#COVID-19: Comparing provinces with other countries 12 August Update

Latest update. No major change in ranking although numbers in some of the hardest hit countries continue to increase.

 

Ottawa must put data first and tie to health funding

Agree in principle but politically hard to achieve (Quebec doesn’t even automatically share its data with CIHI):

The federal government looks yet again about to transfer billions of dollars to the provinces with essentially no strings attached.

We’ve seen this before with $40 billion in the 2004 First Ministers’ Health Accord and then $11 billion in the 2017 Health Accord, both highlighting home care, without evidence of significant progress.

And the prime minister just announced $19 billion for the Safe Restart Program, though without any details, especially as to what the federal government receives in return.

One major quid pro quo could address Canada’s profound lack of high-quality data, especially highlighted by the COVID-19 pandemic. While U.S. analysts are able in near real time to estimate and project COVID cases, hospitalizations and deaths down to the county level, Canada is barely able to produce comparable data by province.

Some of this $19 billion is meant for COVID testing and tracing, and improvements in long-term care.

A major failing in the tragic and disproportionate COVID-19 mortality rates in nursing homes was due to poor staffing levels, an issue that has been known for decades and pointed out in myriad reports and studies. But there are essentially no comparable and complete national data in this area.

As strongly recommended in the recent Royal Society of Canada report, high quality data on current staffing levels, connected at the individual level to health outcomes, are essential, especially for the federal government to develop the evidence-based national standards for long-term care so many have been calling for.

The provinces have typically argued that health care is a provincial jurisdiction, so the federal government cannot compel them to provide sorely needed data. However, in another example, we have had almost two decades of cajoling the provinces with federally funded Canada Health Infoway paying at least half the cost to develop and implement standardized and interoperable software systems for electronic health records.

Most relevant for the current pandemic, Infoway was specifically tasked with producing a system for anticipating and dealing with infectious disease outbreaks. This system, had it been working even 15 years after its initial funding in 2004, would have enabled a very different outcome this year, likely with far fewer cases and deaths from COVID-19.

Paper agreements and cajoling the provinces with optional subsidies have clearly failed. It’s time for a much tougher stance.

The federal government has the necessary constitutional powers, including explicit jurisdiction for statistics, criminal law, spending powers, and the general peace, order and good government (POGG) power, to compel the collection and flows of 21st century kinds of data.

Monique Bégin, as federal minister of health, successfully ended the practice of physicians’ extra-billing by amending the Canada Health Act to deduct any extra billing from an offending province’s fiscal transfer. The Supreme Court has just upheld the federal government’s genetic privacy legislation as constitutional despite objections from Quebec.

In the current pandemic emergency, high-quality, standardized, real-time data on “excess deaths,” COVID cases and hospitalizations, and details on the operations of the thousands of nursing homes and retirement residences across Canada are essential.

For nursing homes, we need these data to learn why some were completely successful in avoiding any novel coronavirus cases amongst residents and staff, while others suffered tragically. In turn, such statistical information will provide the federal government the strong evidence base needed to take the lead in establishing national standards for nursing home staffing levels, though action on staffing must not wait for perfect data.

And once we have standardized individual-level data on COVID cases, including factors like age, sex, neighbourhood, other diseases, individuals’ household composition, race, hospitalization rates, disease severity, and deaths, as the U.K. has been able to do for 17 million of its residents in near real time, then Canada will be able to support far more sophisticated analysis and projections to deal with the current top pandemic issues — not least, whether to open bars or schools.

Children Can Get Severe COVID-19, CDC Says — Especially Black And Hispanic Children

Another example of racial disparities. While the study did not include socioeconomic factors, these likely explain part of the differences:

While most children who catch the coronavirus have either no symptoms or mild ones, they are still at risk of developing “severe” symptoms requiring admission to an intensive care unit, the Centers for Disease Control and Prevention said in a new report released Friday.

Hispanic and Black children in particular were much more likely to require hospitalization for COVID-19, with Hispanic children about eight times as likely as white children to be hospitalized, while Black children were five times as likely.

Despite persistent rumors that children are “almost immune” from the virus, the analysis of 576 children hospitalized for the virus across 14 states found that one out of three was admitted to the ICU — similar to the rate among adults. Almost 1 in 5 of those were infants younger than 3 months. The most common symptoms included fever and chills, inability to eat, nausea and vomiting.

