Coronavirus report card: Experts give Canada a B, U.S. an F
TORONTO -- The novel coronavirus became a reality in Canada six months ago today.
A man who had travelled to Wuhan, China, had fallen ill after returning to his home in a Toronto suburb. He sought medical attention, and doctors diagnosed him with Canada's first presumptive positive case of the virus. Two days later, test results on the man came back positive, and his wife was diagnosed as the country's second presumptive patient.
As this was happening, health officials from B.C. to Ottawa were saying that there was little risk to Canadians, and the World Health Organization (WHO) was holding off on declaring the virus a global health emergency.
Much has changed since then. The disease caused by the virus has been given a name – COVID-19 – and the world is in the grip of the greatest pandemic in decades. There have been more than 15 million confirmed cases of the virus and more than 600,000 deaths worldwide, according to Johns Hopkins University. In Canada, there have been more than 110,000 cases – more than the entire population of Moncton, N.B. – and nearly 9,000 deaths.
Half a year after COVID-19 first showed itself in Canada, CTVNews.ca asked seven prominent epidemiologists, public health experts and infectious disease specialists to look back at the pandemic responses of Canada, the United States and the world as a whole, and put together a report card for each – assessing their strengths and weaknesses thus far, and assigning them a letter grade.
Our expert panel includes:
- Dr. Anna Banerji, an infectious disease specialist at the University of Toronto
- Dr. Lisa Barrett, an infectious disease specialist at Dalhousie University in Halifax
- Dr. Zain Chagla, an infectious disease specialist at McMaster University in Hamilton, Ont.
- Dr. Sumon Chakrabarti, an infectious disease specialist based in Mississauga, Ont.
- Dr. Brian Conway, president and medical director of the Vancouver Infectious Diseases Centre
- Dr. Ronald St. John, the first director-general of the Public Health Agency of Canada's Centre for Emergency Preparedness
- Ashleigh Tuite, an epidemiology professor at the University of Toronto
CANADA BETTER THAN AVERAGE
Although all of our experts said that our country's response to the pandemic had obvious room for improvement, Canada was given high marks relative to the U.S. and the world.
"We're in a position where we have low community spread all over the country, to a point that we even have the option of safely ... opening indoor dining and bars and schools," Chakrabarti told CTVNews.ca via telephone July 21.
"In the grand scheme of things, we have actually done a very good job and we should actually be proud of ourselves for that -- but proud in a way that we don't get complacent."
Chakrabarti gave Canada an A-minus – the highest mark of any of our experts, though not by much. He noted that most other countries with similar caseloads went through periods where their hospitals were overwhelmed, which was never the case here.
"We never were at a point where we felt appreciably out of control," he said.
Many of the experts praised Canada's federal, provincial and municipal governments for often presenting a united front during the pandemic, learning from experiences elsewhere in the country and usually having clear, rational explanations for decisions around shutting down and reopening parts of the country.
"Even though we don’t necessarily agree on every level of risk, there is at least some methodology to it,” Chagla said July 21 in an emailto CTVNews.ca, in which he graded Canada's performance as a B-minus.
The positive comments about Canada's handling of COVID-19 were tempered by concerns about the response in the early days of the pandemic, from difficulties securing personal protective equipment and testing kits to the seeming lack of preparation for outbreaks in long-term care homes and Indigenous communities.
"A lot of health-care workers and front-line workers and EMS really put themselves at risk at the beginning, because we didn't have the supplies," Banerji said in a telephone interview on July 22.
While governments may have fallen short at times, most of the experts had praise for how Canadians as a whole listened to public health advice.
"Canadians get an A-plus. Regardless of what the policy said, they generally did the right thing regardless," Barrett told CTVNews.ca July 23 in a telephone interview. Barrett gave Canada as a whole a lower B-plus, due to foreseeable issues affecting long-term care homes and other vulnerable settings.
That adhering to official advice has continued even as the guidance itself has changed. Think about how face masks went from being considered unnecessary outside hospitals to mandatory in public spaces in some parts of the country.
Canadians' attitudes are also shifting around the accuracy of test results, Banerji said, as more evidence emerges that false negative results are a significant problem – leading to advice that anyone who has symptoms of COVID-19 should stay home, even if they have tested negative.
Inaccurate tests are just one of several problems the experts warned will be on the horizon as provinces reopen the businesses and sectors of society that were closed in the spring. The long-term lack of federal funding for Indigenous health care is another, Banerji said, while Tuite noted that some parts of the country still lack the capacity to carry out effective contact tracing.
Conway, who gave Canada a B-plus, cautioned that young adults may see reopening as a sign that the country is returning to normal, which could be dangerous as long as the virus remains active.
"There is a lack of understanding that public health measures are still needed and that we are possibly not ever going back to the full-on old normal," he said July 22 in an email.
Despite the challenges in the past and those that may be ahead, the experts' grades reflect that they feel Canada has weathered the pandemic relatively well – especially considering the situationon the other side of the world's largest international border.
Chakrabarti said that while he'd give New Zealand an A-plus for its coronavirus response, its geography gives it a built-in advantage over most other countries.
"We don't have the luxury of being an island nation," he said.
"We have the U.S. next door to us, and they have the worst outbreak in the entire world, and we were still able to get to this point."
5 OUT OF 7 SAY U.S. FLUNKS
Is the American pandemic experience really the worst in the world? It depends how you measure it.
