My Letter to the Ontario Minister of Health and Parliamentary Assistant Robin Martin MPP
In response to her statement in the OLA today: “..I get tired of listening to people trying to make a crisis, and make fear in the population at a time in the pandemic even worse by using words and expressions like the ‘worst crisis in generations’.”
November 22, 2022
TO: Hon. Sylvia Jones MPP, Minister of Health and Deputy Premier of Ontario
Hon. Robin Martin MPP, Parliamentary Assistant to the Minister of Health
Catherine Zahn, Deputy Ontario Minister of Health
CC: Hon. Doug Ford MPP, Premier of Ontario
Hon. Peter Tabuns MPP, Ontario Leader of the Official Opposition
Hon. Frances Gelinas MPP, Health Critic, Official Opposition
Office of the Ontario Ombudsman
RE: The Ontario Healthcare Crisis and the failure to respond with public health measures recommended by numerous experts in public health, epidemiology, and infectious diseases since May 2022
I am writing to request this government honour its responsibility to the welfare of all Ontarians, especially those vulnerable to the COVID19 pandemic. It appears this government has endorsed a communications strategy which seeks to minimize COVID19 by referring to it as “endemic respiratory virus” ? We have a Chief Medical Officer who makes a public plea on television to strongly recommend Ontarians mask indoors in public buildings and then appears at a Toronto Life party maskless 3 days later, knowing there would be media present. Not surprisingly, this was a high profile media story. Was that the whole point?
Healthcare professionals know this is not a seasonal respiratory virus. It’s a coronavirus that has picked up genetic material from a bat, binds to ACE-2 receptors in the body, causes large and small vessel vasculitis (blood vessel inflammation), and may directly infect organs such as the brain, kidneys, heart, and liver. It causes myocarditis, sudden cardiac death and stroke, and has been associated with dementia and brain atrophy (shrinkage documenting on diagnostic imaging). It remains a most serious threat to all Ontarians, especially to those who are very young, our seniors, persons who are immunocompromised, persons with disabilities, and marginalized persons living in high density housing, often low income and racialized minorities. COVID19 remains the third leading cause of death in Canada, yet this government would like us to believe it’s a bad cold? Today, I was disappointed and shocked to observe Robin Martin MPP, Eglinton-Lawrence, stand up in the Legislative Assembly and state: “..I get tired of listening to people trying to make a crisis and make fear in the population at a time in the pandemic even worse by using words and expressions like the worst crisis in generations..” I would like to briefly reply to her statements in the OLA:
Ms. Martin, healthcare providers and educators like myself are tired of listening to government representatives minimize the worst healthcare crisis in decades while doing little this year to reduce transmission, encourage vaccinations, or support low income families who have been impacted disproportionately with the absence of paid sick leave. This has been, most certainly, the worst crisis in paediatric critical care since the 1940s polio pandemic. We cannot fully explain the severity of respiratory illness observed in children this fall — COVID19 immune dysregulation may explain some of the severe illness. Less than 41% of children ages 5–11 have completed a primary series of COVID19 vaccinations. Of course, children less than age 5 are largely lacking a single dose and have been most vulnerable to COVID19 infections this year. Over the past month, there were times in Toronto and Ottawa ,where no paediatric ICU beds were available. Indeed, that worry remains. This has been the deadliest year of the COVID19 pandemic yet this government has adopted the least stringent of public health measures. More children have died this year than at any time during the pandemic. COVID19 is the third leading cause of death in Ontario. Excess mortality across Canada has been reported at 12% from the Omicron variant this year. As of November 18th, Dr. Tara Moriarty, Professor of Medicine at the University of Toronto, has projected over 37,000 Omicron deaths in Canada, about half unreported. Frankly, I believe Ms. Martin owes the people of Ontario and her colleagues in the Ontario Legislative Assembly an apology.
It is most frustrating to send emails like this one and receive nothing more than an automated acknowledgement, then observe the Minister of Health appear in public for a photo op or opening ceremony, not mentioning our emergency departments and our hospitals are in crisis, or that our healthcare workers are exhausted. On November 21, 2022, Nadia Surani, Director of the Primary Health Care Branch sent Family Health Teams a most extraordinary memo: “Important Ministry Request — Respiratory Illness Season”. An excerpt is included below, but when was the last time the Ministry of Health requested family physicians work days, evenings, and weekends “until further notice”? There was no additional pay description attached despite a request that family doctors sacrifice additional family and personal time. Ms. Surani’s acknowledgement that “primary care providers continue to work tirelessly in their efforts to maintain comprehensive primary care to their patients” serves as a ridiculous placeholder before requesting they work morning, day, and night, 24/7. As Dr. Michelle Cohen clarified on her Twitter feed, additional clinic hours require additional pay for staff, office expenses etc. Who will cover those costs? Is this a suggestion that some physicians are not working hard enough? It would be important for the Ministry of Health to clarify this memo for all Ontarians. Medical students especially want to know that they will be treated fairly as family medicine physicians working in Ontario. The ultimate goal is to recruit and train new family doctors not dissuade them from practising here.
