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

Doug Ford’s ‘stay home’ message is absurd. Workers in the hardest-hit areas can’t stay home — they’re essential

Seeing more of these kinds of articles, making the needed comparisons:

A retiree in Rosedale is vaccinated against a virus she’s highly unlikely to catch. Meanwhile, the 35-year-old warehouse worker from North Toronto who is boxing up the retiree’s water resistant throw pillows just in time for patio season is still awaiting his shot. 

Maybe the warehouse worker (who is far more likely than the retiree to catch COVID-19) isn’t eligible for a vaccine yet, or maybe he is eligible but he isn’t sure where or when to get jabbed because everything is so goddamned confusing.

He checked the provincial website but no luck. 

He heard something about vaccine pop-up clinics emerging in his area, but the details are vague. He lives in a so-called “hot spot” but he isn’t involved in community groups; he doesn’t belong to a church or a mosque that would advertise such a clinic. If one pops up, unless he’s lucky, he may miss it. 

The good news is that the Rosedale retiree’s pillows will arrive at her house ahead of schedule. Saturday’s physically distanced backyard tea party will be lovely. 

The above is not an excerpt from the “Hunger Games,” or some Toronto-themed dystopia novel. It’s the reality of the COVID-19 vaccine rollout in Canada’s most populous city, one that despite city officials’ efforts has produced the following uneven result: those least likely to get the virus are vaccinated in large numbers while those most likely to get it are not. 

According to recent reporting by Olivia Bowden and May Warren, affluent Moore Park is “the most vaccinated neighbourhood in Toronto” (22 per cent of residents have received one shot), while Jane and Finch “where more than half the residents do not speak English as a first language, and where thousands of essential workers live, had the lowest vaccination rate” (5.5 per cent of residents have received one shot).

But this disparity isn’t just glaring in terms of vaccination rates. It’s glaring in terms of mobility too: how much time Torontonians are spending at home vs. out of the house. 

According to data presented at a Toronto Board of Health meeting Monday morning, Torontonians who live in the city’s northwest end — where essential workers tend to live — are leaving their homes more often than those in neighbourhoods where infection rates are lower. 

What’s more, between late March and early April when Premier Doug Ford pulled the “emergency brake,” time spent at home for Torontonians who live in some essential worker enclaves appears to have actually decreased slightly.

Toronto’s top doctor, Dr. Eileen de Villa, presented a map highlighting the disparity at Monday’s meeting. “What we have seen recently is a reduced mobility overall in the city but not equally experienced in all parts of the city,” she said. “We’re seeing more mobility in the northwest of the city which we know has had disproportionate impact of COVID-19.” 

This isn’t a coincidence says Toronto Board of Health chair Joe Cressy. “What’s critical to understand here is that as the people who aren’t staying home, they’re not going out partying — they’re going to their essential jobs. Since the stay-at-home order was issued, people are staying home more often, but not in those hard-hit neighbourhoods.” 

People are staying home more often, but not in those hard-hit neighbourhoods.

If ever there was a statement that defined the urgency of vaccinating essential workers immediately, this is it. If ever there was a statement that defined the urgency of easy to access paid sick leave, this is it. And if ever there was a statement that defined the absurdity of politicians’ repeated directives to “stay home” this is it. 

“Stay-at-home orders only work for people who can stay at home,” says Cressy. And yet, leaders like Ford continue to hammer home the “stay home” message to people who are already complying, or who can’t comply because they have essential jobs. 

On April 7, Ford tweeted the following: “Stay home. Stay safe. Save lives.” On April 10 he tweeted: “Gardening is a great way to enjoy the outdoors while staying at home.” Earlier this year, the premier butchered about a dozen languages asking Ontarians to stay home. 

The problem is that when people have to go to work it doesn’t matter if you ask them nicely in their native tongue not to. 

It doesn’t matter how many empty directives our leaders give. Until vaccines pick up dramatically in Toronto’s inner suburbs and essential workers get paid sick leave that is effective immediately, the cycle will continue. 

The vaccinated will sit safe at home awaiting the contactless delivery of throw pillows. The people who make that life possible will get sick. Contactless delivery is not contactless for everyone. 

