From the start of the pandemic, the provincial government took decisions for political reasons, not medical ones. It continues to do so. It is clear that the provincial government has maintained very tight restrictions on the public far longer than necessary and that far more extensive efforts to control the public since 30 April are not based on evidence and medical necessity.
This is fundamental mismanagement that is harming the province and its people.
The root of the problem is the political divisions in cabinet. The prospect of a new Premier to replace Dwight Ball brings with it the chance to sort out the problems and get the province ready to deal with COVID-19 for as long as necessary.
The current situation is unconscionable.
Whatever it takes
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| The government's own advisors give evidence that contradicts government's decision. |
The Chief
Medical Officer disclosed the first case of COVID-19 detected in Newfoundland
and Labrador on 14 March.
The woman had recently returned from a cruise in the Caribbean. Public health officials had tested 114 people
half of whom had tested negative for the disease. They and another eight besides were
quarantined at home as a precaution.
The
government’s first action attributed to COVID-19 came two days later.
At a news conference, Premier Dwight Ball, health
minister John Haggie, education minister Brian Warr, and chief medical officer
Dr. Janice Fitzgerald sat literally shoulder to shoulder behind a long desk.
We are “in
uncharted waters” Ball told reporters.
Effective immediately,
Ball and Warr announced, they had closed the province’s schools and daycares as
well as College of the North Atlantic.
The move sent 74,000 children home along with thousands of adults across
the province from the post-secondary college.
Haggie told
reporters that effective immediately, the province’s health system had stopped
all elective, diagnostic and surgical procedures.
Ball said
that public servants were also going to work from home, effective immediately.
“We will do
whatever it takes, when necessary, to ensure your safety,” Ball said.
Asked about
the impact of public cries to close schools as other provinces had done, Ball
said "You always listen to people. We want to do what's best."
Ball and his
ministers made the decisions to close schools, hospitals, and the provincial
government that Monday morning. There
was a single case of COVID-19 in the province.
None of
these measures apparently came at the direction or suggestion of the Chief
Medical Officer. Haggie would take
another two days to declare a public health emergency. He did so, under provincial law, on the advice
of the chief medical officer. The move
gave the CMO and regional medical officers of health across the province
sweeping powers to contain outbreaks of infectious diseases.
Most likely,
Fitzgerald, didn’t advise such a massive shutdown based on a single case. The three ministers involved seem to have been
affected by reports from outside Newfoundland and Labrador rather than what
they faced or were likely to face.
Mitigation
We can say
it is unlikely that the CMO advised to close schools because there is a large collection of studies that deal with closing
schools during public health emergencies. Experience in other places highlight
the concerns about the economic impact as well as the impact on the health care
system as families struggle to arrange for child-care while maintaining essential
services. Closing schools is something
you do at the right time, when children are threatened directly by the disease
involved, or when there is a widespread community outbreak. What Dwight Ball
and Brian Warr announced that Monday flew in the face of all that expert
advice.
A pandemic
was not “uncharted waters” at all for the provincial government. Public health
officials – plugged into a national network of colleagues - had been aware of
COVID-19 since the beginning of the year.
Haggie signed an order in February - almost three weeks before the first
case turned up in Newfoundland and Labrador - that amended the infectious
disease regulations to include COVID-19.
The
government’s pandemic plan dated from 2007.
As with the Canadian plan, which the local plan mirrored, the provincial
government would mitigate an outbreak for which there was no cure or vaccine. Rather
than let the disease run wild, overload the health system, and kill potentially
thousands in a single maelstrom, health officials would identify and contain
infections, applying broader measures as needed to control the impact on health
care and on deaths. The phrase “flatten
the curve” describes the idea of holding down the number of infections to a
manageable level. That was the strategy.
The strategy
is widely known among public health experts globally. A paper by the Imperial
College, London, released on 16 March, applied the well-known strategic
options to COVID-19. It was clear that the measures taken quickly by a couple
of cabinet ministers and the Premier in a quick meeting on Monday morning, a
couple of days after finding a single case in the province, was considerably more
than an over-reaction. They abandoned the government’s plan.
Even with
the public health emergency – declared on 18 March – the government’s response
to COVID-19 remained disconnected from evidence. A hastily-drafted special measure order
issued on 20 March effectively cut off food, medical supplies, and fuel to the
province and would have shut down the economy.
An amendment the next day exempted enough categories of travellers to
keep the province going but preserved the important public health measure that required
other travelers to quarantine themselves for 14 days after arrival.
