@Justin_Ling #COVID19: How did it come to this?

One of the best overviews I have seen:

After a year of struggling with this pandemic, science has developed a relatively good grasp of COVID-19.

We know that it is difficult to catch the virus from surfaces: Sanitizing your groceries and obsessively covering your hands in hand sanitizer is probably unnecessary.

We know community spread is driven, in large part, by large outbreaks and super-spreader events: Big gatherings lead to explosions of cases.

We know that indoor transmission is particularly dicey because the virus is easily aerosolized: Many people can get sick very quickly if they congregate indoors.

We know that outdoor transmission is possible, but unlikely: A combination of air flow and UV light means the virus can’t get very far.

We know vaccines are incredibly effective and safe, but that herd immunity will be needed to stop community spread: They can protect the elderly but won’t stop community spread until the vast majority of people are vaccinated.

While there’s clearly room for smart people to disagree on the details of those conclusions, they have been born out by an emerging body of science. New variants have changed the math a bit, but haven’t fundamentally altered those facts. Early in the pandemic, when these truths and solutions were murkier and less clear, absolute lockdowns, stay-at-home orders and border closures were the safe and prudent choices. Advice on washing your hands and not touching your face were reasonable, cautious, suggestions.

It’s a year later. Those five facts are now incredibly well documented in the scientific literature.

Understanding more about the virus has allowed more effective strategies to come into focus: Avoid indoor gatherings whenever possible. When they can’t be avoided, have as few people indoors as possible, keep people apart from each other, make sure they mask up, and circulate air with good HEPA filters. Where possible, move people outside—and actively encourage the outdoors as an alternative for people who may ignore good public health advice.

Those solutions, of course, are easy to write and hard to implement. Warehouses, prisons, meat processing plants, greenhouses, schools: Even when these places follow the rules most of the time, religious adherence around the clock can be hard to maintain.

So that’s why mass, randomized, testing and aggressive contact tracing is necessary to catch outbreaks before the virus moves down the chains of contact and creates new outbreaks. Shutting down those locations where the outbreaks occur is necessary. When things slip through the cracks and community spread begins, short-term circuit-breaker lockdowns should be a last resort to get cases under control.

There’s no real debate about this. These strategies work: As Atlantic Canada, New Zealand, Australia, Singapore, and a host of other states have proved them effective.

And yet, most of Canada is in the midst of a punishing third wave. Public health officials continue to insist washing our hands will get us out of this mess. Politicians warn us to stay indoors, avoid the outside.

Ontario’s health-care system is hanging on by a thread. Other provinces could be in a similar spot soon.

We are here, in large part, because many of our politicians have ignored the core facts of the COVID-19 virus and the main strategies that will clearly fight the pandemic.

Heading into the spring, off the back of the second wave, the premiers of these provinces have insisted that they were special. That they could reopen the economy—and brag to their voter base about their rosy jobs numbers—without consequence. The leaders of every province west of New Brunswick have laboured under the belief that their gyms, places of worship, and workplaces could open, even amid uncontrolled community transmission, and nobody would get sick. These governments have been sure that they have grown more clever, more agile, more adept than the virus.

Those governments have been wrong, and people have died because of it.

And when things have gone wrong, all the things governments promised us they had done turned to sand. In most of the country, mass testing was promised and not delivered—Ontario and Quebec require appointments, and have not expanded their testing capacity in any significant way since last year. Contact tracing has been essentially abandoned on a provincial basis. Circuit-breaker lockdowns didn’t touch the industries most responsible for spreading the virus.

Governments have begged us to stay at home—except if you need to go to work in an Amazon warehouse (600 cases); the Cargill chicken processing plant (82 cases); the Saskatchewan Penitentiary (more than 260 cases); St. Michael’s Ukrainian Catholic Parish, where congregants could gather without masks (10 cases); Mega Gym, which the Quebec government permitted to re-open (400 cases), and so on.

It is infuriating to find ourselves in the third wave, only to learn that we haven’t learned a damn thing.

Governments have pointed to the variants as some terrifying change in the equation. And, yet, look at Ontario’s data: This is just a ramped-up version of the same virus we’ve been fighting since March, 2020.

In late February of this year, in the lull between waves, nearly 60 per cent of cases could be attributed to a specific outbreak and/or a close contact of someone who tested positive. (A bit more than a third of cases had no known epidemiological link, a failure in and of itself.) In late March, as the third wave was in full swing, that proportion remained unchanged.

Where those outbreaks have occurred haven’t changed much, either.

Around 30 per cent were in congregate living or care spaces: Hospitals, prisons, shelters. Around 30 per cent were in schools. The remainder, about four-in-10 outbreaks, were workplaces.

Recently, Ontario has provided more visibility on the types of workplaces experiencing outbreaks: Hairdressers, restaurants and retail stores are responsible for vanishingly few superspreader events—between the three, they caused just eight per cent of overall outbreaks.

Even as case counts were climbing, and outbreaks were being reported across the province, people congregated on patios at bars and restaurants. In mid-March, before that naughty behaviour was banned, bars and restaurants reported eight outbreaks across the province: 37 cases in total. (This proportion hasn’t changed since last summer, when case counts were low and bars and restaurants were open.) That same week, there were 66 outbreaks in warehouses, food processing plants, and farms: 479 cases.

Dig into the data, as the Globe & Mail has done, and the absurdity becomes more acute: these outbreaks are happening in facilities that manufacture sporting goods. A retail marketing firm. An Amazon warehouse.

Many outbreaks also occurred in settings run by governments. There has been widespread transmission of the virus inside prisons and jails—which governments have been criminally inept at preventing. Shelters, too: Ontario’s data shows there are 32 ongoing outbreaks in shelters across the province.

This story is about the same from one province to the next. The data speaks for itself: Workplaces and schools are driving transmission of this virus. Were the whole country to lock themselves in their closets, except for those students and “essential” workers, the crisis would continue.

An emerging body of research explains what’s happening here. From the start of the pandemic, leaders have told us that the concern is about the transmission of droplets—and, rightly so, because the early science suggested that saliva particles from speaking, coughing or sneezing was the main driver of transmission. Good science is increasingly telling us that the virus is aeresolized.

That means we ought to be less fearful of tiny blobs of the virus covering everything—our hands, our faces, our picnic blankets—and more worried about the air around us. If you think about the virus that way, it becomes immediately obvious how much less risky it is to sit with some friends for a picnic, or on a restaurant patio. Conversely, how risky it is to run a warehouse with hundreds of workers, exerting themselves.

Have governments addressed this? No. Instead, governments have proffered curfews, as though the virus hunts at night. Parks have been closed. Camping has been banned. Outdoor mask mandates have been implemented. Outdoor gatherings limited. Police patrols to harass people out for walks.

Even as projections have shown Ontario teetering on the brink of a deadly crisis, Premier Doug Ford’s solution was to limit outdoor gatherings and to shut outdoor recreation sites.

But here’s the rub: Provinces know outbreaks aren’t happening in parks, or on patios. Quebec public health officials have acknowledged that they have no evidence to prove transmission is happening outdoors. Peer-reviewed studies have said that, on the high end, some eight per cent of global COVID-19 cases were linked to transmission outdoors. On the other end, Ireland studied its own data and found 0.1 per cent of cases occurred outside. Air quality monitoring done in Italy in the height of the second wave found the prevalence of the virus in the open air waseither negligible or not high enough to lead to transmission. (Though researchers admitted that dynamics could change in very crowded areas.)

Scaremongering about outdoor transmission, and instituting curfews is a feat of social engineering. This an effort to ignore the data, withhold information, and twist the facts to scare us.

The conspiracy-minded will see that as an exercise in population control: Politicians getting their jollies off by playing dictator.

The reality is more mundane—governments are doing this because they are frozen with indecision. Actually acknowledging the reality of the data means acknowledging this catastrophe was caused by governments’ idiotic reopening plans: Plans that were warned against by public officials at the time. Doing that means taking action that will hurt employment numbers, which could hurt our politicians fragile egos. Confronting this data and science also means admitting that all of our advice about washing your hands and not touching your face has been useless. And accepting that reality means provinces requiring sick leave, so people can go home if they’re ill.

Governments are loath to do any of that. They would rather shower us in meaningless pablum about how we, as citizens, need to do our part. The implication, of course, is that we are to blame for this crisis. That it’s us wayward youth who are driving this pandemic. Our lack of personal responsibility means they have to ground us to our rooms. Stay home, for god’s sake!

If our politicians stop blaming us for outbreaks, we may start blaming them.

And for good reason.

We need to stop talking to people like they are infants to be controlled. Especially when the politicians issuing these stay-at-home orders have zero credibility with which to be lecturing anyone. Any bit of trust people have in Doug Ford, Francois Legault, Scott Moe, Brian Pallister, and John Horgan has been shredded, and lit on fire.

In Atlantic Canada, the territories, and in Indigenous communities across the country, politicians of various political stripe show what real leadership looks like. How effective management means trusting the public while also accepting responsibility.

