To better understand Ontario’s third wave: This April 17, 2021 CBC Radio interview documents the year-long back story

This post concerns a CBC Fresh Air interview clip which is devoted to Ontario’s response to COVID-19.

By way of background, an April 22, 2021 article by faculty members at the University of Toronto, entitled: “Public Statement from Historians at the University of Toronto, April 21, 2021,” sets the scene.

An excerpt reads:

The provincial government’s evident disregard for scientific advice is costing the health and lives of the most vulnerable Ontarians, many of whom are racialized people, immigrants, women, single parents, the homeless, the disabled and the underhoused. The government, in its utter failure to live up to its basic responsibilities, betrayed its democratic mandate and provoked an unnecessary political crisis. On April 16th, rather than acting responsibly and listening to its own public health experts, the provincial government sought to impose authoritarian measures that undermined democracy while doing nothing to address the public health disaster that its own negligence helped to create.

An April 25, 2021 Washington Post article is entitled: “Ontario hospitals under strain, and a premier under siege.”

An excerpt reads:

But critics say the province made critical missteps and failed to learn the lessons of previous surges, including the need to act quickly and decisively before case numbers hit a level that could stretch a health-care system.

COVID-19 climbdowns

By way of additional background, an April 22, 2021 CBC article is entitled: “The inside story of Doug Ford’s COVID-19 climbdowns: Giving police arbitrary powers and closing playgrounds ‘came out of nowhere,’ says source.”

An excerpt from the article, which underlines the context, for the April 17, 2021 CBC Fresh Air transcript (see below), reads:

One thing the sources do agree on: the recommendations did not come from the government’s health or scientific advisers.

In sharing the transcript, I note the CBC Fresh Air clip in question is from April 17, 2021. The interview warrants close attention even these many days later. We need to step outside the pace of news cycles, and consider what has been unfolding for quite some time.

A key narrative, that does not change with ongoing news cycles, concerns the distinction between public health decisions based on evidence from the government’s health and science advisers, and decisions that ignore the evidence. When the science is ignored, when it’s not acted upon, preventable public health disasters ensue as is now the case in Ontario.

The transcript of the interview, 18 minutes and 48 seconds in length, warrants close study.

Among other things, at the end of this beautifully constructed clip, Dr. Kwadwo Kyeremanteng speaks of the value of focusing on positive messaging, and on doing what can be done, even in difficult circumstances.

Outrage across Ontario; transcript of April 17, 2021 CBC Fresh Air interview

The April 17, 2021 CBC Fresh Air interview clip is entitled: “‘There was unanimous outcry from 14 and a half million people in the province.’ Doctors weigh in on outrage over Ontario COVID-19 measures.”

The subtitle for the clip reads:

Dr. Isaac Bogoch, infectious diseases physician and scientist at Toronto General Hospital and Dr. Kwadwo Kyeremanteng, ICU & palliative care physician at the Ottawa Hospital share their thoughts on the the Ontario government’s recent COVID-19 restrictions, policy changes.

The transcript (lightly edited for clarity) which I’ve put together reads:

Well, the province’s policy changes, restrictions, and new measures continue to be questioned by experts and the public alike. These changes come, of course, as we are seeing record-breaking numbers of new Covid cases daily, and hospitalizations.

And for the latest on what doctors are seeing on the ground, we are joined now by two experts.

Dr. Isaac Bogoch is an infectious diseases physician and scientist at Toronto General Hospital; he’s also a member of Ontario’s COVID-19 vaccine distribution task force; and Dr. Kwadwo Kyeremanteng is an ICU and palliative care physician at the Ottawa Hospital.

Both of them have been good enough to join us now on the line for more.

Good morning.

Dr. Isaac Bogoch: Good morning.

Dr. Kwadwo Kyeremanteng: Good morning, Jason.

Thank you very much for taking the time with us.

Dr. Kyeremanteng, all of these new measures, restrictions, and policy changes, as I say, that we’re seeing are being done with the backdrop of the increase in case numbers, the hospitalizations, and the enormous strain that we are seeing across the province’s ICUs.

To start, can you describe what you’re seeing and hearing these days.

Dr. Kyeremanteng: Yeah, Jason, thanks for having me once again. You know, the situation in Ontario, I think is what we were trying to avoid, throughout this pandemic. Unfortunately, we’re seeing rising hospitalizations, ICU admissions, to the point where some of the patients, for example, within the GTA, are being transferred within our Ottawa Region, to try and offset some of the numbers.

