A Letter to the CMOH, Associate CMOH, MOH, and CEO Public Health Ontario: COVID19
September 21, 2022
To: Dr. Kieran Moore, Chief Medical Officer of Health,
Dr. Wajid Ahmed, Associate Chief Medical Officer of Health,
Hon. Sylvia Jones, MPP, Minister of Health,
Michael Sherar, Ph.D., Acting CEO, Public Health Ontario
Cc: Hon. Patricia DeGuire, Chief Commissioner, Ontario Human Rights Commission
Hon. Peter Tabuns, MPP Leader of the Ontario Official Opposition Party
Hon. John Fraser, MPP, Leader of the Liberal Party
Hon. France Gelinas, MPP, Health Critic, Official Opposition Party
Re: August 31, 2022, Public Health Guidance Changes Violate the Ontario Human Rights Commission (OHRC) Policy on Human Rights in COVID19 Recovery Planning
I am writing with sincere concerns that the policy announced by Chief Medical Officer of Health, Dr. Kieran Moore on August 31, 2022, preferentially disadvantages Code-protected groups as identified by the Ontario Human Rights Commission.
Public Health Ontario, regional MOHs, and public health scientists have all reported on the inequitable impact of the pandemic on disadvantaged groups. From medical frailties, advanced age, persons with disabilities, and BIPOC, many groups protected by the Code have been impacted preferentially and negatively.
In their November 9, 2021, Policy statement on human rights in COVID-19 recovery planning, the OHRC noted:
“Under human rights law, all levels of government have obligations to make sure individuals receive equal benefit from public programs and are not subject to unequal burdens. Given the disproportionate burden that vulnerable groups shouldered through the COVID-19 pandemic, governments[18] must make sure that (a) vulnerable Code-protected groups receive the full and equal benefit of any strategy, policy or program enacted as a COVID-19 recovery measure, and (b) proactive steps are taken to relieve vulnerable groups of the disproportionate harms and disadvantages they have suffered.” https://www.ohrc.on.ca/en/news_centre/ohrc-policy-statement-human-rights-covid-19-recovery-planning
Here the OHRC describes the Human Rights principles for COVID-19 recovery: Principle 1: “ Using evidence-informed approaches, prioritize the rights and needs of the communities hardest hit by the health, economic, and social impacts of the pandemic, and sure the communities benefit equally from any legislation, policy, program, or requirement designed to promote pandemic recovery”.
This is among the most important principles in developing a strategy that improves freedoms while minimizing the risk to vulnerable persons.
The COVID19 pandemic is not over. I am not one to believe it will be here indefinitely. I do not enjoy wearing a mask. Though as an immunocompromised individual, I have done so since March 2020. Globally progress has been made and mortality is falling. However, vaccine distribution remains inequitable globally, especially in developing nations, and even in Ontario, where low-income neighbourhoods have poor vaccine uptake (especially among children). It is true that the pandemic is improving, but our actions now can also simultaneously worsen the impact on vulnerable Code-protected groups.
Sending vulnerable students to school without masking, and without isolation of contagious students at home, does not respect this OHRC principle. By vulnerable, I mean children receiving cancer therapy, immunosuppressed due to organ transplantation, primary immunodeficiency etc. This is not an evidence-informed approach. Nearly 60% of Ontario elementary students have not had 2 vaccinations with an mRNA vaccine. We do not that know if such an approach is safe for vulnerable persons. It isn’t appropriate to proceed on a “trial basis”. There are numerous reports of student and teacher absences already.
Sars-CoV-2 is not another respiratory virus. It is a mistake to consider it in that manner. It’s a zoonotic virus whose origin is uncertain (i.e. it may have originated in a laboratory). It causes diffuse autoimmune responses that have been observed in nearly every organ system. “Pneumonia” is actually an autoimmune inflammatory response that includes clotting in fine vasculature, loss of air sacs (alveoli), and pulmonary fibrosis (scarring). It can cause brain shrinkage (atrophy) and has been associated with an increased risk of dementia (not necessarily causally related). Cardiovascular mortality is higher following COVID19 infection. Most who are vaccinated may only experience fever, body aches and a sore throat. However, one in five infected with the Omicron BA5 variant are developing a long covid19 syndrome. Studies into their impact on children and adults have just been initiated. Vaccination may lessen the incidence. The precautionary principle, as outlined by the Honourable Justice Mr. Archie Campbell in the SARS Commission reports, should be an overarching theme of our response to COVID19. I am afraid that is no longer the case. Ontario is not unique in this populist approach. But that does not mean we cannot be cautious this fall and winter.
