The Second Wave: Science Meets Leadership

Good nuanced discussion of the complexities in finding a balance between public health, economic and other concerns:

When the pandemic first hit, none of us knew what to expect. Medical experts called for a lockdown and governments took their advice. This time round it’s different. Our political leaders are being called on to protect both our health and our economy. As Doug Ford noted on Tuesday, that can be an unpleasant place to be.

In his press conference, Ford commented on his decision to reinstate Stage 2 measures in three key regions of Ontario, much as François Legault has done in Quebec. It was, he says, one of the hardest decisions of his career. We get it but, frankly, he should get used to it. Governments everywhere may be called on to make lots more decisions like this in the months ahead.

Businesses are hurting badly, and many are stepping up the pressure on politicians to help them get through these tough times. This is not just about financial support. In Ottawa, for example, business groups have challenged Ford to produce the data that justifies stricter measures. There is a growing sense that politicians have the tools to open the economy without putting the public at risk, but do they?

We think this is a discussion worth having – cautiously and respectfully. We’re not disputing that public health is the No 1 priority. The hard question is whether it can be better aligned with other priorities. A recent poll from the Innovative Research Group helps us get at the issue:

The response to Question 1 caught our attention. It shows that Canadians are almost evenly split on whether they think experts have too much influence on governments. This sheds important light on the tensions Ford is dealing with, and why other premiers will likely face the same issues, as the second wave grows. Some, such as Legault, already are.

Basically, during the first wave, political leaders deferred to public health officials on how to respond to the pandemic. This served us well, but governments have come a long way over the last eight months. New knowledge and new tools like rapid testing and contact tracing now allow leaders to manage the risks in ways that were not possible before.

For example, experts now know enough about how the virus spreads to contain it within a region, so that governments don’t have to shut down a whole province. This is currently the approach in Ontario and Quebec.

However, there is a price to pay for plans like this. Generally, the more complex they get, the less likely they are to be guided by medical science. In Ontario, for example, the government’s decision to shut down bars, restaurants, and gyms while leaving schools open has raised eyebrows.

There are serious questions about how far the science on COVID-19 can help decision-makers assess the importance of getting children back to school. Striking a balance between public health risks and learning involves weighing lots of things that are outside the purview of medical science.

So, how are these tradeoffs getting made?

In a second slide, IRG reveals an important feature of our political culture. The slide uses a scale of 1 – 100 to assess how strongly Liberals, Conservatives, and NDP members feel about the role of experts in government decision-making. The poll finds a 24-point spread between Liberals and Conservatives, with the NDP in the middle. (See the line on Political Populism.)

Basically, the data show that our political leaders are predisposed to treat expert opinion differently: progressives are more inclined to accept it and conservatives to question it.

Neither predisposition is wrong, but predispositions of any kind can be a barrier to a thoughtful, informed discussion of the issues. They incline us to trust some views more than others and this can shape how we think and talk about the issues.

This is a critical consideration as the second wave advances. When health experts declare that “the evidence” calls for actions that favour health over, say, the economy, political leaders need a reliable way to weigh this advice against other concerns and priorities. And they shouldn’t look to health experts to provide it.

Health experts view the world through a health lens. Their role doesn’t train them to consider how this affects other priorities, such as the economy or learning. That is what elected officials are supposed to do – but they need a reliable way of thinking through the issues.

As things stand, the poll suggests that these decisions often come down to a leader’s predispositions – whether they are a conservative or a progressive. We don’t think that’s not good enough.

Increasingly, our governments are being called on to respond to all aspects of the pandemic, not just public health. Predisposition are not a reliable guide to this. They will not disappear, but we can be conscious of them and keep them in check.

Different priorities should be publicly discussed and balanced against public health. To be clear, we are NOT disputing that public health is the No 1 priority, but we do believe that governments need the flexibility to experiment with different options and to respond to other priorities.

That is the way forward.

Andrew Balfour is Managing Partner at Rubicon Strategy in Ottawa.

Source: The Second Wave: Science Meets Leadership

The Swedish COVID-19 Response Is a Disaster. It Shouldn’t Be a Model for the Rest of the World

Good telling analysis. By way of comparison, Quebec death rate is about 71 per 100,000, Ontario 21 per 100,000 and Canada less Quebec 13 per 100,000.

Money quote: “The Swedish way has yielded little but death and misery.”

The Swedish COVID-19 experiment of not implementing early and strong measures to safeguard the population has been hotly debated around the world, but at this point we can predict it is almost certain to result in a net failure in terms of death and suffering. As of Oct. 13, Sweden’s per capita death rate is 58.4 per 100,000 people, according to Johns Hopkins University data, 12th highest in the world (not including tiny Andorra and San Marino). But perhaps more striking are the findings of a study published Oct. 12 in the Journal of the American Medical Association, which pointed out that, of the countries the researchers investigated, Sweden and the U.S. essentially make up a category of two: they are the only countries with high overall mortality rates that have failed to rapidly reduce those numbers as the pandemic has progressed.

Yet the architects of the Swedish plan are selling it as a success to the rest of the world. And officials in other countries, including at the top level of the U.S. government, are discussing the strategy as one to emulate—despite the reality that doing so will almost certainly increase the rates of death and misery.

Countries that locked down early and/or used extensive test and tracing—including Denmark, Finland, Norway, South Korea, Japan, Taiwan, Vietnam and New Zealand—saved lives and limited damage to their economies. Countries that locked down late, came out of lock down too early, did not effectively test and quarantine, or only used a partial lockdown—including Brazil, Mexico, Netherlands, Peru, Spain, Sweden, the U.S. and the U.K.—have almost uniformly done worse in rates of infection and death.

Despite this, Sweden’s Public Health Agency director Johan Carlson has claimedthat “the Swedish situation remains favorable,” and that the country’s response has been “consistent and sustainable.” The data, however, show that the case rate in Sweden, as elsewhere in Europe, is currently increasing.

Average daily cases rose 173% nationwide from Sept. 2-8 to Sept. 30-Oct. 6 and in Stockholm that number increased 405% for the same period. Though some have argued that rising case numbers can be attributed to increased testing, a recent study of Stockholm’s wastewater published Oct. 5 by the Swedish Royal Institute of Technology (KTH) argues otherwise. An increased concentration of the virus in wastewater, the KTH researchers write, shows a rise of the virus in the population of the greater Stockholm area (where a large proportion of the country’s population live) in a way that is entirely independent of testing. Yet even with this rise in cases, the government is easing the few restrictions it had in place.

From early on, the Swedish government seemed to treat it as a foregone conclusion that many people would die. The country’s Prime Minister Stefan Löfven told the Swedish newspaper Dagens Nyheter on April 3, “We will have to count the dead in thousands. It is just as well that we prepare for it.” In July, as the death count reached 5,500, Löfven said that the “strategy is right, I am completely convinced of that.” In September, Dr. Anders Tegnell, the Public Health Agency epidemiologist in charge of the country’s COVID-19 response reiterated the party line that a growing death count did “not mean that the strategy itself has gone wrong.” There has been a lack of written communication between the Prime Minister and the Pubic Health Authority: when the authors requested all emails and documents between the Prime Minister’s office and the Public Health Authority for the period Jan. 1—Sept. 14, the Prime Minister’s Registrar replied on Sept. 17 that none existed.

Despite the Public Health Agency’s insistence to the contrary, the core of this strategy is widely understood to have been about building natural “herd immunity”—essentially, letting enough members of a population (the herd) get infected, recover, and then develop an immune system response to the virus that it would ultimately stop spreading. Both the agency and Prime Minister Löfven have characterized the approach as “common sense“ trust-based recommendations rather than strict measures, such as lockdowns, which they say are unsustainable over an extended period of time—and that herd immunity was just a desirable side effect. However, internal government communications suggest otherwise.

Emails obtained by one of the authors through Freedom of Information laws (called offentlighetsprincipen, or “Openness Principle,” in Swedish) between national and regional government agencies, including the Swedish Public Health Authority, as well as those obtained by other journalists, suggest that the goal was all along in fact to develop herd immunity. We have also received information through sources who made similar requests or who corresponded directly with government agencies that back up this conclusion. For the sake of transparency, we created a website where we’ve posted some of these documents.