The findings come as school districts across the country are figuring out how to educate the nation’s children while still protecting kids, teachers and family members from the ravages of the virus. The American Federation of Teachers has said it considers in-person schooling to be safe only when fewer than 5% of coronavirus tests in an area are positive.

Researchers don’t fully understand why some racial groups are hospitalized at higher rates than others. But the CDC’s findings are consistent with other studies, the authors of the report said, citing a recent analysis from the Baltimore-District of Columbia region that found that Hispanics had more COVID-19 infections than other groups.

“It has been hypothesized that Hispanic adults might be at increased risk for SARS-CoV-2 infection because they are overrepresented in frontline (e.g., essential and direct-service) occupations with decreased opportunities for social distancing, which might also affect children living in those households,” the CDC researchers wrote.

Underlying medical conditions might have contributed to the children’s hospitalization, researchers wrote, noting that Hispanic and Black children are more likely to suffer from conditions like obesity.

If there’s any good news, it’s that even among children hospitalized with severe COVID-19 complications, the fatality rate remains low, researchers said.

A separate study in the journal Pediatrics also found racial and socioeconomic disparities in children and young adults tested for COVID-19 in Washington, D.C. Hispanic children were more than six times as likely as white children to test positive for the virus; Black children were over four times as likely.

Ultimately, the CDC concluded, it’s crucial to continue prevention efforts wherever children gather, specifically citing schools and child care centers.

Source: Children Can Get Severe COVID-19, CDC Says — Especially Black And Hispanic Children

East Asians have Toronto’s lowest coronavirus infection rate. But other Asian groups are suffering badly

Good article and analysis of the Toronto race-based COVID-19 data

  • Toronto’s ethnic Chinese are weathering the epidemic well – yet it’s a much different story for Filipinos, South Asians and all other non-whites

  • Wide disparities are also reflected according to income, with experts suggesting socio-economic factors like racism and poverty are likely at play, not genetics

North American Covid-19 statistics that group Asian communities together have suggested they are experiencing relatively low infection rates – but new data out of Toronto indicates sharp differences among Chinese, Filipino and other Asian groups in the city.

Toronto’s large East Asian population, which overwhelmingly consists of ethnic Chinese, has the lowest rate of infection among all ethnicities.

But all other Asian groups have been hit hard. Southeast Asians, consisting mostly of ethnic Filipinos, have an infection rate more than eight times higher than that of East Asians; the rate for South Asian Torontonians is more than five times East Asians’.

In fact, all other non-white groups have infection rates that exceed the East Asian rate by huge margins.

This chart shows the wide disparities in Covid-19 infection rates in Toronto, according to ethnicity, with East Asians experiencing the lowest rate and Latin Americans the highest. Graphic: Toronto Public Health
This chart shows the wide disparities in Covid-19 infection rates in Toronto, according to ethnicity, with East Asians experiencing the lowest rate and Latin Americans the highest. Graphic: Toronto Public Health

White Torontonians, meanwhile, have an infection rate that is a more modest 25 per cent higher than East Asians’ – still much lower than the rate for the whole of this diverse city.

Experts suspect that a combination of racism, behaviour and circumstance explains the stark differences among various ethnicities. The fact that wide disparities are also reflected in income-based infection rates suggests that socio-economic reasons are at play, not genetics, they say.

Widespread and early mask usage among East Asians could be a factor, said Dr Jason Kindrachuk, a University of Manitoba virologist who is studying Covid-19.
Covid-19 rate in Canada’s most Chinese city isn’t what racists might expect

But teasing apart causality would take time. “Is it as straightforward as income? Could this relate back to earlier community acceptance of things like masks or social distancing?” he asked.

Either way, the data is crucial to identifying communities that bear the greatest burden in the pandemic, said Kindrachuk.

“In Canada we talk about being a multi-ethnicity community, but we’re starting to identify just how different our communities are, how different the vulnerabilities are … so we need to think about how we provide services to those most in need.”

The Toronto data likely reflected the higher risks of certain jobs, those that relied heavily on non-white employees and were ill-suited to social distancing, Kindrachuk said.

Canada’s care industry has high numbers of Filipino workers, for example, while its meat processing and seasonal agricultural sectors employ many foreign workers from Mexico.