Source: https://www.thestar.com/opinion/star-columnists/2021/04/12/doug-fords-stay-home-message-is-absurd-workers-in-the-hardest-hit-areas-cant-stay-home-theyre-essential.html?li_source=LI&li_medium=thestar_recommended_for_you

#COVID-19: Comparing provinces with other countries 14 April Update

The latest charts, compiled 14 April as the third wave has started.

Vaccinations: Overall, Canada and most provinces ahead of or comparable to EU countries.

Trendline charts

Infections per million: Overall steady increase of infections in most provinces with Alberta and Ontario showing steeper increases but still much better than G7 less Canada.

Deaths per million: No major changes.

Vaccinations per million: Significant shift with most Canadian provinces being slightly better than most EU countries.

Weekly

Infections per million: No relative changes.

Deaths per million: Philippines slightly ahead of India

Working from home is here to stay — and for some Canadians, that’s a big problem

Good highlighting of the inequalities between those able to work from home and those not, mainly younger, visible minority or immigrant workers with lower income. Working from home appears to be a good overall proxy for privilege and class:

Working from home has a bright side for a lot of us, and we really hope it will outlast the pandemic.

No morning commute, no mad scramble out the door with packed lunches and wet laundry left in the machine to grow mildew all day, no race at the end of the day to tie up all the loose ends before rushing home to make dinner.

But that’s not the case for everyone, and new research shows working from home over the long term is often far less than ideal for young workers, immigrants, racialized workers and people living with disabilities.

In other words, the very same people who have been at the sharp end of the stick during the pandemic now risk being thrust into a precarious situation yet again in a post-pandemic world where working from home becomes a norm.

We can decide right now not to do that.

The Environics Institute teamed up with the Future Skills Centre and Ryerson University’s Diversity Institute to figure out what the workforce of the future looks like and how COVID-19 has disrupted so much. They surveyed almost 5,400 people across the country on what their work-from-home experience has been like, and they also dug down into how age, race, immigrant history and income make a difference. 

And they do make a difference — both during the pandemic and, if the survey is a good indication, afterwards too.

Generally, those of us who are working from home are content with the way things are going, and hope to be able to continue spending at least a couple of days a week in our home offices when the pandemic winds down.

“There’s no going back,” says Andrew Parkin, executive director of the Environics Institute.

The stigma of working from home from time to time has dissipated now that so many people have shown it can be done without compromising quality, he added, and employers will need to figure out how to incorporate work-from-home arrangements over the long term.

Of course, not everyone has shared in that experience during the pandemic. As we know, it’s been mainly white-collar workers who have been able to set up shop at their kitchen tables. About half of us have been going into the workplace regularly throughout the pandemic, while 36 per cent of us have been able to work from home full time, according to a report published last week by the Canadian Chamber of Commerce and Abacus Data. 

Low-income workers, people of colour and young people have been more likely to have to keep going into their traditional workplaces. They’ve also been most likely to lose their jobs during the pandemic, according to employment data over the past few months. They’ve had a harder time getting back into the workforce. And they’ve also been more likely to be on the front lines of contagion, holding down essential jobs in taking care of the rest of us.

And now, because their jobs are more precarious, they face more uncertainty about how a work-from-home culture that outlasts the pandemic will benefit them. Doing without frequent face time with colleagues, bosses and networks does not sit well with those who have a fragile connection to their workplaces.

“While it’s reassuring to confirm that many workers in Canada have altered their work arrangement in order to minimize the risk of contracting and spreading COVID-19, these survey results serve as an important reminder that the ability to do so is closely tied to one’s socio-economic situation,” states the Environics report obtained by the Star.

Young people, for example, say they like working from home and can maintain the quality of their work there. But they’re also more worried than others that working from home will hurt their career prospects — which are already hurting because the pandemic has knocked their employment levels severely.

The same fear is expressed by first- or second-generation immigrants as well as racialized workers, and they, too, have seen more of their jobs disappear during the pandemic.

On top of that, immigrants and racialized workers also say, more than others, that they aren’t properly equipped to work from home, and they’re worried the quality of their work has deteriorated.

Workers with disabilities are also far more likely to say they don’t have the right equipment to work from home.

The implications for post-pandemic work are far-reaching. Business groups have emphasized the need to make sure workplaces are safe to return to, with whatever personal protective equipment and health measures are needed to assure employees aren’t going to get sick.