One example showing clearly that government officials had been thinking about herd immunity from early on is a March 15 email sent from a retired doctor to Tegnell, the epidemiologist and architect of the Swedish plan, which he forwarded to his Finnish counterpart, Mika Salminen. In it, the retired doctor recommended allowing healthy people to be infected in controlled settings as a way to fight the epidemic. “One point would be to keep schools open to reach herd immunity faster,” Tegnell noted at the top of the forwarded email.

Salminen responded that the Finnish Health Agency had considered this but decided against it, because “over time, the children are still going to spread the infection to other age groups.” Furthermore, the Finnish model showed that closing schools would reduce “the attack rate of the disease on the elderly” by 10%. Tegnell responded:10 percent might be worth it?”

The majority of the rest of Sweden’s policymakers seemed to have agreed: the country never closed daycare or schools for children under the age of 16, and school attendance is mandatory under Swedish law, with no option for distance learning or home schooling, even for family members in high risk groups. Policymakers essentially decided to use children and schools as participants in an experiment to see if herd immunity to a deadly disease could be reached. Multiple outbreaks at schools occurred in both the spring and autumn.

At this point, whether herd immunity was the “goal” or a “byproduct” of the Swedish plan is semantics, because it simply hasn’t worked. In April, the Public Health Agency predicted that 40% of the Stockholm population would have the disease and acquire protective antibodies by May. According to the agency’s ownantibody studies published Sept. 3 for samples collected up until late June, the actual figure for random testing of antibodies is only 11.4% for Stockholm, 6.3% for Gothenburg and 7.1% across Sweden. As of mid-August, herd immunity was still “nowhere in sight,” according to a Journal of the Royal Society of Medicinestudy. That shouldn’t have been a surprise. After all, herd immunity to an infectious disease has never been achieved without a vaccine.

Löfven, his government, and the Public Health Agency all say that the high COVID-19 death rate in Sweden can be attributed to the fact that a large portion of these deaths occurred in nursing homes, due to shortcomings in elderly care.

However, the high infection rate across the country was the underlying factor that led to a high number of those becoming infected in care homes. Many sick elderly were not seen by a doctor because the country’s hospitals were implementing a triage system that, according to a study published July 1 in the journal Clinical Infectious Diseases, appeared to have factored in age and predicted prognosis. “This likely reduced [intensive care unit] load at the cost of more high-risk patients”—like elderly people with confirmed infection—dying outside the ICU.” Only 13% of the elderly residents who died with COVID-19 during the spring received hospital care, according to preliminary statistics from the National Board of Health and Welfare released Aug.

In one case which seems representative of how seniors were treated, patient Reza Sedghi was not seen by a doctor the day he died from COVID-19 at a care home in Stockholm. A nurse told Sedghi’s daughter Lili Perspolisi that her father was given a shot of morphine before he passed away, that no oxygen was administered and staff did not call an ambulance. “No one was there and he died alone,” Perspolisi says.

In order to be admitted for hospital care, patients needed to have breathing problems and even then, many were reportedly denied care. Regional healthcare managers in each of Sweden’s 21 regions, who are responsible for care at hospitals as well as implementing Public Health Agency guidelines, have claimed that no patients were denied care during the pandemic. But internal local government documents from April from some of Sweden’s regions—including those covering the biggest cities of Stockholm, Gothenburg and Malmö—also show directives for how some patients including those receiving home care, those living at nursing homes and assisted living facilities, and those with special needs could not receive oxygen or hospitalization in some situations. Dagens Nyheterpublished an investigation on Oct. 13 showing that patients in Stockholm were denied care as a result of these guidelines. Further, a September investigation by Sveriges Radio, Sweden’s national public broadcaster, found that more than 100 people reported to the Swedish Health and Care Inspectorate that their relatives with COVID-19 either did not receive oxygen or nutrient drops or that they were not allowed to come to hospital.

These issues do not only affect the elderly or those who had COVID-19. The National Board of Health and Welfare’s guidelines for intensive care in extraordinary circumstances throughout Sweden state that priority should be given to patients based on biological, not chronological, age. Sörmlands Media, in an investigation published May 13, cited a number of sources saying that, in many parts of the country, the health care system was already operating in a way such that people were being denied the type of inpatient care they would have received in normal times. Regional health agencies were using a Clinical Frailty Scale, an assessment tool designed to predict the need for care in a nursing home or hospital, and the life expectancy of older people by estimating their fragility, to determine whether someone should receive hospital care and was applied to decisions regarding all sorts of treatment, not only for COVID-19. These guidelines led to many people with health care needs unrelated to COVID-19 not getting the care they need, with some even dying as a result—collateral damage of Sweden’s COVID-19 strategy.

Dr. Michael Broomé, the chief physician at Stockholm’s Karolinska Hospital’s Intensive Care Unit, says his department’s patient load tripled during the spring. His staff, he says, “have often felt powerless and inadequate. We have lost several young, previously healthy, patients with particularly serious disease courses. We have also repeatedly been forced to say no to patients we would normally have accepted due to a lack of experienced staff, suitable facilities and equipment.”

In June, Dagens Nyheter reported a story of one case showing how disastrous such a scenario can be. Yanina Lucero had been ill for several weeks in March with severe breathing problems, fever and diarrhea, yet COVID-19 tests were not available at the time except for those returning from high risk areas who displayed symptoms, those admitted to the hospital, and those working in health care. Yanina was only 39 years old and had no underlying illnesses. Her husband Cristian brought her to an unnamed hospital in Stockholm, but were told it was full and sent home, where Lucero’s health deteriorated. After several days when she could barely walk, an ambulance arrived and Lucero was taken to Huddinge hospital, where she was sedated and put on a ventilator. She died on April 15 without receiving a COVID-19 test in hospital.

Sweden did try some things to protect citizens from the pandemic. On March 12 the government restricted public gatherings to 500 people and the next day the Public Health Agency issued a press release telling people with possible COVID-19 symptoms to stay home. On March 17, the Public Health Agency asked employers in the Stockholm area to let employees work from home if they could. The government further limited public gatherings to 50 people on March 29. Yet there were no recommendations on private events and the 50-person limit doesn’t apply to schools, libraries, corporate events, swimming pools, shopping malls or many other situations. Starting April 1, the government restricted visitsto retirement homes (which reopened to visitors on Oct. 1 without masksrecommended for visitors or staff). But all these recommendations came later than in the other Nordic countries. In the interim, institutions were forced to make their own decisions; some high schools and universities changed to on-line teaching and restaurants and bars went to table seating with distance, and some companies instituted rules about wearing masks on site and encouraging employees to work from home.

Meanwhile Sweden built neither the testing nor the contact-tracing capacity that other wealthy European countries did. Until the end of May (and again in August), Sweden tested 20% the number of people per capita compared with Denmark, and less than both Norway and Finland; Sweden has often had among the lowest test rates in Europe. Even with increased testing in the fall, Sweden still only tests only about one-fourth that of Denmark.

Sweden never quarantined those arriving from high-risk areas abroad nor did it close most businesses, including restaurants and bars. Family members of those who test positive for COVID-19 must attend school in person, unlike in many other countries where if one person in a household tests positive the entire family quarantines, usually for 14 days. Employees must also report to work as usual unless they also have symptoms of COVID-19, an agreement with their employer for a leave of absence or a doctor recommends that they isolate at home.

On Oct. 1, the Public Health Authority issued non-binding “rules of conduct” that open the possibility for doctors to be able to recommend that certain individuals stay home for seven days if a household member tests positive for COVID-19. But there are major holes in these rules: they do not apply to children (of all ages, from birth to age 16, the year one starts high school), people in the household who previously have a positive PCR or antibody test or, people with socially important professions, such as health care staff (under certain circumstances).

There is also no date for when the rule would go into effect. “It may not happen right away, Stockholm will start quickly but some regions may need more time to get it all in place,” Tegnell said at a Oct. 1 press conference. Meanwhile, according to current Public Health Agency guidelines issued May 15 and still in place, those who test positive for COVID-19 are expected to attend work and school with mild symptoms so long as they are seven days post-onset of symptoms and fever free for 48 hours.

