A panel of experts made further calls for an independent inquiry into Canada鈥檚 COVID-19 response on Tuesday, stressing that the country鈥檚 pandemic response must be reviewed before it鈥檚 tested once again.
The experts, who penned a series of articles on Canada鈥檚 pandemic response that were recently published by the BMJ medical journal, shared their findings at a webinar on Tuesday.
Dr. Sharmistha Mishra, one of the authors, and an infectious disease epidemiologist and physician at University of Toronto and Unity Health Toronto, started her presentation with a number. 鈥52,750,鈥 she said in the webinar, referring to the reported deaths in Canada directly related to COVID-19 as of June 2023.
Dr. Mishra said an independent, public inquiry into the country鈥檚 COVID-19 response would summarize what happened over the past three years and allow the country to better prepare for the future.
鈥淎n independent, public inquiry could systematically -- and with scientific humility -- get at why. And getting at the why in a nuanced way has to come with transformative action, implementation, and would also come with evaluations of the changes that are being made and that have been made,鈥 Mishra said.
鈥淲e are going to be tested again.鈥
Published Monday, the experts鈥 seven-article series was a collaboration from 13 organizations across the country, including physicians, nurses, researchers, legal experts, and humanitarian specialists, aiming to understand the medical and societal complexities of pandemic responses on a national scale.
鈥淥ur aim as a journal is to inform and advance the conversation in Canada and abroad,鈥 said Dr. Jacalyn Clark, the international editor of the BMJ.
鈥淲hat lessons can be drawn from Canada鈥檚 pandemic response?鈥 she said. 鈥淲hat actions need to be taken in the country? And what can others learn? And how can future health preparedness be improved?鈥
Dr. Mishra pointed out that there have been inquiries and reports before, and that a public inquiry could re-examine the last three years to unpack data deficiencies, data distribution inconsistencies, along with social determinants of health, social justice and differential risks of transmission.
One lesson learned from the COVID-19 pandemic was that misinformation during a public health crisis can spread like wildfire, the experts said.
Linda Wilhelm, the president of The Canadian Arthritis Patient Alliance (CAPA), explained that those living with incurable disabilities were disadvantaged by pharmaceutical misinformation, citing former U.S. president Donald Trump鈥檚 unsolicited -- and unsubstantiated -- advice to turn to Hydroxy-chloroquine to prevent COVID-19 symptoms.
鈥淎ll of a sudden, jurisdictions started diverting supply,鈥 she said, explaining that the drug is needed for people with lupus, an autoimmune disease that attacks tissues and organs. 鈥淭hey were diverting supply and denying access to people who have been on this medication very successfully for many years, for [a recommendation] that didn鈥檛 have any evidence behind it.鈥
Wilhelm said this was the first realization that perhaps 鈥渨e weren鈥檛 all in this together鈥 and that 鈥渟ome of us are really going to be left behind.鈥
There was also conflicting information regarding the eligibility of immunocompromised people for COVID-19 vaccines, she said.
鈥淭he U.K. was coming out and saying people who are immunocompromised need to be a priority population [for vaccines] with people who were 80-plus,鈥 Wilhelm said. 鈥淲e see the National Advisory Committee on Immunization in Canada come out recommending that people who are immunocompromised not get vaccinated. Here we were in isolation for over a year, ready to go out, wondering what COVID would do if we ended up catching it with our already compromised immune systems.鈥
Wilhelm further stated that clinicians and CAPA helped issue letters declaring that people were immunocompromised and therefore not eligible for vaccines, a response to being denied service -- in restaurants or movie theatres, for instance -- during vaccine mandates.
The BMJ series attempts to better understand some of the social consequences imposed by public policy for communities experiencing disabilities and social marginalization, Wilhelm explained.
Lead author Dr. Sharon Straus, a geriatrician and clinical epidemiologist and physician-in-chief at St. Michael鈥檚 Hospital in Toronto, discussed medical challenges she saw unfold -- 鈥渘ot just locally, but provincially and nationally and internationally.鈥
Straus mentioned challenges around data and lack of data accessibility, as well as the role that research played and could have played. 鈥淯nderscoring all of that and cross cutting that was two things, really -- fragmentation, and around health and equities,鈥 she said.
While people want to move on from COVID-19, Straus said it鈥檚 necessary to revisit issues in areas like medicine and long-term care that faced immense pressures during the pandemic.
鈥淵es, people want to move on. For many people, they want to return to pre-COVID normal. But for many people, they can鈥檛. And so we worry that the window is closing on the opportunity to really reflect on what happened,鈥 she said.
鈥淢ore than 14,000 lives were lost in long-term care, and it鈥檚 thinking about how we can address that? How can we prevent that from happening again in the next public health emergency?鈥
Straus said there has been lots of reports, in the years before COVID, highlighting the challenges in long-term care. 鈥淭he chronic underfunding, the insufficient support for staff, the lack of recognition of the complexity of the population living in long-term care -- not just the medical complexity, the social complexity. Adding COVID on top of this led to this perfect storm of what we saw. I think we owe those individuals in long-term care to say that we will do better in the future and that we will create transformative change.鈥
Adam Houston, an author of the research and the medical policy and advocacy officer for M茅decins Sans Fronti猫res/Doctors Without Borders Canada (MSF), said in the webinar that the repercussions of Canada鈥檚 policy implementations extend beyond the borders of Canada.
鈥淲e really can鈥檛 forget that, both in an inquiry, and more importantly in actually acting on these lessons,鈥 he said. 鈥淲e鈥檝e all heard the government mantra of, 鈥楾he pandemic is not over anywhere until it鈥檚 over everywhere.鈥 At the same time, in reality, what we鈥檝e seen is Canada鈥檚 role as a major vaccine importer. This is a country that, by late 2020, had secured the most doses per capita of any country in the world.鈥
Houston said Canada hoarded a surplus of vaccines for much of the pandemic, reserving more vaccine doses per person than any other nation and leaving several millions of doses to expire.
A larger review can better determine how to better distribute surplus doses across borders and meet international demand, along with future policies that help Canada contribute to global health-care efforts, he said.
Straus shared a similar remark.
鈥淲e have a rich tradition, in academia and clinical medicine and research, to always reflect back and to question,鈥 Straus said. 鈥淲e talk about clinical humility and scientific humility, that we want to learn from what鈥檚 gone on before to inform us for the future, to think about how we could use this knowledge to move forward.鈥
All articles in The BMJ鈥檚 Canada COVID-19 Series are available at www.bmj.com/canada-covid-series
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