From the November 21, 2022 Memo:
“The difficult and complex fall respiratory illness predicted by the health care system has materialized. COVID-19, influenza and Respiratory syncytial virus (RSV) are actively circulating across Ontario in all of our communities. This scenario is contributing to pressures on our healthcare system, particularly in the pediatric sector, and we are expecting high-volume pressures across our health system now and through the winter.”
“As a result of the above, I am writing to call on your support and requesting your organizations to offer clinical services 7 days a week, including evening availability, until further notice, to meet the needs of your patients. Please advise your patients of this availability so they may seek care in the appropriate place for their health concerns.”
COVID19 is causing premature deaths among seniors and persons with disabilities especially. On a personal note, this past Saturday, I found myself caring for my 86 year old mother who contracted COVID19 from my brother (who works at a Casino that no longer requires masking indoors). She developed fever, vomiting x 8 hours, cough, and sore throat. She would have required hospitalization had I not known how to rehydrate her with oral electrolytes, access her on call physician and then provide this doctor with a detailed medical profile including her blood pressure, oximetry, temperature, chest sounds, medication profile and medical history. We were able to obtain Paxlovid and she improved hours after her 2nd dose. I am an immunocompromised 55 year old doctor with an unknown neurological disorder (I no longer have a clinical practice) and it was up to me to care for her, or risk sending her to the hospital where she may contract influenza and wait > 20 hours in a hallway on a gurney (Her experience a few years ago). I had contracted COVID19 six weeks ago from my partner who worked as a school bus driver trainer and wheelchair/special needs driver. He always wore N95 masks while at work though students and his colleagues did not. He was very ill with a chest syndrome and I had to care for him with regular oximetry monitoring (blood oxygen measurements) for a few days. I received Paxlovid, responded promptly, but developed hearing loss (ruptured ear drum) and loud tinnitus, from bilateral ear infections caused by the virus. My hearing loss and tinnitus remain. I am waiting for a specialist consultation. This isn’t a typical respiratory virus. My partner just quit his job of ten years because of the associated safety risks. Vulnerable persons like my mother and me are contracting COVID19 because masking is not mandatory as before. In October, frequent Code Blacks were recorded in Windsor-Essex where ambulance response times were greater than a couple of hours. How do people with heart attacks or strokes survive under those conditions? What constitutes a health care crisis by this government?
Countless experts in public health, epidemiology, and infectious disease have called for masking indoors, in schools, and on transit. It was the recommendations of three Medical Officers of Health in May, after mandatory masking was removed from public transit. These three physicians had the power to pass a Section 22 order for their own regions, yet elected to write an open letter to the Chief Medical Officer of Health requesting a provincial mandate. Why? I have posed this question before and received no replies from this government. Do Regional Medical Officers of Health continue to have the authority to pass Section 22 orders to manage communicable disease outbreaks, without permission from the Chief Medical Officer of Health or this government, consistent with the Health Protection and Promotion Act? I note no Medical Officer of Health has made a Section 22 order since the spring, unlike pandemic responses in 2020 and 2021.
On August 31, 2022, Dr. Kieran Moore removed the requirements for isolation, even while contagious with COVID19, as long as a person was without fever for a day, with improving symptoms. I have requested the evidence to support such an approach and received no reply. I am waiting for a response to a Freedom of Information request for all evidence used to support that decision. He also said he would consider a masking order only if health care resources were at risk AND with the approval of government, contrary to the Health Protection and Promotion Act, which was amended in 2004 to enshrine the independence of the Chief Medical Officer of Health in managing communicable disease outbreaks.
More recently, Dr. M. Hirji, Acting Medical Officer of Health Niagara Region called for a masking order on the November 18th edition of TVO The Agenda, citing:
1) The low uptake of vaccine booster doses (15% of Ontarians),
2) The expected severe influenza season and other prevalent seasonal respiratory viruses (RSV for example),
3) The failure of this government to continue modelling that was previously carried out by the COVID19 Advisory Science Table (now dissolved),
4) The poor response to the voluntary call to mask from the Chief Medical Officer of Health,
5) The severe COVID19 waves experienced in December 2020 and 2021,
6) The enormous pressures at our hospitals from COVID19 (15,000 in hospital) and ongoing rationed healthcare.
7) The arrival of newer, immune evasive variants with unknown significance.
Masking in schools reduces transmission among students and staff by 29.4% (49 cases per 1000) as reported in a recently published study in the New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2211029?query=recirc_mostViewed_railB_article We have ample evidence that masking reduces community transmission.
Since this pandemic began this government has failed to make substantial investments in homecare supports such as nursing and personal support workers, who could assist seniors like my mother with influenza or COVID19, and reduce ER visits. In fact, it has continued to cut public health funding. I would like to know why? Why haven’t substantial investments been made to promote vaccinations in children and boosters in adults? Have investments have been made to prevent future Code Blacks?
Does this government value the well-being of its citizens? From my perspective, it no longer appears to be the case.
Additional scientific evidence can be found in our September 13, 2022, brief to the Chief Commissioner, Ontario Human Rights Commission, requesting a Section 31 Inquiry into the withdrawal of public health measures and the impact on Code-protected individuals. No government official has commented on our brief.
https://drive.google.com/file/d/1ceci-kYmOLz19LZHdNCLijnP4Ux4WxRb/view
Respectfully,
Christopher Leighton MD, FRCPC
