The province has to embrace this, and fix this. On Wednesday, Ontario’s 34 public health units, in the face of an inflexible approach and insufficient leadership amid a pandemic, decided to take some control for themselves.
“It’s a mutiny,” says Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto, and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network. “They’re actually outlining a strategy. That’s pretty amazing. That’s unbelievable. It’s a mutiny. Wow.
“I’m going to say great for them, like about bloody time. The real issue is going to be whether the province agrees to this or not.”
A document, which was prepared by the medical officers of health and obtained by the Star, lays out several specific categories that should be considered together before different parts of Ontario reopen businesses or organizations, or decide to reinstitute restrictions.
On virus containment it spells out a two- to four-week decline in new daily cases, a decrease in unsourced cases, a decrease in hospital admissions; a seven-day decline in community cases; and more. It also lays out indicators in health-care capacity, public health system capacity, and incidence tracking capacity. And it explains why.
All 34 medical officers of health signed it, and as much as they tried to present the plan as a complement to the provincial reopening plan, the provincial version was considered maddeningly light on actual data thresholds. This is polite, firm mutiny in the name of the public’s health. Some had already considered something similar.
“As public health practitioners we’re obliged to follow the data, and do what makes sense to best protect the health of the populations that we serve,” said Toronto’s Dr. Eileen de Villa, who spearheaded the effort with Ottawa’s Dr. Vera Etches and Peel Region’s Dr. Lawrence Loh.
The plan’s exact numbers haven’t all been established. Dr. Irfan Dhalla, the vice-president of St. Michael’s Hospital, said it may expose gaps in the data we have. Dr. David Fisman of the University of Toronto called it right and coherent. Morris called it wise. Dhalla said it just made sense.
“I don’t want to play Monday morning quarterback and look back, but had we had these parameters from the beginning we probably could have hit a sustainable opening by now, and we could be talking about a Phase 2 opening.”
The province started reopening some businesses in Phase 1 without having met concrete benchmarks, and it neither embraced nor rejected the document. Health Minister Christine Elliott said the province was listening, and said the document would go to the expansive Ontario health command table. Premier Doug Ford argued Wednesday people might travel among regions.
“I always say, we need to stick together as a province, and I think we’re moving along pretty well,” said Ford. “Everyone’s listening, everyone’s following the protocol of their local medical officer of health, people are still self-distancing, we’re ramping up testing, and thank goodness, you saw the numbers, I know they’re up and down like a yo-yo, but last two days have been positive, under 300 (new cases). So there’s positive things that are happening.
“So why make a big divide now, when we’re getting through this?”
“I’ve been aware of at least three (medical groups drafting letters), outside the medical officers for health, saying we’re better than this, we can do better, we’re going in the wrong direction,” says Fisman. “And the most productive ones don’t just say fire the chief medical officer of health. They say, here’s what a different way would look like, and who are some of the people who have that skill set and experience to actually lead that effort and turn this flaming dumpster-fire clown car around?”
Dr. David Williams’s job as Ontario’s chief medical officer of health has been a topic of discussion in medical circles for some time. Williams, for his part, said he considered the plan a complement to his existing framework. He said, “I saw it as much more of a positive thing … My overall approach, I think it’s a good thing they’re doing, and they’re keeping me informed.” That may be a good thing.
“What should have happened is David Williams, along with Public Health Ontario, should have brought together the medical officers of health and said guys, what should we do?” says Morris. “And they would come up with this document and everyone would be on the same page and it would work perfectly. Instead, for a variety of reasons, they have taken it upon themselves to outline a strategy that is in my mind really thoughtful.
“But is this going to advance the cause? I don’t know, because people might be really confused. What happens if the premier says one thing, and all these medical officers of health say something different? Who’s the public going to listen to now?
“And what’s David Williams going to be saying? Because he should be aligned with these guys, but he’s employed by the premier. It’s unclear if the premier needs to go along with any of this.
Morris says he figures the only quick fix is to appoint somebody to quarterback all this, with diplomacy and communication skills and administrative ability.
“If you consider a pandemic to be a health-care equivalent of a war, you actually do need a command-and-control structure,” says Dr. Sacha Bhatia, the chief innovation officer at Women’s College Hospital, and its chief of cardiology. “You have to be a competent general to run it. Bonnie Henry in B.C. — even the premier deferred to this one person.
“I think at the end of the day, a very strong CMOH makes a lot of these problems go away.”
The province needs to embrace this, and fix this. The revolution, as it turns out, was local. But then, most revolutions are.