Sunday, 9 August 2020

Dr. Easton’s Sandstone Outcrop at Gillies Corners, Lanark County

Over the past five years Dr. Michael Easton of the Ontario Geological Survey has been mapping the Precambrian rocks of Eastern Ontario.  This is Dr. Easton's 2017 report of a previously unreported outcrop of Nepean Formation sandstone in Lanark County:    
 
“The northeastern boundary of the geophysical anomaly may also be fault bounded because a  previously undocumented inlier of Nepean Formation rocks occurs at Gillies Corners (UTM 413795E 4984105N), 4.3 km southwest of Frankto[w]n, immediately south of the northwestern boundary of the geophysical anomaly (see Figure 18.3A).   This sudden appearance of a stratigraphically lower unit in an area underlain by rocks of the stratigraphically higher March Formation, suggests that if a fault is present, it is down-dropped to the north.”

Dr. Easton’s location UTM 413795E 4984105N  converts to Latitude : 45.005155 deg, or 45 deg 0 min 18.558 sec.  Longitude: -76.093858 deg, or -76 deg 5 min 37.889 sec.   Plugging 45.005155, -76.093858 into Google will show the location of the outcrop.

In June I took County Road 10 when I was driving back to Ottawa from Perth, and stopped at Gillies Corners to look at Dr. Easton's outcrop of Nepean Formation sandstone.    [While the road is mapped as Perth Road, as Drummond Concession 2 and as County Road 10, most in Perth call it the Franktown Road.   Those living in Franktown call it the Perth Road.  I have yet to meet anyone in Perth who calls it County Road 10, but it is identified as such by those from Ottawa and on Google Maps.]

The sandstone outcrops on both sides of Malcolms Way,  with the best outcrops about 100 meters east of Gillies Corners Side Road.   The better outcrop, on the north side of Malcolms Way,  is about  30 yards long and 5 feet high and is flat lying, fresh sandstone.   Most of the outcrop is Nepean formation white to buff sandstone.   There are additional smaller, badly weathered,  outcrops to the east along Malcolms Way.

Four photographs of the best outcrop are provided below [331, 339, 340, 341] :

The ruler in the photographs is a meter stick, with inches and centimeters marked.

The second photograph shows a layer of dark rock at the top, which is likely March formation (or younger Oxford formation), with an uncomformity between the underlying Nepean Formation sandstone and the overlying March Formation.   (The badly weathered dark rock also outcrops further east along Malcolms Way.)

Interestingly, the Nepean formation sandstone displays three different facies.   In earlier blog postings I mentioned that Dave Lowe (2016 )  has recognized six siliciclastic paleoenvironments in the Potsdam Group sandstones:  a) braided fluvial,  b) ephemeral fluvial, c) aeolian erg, d) coastal sabkha, e) tide-dominated marine and  f) open-coast tidal flat.

At the top of the Nepean formation sandstone at this outcrop is a layer with vertical burrowing (second and fourth photo’s) – Dave Lowe’s marine facies.

Under that is a layer that extends over much of the length of the outcrop that is full of rounded pseudomorphs of evaporite minerals– Dave Lowe’s coastal sabkha facies.  See the second and third photos.  My third photo compares well with Dave Lowe’s (2016) photo 3.8A which he describes as “Impressions of sparry, nodular radiating mineral aggregates from Kanata, ON (locality 14),” which is behind Kanata’s Walmart.

Most of the lower two thirds of the outcrop is a fine grained, white to buff sandstone that is arguably wind blown (aeolian erg) sandstone.

 Williams and Wolf’s (1984) Map P.2725 puts Gillies Corners in the March Formation,  and placed the fault bounded boundary between the Nepean and March at about four kilometers west of Gillies Corners.  Below is a map compiled from   Williams and Wolf’s (1984) Maps P.2725 and P.2724 upon which I have plotted the location of Dr. Easton’s outcrop with a red square.

Wilson, Liberty, and Reinhardt’s (1972) geologic map covers the  area north of where I have written ‘GILLIES CORNERS’ on my map.  They also mapped Gillies Corners as falling within the March Formation and show the boundary between the Nepean and March at about four kilometers west of Gillies Corners.  Interestingly, they also plot a small area of Nepean Sandstone (about a kilometer long and 200 meters wide)  about five kilometers north of Dr. Easton’s outcrop, along Line Road 6 where it  intersects  Gillies Corners Side Road.  I’ve marked this small area on the map with a blue oval shape.

 Curiously, an additional outcrop of Nepean sandstone appeared on Wilson,, Liberty and Reinhard’s (1964) preliminary  Map 7-1964, that did not appear on the finished map.  This was a small area along Gillies Corners Side Road about three kilometers north-northwest of Dr. Easton’s outcrop.  Intriguingly, Reinhardt, who was the last to edit the Paleozoic compilation, was an expert on Precambrian rocks rather than Paleozoic rocks.

Jean Dugas, for his 1952 doctoral thesis, mapped the geology of the Perth map area, which included the area south of Gillies Corners.  GSC Map 1089A by Wilson and Dugas (1961) replicates a map that is part of his thesis.  Dr. Morley Wilson is credited as the first author as part of the map-area had been surveyed in 1930 by Dr. Morley  Wilson, who mapped most of Palaeozoic area on the eastern part of the sheet.  Wilson and Dugas’ map shows a number of areas of Nepean sandstone that do not appear on Williams and Wolf’s (1984) Maps P.2725 and P2724.  For example, their map 1089A shows small occurrences of Nepean sandstone 4 km southwest of Gillies Corners, 4 km south of Gillies Corners, and 3 km east-southeast of Gillies Corners.  The largest of these is 1.5 miles long and 1/4 mile wide and cuts across County Road 10 just west of Cockburn Creek.

It has been over seventy years since Dr. Alice E. Wilson mapped the Paleozoic geology north of Gillies Corners and ninety years since Dr. Morley E. Wilson  mapped the Paleozoic geology south of Gillies Corners, and some outcrops that they found are now difficult to find.  What would have been farmland when they mapped the area is now overgrown with brush and trees.   Other outcrops are obscured by housing developments.


I brought Dr. Easton’s outcrop to the attention of  two geologists who have worked on the Nepean Formation and March Formation and sent them the photos.   One commented “The disconformable contact with the March/Theresa  is very interesting — we generally only see that kind of a relationship in association with a fault.”   The other noted that “A disconformable contact at the “Nepean-March” ... formation boundary has been a contentious issue over the years.”

The outcrop is worth a visit if you are interested in the Nepean Formation of the Potsdam Group.

Below I’ve provided a few of the more recent commentaries on Potsdam sandstone.   I’ve also included two papers by Bernius who reported on core from the GSC’s Borehole Geophysics Test Area at Bell’s Corners, Ottawa. His papers have been overlooked   What is particularly interesting is that the core contains a 50 cm thick shale layer in the Nepean Formation.   Bernius also found that the upper contact of the Nepean formation with the March Formation is a disconformity. 

Christopher Brett
Ottawa

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REFERENCES AND SUGGESTED READING

Bernius, G. R., 1981,
Boreholes Near Ottawa for the Development and Testing of Borehole Logging Equipment - A preliminary Report GSC Paper 81-1C, p. 51-53
 
Bernius, G. R., 1996,
Borehole Geophysical Logs from the GSC Borehole Geophysics test site at Bell’s Corners, Nepean, Ontario, GSC Open File 3157, 38 pages, doi:10.4095/207617 (pdf  6427 KB)

Brett, C. P.,  2016
Gypsum Pseudomorphs that formed in the Sabkha Environment of the Potsdam Group.   Blog posting December 1, 2016
http://fossilslanark.blogspot.com/2016/12/gypsum-pseudomorphs-that-formed-in.html

Brett, C. P., 2017
Why has hardly anyone referred to core from the GSC’s Borehole Geophysics Test Area at Bell’s Corners, Ottawa, when the core contains a 50 cm thick shale layer in the Nepean Formation and the core straddles the boundary between the Nepean Formation and the overlying March Formation?”      Blog posting dated May 22, 2017
http://fossilslanark.blogspot.com/2017/05/

Brink R, Mehrtens C, Maguire H, 2019
Sedimentology and petrography of a lower Cambrian transgressive sequence: Altona Formation (Potsdam Group) in northeastern New York.  Bulletin of Geosciences, 94, 369-388
http://www.geology.cz/bulletin/contents/art1728

Dix, G.R., Salad Hersi, O., and Nowlan, G.S., 2004,
The Potsdam–Beekmantown Group unconformity, Nepean Formation type section (Ottawa, Ontario): a cryptic sequence boundary, not a conformable transition: Canadian Journal of Earth Sciences, v. 41, no. 8, p. 897–902,  https:// doi .org /10 .1139 /e04 -040 .

