Canada

Auditor slams Ontario for sidelining public health experts in COVID-19 response

Auditor General Bonnie Lysyk detailed a lack of emergency preparation and delays and confusion created, in part, by a cumbersome decision-making system.

Ontario was unprepared, slow to act and failed to rely on public health experts in its response to the COVID-19 pandemic, the province’s auditor general concluded in a scathing report released Wednesday.

Auditor General Bonnie Lysyk detailed a lack of emergency preparation and delays and confusion created, in part, by a cumbersome decision-making system that left public health experts sidelined. Some of those failings likely contributed to the spread of COVID-19, the report found.

“We found that Ontario’s response to COVID-19 in the winter and spring of 2020 was slower and more reactive relative to most other provinces and many other international jurisdictions,” she wrote.

Among the report’s most damning conclusions was that Ontario’s Chief Medical Officer of Health Dr. David Williams and other public health officials did not lead the province’s response, as their counterparts did elsewhere in the country.

Ottawa’s Dr. Vera Etches was among a handful of medical officers of health in the province who declared COVID-19 was spreading in the community and advised residents to take precautions while the province continued to study the issue, only later confirming the virus was in the community and wasn’t just being spread by travellers.

Ottawa and the public health units in Toronto and Middlesex-London also developed their own case management and contact tracing systems, at a cost of about $71,000, because of weaknesses in the provincial system.

The report also highlighted that an associate medical officer of health at one of the public health units wrote to Dr. Williams on March 18, saying it was an urgent priority for long-term care workers to wear masks. The province did not make that mandatory for another three weeks. By then, there were 69 outbreaks at long-term care homes in the province, involving 857 cases and 88 deaths.

Ontario ordered long-term care staff to limit work to just one home on April 22, a month after the first long-term care outbreak in the province. British Columbia, by comparison, took similar action weeks earlier and has had significantly fewer outbreaks and deaths in long-term care than Ontario.

“Ontario did not make timely decisions to require long-term care home staff to wear personal protective equipment and to not restrict the movement of these staff between long-term care homes,” wrote Lysyk. “While this can partially be attributed to concerns about personal protective equipment shortages among health-care workers at the highest risk of contracting COVID-19, this contributed to the significant increase in the number of COVID-19 cases and deaths associated with outbreaks in long-term care homes.”

Lysyk is expected to release a separate report on long-term care issues with the provincial response to the pandemic.

The report also found that the sidelining of public health expertise filtered down to the regions, where hospital leaders and ministry staff, not public health experts, were in charge of the regional response structure.

“This hospital-sector leadership in place of public health-sector leadership may not have been the most appropriate, given that almost 90 per cent of people with COVID-19 as of Aug. 31 were never hospitalized.”

The report also pointed to a decision by the province to allow testing of anyone, despite its limited value and no direction to do so from the province’s health table. The move contributed to labs and contact tracers becoming overwhelmed.

The province defended that direction in a response, saying it did so when there was plenty of capacity in provincial labs and amended the guideline once students went back to school and many people went back to work in the fall. By the time that was changed, there were long waits for tests in Ottawa and labs were becoming overwhelmed.

The report also found that recommendations, from the auditor general’s office and elsewhere, that the province needed better resourced public health labs and better information systems were not acted on.

If these long-standing concerns had been addressed earlier, the province “could have responded to COVID-19 more quickly, more effective and more efficiently.”

In response, the province said that “unlike other jurisdictions, Ontario did not start this pandemic with a province-wide lab network and quickly built one. As a result, Ontario has now tested more people than all other provinces combined.”

Among the report’s other findings:

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In a statement, the province denied that and other findings Wednesday, saying Williams “has led, and continues to lead, Ontario’s public health response, including providing recommendations that have been essential to government actions and plans.”

Premier Doug Ford reacted angrily to the report during his daily press briefing, saying it was undermining the province’s response to the “unprecedented” pandemic. He said the current situation in Ontario speaks for itself. Ontario has the lowest rate of active cases outside the Atlantic provinces.

The premier also lashed out at the auditor general, suggesting she had overstepped her mandate.

“Stick with looking for value for money. Don’t start pretending you’re a doctor or a health professional because I’ll tell you, you’re not.”

Among the report’s findings was that a lack of preparation — going back before the Progressive Conservatives were in power —left the province with a critical shortage of personal protective equipment at the beginning of the pandemic and a lack of capacity to do testing and tracing that hampered efforts to control spread of the pandemic, among other things.

When the pandemic hit, the province had updated, but not finalized, its overall emergency response plan. The province’s pandemic plan had not been updated since 2006.

Decision-making was slow and directives were often weak or unclear, the report found, leading local health units to act on their own, in some cases.

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