As well as suggesting communities most at risk, the ethnic data also stood in sharp contrast to what Kindrachuk called “shocking” racist rhetoric about “the ‘China virus’ [and the] implicit targeting of the East Asian, the Chinese communities, as being to blame for the virus”.

Poverty, racism and risk in Toronto

Previous data from New York and Los Angeles suggested that Asian residents of those cities had the lowest infection rates among various racial groups. But those US statistics lumped all Asians together, disguising any disparities within the group.

The Toronto data, presented by the city’s Medical Officer of Health Dr Eileen de Villa last Thursday and current to July 16, split up East Asians, Southeast Asians and South Asians. West Asians were grouped with Arab and Middle East people.

Separate census figures show that Toronto’s East Asian population is 84 per cent Chinese; ethnic Filipinos similarly dominate the Southeast Asian category, representing 79 per cent of the grouping.

East Asians had a Covid-19 rate of 40 infections per 100,000, far below the citywide rate of 145. They make up 13 per cent of the City of Toronto’s population of about 2.7 million – but less than 4 per cent of all infections.

This chart shows the wide disparities in Covid-19 infection rates in Toronto according to ethnicity, illustrated as percentages of total population and total infections. Graphic: Toronto Public Health
This chart shows the wide disparities in Covid-19 infection rates in Toronto according to ethnicity, illustrated as percentages of total population and total infections. Graphic: Toronto Public Health

The second-lowest infection rate (50 per 100,000) was among whites, who make up 48 per cent of the city’s population, and 17 per cent of infections.

Every other ethnic group has fared much worse.

The highest rates are among Latin Americans (481 per 100,000) and Arab/Middle Eastern/West Asians (454 per 100,000). Those communities are relatively small, at less than 3 and 4 per cent of the city respectively – but they suffered 10 per cent and 11 per cent of all Covid cases.

The larger populations of black Torontonians and Southeast Asians had identical infection rates of 334 per 100,000 people. Blacks make up about 9 per cent of the city, and Southeast Asians about 7 per cent, but experienced 21 and 17 per cent of all infections respectively.

South Asians (grouped with Indo-Caribbeans), had an infection rate of about 224 per 100,000. They make up about 13 per cent of Toronto, but have suffered 20 per cent of infections.

Canada has not been releasing race-based Covid-19 data on a national level, something critics call a blind spot.

But the Toronto data echoes previous geographical data from British Columbia, where the rate of Covid-19 infection in Richmond – the most ethnically Chinese city in the world outside Asia – has been the lowest in the metro Vancouver region.

In her presentation last week, Dr de Villa said there was “growing evidence … that racialised people and people living in lower-income households are more likely to be affected by COVID-19“.

“While the exact reasons for this have yet to be fully understood, we believe it is related to both poverty and racism,” she said.

She noted that 83 per cent of reported COVID-19 cases in Toronto involved a patient who identified as a member of a racialised group, compared to 52 per cent among the general population.

The race-based data from Toronto showed that “risk distribution was very unequal”, said Dr David Fisman, a professor of epidemiology at the University of Toronto. But this could be an overlapping function of wealth and income, he said.

There were dramatic differences between infection rates depending on income, with the rate steeply declining as incomes rose. The infection rate among residents of households earning C$150,000 (US$113,000) or more was 24 per 100,000 – less than one-sixth the rate suffered by the lowest earners, on less than C$30,000 per year, at 160 infections per 100,000.

The risk of Covid-19 in Toronto declines steeply as income increases, this chart shows. Graphic: Toronto Public Health
The risk of Covid-19 in Toronto declines steeply as income increases, this chart shows. Graphic: Toronto Public Health

“We were seeing this anecdotally in hospitals; the lockdown extinguished spread [of Covid-19] in higher-income areas, as a lot of professionals with service jobs got to go online,” he said.

“Lower-income folks are more likely to be people of colour and more likely to be in essential in-person work,” such as jobs in factories, food processing or care facilities, Fisman said.

“We can see that the epidemic split off in Toronto into two epidemics: one for wealthier Torontonians, and another, more prolonged, epidemic for those of lesser economic means.”

