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Canada’s Chief Public Health Officer Dr. Theresa Tam is calling for “structural change” across health, social, and economic sectors in the wake of COVID-19, in a new report highlighting the successes and shortfalls in the country’s pandemic response to date.
“I do see COVID-19 as a catalyst for collaboration between health, social, and economic sectors, and I have observed at the federal level, but also from local levels, and provincial levels,” she told reporters during a press conference discussing the report.
Tam said that while there are examples of decisions taken that begin to address some of these shortcomings—such as increasing affordable housing availability and financial supports for low-income and precarious workers—these policies should be extended past the emergency phase of the pandemic.
“What Im really, really keen to see is that this continues… The report is calling for this to be a more sustained approach,” she said. “Why cant we have those governance structures beyond the crisis and into recovery?”
In the Public Health Agency’s annual report made public on Wednesday, Tam offers new insights and statistics related to Canada’s battle against the novel coronavirus over the last several months and the “serious threat” the virus continues to pose.
For example, in Canada:
80 per cent of COVID-19-related deaths have been residents of long-term care facilities;
19 per cent of national cases are among health-care workers; and
92 per cent of hospitalized COVID-19 patients had at least one underlying health condition.
The annual report is entitled “From Risk to Resilience: An Equity Approach to COVID-19,” and it gives an overview of COVID-19’s consequences so far, such as the disproportionate health impacts experienced by workers who provide essential services, racialized populations, people living with disabilities or mental illnesses, and women.
It also includes recommendations on how to improve the country’s pandemic preparedness, response, and recovery.
The report says the “structural change” should include improving employment conditions and conditions inside long-term care homes, increasing access to housing, as well as enhancing Canadians’ ability to access social and health services both in-person and online.
Tam said she hopes that in future pandemic planning, “it cant just be health and public health making it known that all other departments and different sectors, and different aspects of societies need to be part of the response. We need to sort of build it in explicitly so that, you know, future pandemics and health crises have those other supports come into play immediately.”
As Tam argues, Canadians’ health depends on their social and economic well-being and the severity of COVID-19 illness may be influenced by their access to these kinds of supports.
“No one is protected until everyone is protected,” says Tam in the report.
Tam’s overall recommendations are distilled into three calls:
Sustaining governance at all levels for “structural change” in health, social, and economic sectors. The report notes that the health of people in Canada was not equal before COVID-19, but that the pandemic has exposed and exacerbated existing shortcomings. Tam suggests that more data needs to be collected and used to inform policy decisions to eliminate inequities and mitigate some potential long-term pandemic impacts;
Harnessing “the power of social cohesion” to control and minimize the virus’ spread. She suggests this can be done by leaders sharing evidence and information to provide Canadians with confidence in taking public health precautions such as mask-wearing; and
Strengthening public health capacity. Tam says that more work is needed to ensure Canada’s public health system is able to handle case surges while having the capacity to deal with non-COVID-19 health issues, including re-evaluating “what sustained investments and the future of public health would look like.”
GLOBAL COMPARISONS
The report also goes over the timeline from the first confirmed case in Canada and when community transmission began, to the various rolling restrictions and travel advisories imposed.
From a global perspective, according to the report, Canada ranked 79th out of 210 countries with respect to total cases per million inhabitants, and 26th for total deaths per million, as of Aug. 22. The outbreaks in Canadian long-term care homes are cited as a driving factor in why Canada is so high on the list of countries when it comes to deaths.
“Pandemic preparedness did not extend into these settings leaving residents vulnerable to the introduction, spread and impact of a novel virus,” the report states.
Tam was asked whether she thinks enough lessons from the first wave have been learned to prevent the same high rate of deaths in long-term care homes. She said that so far the scale of the outbreaks inside these homes is not as large, and efforts have been taken to improve infection control, but the virus is “very sneaky” and preventing more seniors’ deaths still depends on the actions all Canadians take.
“Right now the second resurgence, a lot of the cases are in the younger adult population, but what were seeing is that its beginning to permeate through other age groups including the elderly,” Tam said.
Further, analysis of international travel-related cases between January and March found that 35 per cent of cases entered Canada from the United States, 10 per cent from the U.K. and France, and 1.4 per cent from China. Once travel restrictions were imposed, 91 per cent of reported cases by August originated in Canada.
COMMUNICATION STRUGGLES
The report notes that in the absence of an effective treatment or vaccine, individual and collective public health measures need to be taken to control the pandemic. However, “accurate, timely and clear communication” has been a challenge.
Tam notes that there have been “a number” of issues on this front, such as Canadians being exposed to a vast amount and varying quality of information and the confusion spawning from the frequently-moving goal posts when it comes to public health advice due to the evolving science.
“Information needs to be tailored and locally contextualized, while at the same time balanced with consistent key messaging being shared across the country,” the report states.
Tam is advising that as long as the virus is uncontrolled, public health officials and governments need to be transparent and provide regular updates on COVID-19 and up-to-date guidance.
It’s a part of Tam’s mandate to provide Health Minister Patty Hajdu with a report on the state of public health in Canada annually, which then is tabled in Parliament.
The report is based on Canadian data available from January to the end of August, and notes that because the virus and evidence around it continues to rapidly evolve, “the report was written with the knowledge that the story of this pandemic is continuing to change every day.”
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