And so, yeah, we’re entering a level of increased need and, for example, tomorrow, I’m going to work on a time where I was supposed to be having some time off, but because of the increased need, because of the need to increase capacity, we’re going to have extra docs, extra staffing. We’re increasing our ability to take on more patients, and this is what’s happening throughout Ontario.

We’re seeing cancellations of elective surgeries to be able to have, once again, more staff available to be able to provide the, you know, exceptional care to our Covid and non-Covid patients, but unfortunately this is the situation we’re in, currently in Ontario.

Jason D’Souza: And doctor, what is that strain like on healthcare professionals like yourselves, like yourself, when you have to go in on your day off and and I imagine work quite a few hours.

Dr. Kyeremanteng: Yeah, I’ll say this, because I know a lot of our nursing staff, respiratory therapists, allied health professionals: they’re tired, they’re gasped. This has been over a year now of dealing with not only Covid patients, but the mental, the mental fatigue, the emotional side, when you’re seeing patients, for example, early in the pandemic, you know, die alone, so scared because of the, you know, everything that could carry with Covid.

But for me, you know, obviously I’m disappointed that it’s time away from the family, but it’s also a rallying time, like it’s a time that we’re all going in to contribute, to help, you know, our city, our province, our country get through this rough time. So I’m actually in some ways looking forward to that camaraderie, that shared motivation, you know. This is my time to do my part but, yeah, this is a fatiguing time, unfortunately.

D’Souza: Dr. Bogosh, there has been heavy criticism from medical professionals about the initial policy changes and restrictions implemented by the province on Friday [April 16, 2021]. How harmful do you think these past two days have been when it comes to public trust in government policy?

Dr. Bogoch: Yeah, obviously we can’t ignore that. You know, we know a year in that, for example, transmission of COVID-19 at outdoor settings is not zero percent, but it’s like the tiniest of tiny fractions of transmission. We should obviously be encouraging people to be outside, because that’s probably the safest place there is in the country. And then, of course, we saw a bunch of outdoor venues banned. So that was puzzling and, you know, yeah, I certainly think that can contribute to some of the mistrust.

And this is the time where we need public buy-in; we need everyone to adhere to public health policies, just so we can get through this third wave with as little damage as possible. So having said that, yesterday the province walked that back. You know, they reopened playgrounds and, you know, I’m of the mindset that, “Listen, it’s never too late to turn around when you’re going down the wrong path.”

They could have dug in their heels and said, “No, we’re sticking with this.” They didn’t; they walked back partially, I guess, because, you know, it’s just the playground aspect and not the other aspect. I take that as a sign that they were listening, and they heard the public outcry about this, and they recognized that the science didn’t align with the policy. And they made a change. So, you know, just really trying to dissociate myself from the situation, and look at it objectively: Good, that’s good; we want a government that listens, that’s responsible.

D’Souza: Dr. Bogoch, I take your point, but at the same time you and I have had how many conversations on this program, let alone all the other interviews you’ve done, talking about the low transmissibility of Covid outdoors, so when you say the province was listening, yes, they may have listened most recently with walking back these measures, but were they not listening beforehand?

Dr. Isaac Bogoch: Well, I mean that just begs the question, like how do you get to that policy in the first place? Like maybe they’re listening, but who are they listening to, right? Like, how does that come to be, which I don’t disagree with you one bit. I don’t disagree with you at all; I mean, that’s very puzzling to me. And, you know, that certainly opens up a lot of questions.

But on the other hand, they did, they did listen. I think there was unanimous outcry, like from 14 and a half million people in the province. They heard that, you know, the, “What? What are you doing?” And then we heard that they had a big meeting the other day, where some of the other policies were discussed, as well, and I understand they walked back some of the policing policies, too.

And, I mean, listen, sometimes, you know, process is important. Process is important and the outcomes are important. That’s true. We can’t ignore the process of how you come to a decision. But truly, it is helpful that at the end of the day the content does matter, and the fact that the playgrounds are open – great; that’s good not just for the kids’ mental and physical health; it’s also good for parents’ mental and physical health, as well.

D’Souza: Dr. Kyeremanteng, what’s your assessment been of the changes and announcements that have been made over the course of these last 72 hours.

