We Are in a Public Emergency Situation – Health Scientists Are Not Qualified to Lead the Response
According to a March 2 press release by the Government of Ontario, “A new Command Table will be the single point of oversight providing executive leadership and strategic direction to guide Ontario’s response to COVID-19.” The Command Table, whose membership has never been disclosed, reports to the Minister of Health, Christine Elliott. The Ministry’s existing Emergency Operations Centre “will continue to provide situational awareness and perform an overall coordination function”. Yet, the Minister, along with the Province’s Chief Medical Officer of Health, Dr. Williams, and municipal and regional MOHs such as Toronto’s Dr. Eileen de Villa, are the public faces of the pandemic response and use their powers to order sweeping restrictions on everyday live. The March 2 press release is clearly focused on the health and medical side, promising to “Safeguard [the] Public from COVID-19” and “Ensure Health System Readiness”.
While this singular focus may have been appropriate in the early phase of the COVID-19 outbreak, doubts have started to emerge as early as March 2020 and continue to grow. In a May 12 post titled “Corona Crisis – Tunnel Vision vs Comprehensive Risk Assessment“, I summarized a leaked report — known as the “false alarm paper” — from Germany’s crisis management specialist Stephan Kohn, in which the author argues that “a new crisis situation should be declared and the out-of-control pandemic crisis management itself be battled”. In “We Have a Different Emergency Than You Think“, an anonymous blogger and self-identified business professional provides a brief but scathing assessment of the Ontario government’s situation assessment and emergency response capabilities. He recommends listening to Canadian emergency management experts, at least two of whom have spoken up about the corona crisis: David Redman and Alex Vezina.
Dave Redman draws from 27 years of service in the Canadian Armed Forces followed by 5 years with Alberta’s emergency management agency, where he held lead roles in the 9/11 response and the development of the province’s Pandemic Support Plan, and another 8 years as an organizational consultant. Redman has been arguing since April that the corona crisis is a public emergency, not a public health emergency, and Canada’s response should be led by emergency managers, not by public health bureaucrats. In a December 7 interview with C2C Journal, Redman notes that government mission statements focusing solely on COVID-19 fall short of addressing the full scope of the emergency, since the crisis affects all sectors of society. In letters to politicians and the media he emphasized the need to translate the characteristic age distribution of COVID-19 victims into targeted protection of elderly populations and isolation of long-term care home residents and staff. As reflected in the title quote of the C2C Journal interview, “Every Store and School Should be Open”, Redman concludes that a proper hazard assessment and pandemic response would dictate a balanced set of goals including COVID-19 control along with mitigation of other health impacts and minimizing social and economic disruption. Redman provided me with his most recent, January 5, 2021, assessment and recommendations for Canada’s COVID-19 pandemic response, which I am honoured to share here. As of mid-January, his recommendations have made their way into the mainstream media, with commentaries in the Calgary Herald and Winnipeg Sun.
Alex Vezina, CEO of Prepared Canada Corp., a business continuity planning and training consultancy, has written a series of newspaper commentaries since April 2020, touching on a variety of aspects of the pandemic. Vezina emphasizes the need for open communication throughout the crisis, discusses the limitations of the available data, and assesses the potential side effects of possible solutions. For example, in a December 22 op-ed in the Toronto Sun, Vezina explains “Why COVID-19 closed some businesses and not others“, referring to essential businesses as well as those services (e.g. schools), the closure of which would have an impact on workers at essential businesses.
The ostensible attempt to balance “the economy” and COVID-19 deaths is a moral reproach often brought forward against lockdown skeptics. Yet, it is naive to view the economy as independent of our wellbeing. In May 2020, a group of medical, economic, and policy experts associated with the MacDonald-Laurier Institute wrote an open letter aptly titled “Beyond Lockdown: Canadians can have both health and prosperity”. In Germany, the Corona Initiative of Small and Medium Entrepreneurs (CIDM) is maintaining its own modelling and forecasting at CIDM.online, which since March 2020 has focused on hospital and ICU capacity rather than raw case counts and includes estimates of the burden of domestic abuse of women and children due to the German lockdown. In Canada, the Canadian Federation of Independent Business (CFIB) is advocating for small- and medium-sized non-food businesses to re-open in order to restore the livelihood of their employees and local communities. At a global scale, Hans Rosling’s “200 Countries, 200 Years, 4 Minutes” comes to mind. In this animated demo, the statistician shows the relationship between health (represented by life expectancy) and wealth (personal income) and the development of countries from “poor and sick” to “rich and healthy”. The positive association between the two metrics is almost universal.
