Good afternoon, ladies and gentlemen.
Thank you for having me back at the health committee. I hope you've been well and that your families have been keeping safe.
When we last met, Canada was in a full lockdown, and I strove to explain how we might get out of it. I offered a road map for exiting the lockdown gradually. That road map remains valid. First, a nationwide lockdown to bring disease transmission to virtually nil, and simultaneously a massive push to increase testing and contact tracing by a factor of ten or more, followed by a sequence of gradual reopenings and infection wavelets that are well calibrated by disease forecasts and monitored by testing to minimize deaths. No competent expert disagrees with this basic strategy.
I said that following this road map would be long and difficult, and I reassured you that there is light at the end of the tunnel. Sadly, some weeks on, today I am here to tell you that the light seems dimmer than I imagined, not for scientific reasons, but for political reasons, which you can fix.
As you know, countries like Australia, Denmark, New Zealand and Norway are executing successful reopenings. Meanwhile, Canada is flying somewhat blind because provincial and federal governments have still not solved their massive failure to co-operate in sharing and analyzing epidemiological data. Without data and analysis, many experts think reopening is arriving too early in some places like Toronto, which will kill people needlessly, and arriving too late in others, like Kingston or the Maritimes, after crippling the economy and ballooning the deficit. This isn't good.
My goal today is to offer a frank reality check, franker than Dr. Tam and Dr. Nemer delivered. I was saddened and frustrated that yesterday many of you asked excellent questions, but got evasive and, at times, mealy-mouthed answers. Please feel free to ask me those same questions. If I can help, I promise I will.
First, let's start with some data and the big question. Is Canada really bending the curve? The answer is sort of.
Many Canadians think we have done well because we are better than the United States, a country that has no public health care, vocal COVID-19 deniers and a president who recommends injecting bleach. The Americans are obviously not the right comparison for us. It's better to compare Canada with other wealthy countries, especially confederations, because they have federal-provincial complications like our own.
Please turn to the line graph I've provided to the committee. It's one of two graphs that were provided.
This graph shows confirmed COVID-19 cases, adjusted for population, starting on the day that a country exceeded the threshold of one case per million population. Canada was the last country to face COVID-19. That's luck, and it gave us extra time to prepare and the benefit of learning from others who went before us. With those advantages we achieved a lower infection peak. However, we come to the question of bending the curve down, we're doing poorly. Instead of the successful nosedive the graph shows for France, Germany, Spain or Switzerland, which they achieved despite a faster and higher peak than ours, our curve looks more like an undulating plateau that gradually drops off like a bunny ski hill. By May 18, our daily confirmed cases were tied with those on April 4. Between those dates are weeks of squandered time, lives and money, the latter being around $12 billion a week to the macro economy.
I find the comparison with Australia the most interesting. It proves that Canada could have done better. It is a large confederation of states, much like our own provinces, and it crossed the threshold of one case per million just one day before we did. In other words, we started off tied, but instead of dithering, Australia smacked down its curve hard and fast. Its results are almost as impressive as South Korea’s, which many reckon to be the world’s most successful country. Now Australia is opening thoroughly, and we are not, so the costs of this failure are just massive. The next time you hear the Prime Minister and Dr. Tam say that Canada is bending the curve, be skeptical. Be much more skeptical than you have been.
Let’s now talk about testing. You heard from nearly everyone that Canada is doing a poor job and that without more and faster testing it is impossible to reopen without unnecessarily risking and losing Canadian lives. The scientific goal is not simply testing the sick, but over-testing the vulnerable and anyone else who might have come been contact with the sick so as to isolate them for 14 days and nip outbreaks in the bud, yet Canada’s testing remains awful, especially in Ontario and Quebec.
The bar graph I furnished to the committee shows over-testing as the ratio of total COVID-19 tests per positive test. The higher that ratio, the better the chance of spotting infections and avoiding outbreaks. If one chooses not to worry about the price of testing—and one shouldn’t, because testing costs peanuts compared to hospitalizations or lockdowns—then it is far better to test too much than too little.
On this measure of testing, Canada lags behind not just top performers like Australia and South Korea, but also behind Ethiopia, Rwanda, Kenya, Cuba and Ghana. We are such testing tightwads that low-income countries in Africa surpass us. Africans also outclass Canada on contact tracing. Addis Ababa’s extensive testing and contact tracing puts Montreal and Toronto to shame.
For Canada to be beaten by the world’s poorest countries has got to puncture the myth of competence and success. It cannot be that Canada lacks Africa's scientists, laboratories, equipment or chemicals, any of that. No. The reason we have failed is the cupidity and stupidity of certain governments, and this is where I put my constitutional lawyer hat on to talk about federalism. American lawyers have a great saying. They say that the Constitution is not a suicide pact, but I’m afraid, ladies and gentlemen, that during a killer pandemic our usually accepted federal-provincial relations can turn into a suicide pact.
I believe that our most fundamental failing right now is that pandemic responses are handicapped by a mythological, schismatic view of federalism. Thus, when provinces withhold epidemiological data or do a poor job of testing, collectively we grumble, we shrug and we mutter that health is provincial, but this is wrong. Speaking as a constitutional lawyer, health is actually a shared federal/provincial jurisdiction. The Supreme Court is dead clear about that. It says, “Health is a jurisdiction shared by both the provinces and the federal government.” That’s our Supreme Court, and it’s perfectly accurate.
I think it is good for the federal government to let provinces run their show, and that’s normally how it should work, but I'll suggest that a pandemic is not normal. There comes a point when the federal government must step in, the point where provincial actions are killing Canadians. If our country cannot show that once-in-a-century flexibility, then, yes, we are turning the Canadian Constitution into a suicide pact.
I know that what I've just said will be outrageously controversial. I’m sorry, but as a person who loves this country, I cannot let obvious mistakes pass and kill my neighbours.
Let me close with three recommendations.
First, Parliament must pressure cabinet into taking legal steps to force provinces to share epidemiological data. These are the data that scientists like Dr. Fisman and Dr. Khan absolutely need to keep me, you and your loved ones alive as this lockdown lifts. Parliament gave cabinet the power to demand data in section 15 of the Public Health Agency of Canada Act, but the Prime Minister has not used that power. It’s frankly pathetic.
Second, demand that the Public Health Agency of Canada set minimum standards for things like testing. We cannot remain stuck behind Africa. Come on. It was only last week that the Prime Minister proposed a national testing strategy. That is much too late. We need it now.