But the new research shows it’s a lot more complex than that. Some people won’t want to come back, but at the same time, a full embrace of a work-from-home culture will penalize those who are already facing intimidating barriers to their careers and futures.

“The key word is flexibility,” says Parkin, pointing to a need to rethink office space and work flow to make sure a range of needs are accommodated.

We have a few months left of lockdown, constraint and forced work-from-home conditions before we have more options open to us in the world of work. Let’s use them to ensure the reopening is done carefully, giving a fair opportunity to those workers who have already paid such a steep price.

Source: https://www.thestar.com/politics/political-opinion/2021/04/12/working-from-home-is-here-to-stay-and-for-some-canadians-thats-a-big-problem.html

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

[CDC] Studies Confirm Racial, Ethnic Disparities In COVID-19 Hospitalizations And Visits

More evidence:

Days after declaring racism a serious public health threat, the Centers for Disease Control and Prevention released a pair of studies further quantifying the disproportionate impact of COVID-19 on communities of color.

The studies, published Monday in Morbidity and Mortality Weekly Report, examine trends in racial and ethnic disparities in hospitalizations and emergency room visits associated with COVID-19 in 2020.

CDC Director Rochelle Walensky said at a regular White House COVID-19 Response Team briefing that the new literature underscores the need to prioritize health equity, including in the country’s accelerating vaccine rollout.

“These disparities were not caused by the pandemic, but they were certainly exacerbated by [it],” Walensky said. “The COVID-19 pandemic and its disproportional impact on communities of color is just the most recent and glaring example of health inequities that threaten the health of our nation.”

After assessing administrative discharge data from March to December 2020, the CDC found that the proportion of hospitalized patients with COVID-19 was highest for Hispanic and Latino patients in all four census regions of the U.S.

Racial and ethnic disparities were most pronounced between May and July, it said, and declined over the course of the pandemic as hospitalizations increased among non-Hispanic white people. But such disparities persisted across the country as of December, most notably among Hispanic patients in the West.

The findings build on earlier studies about racial and ethnic disparities in COVID-19 hospitalizations by showing how they shifted over time and between regions.

Researchers point to two driving factors for the disproportionate hospitalizations among these minority groups: a higher risk of exposure to the virus and a higher risk for severe disease. They said differences in exposure risk associated with occupational and housing conditions, as well as socioeconomic status, are likely behind the demographic patterns they observed.

“Identification of the specific social determinants of health (e.g., access to health care, occupation and job conditions, housing instability, and transportation challenges) that contribute to geographic and temporal differences in racial and ethnic disparities in COVID-19 infection and poor health outcomes is critical,” they said, adding that a better understanding of these factors at the local level can help tailor strategies to prevent illness and allocate resources.

The second study examined COVID-19-related emergency department visits in 13 states between October and December, and found similar disparities between racial and ethnic groups.

During that period, Hispanic and American Indian or Alaska Native people were 1.7 times more likely to seek care than white people, and Black individuals 1.4 times more likely.

Researchers noted that these racial and ethnic groups are also impacted by long-standing and systemic inequities that affect their health, such as limited access to quality health care and disproportionate representation in “essential” jobs with less flexibility to take leave or work remotely.

“Racism and discrimination shape these factors that influence health risks; racism, rather than a person’s race or ethnicity, is a key driver of these health inequities,” they explained.

Such inequities can increase the risk of exposure and delayed medical attention, further heightening the risks for severe disease outcomes and the need to seek emergency care.

Looking ahead, researchers said their findings could be used to prioritize vaccines and other resources for disproportionately affected communities in an effort to reduce the need for emergency care. Walensky also emphasized the implications of the new studies on and beyond the country’s pandemic response.

“This information and the ongoing surveillance data we see daily from states across the country underscore the critical need and an important opportunity to address health equity as a core element in all of our public health efforts,” she said.

A renewed push to address such inequity is now underway at the CDC, which late last week declared racism a “serious public health threat that directly affects the well-being of millions of Americans.”

Walensky has directed the agency’s departments to develop interventions and measure health outcomes in the next year. It’s also provided $3 billion to support efforts to expand equity and access to vaccines, in addition to $2.25 billion previously allocated for COVID-19 testing in high-risk and underserved communities. The CDC has also launched a Racism and Health web portal to promote education and dialogue on the subject.

