Canada's top doctor calls for 'structural change' to address COVID-19 inequities
OTTAWA -- Canada’s Chief Public Health Officer Dr. Theresa Tam is calling for “structural change” across health, social, and economic sectors in the wake of COVID-19, in a new report highlighting the successes and shortfalls in the country’s pandemic response to date.
“I do see COVID-19 as a catalyst for collaboration between health, social, and economic sectors, and I have observed at the federal level, but also from local levels, and provincial levels,” she told reporters during a press conference discussing the report.
Tam said that while there are examples of decisions taken that begin to address some of these shortcomings—such as increasing affordable housing availability and financial supports for low-income and precarious workers—these policies should be extended past the emergency phase of the pandemic.
“What I'm really, really keen to see is that this continues… The report is calling for this to be a more sustained approach,” she said. “Why can't we have those governance structures beyond the crisis and into recovery?”
In the Public Health Agency’s annual report made public on Wednesday, Tam offers new insights and statistics related to Canada’s battle against the novel coronavirus over the last several months and the “serious threat” the virus continues to pose.
For example, in Canada:
- 80 per cent of COVID-19-related deaths have been residents of long-term care facilities;
- 19 per cent of national cases are among health-care workers; and
- 92 per cent of hospitalized COVID-19 patients had at least one underlying health condition.
The annual report is entitled “From Risk to Resilience: An Equity Approach to COVID-19,” and it gives an overview of COVID-19’s consequences so far, such as the disproportionate health impacts experienced by workers who provide essential services, racialized populations, people living with disabilities or mental illnesses, and women.
It also includes recommendations on how to improve the country’s pandemic preparedness, response, and recovery.
The report says the “structural change” should include improving employment conditions and conditions inside long-term care homes, increasing access to housing, as well as enhancing Canadians’ ability to access social and health services both in-person and online.
Tam said she hopes that in future pandemic planning, “it can't just be health and public health making it known that all other departments and different sectors, and different aspects of societies need to be part of the response. We need to sort of build it in explicitly so that, you know, future pandemics and health crises have those other supports come into play immediately.”
As Tam argues, Canadians’ health depends on their social and economic well-being and the severity of COVID-19 illness may be influenced by their access to these kinds of supports.
“No one is protected until everyone is protected,” says Tam in the report.
Tam’s overall recommendations are distilled into three calls:
- Sustaining governance at all levels for “structural change” in health, social, and economic sectors. The report notes that the health of people in Canada was not equal before COVID-19, but that the pandemic has exposed and exacerbated existing shortcomings. Tam suggests that more data needs to be collected and used to inform policy decisions to eliminate inequities and mitigate some potential long-term pandemic impacts;
- Harnessing “the power of social cohesion” to control and minimize the virus’ spread. She suggests this can be done by leaders sharing evidence and information to provide Canadians with confidence in taking public health precautions such as mask-wearing; and
- Strengthening public health capacity. Tam says that more work is needed to ensure Canada’s public health system is able to handle case surges while having the capacity to deal with non-COVID-19 health issues, including re-evaluating “what sustained investments and the future of public health would look like.”
The report also goes over the timeline from the first confirmed case in Canada and when community transmission began, to the various rolling restrictions and travel advisories imposed.
From a global perspective, according to the report, Canada ranked 79th out of 210 countries with respect to total cases per million inhabitants, and 26th for total deaths per million, as of Aug. 22. The outbreaks in Canadian long-term care homes are cited as a driving factor in why Canada is so high on the list of countries when it comes to deaths.
“Pandemic preparedness did not extend into these settings leaving residents vulnerable to the introduction, spread and impact of a novel virus,” the report states.
In an interview on CTV’s Power Play, Tam was asked whether she thinks enough lessons from the first wave have been learned to prevent the same high rate of deaths in long-term care homes. She said that so far the scale of the outbreaks inside these homes is not as large, and efforts have been taken to improve infection control, but the virus is “very sneaky” and preventing more seniors’ deaths still depends on the actions all Canadians take.