Kindrachuk agreed – the income divide was “eye-opening”, he said. “If you have a high income, you likely are going to be able to weather the storm … there is a complete disparity between how the burden of this disease looks between high and low income brackets.”

As for genetics, Kindrachuk said he doubted that it explained the stark disparities among ethnicities. “I haven’t seen evidence that there is a difference” on a genetic basis, he said.

#COVID-19: Comparing provinces with other countries 5 August Update

Latest update, along with chart for infections. Recent uptick in infections can be expected to lead to an uptick in deaths. No major change in ranking.

ICYMI: Toronto’s marginalized communities disproportionately affected by coronavirus, data suggest

Better data on what we have seen worldwide:

COVID-19 has infected racialized and low-income people in Toronto at far higher rates than the general population outside of long-term care homes, data released by the city suggest.

Doctors, community organizations and public-health workers have long suspected that racialized people – especially those who are Black – have been disproportionately affected by COVID-19. The findings released Thursday by Toronto Public Health showed that despite making up 52 per cent of the population, racialized people accounted for 83 per cent of COVID-19 cases between mid-May and mid-July.

The data reveal health inequities that existed long before the pandemic and will continue to if governments don’t look to address the upstream causes, experts say.

“Racism essentially sets up whether you’re able to have a life in which you can protect yourself from risk for any disease, including COVID, or whether you are forced into exposing yourself to risk,” said Arjumand Siddiqi, the Canada Research Chair in population health equity.

According to the data, Black people had the highest share of COVID-19 cases (21 per cent), followed by South Asian or Indo-Caribbean (20 per cent), Southeast Asian (17 per cent), white (17 per cent), Arab, Middle Eastern or West Asian (11 per cent), Latin American (10 per cent) and East Asian (4 per cent). All groups except white and East Asian were overrepresented based on the size of their overall population. Black people had six times the rate of COVID-19 cases compared with white people, while Latin American as well as Arab, Middle Eastern or West Asian populations had nine times the rate.

https://s3.amazonaws.com/chartprod/HuLhs5wv7Pvi3ckkP/thumbnail.png

The data from Toronto Public Health do not include long-term care and retirement home residents, as these people are not asked about their race or their income. The data also did not include Indigenous identities. The data were collected by public-health officials between May 20 and July 16 and provided voluntarily.

Eileen de Villa, Toronto’s medical officer of health, said targeted testing, improved communication and access to social supports – such as voluntary isolation sites for those infected with or exposed to COVID-19 – could address these stark inequities in the short term. But she emphasized the city must work to address the root causes.

“We need to focus on the social determinants of health, like affordable housing opportunities, access to employment and income supports and educational opportunities. And yes, we need to address systemic racism,” Dr. de Villa said.

Mayor John Tory said community organizations will be a key partner in identifying solutions.

“This includes engaging with local community groups to better understand risks and the concerns that residents in these areas have, so that we can work together with them to address those concerns,” Mr. Tory said.

Floydeen Charles-Fridal, the executive director of Caribbean African Canadian Social Services, said her organization, based in the northwest part of the city that’s home to one of its largest Black populations, does the sort of front-line work that has been chronically underfunded for years.

CAFCAN usually spends about $10,000 to $15,000 annually on food-related programming but instead spent nearly $40,000 in the first month of the pandemic on hot meals, food hampers and staff to prepare and deliver them. Food insecurity was already an issue in the neighbourhood but grew worse after lockdown-related job losses, Ms. Charles-Fridal said. A University of Toronto study published last fall found Black Canadians experience food insecurity at nearly twice the rate of white Canadians, even after adjusting for factors such as education, income and home ownership.

“It took COVID-19 and the murder of Black folks here and across the border for people to really understand how anti-Black racism is working,” Ms. Charles-Fridal said.

Studies have repeatedly shown that South Asians and Black people have much higher rates of diabetes and high blood pressure than the general population. For people with one of these underlying conditions who become infected with COVID-19, there is an elevated risk for more severe outcomes, including death.

Michelle Westin, a senior analyst at Black Creek Community Health Centre, which serves neighbourhoods with some of the highest rates of poverty, said she was not at all surprised by the data.

“We know that we have community members that are living in crowded apartment buildings, people who are working in the service and factory industries, people who are underemployed so they don’t have paid sick days,” Ms. Westin said. “So they’re working in positions that are putting them at greater risk for catching COVID.”

