker’s of government officials posteriors who don’t hold negligent officials to account or ask them the tough questions.

      • Well

        Look at this.

        Way to go on this aspect John Horgan. We mentioned this failure specifically in the story above.

        “Breaking: Premier @jjhorgan
        says snowbirds and Canadians returning home on repatriation flights will have to fill out a form on their flights back detailing their self-isolation plan. He says a quarantine site will be arranged for travellers without a plan. #covid19 #Kamloops”

        Now is also the time to put a stop to the out of province people coming to second homes and vacation rentals here in BC and also not quarantining.

        We really can’t leave a stone unturned here.

  9. As hard as this may sound, social distancing should actually be greater than two meters when at all possible just because of what good old gut instinct tells me based on the science of transmission regarding this thing.

  10. I’m “old”, just over 75, and I use a partial, so I can …… eat.

    Could it be that one of the reasons that the elderly, and don’t care call my wife of 48 years elderly, is that ‘we’ are putting our fingers into our mouth to take out and back in, partials etc without cleaning them properly. The question is, is there any protocol set down to deal with this, for any age.

    Will a Polident cleaner kill coronavirus (I doubt it), other than cleaning sink drains?

    • My friend the nurse says it is critically important to wash your hands very well, before and after you put your hands in your mouth,*every single time* and polident is fine for cleaning so long as you are healthy and not sick.

      If you did contract Covid,I would do what you should do after any flu or cold, and toss your toothbrush, get a new one and clean your dentures as advised by your dentist/denturist

  11. All those bitching at the critics of governments slow actions, can sit down now.

    “Canada missed opportunities early on to tackle the COVID-19 pandemic and put itself in a better position to flatten the curve of infections sooner, say experts looking at the country’s response to the pandemic.

    “Look at what the government has had to do in order to get this under control. Our economy is entirely shut down. The number of Canadians who are unemployed is at record levels,” said Dr. Raiyan Chowdhury, a critical care specialist and ear, nose and throat surgeon at the Royal Alexandra Hospital in Edmonton.

    “People’s lives are changed forever.”

    Chowdhury said the government took too long to realize how significant the issue was and took too long to call out the severity of the problem.

    “I always feel like we’re behind the curve,” he said in an interview.

    Chowdhury concedes that hindsight is 20-20 and it’s easier to see mistakes in retrospect, but he points to a list of other countries — South Korea, Singapore, Taiwan and New Zealand — that have fared relatively well to show that other governments, with the same evidence in hand, were quicker to react and did so more decisively.”

    https://www.cbc.ca/amp/1.5529263

  12. I see our officials and leaders here in BC made the same old decisions to go on the basis of trust of people too do the right things this long weekend and said they have no intentions too put more stringent enforcement against travel within B.C. It was Bonnie Henry who said that a couple days ago on the daily announcement on the news. Well that all went to shit, as I expected. I can only say. Oh my god !
    Just look at the disgusting selfish negligent behaviour so many people are playing out this weekend. So now, because of the selfish pieces of you know what and their flaunting the rules, they are going to probably cause this thing to go on longer and cause more suffering and cause harder, or even possibly draconian regulating to happen.

    The madness and naivety and out of touch mindlessness is astounding from leadership. They are causing worse things to continue because they we’re just to rubbery to put actual rules into place instead weak rules of advise, advisories, trust and guidelines. This is what happens when the incompetent reckless politician runs the show from behind the scenes instead of the Health officials and real Health experts having the actual control. And then there’s the Prime Minister’s failings concerning air travel. But we already know that story of political disgust and incompetence.
    Anyone have a nice weekend everyone.

  13. The heroes of our Canadian Forces should not have had to be the whistle blowers regarding the horrible conditions in some seniors long term care homes for one example in Ontario. But they did and I thank them for speaking up. There is no room for being soft or mixing words for not finding blame on government officials at high levels federally and provincially and owners and top management of these place. too try passing the the buck in any attempt to shed or deflect blame from themselves.
    This has been an issue for years and it’s disgusting too listen the same old rehash in the media of what should have been done. What can been done. It’s a constitutional issue because it’s more provincial responsibility, so it’s a sticky tricky situation. Well it tells me nobody gave shit enough to change it all with provincial leadership and federal leadership getting it done. Well everything should have been taken care of long ago.
    Nothing was done even as this crisis was starting. So i have nothing good to say about all of the negligent scum at the top of the heap that I have mentioned. No soft ball words are appropriate and are unacceptable in my opinion. Too listen to Trudeau come out speak as if he is dumb founded about the reported disturbing events makes me want to get sick. A National Inquiry is a must not just too have and maybe force change but to find and bring forth the justified blame for this gigantic, massive, humongous negligence from the paid officials we expect too do there jobs. HOW DISGUSTING THEY ARE FOR LETTING THIS HAPPEN TO OUR VALUED SENIORS. I want people in government too pay for what they allowed. God bless the families of thier lost dear ones, and go after those repugnant and irresponsible ones at the top of this system.

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