Curiosity and Concern
The call for Canadian COVID inquiries grows louder
Tom Thomas, a continuing care aid at the Saskatchewan Hospital of North Battleford is “remembered as an active member of his church and a caring father and husband.” He was the first Saskatchewan health care worker to succumb to COVID-19.
Originally from Louisiana, Warren Montgomery started the popular Big Easy Kitchen in Regina and is remembered as a big man with a big personality. He died in the ICU at Regina General Hospital in 2021.
In Moose Jaw, the teaching community mourned the passing of educational assistant Terry Carriere left behind a young family when she died at the age of 49.
These are some of the stories collected on the Remember Lives Not Numbers memorial website established by researchers at the University of Saskatchewan. One of the project leads, History professor Dr. Erika Dyck, told the CBC this week that "Living through this moment, it is really tempting to just put it in the rearview mirror and think about building things forward. That's really important and we need to do that, but we need to do that with an eye to what has happened and really who suffered the greatest during this period.”
A Larger Scale is not a COVID newsletter. I will be exploring a broad range of topics, mostly but not exclusively related to health and politics. That said, there are few more tangible examples of how political choices affect health outcomes than what we’ve been through with the COVID-19 pandemic. I understand the fatigue with the topic, we all want to be done with this stressful, divisive and frightening period in our lives, but it would be madness to just shrug and move on without trying to learn from the experience. That’s why I’ve written A Healthy Future to try and dig into our recent past to find direction for the years ahead, and why I hope you’ll indulge the occasional revisiting of the topic.
Canada’s COVID response scrutinized
Two things happened this week that brought COVID back in the news. Saskatchewan learned that we had passed 2000 official COVID deaths, the sort of mathematical milestone that tends to prompt a review article. In this case, reminding us that, while we have passed the global health emergency phase of the pandemic, COVID is still with us as an endemic pathogen, still putting people in hospital and still taking lives.
This updated count also reminds us that 2000 is only the official tally. The COVID-19 Resources Canada group, co-founded by Drs. Guillaume Bourque and Tara Moriarty, maintains an Excess Mortality Tracker. Using publicly reported mortality statistics, they calculate how many more people have died since the beginning of the pandemic compared to an average pre-pandemic year. 88, 803 more people died in Canada between January, 2023 and May, 2023 than would otherwise have been expected. Controlling for reported deaths from COVID-19, as well as deaths from suicide, toxic drugs, mass homicide events and natural disasters, we are left with 33, 246 unexplained excess deaths. In the absence of any other explanation, a large percentage of these excess deaths can be attributed to the pandemic.
In Saskatchewan, the unexplained deaths in that period total 2557, the highest age-adjusted excess mortality in the country. This means that the real Saskatchewan COVID death toll could be as much as twice the official statistic. Sadly, this has provoked no concern or even curiosity by provincial leadership, but rather attempts by the premier to discredit Moriarty and her work.
The other reason to revisit our pandemic learnings this week is the publication of a series of seven articles in the influential British Medical Journal reviewing Canada’s national response to the pandemic. One of the key findings is that there was not a national response, per se. While we might be able to describe how New Zealand or Peru or Vietnam responded to the pandemic, it is much harder to say what Canada did. The decentralized health system, while it allows for local control and expertise, also results in vastly different approaches and outcomes in different provinces and territories. We saw major regional differences in the collection and distribution of public health data, the use of preventative measures, the promotion of vaccines and the provision of testing and treatment. And, from jurisdiction to jurisdiction and wave to wave, vastly different results in the numbers of people who became ill with and died from COVID-19.
This inconsistency was not new, as the BMJ article reminded us. Dr. David Naylor, chaired the National Advisory Committee on SARS and Public Health that reviewed the response to the 2003 SARS epidemic and led to the creation of the Public Health Agency of Canada In his report, he described “squabbling among jurisdictions, dysfunctional relationships among public health officials from the three levels of government (federal, provincial/territorial, and municipal), an inability to collect and share epidemiological data, and ineffective leadership” – which, taken together, held hostage the health of Canadians.” It’s hard not to see that description of dysfunction continuing to apply nearly two decades later.