In a report published after the Black Experiences in Healthcare Symposium held earlier this year in Toronto, organizers noted there were “disparities and inequities in health care access and delivery for racialized Canadians.”

Tracey Thompson, 52, experienced this first-hand. Ms. Thompson, who is Black, contracted COVID-19 in mid-March and still lives with serious long-term effects from the virus. She said she was turned away from the emergency room twice, and has not been able to see a doctor to get medication to relieve her symptoms, which are still present.

“I just haven’t been able to access health care in a reasonable fashion,” Ms. Thompson said. “I think that being Black and being a woman didn’t do me any favours in that.”

Toronto Public Health also reported Thursday that having a low income and living in crowded spaces were major risk factors for COVID-19: 27 per cent of cases were among those living in households of five or more, and 51 per cent of cases were among those living in low-income households.

The two are closely connected, Ms. Charles-Fridal said. “When people have low income what that also suggests is they may very well be in [public] housing and living in places where they cannot practice physical distancing.”

Earlier this month, a group of homeless people and activist organizations filed an application with the Superior Court calling a bylaw that bans tents and camping in city parks unconstitutional. Evicting people from parks, they said, would then push them into crowded communal spaces where they faced an elevated risk of contracting COVID-19.

#COVID-19: Comparing provinces with other countries 22 July Update

USA has moved ahead of France in terms of deaths per million. India has moved ahead of Pakistan. No major change in order of Canadian provinces.

Canada provides exception for U.S. students planning to study north of border

That was fast (a few days after this article Canada’s travel rules unfair to first-year foreign students, U.S. parents say:

The federal government appears to have relaxed restrictions at the Canada-U.S. border that would have made it impossible for first-year university students from the United States to enter the country.

An update to the government’s guidance for international students, posted Friday, now says a student coming from the U.S. may no longer need a study permit that was issued on or before March 18, the day the border restrictions were first announced.

New York resident Anna Marti, whose daughter is planning to attend McGill University in Montreal this fall, said she was part of a “group effort” by parents across the U.S. who lobbied their senators, members of Congress and Richard Mills, the acting U.S. ambassador to Canada, to get the restrictions eased.

The rule would have made it all but impossible for U.S. freshmen to get into Canada, while other later-year students with pre-existing student permits could cross the border easily — even after having spent the summer south of the border, where the COVID-19 pandemic has been growing in severity for months.

Marti said she was told by Mills that the issue came up during ongoing discussions in Washington about the Canada-U.S. border restrictions — and that her entreaties, as well as media coverage of the plight of U.S. parents, “helped to put a ‘face’ to the issue.”

Citizenship, Refugees and Immigration Canada now says border officers will accept a “port of entry letter of introduction” that shows the student was approved for a study permit, in lieu of a permit approved before March 18. The exception, however, only applies to students from the United States.

“We celebrated, although we won’t fully celebrate until she is in Montreal,” Marti said, noting that the family — and many others — must now wait for those letters of introduction and study permits to come through.

She’s also well aware of the fact that students hoping to travel to Canada from countries outside the U.S. are still bound by the March 18 restriction.

“I just hope someone continues addressing the issue for all international freshmen,” she said. “International students who quarantine are not the real danger.”

Other parents in the U.S. remain wary of the border, since the rules require anyone seeking entry to Canada to be travelling for a “non-discretionary or non-optional purpose” — a description that could exclude students whose courses are being held entirely online.

The total number of COVID-19 cases in the U.S., growing by tens of thousands of cases a day, reached the 4.4 million mark Monday, with more than 150,000 deaths to date. Premature reopenings, an uneven and cavalier approach to physical distancing in parts of the country and a partisan divide over mask requirements have helped to fuel a surge in cases.

Canada, by comparison, has reported 114,000 total cases and nearly 8,900 fatalities so far.

“There are no measures in place to provide for expedited processing of study permit applications,” Canada’s immigration department said in an update earlier this month.

“Foreign nationals who had a study permit application approved after March 18, 2020 … may not be exempt from the travel restrictions (and) they should not make any plans to travel to Canada until the travel restrictions are lifted, as they will not be allowed to travel to or enter Canada.”