Sweden actually recommends against masks everywhere except in places where health care workers are treating COVID-19 patients (some regions expand that to health care workers treating suspected patients as well). Autumn corona outbreaks in Dalarna, Jönköping, Luleå, Malmö, Stockholm and Uppsalahospitals are affecting both hospital staff and patients. In an email on April 5, Tegnell wrote to Mike Catchpole, the chief scientist at the European Center for Disease Control and Prevention (ECDC): “We are quite worried about the statement ECDC has been preparing about masks.” Tegnell attached a documentin which he expresses concern that ECDC recommending facemasks would “imply that the spread is airborne which would seriously harm further communication and trust among the population and health care workers” and concludes “we would like to warn against the publication of this advice.” Despite this, on April 8 ECDC recommended masks and on June 8 the World Health Organization updated its stance to recommend masks.

Sweden’s government officials stuck to their party line. Karin Tegmark Wisell of the Public Health Agency said at a press conference on July 14 that “we see around the world that masks are used in a way so that you rather increase the spread of infection.” Two weeks later, Lena Hallengren, the Minister of Health and Social Affairs, spoke about masks at a press conference on July 29 and said, “We don’t have that tradition or culture” and that the government “would not review the Public Health Agency’s decision not to recommend masks.”

All of this creates a situation which leaves teachers, bus drivers, medical workers and care home staff more exposed, without face masks at a time when the rest of the world is clearly endorsing widespread mask wearing.

On Aug. 13, Tegnell said that to recommend masks to the public “quite a lot of resources are required. There is quite a lot of money that would be spent if you are going to have masks.” Indeed, emails between Tegnell and colleagues at the Public Health Agency and Andreas Johansson of the Ministry of Health and Social Affairs show that the policy concerns of the health authority were influenced by financial interests, including the commercial concerns of Sweden’s airports.

Swedavia, the owner of the country’s largest airport, Stockholm Arlanda, told employees during the spring and early summer they could not wear masks or gloves to work. One employee told Upsala Nya Tidning newspaper on Aug. 24 “Many of us were sick during the beginning of the pandemic and two colleagues have died due to the virus. I would estimate that 60%-80% of the staff at the security checks have had the infection.”

“Our union representatives fought for us to have masks at work,” the employee said, “but the airport’s response was that we were an authority that would not spread fear, but we would show that the virus was not so dangerous.” Swedavia’s reply was that they had introduced the infection control measures recommended by the authorities. On July 1, the company changed its policy, recommending masks for everyone who comes to Arlanda—that, according to a Swedavia spokesperson, was not as a result of “an infection control measure advocated by Swedish authorities,” but rather, due to a joint European Union Aviation Safety Agency and ECDC recommendation for all of Europe.

As early as January, the Public Health Agency was warning the government about costs. In a Jan. 31 communique, Public Health Agency Director Johan Carlsson (appointed by Löfven) and General Counsel Bitte Bråstad wrote to the Ministry of Health and Social Affairs, cautioning the government about costs associated with classifying COVID-19 as a socially dangerous disease: “After a decision on quarantine, costs for it [include] compensation which according to the Act, must be paid to those who, due to the quarantine decision, must refrain from gainful employment. The uncertainty factors are many even when calculating these costs. Society can also suffer a loss of production due to being quarantined [and] prevented from performing gainful employment which they would otherwise have performed.” Sweden never implemented quarantine in society, not even for those returning from travel abroad or family members of those who test positive for COVID-19.

Not only did these lack of measures likely result in more infections and deaths, but it didn’t even help the economy: Sweden has fared worse economically than other Nordic countries throughout the pandemic.

The Swedish way has yielded little but death and misery. And, this situation has not been honestly portrayed to the Swedish people or to the rest of the world.

A Public Health Agency report published July 7 included data for teachers in primary schools working on-site as well as for secondary school teachers who switched to distance instruction online. In the report, they combined the two data sources and compared the result to the general population, stating that teachers were not at greater risk and implying that schools were safe. But in fact, the infection rate of those teaching in classrooms was 60% higher than those teaching online—completely undermining the conclusion of the report.

The report also compares Sweden to Finland for March through the end of May and wrongly concludes that the ”closing of schools had no measurable effect on the number of cases of COVID-19 among children.” As testing among children in Sweden was almost non-existent at that time compared to Finland, these data were misrepresented; a better way to look at it would be to consider the fact that Sweden had seven times as many children per capita treated in the ICU during that time period.

When pressed about discrepancies in the report, Public Health Agency epidemiologist Jerker Jonsson replied on Aug. 21 via email: “The title is a bit misleading. It is not a direct comparison of the situation in Finland to the situation in Sweden. This is just a report and not a peer-reviewed scientific study. This was just a quick situation report and nothing more.” However the Public Health Agency and Minister of Education continue to reference this report as justification to keep schools open, and other countries cite it as an example.

This is not the only case where Swedish officials have misrepresented data in an effort to make the situation seem more under control than it really is. In April, a group of 22 scientists and physicians criticized Sweden’s government for the 105 deaths per day the country was seeing at the time, and Tegnell and the Public Health Agency responded by saying the true number was just 60 deaths per day. Revised government figures now show Tegnell was incorrect and the critics were right. The Public Health Agency says the discrepancy was due to a backlog in accounting for deaths, but they have backlogged deaths throughout the pandemic, making it difficult to track and gauge the actual death toll in real time.

Sweden never went into an official lockdown but an estimated 1.5 million have self-isolated, largely the elderly and those in risk groups. This was probably the largest factor in slowing the spread of the virus in the country in the summer. However, recent data suggest that cases are yet again spiking in the country, and there’s no indication that government policies will adapt.

Health care workers, scientists and private citizens have all voiced concerns about the Swedish approach. But Sweden is a small country, proud of its humanitarian image—so much so that we cannot seem to understand when we have violated it. There is simply no way to justify the magnitude of lost lives, poorer health and putting risk groups into long-term isolation, especially not in an effort to reach an unachievable herd immunity. Countries need to take care before adopting the “Swedish way.” It could have tragic consequences for this pandemic or the next.

Source: The Swedish COVID-19 Response Is a Disaster. It Shouldn’t Be a Model for the Rest of the World

Ottawa was told about potential problems at Public Health Agency, top doctors say

This is a much bigger scandal than WE in terms of governance and expertise, reflecting in part the previous Conservative government’s disregard for science and expertise:

The federal government was warned years ago that the Public Health Agency of Canada was destined for serious problems unless changes were made to its oversight, but those concerns were ignored, two of Canada’s top doctors say.

A steady erosion of scientific capacity and a chronic shortage of resources over the past decade have left the agency unable to do its job properly, public-health experts Perry Kendall and Paul Gully told The Globe and Mail.

Recent problems, including the mishandling of the country’s pandemic early warning system, emergency stockpile shortages and allegations that scientists were forced to “dumb down” reports for senior government officials, are all symptoms of a larger ailment afflicting the agency, the doctors said.

“We are of the view that long-term deficiencies of expertise and funding prevent the Public Health Agency of Canada from fully carrying out its intended and necessary role,” Dr. Kendall said.

“A lot of the tools that the Public Health Agency had for influencing policy and programs were removed and budgets were cut.”

They are harsh words from two of Canada’s most respected public-health figures. Dr. Kendall preceded Bonnie Henry as B.C.’s provincial health officer from 1999 to 2018, and has been a leading voice in public-health policy. Dr. Gully spent 14 years in senior roles at Health Canada, and was also the country’s deputy chief public health officer from 2004 to 2006. He later worked on pandemic preparedness for the World Health Organization.

Both Dr. Kendall and Dr. Gully say many of today’s problems can be traced back to serious funding constraints that began in 2011, and a controversial 2015 decision to restructure the management hierarchy.

After the 2003 SARS crisis, the agency was created to act as an independent voice within government. But a move by the Harper government to install a president to run Public Health effectively reduced the Chief Public Health Officer (CPHO) to the role of an adviser, and left the department exposed to competing priorities and political influence.