Dugas, Jean, 1952,
 Geology of the Perth map area, Lanark and Leeds Counties, Ontario; Ph. D., McGill, 189 pages, four  maps.  
http://www.collectionscanada.gc.ca/obj/thesescanada/vol2/QMM/TC-QMM-124004.pdf
https://escholarship.mcgill.ca/concern/theses/t435gh12d

Easton, Michael, 2017
Precambrian and Paleozoic Geology of the Carleton Place Area, Grenville Province,  pages 18-1 to 18-18 In Summary of Field Work and Other Activities 2017, Ontario Geological Survey, Open File Report 6333,
http://www.geologyontario.mndm.gov.on.ca/mndmaccess/mndm_dir.asp?type=pub&id=ofr6333

Landing, E., Salad Hersi, O.,  Amati, L., Westrop, S.R., Franzi, D.A., 2019
Early Paleozoic rifting and reactivation of a passive-margin rift: Insights from detrital zircon provenance signatures of the Potsdam Group, Ottawa graben: Comment. GSA Bulletin; March/April 2019; v. 131; no. 3/4; p. 695–698; https://doi.org/10.1130/B35104.1; published online 25 January 2019.

Lowe, David G., 2016
Lower Ordovician Potsdam Group in the Ottawa Embayment and Provenance of the Cambrian – Lower. Ordovician Potsdam Group in the Ottawa. Embayment and Quebec Basin. David G. Lowe. Doctoral Thesis submitted to the University of Ottawa
https://ruor.uottawa.ca/
http://hdl.handle.net/10393/35303
http://dx.doi.org/10.20381/ruor-261

Lowe, David G, and R.W.C. Arnott, 2016
 Composition and Architecture of Braided and Sheetflood-Dominated Ephemeral Fluvial Strata In the Cambrian–Ordovician Potsdam Group: A Case Example of the Morphodynamics of Early Phanerozoic Fluvial Systems and Climate Change
Journal of Sedimentary Research, v. 86, i. 6, p. 587-612, Published in June 2016, doi:10.2110/jsr.2016.39  

Lowe, D.G., Arnott, R.W.C., Chiarenzelli, J.R., and Rainbird, R.H., 2018,
Early Paleozoic rifting and reactivation of a passive-margin rift: Insights from detrital zircon provenance signatures of the Potsdam Group, Ottawa graben: Geological Society of America Bulletin, v. 130, no. 7/8, p. 1377–1396, https:// doi .org /10.1130 /B31749 .1 .

Lowe, D.G., Arnott, R.W.C., Chiarenzelli, J.R., and Rainbird, R.H., 2019,
Early Paleozoic rifting and reactivation of a passive-margin rift: Insights from detrital zircon provenance signatures of the Potsdam Group, Ottawa graben: Reply. Geological Society of America Bulletin, March/April 2019, v. 131, no. 3/4, pages 699-703; published online January 25, 2019.  https://pubs.geoscienceworld.org/gsa/gsabulletin/article/131/3-4/699/568492/Early-Paleozoic-rifting-and-reactivation-of-a

Lowe, David G.;  Arnott, R.W.C.; Nowlan, G.; McCracken, A.D., 2017
Lithostratigraphic and allostratigraphic framework  of the  Cambrian-Ordovician Potsdam Group and correlations  across Early Paleozoic southern Laurentia.  Canadian Journal of Earth Sciences  2017, 54(5): 550-585, https://doi.org/10.1139/cjes-2016-0151

Williams, D.A., and Wolf, R.R.,  1984a
Paleozoic Geology of the Carleton Place Area, Southern Ontario; Ontario Geological Survey, Map P. 2725, Geological Series-Preliminary Map, scale 1:50 000. Geology 1982.

Williams, D.A., and Wolf, R.R., 1984b
Paleozoic Geology of the Perth Area, Southern Ontario; Ontario; Geological Survey, Map P. 2724, Geological Series-Preliminary Map, scale 1:50 000. Geology 1982.

Wilson, Alice E., Liberty, B. A., and Reinhardt, E.W., 1964,
Geology Carleton Place, Ontario.  Map 7-1964, Preliminary Series, Geological Survey of Canada. Scale 1:50,000 Paleozoic geology by A. E. Wilson, 1946.  Paleozoic compilation by B. A. Liberty, 1963. Precambrian geology and compilation by E. W. Reinhardt, 1963.

Wilson, Alice E., Liberty, B. A., and Reinhardt, E.W.,  1972,
Geology Carleton Place, Ontario.  Map 1362, Geological Survey of Canada. Scale 1:50,000
Paleozoic geology by A. E. Wilson, 1946.  Paleozoic compilation by B. A. Liberty, 1963, with changes and additions by E. W. Reinhardt, 1972.  Precambrian geology and compilation by E. W. Reinhardt, 1963, 1969, 1972

Wilson, Morley E. and  Dugas, Jean,  1961,
Map 1089A, Geology, Perth, Lanark and Leeds Counties, Ontario, Geological Survey of Canada; Geology by Morley E. Wilson, 1930 and Jean Dugas, 1949; Descriptive notes by Jean Dugas.
https://doi.org/10.4095/107951

 

Sunday, 7 June 2020

Ontario needs legislation requiring an annual report to the legislature on PPE held in Ontario’s stockpile

These are the important facts.

In 2007   Ontario’s Ministry of Health and Long-Term Care (MOHLTC) developed a comprehensive, detailed Ontario Health Plan for an Influenza Pandemic (OHPIP).   This required that all  health care settings and providers  maintain a four-week stockpile of personal protective equipment and other critical supplies.  The province undertook to develop and maintain a four-week a stockpile of personal protective equipment for the entire health system; and a system for purchasing, storing and distributing supplies.  This would ensure business continuity for the first wave of the pandemic which was estimated to be approximately 8 weeks.

That plan was put into effect and communicated to hospitals and other stakeholders, including Toronto Public Health.  Further, in 2007 Ontario bought supplies for the stockpile.   A number of hospitals and Toronto public health also stockpiled supplies.  When H1N1 struck in 2009 supplies from Ontario’s stockpile were distributed. 

In 2013 Ontario Health Plan for an Influenza Pandemic was updated.  It still required that all  health care settings and providers  maintain a four-week stockpile of personal protective equipment and other critical supplies, and that the province would maintain a four-week a stockpile of personal protective equipment for the entire health system, to cover  the first 8 weeks of the pandemic.   Further, the plan is still in force and on Ontario’s web site.

In December, 2017  Ontario’s auditor general  reported  that  80 percent of Ontario's stockpile had expired, noting that  “The ministry informed us that its budget for these supplies only allowed for storage and not the management of them.”     The Auditor General recommended that the Provincial Emergency Management Office work with ministries to ensure that they plan for and enter into all relevant agreements and plans for any resources that may be needed during an emergency.

In December, 2019   the Auditor General for Ontario reported that it had conducted a follow up audit on its recommendations from 2017.   Sadly, the Ministry was aiming for March, 2021 to have plans in place to deal with goods and services that might be needed in an emergency.

Comments:
Manitoba, Newfoundland, Nova Scotia and PEI also had pandemic plans requiring stockpiles, which they also failed to keep up-to-date. 