Immigration Minister Marco Mendicino announced last week the government would prioritize study permits for students who have submitted complete applications online. Students will also be able to apply time spent studying online toward their eligibility for work permits in Canada, provided at least 50 per cent of the program is completed in Canada.

Ottawa has also introduced a priority processing system and a two-stage process for students who are unable to obtain all the necessary documentation.

A spokesman for Mendicino did not respond to media inquiries Monday.

Source: Canada provides exception for U.S. students planning to study north of border

In Jerusalem’s Old City, The Devout Adjust To Worship In The Coronavirus Era

Of interest and in sharp contrast to some congregations elsewhere who have ignored or defied public health measures:

“The air over Jerusalem is saturated with prayers and dreams like the air over industrial cities,” wrote Yehuda Amichai, one of the city’s beloved poets, in 1980. “It’s hard to breathe.”

Now it’s hard to pray.

In the historic walled Old City, the beating heart of a place sacred to millions around the world, a second wave of the coronavirus has challenged devout communities to rethink how to pray safely. This spring, Jerusalem’s revered religious sites closed partially or fully as prayer gatherings were blamed for some infections. Now Israel permits houses of prayer to operate under restrictions.

New customs accompany old worship rituals: a grid of prayer quadrants at the Western Wall. Only clergy permitted at the Church of the Holy Sepulchre. “Place your carpet here” stickers on the floor of the Al-Aqsa Mosque grounds to keep worshipers distanced.

Here are some of the newest rituals surrounding Muslim, Christian and Jewish prayer in Jerusalem’s Old City.

Bring your own carpet

The Al-Aqsa Mosque, where tradition says the Prophet Muhammad journeyed to heaven, reopened in late May after Muslim authorities closed it to the public for more than two months — its first lengthy closure since the Crusaders captured it in 1099.

Worshipers are now asked to perform the wudu, the ritual washing of parts of the body, at home. Volunteers at the mosque provide hand sanitizer and masks. Participants are also asked to bring prayer carpets from home, to avoid touching the carpeted floor inside the mosque building.

“I have never used as many small carpets as nowadays,” said Mustafa Abu Sway, a member of the mosque advisory council, sitting next to his yellow carpet outside the mosque. “It just goes to the washing machine, because you don’t know what it has been contaminated with.”

Israel restricts prayer gatherings in Jerusalem — initially capped at 50 worshipers, then 19, and now 10 — but Al-Aqsa is hosting several thousand every Friday for the main prayers.

That’s partly to maintain a Palestinian presence at a compound also revered by Jews as the site where the Biblical temple once stood. Orthodox and right-wing Israeli Jewish activists are increasingly paying politically sensitive visits to the mosque grounds and lobbying to allow Jewish prayer there, which Palestinians see as hostile efforts to seize control at the site.

Muslim officials also believe they can hold prayers safely by spilling over into the mosque’s vast outdoor complex. Stickers on the floor show worshipers how to keep spaced at a healthy distance, with partial success.

“It would be a pity if everything is shut down. I mean, you need a place, a source of hope, a source of light, to invigorate people and give them a break,” said Abu Sway.

A recent sermon implored worshipers not to spread false rumors about the pandemic and to take it seriously. After prayers on a scorching Friday, thousands poured out of the Old City holding prayer carpets on their heads and refreshing frozen pops in their hands.

Celebrating Mass on Facebook Live

Nearby, the Church of the Holy Sepulchre, the traditional site of Jesus’ crucifixion, is closed due to the pandemic — except to the clergy who continue their daily rituals inside, behind its wooden doors.

A short walk away, St. Saviour’s Monastery hosts Jerusalem’s main Roman Catholic Mass, with a small women’s choir and no congregation onsite.

For months, Father Amjad Sabbara held a series of mini-Masses, with 19 participants each, so everyone in his Palestinian parish could attend a socially distanced Mass at least once a month. Now, with a second wave of infections afflicting Jerusalem’s Palestinian neighborhoods, congregants watch from home on Facebook Live.

“It’s better, you know, for the protection of the people and the families,” Sabbara says. “It’s better to stay in their homes. And in this way, we can pray together.”

It’s in their homes where his congregants need him most. Sabbara has set up a special counseling hotline and says he’s getting a lot of calls about family tensions from being cooped up at home during the pandemic.

