Long-term care commission grills Ontario’s chief medical officer over failures during COVID-19 first wave
Dr. David Williams, Ontario's Chief Medical Officer of Health leaves a news conference in Toronto, on Monday January 27, 2020, as officials provide an update on the coronavirus in Canada. THE CANADIAN PRESS/Chris Young
TORONTO -- Ontario’s Commission into long-term care tore into the province’s top public health official during a hearing this week, where he conceded homes could not evacuate healthy patients to anywhere but a hospital, were not warned of asymptomatic spread early on and sometimes got positive COVID-19 test results by mail.
A Commission lawyer asked Chief Medical Officer Dr. David Williams if he thought facilities should have evacuated or “decanted” health residents during outbreaks, to which he replied that there were not enough healthy staff available to remove entire cohorts of residents out of hard-hit homes to keep them from getting infected.
Speaking on Tuesday, commission co-counsel John Callaghan asked about research from Hong Kong and other advice that recommended decanting residents to new facilities to keep them safe from infection, Williams said so many staff were out sick with COVID-19 themselves that there was no chance to try that.
“We have facilities, but you haven’t got the staff,” Williams said.
Without decanting, homes were forced to move residents around in their facilities and “cohort” them, separating the sick from the healthy.
“So your Directive doesn't come, I don't think, until March 22nd or March 30th on cohorting. It says that you cohort the well and the unwell, right,” Callaghan asked. “You separate the well and unwell, that is the wording you use in your Directive?”
“The Directive was to ratify what the guidance documents already said,” Williams replied.
“Right, and you used the word "well" and "unwell"; do you recall that,” Callaghan said.
“Yes, well, and we defined that -- those that had signs and symptoms and those who didn't,” Williams replied.
“And when you understood there was asymptomatic spread, how does one cohort?” Callaghan asked.
“That was the difficulty. At that time, there was no asymptomatic spread accepted and approved by our scientists,” Williams replied.
In a news conference in April 2020, Williams told reporters that he and his provincial and federal counterparts did not accept the possibility of asymptomatic spread of infection until April 9.
By then, hundreds of long-term care homes had outbreaks.
Numerous scientists in China, Australia, Taiwan, Japan, Iceland and Italy had warned of asymptomatic spread in bulletins and journals as early as the start of March 2020, but Canadian officials were relying on World Health Organization guidance, which did not acknowledge the possibility until months later.
Long-term care advocate and Ontario Technical University professor Vivian Stamatopoulos said this initial hesitance to accept the possibility of transmission without symptoms violated the precautionary principle, an idea developed after the 2003 SARS crisis where health officials were advised to take the most comprehensive measures possible during a pandemic or other public health crisis even if the science of the matter was not definitively settled.
“The precautionary principle was not sufficiently exercised and people died who didn’t have to die,” she told CP24.
Callaghan probed Williams to explain what he thought the precautionary principle meant as it related to the concept of asymptomatic transmission during the hearing on Tuesday.
“There was materials and anecdotal reports,” Williams said of a March 9, 2020 report from Public Health Ontario that suggested asymptomatic transmission was happening in other jurisdictions abroad. “They were still gathering it to see well the validity of the information.”
This prompted Callaghan to ask Williams what the precautionary principle meant to him.
“You don’t believe that (the precautionary principle) was directly related to not waiting for scientific proof,” Callaghan asked.
“No, his aspect was that if you are waiting for the case control studies and all the science to get formulated, that is too late,” Williams replied. “You need to take some steps before that. But it doesn't say throw science out the door and just wing it.”
In another round of questioning by Callaghan, Williams said he knew that some long-term care homes were receiving individual COVID-19 test results by regular mail in April, 2020.
“Yes, they had no automated system to receive it.”
But after being asked the question four separate times, Williams said he did not raise a concern about that with the Ministry of Long-Term Care.
“Did you at any time raise the issue with the Ministry of Long-Term Care, I’m sensing the answer is no. A direct answer would be helpful,” Callaghan said.
“The answer is that in outbreaks, I raise the issue we want the lab test results back as promptly as possible,” Williams replied.
“And did you then go on to say that it is your understanding that long-term care homes do not have the technology to receive results expeditiously,” Callaghan asked again. “Did you go on to say that?”
“No, because in the middle of it we were dealing with the outbreaks, not with the technology,” Williams replied.
Stamatopoulos said the lack of instant communication of test results was a glaring issue that likely cost some people their lives.
“They were aware of this very early on but did nothing to I don’t know, let’s say put someone in charge of contacting the homes when there was a positive result,” she said.
Since March 2020, 3,864 residents of long-term care homes and 10 staff members have died due to coronavirus infection. The spread in April and May 2020 eventually required the deployment of hundreds of Canadian Forces soldiers to seven of the worst-hit homes to assist with basic care.
In Question Period on Thursday, NDP leader Andrea Horwath slammed the Ford government, saying portions of Williams’ correspondence only reached the commission two days before his testimony.
“The commission received 217,000 documents and 2,000 pages of handwritten notes from Dr. Williams two days before his testimony,” she said. “The notes were heavily redacted and his testimony was interfered with constantly by his lawyers, who were I guess trying to protect Dr. Williams from giving the answers Ontarians deserve.”
She said his testimony looked like a “stinking cover-up,” a comment she was later forced by the speaker to withdraw.
“We set up and allowed a commission to operate because there are many families who were wondering what happened during the course of the COVID-19 situation thus far, they want the answers and we want them to have the answers,” Health Minister Christine Elliott said. “There were some concerns with respect to some of the entries in some of his documents related to cabinet decisions that it was the impression of counsel that they needed to be protected and not released.”
The matter went to mediation and the documents were released, with redactions, she said.