On May 06, 2020 the Manitoba NDP introduced Bill 213, the Personal Protective Equipment Reporting Act. The bill would require the Manitoba government to table a report each year setting out the number of items of PPE purchased during the year and the number of items held in inventory at the end of the year.     See:   https://web2.gov.mb.ca/bills/42-2/pdf/b213.pdf
https://www.mbndp.ca/ppe_stockpile

I believe that it makes sense for Ontario to introduce a  bill requiring Public Health Ontario to report annually on the PPE held in Ontario’s stockpile, and to have a system in place to ensure that the stockpile does not contain expired goods.

Here is a first draft of the bill:

WHEREAS having stockpiles of personal protective equipment prevents shortages of that equipment when it is needed;

WHEREAS since 2007 Ontario has had a  detailed Ontario Health Plan for an Influenza Pandemic (OHPIP) which has required that all  health care settings and providers  maintain a four-week stockpile of personal protective equipment and other critical supplies, and the province undertook to develop and maintain a four-week a stockpile of personal protective equipment for the entire health system, to ensure continuity for the first wave of the pandemic which was estimated to be approximately 8 weeks;

WHEREAS the pandemic caused by the communicable disease known as COVID-19 has demonstrated the need for personal protective equipment to prevent and control infection and has demonstrated the failure of Public Health Ontario to maintain Ontario’s stockpile of personal protective equipment;

AND WHEREAS it is in the public interest that everyone in Ontario is aware of the inventory of personal protective equipment held by health authorities;

THEREFORE HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Ontario, enacts as follows:

 1. For each calendar  year Public Health Ontario and  the minister must prepare a report that sets out, with respect to Ontario’s stockpile of personal protective equipment,
(A) the number of items of personal protective equipment that are purchased during the year;
(B) the number of items that are held in inventory at the end of the year.;
(C) the number of items distributed to the health system during that year;
(D) the number and locations of Ontario’s warehouses storing the stockpile;
(E) the number of items that were disposed of during the year because they had expired;
(F) the number of items in inventory that are within a year of their expiry date;
(G) a plan to distribute to the health system items that are within a year of their expiry date and a plan to replace those items in the stockpile;
(H)    a brief report on whether the supplies in inventory are sufficient to last four weeks in the event of a pandemic;
(I) the cost to acquire  personal protective equipment that are purchased during the year;
(J) the cost to warehouse the stockpile for the year.

2.  The report must include the number of items of the following types of personal protective equipment:
(a) surgical masks;
(b) filtration masks (N95 and higher filtration rate masks);
(c) protective gowns;
(d) face shields;
(e) eye protection;
(f) examination and sterile gloves;
(g) any other type of personal protective equipment, as prescribed by regulation under this Act.

3.  Within two months after the end of each calendar year, the minister must table a copy of the report in the Assembly and make it available to the public

3.  The Lieutenant Governor in Council may make regulations prescribing an item as a type of
personal protective equipment for the purpose of  clause 2(g).

4.  This Act comes into force on the day it receives royal assent.

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It is worth noting that many of the products in the stockpile, if properly managed, and distributed before they expire, do not cost a province that much more than the cost of storage.  This is because Ontario is going to spend the money to buy the products for the hospitals .  For example, the stockpile will contain a one month supply of surgical masks.  Hospitals in a Ontario go through a month’s supply of surgical masks each month.   Ontario will pay for the surgical masks  that the hospitals use whether they are shipped direct to the hospital, or are shipped from storage in the stockpile to the hospitals, and there is no additional cost other than storage, and cost for shipping once per year

Managing a stockpile to ensure that it does not contain expired goods is not rocket science, but does require planning and effort.  Chen et al. (2017) describe how Taiwan maintains a minimum stockpile for the surge demand of PPE in the early stage of a pandemic.  Taiwan  deals with expiration problems of the stockpiled goods by having the oldest stock in the central government stockpile regularly replaced and replenished with the same amount of new and qualified products, ensuring  availability and the maintenance of the stockpiles. Previously,  Taiwan had adopted a traditional way to stockpile PPE in central inventory, with large purchases and then storage until use.  To solve the issue of low consumption and having a mostly out-of-date PPE stockpile in the central health authority during non-epidemic periods, while maintaining the minimum stockpile,   Taiwan developed a replacement model for PPE stockpile management.

Christopher Brett
Perth and Ottawa, Ontario

Reference
Chen YJ, Chiang PJ, Cheng YH, Huang CW, Kao HY, Chang CK, Huang HM, Liu PY,
Wang JH, Chih YC, Chou SM, Yang CH, Chen CH, 2017
Stockpile Model of Personal Protective Equipment in Taiwan.
Health Security, 28 Feb 2017, 15(2):170-174. DOI: 10.1089/hs.2016.0103
https://europepmc.org/article/pmc/pmc5404251

Thursday, 21 May 2020

The COVID-19 Pandemic, Canada’s National Emergency Strategic Stockpile, Expired N95 Masks and Missing Masks

“The federal government's failure when it comes to the National Emergency Strategic Stockpile (NESS) was brought into focus on Monday as Ontario Premier Doug Ford said there are no warehouses full of personal protective equipment to back up the province.  Yet, that is exactly what the NESS is supposed to be.  ...   that stockpile simply isn’t there and so far, the federal government has supplied Ontario with less material than they donated to China at the beginning of February.”
Brian Lilley, Published:  April 6, 2020, Toronto Sun

I suspect that everyone that reads the newspapers or is following this story on television or over the web is as perplexed as I am by the bungling, inefficiency and failings of the public health officials in Canada and in the United States of America.  While public health officials have been great at writing reports predicting pandemics and setting out what should be done in the event of a pandemic, they have failed miserably to make sure that supplies were on hand to fight a pandemic, were unable to recognize a pandemic in the making, made up science on the go to explain their actions, failed for months to roll out tests in sufficient numbers, failed for months to test for asymptomatic carriers,  failed to follow suggestions of the World Health Organization, failed to realize that if a number of cases in Canada could be traced to travel to a particular country perhaps something should be done,  failed to close borders in a timely manner, delayed for six weeks advising Canadians not to get on cruise ships,  kept changing their advice, and in many cases ended up advising people to do the exact opposite to what had been advised earlier.  What is particularly galling is that what could and should have been done has been set out in numerous publications of Health Canada.    The mismanagement by those at Health Canada is almost incomprehensible.   The other thing that boggles the mind is that while public health officials in Canada and in the United States of America had to have been aware that China had been put under lockdown, no one at the Centers for Disease Control and Prevention (‘CDC) or at Health Canada  thought that such a thing could happen in North America, and no one thought to look at the data coming out of China or the data published by the World Health Organization, or to listen to the warnings issued by the World Health Organization. They were living in a bubble with no knowledge of what was happening elsewhere in the world and with no understanding that their inaction could have dire consequences.

The failings by the public health officials and politicians reminds me of twenty years ago when high tech companies were buying vaporware, and their actions resulted in the failure of multimillion dollar companies (e.g., Nortel, JDS  Uniphase).  Certainly the failure of those companies ruined lives and the retirement plans of tens of thousands, but at least the failure of the leaders of those companies didn’t lead to the death of thousands. 

It is not that Canada or the USA were caught by surprise by the novel coronavirus.  Both countries were told in December by at least two different intelligence gathering operations that it was coming.  Both countries ignored the warnings.   One of these, the Global Public Health Intelligence Network (GPHIN) provided warnings in December.   Murray Brewster of the CBC News (posted April 22, 2020) reported “Chief Public Health Officer Dr. Theresa Tam said last week GPHIN was one of the intelligence sources she relied on, crediting it with detecting the outbreak in Wuhan "right at the end of December."”  It is hard not to scream when reading this quote.   If she knew of the outbreak in December, why didn’t she act by taking steps in early January?   Murray Brewster (Posted Apr 10, 2020) also reports that “The medical intelligence cell within Canadian Forces Intelligence Command began producing detailed warnings about the emergence of the deadly novel coronavirus in Wuhan, China in early January.” These reports, based on reports by the U.S. military's National Center for Medical Intelligence,  were ignored by the federal Liberal government.   More detailed reports were provided to the US government, where they were also ignored.  Incredibly while the CDC, Donald Trump,  Dr. Theresa Tam and the federal Liberals failed to act, the Alberta Health Services Contracting, Procurement and Supply Management team noticed the potential problem in Wuhan, China in December 2019 and ordered extra supplies in December, January and February as they were planning for a pandemic.

