A new series published in the British Medical Journal (BMJ) calls for an independent investigation into Canada’s response to COVID-19.
Experts from 13 organizations across Canada, including doctors, nurses, researchers, legal and humanitarian specialists, as well as Jocalyn Clark, a Canadian who is the international editor of the BMJ, wrote the seven articles published Monday.
“We see this as the next stage of the pandemic,” says DD Sharon Straus, Chief Medical Officer at St. Michael’s Hospital in Toronto and one of the lead authors of the “Accountability for Canada’s COVID-19 Response” series.
“This is the start of preparing for the next health emergency,” she adds.
The articles identify gaps in Canada’s response to COVID-19, including difficulty reaching vulnerable and marginalized populations who were most at risk, catastrophic deaths in long-term care homes, and inconsistent public health messaging across provinces and territories.
The articles also acknowledge Canada’s pandemic management successes, including a vaccination rate of over 80%.
“An assessment, two years into the pandemic, found the country had a lower burden of COVID-related cases and deaths and higher vaccination coverage than most other G10 countries,” the authors point out in a BMJ editorial summarizing their findings.
“But this overall impression of adequacy masks significant inequalities depending on the region, the environment and the demography”, they then qualify.
A series of articles previously published in the BMJ on the UK’s response to COVID-19 helped enrich an investigation in that country, said the DD Straus, so the authors hope the same will happen in Canada.
Essential workers and marginalized communities
It’s important to look closely at who really carried ‘the burden of the pandemic’, says DD Strauss. These people included essential workers with low wages and living in disadvantaged neighborhoods, she said.
One of the learnings that the DD Straus hopes to learn from a survey of Canada’s response to COVID-19 is how critical it is to “build relationships with communities most likely to be implicated in these health inequities before the next health emergency occurs.”
These relationships can help ensure that marginalized communities are included in research and that their needs are prioritized in public health outreach, she said.
Failure of long-term care
An investigation is needed to secure “accountability for losses,” which number 53,000 deaths in Canada — many of them in specialized long-term care facilities, the authors say.
“It is shameful that Canada tops wealthy nations for COVID-related deaths in aged care homes, despite more than 100 reports of a crisis in nursing homes,” they write.
These reports identified issues such as chronic underfunding of long-term care and a lack of sufficient support for staff, elaborates the DD Strauss.
Some provincial governments are already rolling back some of the measures they have put in place to bolster long-term care, she said, including sickness benefits for staff.
The DD Straus also noted that it’s important to ensure that long-term care homes don’t use four-bed rooms where COVID-19 and other illnesses can easily spread.
“We have a responsibility to those who have passed away to make sure we do better with them…so this doesn’t happen again. We don’t want to risk the lives of more older adults and those who care for them,” adds the doctor.
Regional disparities and lack of personnel
A national inquiry should also include recommendations to “reform Canada’s health and public health systems, which were struggling before the pandemic and are currently on life support,” the authors allege.
COVID-19 has resulted in “an exodus of exhausted and distressed health care workers,” they add, noting that Canada is grappling with a “critical and continuing labor shortage.”
Canada’s decentralized health system, with provinces and territories responsible for their own public health responses, has contributed to inconsistent messaging and guidance on COVID-19 across the country, according to “BMJ” articles.
The Public Health Agency of Canada develops “national clinical and public health guidelines”, but it “does not have the power to order provincial and territorial health agencies or other organizations with similar mandates to implement its recommendations”, raise the texts.
“Each province and territory has designed its own interventions and timelines for protective measures such as school closures, border controls and closures, bans on gatherings and mask-wearing requirements, which has resulted in substantial variation in policies and practices across the country, widely varying hospital admission rates and public confusion,” it says.
A key lesson to be learned from this, says DD Straus, is the need to be “explicit and transparent” about why there are different approaches in different regions.
Not being transparent about why public health decisions are made leads to “mistrust”, she believes.
Examining what went right and what went wrong in Canada’s response to COVID-19 through independent investigation is “essential”, say the authors.
“Not looking at the past will guarantee an unchanged future. Undoubtedly, lessons can be learned to inform new health investments and preparedness, and much learning comes from decisions and actions that failed or did not succeed,” they write.
When asked to respond to the call for a national inquiry and questions raised by the “BMJ” series, Guillaume Bertrand, press secretary to federal health minister Jean-Yves Duclos, said in an email that his department was “committed to a review of the response to COVID-19 in order to take stock of lessons learned and better inform preparations for and responses to future health emergencies.”