The rest of our provincial politicians need to act immediately to undo the damage they have enabled. Businesses need to be shut, unless they are absolutely essential. Those that need to remain open need stringent measures to deal with air quality. Given the pressure it puts on parents and students, schools should probably remain open: But, again, actual measures need to be taken to reduce the risk of that aerosolized transmission.

And we need to provide clear, coherent advice to people on what to do. Advice that follows the science.

We need to avoid indoor gatherings as much as possible. We should wear masks whenever possible. We should give each other two metres of distance. We should stay home when we have any symptoms, check our temperatures daily, and get tested if we feel sick.

But we also need to tell people what is safe. And it is very safe to go outside—it is extraordinarily safe, in particular, if you give people a little extra space and avoid crowded areas.

Have a picnic. Hold a barbecue in your backyard. Go for a walk. Play tennis. Go camping.

People need hope. Lying to them won’t engineer a solution. Politicians need to do their job.

Source: How did it come to this?

Remaking the public service: After a year of COVID, what has the federal government learned about how it operates?

Useful and informative overview:

Not since the Second World War has the federal government loomed so large over the affairs of Canadians. During the first ten months of the pandemic — from April 1, 2020 to January 31, 2021 — the government shelled out half a trillion dollars compared to $287 billion during the same period in 2019.

The vast majority of the increase was courtesy of emergency spending on an extraordinary range of anti-virus measures.

About $78 billion was taken up by programs to help individuals directly affected by COVID-19. Another $66 billion went towards subsidizing wages of employees who would otherwise be laid off. Billions more were directed at shoring up the weakening balance sheets of small business, and to secure vaccines, testing equipment and personal protective gear.

At times, it seems scarcely a segment of the economy has been left untouched by Liberal government largesse, which by the end of January had pushed the federal net debt to $1.1 trillion. This represented more than half the country’s gross domestic product, not a record by any means, but up from less than one-third practically overnight. This does not include the rapidly deteriorating balance sheets maintained by the provinces.

While the potential risks associated with this level of debt have been put off until the virus has been tamed, the impact of the sudden spending spree on government operations has been profound.

In the year of COVID, dozens of federal agencies and departments have been forced to behave in starkly uncharacteristic ways.

Deep-rooted policies were re-crafted on the fly, procurement moved at warp speed and multiple departments were tasked with building a health products industry nearly from scratch.

On top of this, key ministries are about to be tasked with managing an ambitious program, to be outlined in the April 19 federal budget, to refurbish the country’s infrastructure and help jumpstart the post-COVID economy.

Behind the scenes, government executives are ramping up plans for modernizing operations. They are also asking themselves what permanent lessons they should draw from the tumult of 2020.

These range from the profound: how to prepare for a new pandemic, to the practical: how should government better organize itself for the digital world?

The first lesson involves drilling into the overarching weakness of Canada’s response to the coronavirus — not just the egregious intelligence failure of the Public Health Agency of Canada, but also the relaxed oversight of a cabinet that could not bring itself to accept a worst-case scenario.

PHAC had assured Canadians the health risk to them was low early last year even as the coronavirus was circulating widely.

At heart, this was a failure of leadership culture, not a lack of early warning. The infection that became known as COVID-19 was in plain sight from the start. What PHAC missed, or at least declined to act upon, was the fact that COVID-19 was spreading asymptomatically, despite evidence that had been brought to its attention.

The result was a sharp, early rise in the number of infections, followed by a sub-par rollout of COVID-19 vaccines, which reflected a general lack of preparedness.

For other departments and agencies, the lessons of COVID are more straightforward.

The rapid spread of the coronavirus has demonstrated clearly the importance of the digital world. While the federal government has built one of the country’s largest communications networks, much of it is in need of refreshing and very little is easy to use.

The technology gaps were particularly shocking when it came to tracking stockpiles of personal protective equipment, conducting tests for the coronavirus and tracking the networks of people affected. This was both a provincial and federal government failure.

Anxious to avoid a repeat, federal departments in the past few weeks have developed ambitious plans for upgrading their infrastructure, and expediting new online services for Canadians. Whether these actually succeed will depend heavily on the government’s willingness to reverse its traditional antipathy for investing in operations. Encouraging executives to bear direct responsibility for projects will help.

“The path set out during the early days of the pandemic points to a new way of doing business,” the Canada Revenue Agency declared in its priorities report for the fiscal year ending March 31, 2022.

The agency, which spends half a billion dollars annually on information technology and was a key player in the delivery of the Canadian Emergency Response Benefit, is making permanent adjustments to its networks to give it more flexibility in the event of future crises. It is also developing a series of software applications to simplify tax returns, permit more tax verification information to go online and automate more of the tax filing process.

Employment and Social Development Canada is managing a massive, multi-billion dollar upgrade of the systems that deliver Canada Pension Plan, Old Age Security and other payments. While that was in train before the pandemic, the urgency has increased.

“Past decisions to defer maintenance and updates have increased the risk of systems failure,” the department noted bluntly in its most recent plan, “Modern applications need up-to-date technology.”

During the first few days of the economic lockdown a year ago, ESDC’s system for delivering employment insurance claims very nearly crashed. The department now has in place a program for accelerating its investments in information technology until 2026 to try to make up the gap in its capacity.

ESDC is hardly alone in playing catch-up.

Federal departments across government currently maintain some 14,000 software applications, ranging from weather forecasting to applications for business loans. Many are built on technology so old the original providers have simply stopped supporting it. In order to keep the entire apparatus humming, the government relies on thousands of software jocks familiar with products now past their prime. Many are employed by private sector specialist firms.

“We have to deal with the legacy stuff we inherited, fix it, replace it, modernize it,” Shared Services president Paul Glover acknowledged last fall before a House of Commons committee.

One way to look at it: older software programs need to be upgraded or replaced before they can be shifted from legacy locations to one of the pristine data centres now up and running. To date, just five per cent of the workloads associated with the software have migrated from old data centres to new ones, with another 40 per cent in various stages of planning.

What’s needed, in other words, is a concerted effort to modernize government faster than it’s aging. Departments and agencies will have to stretch.

Thanks to the experience of COVID-19 they now understood just how quickly they can move. Some of the more inspiring examples include:

  • Canada Revenue Agency and ESDC developed generous financial assistance programs for millions of Canadians in a matter of days.
  • Shared Services Canada boosted by 50 per cent the capacity of its networks serving Canadians online, and doubled to nearly 300,000 the number of secure connections used by government employees working from home.
  • Global Affairs seconded more than 600 employees to an emergency response centre at Lester B. Pearson headquarters. There they organized the repatriation of more than 60,000 Canadians from 100 plus countries in the largest post World War II exercise of its kind.
  • Public Services and Procurement Canada — the government’s contracting arm — arranged for the flights for repatriated nationals, and negotiated billions of dollars’ worth of medical supplies, testing equipment and other gear on behalf of the Public Health Agency of Canada. PSPC managed all this with a 3 per cent bump in the size of its procurement group.

So it was, across government. While Canadians in other parts of the country were suspicious that thousands of federal employees had simply booked time off for a COVID holiday, things actually got done.

Yes it was messy. Mistakes were inevitable in this environment, the prime minister acknowledged, but these would be corrected later, he promised. Indeed Canada Revenue Agency and ESDC are conducting audits of the billions of dollars of emergency payments, an exercise that will rely to some extent on artificial intelligence software.

Dealing quickly with the vast knock-on effects of COVID-19 was considered more important last year than upfront due diligence — an assessment with which Auditor General Karen Hogan agreed.

In some ways the government was lucky. Had COVID-19 struck a few years earlier, the response might have been an unholy mess. As recently as 2018, Shared Services Canada, the core supplier of data centres, Internet service and telephone networks, was working itself out of a deep hole created when Stephen Harper’s Conservatives cut its budget just as the department was launched.

The government only recently put in place a cloud services program with third parties, allowing departments to quickly expand network capacity in emergencies. It’s what saved the CERB program.

Just as fortunate, federal departments have been experimenting with pilot projects — such as work-from-home arrangements and automatic bank deposits — that allowed near instant responses to COVID developments.

These signs of flexibility and speed were the fruit of an extraordinary exercise in workplace consultation.

In June 2013, Wayne Wouters, the government’s top mandarin and clerk of the Privy Council asked federal workers what they thought of Blueprint 2020 — an analysis of global trends in technology and management. The document set out a series of principles that would govern how employees would do their jobs in light of these new realities.

The gist was that in order to properly serve Canadians by 2020, government workers would be equipped with state-of-the-art technology, and encouraged to be flexible, to experiment with ideas, and collaborate with other departments. They would also be given freedom to make mistakes and to learn from them.

More than 100,000 offered their views, most of them keen on the idea of making a difference. Others viewed the exercise with scepticism. They knew that as long as politicians felt they had to answer for errors in their departments, the business of running government would default to avoiding risk. Top-down management would prevail. In many ways, it still does.