What is also interesting is that at least one U.S. manufacturer of N95 masks forecast the extreme need for masks in the third week of January.   In an article published May 9th in The Washington Post, Aaron Davis wrote that Mike Bowden of Prestige Ameritech, a medical supply company located in Texas, noticed on January 22 , a day after the first case of COVID-19 was detected in the United States, that orders were pouring into his company “some from as far away as Hong Kong.”  On January 22 and 23  Mike Bowden sent emails to top administrators in the Department of Health and Human Services offering to reactivate four N95 manufacturing lines that could make more than 7 million masks a month.    It was not until  April 7 that FEMA awarded Prestige a contract to provide a million N95 masks a month for one year.

Further,   Global News has reported that starting in January the City of London, Ontario started building up a stockpile of PPE and secured “hundreds of thousands of masks and gloves, hundreds of tubs of disinfectant wipes, and dozens of litres of sanitizer.”  Trevithick of Global News quotes Dave O’Brien, London’s manager of corporate security and emergency management, as saying “Given our experience with [SARS-CoV-1] and H1N1, we sort of saw what was happening overseas and began sourcing additional stockpiles of different PPE.” 

One has to ask "If in December and January Alberta Health Services Contracting could see the pandemic coming, if in January Prestige Ameritech could forecast a shortage of masks, and if in January  London, Ontario's corporate security and emergency management department could see the need to stockpile additional PPE goods, why couldn't our public health officials see the pandemic coming?"

Some in the press in Canada like to contrast Canada’s response with that of the United States, in large part to show that we are doing a better job. With respect, when you compare Canada’s response with that of a country where its leader denied that the coronavirus was a problem, where for  most of February commercial tests were disallowed by CDC regulations and  manufacturing defects rendered most CDC developed test kits unusable, where precious few tests were carried out in February or March, and where every pronouncement by its President comes with a disclaimer and correction by the News organization reporting it,  and where the leader of that other country recommends drinking bleach as a cure, you have set the bar low.  Justin Trudeau and Theresa Tam have not recommended drinking bleach, but otherwise have responded much in the same way as the United States.  There are multiple reasons why Canada has ranked number ten in the world in deaths for most of the last two months.

Others in the press in Canada contrast Canada’s response with that of the Taiwan, Hong Kong, Australia, New Zealand, Japan, South Korea, and Singapore,  to show how we could be doing a better job.  Sadly, when you sum up the populations, total cases, and COVID-19 deaths in those six countries and one administrative area, you realize that they have six times the population of Canada, about the same number of cases as Canada, but a third of the deaths that we have.  We would be wise to study what they did.  Interestingly, it is not a secret.  They closed borders, restricted travel, tested, isolated, quarantined, traced contacts, and tested, tested, tested.   It is laid out in Canada’s 2006 Pandemic Plan, in Canada’s 2009 report on the H1N1 virus and in Canada’s recent 2015 (revised 2018) pandemic plans.

My wife suggested that comparing Canada with nations such as Taiwan, Australia, New Zealand, and Japan  is unfair as they  are islands.  I went back and looked at the fourteen countries that share land borders with China.  They have a total population of over two billion,  52 times greater than Canada, but Canada has more deaths than the fourteen countries combined.  Closing borders, quarantining, tracing and testing works.

Canada's National Emergency Strategic Stockpile (NESS)


Canada's National Emergency Strategic Stockpile (NESS)  facilities consist of a central depot in the National Capital Region and warehouses strategically located across Canada.  It contains supplies that provinces and territories can request in emergencies, such as infectious disease outbreaks and natural disasters, when their own resources are not enough. These supplies include a variety of items such as medical equipment and supplies,  pharmaceuticals and supplies such as beds and blankets.  It traces its history back to a program created in the 1950s.

The Government of Canada’s web site describing the NESS mentions that “In 2004, following the Severe Acute Respiratory Syndrome (SARS) outbreak, the Public Health Agency was established to provide a focal point for federal leadership in managing public health emergencies and improved collaboration within and among jurisdictions. Still part of the federal Health Portfolio, the NESS assets were transferred from Health Canada to the newly created Public Health Agency.   The SARS outbreak triggered preparations for a new global threat, pandemic influenza, with the subsequent initiation of substantial NESS stockpiling of pandemic response supplies. This surge supply included antiviral agents, antibiotics specific to pandemic response, syringes, ventilators and related oxygen supply equipment, personal protective equipment (masks, face shields, gloves), and other supplies such as gowns, disposable sheets, pillows, needles, syringes and body bags.”

 It is important to note that this web site mentions that the NESS contains “personal protective equipment (masks, face shields, gloves).”

Timeline of Mentions of Masks and the National Emergency Strategic Stockpile


2003:
Health Canada’s report ‘Learning from SARS’ published in 2003 contains the following statement “Health Canada also facilitated the purchase of  approximately 1.5 million N95 masks for the National Emergency Stockpile System [NESS], and sent 10,000 to Toronto health officials.”

2003 - the Initial report of the Ontario expert panel on SARS and infectious disease control (“Walker report”) noted that “ SARS had a profound effect on the traditional supply and distribution of the protective equipment needed by healthcare providers, particularly at the  onset of the outbreak. The Panel heard of the significant challenges experienced at the facility  and provider level in accessing basic supplies, as well as at the provincial level.... [SARS]  resulted in healthcare organizations across North America attempting to secure the same supplies at the same time.  With no ready access to a domestic supplier of certain forms of protective gear, simply obtaining a basic supply was a huge challenge.”  The Expert Panel  recommended that Ontario create an Office of Health Emergency Preparedness (OHEP) ... and that “ the OHEP should begin to work closely with Health Canada ..ensuring the relevance and readiness of any emergency stockpile system and of appropriate provincial linkages and protocols as required for the purposes of coordination”


2003-04-28 Hansard:
Hon. Hedy Fry (Liberal Member of Parliament for Vancouver Centre):    “Mr. Speaker, I would like to deal with the facts of this issue. We have heard so much from members across the way about the disaster that is occurring and about the national crisis. Members have been ratcheting up the heat on this issue. There is a lot of rhetoric. There is a great deal of heat. However, very little light has been shed on this issue, and I intend to shed some of the light on it tonight.    ...  The department activated its emergency response team so that 10,000 class N-95 masks be sent out with money for 1.5 million more to be sent as needed. “

2004 - Lim, Closson, Howard and Gardham publish an article in The  Lancet Infectious Diseases in which they discuss the problem of Ontario hospitals obtaining masks and other supplies during SARS and  suggest the possible solutions: “Develop pre-existing stockpiles of personal protective equipment. Secure supply chain.”   They specifically mention the problem obtaining N95 mask commenting “With 211 hospitals in Ontario alone requiring these supplies, Canadian suppliers rapidly ran out of stock. There was no pre-existing supply stockpile, and our mask supplies were obtained from foreign manufacturers. Because SARS was a worldwide threat, there was great difficulty in acquiring masks from other countries, since foreign governments understandably wanted to keep such supplies for their own citizens. ... Had there been a pre-existing stockpile of isolation equipment and a secure supply chain from a Canadian supplier, this tense situation could have been partially averted. Following the SARS outbreak, our hospital and others, as well as the Ontario and federal governments, have begun this process. At the University Health Network, we now have 2 weeks worth of isolation equipment on site, in addition to our regular supply. Whereas this supply would not last for a prolonged outbreak, it would provide some leeway while awaiting supplies.”

2006: The federal election yielded a minority government under the Conservative Party.