While Canada fared better than the UK and the US in terms of illness and death, many countries did far better and there were major failings that cannot be ignored. The article title predictable crisis described how, despite years of warnings and reports on the inadequacy and danger of Canadian long-term care, inaction across the country led to the highest proportion of deaths in long-term care in the world. In the words of Canada’s Chief Medical Health Officer, Dr. Theresa Tam, “we failed the most vulnerable.”
That failing extended beyond our borders into Canada’s role at the world stage. At A Larger Scale, we are exploring a broader view of health and justice, one that looks at our place in our local communities and in the world. This is where the BMJ series is truly devastating, examining Canada’s role in COVID-19 global vaccine equity failures and concluding that “Canada hoarded vaccines during the most critical phase of the pandemic, while not supporting measures intended to increase global supply.” Obtaining adequate supplies to vaccinate Canadians was more than a political imperative, it was an important part of the public health response. However, Canada over-procured by tens of millions of doses and a large percentage of these doses expired rather than being distributed to countries in need. People deserve to share in the world’s advances in medical treatment, no matter where they live. And a world where they are not is a world where there is more conflict, more immigration of desperation, and more transmission of infectious diseases that are not limited by borders. This was seen in real time during the COVID-19 pandemic, as the failure to control transmission led to the development of new variants that would escape the protections in place in wealthy countries. A world where the best of what was available was shared more equitably may have been one where we saw a shorter and less virulent course of COVID.
A call to be curious
The BMJ series proposed a number of important measures worthy of deeper examination, including improving LTC care through support for care workers and increased hours of support per resident and the development of greater public capacity for vaccine production. The central argument is that the world expected more from Canada and there is a need for a national public inquiry into the country’s pandemic response.
Because of that previously described decentralization, that inquiry also needs to examine provincial responses, or separate inquires need to take place in each province. When I was in opposition in Saskatchewan, we called for an independent inquiry into the Saskatchewan response. Regina Leader-Post editor Russell Wangersky wrote at the time: “Sadly, a forward-looking government probably would have recognized the clear value of such a process and started a COVID inquiry on its own. But, because the provincial NDP suggested it, the inquiry baby is likely to be tossed out with the political bathwater.” That appears to have been exactly what happened, and not only in Saskatchewan.
Federal health minister Jean-Yves Duclos had indicated that a “broad review on Canada’s pandemic response is coming” but as of yesterday he is no longer in the post and we have not seen movement in that direction thus far. Dr. Naylor, author of the SARS report, has called for a national post-pandemic review led by international experts that includes an examination of federal and provincial gaps. At the provincial level, only British Columbia has completed a “lessons learned” review. Danielle Smith’s Alberta, has gone a different direction, naming Preston Manning, who had already authored a fictional review of Canada’s COVID response heavy on discredited theories, to lead that province’s COVID review commission. This highlights another reason why independent reviews are so important. Those who are serious about improving public health and responses to future pandemics, who want to see Canada do better, must lead the way. If not, others will continue to malign public health experts and align with those who wish we had done worse. The lesson is clear, if want a healthy future we have to resist the natural urge to move on and be curious enough to learn from the past.
Smaller Notes
Given his work came up in today’s article, I thought I’d share Dr. David Naylor’s endorsement of A Healthy Future. It’s an honour to have words of support for the book from people whose work and leadership I admire, and I’ll be sharing more of those in upcoming posts.
“A Healthy Future is at once a pandemic narrative and a rich tapestry of observations. Drawing on insights from his vantage points as Saskatchewan Opposition Leader, family doctor, spouse of a busy pediatrician, and father of two young sons, Ryan Meili's engrossing account of COVID-19 in Canada reveals important lessons for our country’s future.”
David Naylor MD, Professor of Medicine, University of Toronto.
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