Yet, fitfully, and somewhat improbably, the work culture began to shift. Here and there, departments and agencies set up those pilot projects. Government planners lost their enthusiasm for huge, all-encompassing programs following the botched rollouts of Phoenix Pay and email systems for federal employees. Both of these had been launched prior to the publication of Blueprint 2020.

Instead, the government has encouraged minimalism — the idea that new online services for Canadians or government employees should be developed in more manageable stages, with each one tested before moving to the next.

When responding to COVID, of course, there was little time for testing. But even there, the lessons of Phoenix Pay had been absorbed. In developing the Canadian Emergency Response Benefit for millions of people affected by the virus, the Canada Revenue Agency aimed for what it called a “minimum viable product” — a software application stripped to absolute essentials.

Along with making changes to the government’s electronic backbone, departments are wrestling with how to deploy their workers, post-COVID.

The Canada Revenue Agency — with 45,000 employees, including some 12,000 in the capital region — is also taking the lead on creating a permanently distributed workforce. In response to queries by this newspaper, the agency said it is looking to shift towards “a hybrid model” that will see a certain core work full-time from the office, while giving other employees the flexibility to work from home.

The collective decisions will have a profound effect locally. Not only do federal government employees make up more than 20 per cent of the Ottawa region’s total workforce, they work in buildings that account for nearly 30 per cent of the capital’s commercial real estate.

Managers and workers alike have learned much of their work can be done from anywhere, leading some to query why 42 per cent of the government’s 300,000 civilian employees need to be based in the national capital region. Departments with more than 80 per cent of their workforce located in Ottawa or Gatineau include: Finance, Statistics Canada, Treasury Board, Innovation and Global Affairs.

Real estate planners suggest the government’s future workforce will likely be split into three groups: small minorities who choose to work permanently from home or the office, and a majority who will work remotely for part of the week.

With thousands of work rules at play across dozens of union bargaining units, none of this will be easy to sort out.

“The work office will have to be re-thought,” says Stéphane Aubry, national vice-president of the Professional Institute of the Public Service of Canada, which represents 60,000 government workers. “Some of our members will prefer to keep working at home,” he adds. “We will not be going back to what was before.”

Before the pandemic struck, the government had been nearing the end of a multi-year program to reduce the amount of office space available for each employee. Almost certainly this strategy will be reversed to accommodate workers still concerned about working in close proximity with colleagues. This means fewer workers for the same amount of office space.

This won’t necessarily be a problem, at least in terms of logistics, assuming sufficient numbers of employees work from home. But it will likely increase overhead costs for government workers overall.

In coming years, as the government starts winding down its spending, the nearly $50 billion it spends annually on payroll for permanent staff will likely come under increasing scrutiny, not to mention the $11 billion it spends each year on professional services.

A strong counter-argument would be to point to a sprawling organization that, prompted by COVID, learned to serve Canadians with dispatch and efficiency. Will it actually happen?

Put it this way: the federal government over the past decade wasted billions of dollars of taxpayers’ money on failed information technology projects — and both government and private firms were at fault.

Departments now have another opportunity to get things right and rehabilitate their reputations. Many of the pieces are in in place but the big unknown is whether the flexible culture foreseen by Blueprint 2020 will actually be permitted to flourish.

Source: https://ottawacitizen.com/news/postpandemic/remaking-the-public-service-after-a-year-of-covid-what-has-the-federal-government-learned-about-how-it-operates

Germany Is Expected To Centralize Its COVID-19 Response. Some Fear It May Be Too Late

Uncomfortable parallels with Canada? That being said, unclear whether stronger federal role would have avoided some of the provincial mistakes and/or denial about the risks of a third wave:

This week, German Chancellor Angela Merkel is making good on a veiled threat she issued two weeks ago to centralize pandemic management. Amid growing calls for Merkel to take control of the situation and bypass the country’s 16 state leaders, Germany’s parliament is expected to pass a measure this month that will allow her finally to take charge of the country’s COVID-19 response.

As the third wave of infection rages, some worry it may already be too late. Hospitals in Germany warn they’re about to run out of intensive care beds, even as state leaders continue to relax coronavirus restrictions.

Germany, with a population of 83 million, has lost nearly 79,000 lives to the pandemic. With the more contagious B.1.1.7 variant now dominant, the national seven-day incidence rate has risen in recent weeks from below 100 to 136.4 cases per 100,000 people. The country’s total number of infections has surpassed 3 million.

A year ago, Germany was weathering the pandemic relatively well and Merkel’s coronavirus response — attributed to her scientific understanding of the virus and a robust test, track and trace system — was praised far and wide. But exponential growth has long since overwhelmed virus trackers, and the slow start to vaccine rollout, combined with an increasingly confusing patchwork of regional lockdown regulations, has left the country in epidemiological disarray and sent Merkel’s party plummeting in the polls, losing 10 points in recent weeks.

“It’s been a bit of a rude awakening for us Germans to realize that we’re not the masters of organization,” says Melanie Amann, who heads the Berlin bureau of Der Spiegel.

While the pandemic has debunked the myth about German efficiency, the same cannot be said of another cliché — the nation’s love of red tape.

“Our ability to create complex systems and bureaucracy have pretty much stopped us from effectively fighting the pandemic,” Amann says. Nonfunctioning websites, unstaffed hotlines, excessive paperwork and authorizations are among the issues she cites — amid regulations that differ from state to state.

Severin Opel, a 23-year-old Berlin resident, had to wait several days to get an appointment for a recent rapid coronavirus test.

“Paperwork is getting in the way of this pandemic,” he laments. “There’s so much focus on minutiae and documenting every step to the nth degree, guidelines end up contradicting each other and nothing makes sense.”

Merkel is known for her careful, measured responses to crises, but even she admits there’s sometimes too much devil in the details.

Speaking in a rare television interview last month, Merkel conceded: “Perhaps we Germans are overly perfectionist sometimes. We always want to do everything right because whoever makes a mistake gets it in the neck publicly.” But “in a pandemic,” she went on to say, “there needs to be more flexibility. We Germans need to learn to let go.”

Janosch Dahmen, a front-line doctor and health spokesperson for the Green Party — which is close to rivaling Merkel’s conservatives in the polls — believes the government’s cautious approach is actually reckless.

“A strategy or intervention without risks doesn’t exist,” Dahmen says. “Waiting for the perfect, flawless game plan is a recipe for failure, especially in the face of this virus, which is mutating insanely fast.”

And yet Merkel’s crisis management style is only one factor. Germany’s system of federalism means she has little say in the country’s vaccination and lockdown strategies, of which there are no fewer than 16 — one for each German state.

Amann argues, though, it’s high time that Merkel — who leaves office this fall — used her considerable political capital to take charge, rather than simply advising and negotiating pandemic guidelines with the 16 state premiers.

“Because her term is ending, she theoretically has all the freedom and all the independence she wants to take bold steps in the corona management,” Amann says. “Nobody could run her out of office. And she’s not using this. She’s just working as if she were at the beginning of her first term.”

State leaders agreed in March on an “emergency brake” strategy to impose more rigorous measures as infections rose, but the agreement was only in principle, and few states have implemented the measures strictly.

After weeks of frustration, political commentators have observed, Merkel looks the way many Germans feel — namely mütend, a pandemic-era mashup that means both tired (müde) and angry (wütend).

And while there’s concern that parliament might take too long to pass a bill allowing Merkel to streamline and centralize pandemic crisis management, the chancellor and most of the state premiers agree the current situation is untenable.

Source: Germany Is Expected To Centralize Its COVID-19 Response. Some Fear It May Be Too Late

@Justin_Ling: Canada’s public health data meltdown

Good long read, highlighting ongoing policy failure at both federal and provincial levels:


For weeks, Canadians have been casting their envious eyes to Israel, where more than half the country has been inoculated against COVID-19. Israel, less than a quarter the size of Canada, has administered nearly twice as many doses of the COVID-19 vaccine.

The Middle Eastern country has some innate advantages: It is small and centralized, and offered top dollar to ensure vaccines from Pfizer and Moderna would come fast, and in large volumes. But geography and money aren’t the reason why Israel is outpacing Canada by 10-to-one.

Israel has the vaccines because it has the data.

In its shrewd deal with Pfizer, Israel offered to turn the country into one giant clinical trial: Providing the vaccine manufacturer unprecedented large-scale visibility as to the vaccine’s efficacy. It’s all made possible because of the country’s state-of-the-art information technology and robust national vaccination database.

The rest of the world is currently benefiting from that incredibly granular information.

Canada could never have struck such a deal. Its health technology is, charitably, a decade out of date. It lacks the ability to adequately track infectious disease outbreaks, efficiently manage vaccine supply chains and storage, quickly administer doses, and monitor immunity and adverse reactions on a national basis.