That part
was important because, as Haggie has noted earlier in the week, the disease was
entering the province from outside.
National and international restrictions on movement to deal with far
greater outbreaks outside Newfoundland and Labrador limited travel to all but
what was essential, anyway. The
requirement to quarantine on entry for 14 effectively contained any likely new
disease from entering the province.
Combined with identification of outbreaks, and isolation of those
already in the province, public health officials had in place the means they needed
to control the disease.
They had
also dodged a huge bullet that affected other provinces. March is normally a
time for Canadians to flock to the southern United States for a couple of
week’s break from winter. When they
flooded back to Ontario, Quebec, and Alberta in the middle of March 2020, they
brought with them disease they had acquired on the beaches and in the bars from
Florida, along the Gulf coast, all the way to California.
But in
Newfoundland and Labrador, spring break 2020 wouldn’t come until April, because
schools still tie their calendar to major religious holidays as they did in the
days when seven Christian sects controlled them. As a result, there were far fewer likely sources
of disease in Newfoundland and Labrador that came flooding back to the province
between the Monday that government closed down and the Friday of the travel
quarantine order. By the end of the
week, the flow was a trickle and it stayed a trickle afterward.
Piling on restrictions
Given that
COVID-19 takes about a week, on average, to incubate and appear, it’s not
surprising that the largest daily number of cases started turning up a week
after the travelers started coming back.
On 23 March, public health officials reported 15 new cases.
In the
afternoon briefing on 23 March, the CMO announced extensive restrictions on the
public. Fitzgerald closed retail stores,
except for a handful deemed essential. She shut gyms, tennis courts,
restaurants’ dining rooms, bingo halls, hair salons, and dog grooming
shops. Gatherings of more than 10 people
were banned, and funerals and weddings were limited to no more than 10 people.
The next
day, the CMO closed health care outside hospitals except for physician or nurse
practitioner clinics.
On 25 March,
the CMO reported her officials had confirmed 32 new cases. That was the peak of new cases. A week later,
the CMO banned funerals, visitations, and wakes and limited gatherings –
including weddings and burials – to a maximum of five people. She also closed
campsites and municipal and provincial parks and banned the sale of scratch
tickets – but no other such gambling – in corner stores.
What’s
remarkable about the week of added restrictions is that they were obviously
disconnected from the number of active cases.
Sure, they were accumulating, but the rate at which they grew was
already waning. Analysis by the
province’s COVID advisory team subsequently confirmed what the numbers
themselves showed as they were being released daily.
The expert
advisors pegged 25 March – just two days after the CMOs sweeping restrictions –
as the peak of the infections. They
assessed the rate of transmission after that date as well less than the level
public health officials would be worried about.
The disease was under control and on the decline.
There’s no
way that the CMO’s restrictions on 23 March halted the growth of infections in
two days when the disease takes at least three times that to ripen, on average
and make someone sick. The bulk of the
cases that turned up the week of 23 March and the following week came from a
single traveler who had attended two wake’s at a local funeral home between 15
and 17 March. The cluster from that
single traveler would eventually account for 70% of the cases identified in the
initial wave of COVID-19 in Newfoundland and Labrador.
Public
health officials found them through contract tracing and with a general order,
issued on 25 March for people connected to the funeral home outbreak to
self-isolate. That’s what worked. Closing parks and dog grooming salons,
preventing people from getting scratch tickets or seeing a chiropractor didn’t
do anything anyone could detect to affect the trajectory of COVID-19 in
Newfoundland and Labrador. Basic public health measures coupled with some good
luck did the job.
By early
April, it was clear the disease was declining.
The peak number of active cases came on 06 April. Five days earlier, the number of cases in
hospital had peaked at 15 before starting to decline.
Haggie’s order to shut the health system in
the province to all but emergencies – taken when there was only a single case
identified – kept half the province’s hospital beds vacant and prevented tens
of thousands of people from getting treatment. A system that on some days went
well over 100% capacity for necessary care shrank to less than half capacity
but it was never in danger of being overwhelmed by COVID-19.
Regardless of what the numbers say
The Premier
and other officials insist their decisions came from evidence and science, but the
evidence says otherwise. The pattern of
making decisions without evidence continued at the end of April with the
decision to lessen some of the restrictions.
