“Local medical officers of health informed us that they were confused by provincial politicians delivering public health advice in place of the chief medical officer of health,” a report from Lysyk’s office released Wednesday morning said.
“Public health units and other impacted stakeholders were not always made aware of provincial decisions that impacted their operations prior to these decisions being announced publicly. This left these parties unprepared to act in a timely manner.”
The comments were made in the first of two special reports on the pandemic. The first report, which is 231 pages long, focused on the provincial government’s emergency management planning and bureaucracy, how it responded to the pandemic, outbreak planning and decision-making, laboratory testing, COVID-19 case management, and contact tracing.
Overall, Lysyk said the Ontario government’s response to COVID-19 was “slower and more reactive” compared to other provinces, noting many issues were avoidable because the provincial government “failed to act on key lessons identified after the 2003 SARS outbreak that had not been implemented.” She also said the provincial command and response structure became too “cumbersome” with many tables.
“We recognize that decision-makers, the health-care system and the public made every effort so that Ontario’s health system would not be overrun in the first wave,” Lysyk wrote.
“As we continue into this second wave, it is still not too late to make positive changes to help further control and reduce the spread of COVID-19.”
When it comes to the communications aspects of the government’s response, the report looked at several different elements.
It cited a September study by the Canadian Medical Association Journal that found messaging in Ontario surrounding the state of the pandemic and recommendations was “less coordinated” and inconsistent compared to British Columbia, where that province’s chief medical officer of health, Dr. Bonnie Henry, received praise in some public circles for her work as a lead spokesperson.
“During the first wave of the pandemic in the spring and summer of 2020, the premier of Ontario was often the spokesperson on health recommendations, leading daily press conferences, with the chief medical officer of health or associate chief medical officer of health being called on to reiterate advice afterward,” the report said, noting it was the opposite approach in B.C., Alberta and Manitoba.
Two particular instances of conflicting information were cited in Lysyk’s report: Diverging advice on whether or not to travel during March Break and acknowledging there was community spread of COVID-19.
The report noted the World Health Organization declared COVID-19 a pandemic on March 11 and on March 12, provincial officials “advised Ontarians to travel and enjoy themselves on March Break vacations.” It noted Williams issued a memo dated March 12 that advised residents should “avoid all non-essential travel” out of the country. On March 16, the Government of Canada announced border closures.
“If the province’s advice had aligned with that of the rest of Canada at this time, Ontarians would likely have taken fewer international flights for March Break, travellers would have been less confused and the spread of COVID-19 in Ontario have been reduced,” the report said.
When it came to community transmission of COVID-19, Lysyk’s office said the Ontario Ministry of Health didn’t publicly acknowledge it in a timely fashion “despite strong evidence.”
“Timely awareness of community transmission was of critical importance, not only to enable members of (Ontario’s) health command table to identify appropriate actions, but also to enable the public to take appropriate precautions,” the report said, noting there was some evidence of community spread on March 15.
“Despite this evidence, the chief medical officer of health for Ontario still communicated to the media on March 17 that the province was ‘still waiting to see actual examples of community spread.'”
A response from Williams’ office said a small number of cases without a clear link “does not immediately indicate community spread,” but acknowledged data at the time began to show a “gradual increase” when travel and close contact couldn’t be identified.
Confusion and a lack of clarity were also reported by Lysyk’s office with respect to the Ontario government’s announcement of its three-stage reopening guidelines in April during the first wave of the pandemic. Specific targets weren’t listed to indicate when stages should be changed.
“Directional information is also not shared publicly to help Ontarians understand exactly why public health measures have been restricted or what needs to occur for further relaxing of such measures,” the report said, adding there was also a lack of clarity in the new colour-coded framework unveiled earlier this month.
When it comes to a public information strategy more broadly, after the 2003 SARS outbreak there was a recommendation for the Ontario Ministry of Health to develop a “public health risk communications strategy.”