Even though all the shipments of vaccines arriving in Canada come with scannable barcodes, to make tracking and logistics easier—with some manufacturers even barcoding the vials themselves—no Canadian province can scan them. In many provinces, pharmacies can’t access the provincial vaccine registry. Provinces do not automatically submit reports on COVID-19 cases or vaccines into the federal system, and must submit reports manually. Many crucial reports are still submitted by fax: Where fax has recently been phased out, they have been replaced by emailed PDFs.

Ours is a dumb system of pen-and-paper and Excel spreadsheets, in a world quickly heading towards smart systems of big data analytics, machine learning and blockchain. It’s unclear how Ottawa will be able to issue vaccine passports, even if it wants to.

At the core of the omnishambles is a simple fact that Canada has no national public health information system, but 13 different regional ones. Many of those regional systems have smaller, disconnected, systems within: Like a Russian nesting doll of antiquated technology.

But there’s good news: It doesn’t have to be this way. In some parts of the country, real progress is being made. Small technology start-ups are figuring out cheap, scalable and innovative solutions. In some provinces, progress can be as simple as updating operating systems.

If we are ever going to build efficient, cost-effective, and effective health infrastructure, Ottawa needs to take the lead. We need to abandon the idea that federalism requires us to have each sub-national government run entirely independent, walled-off, health databases.

We need data sharing. We need shared infrastructure. We need a national public health system.

***

For decades, Canada has been building out computer systems designed to track infectious disease outbreaks and vaccination campaigns. In non-pandemic times, that means monitoring the spread of sexually transmitted infections, keeping track of supplies of vaccines for things like influenza and mumps, and keeping an eye out for novel outbreaks of infectious diseases.

Most of the country relies on a public health system called Panorama, but not everywhere: Alberta, P.E.I., Newfoundland and Labrador, Vancouver Coastal Health, and the Public Health Agency of Canada itself all use other systems.

The provinces and territories that do have Panorama use it to varying degrees. From one province to the next, the heath infrastructure has different names, different features, unique customizations and varying capabilities.

This was never the plan. Canada, in fact, was once a world leader in digitizing its public health infrastructure.

In 1996, at a national conference of health officials, it was decided that “an immunization tracking system is urgently needed in Canada.” It included a list of goals: To identify children in need of vaccination, to book appointments, to do population-level analysis of immunity to diseases, and so on.

In 2002, basic national standards were drafted: “The time has arrived for a national program to be administered provincially, thus ensuring compatibility between provinces so that this health care information can be accessed when needed.”

When SARS hit Canada in 2003, before any of this technology could actually be implemented, health authorities found themselves woefully unprepared. The federal government and province of Ontario tried to manage the epidemic relying on “an archaic DOS platform used in the late 80s that could not be adapted for SARS,” per an Ottawa-commissioned report.

The country had only gotten a taste of what a deadly and hard-to-control infectious disease outbreak looked like. And it wasn’t ready. It only underscored just how crucial this national database was. The solution to that was Panorama.

It wasn’t cheap. Paul Martin’s government committed $100 million in its 2004 budget to seed the creation of Panorama, through the not-for-profit, government-funded Canada Health Infoway. His government also created the Public Health Agency of Canada to ensure there was central preparedness for the next SARS.

“With this budget, we begin to provide the resources for a new Canada Public Health Agency, to be able to spot outbreaks earlier and mobilize emergency resources to control them sooner,” then-finance minister Ralph Goodale said in his budget speech. He promised “a national real-time public surveillance system.”

The subsequent Harper government, seemingly recognizing the wisdom of what his predecessor had started, provided another $35 million more to fund the work. The contract to build this national surveillance system would ultimately go to IBM Canada.

In 2007, Canadian health officials flew to a conference in Florida to tell their American colleagues how far ahead we were on this health technology.

“By 2009 there will be a national surveillance system that will include a network of immunization registries,” their powerpoint presentation said. They broke down how it would work: A vaccinator would enter a patient’s information, scan the barcode on the side of the vaccine vial, and it would all go straight into the provincial database and, later, the federal system. A computer system could manage an outbreak from infection to immunity.

Dr. Robert Van Exan, who ran health and science policy at Canadian vaccine giant Sanofi-Pasteur, was tapped by Ottawa to figure out how to effectively barcode vaccines in the early 2000s.

“Technically, it’s a huge challenge,” Van Exan told me when I interviewed him in March for the Globe and Mail. “At least, it was.”

At the manufacturer, vaccines moved along a conveyor belt at a rate of about 300 to 1,000 vials per minute, he explained—adding new labelling was a logistical nightmare. But, within a few years, he had corralled the technological know-how to get it working. He went back to the federal government, excited that he and his company were part of this digital revolution.

“Canada was ahead on this by a decade,” Van Exan told me.

But through the late 2000s and early 2010s, that plan seemed to fall further away. There were delays and cost overruns, which largely fell to the provinces and territories. In 2015, British Columbia’s auditor general reported that the province had budgeted less than $40 million to build and maintain Panorama. The cost wouldn’t just double: It nearly tripled. The B.C. government alone would pay more than $110 million, not including ongoing annual costs.

As the program struggled, the Public Health Agency of Canada—the body specifically created following SARS to help build a national public health strategy—pulled out of Panorama. It let the provinces and territories fend for themselves. Nobody was left to actually enforce those brilliant minimum standards from years earlier. It stopped being a cross-compatible national system, administered provincially, and became a smattering of incompatible systems with no real national buy-in at all.

Provinces like Alberta bailed on Panorama in frustration.

The provinces and territories that stuck with it wound up with an inferior product. Beyond just the increased costs, the devastating report from the B.C. auditor general found that core components were just missing. Online vaccine appointments? Vaccine barcoding? Offline usage? Federal integration? All those features were promised, but “not delivered.”

“The system cannot be used to manage inter-provincial outbreaks, the main reason for which the system was built,” reads one particularly galling passage.

Other features didn’t work, or had severe limitations.

Van Exan recalls how “fed up” the vaccine industry was with Ottawa. “They went through this trouble to put the label on the vials,” he said. And for what?

“Despite a substantial federal investment,” one peer-reviewed study pointed out in 2013, “Canada continues to lag behind other countries in the adoption of public health electronic health information systems.” A 2015 study found that multiple provinces failed to even meet the minimum standards set out in 2002—standards that were already becoming stale and anachronistic.

Those 2002 national standards haven’t been updated since. (Health Canada told Maclean’s that the most recent standards were issued in 2020, although the document it pointed to clearly labels them as recommendations for new standards.)

Whether the standards are from 2002 or 2020 is somewhat immaterial. Ottawa doesn’t even know to what degree the provinces follow the standards.

The standards clearly call for Canada to have “reliable digital access and exchange of electronic immunization information across all health providers with other jurisdictions (including federal).”

In response to a question submitted in the House of Commons, Health Canada wrote last summer that “it is not possible for the federal government to know the details of any of the configurations of the provincial/territorial instances of Panorama in order to judge whether it meets a particular standard.” The Public Health Agency has not performed an audit of Panorama, the government added.

There are lots of reasons for the boondoggle. Many provinces and territories had competing priorities for what their health infrastructure ought to look like, and many balked at the idea of sharing data with Ottawa or even their neighbouring governments. “The provinces chose to do things independently,” said one source with knowledge of the system, who spoke on the condition of anonymity. Some provinces tried to make Panorama “too many things to too many people,” they said, and ended up with a system that disappointed everyone. That’s a common problem in Canadian technology procurement.

Part of the issue was the technology itself. Canada tried to stand up an ambitious IT infrastructure at a time when things like cloud hosting and barcoding capabilities were still expensive, clunky and hard to do on a large scale. But the core problem was a total lack of leadership. Ottawa pioneered the idea for a national registry, then walked away when things got hard.

Ontario family doctor Iris Gorfinkle has been calling for this national strategy for years. Last year, before we even saw our first vaccine, she warned in the Canadian Medical Association Journal that “it is imperative that we have the ability to provide potentially limited vaccines to those jurisdictions with higher disease rates to optimize vaccine distribution and coverage.”

I asked her why we haven’t been able to do this. She answered in a word:

“Inertia.”

***

In the last decade, provinces have had to make do. Alberta has modernized the legacy system it reverted to when Panorama went sideways. Ontario has tried valiantly to customize and upgrade Panorama until it resembled the system the province ordered.

Over time, however, Panorama did improve. By about 2017, IBM was finally adding those features that had been left off. It built out new data dashboards, integrated barcode scanning, and added APIs to make Panorama compatible with other systems. Most critically, Panorama went from a clunky program that could only run on designated computers to a cloud-based program that could be accessed by any laptop, tablet or phone.

Indigenous Services Canada, which administers some health services to First Nation communities, actually won an eHealth award in 2014 for its implementation of Panorama. One B.C. public health official lauded the agency’s work, saying it would allow health professionals “to better detect early signs of outbreaks by enabling sharing vital information between different public health related services providers.”

