Clearing the COVID ‘Time Fog’

• A Healthy Future: Lessons from the Frontlines of a Crisis
• Ryan Meili
• UBC Press (2023)

Slowly and reluctantly, some countries are beginning to look at the outbreak of COVID-19 and the responses to it. In the U.K., a public inquiry into the early pandemic under former prime minister Boris Johnson has revealed gross incompetence.

It’s not much better here in Canada. In September, the prestigious medical journal The BMJ said in an editorial that “the world expected more of Canada,” observing that “beneath the surface of a general sense of satisfaction lie major pandemic failures.”

The journal detailed those failures in a series of articles. They’re no substitute for a full-scale public inquiry, but they do show the need for one.

The best that the Public Health Agency of Canada could do was to compare the toll on Canada with that inflicted by COVID-19 on the U.S., U.K., France and Australia. So Canada did far better than the U.S., better than the U.K. and a little better than France. We also did worse than Australia. Again, this is nothing like a real public inquiry.

No doubt some would argue, in the classic Canadian style, that health is a provincial responsibility, and the provinces should examine their own responses. And we should indeed have provincial inquiries, though I’m not holding my breath.

If the provinces ever do gather their political courage and create public inquiries into COVID-19, they now have a model to guide them.

When the pandemic arrived, Dr. Ryan Meili was both a physician and the leader of the NDP opposition in Saskatchewan. He was in a unique position to take part in both the medical and the political responses to COVID-19, and he kept meticulous notes. He transformed them into an insightful journal of Saskatchewan’s plague years in A Healthy Future: Lessons from the Frontlines of a Crisis, his new book published this fall.

Brain fog and time fog

As Meili himself notes, “‘Brain fog’ is one of the symptoms described post-COVID, but there is also a time fog that has affected us all. Things are moving so quickly that we have a hard time remembering the present, let alone the past few chaotic years.”

Perhaps time fog is understandable as a coping mechanism, but it almost guarantees that we will again be caught flat-footed when the next pandemic hits.

Meili organizes his book by the waves that swept over the province beginning in early 2020. Each chapter contains key dates for the period, with a running tally of cases in Saskatchewan, the rest of Canada and the world. As well, he includes a timeline of measures the province took during that wave, and something about his own experiences and those of his family.

Reading his account of the first-wave measures in the spring of 2020, they suddenly flash back into memory: “Essential visitors” only in hospitals and long-term care centres. International travellers self-isolating and self-monitoring for 14 days on returning to Canada. “Non-essential” businesses and public facilities abruptly closed. The dates varied from province to province, but we all obeyed (or most of us did).

Such flashbacks work very well: as they bring back our own memories, we realize we had a lot of skin in this game — and still do.

Meili builds on public events with his own recollections as a parent, politician and rapidly relicensed physician. In the spring of 2020, despite the rapid spread of COVID-19, Saskatchewan Premier Scott Moe was speculating out loud about calling a snap election, which Meili strongly opposed on medical grounds. The government responded with jeers: “The minister of finance referred to me and my opposition colleagues as ‘Doctor Doom and his whole caucus of gloom,’” Meili writes.

The snap election didn’t happen, but the provincial government had set a tone of false optimism. It rightly saw the economic threat posed by the pandemic but preferred to downplay the disease so business could carry on.

For example, Alice Grove was the first COVID death in Saskatchewan, on March 20, 2020. But she wasn’t listed as such, Meili tells us, until her sister “threatened to demand an autopsy.” Almost from the start, the authorities were reluctant to share information on cases, hospitalizations and deaths.

Information rationing

“This,” says Meili, “was one of the failings of an otherwise robust early pandemic response, and though it would change over time, limiting information would be a constant theme throughout the pandemic.”

Information rationing was certainly true of B.C., as well, where we heard less and less about more and more cases until many of us simply stopped trusting Health Minister Adrian Dix and provincial health officer Dr. Bonnie Henry.