Dr. Kyeremanteng: Yeah, I mean, I’ll go what Isaac mentioned briefly about, you know, the changing gears a bit, and being responsive. I was glad to see that the province was responsive to the, as Isaac said, 14 and a half million people, that probably were against a lot of, at least the playground approach.

But to me, Jason, it always comes down to what does the data show us, you know. And when we look at where the areas of spread have been throughout this pandemic, we knew long-term care was a huge problem; we addressed that with vaccines, which have been ultra-effective, extremely effective, at reducing the hospitalizations, even cases, within long-term care. It’s been amazing.

And then you look at the other piece, it’s been the essential workers’ side, and I know Isaac’s been preaching, I know I’ve been preaching that we need to be addressing this, like months ago, but now it’s starting to get attention. And so now we’re addressing it by getting the vaccines addressed, within those essential workers, hardest hit areas, you know.

But still, I’ve been preaching about the paid leave as an extremely important component to this. And I’ll just give it – just maybe just walk through, why.

So if you are an essential worker, you work in a factory, and you have a runny nose, you got a mild cough, and you’re barely making ends meet. You’re gonna ask that person to take a day off, not get paid, to get tested, and if they get tested, you’re looking at a two-week quarantine, where maybe they get paid, maybe they don’t, you know.

If you’re at a high risk area where it’s much easier to transmit, you might be living in a multi-generational home. Who knows if you have a job at the end of that two-week run. So, like we really need to take away the obstacle, you know. And this is what I think why the paid leave component was so important.

I’m very encouraged that we’re focusing our vaccinations in hard-hit spots, which ties in the essential workers’ multi-generational homes, racialized communities. Like I think this is an important component to that. But once again, sorry, I think, sorry, I’ve maybe heard my own voice but, once again, I think it’s – to me, let’s focus on where this is telling us. So let’s focus on where the problems are.

D’Souza: Dr. Bogoch, yesterday on CBC Radio we heard from a quite emotional Dr. Peter Jüni, science director, of course, of the province’s science advisory table on COVID-19, and he talked about not feeling like he’s being heard by the government, despite the position that he holds. I just want you to have a listen to some of what he had to say.

[Clip is played: Jason D’Sousa in conversation with Dr. Peter Jüni:]

D’Souza:  Dr. Jüni, do you mind if I ask quite frankly, do you still feel like an adviser to the provincial government, if there’s this much of a disconnect between what you’re saying and suggesting, versus what’s actually happening?

Dr. Peter Jüni: I don’t know. It’s, to be honest, yesterday was one of the darkest days in my professional and my career and also personally. We need to do that differently and, you know, a lot of people implored me not to step down. Because we, you know, we need to move on, and we just need to make the best out of it, and probably what is needed is that we just all focus on what every single one of us can do. This is really just common sense.

Yeah, I feel terrible. I mean, yesterday, I had, you know, a crying fit, when I was on the call with Danny Brown. He actually tried to comfort me. It’s just wrong, you know, it’s just wrong.

[Conclusion of clip with Dr. Jüni.]

D’Souza: So, Dr. Bogoch, you’re a member of Ontario’s COVID-19 vaccine distribution task force. Do you feel as though you have the ear of the government right now?

Dr. Bogoch: Just let me address a couple things, and, yeah, I’d love to address that as well.

So, I was one of the people that called him [that is, Dr. Jüni]; I know him well. And I called him, too, among the others that said, “Don’t step down,” right?

This is, he’s doing a great job, there’s lots of people – of course, Peter Jüni, but a whole army of people, as well, on that science table, on various other tables and committees – that are truly doing good work, and doing their best to help Ontario navigate this, obviously, very, very, very challenging time.

And, you know, everyone will do what they think is best. I’m not here to pressure anyone to do anything, that they don’t want to do. But, you know, one approach is: Appreciate that this is an extremely challenging time, and, you know, let’s get our work boots on, and let’s go, right?

Like, some of us are in positions, where we can – we’re better at the table than not, you know. Even if not a hundred percent of what’s being said is adhered to, or listened to, you can still make some meaningful changes. And if you want to have a positive impact, it’s much easier to have that positive impact, when you’ve got a seat at the table. And Peter has had a tremendous positive impact.

Yeah, I get it. Yesterday was a bad day, but there’s – he’s done a lot of good, and there’s a lot of people on that science table that have done a lot of good. And I really hope that they continue to do what they do best, which is look at the science, convert it into meaningful policy, and advise the government on how to best navigate.

