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  • Writer's pictureDr. Sandor Demeter

We need to avoid the name, shame and blame game!

Don Quixote (Picasso 1955)

At times politicians and senior public health leaders have been selective in what information is shared with the public, especially when things start to go downhill. The anecdotal “house party”, or a COVID case with a gazillion contacts, are presented to defend more stringent lock-down measures such as curfews. There are instances where governments blame people for the consequences of government policy decisions and use “fear tactics” to elicit compliance.

To be frank this meets the Cambridge dictionary definition of propaganda:

- information, ideas, opinions, or images, often only giving one part of an argument, that are broadcast, published, or in some other way spread with the intention of influencing people's opinions:

For example, while Manitobans were awaiting an announcement on new lock-down measures the headline in the (WFP April 17, 2021) was:

Province points to rule-breakers for fuelling pandemic’s third wave but has yet to implement new restrictions - ‘This is on all Manitobans’

Without presenting how these anecdotes fit into the bigger COVID picture, or how they significantly contribute to new COVID cases, governments erode confidence in their leadership. Optically, it also feeds into the perception of diverting attention, and accountability, from how the health care system is performing during the pandemic (e.g., health care worker shortages, not releasing persona care home inspection reports).

We have all been riding the roller coaster of increasing COVID restrictions when COVID cases rise, easing of restrictions when cases go down, reimposing restrictions when cases start to climb again, especially when undue pressure is put on the acute health care system. Repeat as needed.

This “yoyo” pattern is now obvious and expecting something different fits with Einstein’s definition of insanity, i.e.: “doing the same thing over and over and expecting different results.”

This article is not necessarily a criticism of the varying, and at times inconsistent, COVID restrictions across Canada but exposes the fact there is significant lack of leadership and transparency in providing rationale and supportive evidence for COVID mitigation measures and communicating other COVID related metrics (e.g., cumulative transparent reporting on sources of transmission, adverse impacts on mental health such as suicide and drug overdoses etc.).

Some measures appear to be internally inconsistent which give us a glimpse of possible rifts between politicians and senior public health advisors.

For example, recently MB public health was suggesting mandatory masks both indoors and outdoors; except for indoor faith based settings where household members could take their masks off after being seated (This decision was reversed as of April 28, 2021).

Also, strong opinions have been shared about recent strict orders (April 28, 2021) not allowing any indoor, or outdoor visits from members outside of your household (except for specific allowances such as if you live alone) but still allowing four, down from six, members from different households to get together at outdoor restaurant patios. The rationale provided is that the “patio” scenario is better controlled from a COVID disease transmission point of view. My take is that this is a political balance point between economic and COVID transmission factors.

It is difficult to legislate and regulate human behaviour and with each COVID lock down cycle there appears to be escalating resistance to measures which are perceived to impact personal liberties as set out in the Canadian Charter of Rights and Freedoms. For example, recent protests to re-imposed curfew restrictions in Montreal are a testimony to this. To be clear I am not condoning and strongly oppose the violence and property damages that occurred in Montreal. I am pointing out that we are a tipping point in civil obedience related to COVID restrictive measures and the recent “anti-mask” rally at the Forks may be a testament to this.

The Harvard Business School lays out six characteristics of effective leadership. They include: the ability to influence, transparency, encourage risk taking and innovations, value/ethics/integrity, decisiveness, and balance hard truths with optimism. Although some of these characteristics are more applicable to the private sector, they can also be applied to government policies, especially transparency, value/ethics/integrity, and balancing hard truths with optimism.

Some governments openly disregard that one of the key roles of transparency and communication is to enhance trust and credibility. For example, the standard line from the MB government is: “We don’t have any additional information to provide beyond what is listed on the dashboard and in the bulletin,” … “If a public health risk is assessed and it is deemed necessary to protect the health of others, further information is released.” (WFP, April 16, 2021).

Another example is that MB will not share who is on their COVID Task force(s) other than the leads/chairs. Science is supposed to drive policy decisions and transparency about the expertise and credibility of those giving such advice is important. Ontario (e.g. Science Table COVID Advisory for ON, COVID Vaccine Distribution Task Force , and the Public Health Agency of Canada, openly post who their members are including important affiliations.

The BC Centre for Disease Control has one of the more comprehensive dashboards available, which is published weekly. Their dashboard includes likely sources of infection and detailed summary hospital utilization/clinical data. Table 2 below is an example table from their weekly report.

This is noting that routine system performance metrics, such as turnaround times for contact tracing and COVID testing, are hard to find in any Canadian jurisdiction.

The US Centers for Disease Control and Prevention (CDC) published metrics on how to evaluate success in managing the COVID pandemic.

The CDC advocates: Routine review of both process and outcome metrics will also be crucial for case investigation and contact tracing success. By examining these data regularly, issues can be identified and rapidly addressed, changes to internal case investigation and contact tracing processes can be made, and the local health authority can more easily pivot when new high-risk populations are identified.

The CDC guidelines identify information that Canadians may appreciate knowing. Transparent sharing of such information may comfort the community, or identify deficiencies and who is accountable for addressing such. It may also help to quell resistance to imposed measures and improve vaccine uptake.

Provinces and territories have jurisdiction over health care, and unless the Federal Government invokes the Federal Emergency Act, we will continue to have 13 different ways of responding to the COVID pandemic. As there is no single standard Canadian dashboard providing the public essential details on the pandemic and how we are responding it would beneficial to all for our provincial and territorial leaders to be as transparent as they can be in sharing information.

We are all on the COVID roller coaster until the population achieves protection through a combination of natural infection and vaccination. Although there may be light at the “end of a syringe” we are months away from achieving sufficient protection to get back to what will become a new normal.

Leaders, especially politicians, have to realize that trust is earned. Until it is earned, and to quote Suzanne Massie/Ronald Regan, trust but verify.

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