Dr. Kendall warned during federal hearings five years ago that the change would weaken the agency in ways that were not readily apparent.

By taking oversight of programs and budgets away from the CPHO, whose job was to plan for a pandemic even in times of relative safety, and placing them in the hands of government appointees instead, the agency would be subject to inadequate planning, he warned in 2015. This was particularly risky during the years in between a crisis, Dr. Kendall argued, when resources could be reallocated without thought to the consequences.

That erosion is now on display during the COVID-19 crisis, Dr. Gully and Dr. Kendall said. They argue that current CPHO Dr. Theresa Tam and other public-health doctors have performed their roles well in the face of these constraints, but the agency itself was never intended to operate this way.

Public Health has been beset by numerous problems, including the silencing of the country’s once highly respected pandemic early warning system, known as the Global Public Health Intelligence Network. GPHIN was the focus of a Globe and Mail investigation in late July, which prompted the Auditor-General and the Health Minister to launch separate probes into the the matter.

Doctors and epidemiologists at Public Health told The Globe that the agency experienced an influx of senior government officials in recent years who lacked a sufficient understanding of science. That made it difficult to convey urgent and crucial information up the chain of command, and complex reports had to be oversimplified or “dumbed down.”

Soon after those concerns came to light, management at the agency was shuffled. Public Health president Tina Namiesniowski, who came to the job with no background in science, resigned suddenly last month and was replaced by the former head of the National Research Council, Iain Stewart.

“Certainly, my sense is that there’s been a loss of that scientific capacity,” Dr. Gully said, which impacts how Canada responds to a crisis such as COVID-19.

“If the scientific capacity of PHAC was such that the agency could rapidly analyze and give advice, in real time, on the numerous issues that require policy and political decisions, then the federal role would have been more effective,” Dr. Gully said.

The silencing of GPHIN, which was renowned for its ability to gather intelligence on past outbreaks to help speed government decision-making, is an example of the kinds of breakdowns Dr. Kendall warned could happen in his testimony five years ago. With no threat of a deadly outbreak in years, the department officials believed in 2019 that GPHIN’s analysts and resources could be put to better use on domestic projects that did not involve pandemic preparedness.

Dr. Kendall called that decision “short-sighted,” adding that the warning and surveillance system had once worked effectively. “In the past, as a prime source of intelligence, GPHIN would have been able to provide a more timely alert and analysis.”

However, the concerns are not limited to GPHIN, he said.

“Obviously, rebuilding the Global Public Health Intelligence Network capacity is important, and big data is on everybody’s lips, so maybe there’s some way of using big data to enhance [GPHIN],” he said.

Both Dr. Kendall and Dr. Gully believe the government should now revisit the structure of the Public Health Agency, including how it is funded.

“I would strongly support revisiting and reopening the Act and creating the Chief Public Health Officer as the head of the agency. And then having the necessary administrative and political support underneath,” Dr. Kendall said.

Their comments echo those of another respected public-health doctor, David Butler-Jones, the country’s first CPHO, who warned in February that Canada had, over the years, “replaced public-health managers and analysts with generic public servants.” He added: “Resources, expertise and capacity have been reduced, and expertise positioned further away from where organizational decisions are made.”

In creating the president’s role in early 2015, the government said it wanted to ease the CPHO’s administrative workload. However, the doctors don’t buy that argument, saying the change allowed for greater control over Public Health’s decisions and hindered its ability to handle a crisis.

“We sincerely hope that there is a comprehensive examination of federal public-health capacity,” Dr. Gully said. “And that Public Health will be adequately resourced and empowered to return to its former pre-eminence as a trusted source of independent advice, scientific knowledge, and national and global leadership.”

“That’s why we’re coming forward now – because it’s obvious now,” he said.

Source: https://www.theglobeandmail.com/canada/article-ottawa-was-told-about-potential-problems-at-public-health-agency-top/

Ending Canada’s pandemic alert system was a mistake, internal government e-mails show

More details regarding this fail continue to emerge:

Internal government e-mails show at least one senior manager at the Public Health Agency of Canada believed the decision that caused the country’s pandemic early warning system to go silent last year was a mistake. In an e-mail sent to staff July 27 – two days after The Globe and Mail published an investigation into the Global Public Health Intelligence Network, or GPHIN – a senior department official acknowledged the shutdown shouldn’t have happened.

The investigation detailed how Canada’s globally respected pandemic alert system went silent in early 2019, after the department issued an edict requiring GPHIN’s doctors and epidemiologists to obtain “senior management” approval before they could warn of potentially deadly outbreaks.

That edict, which came as the department sought to reallocate GPHIN’s resources to other projects, effectively shut down one of its most critical functions. With no management approvals, the alert system went silent. And with it, much of the unit’s advance warning and intelligence gathering soon dried up – less than a year before the COVID-19 outbreak hit.

“I believe I can make the assumption that you’ve all noticed that The Globe did an article on GPHIN,” Christopher Burt, a senior manager at Public Health, told colleagues in the e-mail, which was obtained under Access to Information laws.

“You and I know the right answer was always to let the analysts issue alerts where they see fit.”

It is a surprising admission, providing a glimpse into the mindset of a department that has largely kept quiet about the GPHIN problems. It suggests that different layers of managers disagreed over the decisions that would ultimately hinder Canada’s pandemic warning and intelligence gathering.

In a statement this summer, the government initially denied the system had stopped working. However, The Globe obtained 10 years of internal GPHIN records that showed the alert system suddenly ceased operating on May 24, 2019, as a result of the decision.

After the edict was made, some of the analysts inside the highly specialized unit – whose job was to detect and monitor dangerous outbreaks around the world and issue warnings of potential threats – were reassigned to other work that didn’t involve pandemic preparedness. With no threats of a pandemic for years, the analysts were moved to domestic projects deemed more valuable to the government, such as studying the effects of vaping in Canada.

However, GPHIN’s role in pandemic preparedness is now being reassessed. Canada’s Auditor-General is investigating the matter and, last month, Health Minister Patty Hajdu ordered an independent federal review into the department’s oversight of GPHIN.

“The conversation around alerts is still a schmozzle,” Mr. Burt told staff in the July 27 e-mail. “That this conversation is even occurring is further proof that GPHIN remains an important and valuable tool – respected in Canada and around the world.”

Referencing The Globe’s investigation, Mr. Burt said, “It’s clear the reporter had a number of sources, all of whom seem to have painted a rather stark picture. Democracy is messy sometimes.”

He added. “From a policy effectiveness standpoint, all news is good news. Although the tone of the article is negative, I believe that the effect for GPHIN will ultimately be a positive one.”

Created in the mid-1990s when Canada realized it needed better advance warning of potentially dangerous global outbreaks, GPHIN’s role was to act as a sort of smoke detector inside the government, sounding alarms early and often – not merely when problems were initially detected, but also as they worsened. The idea was to inject urgency into government decisions by gathering intelligence on situations, so that officials could assess the threat early and take quick action to protect the country.

As an intelligence unit, GPHIN was also intended to help inform Canada’s risk assessments on a potential crisis.

The government has faced criticism over the accuracy of its official risk assessments. For much of January, February and March, Canada’s official position on the outbreak was that the novel coronavirus posed a “low” threat to the country, despite evidence the virus was spreading aggressively and that human-to-human transmission was a reality. Even after the World Health Organization changed its rating to “high” at the end of January, and warned countries to begin preparing, Canada maintained that low rating for another seven weeks.

Several Public Health employees, who The Globe is not naming because they are not authorized to speak publicly, have said the government preferred to rely on “official” information provided by the Chinese government and the WHO, and dismissed intelligence gathering as “rumours.”

Intelligence experts say this was a critical mistake, particularly since countries have been known to hide or play down outbreaks in the past.

“It’s invaluable to have a separate monitoring source so that you can know everything that’s possible to know about the course of the disease and what the country of origin, or city, knows about it,” said Greg Fyffe, the former executive director of the government’s Intelligence Assessment Secretariat from 2000 to 2008.

