Ontario public health hasn’t stepped up—we need it to, now

Doctors have been getting conflicting information about how to handle this pandemic, and PHO has failed to clarify the confusion

Written March 14, 2020

By Dr. Blair Bigham

Dr. Blair Bigham

Dr. Blair Bigham

Ontario’s front-line health workers are confused, and Public Health Ontario is partly to blame. A void in communication and direction from PHO has left hospitals, already bursting at the seams and terrified of a surge in demand, making up rules on the fly, with discrepancies between and within the very buildings central to saving lives.

If you live in Ontario, you probably know the name and face of Dr. Bonnie Henry, the medical officer of health for British Columbia. But you probably don’t know what Dr. David Williams looks like. Unlike in BC, where Dr. Henry has been very clear in front of the cameras and in directives to healthcare workers, Ontario’s chief medical officer of health, has been far less visible. Much like the agency responsible for communicating and directing hospitals about what measures to implement to stop the spread of coronavirus.

Doctors are getting the run-around. My Whatsapp chats of various doctor groups across Canada (and, in my cohort from my training at the London School of Hygiene and Tropical Medicine, the world) show vastly different guidance to doctors. The Employee Health offices at many hospitals, overrun with phone calls from staff asking if they should come to work or not, are giving advice contradictory to the infectious disease departments at the exact same hospitals. Memos from hospital CEOs are making proclamations beyond what has been said publicly by the Public Health Agency of Canada, causing uproars. Policies around isolation and necessary personal protective equipment seem to change daily, and continue to generate controversy because of mixed messaging on the rationale for flip-flopping rules. A doctor returning from the USA, who works at two different emergency departments in the same city, was told he could come to work at one, but not the other. Calls to local public health departments go unanswered.

Ontario’s doctors are relying on newspaper articles written by hustling journalists and tweets from brave specialists who are filling the void left wide open by PHO to make daily clinical decisions.

It’s not just doctors getting the run-around. While Dr. Henry is strongly advising British Columbians against travel during March break, Ontario’s Doug Ford said Thursday, March 12, that “I just want the families and their children to have a good time. Go away have a good time, enjoy yourselves, and we’re going to be monitoring the situation as it changes every single day.” Ontario’s Dr. Williams said people should do a “precautionary assessment” before they travel for March break. Thanks. Contradictions like this grow distrust and can lead to the panic playing out in the toilet paper aisle at my local Loblaw’s.

It doesn’t have to be this way. Ontario should be leading, not lagging. After all, this isn’t our first epidemic. I remember being new to ambulance work as a paramedic student during Toronto’s SARS epidemic. The calm, clear presence of Dr. Sheela Basrur, Toronto’s medical officer of health at the time, was pivotal in reducing panic and increasing understanding of the unfolding spread of a new disease. The province’s direction to ambulance services was clear; paramedics didn’t know much about SARS, but we knew how to protect ourselves and serve our patients.

Now, Ontario’s doctors are relying on newspaper articles written by hustling journalists and tweets from brave specialists who are filling the void left wide open by PHO to make daily clinical decisions. Hospitals are doing what they do in a crisis—trying their best. But in a system as complex as healthcare, that means the left hand and the right hand aren’t saying the same thing.

This isn’t right. In addition to the confusion, there is potential for the loudest voices to drown out the smartest ones. Trusted information should be disseminated consistently and implemented across the board.

To be sure, PHO (along with other public health agencies) have been gutted of their funding of late. Like our hospitals, they operate without true surge capacity. We are seeing the impacts of that now, and we will pay dearly for the complacency that has thrown aside lessons learned from outbreaks of SARS (2003), H1N1 flu (2009) and Ebola (2014). We are seeing now, in real time, the economic impacts of a fragile, underfunded public health infrastructure locally, nationally, and globally.

In the emergency department, clear, direct orders are barked out when a patient is crashing. It’s how we make a lot of things happen, all at once, as a team rowing in the same direction. Ontario’s healthcare workers need this kind of leadership, now. The Ontario government, through PHO, needs to step up and tell us what to do in these extraordinary times.

Dr. Blair Bigham is a physician working in various Ontario emergency rooms. He is a graduate of the London School of Hygiene and Tropical Medicine. He’s on Twitter @BlairBigham.

*Correction: An earlier version of this article misspelled Dr. Basrur’s name. We apologize for the error.

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