Ford attacks, Ontario Nurses' Association supports Auditor General's pandemic report
Ontario Premier Doug Ford tells Auditor General Lysyk to "Stick with the job that we hired you for. Don’t pretend you’re a health professional." But one group of health professionals says it "strongly supports" her findings.
Ontario's Auditor General, Bonnie Lysyk at the November 25 press conference.
Ontario's Auditor General, Bonnie Lysyk, released a scathing report today (November 25) which says that the "province's response to COVID-19 in the winter and spring of 2020 was slower and more reactive relative to other provinces." Lysyk says this was entirely avoidable and was a result in part of the fact that "Ontario failed to act on key lessons identified after the 2003 SARS outbreak that had not been implemented."
After the report's release Ontario's Health Minister Christine Elliott "said the report is "a disappointment, and in many respects a mischaracterization of the province's pandemic response."
Premier Doug Ford went much further and in a press conference that amounted to an extended temper tantrum fired back at Lysyk:
There’s a problem when an accountant is giving health advice. If there’s financial issues, I’ll answer the questions but to sit in the office and throw hand grenades at the Chief Medical Officer and the Health Minister is not right. Stick with the job that we hired you for. Don’t pretend you’re a health professional.
One group of health professionals, however, is backing the report. The Ontario Nurses' Association (ONA) says that it "strongly supports the findings" and "urges immediate changes be implemented." The ONA represents "more than 68,000 registered nurses and health-care professionals, as well as 18,000 nursing student affiliates".
The report's damning findings are that:
Ontario's command structure evolved to become overly cumbersome, and it was not dominated by public health expertise. The Chief Medical Officer of Health and other public health officials did not lead Ontario's response to COVID-19. Ontario's COVID-19 response structure included a Health Command Table that took on an increasingly complex structure during the pandemic and had grown from 21 members to 83 participants by August. For months, all communications were by teleconference, which created confusion. It was not until July 14 that meetings began to be held by videoconference, meetings were not held in person, and there is no fulsome documentation of the discussions that took place. In total, more than 500 people are now involved in the Health Command Table.
Given the significant changeover in leadership in Ontario's Provincial Emergency Management Office (EMO), outdated emergency plans and the lack of sufficient staff, the province was not in a good position to implement the provincial response structure in its provincial emergency response plan when the province declared an emergency on March 17, 2020. It responded by hiring an external consultant to create a new governance structure, based on the belief that there was a need to create a whole-of-government approach. This approach took time, with a Central Co-ordination Table being established that held its first meeting almost a month into the emergency, on April 11, 2020. In contrast to Ontario, other provinces activated their existing response structures and emergency plans. As well, we found that when we completed our work, the EMO had still not undertaken detailed planning or worked with municipalities to plan for subsequent waves of the pandemic.
We found that key lessons identified in the aftermath of the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 had not been implemented by the time COVID-19 hit Ontario, and were not followed during Ontario's COVID-19 response. For example, the SARS Commission's final report identified the precautionary principle—taking preventative measures to protect the public's health even in the absence of complete information and scientific certainty—as the most important lesson of SARS. Following this principle means taking decisive action early. This is not what we saw in our audit work; instead, we saw delays and confusion in decision-making.
The Chief Medical Officer of Health did not fully exercise his powers under the Health Protection and Promotion Act to respond to COVID-19. He did not issue directives to local Medical Officers of Health to ensure public health units responded consistently to the COVID-19 pandemic, nor did he issue directives on their behalf. In May 2020, 34 local Medical Officers of Health jointly prepared and signed a document stating there needed to be more direction and regional consistency. For instance, it was the province, not the Chief Medical Officer, that finally issued an emergency order in early October 2020 to require masking for the general public.
Public Health Ontario played a diminished role in the overall provincial response, and even regional response structures were generally not led by public health experts. Some tasks that typically would have been Public Health Ontario's responsibility were done by Ontario Health instead, such as reporting provincial surveillance data to the Health Command Table and co-ordinating provincial laboratory testing for COVID-19. Local Medical Officers of Health informed us that they were confused by provincial politicians delivering critical public health advice in place of the Chief Medical Officer of Health.
Variations in management and operations among public health units contributed to fragmentation and inconsistencies across Ontario. Public health in other jurisdictions, such as British Columbia, Alberta and Quebec, is more simply organized. Public health reform recommended about 15 years ago by the SARS Commission had not been fully acted on. As of the writing of this report, Ontario's 34 public health units were still operating independently, and best practices were still often not being shared.
The Ministry of the Solicitor General did not implement our recommendations from three years ago to regularly update and finalize its emergency response plans. As well, the Ministry of Health had not acted on recommendations in our 2003, 2007, 2014 and 2017 audits to address the weaknesses in public health lab and information systems. This had negatively impacted the work of public health units during COVID-19. Information systems now in use have limited functionality for case management and contact tracing. Also, the Ministry of Health did not make the improvements needed in its fragmented management of the laboratory sector. Laboratory testing still follows a substantially manual, paper-based process, and the laboratory information system is not integrated with the public health information system.
Ontario did not contact all travellers entering the province due to a lack of dedicated resources and the inability to receive accurate, complete and timely information from the federal government. Between April and August 2020, about 2.5 million international travellers entered Ontario. Approximately 9%, or 233,000, of them were reported to Ontario.
In a press release today ONA President Vicki McKenna wholeheartedly endorsed the report saying that Ontario needs "our public health officials to have the ability to do what they do best – keep Ontarians safe – without political interference."
She also says:
The report released today is perceptive and on-target. As the union representing more than 68,000 registered nurses and health-care professionals, ONA has tried to provide our expertise and experience to decision makers before, during and throughout the pandemic with varying degrees of success.
As RNs, we experienced the reality of SARS and warned government early about the need for proper protective equipment, appropriate infection prevention and control measures for long-term care and congregate settings. ONA has made every effort to ensure Ontario avoided repeating the mistakes of SARS. Unfortunately, much of our advice has not been acted on – and when it was, it was not acted on quickly enough.
Government did not heed the lessons from SARS, and we find ourselves today in a serious second wave of the pandemic and with thousands infected. Cuts to public health units also contributed to challenges in slowing the spread of COVID-19.
The Office of the Auditor General says it "is now working on a second Special Report on Ontario's response to COVID-19. It will look at: management of health-related COVID-19 expenditures; personal protective equipment; and long-term-care issues."
It seems unlikely that Ford is looking forward to its conclusions.