2006 - Ontario SARS Commission reports, and comments on N95 respirator and protective equipment shortages: “As was noted in the second interim report, getting enough supplies of N95 respirators was a widespread problem during SARS.   The Ministry of Health and Long-Term Care noted the problem of masks during its presentation to the Commission at public hearings: The lack of a domestic mask supplier and an insufficient inventory of masks to deal with the infection protocols as the emergency progressed was also problematic.    ...In order to address the serious problem of the lack of a sufficient supply of personal protective equipment for health care workers, patients and others that arose at the outbreak of SARS I, the Ministry has begun to stockpile and secure its supplies. The Ministry reported that a two-month stockpile of personal protective equipment, including masks, gloves, gowns, eye protection and other clinical supplies, for a community the size of Toronto is available and could be distributed quickly through a central distribution system.” ... 

2006 - Prince Edward Island adopts a Pandemic Influenza plan for the Health Sector, which mentions that a pandemic may result in shortages of personal protective equipment, noting that “In an effort to reduce costs, most health organizations have moved to a ‘just-in-time’ inventory systems that results in minimal supplies on hand.”  It recommends that facilities and organizations “Develop a stockpile of critical supplies (size to be determined) and a process for rotating those items that might expire through the supply chain.” and that “Once personal protective equipment recommendations are finalized, add to the stockpile of personal protective equipment.”

2006, October  - Renfrew County, Ontario adopts a pandemic plan which recommends that municipalities, agencies, boards, and commissions should “make plans for regular shipments, and stockpile 6 to 8 weeks of critical supplies (those required to maintain service operations). In addition to critical supplies, all essential/emergency services should have an adequate supply of disposable tissues, hand sanitizers, and hand-washing supplies.”

2007 - Ontario: The Ministry of Health and Long-Term Care (MOHLTC) developed a comprehensive, detailed Ontario Health Plan for an Influenza Pandemic (OHPIP).   This required that all  health care settings and providers  maintain a four-week stockpile of personal protective equipment and other critical supplies.  The province undertook to develop and maintain: a four-week a stockpile of personal protective equipment for the entire health system; and a system for purchasing, storing and distributing supplies.  This would ensure business continuity for the first wave of the pandemic (estimated to be approximately 8 weeks).

2007 - the Ontario Hospital Association issues the 186 page ‘OHA Pandemic Toolkit For Small, Rural, and Northern Hospitals’ which states that “All health care settings and providers will plan for and maintain a four-week stockpile  (weeks 1-4) of  Infection Control supplies and Personal Protective Equipment (PPE), where health care settings are hospitals, Community Care Access Centres, community support services, Emergency Medical Services, home care providers, long-term care homes, primary care providers and midwives, laboratories, mortuaries, flu centres, and public health.”   It also mentions that “The MOHLTC has developed a procurement strategy and is managing a stockpile of  infection control supplies (e.g., hand hygiene, disinfectants) and PPE (e.g., masks, N95 respirators, gloves) to provide health care settings with product for weeks 5-8 of a pandemic influenza.”

2007 - Toronto Public Health, as part of the Toronto Pandemic Influenza Plan includes a Planning Guide for Businesses, commenting that “Given widespread social disruption and employee absenteeism, supply chains may be interrupted. The pandemic will affect countries around the world, with some regions hit earlier, longer, and harder than others. If border crossings or transportation systems are disrupted, the delivery of supplies may be delayed.  Organizations should purchase from local suppliers wherever possible, make plans for regular shipments, and stockpile six to eight weeks of critical supplies (those required to maintain service operations). In addition to critical supplies, your organization should have an adequate supply of disposable tissues, hand sanitizers, and hand-washing supplies.”

2007 - The Auditor General of Ontario in his Annual Report commented that “Medical supplies such as masks, gloves, gowns, and hand sanitizers are mostly made outside Canada, in places where the influenza pandemic may originate and where border closure is a possibility during a global epidemic. The Ministry had therefore, in early 2007, contracted with a number of vendors to provide a four-week supply of such equipment and supplies for health-care workers who are in contact with patients with infectious diseases. As of March 31, 2007, the Ministry had obtained more than 60% of the required quantities and planned to have all items stockpiled by March 2008.” ... “that it had stockpiled a limited number of N95 respirators,” .  (A report by Ontario’s auditor general , completed in December 2017  found that more than 80 percent of that stockpile had expired.  By 2020 it was not clear whether there were any masks in the  stockpile. )  The Auditor General also commented “that health-care providers are responsible for obtaining their own four-week stock of personal protective equipment, so that collectively, the province will have enough supplies for eight weeks, which is the estimated length of the first wave of an influenza pandemic.”   However,  “ as of January 2007, a significant number of health-care providers had not completed their personal stockpiles”. ...  “[M]any public health units reported that over half of the facilities and practitioners in a particular category of health-care provider did not have four-week stockpiles.” ... including 80% of long-term-care homes, 60% of hospitals, 49% of independent practitioners.

2007  Ontario said it would buy 55 million N95 masks and other medical supplies to prepare for future epidemics.

2007, December  - Toronto Auditor General’s Office reports on a Review of City of Toronto Pandemic Planning and Preparedness, noting that “According to an internal survey in May/June 2007, certain City divisions have not stockpiled any personal protective equipment while others have stocked supplies sufficient for six months or longer. For instance, Toronto Emergency Medical Services has stocked various types of personal protective equipment sufficient for six months. Toronto Fire Services has also purchased a large quantity of personal protective equipment (gowns and surgical masks) sufficient for several years of usage. In comparison, other divisions reported they have not purchased any supply of personal protective equipment as of May 2007.”  It recommended that Toronto “develop a  corporate procurement policy and plan for infection control supplies, personal protective equipment, and critical operational supplies, in preparation for a pandemic emergency.” and that “Factors such as shelf-life, storage and transportation, and supply chain uncertainty, should be considered in formulating a corporate procurement policy and plan.”

2009 - Toronto published a status report on ‘Stockpiling Requirements for Pandemic Influenza
Preparedness’, commenting that “The City of Toronto has initiated the process of stockpiling essential supplies to ensure continuity of business operations should an influenza pandemic strike. These supplies include personal protective equipment,...”, noting that a supply of Personal Protective Equipment was purchased  by Toronto Public Health, Long Term Care Homes & Services, Emergency Medical Services at a cost of over eleven million dollars for the three years from 2008 to 2010, and that additional supplies would be purchased and warehoused.

2009:
For the  H1N1 pandemic the provinces were able to draw down on almost 200,000 masks from the federal stockpile.

In 2009 the federal Conservative government purchased an additional two million N95 respirator masks for the NESS, and these were kept in storage until 2019

2009   - Nova Scotia’s  2009 Auditor General’s Special Report on Pandemic Preparedness states that “Nova Scotia does not have adequate stockpiles of supplies to access during a  pandemic.  The existing stockpiles are valued at $1.7 million – a shortfall of   $5.8 million from total required reserves.  Funding requests for supplies have  been significantly less than required.” noting that “During a pandemic, there will be an increase in the demand for healthcare services at a time when the availability of medical supplies such as gloves, masks, medical first responder kits and other items may be reduced due to worldwide demand and potential supply disruptions.”

2009 - After the H1N1 pandemic in 2009 the Newfoundland eastern regional health authority bought 500,000 N95 masks, a million procedure masks, 15 million gloves and one million isolation gowns.    (See below -  expired supplies were thrown out in 2016.)

2009, May- Ottawa Public Health publishes a pandemic plan (dated November, 2008) requiring that “all health care providers must establish at least a one-month supply of personal protective equipment including the following:  Alcohol-based hand gel,   N95 respirators,  Eye protection (face shields or goggles),    Gloves,  Gowns (if exposed to bodily fluids).”

2009, October - the Canadian Pharmacists Association publishes an updated Pharmacist’s Guide to Pandemic Preparedness, which recommends that pharmacists ensure that they “have sufficient resources to protect your staff and clients during the pandemic”, [including]  infection control supplies (e.g., hand hygiene products, tissues, gloves, masks and appropriate disposal techniques).”