“Right now the second resurgence, a lot of the cases are in the younger adult population, but what we're seeing is that it's beginning to permeate through other age groups including the elderly,” Tam said.
Further, analysis of international travel-related cases between January and March found that 35 per cent of cases entered Canada from the United States, 10 per cent from the U.K. and France, and 1.4 per cent from China. Once travel restrictions were imposed, 91 per cent of reported cases by August originated in Canada.
The report notes that in the absence of an effective treatment or vaccine, individual and collective public health measures need to be taken to control the pandemic. However, “accurate, timely and clear communication” has been a challenge.
Tam notes that there have been “a number” of issues on this front, such as Canadians being exposed to a vast amount and varying quality of information and the confusion spawning from the frequently-moving goal posts when it comes to public health advice due to the evolving science.
“Information needs to be tailored and locally contextualized, while at the same time balanced with consistent key messaging being shared across the country,” the report states.
Tam is advising that as long as the virus is uncontrolled, public health officials and governments need to be transparent and provide regular updates on COVID-19 and up-to-date guidance.
It’s a part of Tam’s mandate to provide Health Minister Patty Hajdu with a report on the state of public health in Canada annually, which then is tabled in Parliament.
The report is based on Canadian data available from January to the end of August, and notes that because the virus and evidence around it continues to rapidly evolve, “the report was written with the knowledge that the story of this pandemic is continuing to change every day.”
TIMELINE OF KEY MILESTONES
- December 31, 2019: PHAC was notified of a pneumonia-like illness of unknown cause originating in Wuhan, China.
- January 22, 2020: Canada implements novel coronavirus screening requirements for travellers returning from China. Residents are asked additional screening questions to determine if they have visited the city of Wuhan, China.
- January 25, 2020: First presumptive confirmed case of 2019-nCoV related to travel to Wuhan, China confirmed in Ontario.
- February 20, 2020: First COVID-19 case in Canada from travel outside mainland China, from Iran, reported in British Columbia.
- February 23, 2020: First recorded COVID-19 case in Canada linked to community transmission.
- February 24, 2020: Alberta records first COVID-19 case in Canada linked to travel to the U.S.
- March 7, 2020: First COVID-19 outbreak at a long-term care home in Vancouver, British Columbia involving 79 cases.
- March 11, 2020: Canada surpasses 100 reported COVID-19 cases.
- March 12-22, 2020: Physical distancing measures are implemented across the country. All provinces and territories declare a state of emergency and/or public health emergency. Non-essential businesses close or have significantly reduced capacity; gatherings are restricted; schools close; advisory issued for those who can, to work from home.
- March 13, 2020: The Government of Canada recommends avoiding non-essential travel outside of Canada,
- March 16, 2020: Government of Canada advises all travellers entering Canada to self-isolate for 14 days.
- March 18–19, 2020: Additional international travel advisories and border restrictions are implemented: Entry to Canada by air is prohibited to all foreign nationals (except those from the United States); Canada and the United States agree to temporarily restrict non-essential travel across the Canada-US border; International flights are redirected to only 4 airports.
- March 28, 2020: First reported outbreak among temporary foreign workers in an agricultural setting, involving 23 people.
- April 7, 2020: Council of Chief Medical Officers of Health issue a statement supportive of wearing non-medical masks as an additional layer of protection for other people in close proximity.
- April 14, 2020: Largest known COVID-19 outbreak reported at homeless shelter in Toronto, Ontario, involving 164 cases.
- April 15, 2020: Lockdown in response to largest known outbreak at a correctional facility in Laval, Quebec involving 162 cases.
- April 17, 2020: First reported COVID-19 outbreak in an isolated northern community in Saskatchewan, affecting 117 residents.
- April 24, 2020: New Brunswick is the first province to ease physical distancing restrictions.
- May 6, 2020: Alberta reports a COVID-19 outbreak at a meat processing plant, which becomes the largest outbreak at a single location in Canada (by the end of August) with 1,560 people confirmed.
- June 17, 2020: First COVID-19 outbreak in a religious-cultural community declared in Saskatchewan, involving 285 people.
Timeline source: Public Health Agency of Canada.