One area of particular focus is making sure the distribution of COVID-19 vaccines across the U.S. reaches the communities that have been hit hardest.

Data so far indicate that Black individuals make up roughly 12% of the country’s population but just 8.4% of those who have received at least one dose, Walensky said. And while 18% of the country identifies as Hispanic or Latino, she said, they make up only 10.7% of those who have been vaccinated.

Officials at Monday’s briefing highlighted further progress in the race to get shots into arms, noting that 120 million Americans have been vaccinated — 46% of adults have had at least one dose and 28% are fully vaccinated. And in exactly one week, all adults will be eligible to sign up for an appointment.

“This means that there has never been a better time than now for seniors and those eligible to get their shots,” said Andy Slavitt, senior advisor on the White House COVID-19 Response Team. “Make an appointment today. And if you have someone in your life, particularly a senior, who has not gotten a shot yet, reach out and see what help they need.”

Source: Studies Confirm Racial, Ethnic Disparities In COVID-19 Hospitalizations And Visits

COVID-19 and essential workers at risk, some examples

Two classic cases, where private companies and weak government regulators have failed to protect workers from COVID-19 (largely immigrants, visible minorities or temporary workers), and the Ontario and Alberta governments only belatedly addressing risk in workplaces through vaccination of workers. Older stories, haven’t seen many updates:

Amazon Brampton Warehouse

An Amazon warehouse that was ordered to shut down last week due to a major COVID-19 outbreak is also being investigated for potential labour violations, the Ontario government said Monday.

A spokesman for the Ministry of Labour said the investigation was already underway when the local public health unit ordered thousands of workers at the Brampton, Ont., facility on Friday to isolate for two weeks,

“We continue to work closely with Peel Public Health and others to provide support, advice and enforcement as needed to ensure the health and safety of Ontario’s workers,” Harry Godfrey said in a statement.

Godfrey noted that penalties for labour violations could be as high as $1.5 million or imprisonment. He said the government would not hesitate to hold employers accountable if they fail to keep their employees safe.

Peel Region’s top doctor said the outbreak at the Amazon facility, which employs approximately 5,000 workers, began in October and has since been linked to more than 600 cases.

Dr. Lawrence Loh said nearly half of the cases were detected in the last few weeks, prompting the public health unit to issue a special order requiring the workers to self-isolate for two weeks starting March 13.

Workers were ordered to isolate until March 27 unless they’ve tested positive for COVID-19 in the last 90 days and have already completed their isolation period for that infection.

Amazon Canada said workers would be paid during the 14-day quarantine, but it disputed the data being used to support the plant closure, pointing to a round of tests that recently came back with a positivity rate of less than one per cent. It has said it plans to appeal the decision.

Peel Public Health said the closure will give the company further time to consider additional operational changes that may help prevent outbreaks in future.

The Ministry of Labour said its inspectors had visited the site 12 times and issued eight orders since March 2020.

Gagandeep Kaur, an organizer with Brampton-based Warehouse Workers Centre that advocates for workers’ rights in the sector, said conditions had been getting worse in the facility for months. She said workers “were kind of surprised” that it took so long for public health to get involved and force the shutdown.

Kaur said people reported that safety precautions like physical distancing have been impossible to maintain inside, especially as workers rushed to meet strict productivity targets.

She said workers are now concerned that they will be asked to push themselves harder once they return from quarantine.

“They are not at home right now enjoying this two week vacation,” Kaur said by phone. “They are more worried that once they are back … management might put higher targets for them to reach.”

Kaur said the pressures of the warehouse workplace, where employees’ time on floor is constantly measured and tracked, created safety issues before the pandemic. Those challenges only increased with the viral threat that also coincided with more hiring, and greater demands as more people relied on the delivery service.

She said the company should use the two-week shutdown to implement changes at the plant such as further separating work stations and reducing performance targets as workers are dealing with the added stress of the pandemic.

“Amazon must use it wisely,” she said of the shutdown. “Maybe implementing those changes inside the facility that will make the work safer so that we don’t end up with this crisis again.”

Last month, labour inspectors carried out a “blitz” operation on the warehouses and distribution centres in Peel Region – a COVID-19 hot spot with a high number of outbreaks in workplaces.

About 200 inspections took place and 26 tickets were issued, according the Ministry of Labour.

