Ontario's COVID-19 response was 'slower', 'disorganized and inconsistent', Auditor General report finds

Elisabetta Bianchini
·7-min read
COVID-19 in Canada
COVID-19 in Canada

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Ontario Premier Doug Ford said he has “serious problems” with the report released by the Auditor General on the province’s COVID-19 response.

“To say that Dr. [David] Williams wasn’t leading this response, it just isn’t right, it’s actually wrong,” Ford said. “This does nothing but undermine our entire health team and I can’t stand for this and I’ll tell you, I won’t stand for this.”

The premier stressed that the Auditor General’s job is to “go through the financial statements of all ministries and look for value for money.”

“Stick with looking for value for money, stick with the job that we hired you for,” Ford said. “Don’t start pretending you’re a doctor or a health professional because I can tell you, you aren’t.”

“To sit in the office and throw hand grenades at Dr. Williams and his team, and the minister of health is totally unacceptable.”

Ontario’s ‘disorganized and inconsistent’ response

A newly released report from Ontario’s Auditor General Bonnie Lysyk reveals the provincial government was “slower and more reactive” to respond to the COVID-19 pandemic than other provinces, and found that Dr. David Williams, chief medical officer of health, did not “lead” the response.

Lysyk determined that some of the factors that led to this delayed response include, “outdated provincial emergency plans, insufficient staff and significant changeover in leadership at Ontario’s Provincial Emergency Management Office (EMO), as well as systemic issues such as the lack of lab surge capacity and outdated IT systems.”

“Given the significant changeover in leadership at EMO, outdated emergency response plans and the lack of sufficient staff, when the COVID-19 pandemic arrived in Ontario, the province was not in a position to activate the provincial response structure in its emergency response plan,” the Auditor General determined. “Instead, it hired an external consultant to create a new governance structure.”

“In contrast to Ontario, other provinces activated their existing response structures and emergency plans. The new provincial governance structure did not give EMO a prominent role.”

The report also determined that many of the shortfalls in the provincial government’s response were “avoidable” and there were “systemic issues and delays in decision-making.”

“For example, the SARS Commission’s final report identified taking preventative measures to protect the public’s health even in the absence of complete information and scientific certainty as the most important lesson of SARS,” a statement from Lysyk reads. “Following this principle means taking informed decisive action early.”

The auditor general also called Ontario’s COVID-19 response “disorganized and inconsistent” due to the operations throughout the province’s different health units.

“In May 2020, Ontario’s 34 local public health units jointly issued a document stating that there needed to be more direction and regional consistency,” the report reads. “As of the writing of this report, these 34 public health units were still operating independently, and best practices were still often not being shared.”

The Ministry of the Solicitor General also did not implement Auditor General recommendations from three years ago to update emergency response plans. The Ministry of Health also did not implement recommendations in the 2003, 2007, 2014 and 2017 audits to address “weaknesses in public health lab and information systems.”

“Had these recommendations been addressed, Ontario would have been much better positioned to respond to COVID-19,” the report reads.

There were also concerns about testing, contact tracing and case management that was “not all being performed in Ontario in a timely enough manner to contain the spread of the virus.”

“For example, between January and August, all but one public health unit could not meet the target of reporting lab test results within a day of specimens being collected 60% of the time,” Lysyk states. “We also found public health units in Toronto, Ottawa, Peel Region and York Region were failing to contact people in a timely manner after testing revealed they were COVID positive between March and August 2020.”

“This may have led to further exposure and spreading of the virus.”

With regards to Dr. Williams and his role throughout the COVID-19 pandemic, the Auditor General determined that the chief medical officer of health “did not fully exercise his powers under the Health Protection and Promotion Act to respond to COVID-19.”

“For instance, it was the province, not the Chief Medical Officer, that finally issued an emergency order in early October 2020 to require masking for the general public,” the report highlights.

While taking questions from reporters on Wednesday, Lysyk repeated that Dr. Williams was very much in an “advisory role,” something that she said he personally recognized

“What we’re saying is that he provided advice to the health table, and that advice to the coordination table and advice to government but the ultimate decision making is government,” she explained. “Governments can make decisions, I think that the disconnect we saw here from the discussion with the public health community was when their advice is not followed.”

“They just want to understand why it’s not followed.”

The Auditor General went on to say that some situations where advice was not followed included testing of visitor to long-term care homes, where the advice was that tests are “as good as the day you get it” but can create a false sense of security the next time someone enters these vulnerable settings. Another is the framework classifying different regions of the province under different levels.

“Even the one that exists today doesn’t exactly match the recommendations of Public Health Ontario,” Lysyk said.

Deputy premier calls report a ‘mischaracterization of the province’s pandemic response’

Deputy Premier of Ontario and Minister of Health Christine Elliott responded to the Auditor General’s report on Wednesday morning, indicating that, “we have different views on various aspect of her report.”

“There were some issues regarding some factual concerns that we had with issues mentioned in the Auditor General report that we tried to resolve in advance,” Elliott said. “But no changes were made to the report so it’s my responsibility to raise those issues, because they are important for the people of Ontario to know about.”

She identified that a core aspect to the disagreement is related to the finding about Ontario’s “slow” initial pandemic response.

“That’s simply not the case...we were not behind in any respect,” Elliott said, highlighting that Ontario was the first to report COVID-19 as an infectious disease, the first province to close public schools and the second province (after Quebec) to declare a state of emergency.

“We continue to face serious challenges however, today’s Auditor General report is a disappointment and in many respects, a mischaracterization of the province’s pandemic response,” she said.

Elliott maintained that the province has “always” followed the recommendations put forward by the chief medical officer of health but admitted there may have been a few times where there were discussions about possible “small changes.”

She added that Dr. Williams speaks to the public multiple times each week and he is “welcome” to tell Ontarians what his specific recommendations to the government officials have been.

“We are not experts on public health, I’m not, the premier’s not, Dr.Williams is,” Elliott said. “It would be reasonable to assume for anyone that we would need to rely on public health experts when we’re dealing with a public health crisis, and we have relied on Dr. Williams.”

The report revealed that after the province declared an emergency on Mar. 17, it hired an “external consultant” for $1.6 million to “create a new governance structure,” resulting in a Central Co-ordination Table being established and holding its first meeting on Apr. 11.

Elliott said the consultant was brought in after the province determined a “coordinated response” between public health units was necessary, moving away from the “siloed” system that was in place.

Lysyk called this pushback “a little unexpected” and indicated that all the stakeholders in the reports get provide letters to signed off at the end of the audit.

“The intent behind our work is not a blame game here,” she said. “The intent is to make sure that issues that have been highlighted finally get address because it’s been 15, 20 years that some of these things are still not fixed in Ontario.”

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