When word of the coronavirus outbreak leaked out of China through social media on Dec. 30 last year, GPHIN’s intelligence gathering and surveillance capabilities had been significantly diminished. In his e-mail to GPHIN’s analysts, however, Mr. Burt expressed doubts that Canada’s response was slowed by the changes to the alert system.

However, that opinion puts Mr. Burt at odds with several of the scientists he oversees. One GPHIN employee said senior officials lacking a background in public health struggled to understand the purpose of the alert system.

Other internal department e-mails obtained by The Globe show Sally Thornton, vice-president of the Health Security Infrastructure Branch, and Jim Harris, director-general of the Centre for Emergency Preparedness and Response, oversaw the decision that curtailed alerts. An e-mail from late 2019 explaining the changes to staff summarizes the instructions given by “Jim and Sally.”

Rebuilding the pandemic warning and surveillance system will fall to a new set of managers.

Mr. Harris has since left the department, while the government said in a statement last month that Ms. Thornton retired. She departed about a week before the government announced the sudden resignation of Public Health president Tina Namiesniowski. The government has declined numerous requests by The Globe to speak to department officials.

Source: Ending Canada’s pandemic alert system was a mistake, internal government e-mails show

Lapse in early pandemic warning system ‘a colossal failure,’ says former federal Liberal health minister Dosanjh

Appears, if Minister’s spokesperson correct, decision was taken at the official not political level:

Following the abrupt resignation of the Public Health Agency of Canada’s (PHAC) president Tina Namiesniowski on Sept. 18, a former Liberal federal health minister says the lapse in the Global Public Health Intelligence Network (GPHIN)’s role under this government’s watch was “a colossal failure,” with the Bloc Québécois’ health critic saying the new president of PHAC will have to work hard to rebuild the agency “so that it can be more efficient in carrying out its duties [of] prevention, detection and management of public health crises.”

Former health minister Ujjal Dosanjh, who was in the role from 2004 to 2006 under then-prime minister Paul Martin, told The Hill Times that “the Public Health Agency isn’t an agency that’s supposed to sleep, ever. Its job is to continuously surveil, nationally, and internationally.”

“I think there is something the matter. If you are an activist minister, and you’re not just a politician who got elected, but you’re there to change the world even in the [most minute possible way], you would ask questions as to why GPHIN was folded. You would ask questions [about] when the information was coming from China,” Mr. Dosanjh said in a phone interview.

Canada was a leader in pandemic preparedness during his tenure, according to Mr. Dosanjh.

“I think it was a colossal failure on the part of government, and unfortunately no one is looking at these things because we are so wrapped up—and rightly so—dealing with the here and now, and we’re prepared to forgive the errors that have been made.”

“Whoever is responsible for it, it’s been a near fatal mistake in the pre-pandemic era which has come back to bite us in the pandemic era,” said Mr. Dosanjh, who also served as premier of British Columbia from 2000 to 2001.

“We would have been far better prepared, we would have had far more robust tools at our disposal, had we not put GPHIN to sleep,” said Mr. Dosanjh, who also noted that GPHIN was initially established following the SARS epidemic in the early 2000s.

“The infrastructure had been put in place before I got there, it was only completed when I got there, so I can’t take responsibly for it, but I’m somewhat saddened (which is not the best word), but knowing what I know, I’m angry,” said Mr. Dosanjh. “I’m actually sad at the kind of conflicting and unclear information that’s emanated from all of the responsible sources as COVID-19 started.”

Protecting the health and safety of Canadians ‘top priority’ 

According to Cole Davidson, spokesperson for Minister Hajdu, “protecting the health and safety of Canadians is our top priority.”

“Public health intelligence is vital to that goal,” said Mr. Davidson. “The minister was concerned to learn about the changes made to the Global Public Health Intelligence Network (GPHIN), and has ordered an independent review to look into these changes. The minister is expecting recommendations from this review in the next six months.”

“As the minister has said, these changes were made within the Public Health of Agency of Canada, not at the political level. These are serious and disturbing allegations—ones that we take seriously,” wrote Mr. Davidson. “When the minister became aware of these changes, she requested an independent review to investigate the questions that she had. GPHIN is an important tool for the government of Canada, and the analysts that serve this country must be empowered to do their work.”

PHAC’s president Tina Namiesniowski announced she was stepping down from the organization on Sept. 18, saying she was “now at a point where I need to take a break” and that she felt she “must step aside so someone else can step up” in a message to staff that day, according to multiple media reports.

Ms. Namiesniowski worked as a bureaucrat within the federal public service for decades, including stints as executive vice-president with the Canada Border Services Agency, as an assistant deputy minister at the Department of Agriculture, and as assistant secretary to cabinet, operations secretariat, with the Privy Council Office. She was appointed as president of the PHAC in May 2019.

‘There should be a strong public health capacity at different levels of government’

Dr. Paul Gully, a senior public health physician who was director of Health Canada’s population and public health branch and the department’s main spokesperson during the 2003 SARS outbreak, said he believes the Public Health Agency of Canada has responded well and continues to respond well to COVID-19.

“But I think lack of increased funding over the last few years, which probably goes back to the creation of the agency in 2014, is that it hasn’t been able to do a number of things,” said Dr. Gully. “One is to enhance its scientific capacity, while at the same time losing scientific capacity. It also hasn’t been able to deal with issues which have been well-known, such as the national emergency stockpile, for example.”

“There should be a strong public health capacity at different levels of government, that could then advise government and ensure that fiscal policies and all of the other policies are scientifically-based,” said Mr. Gully.

Government ‘asleep at the switch’ in ensuring strong PPE stockpile, says NDP’s Don Davies 

“I think the rapid removal of Ms. Namiesniowski and her rapid replacement is a clear acknowledgment that PHAC has been mismanaged for a long time now,” said NDP MP Don Davies (Vancouver Kingsway, B.C.), his party’s health critic. “The speed at which they replaced Ms. Namiesniowski, I think is also concerning.”

“Without casting any personal aspersions at the current appointment, the process makes me concerned,” said Mr. Davies.

“The Public Health Agency was slow to understand and acknowledge the risk level of COVID-19, they were slow to acknowledge community transmission, they were slow to acknowledge asymptomatic transmission,” said Mr. Davies. “They were also slow to acknowledge the efficacy of closing borders, and perhaps most egregious, they were completely asleep at the switch in making sure that we even had a good PPE stockpile.”

Bloc Québécois MP Luc Thériault (Montcalm, Que.), his party’s health critic, told The Hill Times that the “hasty and unexpected departure” of Ms. Namiesniowski will “definitely complicate the management of the current crisis.”

“But as the resignation of Mrs. Namiesniowski seems to be linked to personal burnout, it is difficult to blame her for this decision,” wrote Mr. Thériault in an emailed message to The Hill Times.“As for Mr. Iain Stewart, who has, it seems, a solid scientific profile, he will have to work hard to rebuild the Health Agency of Canada so that it can be more efficient in carrying out its duties [of] prevention, detection and management of public health crises. Especially since scientists warn us that such crises may be more common in the future because of increasing interference between human activities and nature, and accelerating climate change.”

Mr. Thériault also said that PHAC has shown “several shortcomings” in its handling of the COVID-19 crisis, and that the pandemic has shown that the agency isn’t adequately prepared to face such a crisis.

The government’s stock of masks and PPE was “clearly insufficient,” and PHAC erred by failing to heed warning from GPHIN about the pandemic, said Mr. Theriault.

“In addition, it was only two weeks after the onset of active community transmission and the rise in infections and deaths that the agency recommended social and economic restrictions, due to ineffective data collection,” he said.

“In short, PHAC must redefine its methods of preventing and preparing for future health crises, and it must make its responses to a public health crisis more rapid and effective. With the arrival of the new wave of COVID-19, it will have no room for error, as this wave had been expected for several months. We will be closely monitoring her actions in the face of this second wave.”

Mr. Thériault also said Quebec and the provinces were too much at the mercy of the ineffectiveness of PHAC.

“Indeed, they themselves suffer from systemic underfunding of their health system. That is why the Bloc Québécois, like Quebec and the provinces, is calling for an immediate [provision] of $28-billion in health transfers, an annual indexation of six per cent, and a federal contribution of 35 per cent,” said Mr. Thériault. “As health is a provincial responsibility, this will be the best way to prevent the different health systems from suffering once again from PHAC’s poor preparation for a future health crisis.”