Reporters
started asking about the possibility of easing restrictions the week before
Easter. They did so partly because other
provinces had started talking of similar moves and partly because a fairly
simple assessment of trends in the province pointed to a steady decline in new
cases. By the end of April, as SRBP noted on 13 April, the government would likely
face a situation of having virtually no new cases every day. That’s what
happened.
The three
officials in the daily briefing dismissed such talk out of hand. They used phrases like “a few days of low
numbers” to insist that the province needed to stay under restrictions that
were more in line with the number of cases, the outbreaks in long-term care
facilities, and with pressure on health care in Ontario and Quebec.
CBC’s Peter
Cowan asked on 13 April about the constant talk of a surge
in cases even though local cases were declining. Haggie in particular justified current high
levels of restriction on the need to avoid a surge. ‘The facts of the case” Haggie replied, using
one of his pet phrases even though what he frequently stated wasn’t
factual.
Continued
restrictions kept the virus from spreading, Haggie said, because it was in the
community. “Regardless of what the
numbers show,” Haggie said, “we cannot relax physical distancing. The only
question in my mind is whether we need to be even more strict or even more
restrictive.”
The average
number of new cases reported each day that week would be less than two. Over
the next month, the daily briefing reported more days with zero cases than
not. From the first week of May onward,
Haggie’s own advisors would assess the rate of transmission at zero.
Looser and tighter at the same time
Another two
weeks of constant questioning pushed Ball and Haggie to have Fitzgerald draft a
plan to lower restrictions. She
announced on 30 April that restrictions would change on 11 May, followed by
further changes 28 days later.
Fitzgerald’s plan assumed the restrictions in place on 30 April were the
highest level. While she insisted the entire
scheme was based on evidence, Fitzgerald could not and still has not been able
to explain the reason for using fixed dates for making changes or what triggers
would cause an increase or decrease in the so-called alert level. She has also rejected any changes to the
timing in the plan, although there is no explanation for why given the disease
simply doesn’t exist in the province any longer.
The trigger
dates are bureaucratic, selected to give time for government officials to put
in place a bewildering level of added restrictions on residents. The first date
was Monday, 11 May, two weeks after Fitzgerald unveiled the plan. The next was a Monday 28 days later.
Officially, the 28 days was two incubation periods but the facts of the case –
easily discerned by the lack of evidence in favour of the dates – suggest that someone
chose the date arbitrarily because it was a Monday. Four working weeks gave officials plenty of
time to sort out restrictions on everything from hair salons and spas to
tennis.
The mitigation
strategy described by the Imperial College and others isn’t tied to dates but
to rates of hospitalization, impact on the health system, and number of deaths.
Specific points on the calendar are no
marker. That shouldn’t be very hard to figure out. Experts
in the United
Kingdom are warning that the country’s plan to lower COVID restrictions
ignores the risk of the disease, which is still widely active. Use the indicators about the spread of the
disease and risk, they say, and lower the restrictions when the risk is lower.
The UK government’s official Scientific Advisory Group for Emergencies
(SAGE) said in early
May that the government should lower restrictions when
the number of new cases had dropped, instead of setting a fixed date. The political
origin of the plan in Newfoundland and Labrador should be plain in comparison.
There are other examples that decisions are not guided
by evidence. The day before she unveiled her scheme, Fitzgerald closed the
province to non-residents, except for essential workers. The order came after a day of unfounded
claims from one part of the province that tourists were in the province. There was no evidence the tourists existed or
that they had violated any of Fitzgerald’s public health orders. Rumour and speculation, which Haggie readily
accepted, was apparently more important than evidence.
The provincial government also passed an amendment to
the public health law that allowed the minister of justice to send police to
detain anyone accused of breaking one of Fitzgerald’s special measures orders. There has never been an explanation of why
government needed the power of arbitrary detention given that there were
enforcement measures already in the public health protection law.
As with the other government COVID-19 decisions,
Fitzgerald’s travel ban was also subject to amendment based on something other
than evidence. She amended the order in a deal with opposition leader Ches
Crosbie who, according to Crosbie’s account, agreed to support the
unconstitutional detention powers as part of the bargain.
That wasn’t the last of it. The amended list of
exemptions to the travel ban included returning to care for elderly
parents. Two people were denied entry to
attend the funeral of a parent who had died. That option wasn’t on the
list. In both cases, publicity of the
two rejections prompted Fitzgerald to grant hasty approval to both women to
attend separate funerals.
