When the coronavirus pandemic hit, Ontario didn't have an up-to-date pandemic plan, nor a stockpile of emergency supplies. The province's labs didn't have the capacity to run enough tests.
The independent commission into the COVID-19 crisis in long-term care questioned deputy premier and Health Minister Christine Elliott this week, along with Deputy Minister of Health Helen Angus, about who was responsible for that lack of emergency preparedness.
Elliott took responsibility for the province's failure to replenish its stockpile of emergency supplies after the medical masks and respirators — desperately needed at the beginning of the pandemic — had expired and been disposed of.
"So does any responsibility lie with the government for those people who died at long-term care where long-term care homes did not have a supply of PPE?" asked commission lawyer John Callaghan, early on in the four-hour interview.
"The loss of life here is tragic," Elliott initially replied.
"It is," said Callaghan.
Elliott said she thought the province's long-term care inspection regime would have ensured that homes had a four-week supply of personal protective equipment, which they had been instructed to have.
Elliott also attributed the failure to replenish the stockpile in large part to the province's decision to centralize procurement, a major cost-saving initiative of the treasury board. She told the commission that while most of the expired stockpile was being destroyed under her tenure she thought it would be replenished and she did not realize that this had been delayed because of the procurement overhaul.
But she ultimately took ownership of the depleted stockpile: "That would have been my responsibility."
The personal protective equipment shortages had a devastating impact. The commission has heard that workers went unprotected and their fears about being unprotected contributed to dire staffing shortages.
"People die because of the spread of that disease and, as we have heard in quite graphic terms, because of the shortage of staff who won't show up, in part because they are afraid they are going to get sick," said lead commissioner Frank Marrocco.
Callaghan pointed out that wasn't the only aspect of emergency preparedness that was delayed for bureaucratic reasons — Ontario didn't have a single up-to-date emergency plan to guide its response and a strategy inspired by the Ebola epidemic that would have been applied was still in development after four years.
"What I don't understand — this is twice now we are talking about policy reviews delaying protecting Ontarians, one, by [not] having a single plan, and now by not having a stockpile," Callaghan said. "When do we tell the public that not protecting them is OK because we are doing a policy review? What is the timeline? These are four years. The public should be left for four years, is that the understanding, when we do policy reviews?"
Callaghan also focused on Ontario's testing capacity, emphasizing the evidence the commission has been given about how delays in receiving test results cost lives in long-term care.
Near the beginning of the pandemic, the province was able to do about 4,000 tests a day and realized that needed to be ramped up considerably, said Elliott. While other places, including Alberta, had laboratory networks with greater capacity, Ontario didn't initially have any connections between the public, hospital and private labs in the province capable of doing the testing, and that took time to establish.
Callaghan questioned whether that was something the province would have realized was needed before COVID-19 if it had done more pandemic planning exercises.
"I don't have the benefit of hindsight on that," said Angus.
When Elliott and Angus took him through the steps the province took once the pandemic started, he quipped, "I don't think anybody is quarrelling with the fact [that] when the government found themselves in a position, that they tried to build the lifeboat as quickly as they could."
Callaghan also questioned the province's decision to open up testing to all Ontarians, even if they had no symptoms, announced on May 24. He cited evidence from the province's own testing advisers and Chief Medical Officer of Health Dr. David Williams that they were concerned it would overwhelm the laboratory network and slow down the receipt of test results, which came to pass.
He asked several times why the decision was made when it was against the scientific advice, and harmful in long-term care, but was effectively stonewalled by the minister who repeated an answer about being concerned about levels of community transmission of the virus.
The lawyer's questions on the vaccine rollout were also blunted by Elliott and her deputy.
The commission was presented with modelling evidence that showed delaying the vaccination of long-term care residents would cost lives because of the high number of outbreaks this winter. The biggest factor in Ontario's delay was the decision not to bring the Pfizer vaccine, which the province received first and in the highest numbers, into long-term care homes based on the advice of the company and the National Advisory Committee on Immunization.
Asked if she was aware that other Canadian provinces were moving it into long-term care at that time Angus said no — Ontario was focused on its own vaccine rollout.
Callaghan said the government's statistics showed by Jan. 12 the province had administered 144,000 doses, but only 13,000 had gone to long-term care or retirement home residents — the vast majority had gone to hospital staff.
Making matters worse, around that time expected vaccine shipments began to slow and Ontario didn't complete its goal of offering the first vaccinations to all long-term care homes until mid-February.
Elliott pushed back on the suggestion that Ontario could have vaccinated long-term care residents faster.
"I would not agree with that," she said. "Residents of long-term care homes were our absolute top priority, and we did hear very strongly from Pfizer that they could be delivered to one place, that we could not move [the vaccine doses], that they would become less stable, and that if we didn't follow their instructions, any future shipments of Pfizer might be in jeopardy to us because they would ship them to other users who would follow their rules."
At other times, the interview turned to more collegial discussions of public policy decisions the government may make in the future. Elliott and Marrocco discussed plans for the province to make personal support work a regulated profession. Marrocco mentioned the college of nurses as a potential regulator; Elliott said she'd discussed some aspects of this issue with the Ontario Personal Support Workers Association.
Angus discussed the future of congregate seniors living, speaking of a village model used in some jurisdictions or college dormitory-like residences for older single women.
Elliott's overhaul of the health-care system, underway but not completed when the pandemic hit, found considerable support among the commissioners, who said they'd heard testimony that the links between health-care providers formed through the local Ontario Health teams that are the foundation of the new model helped in some aspects of the pandemic response.