2009-09-14 - Hansard - Question No. 309--
Ms. Kirsty Duncan (Liberal Member of Parliament, member of official Opposition):  With regard to the current outbreak of new influenza A (H1N1) virus, including its potential global spread, and including the probability that it will become widely established ... (y) what advice is being given to medical personnel and community members regarding masks, (i) what is the Canadian stockpile of N-95 and surgical masks, (ii) could Canadian companies supply enough of the required masks for a serious outbreak, (iii) what is the Canadian supply of respirators and does it meet the needs of the government's estimate; ...

2009-11-16 Hansard - Question No. 425--
Ms. Kirsty Duncan:  With respect to the current pandemic of new influenza A (H1N1):   ... (k) what contingency plans are being put in place should Canadian distributors run out of stock of N95 masks;

2009-11-20 Hansard - Question No. 456–
Ms. Kirsty Duncan:  With respect to the current pandemic of new influenza A (H1N1): ...  (i) what, if any, differences exist between the national guidelines and those of the provinces and territories, with respect to antivirals, N-95 masks, vaccines, and other personal protective measures, and how should healthcare professionals address any discrepancies; ...


2010 -  Alberta’s report on its response the 2009 H1N1 influenza pandemic mentions that during the pandemic there was a change in personal protective equipment guidelines specifying when  the use of N95 masks rather than surgical masks was required.  It notes that “AHS had stockpiled sufficient surgical masks but their supply of N95 masks was limited due to a global shortage. AHS participated in a federal/provincial/territorial procurement initiative to obtain a surge capacity of N95 masks for provincial use.”

2010  - Ontario releases its report on Ontario’s response to HIN1(2009) noting that “Ontario began developing a stockpile of personal protective equipment and mass immunizations supplies in 2004.  In 2009, the ministry developed an online system and pre-assembled kits to support efficient ordering and processing.  During pH1N1, the system worked effectively and processed over 4,300 orders – representing over 28 million individual supplies distributed to the health system– and shipped them within 24-48 hours of receipt of the order.” It also mentioned that “Ontario recommended the use of N95 respirators for health worker who had contact with symptomatic influenza patients.  The recommended use of N95 respirators was difficult for some parts of the health system to implement due to a lack of prior fit-testing of the respirators and limited stockpiling of protective equipment. The ministry opened its stockpile of personal protective equipment to health providers during the second wave of pH1N1, starting with community-based organizations and primary care providers.”

 2010 - Manitoba’s report on lessons learned from H1N1 Flu mentions that “Manitoba will build on the success of the planning and preparation and move forward with ...  “maintaining a permanent stockpile of personal protective equipment for health professionals for future incidents”  (This does not appear to have been done.)

2010, September - The County of Simcoe and the District of Muskoka, Ontario adopts a pandemic plan and undertakes to “stockpile a four-week supply of appropriate personal protective equipment required” by the Ontario Health Plan for an Influenza Pandemic

2011 - The Public Health Agency of Canada conducted an Evaluation of the National Emergency Stockpile System.  It recommended that the NESS “Continue to ensure the following stock is available for provincial/territorial surge:  pandemic preparedness supplies.”  It also found that “Pandemic preparedness is a key and clearly defined role of the Public Health Agency.” and that “As outlined in the Canadian Pandemic Influenza Plan for the Health Sector (2006), the Public Health Agency is the lead federal agency responsible for addressing pandemic influenza preparedness and response.  Key activities include the following:   ...    stockpiling pharmaceuticals, equipment and supplies to assist the provinces and territories with surge capacity.”  It also found that “Pandemic supplies include: antiviral agents, antibiotics specific to pandemic response, syringes, ventilators and related oxygen supply equipment, personal protective equipment (masks, face shields, gloves), and other supplies such as gowns, disposable sheets, pillows, needles, syringes and body bags.”

2013 -  Ontario Health Plan for an Influenza Pandemic is updated.  It recommends that health organizations develop a four-week stockpile of PPE, and have supplies of both N95 respirators and surgical masks for health workers.   It also mentions that information on how health organizations can access Ontario’s stockpile of PPE, if required, will be provided during an influenza pandemic.

2015 - The Liberal Party wins the federal election and forms a majority government.

2016 -  the Newfoundland eastern regional health authority decided to stop renting space, and use up the N95 masks,  procedure masks,  gloves and isolation gowns purchased in 2009 .   Most had expired and were thrown out.  The health authority didn't buy new supplies, and saved money by no longer renting the warehouse space.

2017 - Ontario’s auditor general  reports that  80 percent of Ontario's stockpile had expired: “Although the Ministry of Health and Long-Term Care currently has a stockpile of over 26,000 pallets of supplies for medical emergencies, including respirators, face shields, needles, disinfectant wipes, disposable thermometers and other items, more than 80% of these supplies have reached their expiry date. The original cost of the expired supplies is approximately $45 million. Although the ministry has donated a small amount of supplies to two other countries for emergency situations, it did not put the majority of these supplies into circulation within the healthcare system so that they could be used before expiring. The ministry informed us that its budget for these supplies only allowed for storage and not the management of them.   The Ministry of Health and Long-Term Care continues to pay to store these expired supplies at a cost of over $3 million per year. The ministry has started to dispose of some of the expired supplies. For example, it disposed of a relatively small amount (7%) of the total  expired supplies last year—1,500 pallets—at
a cost of $370,000. It will continue to incur these storage and disposal costs until all the expired supplies have been disposed of.”   The Auditor General recommended that the Provincial Emergency Management Office work with ministries to ensure that they plan for and enter into all relevant agreements and plans for any resources that may be needed during an emergency.

2017 - Dr. Theresa Tam is named Canada's Chief Public Health Officer (CPHO)

2018, June- The Conservative Party wins the Ontario provincial election and forms a majority government.

2019
The government of Canada throws out two million N95 masks and 440,000 medical gloves when it shuts down the NESS emergency stockpile warehouse in Regina.   The masks and gloves were well past their expiry dates.  At the same time the government of Canada shuts down two other warehouses.

December, 2019 - Alberta Health Services Contracting, Procurement and Supply Management team  notices the potential problem in Wuhan, China and orders masks and extra supplies in December, 2019 and January and February, 2020.

December, 2019 -  the Auditor General for Ontario reported that it had conducted a follow up audit on its recommendations from 2017.   The Ministry was aiming for March, 2021 to have plans in place to deal with goods and services that might be needed in an emergency.

2020
January - London, Ontario’s Corporate Security and Emergency Management department  notices what was happening in China and started sourcing additional supplies of PPE

January 27, 2020 - The novel coronavirus is confirmed in Canada, after an individual who had returned to Toronto from Wuhan, Hubei, China, tests positive.

January 31, 2020 - The World Health Organization declares the novel coronavirus outbreak a Public Health Emergency of International Concern.

February 4th to  9th - Justin Trudeau and the federal Liberal Government ship 16 tonnes of personal protective equipment to China from Canada's NESS.  These shipments included  50,118 face shields, 1,101 masks, 1,820 goggles, 36,425 medical coveralls, 200,000 nitrile gloves and 3,000 aprons.  Some of those products were close to their expiry date.

February 6 - BBC News reports that China’s production of medical masks is “clearly not sufficient to meet even the current demand in China”, that “[a]cross China, there have been reports of shortages and soaring prices”, that “China bought 220 million face masks between 24 January and 2 February, with South Korea one of the countries supplying them,” that 3M was increasing production of masks at its facilities around the world, and that some US retailers of mask US “had already experienced shortages.”

February 12 - The Canadian federal stockpiles of personal protective equipment included 540 ventilators, 94,000 surgical masks, 100,000 N95 respirator masks, 400,000 face shields, 500,000 gowns and two million gloves.    Accordingly, Canada had shipped to China over ten percent of Canada’s face shields from the NESS, over ten percent of Canada’s nitrile gloves from the NESS and about one percent of Canada’s stockpile of surgical masks.