Some provinces, like Nova Scotia, upgraded Panorama into the new, more functional version. “One of the great things about Panorama in terms of helping in an outbreak is just having more timely access to information,” a prescient Nova Scotia provincial health official told CBC in 2019.

But it hasn’t been uniform: Ontario’s heavily customized system is running an old version of Panorama. Saskatchewan still hasn’t implemented core Panorama modules, like the one that tracks adverse reaction reports.

One source said provinces could enable its system to scan barcodes and health cards with a flip of a switch—several provinces, the source said, actually refused, insisting manual entry was more efficient.

Meanwhile, provinces and territories are still relying on manual data entry and spreadsheets to track inventory and shipments. Some jurisdictions are logging immunizations with pen and paper. A citizen can’t readily carry their immunization record from the Northwest Territories to Yukon.

Pharmacists in Ontario need to enter every immunization into two systems: once, into their own record management program; and again, into Ontario’s newly fashioned COVaxON, a front-end interface that is supposed to feed into Ontario’s outdated version of Panorama.

The inefficiencies are glaring. But it gets worse.

Notwithstanding inefficiencies and outmoded technology on the local level, the whole point of the Public Health Agency of Canada is to be able to track infectious disease outbreaks across the country. Right now, this is top of mind, as we wait to see the countervailing impacts of the COVID-19 variants and vaccines. A good system should be able to show us how different variants are spreading, and whether any or all of the vaccines are effective against which strains. But that only works if PHAC has the data.

Ottawa technically has information-sharing agreements with the provinces, but a government response to a question filed by Tory MP Scott Reid exposes how archaic the infrastructure truly is. Ottawa “does not have automatic access to data held in [provincial and territorial] systems, including Panorama,” the government wrote. “In the early weeks of the outbreak, some provinces were sending case information to PHAC via paper.” For the first four months of the pandemic, Ottawa wasn’t even collecting basic data on COVID-19 cases, like ethnicity, dwelling type, or occupation. Things have improved somewhat: Provinces now submit their reports manually, via a web portal.

The Public Health Agency of Canada reported that its “emergency surveillance team receives electronic files in .csv format from provinces and territories.”

A March report of the federal auditor general found that “although received electronically from provincial and territorial partners in the majority of cases, health data files were manually copied and pasted from the data intake system into the agency’s processing environment.” The audit also reports that many aspects of Ottawa’s data sharing agreements with the provinces and territories are not yet finalized. The audit further found that crucial information about COVID-19 cases—such as hospitalizations and onset of symptoms—was often not being reported to Ottawa.

The auditors came to a similar conclusion to many experts, like Gorfinkle and Van Exan: “We found that for more than 10 years prior to the COVID‑19 pandemic, the agency had identified gaps in its existing infrastructure but had not implemented solutions to improve it.”

When it comes to any vaccine, there are reports of adverse reactions—while they are rare, the recent panic over the AstraZeneca vaccine and blood clots shows this tracking is absolutely crucial. When a Canadian reports an adverse reaction to any vaccine, the province must pass it onto PHAC—which must, in turn, send it to the World Health Organization. Until very recently, Ottawa required that provinces and territories submit those reports via fax. More recently, it has modernized: “provinces and territories submit data [on adverse reactions] in a variety of formats, including line list submissions and PDF submissions,” the government said. That still means the reports must be entered manually. Some provinces only submit their reports weekly.

Panorama, meanwhile, has an adverse reaction tracking and reporting feature. PHAC just hasn’t been using it.

PHAC insists it has “well-developed surveillance and coverage information technology” and it responded to the auditor general with further more promises to address the gaps it has been vowing to fix for a decade. It’s hard to know if that progress is real or not.

In November—already some eight months into the pandemic—the federal government sent a secret request for proposals to a shortlist of pre-qualified suppliers looking for a “mission-critical system” to manage vaccine supply chains, inventory, and to ”track national immunization coverage.” The $17-million contract went to Deloitte, and it is supposed to plug into the disparate provincial systems to provide some semblance of a national picture. But Ottawa is refusing to disclose any timelines, details of the project or really anything beyond some boilerplate talking points. We only know about the project because the request for proposals was leaked to me in December. (“It’s awe-inspiring that they would withhold that information,” Gorfinkle says. I agree.)

So long as we commit to this madly off in all directions strategy, Ottawa can’t build a functional national system. Federal agencies can’t coordinate, much less individual provinces and territories. The patchwork makes national visibility impossible. Worse than a garbage-in, garbage-out problem—provinces can’t even agree on how to format the garbage. The result has been error and inefficiency.

One Ontario woman was hospitalized after receiving three doses of a COVID-19 vaccine, two of them just days apart—something that would never happen if she had an accessible, up-to-date vaccination record.

Meanwhile, seniors have been forced to stand in line for hours in Toronto, as health staff waste time doing work that could be easily automated. Epidemiologist Tara Gomes tweeted that her mother “had to repeat her address so many times to the person at check-in that she finally asked for a pen and paper and wrote it down.” It gets more frustrating when you realize, as Gomes noted, that her mother had to provide her personal information to get the appointment—the province’s COVaxON booking portal doesn’t connect to the COVaxON vaccine registry.

“You can’t blame one government,” Van Exan says. Every level of government of every political stripe has let this Frankenstein’s monster of a digital health system continue to limp along.

”Including the current one.”

***

The barriers to improvement are lower than you might think.

There is no particular reason why Vancouver ought to be using different vaccine management software than Victoria, or why Toronto should be running a different version of Panorama than Halifax. The diseases these health authorities face are the same, as are the vaccines dispatched to combat them.

Ottawa seems, a year after the start of this wretched pandemic, to be coming around to that idea. The Public Health Agency of Canada told Maclean’s it will finally be adopting Panorama, which “will enable more automated and timely data sharing and reporting.” At the end of March, it wrote that the new system “is expected to be online in the coming weeks.” Deloitte, IBM and the Government of Canada have been working together to get Panorama working with the Public Health Agency’s existing systems.

But just adopting Panorama isn’t nearly enough.

Step one is deciding if we really want a national system. If the provinces and territories are truly, completely incapable of running a system to national standards—or Ottawa is incapable of managing those standards—then maybe we should actually commit to decentralization. Shut down PHAC and download money and responsibility for public health to the provinces.

The benefits of a national system, however, are real and obvious. If we can agree with that principle, then step two is picking a technology and sticking to it.

We shouldn’t be married to sunk costs: If there is a better system out there than Panorama, we should consider it. But actually committing to Panorama is the obvious choice. It is already the standard for most of the country, and there’s no guarantee that starting from scratch will rectify our jurisdictional issues. What’s more: A list of other countries are now relying on Panorama. The more customers, the better.

Sticking with Panorama doesn’t mean that Alberta and Vancouver need to abandon their proprietary systems—but it does mean they need to be speaking the same language.

To that end, step three is standardizing data collection and sharing.

This, of course, needs to be done wisely: Patient data should be anonymized, for security reasons. Any cloud systems must have their servers within Canada (Nova Scotia’s data is available on the cloud, but entirely located in Halifax and Quebec.) And we need to make sure that governments are entirely transparent about how, when and why they use this aggregated health data. But all those jurisdictions need to use the same file formats, collect the same variables, and report them in the same efficient, automatic, manner.

Step four is investing in the infrastructure we need to make all this work—and sharing resources where that makes sense. If health authorities need an app to scan barcodes to track shipments, it doesn’t make sense for every province and territory to be using a different app. If we need to buy barcode scanners, every province should be buying the same one. Where it makes sense to share servers, we should share servers.

Step five is the easiest: Keep things current. It’s hard to think of any other instance where relying on 20-year-old technology standards makes sense. We need to be constantly revising and updating how we handle infectious diseases—the benefits will be apparent, in how we tackle everything from mumps, to HIV, to the next highly infectious disease that reaches our shores.

Again, these things are very doable, and don’t require any government to sacrifice autonomy. And, best yet, it can save us money.

On barcoding alone, a government panel estimated in 2009 that Canada would see $1 billion in savings by saving time, preventing wastage and reducing errors. On virtually every other front: Struggling through antiquated IT, and relying on overworked health staff to make up the difference, is expensive.

Governments don’t have to do it alone, either. Private industry can help.

In Alberta, start-up Okaki devised a simple, scalable system that can manage vaccination campaigns and even scan vaccine barcodes. The company has been running immunization drives for years, mostly in First Nations, and feeds its data directly into the provincial system—it is also compatible with Panorama.

CANImmunize, which began as an app allowing individuals to track their own vaccination record, now does many of the things Canada’s national system was supposed to do—including tracking appointments, monitoring adverse reactions, scanning vaccine barcodes. The technology can be fully integrated with Panorama.

Since I began writing about this issue for the Globe and Mail, my inbox has been inundated with emails from companies insisting that they could fix these problems in no time at all. There is no shortage of qualified people looking to help, and to innovate.

