Ontario’s leaders need to tell us what’s guiding their pandemic response

OPINION: What would it take for the government to reimpose certain COVID-19 restrictions? What’s guiding its decision-making? We all need to know what the red lines are
By Matt Gurney - Published on Sep 17, 2020
Chief Medical Officer David Williams and Premier Doug Ford at a Queen’s Park briefing on June 12. (Frank Gunn/CP)

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For most human beings, stress does not improve decision-making abilities. We may well respond effectively to a sudden threat — we yank our hands off hot burners or duck if we hear a loud crash. Making good decisions, in the heat of the moment, though, isn’t something most of us are wired to do. But we can be trained.

We train our first responders in all kinds of scenarios they are likely to face, and some they aren’t. Doctors and pilots train exhaustively before they ever operate on a patient or solo a flight. Soldiers drill intensely not just in the concepts of war, but also in the thousand little details that might save their life under fire. Sighting a target or swapping out an expended magazine becomes a matter of instinct; indeed, modern militaries seek to train their soldiers as hard as they can so that battles will seem surprisingly easy by comparison.

These are the things we do to give people an edge in a crisis. We automate as many of their reactions as we can.

But how do we train leaders?

This question has long fascinated me. Voters pay a lot of attention to what a would-be elected official did before they ran for office, and search for signs that they have the right stuff. What you want to see depends a lot on what kind of leader you’re looking for, but we all look for something that will convince us that someone is cut out for the job. What prepares you, though, to lead a province or country during a global pandemic?

It’s tempting to say “nothing,” but that’s not quite true. A pandemic is one of the scenarios we knew was possible, alongside wars, terrorism, and natural disasters. Our emergency planners run scenarios and exercises on a regular basis to make sure key people know their roles and memorize the little tasks. (How good a job we did preparing for this pandemic is, of course, a matter of continued debate.) But now, with a second wave of COVID-19 looking imminent — if it hasn’t happened already — we have one big advantage going in. The response to the second wave will benefit not just from the lessons learned during the first, but also from the experience obtained by our leaders. They are quite literally infinitely more experienced this time.

They have been trained, the hard way, on how to respond.

What seem conspicuous by their absence, though, are any objective measures that could guide our provincial government — and Premier Doug Ford, specifically — as the second wave arrives. The premier has been asked often in recent days about when he’d reimpose restrictions, what would be required to move a region back to Stage 2 (or something like it). There’s been no firm answer from him or anyone else. We’re assured they’re watching things closely. Questions about specific metrics, though, go unanswered.

I can speak from direct experience: I emailed the Ministry of Health and the communications staff for David Williams, Ontario’s chief public-health officer, with those exact questions. Specifically, I asked, “What, if any, guidance exists that will use evidence, metrics, etc, in order to possibly trigger a re-imposition of restrictions in Ontario to blunt the spread of COVID-19?” I also asked, “If they don't exist at this time, are such guidelines being developed?”

I received no response of any kind from Williams’s staff. The Ministry of Health told me in a reply email that “protecting the health and well-being of Ontarians remains our government’s top priority. The government has taken decisive action to expand testing capacity and enhance case and contact management in order to limit transmission, and prepare for outbreaks or surges in the future. … Our government will continue to use evidence and scientific advice to inform our decisions.”

That’s not exactly what I was asking, was it?

In a best-case scenario, the second wave won’t be serious: It won’t surge. It won’t overwhelm hospitals. It won’t force more lockdowns or shut down schools. There is genuine reason for optimism here. Predictions of disaster this fall and winter may well prove accurate, but that result is by no means guaranteed.

One of the main lessons of the first time ought to have been how quickly our governments clearly became overwhelmed by the scale and breadth of the crisis. And setting out clear benchmarks to guide our response now, before the crisis becomes acute (if it does), would make our future responses better. Put bluntly, we don’t have to wing it again, unless we choose to. Which we shouldn’t.

The benchmarks could be any number of things. We could use testing capacity as a signal of danger — if we can’t keep up with the number of tests, we could slow the economy down. We could use the test results as our benchmark: a certain number of positive tests, a certain rate of positive tests, or a certain number of positive cases per local population could all function as  red lines triggering new restrictions. Hospital capacity could be our metric. All these metrics could be weighted to local conditions and then adjusted: for example, in the event of a major second wave, hospital capacity would likely bounce up and down as health-care workers fell but also as new field facilities opened. As capacity shifted, so could the red line.

The point isn’t to pick which red line is best or where to set it. I’m not qualified to do that. The point is that we should have a red line, one that is clear, simple, reasonably easy to monitor even with our lagging indicators, and disclosed publicly in advance. This would give everyone — from the public right on up to the premier — the ability to have clear, understood targets, a threshold chosen rationally and coolly in advance that could be referred to later, even during a catastrophe.

The other option is to do what we did the first time: leave it up to individual public-health officials and elected leaders to make their decisions on the fly, in the heat of a rapidly unfolding crisis.

There is absolutely no one who’d argue that that’s the right way to do things. Choosing red lines beforehand — and then applying public-health restrictions automatically if those lines are crossed — is far and away the better option.

Ontario may not have any clear red lines. Or, any rate, if it does, it isn’t sharing. That’s a problem. But it’s one we probably still have time to solve.

Here is the full text of the Ministry of Health’s response to the author’s request for comment. Only the personal details of the sender have been removed. The author received the email at precisely 4 p.m. on September 16.

Hi Matt,

Please see our response below.

Questions

  1. What, if any, guidance exists that will use evidence, metrics, etc, in order to possibly trigger a re-imposition of restrictions in Ontario to blunt the spread of COVID-19?
  2. If they don't exist at this time, are such guidelines being developed?

Response

Protecting the health and well-being of Ontarians remains our government’s top priority.

The government has taken decisive action to expand testing capacity and enhance case and contact management in order to limit transmission, and prepare for outbreaks or surges in the future.

The government, in consultation with public health experts, continues to review trends from a range of criteria on an ongoing basis to determine if public health measures need to be adjusted or tightened. This includes:

    • Virus spread and containment (including number, type and setting of outbreaks);
    • Health system capacity;
    • Public health system capacity; and
    • Incidence tracking capacity (e.g., testing capacity).

Our government will continue to use evidence and scientific advice to inform our decisions.

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