Source: https://www.cp24.com/mobile/news/ontario-labour-ministry-investigating-brampton-amazon-site-ordered-to-shut-down-over-outbreak-1.5348106?cache=

Alberta Olymel meat packing

Slaughterhouses. Meat packing. Sick and dead employees. The pandemic has sharpened our vision about a lot of things.

Such as: the workers who are key to making sure Canadians have plenty of steaks, hamburger, and bacon on the menu have become about as disposable as paper plates. This became more than evident over the past month as hundreds of workers in yet another meat packing plant in Alberta became infected with COVID-19.

Three employees have died. The first to die was 35-year-old Darwin Doloque, a recent immigrant from the Philippines who was found dead in his home at the end of January. 

At that point it was clear that infection was spreading among the 1,850 women and men at the Olymel slaughterhouse and pork processing plant in Red Deer. And yet neither government nor public health officials moved to it shut down.

It was only in mid-February after public pressure from the Union of Food and Commercial Workers, which represents the employees, that Olymel management decided to shut down for two weeks. Workers were laid off without pay and advised to apply for Employment Insurance so the government could pick up the bill.

And lest you think Olymel is owned by a U.S. or Brazilian mega-meat packer, it is not. It is a division of Quebec-based Sollio Cooperative Group, Canada’s largest agriculture co-op, which last year reaped $8.1 billion in revenue. Besides being the biggest pork and poultry producer in Canada, Olymel exports to China, Japan, South Korea and Australia.

Most of the workers at the Red Deer plant — midway between Calgary and Edmonton — are recent immigrants, refugees, or temporary foreign workers. They come from Sudan, Guatemala, the Philippines, Mexico, and Dominican Republic and usually don’t speak English. 

It’s the same story at most large slaughterhouses/meat packing plants because it is bloody, back breaking, and dangerous work that only people with limited employment options are willing to take. 

For most of us working at a job site where 45,000 hogs a week are killed is beyond imagination. But that is par for the course at the Olymel plant. Every week, the pigs just keep coming from hog farming operations in Alberta and Saskatchewan, which need to keep those pigs moving if they are to be profitable. They do not want processing plants to close down because it hits them right on the bottom line. 

So workers are pushed to keep working even after a quarter of them have been infected with the coronavirus; even though the majority of those workers have jobs outside the plant and could spread the virus in the larger community.

The COVID-19 outbreak at Olymel and the subsequent inaction on the part of government, public health officials, and plant management could be better understood if we were in the beginning stages of the pandemic and those in charge were still trying to figure out what to do about workplace outbreaks.

But this is hardly the case. In Alberta alone during the past year we have seen serious outbreaks in eight meat packing facilities.

In April, the Cargill plant in High River (owned by a U.S. mega-meat packer) had a total of 950 cases among 2,000 employees, the worst COVID-19 outbreak in Canada. Three people died, dozens were hospitalized. 

In the U.S, 50,000 meat packing workers were infected, and about 250 died. Communities around those facilities had some of the highest infection rates in the country. 

This was all known long before the outbreak at Olymel. The U.S Congress has launched an investigation into how the meat packing industry responded to the pandemic.

In Alberta, both Rachel Notley, leader of the official opposition, and the Alberta Federation of Labour have called for a public inquiry into the Alberta government’s handling of the outbreak at the Olymel plant. 

A public inquiry takes time but given the repeated performance of government agencies and meat packing companies during the pandemic we need to know more about why so many people became infected and died so it won’t happen again. 

In the meantime Olymel is re-opening the Red Deer plant and calling back workers. Bacon anyone?

Source: https://www.thestar.com/opinion/contributors/2021/03/08/alberta-is-still-not-protecting-its-meat-packing-workers.html 

@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

#COVID-19: Comparing provinces with other countries 31 March Update

The latest charts, compiled 7 April as the third wave has started.

Vaccinations: Change from last week: Some Canadian provinces doing slightly better than EU countries. Quebec ahead of France, Ontario ahead of Germany, British Columbia and Canada ahead of Sweden,  Prairies ahead of Alberta.

Trendline charts

Infections per million: Overall steady increase of infections in most provinces but better than G7 less Canada.

Deaths per million: No major changes.

Vaccinations per million: While the gap between G7 and Canada remains, the rate has largely approached other G7 countries. Of note is the increase in vaccination rates of immigration source countries (China and India).