A group of companies, led by IBM, recently won a contract to build Germany’s vaccine passport system. It will use blockchain technology to make citizens’ vaccination records accessible, secure and verifiable. If we don’t get our act together soon, Canadians will be lucky to even get laminated paper vaccination records.

The provinces and territories need to come to the table and do this together. Our self-injurious commitment to federalism at all costs is endangering our own citizens. Because every province plays in their own needlessly walled garden, they are less prepared to deal with epidemics, they are less efficient at administering vaccines, and their citizens are more at risk from getting sick and dying.

Our country is supposed to be one of cooperative federalism, where provinces and territories can pursue creative solutions to unique problems. But when it comes to the basic mechanics of infectious disease outbreaks, there is no central leadership.

COVID-19 does not change shape when it crosses from Manitoba to Nunavut. We need the same set of tools in every province, or else we’re never going to fully beat this virus—and we’re going to be dangerously ill-equipped for the next one.

Source: Canada’s public health data meltdown

Input from public sector leaders needed in shaping a post COVID future

Reasonable call and consultation. However, I would hope that the focus would not just be at the deputy and ADM level, but executives and others closer to the front-line.

We have recently seen the disconnect between top levels and greater expertise in PHAC decisions and for such a survey to be more useful, it needs to draw on the deeper policy and subject expertise than in senior leaders who understandably have to focus more on policy management:

In a time of tremendous uncertainty, information overload and misinformation, Canadians are getting reams of advice and opinion on everything from how to manage the pandemic to the Supreme Court decision on climate change. The commentary comes from pundits, political actors, academics and interest groups, all important contributors to democratic debate. Some of it is informed, some of it is not.

Canadians are not hearing from those who, on a daily basis, are managing the challenges, developing the policies, implementing the programs and responding to the ever-changing political, legal and public opinion winds blowing on any given issue.

We are referring to senior, respected, professional public service executives who support elected municipal, provincial and federal representatives on complex challenges each and every day.

Who are these individuals?  Public sector executives and their organisations who are responsible for nearly 40 per cent of Canada’s GDP and an estimated 20 per cent of the country’s workforce.  They are distinguished by a ‘calling to serve’ and have a sense of duty to the community and a responsibility to help make things better.  They put collective interest over personal interest. While reasonably compensated it is often lower than the market compensation of their private sector counterparts.  And that’s okay.  These committed leaders are tireless in their pursuit of service and often burn the midnight oil through weekends and family events to help decision-makers make the best choices with the best advice.

These professional public servants wield tremendous influence on the quality of life we enjoy by advising, delivering services and providing effective stewardship of public resources to serve the priorities of democratically elected leadership.

Public sector leaders today are both driving and being driven by change. Facing paradigm shifts of seismic proportions, these experts and informed leaders are on the front line, supporting democratic institutions and governments, battling the pandemic, climate change and social polarization.  Public service executives are having to adapt, innovate and transform government organizations and services at top speed.

As we begin to consider what life will be like after the pandemic, and at a time when Canadian society is becoming increasingly polarized and diverse, and conflicts between different interest groups – including racialized tensions – are on the rise, the weight placed on the shoulders of this cadre of professional executives is unprecedented.  The pandemic and the difficult economic times are further straining public trust and governments will need to develop and enact policies and programs that address ongoing complex issues in a way that fosters better confidence in public institutions.

The chief administrative officer of a large metropolitan city or the deputy minister of a provincial or federal department has tremendous responsibility, knowledge and expertise.  They are impacted by changes to Canadian society, declining trust in government and concerned about whether or not their respective public institutions are equipped to deal with new, yet-to-be defined modern public administration practices.

Canadians need to hear from this informed cadre of dedicated experts. As vanguards of the public interest, they possess a unique knowledge, perspectives, and insights to the forces shaping society.  There is a need to give voice to, and share learnings from, the experience of public sector leaders regarding today’s issues and future challenges.

The Institute on Governance, with the support of the Mulroney Institute of Government, will be interviewing influential public sector leaders across the country and at all levels of government to collect their insights, learnings and assessments of the challenges and opportunities on the near and far horizons.  Knowing what is top of mind of this class of executives will offer an informed perspective to the important debates over Canada’s future and the role of governments in getting us there.

Toby Fyfe is the president of the Institute on Governance.  Stephen Van Dine is the senior vice president of public governance at the Institute on Governance.

Source: Input from public sector leaders needed in shaping a post COVID future

GPHIN: Top scientists propose moving pandemic warning system outside government

Understand and share the concerns, but I would prefer to address these and related problems at PHAC identified by media coverage and the recent OAG report.

The WHO also had its issues, relying too much on Chinese government information (or lack thereof).

But hopefully this initiative will increase government focus and attention that COVID has brought to current weaknesses:

A group of top scientists concerned about the decline of the federal pandemic early warning system in the years before COVID-19 emerged have proposed relocating the operation to a university where it can work independently of government.

The proposal is aimed at restoring the Global Public Health Intelligence Network to its former status as an internationally respected pandemic surveillance system. Documents outlining the plan were submitted to an independent panel in Ottawa that is reviewing the system’s future.

According to the documents, GPHIN would work with the World Health Organization and be based at the University of Ottawa’s Bruyère Research Institute. The university and the WHO back the idea, says the proposal, which was reviewed by The Globe and Mail.

“We propose the creation of a Canadian-based WHO collaborating centre for global health intelligence,” the proposal states. Such a move “would provide a new, stable and cost-effective environment for the future management of GPHIN.

“GPHIN must be guaranteed freedom from government influence or interference. To achieve independence of any future government influence, bias or interference, GPHIN must be situated outside of government.”

A Globe and Mail investigation last year found that GPHIN’s capabilities had been allowed to erode over the past decade as priorities within the government changed, and senior officials in the Public Health Agency of Canada (PHAC) sought to deploy its resources elsewhere.

Some of the core functions of the system, which provided crucial intelligence before and during the 2003 SARS crisis and 2009 H1N1 outbreak, were silenced in 2018 and 2019. With no pandemic threats apparent, management in the department sought to shift resources to areas that didn’t involve outbreak surveillance.

The proposal to partner with the WHO is being led by Ron St. John, a former top federal epidemiologist who helped create GPHIN in the 1990s, and other current and former top federal scientists. If it succeeds, the operation would run as a non-profit, funded in part by the federal government, and also able to seek science and technology grants from other sources, which it currently cannot do.

That new funding would be used to rebuild GPHIN’s operations and expand the system’s technical capabilities, taking some of the financial burden off the government, the documents say. GPHIN’s annual budget is around $3-million, and federal documents show it lacked the resources needed to update or grow its surveillance capacity, particularly as the system was allowed to erode.

The proposal argues that the environment needed to properly run the pandemic early warning system no longer exists inside Public Health, due to a drain of scientific and medical expertise over the past decade.

“Meeting these principles and operational conditions is not possible within the current managerial environment that exists in PHAC,” the document states. “We cannot wait for these changes to happen, as waiting will result in irreversible degradation of GPHIN and further depriving users within the global public health surveillance community of an essential tool to detect and monitor public health threats.”

WHO collaborating centres around the world are a way for member countries to contribute resources to the WHO by offering skills or technology they have. The Bruyère Research Institute is already home to one such collaborating centre, which focuses on technology used to track global health equity.

At one time, GPHIN provided the WHO with as much as 20 per cent of its epidemiological intelligence, according to Ottawa’s records. The proposal documents say GPHIN would remain one of Canada’s key contributions to the WHO, with the government providing funding for the system’s analysts to work.

Health Minister Patty Hajdu ordered an independent review in September of how PHAC handled the system after a Globe investigation last summer detailed many of the problems.

A report by the Auditor-General of Canada issued two weeks ago also found that the federal government did not use the pandemic early warning system appropriately in the early days of the COVID-19 outbreak, and that GPHIN failed to issue alerts. This contributed a series of faulty risk assessments as the virus began to spread around the world.

The independent review is expected to issue its final report in May, and the government won’t comment on its progress.

This is not the first time the idea of a WHO collaborating centre has been proposed for GPHIN. The proposal documents say the WHO has supported the idea since the SARS crisis, and has held talks on the subject six times, but those negotiations never came to fruition.

In 2005, talks were put on hold amid management changes inside Public Health. In 2009, similar discussions were halted due to the H1N1 outbreak. In 2012, another proposal was frozen during the Harper government’s deficit reduction plan. Similarly, talks in 2013, 2017, and 2018 never progressed due to internal restructuring in the Public Health Agency that resulted in management changes, and no further steps were taken.

The push to rebuild GPHIN comes at a time when other countries have identified the need to build their own early warning systems to help the international community detect major threats early and better contain outbreaks. The U.K. government and the Biden administration in the United States have signalled plans to bolster such capacities in recent months. An independent review examining the WHO’s pandemic preparedness is also expected to highlight the importance of such systems in its final report, expected this spring.

The epidemiologists behind the proposal say they want to restore Canada’s leadership in pandemic early warning and detection.