Moe’s government did adopt emergency measures for the first wave and was rewarded with relatively low case counts, hospitalizations and deaths. But once the first wave was over, the government relaxed and set the province up for much higher losses.

In the third wave, in the spring of 2021, the first COVID vaccines arrived — a miracle of science when most vaccines take years or decades to be developed. But after an early surge in demand, something went wrong.

“Just as Saskatchewan’s nation-leading first-wave response collapsed into deadly second, third and fourth waves,” Meili writes, “the early vaccination success did not hold.” The Moe government decided that once 70 per cent of those over 18 had been vaccinated once, restrictions would end.

“To suggest, as the premier did, that reaching those levels would mean the end of the need for public health measures for good was wishful thinking at best and clearly reckless behaviour. Rather than promoting vaccine uptake, this approach had the opposite effect. From the moment the reopening plan was released, the implicit message was ‘we’re good now, move on.’”

Sorry for the inconvenience

Meili says nothing about any backstage conversations with Moe and his government; they seem not to have happened, and the premier remains opaque.

But Meili does mention that Moe once “teared up” in the legislature when announcing that seniors would have to be isolated from their families. Then he and the health minister stopped mentioning lives lost when they met the media. Meili tells us they “gave the strong impression that they cared more about those inconvenienced in their lives than those who lost them entirely.”

Meili is very aware of the social determinants of health and quotes the great 19th-century politician and pathologist Rudolf Virchow: “Medicine is a social science, and politics is nothing else but medicine on a large scale.” Having worked in small communities in northern Saskatchewan, and with racialized and other marginalized people, he knew how politics could be medical malpractice for them — especially when governments were dealing not only with COVID but also with mental illness, opioids and homelessness.

Health-care workers also suffered. Meili starts his book with the breakdown of the province’s chief medical health officer, Dr. Saqib Shahab. Speaking to the media when the Delta wave was at its worst, when ICU patients had to be shipped to Ontario and military medical staff had to be imported, Dr. Shahab described how much worse it was going to get. His voice shook.

Zak Vescera, The Tyee’s labour reporter, then with the Saskatoon StarPhoenix, said: “This wasn’t the question I was planning on asking, but Dr. Shahab, are you OK?”

“What followed,” Meili writes, “was hard to hear, even though nothing was said. Something about that moment, that particular question, broke through Dr. Shahab’s renowned composure. For just over 20 seconds, Saskatchewan’s chief medical health officer choked back tears and struggled to find his voice. He was not OK, and there was no way to hide it.”

The malaise afflicting the health-care professions hit Meili himself; for a time, he tells us, he was on antidepressants.

When Moe did eventually call an election, the Saskatchewan Party won again and Meili’s NDP was defeated. Not long after, he resigned the leadership. But he didn’t go out a loser: he cites Dr. Paul Farmer, the American physician who provided free medical care to poor people around the world, and who died suddenly, only 62, in Rwanda.

Farmer called caring for the poor “the long defeat” — to restore health for a little while, to postpone death for a year or a day, but eventually to lose.

“It’s a concept inherent to medicine as well,” Meili adds; “no matter how good your treatment, all of your patients will die.”

The pandemic is still very much with us, but Meili concludes his book with eight lessons learned that we could apply today, if we wanted to.

1. The best measure of a society is the health of its people.
2. A healthy economy requires healthy people.
3. More equal societies are healthier, including during a pandemic.
4. Facts are worth fighting for.
5. We need to trust people with the truth, even as the truth changes.
6. Leaders need to learn to work together in times of crisis.
7. For Medicare to work, we need to build a robust and resilient health system.
8. To learn the lessons, our stories must be shared.

Saskatchewan, and Canada in general, did not know these lessons when the pandemic began, and we have stubbornly preferred to forget that we even took the test, let alone failed it.

By sharing his stories, Meili gives us a chance to learn the lessons and remember them. I have no doubt that his book will be taught and studied in schools of public health, in medical schools and in political science departments. It should also be read by everyone who wants to live in a healthy society.