D’Souza: But is that not the issue, that it’s not translating into meaningful policy?

Dr. Bogoch: I wouldn’t say that that’s a hundred percent correct. You certainly see that it is happening. You certainly see that there are many things that don’t get translated, but, like, look at the other stuff the science table has come out with.

For example, as a member of the vaccine task force, we work very closely with the science table, to help come up with science-based vaccine distribution plans for the province, that gets translated into policy. So, like, I’m not denying that, you know, the last 48 hours have been tough. Of course they’ve been tough, and of course it’s been, you know, an earthquake, for many people on the science table.

But what I am saying is, you know, better to have a seat at the table, and contribute to policy and keep pushing, pushing, pushing toward doing the right thing, than not.

Now, listen, some people will choose not to be there. Some people obviously don’t, and that’s okay. Like, it’s none of my business, if some people feel that they’re not being heard, and this is, you know, this is not for them.

I completely respect that; I completely respect that. And I also completely respect people that say, “I’m going to stick it, out and keep pushing for good, and for a science-based approach, by sticking around.”

I think both are right answers, and people can make an individual choice, and we should be proud of everyone, on that science table, regardless of what they – regardless of what their decision.

Just from my own personal experience, though, on the vaccine task force, you know, we work very closely with them. That’s actually how I know Peter. I didn’t really know him all that well, before the pandemic. And, you know, those meetings have been invaluable, and our collaboration has been invaluable in shaping, and operationalizing, vaccine distribution.

Now, of course, sometimes the province listens, sometimes the province doesn’t listen. And, you know, that’s that. But I would say that a lot of the vaccine distribution, and many of the measures were taken, and were implemented, because of the science table.

And I’m glad he’s not stepping down because, you know, he’s providing a tremendous service for Ontario.

D’Souza: Dr. Kyeremanteng, for you, what goes through your mind when you hear that from Dr. Jüni?

Dr. Kyeremanteng: Yeah, I emphasize, because I personally don’t know Dr. Jüni, but, you know, when you’re putting this much effort into providing reliable science-based recommendations, and you feel like you’re not being heard, I think that could be frustrating.

And, you know, and this is my humble opinion, what I’m saying here, but, you know, when you look at our situation in Ontario, you know, we gotta – there’s gotta be some level of pivoting, you know.

Like, when we look at, say, in the GTA, there’s been some form of of restrictions throughout, and despite that we’re in the stage that we’re in, now.

And so, and even heard Premier Ford saying, you know, we have had some of the strongest restrictions within North America, and we’re still in this predicament.

So, you know, whatever is happening, whatever our science table is recommending, as you know, it has to be data-driven, and it has to also think, like, at some point, when we keep approaching things the same way, you know: Lock down harder, harder, harder – ask ourselves: Are we actually making a difference? Is this going to be the change that we need? Instead of looking at the data: Where are our problem spots? And let’s focus there; let’s focus there.

And, I mean, without speaking to Dr. Jüni myself, I would be confident that the science table would be saying similar – similar approaches: to follow the data.

And the other thing I would love from our province, too, is, you know, let’s focus on what people can do.

Like, let’s have that positive messaging throughout this. We’ll do our part. Our healthcare providers, we’re going to step up and do what we need to do with the front lines to keep you guys safe, you know. But what the population can do: Address vaccine hesitancy. Take your vaccines. Stay at home. Don’t social gather indoors. But focus on what you can do. Being outside as we talked about with Isaac and myself: It’s such an important element to maintaining mental health, physical health, morale.

And especially when we see the patients that we see in the ICU. Like you’re going to hear more and more data about people coming in younger, but still the narrative that you don’t hear, is that most of our patients have poor metabolic health, as in their obesity, hypertension, Type 2 diabetes and being at home, and not moving at all, is not going to help these conditions. So, focus on what we can do, you know.

This is the kind of messaging that I think we’re missing it, throughout this pandemic.

D’Souza: We are going to have to leave it there. I want to thank the both of you very much, for joining us this morning.

Dr. Isaac Bogoch: My pleasure.

Dr. Kyeremanteng: Thanks, Jason, you take care.

D’Souza: That is Dr. Isaac Bogoch who’s an infectious diseases physician and scientist at the Toronto General Hospital, also a member of Ontario’s COVID-19 vaccine distribution task force and Dr. Kwadwo Kyeremanteng who’s an ICU and palliative care physician at the Ottawa Hospital.