On a recent Sunday, he offered his homily in Arabic and raised a golden goblet and round communion wafer, all in front of a web camera.

Somehow, two devoted churchgoers managed to slip into the closed, cavernous church. They were allowed to stay.

No kissing the Torah scroll

Jewish prayers continue at the Western Wall, a remnant of the ancient Biblical temple compound. But the outdoor prayer plaza is now divided into quadrants designed to keep worship groups small.

Nearby, at the Ramban Synagogue in the Old City’s Jewish quarter, longtime elementary school teacher Yehezkel Cahn, 71, oversees the morning prayers — for several dozen worshipers sitting six feet apart in designated seats — as if the synagogue were his classroom. He’s drawn cartoons with handwritten instructions: No wearing masks on your chin. No turning on the ceiling fan.

“Because the corona goes from his nose to my mouth,” Cahn says.

Another sign reads: “Don’t try to be a wise guy! You have no permission to use the prayer books of the synagogue.”

Cahn wears blue surgical gloves as he cradles the Torah scroll, turning his back as he passes a veteran white-haired worshiper. He says the man often forgets the synagogue’s new health rule against kissing the scroll, a traditional sign of respect performed by touching the scroll and then kissing one’s own hand as it is paraded around the congregation.

“I don’t want him to kiss,” Cahn says.

Cahn repeatedly looks at his watch, to usher in three shifts of morning worshipers in 45-minute slots. He’s keeping the prayer groups small. Inside the synagogue, he allows no more than 10 men. That’s the minimum quorum required by Orthodox Judaism for Torah readings and certain prayers — and the government’s latest restriction on indoor gatherings is 10 people. Whoever doesn’t get a seat indoors prays in the courtyard.

As with efforts by Jerusalem’s other major faiths, it’s an attempt to protect worshipers’ safety during the pandemic while permitting the uninterrupted rhythm of religious life.

Source: In Jerusalem’s Old City, The Devout Adjust To Worship In The Coronavirus Era

‘Without early warning you can’t have early response’: How Canada’s world-class pandemic alert system failed

This has to be considered a significant fail: disbanding the PHAC Global Public Health Intelligence Network, or GPHIN a few years before COVID-19.

Kudos to the Globe for good investigative reporting and analysis.

Given that resource reductions and reallocations are normally executed at the bureaucratic level (with political sign-off), one would hope that PHAC is revisiting this decision and the relative importance within PHAC of senior bureaucratic decision-makers vs scientific advice and expertise. Savoie’s comments on senior public servants as courtiers comes to mind when reading about these differences so well captured in the Globe report.

Some form of enquiry (preferably external) is needed  to assess how this short-sighted decision took place and the related accountabilities.

While there is no excuse for the ethical violations of the PM and Finance Minister regarding WE, it would be a far better use of Parliament to investigate this decision and its impact, given that it contributed to Canada’s missing the opportunity for an early and thus likely more effective response, with fewer deaths of Canadians:

On the morning of Dec. 31, as word of a troubling new outbreak in China began to reverberate around the world, in news reports and on social media, a group of analysts inside the federal government and their bosses were caught completely off guard.

The virus had been festering in China for weeks, possibly months, but the Public Health Agency of Canada appeared to know nothing about it – which was unusual because the government had a team of highly specialized doctors and epidemiologists whose job was to scour the world for advance warning of major health threats. And their track record was impressive.

Some of the earliest signs of past international outbreaks, including H1N1, MERS and Ebola, were detected by this Canadian early warning system, which helped countries around the world prepare.

Known as the Global Public Health Intelligence Network, or GPHIN, the unit was among Canada’s contributions to the World Health Organization, and it operated as a kind of medical Amber Alert system. Its job was to gather intelligence and spot pandemics early, before they began, giving the government and other countries a head start to respond and – hopefully – prevent a catastrophe. And the results often spoke for themselves.

Russia once accused Canada of spying, after GPHIN analysts determined that a rash of strange illnesses in Chechnya were the result of a chemical release the Kremlin tried to keep quiet. Impressed by GPHIN’s data-mining capabilities, Google offered to buy it from the federal government in 2008. And two years ago, the WHO praised the operation as “the foundation” of a global pandemic early warning system.

So, when it came to the outbreak in Wuhan, the Canadian government had a team of experts capable of spotting the hidden signs of a problem, even at its most nascent stages.