The Lancet Commission reported the global COVID-19 response as “A massive global failure” in their September 14, 2022, publication (https://doi.org/10.1016/S0140-6736(22)01585-9). One identified failure: “Failure to follow normal public health practice”. This refers to testing, tracing, isolation, and effective public health measures, such as masking and vaccination. Recording infections and monitoring admissions to hospitals are important actions. We must monitor conditions that are worsened by COVID19 infection. The use of the anti-viral, Paxlovid is limited to a smaller subset of patients. Additionally, Paxlovid is not approved in children < age 12, which makes their significant unvaccinated status even more worrisome.
Accommodations should include an approach that provides all children with in-person learning rather than excluding higher-risk children. This was described by the OHRC also. The Ministry of Health policy does not consider that children share their homes with vulnerable adults and siblings. Likewise, it does not consider the impoverished who live in high-density housing and are reliant on public transportation. Masking is no longer required on public transit. Who will provide N95 masks to them? Their communities must be protected.
We cannot compare our population to the USA. We have about 1/3 to 1/2 less natural immunity. Many people have had successive infections with the Wuhan type and the Omicron variant, in addition to vaccines. They have lost over a million persons, probably much more from unaccounted mortality to COVID19 conditions worsened by infection, such as cardiovascular disease. We have succeeded in minimizing mortality rates until this year: Child mortality, under age 12, is higher this year than at any time of the pandemic.
Masking was recommended by the former Scientific COVID19 Advisory Science Table Director, Dr. Fahad Razak, and Dr. Gerald Evans, an infectious disease specialist and former Science Table member before its dissolution by Public Health Ontario, and by Dr. David Fisman, Professor of Public Health, University of Toronto. The usefulness of masking is documented in a Public Health Ontario systematic review accessible online. This government did not develop a consensus or even consult with their own Advisory Science Table experts before enacting the August 31, 2022, policy. That is most concerning.
On behalf of 47 physicians, nurses, scientists, and educators, I have submitted a request to the Chief Commissioner of the OHRC, the Honourable Patricia DeGuire, for an immediate inquiry by the Commission, to review the public health policy of the Ministry of Health. Whether an inquiry occurs or not, this government must acknowledge that most often, the vulnerable cannot protect themselves. They look to the government to do so. “Wear a mask, if it’s right for you” is an unproven approach during this pandemic. We know masking with other measures, ‘cohorting’, testing and isolating when contagious, are indeed effective. We know that approach reduces transmission in schools.
Therefore, please consider my request to bring masking back to public areas where vulnerable Code-protected persons must frequent. At least in elementary schools, where vaccination uptake is poor, secondary schools, grocery stores, pharmacies, libraries, and public transit. Low-income individuals and families should be supplied with masks. Isolation should not be abandoned. “People cannot distinguish the flu from COVID19.” — Dr. Isaac Bogoch, Infectious Disease Specialist at the University Hospital (CBC TV, September 20, 2022). A five-day minimum period of isolation for any febrile illness this year, strongly endorsed by the Chief Medical Officer, would be a prudent approach, and one that respects the precautionary principle. Perhaps by the winter, such measures will not be warranted. I do not know. Newer variants are emerging. And our healthcare system remains under serious strain. These facts must also be considered with new public health policies.
I have provided a link to our OHRC submission. We have also commented on matters of existing Ontario law from the Education Act and the Health Protection and Promotion Act that the government appears to have violated, with the current public health approach to the COVID19 pandemic.
https://drive.google.com/file/d/1ceci-kYmOLz19LZHdNCLijnP4Ux4WxRb/view?usp=sharing
Thank you for your ongoing dedication and understanding that vulnerable Code-protected classes require special consideration.
These are my own comments and do not reflect any organization or institution.
Most Sincerely,
Christopher C. Leighton MD, FRCPC