Last week, again in apparent response to public
criticism of the delay in lowering restrictions again, Fitzgerald unexpectedly
announced a change to her guidance on social distancing. As with the initial announcement of the
restrictions scheme, Fitzgerald said the public could expand the size of their
personal “bubble” in advance of the official start of the next phase. The bubble concept is nonsense, anyway but
even in the provincial government’s decision-based evidence-making scheme,
there’s no rationale for deviating from the scheme by expanding “bubbles”
before the fixed date. No rationale, of
course, except for a response to political pressure made with the full
knowledge it won’t cause any problems.
After all, there is no active disease in the province
except for two cases both of which are isolated and under control.
Headless Bureaucracy
On
Friday, the provincial government’s advisor on COVID-19 told reporters that
the provincial government’s response to COVID-19 had worked. Dr. Proton Rahman specifically singled out
contact tracing and social distancing as key measures that had worked very
effectively. The available evidence
supports his observation.
But that isn’t the whole story of what has happened
since the middle of March. A more
detailed assessment of the kind presented here - something that Rahman’s team
was not mandated to do – tells a different story.
There are problems in government’s management of the
emergency. In particular, there is
strong evidence that the provincial government implemented measures for
political reasons and continues to do so. It is especially clear that the
provincial government has maintained very tight restrictions far longer than
necessary and that far more extensive efforts to control the public since 30
April are not based on evidence and medical necessity.
While there may well be specific issues like shorts of
hospital protective equipment that may be driving decisions to some extent,
there are unmistakable signs of problems in the management of the crisis at the
highest levels.
Major emergencies like a pandemic or severe weather
event affect so many aspects of life in the province that they require the
provincial government to manage its response using time-tested approaches. In particular, emergency management during a
pandemic makes it imperative that government actions be coordinated from the
highest level. In making its decisions, cabinet
or a committee of senior cabinet ministers must consider many aspects of a
single initiative before taking a decision.
The provincial government’s response to COVID-19 does
not use that “whole-of-government” approach to a whole-of-government
problem. The Public Health Protection
Act allows the minister of health alone to declare an emergency. Under the old Communicable Disease Act,
cabinet declared the emergency. That was consistent with its other emergencies
legislation that out cabinet at the apex of the decision-making.
Dwight Ball could have used a cabinet level committee
to manage the emergency, but he did not.
The most likely reason for this is his ongoing political problems within
cabinet and his own caucus. Instead of group decisions, Ball seems to be
juggling things himself with the help of his office staff and ministers with
whom he deals one by one. Andrew Parsons’s
refusal to speak about the detention orders suggests this is the case.
The result is that Haggie has far more control over
government’s response to COVID than would have been the case before or need be the case now. He also has an extraordinary influence over
the Chief Medical Officer, who must persuade him and no one else of the need to
maintain the emergency order.
Collective decisions – the way cabinet normally
works – prevent one person from gaining too much sway. It can serve as a check on rash or misguided
decisions. But with Dwight Ball alienated from his cabinet and running the province more or less alone, the provincial government
simply doesn’t have that important governor on action at the top-most levels during
COVID-19. As a result, it has obviously
been easy for a strong-willed minister to get his way regardless of the costs
across society.
Another result of the imbalanced decision-making
process is that health officials such as the Chief Medical Officer are making
decisions that affect things beyond health care. Neither the CMO nor her staff are equipped to
decide about the provincial economy or government finance. There’s no indication that cabinet or the
House of Assembly wanted this when they approved the current public health law
in 2018. And yet, today, the Chief Medical Officer is adjudicating everything
from tee-off times at a golf course to social distancing rules on fishing
boats.
The result of all this has been:
- a lockdown that has gone on longer than necessary,
- a lockdown that is being replaced by far more restrictive measures than are warranted by the evidence,
- severe constraints on the provincial economy,
- two unconstitutional measures (the travel ban and the detention powers), and
- a health system that continues to operate far below capacity, and health consequences for tens of thousands of Newfoundlanders and Labradors that have not been assessed publicly.
It is likely that
one woman who carried a dead fetus for eight weeks is just the tip of a very
large iceberg of health care problems that have resulted solely from ongoing strategic
mismanagement of the provincial response to COVID-19.
Whatever the cause of the current mismanagement, the
prospect of a new Premier to replace Ball brings with it the chance to sort out
the problems and get the province ready to deal with COVID-19 for as long as
necessary. The current situation is unconscionable.
-srbp-