|Loss of life|
– both hands or both feet
– sight of both eyes
– one leg or one arm
– one hand and one foot
– one hand and the sight of one eye
– one foot and the sight of one eye
– speech, and hearing in both ears
Loss of use of:
– both arms or both hands
|Loss of use of:|
– one arm or one leg
– one hand or one foot
– sight of one eye
– hearing in both ears
Loss of use of:
– one hand or one foot
|Loss of: |
– thumb and index finger of the same hand
|Loss of: |
– hearing in one ear
– all toes of one foot
|Quadriplegia, Paraplegia, Hemiplegia||$200,000|
Is it morally corrupt to put a dollar value on a life? It feels wrong but we are doing it anyway, all the time. If you are fortunate to have accident insurance at work, check the coverage details. Mine are dependent on annual earnings, but the guest coverage shown in the above table is illustrative enough. A life is worth $100,000, a leg or arm $75,000, and so on. I don’t know about you, but I have to say that I cringe when reading this. Yet, I rationally understand that it can be useful for decision-making to quantify the loss of human health and life.
Similarly, we can quantify the public health impacts of both COVID and the pandemic response measures. Dr. Ari Joffe is a scientist who uses quantitative cost-benefit analysis to compare the benefits of lockdowns to their true costs. The results reported in his comprehensive preprint article “COVID-19: Rethinking the Lockdown Groupthink” are shocking. Dr. Joffe estimates that the cost of lockdowns at a global scale as well as for Australia and the US is at least five times (5x) as great as their benefit.
The most important element of these calculations is to translate the benefits and the costs to the same metric. The metric commonly used is the “quality-adjusted life year” (QALY). The costs of lockdowns far exceed their benefits because the costs affect all age groups including young people with many QALYs at risk, while lockdowns primarily benefit advanced age groups with fewer QALYs left. While QALYs are directly comparable, they can also be monetized to associate lockdown costs and benefits with dollar values. An example is shown in the above table from Dr. Joffe’s article, in which he refines a previous cost-benefit analysis for the US.
In a separate commentary for the MacDonald-Laurier Institute titled “Rethinking lockdowns: The risks and trade-offs of public health measures to prevent COVID-19 infections“, Dr. Joffe estimates that the cost of lockdowns exceed their benefits by a factor of 10 globally and a factor of 17 in Canada.
According to the March 2 press release cited at the beginning of this post, “A Scientific Table, led by Public Health Ontario, will support the provincial and regional components of the response structure with the provision of evidence, and scientific and technical advice to inform planning and response.” The “Ontario COVID-19 Science Advisory Table” includes 31 eminent Ontario medical scientists and health administrators, but not a single non-health scientist. Representation from fields such as psychology, social science/work, and economics is ominously missing. At this point, ten months into the crisis, the provincial government is under-estimating the situation, when it reduces it to a health emergency.
My confidence in the public health sector would be greater, if dissenting opinions from within public health would be considered more seriously instead of being censored and silenced. This is eloquently argued by Dr. Vinay Prasad in an op-ed titled “We Need More Than Pandemic Preparedness — Next time, we need scientific preparedness“. Among other observations, Dr. Prasad asserts that “we must be open to debate”, the media should feature “academics and thoughtful people with diverse views”, and “a scientific preparedness plan would leverage incentives” for critical thinkers. German MD, retired health politician, and lockdown critic Dr. Wolfgang Wodarg, who has recently filed a defamation law suit against a mainstream media fact checker, had a humorous view of the failure of the global COVID-19 response. At the conclusion of an interview with Nick Hudson of South Africa’s Pandemics ~ Data & Analytics (PANDA), he equated the failure of communication during the pandemic with an “auto-immune disease in politics”.
I think this metaphor applies beyond communication, censorship, and cancel culture. It applies to the ill-advised reliance on health “experts” and, within health, to the singular focus on COVID-19. By shutting down social live and shrinking the economy, we have inflicted great and lasting damage to a functioning society. Unlike in the movies, our politicians did not accidentally shrink the economy though; rather, they knowingly entered the unprecedented lockdown experiment. And their public health advisors, who normally have a broader view of socio-economic determinants of health, should have known better. It is high time that the pandemic response is taken over by real experts and holistic thinkers.