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A repost from 8 months ago because we are still making the same mistakes: “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

13 Comments »

  1. I think our top Politicians, Health officials, coast to coast, Bonnie Henry, Dix, and company must have never ever read the Precautionary Principle. They have screwed up so badly. In BC alone Henry Inc. and her slow, reactionary, and power centered stubborn half measured policies have in my view caused way more bad results. Nervous Dix just claps on like a trained seal. Oh they are good at giving out the body count and numbers and graphs. Too many media figures who lost their objective minds continue to blindly worship. Whatever makes one sleep all fuzzy and warm at night I suppose, wether it’s the fairy god mother, sparkly unicorns , or Chris Kringle.
    The extra masking orders came only because of public pressure and not by her own hand. That says a lot. It still a half measure, without a full school masking policy. How F……G stupid is that. The LTC catastrophe is whole other level of incompetence by government. They have had years to straighten things up, but they did ZERO. All of them. Imagine the amount of money that has been wasted on so much useless things over the years. Bleep bleep most of them. Look away nothing to see hear because public schools aren’t considered public places and there’s no transmission in schools. Horgan and Dixes words. Reprehensible.

    Like

    • You’ve got to follow https://mobile.twitter.com/realreporter

      He was the one who discovered the daily tests performed reported on the Bc cdc dashboard, was thousands higher than the number reported to Federal public health.

      Turns out they were adding privately paid for asymptomatic movie test results, in with public testing. Which, because movie industry testing has a very low positivity rate, made the community positivity look lower than it was.

      Yesterday, she admitted they had been doing this and that they will now be separating them, because it does skew positivity rates. Turns out without those tests combined, our actual positivity rate IS higher.

      Zussman also finally did his job and pointed out she was giving incorrect information on school mask policies.

      Its hard to keep public trust with this kind of nonsense going on. They’ve done this to themselves

      Like

  2. Here is the problem as i see it.

    For decades, we (the public) have been told to be prepared for the big one, that big earthquake or any other natural catastrophe, by having an emergency bin with water medical supplies, tent, radio and of course food, to last several days.

    I call this a plan B and I have a gardeners wagon, stashed in a container outside, with all that is needed to survive a a week at the most. I hope it is never needed. Except for the water and food, everything else was purchased at garage sales, etc, and the total cost is around $150.

    With Covid-19, the government did not have a plan B, not even close and precious weeks were wasted as government dithered.

    Covid spread and attacked the most vulnerable. Government dithered and more precious weeks were last, ensuring Covid was entrenched in BC and Canada.

    This is what the NDP did, they dithered and when things were looking dark, they made damn sure that their base came first, when aide money was dolled out.

    The NDP threw the 2020 graduating class under the bus, with a “so sad, too bad” attitude. Incomplete year, no summer work, little chance of success in 2021.

    During the summer, BC still did not have a Plan B, oh lots of cash was spent, but most what was offered was window dressing.

    Then Horgan’s response to Covid, a snap election, that was his plan B, the NDP spent the summer ponder polls to see a good window to thrash the liberals.

    Horgan and the NDP’s plan B has cost us a massive uptake in Covid 19 cases and deaths, for many weeks, government was in stasis and Covid spread, like plagues of old.

    Government did not learn from past experience, nor are they learning from Covid today, as the government is more intent selling it political agenda than dealing with Covid.

    What should have been done, was not done and from my viewpoint, Horgan’s NDP must take responsibility for this fiasco.

    Notes:

    We need municipal and district breakdowns of Covid infection. The government refuses to do this for fear of political retribution. I live in Delta, and it would be very informative if covid-19 cases were given for South Delta, Ladner and North Delta.

    My friends brother who is at Abbotsford ICU is recovering, slowly; happier news.

    Anti-maskers, especially those who cause fights or public disturbances should be arrested and held under the mental health act. I have no time for these people. Masks prevent those with Covid from spreading it. Masks tell me that the person wearing a mask is not a threat to my health.

    The news reported that reports of the seasonable flu are down significantly; well duh, we are masked up and isolating, what would one expect!

    Like

  3. “Some of you May Die, But it’s a Sacrifice I am Willing to Make” Lord Farquaad
    This statement couldn’t be so true when it comes to the handling of this covid disaster.
    I agree with the article and everyone’s comments. The dithering around and slow reaction tip-toeing around when we are dealing with, and always have been, an airborne highly infectious deadly virus.
    Calling an election right in the midst of a pandemic was idiotic and irresponsible, to say the least. I think Dr. Henry et al are all too political or has become one. I followed another scientist and knew this was airborne way back in Feb. listening to anyone in Canada they were still talking about only coughing and sneezing will spread the disease no need for masks. My question has always been if I knew back then what we were dealing with why didn’t our so-called leaders? If they didn’t know why didn’t they? If they did know why weren’t they saying? Care homes and schools are in trouble and until they take this seriously a lot of people won’t either.

    Like

    • I don’t know the answers and I dont see them coming anytime soon with the way the press conferences are so tightly controlled. Its not at all what I expected from an ndp govt, to be honest.

      Clark govt, absolutely. Ndp govt? No. I think I’m beyond cynical because every illusion I’ve had over media and govt has been shattered, and then something happens to further shatter even the broken ones, if that makes sense.

      If there was anything to be thankful for in 2020, is that so many people showed their true colours. All the ones being silent right now while covid ravages all the long term care homes, I see them in their silence, particularly because if this was happening under a different premier they would be as disappointed and saddened as I am, and as vocally outraged….but silence from so damn many online..

      My heart goes out to all these families 💔

      Like

  4. Its here and it doesn’t surprise me.

    I also downloaded the documents Pfizer presented to the FDA and read them, and both allergies and Bells Palsy was minimized. The FDA documents also are clear the emergency use authorization and roll out is essentially the final stage study. Which is why I suspect Health Canada is banning use in Children under 16, pregnant women and anyone with severe allergies. There simply isn’t enough data to assert its safety in those groups.

    I fully support vaccinations, all my kids are vaccinated, just had my flu shot again this year, but if the opportunity to take either the Pfizer or Moderna vaccine came up, I wouldn’t take either. I just had a double surgery this summer and a mesh implant I’m hoping my body doesn’t reject, and with autoimmune disease, its not a risk I would take. I have read there is a more traditional stream vaccine from.Johnson and Johnson anticipated later next year. Living where I do, cases are low and its been easy to carry on life and stay safe.

    I do have to point out the story below, which is also the case with the Moderna vaccine. As with opioids, or any of the other drug disasters the physician in your linked piece details, its always good to follow the money.

    https://www.google.ca/amp/s/financialpost.com/financial-times/why-the-pfizer-ceo-selling-62-of-his-stock-the-same-day-as-the-vaccine-announcement-looks-bad/wcm/b857c9fe-4a3e-4777-9111-6bf8ebddb87c/amp/

    Like

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