Mr. Chair and members of the committee, it's a privilege to speak with you today.
I'm a retired physician. I practised medicine for 40 years in two specialties: public health and internal medicine. I worked in local public health for 15 years. I was Ontario's chief medical officer of health for 10 years. I was directly involved in the 2003 SARS outbreak as the chief of staff of York Central Hospital. I have published academic and popular articles on relevant subjects, such as SARS, quarantine and bird flu.
Canadians on the whole enjoy a wonderful standard of health, resting on the foundation of the social determinants of health: education, employment and our social fabric. Anything that threatens these foundations threatens our public health.
Canada is now faced with both a tragedy and a crisis. The tragedy is caused by COVID, a respiratory virus. It has the potential to cause the deaths of tens of thousands of Canadians, overwhelmingly old and infirm.
The crisis is caused by our attempts to control that virus. The crisis has the potential to cause severe and lasting damage to the fabric of our country's economy, education, social and cultural institutions, and mental health that will have repercussions for our public health for decades.
The tragedy is a natural disaster that saddens me and saddens us all. The crisis is a self-inflicted wound that frankly terrifies me. It offends social justice, because the burden of the crisis falls disproportionately on children, young families and blue-collar workers. The more we focus exclusively on COVID, the greater the danger to our public health.
The best analogy to the COVID outbreak is the H2N2 Asian flu pandemic that swept around the world in the fall of 1957. Asian flu caused more disease and a much higher death rate, especially in younger people, than COVID. Asian flu killed between one million and two million people in a matter of a few months in a world population one-third the size of today's. That's the equivalent of three million to six million deaths today, many more than from COVID. Asian flu was a tragedy, but it wasn't a crisis, because 60 years ago people responded differently. Some modest control measures were taken, but they were very temporary. The world moved on.
Perspective isn't very popular with COVID, but I think it's important. We get spooked by COVID deaths because every day we see the numbers for COVID, but not for anything else. Death is a common phenomenon in our world. Almost 300,000 Canadians will die this year, like every year, from cancer, heart disease, stroke, motor vehicle crashes, suicide and a myriad of other causes. Since mid-March, for every Canadian outside long-term care who has died of COVID, 50 Canadians have died of something else.
We have frightened people. Predictably, the media has led the way. But public health has also frightened people, I think, to promote better compliance with social distancing. This was wrong for two reasons: first, it's cynical; and second, it now will make it that much harder to step down.
My wife and I live in Toronto. When we walk our dog, we see two kinds of people— those like us who have done the math and aren't really frightened by COVID, and those who think walking the streets is dangerous. But there's a third group, the people in our building whom we haven't seen for two months who are too terrified to even go outside. Getting them to re-enter the world will be a tremendous challenge.
The only reliable defence against a respiratory virus is immunity. You can get immunity from being infected or you can get it from a vaccine. A safe and effective vaccine would be wonderful, but it would be foolish to build public policy around expectations of a vaccine any time soon. Any strategy that doesn't take us towards immunity ultimately leads us nowhere. So long as the disease is circulating elsewhere, it's coming back here too. Provincial or national elimination is a false promise.
Population immunity leading to herd immunity is a natural phenomenon not an intervention, not an experiment. Herd immunity is what has controlled every other respiratory virus. We will get there sooner or later with COVID. The policy challenge is to mitigate the worst effects of the disease while protecting the real determinants of our health: education, employment and our social fabric.
We have better information about COVID than we did two months ago. We know that COVID is very serious, certainly much more serious than I, for one, expected. However, it's also not the apocalypse that some of the models had predicted, not even remotely close. The comparison should be with 1957, not 1918.
We know that our health care system can cope. A combination of expanded capacity, better treatment strategies, and triage mean that the apparent capacity crisis in Italy has not been repeated here or really anywhere else. We know that the great majority of people in Canada are at very little personal risk of death from COVID. For virtually everyone under the age of 60 and for people without serious comorbidities to a much older age, the risk of death from COVID infection is not materially different from the risk of dying from influenza. We are two populations: the frail elderly for whom COVID is a deadly disease and the great majority for whom it is not.
Canada's experience in the last two months has been problematic. We seem to have been reasonably effective at reducing infection in the community, but we have not been effective in protecting the institutionalized, frail elderly because of a massive failure of infection control in some facilities. As a consequence, we have had many deaths, but we have relatively little population immunity.
The COVID outbreak in the northern hemisphere has been on the wane since late March—for almost two months. The policy tide worldwide is now towards reopening. Canada will be swept along.
My real concern is that the virus will return, probably in September, and that our attempts to control it with widespread testing and contact tracing will probably fail. I've worked long enough in public health to understand the limitations of contact tracing as a disease control strategy, particularly for a disease like COVID.
However, when this strategy fails, will we panic and lockdown again, this time indefinitely, or will we respond in a more measured and rational way? We have some time to prepare. If plan A is based on testing and contact tracing, we need a plan B. What should we do now?
First, we need to identify those things that are fundamentally non-negotiable. Education, which requires the reopening of schools, and employment, which requires that many people return physically to work, should be top of the list, along with access to medical and dental care.
Second, we need to be clear that we are pursuing the policy of mitigation not elimination. With mitigation, we can tolerate an increase in cases when we open up now, and again when the disease resurges in the fall. We will regard community spread as inevitable and as a step towards population immunity.
Third, we need to do serious policy work to identify those aspects of social distancing that are effective, acceptable and sustainable. Canada's latest fad is for non-medical masks, based on the thinnest of evidence. Let's think carefully before we change ourselves into a society that hides its face in public.
Fourth, we must develop better strategies to protect the vulnerable, particularly better infection control in long-term care institutions. This alone will go a long way towards reducing mortality.
Fifth, we need to change our messaging to the public to better reflect their real risk of serious illness and death so that people will be willing to come out of isolation and resume normal life.
Sixth, we need to look for ways to develop public health policy nationally. We need a national, not a federal, public health agency that engages the provinces with the federal government as equal partners.