Source: Lapse in early pandemic warning system ‘a colossal failure,’ says former federal Liberal health minister Dosanjh

Public Health Agency head should have a science background, advisor says

Good summary of some of the issues regarding whether the head of PHAC should be a general administrator or one who also has a scientific or medical background (government announced the appointment of the president of the National Research Council, Iain Stewart, who also has extensive government experience):

With the government expected to name a new president of the Public Health Agency of Canada this week, a former top adviser says the COVID-19 pandemic has shown that the department needs a person with a science background at the helm, not an administrator.

After the sudden departure of president Tina Namiesniowski on Friday, the naming of a new leader is under heightened scrutiny. The resignation followed a string of problems associated with Canada’s pandemic preparedness and response over the past several months that were recently made public.

The government has signalled it will name a replacement as early as this week, but Michael Garner, a former senior science adviser and epidemiologist at the federal department, said the lessons of the pandemic are that a background in public health should be a primary requirement for the job.

“We can have all the expertise in the world working at PHAC, but if the leaders don’t understand public-health science, our pandemic response will continue to suffer,” Mr. Garner said. “It’s someone who can ask the right questions of the scientists. They have to be able to rapidly adjust as they get new information.”

Mr. Garner, who left Public Health last fall, is speaking out to The Globe and Mail on behalf of some of his former colleagues, including doctors and epidemiologists who still work at the department and are not authorized to speak publicly.

Several Public Health employees, who can’t be named owing to fears they could face reprisals, have told The Globe that they often struggled to communicate urgent and complex messages up the chain of command inside Public Health. Because senior officials within the department lacked an understanding of the science, key messages often had to be “dumbed down” one scientist told The Globe this summer.

Ms. Namiesniowski, who previously worked at the Border Services Agency, after roles with Agriculture and Public Safety, came to the agency with a political-science background. Vice-president Sally Thornton, who also left recently, had a background in law, and served in the Treasury Board and Privy Council before being appointed to a senior Public Health role.

Both oversaw critical aspects of the country’s pandemic preparedness and response systems. That included the handling of Canada’s early warning and surveillance unit, the Global Public Health Intelligence Network or GPHIN, which had its operations cut back last year, and the national emergency stockpile, which came up short in supplying personal protective equipment.

In an e-mail sent to staff, Ms. Namiesniowski said she needed a break, and was stepping aside to spend time with family. The e-mail indicated a new president for Public Health would be named early this week, suggesting the government already had a replacement for Ms. Namiesniowski in mind when her resignation was announced.

The selection of a new president has taken on increased importance with Canada seeing a spike in COVID-19 cases, and signs of a second wave of the outbreak emerging.

Canada’s pandemic response has been criticized for delaying critical decisions, and for underestimating the threat of the virus, particularly as the country curtailed much of its intelligence-gathering capacity by early 2019. That led to the government’s official risk assessments of the outbreak repeatedly labelling the virus a “low” risk to the country, even as it began to spread aggressively around the world in February and mid-March, and new evidence emerged about human-to-human transmission.

A Globe investigation in July detailed the problems inside Public Health, including the concerns from staff who said that science had been “devalued” within the department. Health Minister Patty Hajdu told The Globe those revelations were troubling.

“The pleas from the scientists and the researchers [inside Public Health] were particularly profound,” Ms. Hajdu said two weeks ago, as she ordered a federal review into the department’s handling of the pandemic early warning and surveillance unit, which was cut back against the protests of the scientists inside the department.

“The review, hopefully, will get at why are these processes in place, and are there better ways to manage?”

The Auditor-General has also launched an investigation of its own into the oversight of GPHIN and the decisions surrounding the intelligence-gathering unit.

Mr. Garner and several employees working inside Public Health say the department underwent a crucial shift in 2014, when the Conservative government revised the Public Health Act. That decision moved the leadership of PHAC from the Chief Public Health Officer, which is a public-health doctor, to the role of President, which became a government appointee.

While the Chief Public Health Officer is the face of the agency, and speaks directly to Canadians, the structural decisions for the department, which have the greatest influence over how the various programs operate, are made by the president.

Though the Liberals opposed the move when it was made, the structure remained in place when the government changed.

“This decision set PHAC on a course that has gravely influenced its ability to put into place the foundational elements required to proactively prepare for and effectively respond to the coronavirus pandemic,” Mr. Garner said.

Ms. Thornton has been replaced as vice-president by Brigitte Diogo, who recently worked in rail safety for the federal government. A spokesman for Public Health told The Globe that Ms. Diogo has experience in safety and security policy at Transport Canada and the Privy Council, and risk mitigation while at Immigration Canada.

Source: https://www.theglobeandmail.com/canada/article-public-health-agency-head-should-have-a-science-background-advisor/

 

HHS Spokesperson Takes Leave of Absence After Disparaging Government Scientists

Posted given Canadian connection (Paul Alexander):

Michael Caputo, the top spokesperson for the Department of Health and Human Services and a longtime ally of President Trump’s, is taking a 60-day leave of absence after a social media tirade in which he falsely accused government scientists of engaging in “sedition.”

HHS announced the leave in a news release Wednesday, which said Caputo decided to take the two months off as the department’s assistant secretary for public affairs “to focus on his health and the well-being of his family.” In a statement, Caputo described the situation as a medical leave for “a lymphatic issue discovered last week.”

The leave of absence effectively removes Caputo from government operations through November’s election. The statement also announced that Paul Alexander, whom Caputo had brought in as a scientific adviser, would be leaving the department altogether.

Last week, Caputo came under fire after reports that he and Alexander sought to edit and delay public health reports from the Centers for Disease Control and Prevention. Emails from Alexander obtained by Politico complained to CDC Director Robert Redfield that the agency’s Morbidity and Mortality Weekly Report “hurt the President,” and described data-based publications on the risk of the coronavirus in children as “hit pieces on the administration” that undermined Trump’s school reopening plan. NPR has confirmed Politico’s reporting.

Regarding the reports of interference with the publication, “It’s very concerning, if people who are really motivated by politics and not by science and don’t have a scientific background are suddenly interfering,” said Erin Marcus, a physician at the University of Miami Health System and Public Voices fellow. “These actions have real effects on the health of our population and on our ability to function as physicians.”

In a Facebook Live video streamed on his personal page on Sunday, Caputo described a conspiracy in which policymakers, the media and “deep state” scientists are keeping Americans sick with COVID-19 to improve the Democrats’ chances of winning November’s presidential election. He accused “scientists who work for this government” of “sacrificing lives” for personal gain and of engaging in “sedition.”

His language echoed an Aug. 22 tweet from Trump accusing “the deep state, or whoever, over at the FDA” of deliberately delaying the recruitment of clinical trial participants for COVID-19 drugs and vaccines to hurt his chances of reelection. There is no credible evidence for these theories.

Caputo’s video, subsequently deleted, was first reported Monday by The New York Times. Clips from the video were later published by Yahoo News.

Caputo is a longtime Republican consultant who specializes in public relations. He joined HHS in mid-April at a time when the Trump administration was under heavy criticism over its handling of the pandemic. White House observersconsidered his appointment a move by the president to gain more control over the U.S. health department. In his five-month tenure as the top communications official, Caputo shaped messages from health agencies to align with the Trump administration’s political messaging in the heat of the COVID-19 pandemic.

Caputo is considered a Trump loyalist who was a communications director for Trump’s presidential campaign in 2016 — a role he resigned from after sending a public tweet celebrating Trump campaign manager Corey Lewandowski’s exit from the campaign.

While his social media tirade was highly unusual for a government spokesperson, Caputo promoted conspiracy theories about politics in Washington, D.C., before he joined the administration. In a March 13 episode of his former podcast Still Standing, first reported by Media Matters for America, he said Democrats wanted Americans to die from COVID-19 so they could unseat Trump in the next election. “How much does our economy have to die and how many Americans have to die for these Democrats to get what they want?” he asked rhetorically.

