Earlier this week, rookie backbench MP and current candidate for Conservative leader Derek Sloan questioned the loyalty of Theresa Tam, Canada’s chief public health officer, musing aloud if her loyalties were with China over Canada.
The underlying xenophobic sentiment is abhorrent, though that is not the point of this commentary. The crux of what Sloan said in both an initial video posted to Facebook and a subsequent email to supporters — that Dr. Tam was wrong on two specific issues: masks and travel bans — have been echoed by some conservative politicians and even some political and opinion journalists.
The issue of masks has been covered extensively by health and science reporters, including in this excellent piece by Ed Yong in the Atlantic.
The subject of universal mask-wearing to confer protection to the wearer, or to reduce asymptomatic or subclinical spread, is not, as some politicians and media make it seem, a clear black-and-white issue.
One of the more comprehensive looks at mask-wearing was done by science journalist Tara Haelle for Forbes, in which she answered the question of universal mask-wearing.
“Quite possibly, yes, universal mask-wearing might decrease asymptomatic and pre-symptomatic transmission of the disease,” she wrote. “The evidence isn’t strong, solid or crystal clear (it rarely is), but it might be better to err on the side of trying it.”
She also made this rather pressing point: “If anyone tells you that the mask question is ‘simple’ or that everyone ‘obviously, unquestionably’ should wear masks, that person is not coming from a thoughtful, conscientious exploration of the evidence.”
One thing that seems to be lost on Dr. Tam’s harshest critics, many of whom sound like they would not have passed a high school science class, is the fact that this is a novel virus. We have literally never encountered this virus before. That means that public health officials are responding to new information in real time and making policy decisions dependent on the data that is in front of them.
When I asked Isaac Bogoch, an infectious diseases specialist at the University of Toronto and Toronto General Hospital, about some of the reaction to Dr. Tam’s policy, he told me: “Nobody should be free from scrutiny, and we should always hold our politicians and other officials to account, but we’ve had reasonable policy throughout this. The federal policy evolved with the evolving epidemic.”
David Fisman, a professor of epidemiology at the University of Toronto, made a similar point to me, saying: “You have to make the decisions prospectively. The Monday morning quarterbacking is predictable; the politicization, and some of the nastiness directed at Dr. Tam, is offensive to me.”
Dr. Bogoch also pointed out that respiratory viruses are generally quite hard to contain.
“Respiratory viruses like this are easy to transmit and are very challenging to contain. Just look at the example of the regular flu. The flu kills anywhere between 300,000 and 500,000 people every year, and we have a vaccine for that,” he said.
So what does that mean for border closures? Should Canada have shut down travel earlier?
It’s tempting to conclude that had Canada only restricted travel from countries with high rates of infection earlier, we would not be in the position that we’re in today. However, that conclusion is not borne out by the current research or evidence.
Border closures don’t really work to stop a pandemic, though they can delay transmission rates.
“It doesn’t mean you don’t be careful, that we can’t screen travellers. But the take-home point is travel restrictions don’t stop a pandemic, they slow it down,” Dr. Bogoch said.
Dr. Fisman also expressed doubt at the notion of travel bans being a panacea.
“I, too, have been skeptical of travel bans for a long time. They tend to just wind up as vehicles for latent xenophobic sentiment. Had we known how explosive this would be in February, we would have shut down travel. We didn’t know, or I certainly didn’t,” Dr. Fisman said.
“Had the CPHO (chief public health officer) tried to shut down trade and travel at a time when we had no clue about how widespread silent infection was — I think this really gelled in mid-March — there would have been absolute howls of outrage from business leaders.”
Dr. Bogoch made a similar point, saying: “Canadians need to be honest with themselves on this point of border closures because the full-scale border shutdowns that we are seeing now would not have been appealing to Canadians in early March or late February.”
Given the fact the virus was already making its way around the globe in early January, any border restrictions or travel bans would have to be much more comprehensive than country-specific bans. And even then, we have to keep in mind that it would not have applied to Canadians abroad. Canadians always have a right to come home, even if they are coming home from countries with cities that you can’t pronounce.
For all the clamouring about needing to have closed off travel to certain countries, it’s rather curious that so few of Dr. Tam’s critics seem to include the United States in this. Yet both Dr. Fisman and Dr. Bogoch agreed that overlooking the United States as a hot spot for COVID-19 was an oversight.
Dr. Fisman said he found “the lack of focus on the U.S. surprising,” while Dr. Bogoch said: “It was painfully obvious there was a significant burden of infection in the U.S., so this was really frustrating.”
It’s clear that there are things Canada could have done differently. And there is plenty of legitimate criticism to go around.
But we have to be honest with ourselves about how we can be better prepared next time — and there will certainly be a next time — part of which means being truthful about what went wrong this time around.
It’s not too late to start doing that.View link »