March 11, 2020  Evidence - Standing Committee on Health  - House of Commons of Canada
Ms. Linda Lapointe ( vice-president of the executive committee for the FIQ, the Fédération interprofessionnelle de la santé du Québec):  As a result, Ms. Hajdu said, the national emergency strategic stockpile does not have all the equipment needed to deal with a pandemic of this magnitude. We regret that this reserve has not been regularly reviewed and that the amounts invested are still not adequate. A well-provisioned national stockpile would have been useful, especially since Canada depends largely on foreign industry for the supply of personal protective equipment.
Mr. Matt Jeneroux (Conservative):      We saw that the Prime Minister sent a letter to the premiers asking for a state of readiness. Obviously, we thought that would have happened earlier. Regardless, do we now have an accurate accounting of masks, beds, tests and ventilators that you, as head of the Public Health Agency, are comfortable with?
Mr. Don Davies (New Democratic Party):      There have been alarms raised by the hospital system and by doctors about whether we have enough masks, whether we have enough ventilators, whether we have enough negative pressure rooms, whether we have the diagnostic capacity and whether we have enough critical care beds.   https://www.ourcommons.ca/DocumentViewer/en/43-1/HESA/meeting-8/evidence

April 11 - Premier Jason Kenney of Alberata announces that Alberta will in donating 750,000 N95 masks, seven million procedural masks and 50 ventilators to Quebec, Ontario and British Columbia

2020 - May:  The Labrador, regional health authority confirmed to CBC News that there are 103,700 surgical and procedural masks and 111,960 expired N95 masks sitting in a warehouse.  Samples of the expired masks have been sent for testing to see if they can be used

May 06, 2020  - The Manitoba NDP introduced Bill 213, the Personal Protective Equipment Reporting Act. The bill would require the government to publicly report on the number of PPE held by health authorities annually.

Comments on Events in Timeline


It is worth noting that the  number of warehouses for the National Strategic Stockpile  were reduced from eleven warehouses to eight warehouses in 2019.    We know that when Public Health Canada closed the warehouse in Regina in 2019, it tossed out at least two million expired N95 respirator masks and 440,000 expired medical gloves (and we only know that because the person who didn't win the contract to dispose of the products contacted the press).  We don’t know what else was stored at that warehouse and tossed out.  Further, no one has asked what was stored in the other two warehouses that were closed, and in particular whether masks, medical gloves were also stored in those warehouses and tossed out.   Further no one has asked ‘Whether when the expired masks and gloves from the Regina warehouse were tossed out, did Health Canada go through its inventory and toss out expired masks and gloves that were stored at the warehouses that were not closed?’

However, the most grievous error in the press is in not challenging the statements by Canada’s Public Health Agency that the NESS was never meant to backstop the provinces for masks or PPE.    In 2003 “Health Canada also facilitated the purchase of  approximately 1.5 million N95 masks for the National Emergency Stockpile System [NESS], and sent 10,000 to Toronto health officials.”    For the H1N1 pandemic in 2009 the provinces were able to draw down on almost 200,000 masks from the federal stockpile.  Further, in 2009 the federal Conservative government purchased an additional two million N95 respirator masks for the NESS, and they were kept in storage until 2019.     If 1.5 million N95 masks were bought in 2003 and at least 2 million N95 masks were bought in 2009, it suggests that someone thought it wise to keep millions of masks in the NESS stockpile for sixteen years.   Further, if the National Stockpile was accessed for masks for the 2003 SARS pandemic and for the 2009 H1N1 Pandemic, why then would you adopt in 2019 a policy of not carrying masks?   Further, the Public Health Agency of Canada's 2011 evaluation of the National Emergency Stockpile System  recommended that the NESS continue to ensure that pandemic preparedness supplies were available for provincial/territorial surge and that such supplies include ventilators personal protective equipment (masks, face shields, gloves), and other supplies such as gowns.

Interestingly, Alberta’s Pandemic Influenza Plan 2014 mentions that the federal First Nation and Inuit Health Branch is responsible for “Maintaining a PPE stockpile for health care workers assisting in the delivery of health care services for on-reserve First Nations communities.”   In 2020 the stockpile exists.  One would think that if the federal government maintains a PPE stockpile for first nations communities it would be willing to maintain a PPE stockpile for the rest of the country.

Another point worth repeating is  that this year between February 4th and  9th,   Justin Trudeau  shipped 16 tonnes of personal protective equipment to China, which included  50,118 face shields, 1,101 masks, 1,820 goggles, 36,425 medical coveralls, 200,000 nitrile gloves and 3,000 aprons from Canada's NESS, and that some of those products were close to their expiry date.  We also know that  on February 12, after Justin Trudeau had sent those products to China,  federal stockpiles of personal protective equipment included 540 ventilators, 94,000 surgical masks, 100,000 N95 respirator masks, 400,000 face shields, 500,000 gowns and two million gloves. We also know that the NESS  started ordering more supplies in January, and that small amounts had already arrived by February 12.   Leaving aside the issues of why you would send over ten percent of our face shields and over ten percent of our nitrile gloves to China, and why you wouldn’t immediately replace them, it is worth noting that at the beginning of February the NESS had at least 2.2 million nitrile gloves and 450 thousand face shields in storage.   It is also worth noting that if some of the products shipped to China were close to their expiry date, they must have been purchased in the years 2015 to 2017, and would have overlapped with the masks and gloves stored in Regina that were tossed out in 2019.   How then can Public Health Canada say there was no policy of keeping masks, gloves and PPE in the NESS when from 2015 to 2019 it was storing the products in multiple warehouses, and from 2003 to 2019 had millions of N95 masks in storage?

I have included in the timeline comments on masks made  in 2003 by the Hon. Hedy Fry (Liberal Member of Parliament for Vancouver Centre) and  in 2009 by Kirsty Duncan (Liberal Member of Parliament).   Both are still Liberal  members of Parliament.  Hedy Fry is also a physician.  Kirsty Duncan is the deputy leader of the government in the House of Commons, is a medical geographer, has published a book on the Spanish Flu, and has lectured on pandemics.  Both are knowledgeable on the need for masks to fight a pandemic, each commented on the masks in Canada’s stockpile,  but sadly neither appears to have had any input into the federal government’s plans to fight COVID-19.

I included in the timeline that in 2007 Ontario bought 55 million N95 masks and other medical supplies to prepare for future epidemics, but that by 2017 more than 80 percent of that stockpile had expired and that by 2020 it was not clear whether Ontario had any masks in the  stockpile.   The masks were bought by the Provincial Liberals, who were in power until they lost the provincial election in June, 2018.  After they won the election in 2018 the provincial Conservative government bought no masks for a stockpile.   What is disheartening is that in 2007 Ontario developed a pandemic plan that required all hospitals, health care settings and providers to maintain a four week stockpile of personal protective equipment and other critical supplies, while the province undertook to develop and maintain a four week a stockpile of personal protective equipment for the entire health system.  This would ensure business continuity for the first wave of the pandemic (estimated to be approximately 8 weeks).  This was still in the plan when it updated in 2013 and is still in the plan today.  

I also included in the timeline that in April 2020 Alberta  donated 750,000 N95 masks, seven million procedural masks and 50 ventilators to Quebec, Ontario and British Columbia .  I was struck by the  presence of mind of Alberta Health Services Contracting, Procurement and Supply Management team to notice the potential problem in Wuhan, China in December 2019 and to order extra supplies in December, January and February.   Incredibly, they had to foresight in December to order an additional 500,000 N95 masks, looked at the daily burn rates for key supplies, planned for a lengthy pandemic and  prepared for the worst-case scenario by ordering extra masks and ventilators throughout January and February.   Canada owes J.P. Prasad and his team at AHS supply procurement a vote of thanks.  The masks they ordered will save the lives of doctors and  nurses while the ventilators they ordered will save the lives of  patients in Ontario.  I would contrast their actions with the federal public health officer and many provincial  public health officers, who failed to realize that there was a problem or potential problem until the second week of March when Italy, France and Spain started to hemorrhage dead bodies.  By then it was too late to order supplies with any expectation of getting them in a timely manner.  Would that all of our federal and provincial health bodies were as efficient as those in Alberta and had been able to recognize a pandemic in the making.   If they had been, we would not now be in lockdown.