Caputo had previously been investigated over his ties to Russia, where he lived in the 1990s and was an adviser to the Russian government, during the Justice Department investigation into the 2016 presidential election campaign. In 2020, before joining the administration, Caputo released a book and a documentary called The Ukraine Hoax, pushing discredited claims that Ukraine’s government — and not Russia’s — had interfered with the 2016 U.S. presidential election.

Source: HHS Spokesperson Takes Leave of Absence After Disparaging Government Scientists

Ottawa appoints new management to ‘strengthen’ pandemic surveillance system

Needed given short-sightedness of PHAC-decisions regarding pandemic preparations:

The Public Health Agency of Canada has installed new management to oversee and “strengthen” the country’s pandemic surveillance system, a once-globally renowned unit whose capabilities were curtailed less than a year before the COVID-19 crisis hit.

In a statement provided to The Globe and Mail, the department said Brigitte Diogo, a senior official with 25 years of experience in government, has taken over as the vice-president of the Health Security Infrastructure Branch. The division oversees the government’s pandemic early warning and surveillance unit, known as the Global Public Health Intelligence Network, or GPHIN, among other operations, such as an emergency stockpile of medical supplies.

Sally Thornton, who previously served in that role, left the government last week, the department said. “After a long and distinguished career, Ms. Thornton is retiring from the federal public service,” Public Health spokeswoman Natalie Mohamed said in an e-mailed statement.

Ms. Thornton declined requests for an interview. Ms. Diogo was also not available for comment, the department said.

GPHIN has been at the centre of controversy since a Globe investigation in late July detailed how the intelligence-gathering capabilities of the government’s pandemic early warning system were reduced significantly in late 2018 and early 2019. That effectively shut down much of its surveillance work on international health threats less than eight months before the outbreak in China began to spread, and appears to have impacted Canada’s ability to gauge the risk of the virus.

Throughout January, February and much of March, the government judged the threat from the outbreak as “low” in its official risk assessments, even after the World Health Organization warned in late January that the risk to the world was high.

In her new role, Ms. Diogo’s mandate will include bolstering the surveillance system, although no specifics were provided.

“Ms. Diogo will lead efforts to maintain and strengthen Canada’s public health event-based surveillance system including the Global Public Health Intelligence Network,” department spokesman Eric Morrissette said in a statement.

In late 2018, believing that GPHIN was too internationally focused and could be put to better use on domestic projects, the department reassigned doctors and epidemiologists in the highly specialized unit to projects that didn’t involve pandemic preparedness. A once-prolific alert system operated by GPHIN, designed to track evolving health threats and inject urgency into government responses, was effectively shuttered when a new edict required that Ms. Thornton approve all such alerts.

With no approvals given, the alert system eventually went silent on May 24, 2019, according to 10 years’ worth of PHAC records obtained by The Globe. With it, much of the unit’s surveillance activities – designed to track early signals of an outbreak and inform government risk assessments – effectively shut down as well.

The alert system remained silent for 440 days, and was restarted only last month, less than two weeks after the Globe investigation. During the intervening months, employees inside Public Health say GPHIN’s intelligence-gathering abilities were a fraction of what they once were. Created in the 1990s, GPHIN had garnered international acclaim for its ability to detect and gather continuing intelligence on outbreaks of diseases such as H1N1, Ebola, Zika and others, helping the government formulate a response if needed.

In addition to GPHIN, Ms. Thornton also oversaw the national emergency stockpile of medical supplies, which came under heavy scrutiny this spring after it fell short of supplying the provinces and territories with badly needed personal protective equipment.

In April, Ms. Thornton testified before the House of Commons Health Committee that the stockpile held a “minimum level” of equipment, and wasn’t designed to handle the surge of a pandemic, raising questions about how it was being managed.

The Globe has made several requests since May to interview department officials connected to GPHIN, including Ms. Thornton. All of those requests were declined.

Last week, Health Minister Patty Hajdu ordered an independent federal review of the problems at GPHIN, saying she was troubled that scientists at Public Health told The Globe they were not being listened to within the department. The Auditor-General has also launched an investigation.

Scientists within Public Health told The Globe that over the past decade, the department has suffered from an influx of senior officials from other areas of the government, such as the Treasury Board, Border Services and others, who lacked sufficient grounding in Public Health. Epidemiologist Michael Garner, a former senior science adviser at the agency, said it became difficult for scientists to communicate urgent and complex messages up the chain of command, because those officials often didn’t comprehend the problems.

Ms. Diogo, who moves over from Transport Canada, has no science background, which may add to such concerns. However, Mr. Morrissette said she has extensive experience working on safety and security policy, and on program design and delivery.

“While a newcomer to the agency, Ms. Diogo understands the merit of a well-functioning, event-based surveillance system including the timely dissemination of information such as alerts, to inform decision-making in addressing public health threats,” Mr. Morrissette said.

According to information from the department, Ms. Diogo was director-general of rail safety at Transport Canada from 2015-20, and director of operations at the Security and Intelligence Secretariat in the Privy Council Office, where she oversaw matters related to national security from 2011-14. She also has a background in risk mitigation while at Immigration, Refugees and Citizenship Canada, the department said.

Source: Ottawa appoints new management to ‘strengthen’ pandemic surveillance system

Bill Blair orders prison data to be turned over, but does the data even exist?

Good question in the header (follow-up article to Paul Wells’ Another farce on Bill Blair’s watch:

Public Safety Minister Bill Blair says he has ordered Correctional Service Canada to hand over data to an independent panel reviewing its practises, nearly a year after the panel first requested the information. But new documents from the corrections agency reveal it may be failing to accurately collect the data altogether.

In an interview with Maclean’s, Blair vows that “we are working very hard to make sure that we are able to provide that information and access to what the panel needs before they would consider continuing their job.”

Anthony Doob, the former head of the panel, says he still hasn’t heard from Correctional Services and has not been convinced to continue his work. “I need to know that we can actually do our work,” he told Maclean’s.

Last month, the panel tapped by the Trudeau government to review the implementation of its Structured Intervention Units (SIUs) was disbanded. Its scathing final report pointed to a lack of cooperation from Blair and Correctional Services, which rendered the panel “powerless to accomplish the job that it was set up to do.”

The new SIUs were supposed to replace an existing solitary confinement regime, which courts in Ontario and British Columbia called unconstitutional and, possibly, torture. Yet when Doob and his panel tried to analyze whether the new units were complying with the court orders and a new legal regime, they were stonewalled.

Doob says the information is crucial to the implementation of these units and that “the bulk, or all of the data, that we’re asking for is stuff they should want for their own purposes.”

But Correctional Services was unable to turn over the necessary data before the panel’s appointment ended in August. It has yet to offer a timeline on when it might supply the statistics.

On Wednesday, Correctional Services posted a request for information to the Canadian government’s procurement platform, seeking companies capable of updating its offender management system. The system, which tracks every inmate in custody, was implemented in the early 1990s and last updated in 2002.

The system governs just about every part of Canadian prisons, and is responsible for tracking the accommodations and mental health status of inmates. It is also the system that monitors inmates placed in the Structured Intervention Units.

Correctional Services first identified the need to update the system in 2015. Today, the database is strained, the document reveals. The systems to input and check crucial information on inmates, including their risk of suicide, “are manual, cumbersome, redundant and open to potential human error in data entry.” Other indicators, such as social history, are “not well integrated into the overall process.”

Correctional Services also notes that, on several fronts including inmate discipline, the process is “cumbersome and relies on paper and humans to ensure that information is gathered.”

Doob says that while their computer systems may be “not ideal,” that technology is no excuse. “They do lots of research themselves using their old system to get data. And, as I’ve said many times, if they truly cannot get the data for the panel, that means that they don’t know what is happening, in a systematic way, in their institutions.”

Often, the only recourse for inmates to contest the conditions of their confinement is to file a grievance. As Correctional Services notes in the procurement documents, the “offender grievance process is approximately 90 per cent paper based. This process has resulted in delays in processing offender grievances from the 60-80 day policy prescribed timeframes to up to three years.”