But last year, a key part of that function was effectively switched off.

In May, 2019, less than seven months before COVID-19 would begin wreaking havoc on the world, Canada’s pandemic alert system effectively went dark.

Amid shifting priorities inside Public Health, GPHIN’s analysts were assigned other tasks within the department, which pulled them away from their international surveillance duties.

With no pandemic scares in recent memory, the government felt GPHIN was too internationally focused, and therefore not a good use of funding. The doctors and epidemiologists were told to focus on domestic matters that were deemed a higher priority.

The analysts’ capacity to issue alerts about international health threats was halted. All such warnings now required approval from senior government officials. Soon, with no green light to sound an alarm, those alerts stopped altogether.

So, on May 24 last year, after issuing an international warning of an unexplained outbreak in Uganda that left two people dead, the system went silent.

And in the months leading up to the emergence of COVID-19, as one of the biggest pandemics in a century lurked, Canada’s early warning system was no longer watching closely.

When the novel coronavirus finally emerged on the international radar, amid evidence the Chinese government had been withholding information about the severity of the outbreak, Canada was conspicuously unaware and ultimately ill-prepared.

But according to current and former staff, it was just one of several problems brewing inside Public Health when the virus struck. Experienced scientists say their voices were no longer being heard within the bureaucracy as department priorities changed, while critical information gathered in the first few weeks of the outbreak never made it up the chain of command in Ottawa.

‘WE NEED EARLY DETECTION’

The Globe and Mail obtained 10 years of internal GPHIN records showing how abruptly Canada’s pandemic alert system went silent last spring.

Between 2009 and 2019, the team of roughly 12 doctors and epidemiologists, fluent in multiple languages, were a prolific operation. During that span, GPHIN issued 1,587 international alerts about potential outbreak threats around the world, from South America to Siberia.

Those alerts were sent to top officials in the Canadian government and throughout the international medical community, including the WHO. Countries across Europe, Latin America, Asia and Africa also relied on the system.

On average, GPHIN issued more than a dozen international alerts a month, according to the records. But its purpose wasn’t to cry wolf. Only special situations that required monitoring, closer inspection or frank discussions with a foreign government were flagged.

GPHIN’s role was reconnaissance – detect an outbreak early so that the government could prepare. Could the virus be contained before it got to Canada? Should hospitals brace for a crisis? Was there enough personal protective equipment on hand? Should surveillance at airports be increased, flights stopped, or borders closed?

This need for early detection sprang from a climate of distrust in the 1990s, when it was believed some countries were increasingly reluctant to disclose major health problems, fearing economic or reputational damage. This left everyone at a disadvantage.

For Canada, the wake-up call came in 1994 when a sudden outbreak of pneumonic plague in Surat, India, sparked panic. Official information was sparse, but rumours promulgated faster. As citizens fled the city of millions, many on foot, others boarded planes.

Public Health officials in Ottawa were soon alerted to an urgent problem: Staff at Toronto’s Pearson International Airport, fearing exposure to the plague, threatened to walk off the job if a plane arriving from India was allowed to land. The government scrambled to put quarantine measures in place.

“We were caught flat-footed,” said Ronald St. John, who headed up the federal Centre for Emergency Preparedness at the time. The panic demonstrated the need for advance warning and better planning.

“We said, we’ve got to have early alerts. So how do we get early alerts?”

Waiting for official word from governments was often slow – and unreliable. Dr. St. John and his team of epidemiologists didn’t want to wait. They began building computer systems that could scan the internet – still in its infancy back then – at lightning speed, aggregating local news, health data, discussion boards, independent blogs and whatever else they could find. They looked for anything unusual, which would then be investigated by trained doctors who were experts in spotting diseases.

It was a mix of science and detective work. A report of dead birds in one country, or a sudden outbreak of flu symptoms at the wrong time of year in another, could be clues to something worse – what the analysts call indirect signals.

Find those signals early enough, and you can contain the outbreak before it becomes a global pandemic.

“We wanted to detect an event, we didn’t want a full epidemiological analysis,” Dr. St. John said. “We just wanted to know if there was an outbreak.” …

Source for remainder: https://www.theglobeandmail.com/canada/article-without-early-warning-you-cant-have-early-response-how-canadas/