However, as of March, the report said the ministry didn’t have a plan for crisis emergency communications. It said existing plans were “silent” on how staff should communicate with the public. It also said a ministry emergency response plan had the words “under development” when it came to the section on crisis emergency and risk communications response guide.
Complaints from stakeholders about lack of information
The report also conveyed complaints from officials in public health units and other stakeholders about not being told of important provincial decisions that would impact operations ahead of time, leaving them “unprepared to act in a timely manner.”
On May 24, the provincial government announced anyone who wanted a coronavirus test — even if they were asymptomatic — and the following week visits to assessment centres reportedly more than doubled. The report said those centres weren’t able to ramp up staffing and collecting tests in time due to the late notice.
More than two weeks later when the government announced certain daycares could reopen on June 12, facility operators with questions were advised to call their local public health units. The report said 40 per cent of medical officers of health who responded to a survey from Lysyk’s said their staff were left unprepared to answer questions since they didn’t receive advance notice.
As for the health command table, the body of dozens of medical professionals that provides advice to the Ontario cabinet, the report noted a lack of documentation in the early months of the pandemic when they met through conference calls (videoconferencing didn’t happen until July).
It said there wasn’t written information to show who, if anyone, voiced opposition to proposed measures. The report stated it wasn’t clear at times who attended the meetings and who spoke.
“Key participants at the health command table also shared with us their concern that it was not always clear who was speaking or whether the speaker had expertise in the subject matter being discussed and that some knowledgeable participants may have felt intimidated to speak due to the personalities and seniority of the other participants on the call,” the report said.
Recommendations for increased sharing of information
Throughout the report, there were broad recommendations about clearer and more open communications. For instance, it noted the chief medical officer of health is not making advice to the Ministry of Health publicly available, something recommended by the commission that reviewed the SARS outbreak.
Lysyk’s office also said there was “value” in publicly sharing information provided to the government by Public Health Ontario, the organization charged with providing scientific and technical health advice.
“This can give the public comfort that ministry and government decisions are aligned with the advice that has been received and makes it transparent when such advice is not being followed,” the report said.
The office called for all advice to the Ontario cabinet by Ontario’s chief medical officer of health and the public health measures table to be shared publicly and for the lead government coordinating table to develop a communications strategy to communicate decisions to stakeholders before being announced.
A response provided in the report from Ontario government officials didn’t commit to making changes and increasing transparency, saying they share information online and through news conferences to ensure people are “aware of government decisions in a timely manner.” They also said the coordinating table already engages in “timely communication with stakeholders.” The response said the cabinet receives advice directly from officials but there wasn’t a commitment to release that advice.
Not long before the report was released by Lysyk’s office and unrelated to the specifics mentioned in it, Global News spoke with Eric Kennedy, an assistant professor of disaster and emergency management at York University, about the best practices of emergency communications and management.
Kennedy didn’t comment on specific individuals or particular actions taken by officials at any of Canada’s three levels of government, but he stressed concise, clear, evidence-based, and consistent communications are essential during public emergencies.
He added his research has generally found the level of confidence by the public is greater in provincial medical officers of health versus provincial ministers, and that there was a higher degree of confidence in Canada’s chief public health versus federal ministers. However, universally he said all fared “quite well” during the pandemic.
Kennedy also said it can be “potentially catastrophic” for emergency management messaging if politicians who speak during news conferences float “trial balloons” or those who offer contradicting advice.
“Emergency managers, in short, really care about making sure that the message is the same across everyone who is speaking and really make sure that each of the messages are something everyone can get behind, that they’re thought through carefully and that reflects the best available evidence,” he said.
“If a decision has been made, it should be announced. There’s not necessarily a lot of reason to sit on a decision that has been made. But it’s also useful, and important, and appropriate to wait for more information too — the key there is just to be transparent about what you’re waiting on, what information you’re looking for, and what the factors are that are causing that need for that period of assessment.”