Our southern neighbour does have the highest raw numbers of COVID-19 cases and deaths anywhere, and its testing rate is low enough that it cannot account for that. But several European countries have worse per capita death rates.
Regardless of whether the U.S. is at the absolute bottom of the list, our panel made it clear they can find little to praise in the American response. Five of the seven experts gave the U.S. a failing grade.
"[The U.S. is] a raging flunk. What's your lowest letter?" St. John said July 21 during a telephone interview.
Common criticisms of the American approach included the politicization of public health advice such as mask-wearing, and decisions to reopen businesses before virus activity had tampered down enough to make doing so safe.
The greatest scorn, though, was reserved for what many of the experts described as a clear lack of federal leadership. Unlike in Canada, where provincial and local authorities have generally followed the federal handbook, mixed messages have abounded.
"There's been conflicting messaging and communication and an overall anti-science feel to national response," Tuite said July 21 in an email.
Tuite actually gave the U.S. the highest grade of anyone we asked – a D – but categorized the American response as disappointing, noting that the surges of the past month were "predictable and preventable."
Those surges have led to "50 states [that] seem like they're doing 50 different things," as Chakrabarti put it, with no clear nationwide approach to stopping the virus or even fully understanding its progress.
"I don't even know if this is a first wave or a second wave," Banerji said.
Barrett noted that there has been "a lot less overall buy-in" from Americans than Canadians and others when it comes to adjusting lifestyles in order to halt the spread of the virus.
"You can open Disney World, but no one has to go – and everyone did," she said.
St. John, who started his career at the U.S. Centers for Disease Control, said he has been "amazed" by how small a role that organization has had in the American response.
"Ordinarily it would be the CDC that would be leading this and co-ordinating things across the entire country -- and they're nowhere to be seen," he said.
The CDC may be nearly invisible in Washington's response to the pandemic, but one public health leader has been much more prominent. Several of our experts singled out Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, for his work to keep science at the forefront of the American debate.
In giving the U.S. a D-minus, Chakrabarti described Fauci as "one of the brightest shining lights" of the American pandemic experience, noting that he was one of the first prominent voices to tout the staged approach to reopening now being used across Canada.
However, Fauci's frank manner and willingness to contradict the White House have repeatedly put him at odds with U.S. President Donald Trump, who appears to be less rigorous about sticking to scientific consensus.
"You have to give [Fauci] credit for trying to talk about science, but you've got the head of the country that says maybe by injecting bleach, you can stop COVID," Banerji said.
The experts also noted Trump's recently-ended refusal to promote masks and his eagerness to promote hydroxychloroquine, a potential COVID-19 treatment that has not been shown to work and comes with deadly side effects, as actions that hindered America's ability to fight the virus.
"There's no consistency. There's nothing there. To me, it's unbelievable," Banerji said.
And things could well get worse as community spread continues unchecked in some parts of the country. Even Trump has admitted that there will likely be further escalation of virus activity before the situation starts to improve.
"It is still early days, and the U.S. is in the worst possible position to deal with events going forward," Conway said.
THE WORLD GETS A 'C'
Ultimately, neither Canada nor the U.S. can eliminate COVID-19 on their own. As Health Minister Patty Hajdu has said, "as long as COVID is raging out of control in another country, Canadians will not be safe."
So, how are we doing on that front? How is humanity doing at fighting off what might be the greatest collective threat to emerge in decades?
Our experts were nearly unanimous on this question, with six out of seven giving the world a C. Most said this was a sort of average grade, taking into account the parts of the world where the virus has been beaten back and those where it is still raging uncontrollably. Overall, though, there was a general air of pessimism.
"Globally we have learned that we were not prepared for a pandemic," Tuite said.
Since it was first reported in China at the end of 2019, the virus has followed a relatively straight pattern across the planet – first affecting South Korea, Japan and other Asian nations, then moving on to Europe and crossing the Atlantic Ocean to North America, before finally emerging in South America and Africa.
By following this track, the virus has been able to ramp up its activity in countries including Brazil, India and South Africa even as earlier-hit nations in Asia and Europe have largely got a handle on it.
Several of our experts said this should not come as a surprise, especially given the lack of proper health-care resources in some parts of the developing world – the gulf between "the haves and the have-nots," as Banerji put it.
"At least the States has the ability to contain this. We don't have that in other [countries]," Chakrabarti said.
"What's happening in other parts of the world is likely going to get worse before it gets better."
Barrett said that she fears the deteriorating situation in the developing world may be ignored by the developed world, presenting a major hurdle to eradicating the virus.
"The biggest challenge right now really, really, really is that we're nowhere near done," she said.
Several experts noted that the pandemic has shown the ability of many of the world's countries to work together, both in sharing information about the virus and in working to develop vaccines and treatments for it – even though there has never before been a successful vaccine for a coronavirus in humans.
"[There is] a clear understanding this is a pandemic and we are all in this together," Conway said.
And while disastrous COVID-19 situations in some countries can have some questioning the world's readiness to deal with a pandemic, Banerji said that it's important to remember the virus itself is a difficult enemy to defeat.
"This is one of the most highly infectious viruses that we've had at least in 100 years, maybe in several hundred years. This is as bad as it gets," she said.
"Even with the best procedure or policy, it's still very difficult to contain."
Infographic by Mahima Singh