“GPHIN has achieved world-wide recognition as a rapid provider of accurate information regarding a variety of global events of public health importance,” the proposal says. “Future versions of GPHIN must build on and maintain this pre-eminent position. It’s Canadian origin and Canadian support during its lifetime is recognized and should be retained.”

Source: https://www.theglobeandmail.com/canada/article-top-scientists-propose-moving-pandemic-warning-system-outside/?utm_medium=email&utm_source=Morning%20Update&utm_content=2021-4-6_7&utm_term=Morning%20Update:%20Top%20scientists%20propose%20moving%20pandemic%20warning%20system%20outside%20government&utm_campaign=newsletter&cu_id=%2BTx9qGuxCF9REU6kNldjGJtpVUGIVB3Y

Wolfson: Without good data, we’re flying blind on good health care

Hard to disagree:
Yet again, the provinces are wailing about the need for more federal money for health care, with no strings attached. These are the same provinces who have for decades grossly underfunded long-term care. And as we are seeing in real time, many of the provinces are scrambling last minute to have the data to understand and manage the pandemic, most recently in rolling out vaccinations.Of course, the federal government should not cave in to these unwarranted provincial demands. It is entirely within the federal government’s constitutional authority, despite what the provinces are saying, to play all kinds of roles in the health sector. The provinces never object to the billions of dollars the federal government pours into health research every year.

But many of the provinces are still in the dark ages when it comes to collecting and making available for crucial health services research the kinds of data essential to understanding how well health care is being delivered.

Car dealers and airlines have for years had far better computer systems to keep track of the health of your car, and every airplane seat in the world. The Big Tech software companies not only collect humongous volumes of data on many of us, with their real-time technologies; they are continually doing experiments to see what will induce us to click more on their sites and advertisements.

Yet our public health authorities are having difficulties even connecting our COVID-19 tests, our vaccinations, and any hospital visits, as in many cases these software systems are completely separate silos.

So, what’s wrong with the federal government saying to the provinces, if you want more cash, you first have to implement decent real-time data systems? Indeed, the constitution expressly assigns jurisdiction for statistics to the federal government, hence the authority to play a strong leadership role in health data systems in the provinces.

The federal government has to be accountable to us in our role as federal taxpayers, not only as provincial taxpayers. It is incumbent on the federal government to ensure that any monies it transfers to the provinces are used for the purposes intended.

If the transfer is for health care, a province cannot use the cash received to finance tax cuts. If the transfer is to push the provinces to improve the generally awful state of long-term care, then it is entirely reasonable for the federal government to impose requirements on the ways the provinces spend the money, including collecting data and other reporting to ensure that provincial promises are more than rhetoric.

These requirements are more than just reasonable; they are based on the federal government’s constitutional authorities for the spending power, and for peace, order and good government.

At the same tine, the federal government sorely needs to up its game.  For example, the most recent speech from the throne committed the federal government to take the lead in developing national standards for long-term care. But one has to wonder how this can be achieved when there is virtually no nationally comparable data on one of the most crucial aspects of long-term care quality, namely staffing.

The federal government was negotiating the purchase of COVID-19 vaccines many months ago. That should have been more than sufficient lead time to ensure that there would also be a national system in place when the vaccines started arriving to track how the vaccine rollout was progressing.

Yes, it can and should be left up to each province to decide vaccine allocation. But with the current hodge-podge of computer, fax and email systems, there is no way to keep track in real time of what’s being done across the country. There’s also no way to connect vaccinations to rises and falls in outbreaks at the level of detail needed to inform lockdown policy.

Health care and public health are quintessentially knowledge industries. It should be obvious that they should be organizations that learn from experience. But it is impossible to learn from experience if you have no way of knowing just what you are experiencing.

Proper data collection and analysis are essential.

It is long past time that the federal government stiffened its spine and, in addition to saying it will work collaboratively with the provinces, put some muscle into meeting nation-wide concerns.

Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

Source: Wolfson: Without good data, we’re flying blind on good health care

PMO scrambled to contain controversy over pandemic early-warning system, internal e-mails show

Makes pretty clear that failure was at the senior bureaucratic level:

Internal e-mails show the Prime Minister’s Office was scrambling last summer to contain the fallout over the silencing of Canada’s pandemic early-warning system after learning it was curtailed less than a year before COVID-19 struck.

The e-mails, which provide a rare look at exchanges between the Prime Minister’s top political aides, show the upper levels of government were caught off guard when details about the silencing of the Global Public Health Intelligence Network (GPHIN) were made public by a Globe and Mail investigation.

The internationally respected system was created to detect and monitor international health threats to help Canada and other countries respond faster and more effectively to a deadly outbreak. However, The Globe found that the operation’s alert system was silenced in early 2019 amid shifting government priorities.

During an exchange of early-morning e-mails on Aug. 13, advisers to the Prime Minister can be seen trying to figure out what went wrong with GPHIN, and whether the blame for its mishandling could be contained to the Public Health Agency of Canada (PHAC), and decision makers within that department, without political ramifications for the government.

“Can you confirm all the decision are internal to PHAC?” Samantha Khalil, the PMO’s deputy director of issues management, said to a colleague in an e-mail at 8:33 a.m. “I’ve got a hard deadline of 8:45 now to update my senior team.”

That morning, The Globe reported the pandemic alert system was suddenly restarted about two weeks after it published its investigation that showed GPHIN had gone silent in 2019. The shutdown of the alert system, and its reinstatement, appear to have blindsided the government.

At 7:15 a.m., the Prime Minister’s chief of staff, Katie Telford, sent an e-mail to PMO staff with the article attached, saying, “Front page of globe. How will we respond to this?” The replies to that e-mail paint a picture of the Prime Minister’s Office trying to find answers, and concerned with whether the blame will spread beyond the Public Health Agency.

Responding to Ms. Telford’s e-mail at 8:03 a.m., PMO senior adviser Ben Chin told colleagues: “The thing I’d like to understand better is whether all decisions on this are internal to PHAC. I understand there was no funding reduction.”

In another e-mail, Ms. Khalil asks a colleague: “Can you send me any background there is on why this was stopped and restarted? As well as your messaging on it.”

At 8:53 that morning, Cole Davidson, press secretary to the Minister of Health, responds to Ms. Khalil, “We’re working on getting specifics and answers to some questions. … When did this change happen? Why did this change happen? Who made the decision?”

The e-mails are among thousands of federal documents being disclosed in response to a production order for COVID-19 records that the House of Commons approved in October despite objections from the Liberal government.

Before it was curtailed, GPHIN was internationally renowned for tracking deadly outbreaks, and provided the World Health Organization with 20 per cent of its epidemiological intelligence that fed global advance warnings. The system was used effectively during H1N1 and Ebola, helping governments respond swiftly to contain those deadly outbreaks. However, in 2018, with no pandemic threats on the horizon, senior management reallocated some of GPHIN’s resources to domestic projects.

As PMO officials arranged a 10 a.m. briefing from Public Health Agency officials that morning, they also worked on the messages that would be delivered to Canadians on the matter.

At 11:16 a.m., after the briefing, Mr. Davidson e-mailed Ms. Khalil with an update. That e-mail confirmed several key details of The Globe’s investigation, which reported that, in late 2018, managers at Public Health began requiring GPHIN analysts to obtain senior-managers’ approval before issuing alerts. This effectively suffocated the early warning system. When approvals never came, the international alerts stopped. Meanwhile, GPHIN analysts were reassigned to tasks that did not involve international outbreak surveillance.

“A new process was put in place requiring approval of all alerts by a VP at PHAC in fall of 2018,” Mr. Davidson reported to the PMO. “This change was not supported by the GPHIN analysts.”

He also confirmed the silencing of the alert system, which Public Health had initially told The Globe last summer did not occur. “From May, 2019, until last week, no alerts were issued,” Mr. Davidson told the PMO.

“PHAC is getting us answers on these questions: Who made the decision to change the approvals? Why was this change necessary? Was MinO briefed on this change? (we don’t believe so),” Mr. Davidson wrote, referring to the Health Minister’s Office as MinO. “Why did the alerts nearly stop after the change?”

Three weeks later, Health Minister Patty Hajdu ordered an independent federal review of the way GPHIN was handled. The Auditor-General has also launched an investigation.

Department management has also been shuffled amid the GPHIN controversy. The president of the Public Health Agency stepped down in September, and was replaced by the head of the National Research Council, while the government appointed a new vice-president to oversee GPHIN.

Source: PMO scrambled to contain controversy over pandemic early-warning system, internal e-mails show

Public Service Disaggregated Data for Visible Minorities and Indigenous peoples, Citizenship status

Over the past few months, I have been analyzing the various datasets breaking down public service employment and employee survey data by the individual visible minority and Indigenous groups.

