June 5, 2020

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All kept quiet on the health-care front

A fear of reprisal for speaking out, inconsistent messaging has kept Manitobans from fully knowing the impact of COVID-19 on the province

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Five days after it was confirmed the novel coronavirus pandemic had arrived in Manitoba, a respiratory technician at Winnipeg’s largest hospital contacted the Free Press to raise concerns the province wasn’t prepared for the looming crisis.

The technician said hospitals were understaffed in key areas, and there was a lack of personal protective equipment that could result in unnecessary exposures to the deadly virus. The technician also claimed staff were being left in the dark about what steps were being taken to address concerns.

Resolve to blow the whistle on these issues — even anonymously — faltered when a colleague warned the technician could be fired for speaking up.

"If I lost my job because I spoke out in the wrong way and said something that I wasn’t supposed to, what would I do? This is my life," the technician said in a recent interview with the Free Press.

"I love my job. I want to be here until retirement. I have people depending on me."

Roughly two weeks later, the technician was one of 70 front-line workers at the Health Sciences Centre sent home —without pay — to self-isolate, after a cluster of cases was confirmed among staff.

That same day, it was reported the number of COVID-19 cases had reached a grim milestone, surpassing one million globally.

The technician said staff were exposed to the virus on the job, in a situation where they were explicitly instructed by superiors not to wear an N95 face mask in order to save supplies.

"That had me over the roof," said the technician, who ultimately tested negative for the virus.

Amir Attaran, Professor, Faculty of Law & School of Epidemiology and Public Health at the University of Ottawa, in Ottawa on May 22, 2020. (Justin Tang for Winnipeg Free Press)

JUSTIN TANG FOR WINNIPEG FREE PRESS

Amir Attaran, Professor, Faculty of Law & School of Epidemiology and Public Health at the University of Ottawa, in Ottawa on May 22, 2020. (Justin Tang for Winnipeg Free Press)

From coast to coast, Canadian nurses and doctors have shared emotional stories about dealing with COVID-19. South of the border, where there have been more than 95,000 deaths, the reports from front-line workers have been even more dramatic.

But they are not coming from Manitoba, where the fear to speak out appears to override the public’s right to gain greater understanding of the biggest health-care story in our lifetime.

David Hutton, a senior fellow at Ryerson University-based Centre for Free Expression’s whistleblower initiative, was not surprised the respiratory technician in Winnipeg was scared about speaking to the media.

"This is completely predictable, because Canada is one of the worst countries in the developed world for protecting whistleblowers. This is not just my opinion… We’re known internationally as the Titanic of whistleblower protection," Hutton said.

"We’re the country that demonstrated how not to do it."

Hutton said potential whistleblowers are often terrified into silence due to the repercussions they’ll face for speaking out, which often include being fired and blacklisted in their profession.

"That’s the typical trajectory. It’s like a playbook," Hutton said.

Steve Homick of Windsor, Ontario is a registered nurse at Beaumont Hospital Royal Oak emergency room in Royal Oak, Michigan.  Homick is among about 1,600 Canadian nurses fighting the pandemic at Detroit hospitals, but some Canadian health officials are worried they could spread the disease in Canada and want to restrict their movements across the border. (Robin Buckson / The Detroit News/TNS)

TRIBUNE MEDIA TNS

Steve Homick of Windsor, Ontario is a registered nurse at Beaumont Hospital Royal Oak emergency room in Royal Oak, Michigan. Homick is among about 1,600 Canadian nurses fighting the pandemic at Detroit hospitals, but some Canadian health officials are worried they could spread the disease in Canada and want to restrict their movements across the border. (Robin Buckson / The Detroit News/TNS)

Steve Homick, a Windsor, Ont., resident who works as an emergency room nurse at Beaumont Hospital in Royal Oak, Mich., has done several interviews with media since the pandemic began.

While he has the support of hospital administration, Homick said other nurses in the state have faced repercussions for publicly raising concerns over unsafe work environments.

Despite the repercussions that often follow, Homick said he believes it’s important for front-line workers to sound alarm bells, when needed.

"Things don’t change unless people know there’s an issue. If it can help jumpstart things getting better in some of these really bad work environments, it’s not just better for the staff, it’s better for patients, too," he said.

Transparency concerns in Manitoba don’t start or stop with front-line workers worried about repercussions for speaking out.

Critics charge while the provincial government has provided the public with information during the pandemic, it has done so inconsistently, at times incoherently, and always in a highly-guarded manner.

In Manitoba, the disclosure of public health information related to COVID-19 has fallen short of what’s been offered by some private-sector companies, such as grocery stores.

Manitoba initially reported details of confirmed and probable cases including age, gender, health region and source of infection. Within weeks, however, the province clawed that information back, revealing only summary counts and status of cases.

By comparison, on its corporate website, the grocery chain Sobeys posts a running list of cases where employees have tested positive, including details such as the location of the affected store and the last day the employee worked.

Meanwhile, when a cluster of cases was discovered at a business in Brandon, the Manitoba government refused to reveal which company was affected and what sector it operated in — stressing only the outbreak wasn’t believed to pose a wider risk to public safety.

