COVID-19 Diary – Day 190

Today Tina Namiesniowski, resigned her position as the president of the Public Health Agency of Canada. She was appointed to the role on May 6, 2019, and completed only a little over 1 year of her possible 5-year term. In her public statement, she hoped to remind everyone of the toll that a relentless pace can have on each of us and our loved ones and spoke about wanting to reconnect with her family before deciding on her next steps.

This news came just weeks after Sally Thornton, the Vice-President of the Public Health Agency of Canada, who is in charge of Canada’s pandemic early warning system and national emergency strategic stockpile, also resigned. Sally Thornton has been in the centre of a storm of controversies lately, with many words of criticism and frustration being shared by other ministers over her performance.

Under Sally’s guidance, Canada’s pandemic early warning system, officially called the Global Public Health Intelligence Network, was effectively shut down with staff re-assigned in May of 2019. Before the shutdown, the GPHIN was said to supply “approximately 20 percent of the WHO’s epidemiological intelligence”. This was just 8 months before COVID-19 would be officially recognized as a threat in China, and is exactly the kind of thing the system was built to detect and help us defend against.

It may be no coincidence that Sally Thornton’s resignation comes just a little over a month after the Auditor General of Canada began an investigation into what went wrong with the GPHIN system, and what led to allegations that scientists were reporting their voices were marginalized within the department, preventing key messages from making it up the chain of command. Canadian’s everywhere owe The Globe & Mail a debt of gratitude for their investigative report, which happened to catch the eye of the Auditor General and directly led to their investigation.

Another interesting piece of data is that back in April 2020 we were getting a very different story about the state of GPHIN from the Pubic Health Agency. Canadians were told “The Global Public Health Intelligence Network was getting an overdue tech upgrade when COVID-19 hit” and “The network delivered its first report about COVID-19 on Dec. 31, 2019”. However, we now know that GPHIN was disbanded on May 24th, 2019 and that a department edict went out that all public alerts had to be approved by senior managers. The senior managers at the time were Dr. Theresa Tam (Chief Public Health Officer), and Tina Namiesniowski (Appointed President a few weeks prior on May 6th, 2019). This means that the information provided claiming that GPHIN was getting a tech revamp must have been approved by one of the senior managers. This does lead to the question of why Dr. Theresa Tam was claiming to be receiving reports from GPHIN long after it was shut down though, and also why they were not forwarding reports to countries that used to receive data from GPHIN, just in the interests of global health?

Another of the controversies surrounding Sally Thornton is the handling of the national emergency strategic stockpile, which has been referred to as “a national scandal“. But what is the national emergency strategic stockpile? According to the official public health page, it is a collection of items used to help the federal government response to the following kinds of situations:

• emerging and re-emerging diseases
• the increasing severity and magnitude of natural disasters
• health threats due to exposure to harmful chemical, biological, radiological or nuclear agents

And some of the specific items stored include (this is not an exhaustive list):

• ventilators
• stretchers
• mini-clinics for triage and minor treatment
• personal protective equipment including masks, gloves and disposable gowns

Since the SARS epidemic in 2009, the stockpile has seen reduced funding and support. In 2012 the number of active warehouses it maintained shrunk from 11 warehouses in 9 cities, to just 8 warehouses in 6 cities across all of Canada. In 2019 the budget for maintaining the stockpile was listed at $3 million.

On December 31st, Canada received a report about the existence of COVID-19. In early January the global supply chain for PPE was already disrupted, with some items on indefinite backorder. On January 25th the first presumptive case of COVID-19 was declared in Canada. On January 30th the W.H.O. declared the coronavirus “public health emergency of international concern“. On March 11th COVID-19 was declared a global pandemic. And finally, at the end of March Canada signs our first contracts for domestic production and supply of medical supplies including surgical masks and rapid tests for COVID-19. On April 1st the Ontario Hospital Association declared they were critically low on PPE, and requested immediate answers on when additional PPE would be available.

At an April 22nd meeting of the Standing Committee on Health, Sally Thornton was questioned by committee members on the status of the strategic stockpile, the level of PPE stock on hand with provinces, and for information on how quickly they were burning through their existing stock of PPE. Unfortunately, Sally was unable to answer any of these questions. One of the few questions she was able to answer directly was regarding the amount of expired PPE that had been destroyed in 2019, and she had this to say:

“approximately two million expired masks and 440,000 expired gloves were disposed of during the closure of one of the warehouses in Regina. The masks and gloves had been purchased in 2009. They passed the manufacturer’s recommended limit of five years for their use.”

Later, in a committee meeting that took place on May 15th, Sally Thornton continued to dodge specific questions about the state of PPE in the strategic stockpile, both prior to the pandemic as well as the current state. She also repeatedly claimed that the strategic stockpile was not intended to solve a national supply problem of PPE, and they had been following their mandate. I have been unable to find any explanation for why the PPE that was expired and destroyed in 2019 was never replaced, other than the following quote: “We do not focus on PPE and that wouldn’t be a major element, because we count on our provinces, within their respective authority, to maintain their stockpile.”.

Looking forward again to recent news, Patty Hajdu the Minister for Health, called for an independent review of our pandemic warning system, after spending a month looking into the problems at its departmental level (formerly Sally Thornton’s department). “We’re working on [appointing] some professionals that would have the experience and the expertise to be able to do this review thoroughly, but also expeditiously … I don’t want this to be a two-year review,” the Health Minister said. The people leading the review are expected to be named in the coming weeks and will be independent of Public Health Canada.

That’s all for now, stay safe everyone!