The service did provide a batch of files to the panel in May but, Doob says, the tables were unusable, inaccurate and essentially worthless for his study. For example, he says, the data noted when an inmate had a mental health issue—but not whether it was noted before, during or after their stay in the Structured Intervention Unit. The service employee responsible for data analysis admitted the information was essentially worthless, Doob says.

Maclean’s asked Correctional Services about deficiencies in their inmate tracking system, but has yet to receive a response.

Blair acknowledges that “Correction Services Canada struggled to collect and then make available the information in a timely way.” The panel first alerted Blair to its issues obtaining data in mid-March, then filed an interim report, noting “this panel has not been allowed to do its work” on July 23, and filed its final report on Aug. 11.

It wasn’t until the details of the report were released by Vice on Aug. 26 that Blair’s office responded. The day after, Blair called Doob to discuss next steps.

Asked why he didn’t intervene sooner, Blair didn’t answer. “When it was brought to my attention, I immediately gave direction that the information was to be collected and made available to the panel,” he says.

Doob says that, even if Correctional Services produces the data, he’s not sure he’ll rejoin the panel. He wants assurances that he’ll be able to properly review the service’s practises, including on-the-ground access to the new cells. “I’ve heard zero from CSC,” he reports.

Zilla Jones, a Winnipeg-based lawyer and a fellow member of the panel, has clients who have been placed in the Structured Intervention Units at the Stony Mountain penitentiary in Manitoba. She says the upgrades to some of the cells have been limited to “cosmetic” changes, such as a new coat of paint and some posters.

In a series of court rulings declaring the old system unconstitutional, the courts of appeal in Ontario and British Columbia ruled that inmates must be given more than two hours outside their cell per day. As part of the new Structured Intervention Units, the Trudeau government vowed that 20 hours per day would be the maximum amount of time per day that inmates would be locked up.

Through the COVID-19 pandemic, Correctional Service Canada has locked some inmates—especially those who are awaiting tests for the virus, or who exhibit symptoms—in the Structured Intervention Units for upwards of 23 hours a day.

Blair disagrees that doing so has run afoul of the courts’ rulings. “That was not for the purposes of either administrative or disciplinary segregation,” he says. “It was medical isolation for those who were ill.”

Given that Correctional Services has not been collecting data on those put in these units, Doob and the panel have questioned if Ottawa even knows whether the new law is being followed.

Nevertheless, Blair is confident. “The law is explicit, in that it eliminates the administrative and disciplinary segregation in those institutions,” Blair says. “We have eliminated [solitary confinement].”

Source: Bill Blair orders prison data to be turned over, but does the data even exist?

Health Minister orders review of pandemic warning system, concerns raised by scientists

Really hope the review will be truly independent, review all appropriate documentation, analysis and memos and identify what level and persons were responsible for the decision (i.e., was the decision made at the bureaucratic or political level):

Canada’s Health Minister has ordered an independent review of the country’s pandemic early warning system, after The Globe and Mail reported that the respected surveillance and research unit was silenced last year, several months before the COVID-19 outbreak hit.

Health Minister Patty Hajdu said the federal review will probe the shutdown of the system, as well as allegations from scientists inside the Public Health Agency of Canada that their voices were marginalized within the department, preventing key messages from making it up the chain of command.

“My hope is that we can get the review off the ground as soon as possible,” Ms. Hajdu said in an interview. “The independence of this review is critically important.”

A Globe investigation in late July detailed how the unit, known as the Global Public Health Intelligence Network, or GPHIN, was effectively silenced in May, 2019. The team of analysts – including doctors and epidemiologists specially trained to scour the world for health threats – were reassigned to other tasks within the government amid shifting department priorities.

Though GPHIN had garnered a stellar reputation internationally, and was dubbed a “cornerstone” of global pandemic preparedness by the World Health Organization, officials within Public Health decided in late 2018 and early 2019 that the operation was too internationally focused and could be put to better use working on domestic projects. The new work did not involve pandemic preparedness.

Those changes led to the shutdown of a special surveillance and alert system that helped Canada and the WHO gather intelligence on potentially threatening outbreaks, particularly in situations where foreign governments were trying to hide or play down the event.

Current and former scientists and doctors at Public Health also said they began to fear that their messages were not being heard, or understood, by layers of department officials who lacked a sufficient background in science. That made it difficult to convey urgent and complex information up the chain of command.

Responding to those concerns, Ms. Hajdu said her office has spent the past month looking into the problems at the departmental level, which led her to order the review.

“I’m concerned when there is an accusation that scientists are not being fully empowered, or in some way feel their voices are being blunted or muted,” Ms. Hajdu said in an interview.

“I can listen to those kinds of worries and do the kinds of things that I’m prepared to do, which is to order a review of the program and to determine whether or not the changes are actually resulting in the kind of information that Canada needs.”

Ms. Hajdu said she has asked that the review be done expeditiously, so that fixes can be identified and the recommendations implemented as soon as possible. She said that could mean having the recommendations back in six months.

“We’re working on [appointing] some professionals that would have the experience and the expertise to be able to do this review thoroughly, but also expeditiously … I don’t want this to be a two-year review,” the Health Minister said. The people leading the review are expected to be named in the coming weeks and will be independent of Public Health Canada.

Created as an experiment in the 1990s, GPHIN became a key part of Canada’s pandemic preparedness capacity after the deadly 2003 SARS outbreak, and was seen as a way to collect intelligence on global outbreaks. The point was not merely to identify the threat early, but also to monitor crucial developments and clues about the spread, often before official announcements were made by foreign governments, to speed up government decision-making.

With a team of roughly a dozen highly specialized analysts working in multiple languages, GPHIN was globally renowned for its ability to collect and disseminate credible information. It scoured more than 7,000 data points a day, including medical data, news reports, scraps of information on social media, and details on internet blogs to gather intelligence on outbreaks.

GPHIN had been credited with detecting some of the most important signals from the 2009 H1N1 outbreak in Mexico, outbreaks of Zika in West Africa, and a potentially catastrophic 2005 bird flu outbreak that the Iranian government tried to hide. As recently as two years ago, the WHO credited the Canadian unit for supplying 20 per cent of its “epidemiological intelligence.”

However, department changes effectively shuttered the operation, and limited the power of scientists inside the agency. The Globe obtained 10 years of internal GPHIN records which showed the system, which had issued more than 1,500 intelligence alerts about potential health threats over that time, went silent on May 24 last year. That coincided with a department edict that all such alerts had to be approved by senior managers inside Public Health. GPHIN analysts were shifted to domestic projects, such as tracking the effects of vaping in Canada, which effectively curtailed Canada’s surveillance of international health threats.

Past and present employees told The Globe that the system was designed to provide information to speed up Canada’s response to a dangerous outbreak such as COVID-19, including measures such as shutting down the border, quarantining travellers, enforcing physical distancing, and locking down long-term care homes.

“A lot of the work that we’ve done [over the past month] is to try to dig a little bit deeper into how this is working and why were these changes made,” Ms. Hajdu said.

GPHIN “has the potential to be a very valuable asset for Canada. It can’t be wasted,” the Health Minister said.

“The intent when there is an emerging pathogen is to close it off, to try and contain it as best as possible – at its source. So that you don’t end up in a pandemic like this again.”

The independent review follows a pair of other developments in recent weeks. Last month, the Auditor-General of Canada launched an investigation into the shutdown of the pandemic surveillance unit. And Public Health officials have restarted the GPHIN alert system.

COVID-19 has been a reckoning for governments around the world, exposing weaknesses in pandemic readiness and responsiveness. Ms. Hajdu said countries must now take stock of what needs to be done to implement stronger measures, including early warning and surveillance capacity, that will remain effective and not be eroded over time, when the memories of the crisis fade.

The federal review will look at “governance and what works best” for GPHIN, Ms. Hajdu said, adding that the messages raised by scientists inside Public Health, who took risks by speaking out publicly, resonated with her.

“In [The Globe’s] reporting, the plea from the scientists and the researchers that work in that team were particularly profound,” Ms. Hajdu said.

“There is still enough there to save, and to boost, and I think this independent review is going to be very helpful,” she said. “Obviously there is a lot of work to do.”

Source: Health Minister orders review of pandemic warning system, concerns raised by scientists