HARDING: Urgent need for Integrated Federal Strategy

[Oscar]

Our Patchwork of Provincial Pandemic Scenarios Shows Urgent Need for an Integrated Federal Strategy

By Jim Harding, Ph. D. April 12, 2020

Finally, we have provincial scenarios.

Saskatchewan Health Authority (SHA) assumes 15% to 40% will get infected. But why is their lowest estimate of 3,075 people dying, within our small population, so close to China’s total? And why was their lowest estimate higher than from provinces with larger populations?

Why did the Public Health Agency national scenario have a low estimate of 11,000 deaths for all Canada?

There is lots of room for public confusion.

By World Health Day (April 7th), 5% of those diagnosed globally had died. It was over 10% for Italy and Spain but only over 1% for Germany. U.S. was 3%, and Canada 2%, the figure SHA uses.

These seemingly small differences make a huge difference in lives lost or saved. We should know why death rates are so variable; Ontario so far at nearly 4%, B.C. above 3%, while Quebec is above 1%.

SHA modelling is vague, with no prediction for peaking or timeframe for social distancing. SHA claims it can’t be specific because the disease “progression here is behind” other places. Actually, this lag is what enables more effective strategies. This also requires federally-coordinated leadership.

70% of our 271 cases to date were in Saskatoon and north. What is the specific strategy to stop transmission so that feared surges don’t occur? What’s the plan for at-risk Indigenous communities?

SHA’s “key strategies” are increasing testing to identify cases early and allow contact tracing. We know from abroad that this is vital, but it must be aggressive, including early intervention with communities, and with vulnerable patients, to avert serious symptoms that will stress emergency care.

Our testing rate of 1,000 per 100,000 by April 3rd, was second highest, after Alberta. BC and Quebec were similar, but Ontario was lower (445). We need standardized practices everywhere.

However, testing criteria still vary widely. Saskatchewan tests travellers, contacts of infected, respiratory patients and healthcare workers, but not yet long-term care patients, other essential workers, clusters and the asymptomatic, which would enable quicker quelling of the virus. Some provinces rolled back testing because they lack capacity.

The high number of active cases involving “events” suggests that social distancing is being ignored. 400 calls re public health violations is not a good sign. Obtaining compliance may be more challenging because libertarian de-regulation has been politically promoted here for so long. Any enforcement must go hand in hand with aggressive testing, tracing and monitoring to stop transmission. However, a Pan-Canadian strategy is still lacking.

We did not get into this fix by accident. Hospital and acute care beds per capita sharply declined since the 1970s. In 2018 Canada was near the bottom for ICU beds among OECD countries; only 1.95 per 1,000, lower than the U.S., and far below Germany (6.02). We are left desperately trying to expand ICU spaces, by ten times, to 950, says the SHA. But unless we successfully flatten the curve, there still could be deadly shortfalls.

Ill prepared, we gravitated towards crisis-management to plan care for the seriously ill and protect health workers. We have scurried around for PPE. After SARS, Canada maintained a large inventory, but once expired, it was not replaced.

We are slow to respond. We knew over a month ago from Seattle that having care workers going to other workplaces spread the disease. BC finally acted. With its high deaths among elderly in care, why didn’t Ontario act quickly? And Saskatchewan?

Contrast this with Germany’s federalism. States there had authority and capacity to test, and the federal government immediately coordinated. Widespread testing could isolate and contain the spread and direct early intervention. The average age of the cases in Germany was 49, compared to 62 in Italy.

Canadians' health was not at the top of our leaders’ minds when this pandemic hit. The “health” of the economy was of greatest concern. Popular culture was fixated on Trump’s tweets. Yet two months before Covid-19, the WHO and World Bank issued a joint pandemic warning. Leaders didn’t listen and act any more than they have about the climate crisis. Now look at the “health” of the economy.

We will learn some hard lessons, but we still face big choices. The feds are working hard on a Pan-Canadian aid and recovery plan. Will they please also quickly help devise an effective testing and containment strategy to complement the impact of social isolation and lessen the burdens to come?

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Jim Harding is a retired professor of environmental and justice studies. He is a founding director of the Qu’Appelle Valley Environmental Association (go to: QVEA.CA). He was director of research for Sask Health’s Alcoholism Commission and for the University of Regina’s Prairie Justice Research Consortium.
306-332-4492
Other articles on the pandemic at: crowsnestecology.wordpress.com