(The media subsequently confirmed the affected business as Paul’s Hauling, a trucking company with multiple locations in the province. There have been 10 confirmed cases connected to its Brandon operation.)

Another example of a lack of communication came Thursday, when it was discovered Manitoba has begun testing asymptomatic individuals for COVID-19. The provincial government chose to not publicly announce the initiative, instead burying the information in a document posted to Shared Health’s website. On Friday, Chief Public Health Officer Dr. Brent Roussin said those testing protocols weren't announced publicly to avoid an overwhelming influx of asymptomatic people showing up to be tested, and to try to maintain a random sampling.

Testing people that don’t exhibit symptoms can provide a better sense of how widespread the virus is in the community, and the initiative marks a major shift in the province’s approach to tackling the pandemic.

Issues surrounding poor communication have not been limited to Manitoba. On Friday, Ontario’s top doctor acknowledged for the first time public health messaging during the pandemic has been inconsistent, and vowed to do better moving forward.

Unlike other provinces, Manitoba’s model included a single scenario that assumes no public health measures or travel restrictions are in place and does not contain any references to possible deaths. (Screenshot / Manitoba Health, Seniors and Active Living)

Unlike other provinces, Manitoba’s model included a single scenario that assumes no public health measures or travel restrictions are in place and does not contain any references to possible deaths. (Screenshot / Manitoba Health, Seniors and Active Living)

Manitoba has also fallen far short when it comes to modelling.

In late March and early April, federal and provincial agencies began preparing and releasing models of the potential spread of the virus, including forecasts of cases, deaths, and the impact on health-care systems based on scenarios of varying degrees of compliance with public health measures.

While other provinces prepared projections, and in some cases released updated models, Manitoba resisted pressure to do so.

Premier Brian Pallister dismissed using a "conjectured guess" about possible trajectories of COVID-19. He referenced the wide range of possibilities projections provide, and stated he wasn’t interested in scaring everyone to get the attention of a minority of Manitobans who were not following public health measures.

While the province eventually released a single model in April, which has not been updated, the lack of detail — compared to other jurisdictions — is striking.

Manitoba’s model included a single scenario that assumes no public health measures or travel restrictions are in place and does not contain any references to possible deaths.

Amir Attaran, Professor, Faculty of Law & School of Epidemiology and Public Health at the University of Ottawa, holds a graph showing the seven day rolling average of cases per capita, with Canada shown in black. (Justin Tang for Winnipeg Free Press)

JUSTIN TANG FOR WINNIPEG FREE PRESS

Amir Attaran, Professor, Faculty of Law & School of Epidemiology and Public Health at the University of Ottawa, holds a graph showing the seven day rolling average of cases per capita, with Canada shown in black. (Justin Tang for Winnipeg Free Press)

Amir Attaran, a professor in the faculties of law and the school of epidemiology and public health at the University of Ottawa, sharply criticized Pallister for playing down such work.

"The weather forecast is an educated guess. Are you seriously going to tell farmers in Flin Flon they can’t have the weather forecast before they plant? Can you imagine the Bank of Canada saying, ‘We’re not going to produce an economic forecast because it may be wrong?’" Attaran said.

"The reason you don’t see good modelling in Canada is because the governments have done such an incompetent job marshalling data that they can’t feed that data into a model. Most governments in this country continue to acquire epidemiological data from the regions by fax machine. We are primitive. It’s as if we only just retired the carrier pigeon."

Attaran points to countries such as Norway, South Korea, Switzerland and Germany, who lead the way globally on data aggregation and communication, painting a clear picture for their populations about the situation they’re in, the steps being taken, and where trip lines are that could lead to lockdown measures being reimplemented.

Canada was one of the last countries to be hit by the pandemic, which gave governments additional time to prepare and the benefit of watching the approaches of other countries. While that’s led to a lower infection peak, Attaran said many of Canada’s benefits have been squandered, leading to unnecessary economic disruption and deaths.

Without good data and scientific modelling, Attaran said provinces will end up keeping lockdowns in place too long — costing billions of dollars — or lifting them too soon, leading to deaths. 

"I have not seen a single province do a competent, transparent job at data acquisition and analysis and disclosure. And I don’t think this is hyperbole," Attaran said. 

"I’ve worked in public health and policy in numerous countries. I’ve been educated in several countries. I’ve never seen a western country as scientifically incompetent as Canada." 

In a pandemic, when the margins of error are so small, and the risks of a misstep so high, Attaran said concrete action must be taken to address these shortcomings — and fast. 

"We’re in the middle of a maelstrom. It’s a storm and we need to get out of it… But we’re walking with a blindfold on and we’re walking on a ridge with a cliff on each side," he said. 

"And on one side is impoverishment, and on the other is death."

 

ryan.thorpe@freepress.mb.ca

Twitter: @rk_thorpe

 

michael.pereira@freepress.mb.ca

Twitter: @__m_pereira

Ryan Thorpe

Ryan Thorpe
Reporter

Ryan Thorpe likes the pace of daily news, the feeling of a broadsheet in his hands and the stress of never-ending deadlines hanging over his head.

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History

Updated on Saturday, May 23, 2020 at 11:58 AM CDT: Adds Roussin's explanation of why the decision to start testing asymptomatic people wasn't publicly announced.

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