The three articles, What new disaggregated data tells us about federal public service diversity (Policy Options, October 2020), What the Public Service Employee Survey breakdowns of visible minority and other groups tell us about diversity and inclusion (The Hill Times, November 2020) and Diversity and Inclusion: Public Service Hirings, Promotions and Separations (The Hill Times, March 2021) allow for a more comprehensive view of visible minority and Indigenous groups in the federal public service. Moreover, recent Public Service Commission studies analyzing recruitment of employment equity groups add an important element to discussions on public service staffing and recruitment practices.

Much of the debate and discussions have understandably focussed on Blacks in the public service. Yet public service data indicates that their situation is not unique in terms of representation, hirings and promotions and the employee satisfaction, with many commonalities with the other groups. A more granular analysis within each occupational group (i.e., comparing representation at each level by occupational group, as some departments are conducting, may very well provide such evidence).

Key findings are:

  • Overall EE analysis shows considerable variation among the different visible minority and Indigenous groups
  • Visible minorities
    • Correlation between lower educational attainment and representation for most groups save Chinese
    • Overall under-representation common to most groups
    • Blacks, West Asian/Arab small over-representation
    • EX: All groups under-represented save Japanese with Filipino, Latin American and Blacks having the largest gaps
    • Hirings: Hirings of visible minorities have increased for all groups in most occupational groups save for technical and administrative support. Hirings at the EX level have increase for Black, Chinese, South Asian/East Indian and West Asian/Arab, with other groups showing no increase.
    • Promotions: While promotions have increased marginally for virtually all groups at the agregate level, promotions by occupational category provide a mixed picture, with most groups and most occupational categories experiencing a marginal decline in promotions.
  • Indigenous peoples
    • First Nations under-represented, Métis and Inuit over-represented
    • Hirings: While hirings at the EX level have increased slightly, this is less the case for the other occupational categories. Hirings of Métis have increased the most in the operational category, hirings of First Nations the most in the technical category, while hirings of Inuit the most at the EX level.
    • Promotions: A marginal decline across all Indigenous groups and occupational
  • Harassment/Discrimination experiences vary
    • Harassment: Japanese report the most as do First Nations and Métis, Chinese and Filipino least satisfied with resolution as is the case with Métis
    • Discrimination; Blacks report the most, but all groups encounter discrimination on the basis of race, ethnic origin or colour. Black, Japanese and Latin American least satisfied with resolution. All Indigenous groups report having been discriminated against, mainly based on race or ethnic origin, with Métis also least satisfied with resolution

The recent PSC Audit of Employment Equity Representation in Recruitment provides some interesting data and analysis of the staffing process and how the different employment equity groups, and visible minority largest sub-groups, fare at each of the five stages in the staffing process: job application, automated screening, organizational screening, assessment and appointment (FY 2016-17 data).

The most significant stages were organizational screening and assessment where most filtering took place as shown in the table below:

The next table breaks down visible minorities by the largest groups:

As noted in the audit, Blacks have the largest decrease in representation at all stages save for appointment, with a non-negligible being screened out by automatic screening. Chinese are screened out more by organizational screening whereas West Asian and South Asian are more likely to be screened in as the assessment stage.

The audit provides the following explanation for visible minority groups. Overall, visible minority women have higher success rates than visible minority men at the organizational screening and assessment stages. Visible minorities screened out at the organizational screening stage due to citizenship status (Canadian citizens are given preference over non-citizens) and experience qualifications. Those with public service work experience were more likely to be screened in at this stage but overall “experienced less success than their counterparts regardless of whether or not they had federal public service experience.”

At the assessment stage, visible minorities were less successful when written tests were used, particularly the case for Black candidates.

A separate PSC report addresses the Citizenship of applicants and external appointments. While Canadian citizens have a hiring preference, the share of non-citizen applicants has risen from 9.4 percent in 2015-16 to 14.5 percent in 2018-19, with the share of hires has increased to 2.5 percent from 1.5 percent over the same period

Non-citizen visible minority applicants account for 22.9 percent of all visible minority applicants, for non-visible minorities, the share is only 12.1 percent.

The table below contrasts applicants and appointments by citizenship status for the past four years. For Canadian citizens, the percentage of applicants and appointments are comparable, for Permanent Residents and others, appointments are significantly greater than applicants suggesting that citizenship may be less of a barrier than commonly believed.

Visible minority Canadian citizens represented 17.2 percent of all applicants and 19.5 percent of all hires (2018-19).

Federal documents show sharp decline of Canada’s pandemic warning system, and debate over who was to blame

Looks like decision was mainly at the bureaucratic, not political level:

Newly released government documents paint a stark picture of how quickly Canada’s pandemic early warning system fell into decline before COVID-19 hit.

E-mails between staff at the Prime Minister’s Office show how alerts issued by the Global Public Health Intelligence Network, or GPHIN, dropped precipitously from 2009 to 2019, when key parts of the operation were curtailed.

The numbers confirm internal Public Health Agency data obtained by The Globe and Mail last summer, which showed how Canada’s internationally renowned pandemic early warning system was effectively shuttered less than a year before COVID-19 began spreading.

GPHIN was created in the 1990s to provide Canada and its allies with the earliest possible warnings of outbreak threats, so that governments could move quickly and decisively. A Globe investigation last year detailed how GPHIN played an integral role in detecting and helping the international community respond to past outbreaks such as SARS, H1N1 and MERS.

The e-mails between PMO staff are part of a release of thousands of federal documents that are being disclosed in response to a production order for COVID-19 records that was approved by the House of Commons in October over objections from the Liberal government.

In those e-mails, PMO advisers are responding to The Globe’s GPHIN investigation, which reported that the pandemic early warning system had issued more than 1,500 alerts on potential outbreak threats between 2009 and 2019. The probe found that GPHIN suddenly fell silent on May 24, 2019, less than eight months before COVID-19 started to become a world crisis.

The investigation detailed how shifting priorities within Public Health led to GPHIN’s resources being moved to other areas. With no apparent pandemic threats on the horizon, analysts were reassigned to study domestic issues, such as the effect of vaping and the spread of syphilis in Canada. When GPHIN’s alert system went silent last year, its surveillance of international outbreaks was also significantly curtailed.

According to an e-mail between PMO staff on Oct. 8, GPHIN issued 1,598 alerts between 2009 and 2019, including 877 in 2009, the year of the H1N1 outbreak. These alerts spanned a wide range of threats – from Zika to Ebola, yellow fever and Crimean-Congo hemorrhagic fever – and most never evolved into a crisis, though GPHIN would have kept close tabs on each situation as needed.

But the numbers began to decline sharply. After issuing 198 alerts in 2013, when an outbreak of H7N9 bird flu emerged, GPHIN’s alerts dropped in half the following year and soon declined further. By 2018, GPHIN issued just 21 alerts, a drop of 97 per cent from 2009 levels.

The e-mails suggest that as staff inside the PMO deliberated on how to respond to The Globe’s investigation, they appeared concerned about whether the Liberal government could be blamed for financial cuts to the operation, or whether the decisions that shifted GPHIN’s focus and resources inside the department rested solely with the Public Health Agency of Canada (PHAC).

“PHAC may have reprioritized its efforts, but it is an Agency that gets to decide, to an extent, their own priorities – those would be internal, bureaucratic decisions, not political ones,” Elise Wagner, a senior special assistant in the PMO wrote to a colleague. “Our government did not cut funding for the global early warning system.”

The shuffling of resources within the department had a significant effect, though. GPHIN’s role was not only to detect the first signs of an outbreak, but to provide continuing, rapid intelligence of an evolving situation, so that Ottawa could quickly bolster stockpiles of personal protective equipment and ensure hospitals and long-term care homes were ready if needed.

The goal was to inject urgency into government decisions, including when to implement physical distancing, mask wearing and stricter border measures. However, scientists inside PHAC told The Globe that they struggled to get important messages up the chain of command.

Members of the Canadian intelligence community have since raised concerns about the curtailing of GPHIN, given its role in informing the government’s risk assessments on COVID-19. Through January, February and into March of 2020, Ottawa rated the outbreak a low threat to the Canadian public, even as evidence emerged about how deadly the virus was and how easily it was spreading, and despite other countries implementing unprecedented measures.

Faced with criticism over the government’s early response, Prime Minister Justin Trudeau said he wasn’t sure what role added intelligence could have played in Ottawa’s decisions, but said he regrets not acting sooner to bolster stockpiles of personal protective equipment. However, informing such decisions is exactly what GPHIN was created to do.

The federal documents show GPHIN first picked up on the outbreak on Dec. 31, 2019, after news of a strange pneumonia in China made international headlines and a New York based disease-tracker called ProMed issued an alert to doctors and hospitals around the world. Scientists now believe COVID-19 had likely been spreading several weeks by that point, and that China did not fully disclose the problem.

Epidemiologists say the speed at which governments can implement containment measures has a major effect on the spread of a virus and its death toll, even if only by a few days or a week.

The problems surrounding GPHIN are now the subject of two federal probes; the Auditor-General of Canada has launched an investigation while the Minister of Health has ordered an independent federal review. The results of both are expected sometime this spring.