Weekly

Infections per million: Some minor shifts: Alberta ahead of Germany, Canada ahead of Prairies.

Deaths per million: No relative change.

USA: African Immigrant Health Groups Battle A Transatlantic Tide Of Vaccine Disinformation

Of note:

Switching between Swahili and English, Dr. Frank Minja asked the African immigrants on the Zoom call if they had any questions about the COVID-19 vaccine.

Minja, who is originally from Tanzania, was asked how to get the vaccine, how it works, whether it’s safe.

Then one person asked him about a video promoting the conspiracy theory that the vaccine is part of a plot to reduce the Black race.

“That’s the realm of nonsense and misinformation,” he said.

Minja’s Q & A was hosted by the organization, African Family Holistic Health Organization (AFHHO), in Portland, Oregon. It’s one of a number of grassrootsorganizations across the country that are helping Africans in the U.S. get vaccinated.

In the United States, skepticism about the vaccine can be found in all segments of the population, including African Americans. However, efforts to address hesitancy among Black people often overlook African immigrants, who get much of their information from their countries of origin.

Minja has been paying close attention to threads of COVID-19 disinformation coming from Africa.

“We’ve seen the whole gamut of misinformation that basically started with the fact that Africans and people of African ancestry are not susceptible to COVID,” he said in an interview following the Zoom session.

Minja said many African immigrants do not rely on American media as trusted sources of information. Some do not speak English well enough yet. Others are used to getting information from friends and family back home through social media platforms, such as WhatsApp.

Chioma Nnaji, a health worker and community organizer for African immigrants and the wider Black community in Massachusetts, said it’s important to take into account that “certain communities live and operate in two spaces.”

“This is usually applicable to immigrants and refugees where they still have connections to their home countries while they are resettling in a new country,” she added.

A lot of what they hear from back home is helpful, she said. For example, traditional herbal remedies are popular. Minja said those can be useful for treating symptoms of non-severe forms of COVID-19.

However, there’s also quite a bit of misleading information about the vaccine that is spread through these channels, Minja said.

“And a lot of it is really about just planting the seeds of distrust,” he said.

For African immigrants, the distrust is partly rooted in the memory of being exploited by western countries, said Dr. Ifeanyi Nsofor. He’s a global health expert from Nigeria, who has also been battling vaccine misinformation on the continent.

“It’s almost like anything that you say is coming from the white man, people look at it with lots of suspicion, based on that experience of colonialism,” he said.

And that experience did not end with independence. Over the years, global health advocates have accused multinational pharmaceutical firms of using African countries as living laboratories for clinical trials of experimental drugs. In 1996, 11 children died and dozens were left disabled in Nigeria after being given an experimental anti-meningitis drug created by Pfizer — the developer of one of the COVID vaccines.

A year later, the U.S. government was accused sponsoring studies that gave pregnant women in developing countries a placebo during tests of the effectiveness of an antiviral drug for HIV.

And in April 2020, two French doctors sparked outrage when they suggested that a potential treatment for COVID-19 should be tested in Africa. The director of the World Health Organization, Tedros Adhanom Ghebreyesus, condemned the suggestion as a “hangover from a colonial mentality.”

“All this fear comes from a history,” said Haika Mushi, a health worker at AFHHO. She is also originally from Tanzania and moved to the U.S. 12 years ago. She has been helping organize the group’s Zoom calls since the pandemic began.

When the vaccine became available, AFHHO started helping people sign up for appointments. At first, it brought in a white doctor to answer questions, and people were still skeptical. She says the group had more success when it brought in Minja and a doctor from Zimbabwe. They also have translators speaking French, Swahili and Tigrinya.

“It makes sense to hear from our own,” she said.

Another type of disinformation that is being spread, according to Nnaji, is that immigration status affects a person’s ability to get the vaccine. She says that is why community-based organizations who can help people sign up for vaccinations, such as AFHHO, are so important.

AFHHO hopes that its sessions will also help curb disinformation in the countries of origin, too.

“We feel like if the people here are well enough educated about the vaccine, they will be able to educate our families back home — our friends, neighbors back home,” Mushi said.

Source: African Immigrant Health Groups Battle A Transatlantic Tide Of Vaccine Disinformation