It is hard not to compare Alberta’s actions  with  Ontario’s inaction: Alberta stockpiled supplies planning for a pandemic; while  Ontario had let its stockpile expire and did nothing to replenish the stockpile.  What is particularly astonishing is that in December, 2017 the Auditor General for Ontario reported that the stockpile had expired and recommended that the Provincial Emergency Management Office ensure that they plan for and enter into all relevant agreements   for any resources that may be needed during an emergency.  In December, 2019 the Auditor General for Ontario reported that it had conducted a follow up audit on its recommendations.  It reported that the “Ministry hired a staff member to support the development of the Emergency Management Supply Chain and Logistics...  The Ministry planned to have the new program in place by March 2021.”  It is unfortunate that Canada was visited by COVID-19 in 2020.  Perhaps Ontario would have been ready in March 2021.

Ontario was not alone in failing to maintain its stockpile: Newfoundland, Nova Scotia and Manitoba reacted to the 2009 H1N1 pandemic by promising  to stockpile PPE, but no stockpiles existed by 2020.  Prince Edward Island has also promised to stockpile PPE, after noting that "most health organizations have moved to a ‘just-in-time’ inventory systems that results in minimal supplies on hand".

It is also hard not to compare Alberta’s actions in December 2020 with the federal government’s actions in December, 2020: Alberta stockpiled supplies planning for a pandemic; the federal government tossed out expired mask, etc. and did not replace the stockpile.

In 2010 Dr. Arlene King, the then Ontario Chief Medical  Officer of Health, in her report on How Ontario Fared in the H1N1 Pandemic commented:

“There is going  to be another influenza pandemic or emerging infectious disease to be dealt  with, and there  will be another after  that.  At some  point, there  will be one that exceeds in severity the one we have just gone  through. We have  an opportunity now to use the lessons we have just learned to build  on the spirit  of collaboration that currently exists to make  the changes that are necessary so that we will continue to be ready, no matter how grave  the threat.”

Sadly, Ontario and the Federal Government  took the exact opposite approach.  Both disregarded their pandemic plans, let their stockpiles expire, and were unprepared for the COVID-19 pandemic.

Based on my calculations, if spent in 2019 (i.e., before COVID-19 caused prices to rise):

$1 million buys   one million  N95 masks
$1 million buys   five million  surgical masks
$1 million buys   500,000 face shields
$1 million buys   five to ten million nitrile gloves
$1 million buys over one million pairs of clear Safety Eyewear with peripheral eye protection
$1 million buys   200,000 disposable medical aprons
$1 million buys   250,000 sets disposable protective clothing (50 pack)

Further, various companies in Ottawa,  Toronto and other cities across Canada provide secure, climate controlled, self storage with 24 hour access.  I would estimate the cost of storing  one million  N95 masks at about $10,000 to $20,000 per year.   Why then wouldn’t you buy and stockpile masks, faceshields, and PPE?   Admittedly, it would cost more to store heavier and bulkier products such as protective clothing, but in each pandemic (SARS, HIN1 and COVID-19) the same problems surrounding obtaining supplies repeat themselves.  

Christopher Brett
Ottawa, Ontario

[Addendum: May 31: I added to the timeline Lim's article, Auditor General of Ontario 2007 Annual Report, 2003  Walker report, and 2006 Ontario SARS Commission Report. June 1: I added the 2011 Evaluation to the timeline. June 2: added First Nation and Inuit Health Branch  PPE stockpile, Alberta 2010 report, Ontario 2019 audit, King quote. June 5 - increased coverage of Ontario's pandemic plan.  June 11 - added PEI's plan, Renfrew's plan, Simcoe's plan, Pharmacist's guide,  Toronto 2007 auditor general,  Ottawa Pubic Health, and London, Ontario ordering extra supplies starting in January. ]

References and Suggested Reading/Viewing


Anonymous,  February 9, 2020
Canada supports China’s ongoing response to novel coronavirus outbreak.  Global Affairs Canada News Release
https://www.canada.ca/en/global-affairs/news/2020/02/canada-supports-chinas-ongoing-response-to-novel-coronavirus-outbreak.html

Auditor General of Ontario
2007 Annual Report of the Office of the Auditor General of Ontario, Chapter 3, Section 3.12, Outbreak Preparedness and Management. Tabled December 11, 2007
https://www.auditor.on.ca/en/content/annualreports/arreports/en07/312en07.pdf
https://www.auditor.on.ca/en/content/annualreports/arbyyear/ar2007.html

Jorge Barrera , CBC News.  May 29, 2020
Saskatchewan First Nations request $120M US to build own PPE stockpile
https://www.cbc.ca/news/indigenous/ppe-fsin-request-isc-funding-1.5590984

BBC News,  February 6, 2020
Coronavirus: Does China have enough face masks to meet its needs?
https://www.bbc.com/news/world-asia-china-51363132

CDC  - Updated April 16, 2020
Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life https://www.cdc.gov/coronavirus/2019-ncov/hcp/release-stockpiled-N95.html

Cooper, Sam, April 30th, 2020
United Front groups in Canada helped Beijing stockpile coronavirus safety supplies
https://globalnews.ca/news/6858818/coronavirus-china-united-front-canada-protective-equipment-shortage/

Cowan, Peter CBC News  Posted: May 05, 202
N.L. closed warehouses with millions of masks and gowns in years before pandemic.
www.cbc.ca › news › canada › newfoundland-labrador

Duncan, Kirsty ,  2003
Hunting the 1918 Flu: One Scientist's Search for a Killer Virus. University of Toronto Press

King,  Arlene, 2010
The H1N1 Pandemic - How Ontario Fared : A Report by Ontario's Chief Medical Officer of Health.  June 2, 2010
https://collections.ola.org/mon/24006/301054.pdf

Leo, Geoff , Apr 15, 2020 | Last Updated: April 16
Experts criticize Ottawa for mismanaging and destroying millions of N95 masks. CBC News
https://www.cbc.ca/news/canada/saskatchewan/heath-minister-emergency-stockpile-1.5530081

Levitt-Safety, 2020
Can I still use an expired N95 mask? Levitt-Safety explains the answer.
https://www.levitt-safety.com/blog/can-you-use-an-expired-n95-respirator/

Lilley, Brian, Apr 5, 2020 -
LILLEY: Public Health Canada failed to look after strategic stockpile.  Toronto Sun
https://torontosun.com/opinion/columnists/lilley-public-health-canada-failed-to-look-after-strategic-stockpile

Lilley, Brian,  Published:  April 6, 2020
LILLEY: Trudeau government owes public the truth on missing stockpile.   Toronto SUN
https://torontosun.com/opinion/columnists/lilley-trudeau-government-owes-public-the-truth-on-missing-stockpile

Lilley, Brian,  May 20, 2020
LILLEY UNLEASHED: Dr. Theresa Tam needs to be fired.  Toronto Sun
https://torontosun.com/opinion/columnists/lilley-unleashed-dr-theresa-tam-needs-to-be-fired

Lilley, Brian,  May 22, 2020
LILLEY: Liberals not telling the truth on PPE and the stockpile.   Toronto Sun
https://torontosun.com/opinion/columnists/lilley-liberals-not-telling-the-truth-on-ppe-and-the-stockpile

 Lim, S., Closson, T., Gillian Howard, and Michael Gardam, 2004
Collateral damage: the unforeseen effects of emergency outbreak policies. The Lancet Infectious Diseases. 2004;4(11): 697-703
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128908

MacCharles, Tonda , April 13, 2020
Document reveals why Canada sent protective equipment to China as COVID-19 threat was growing. Ottawa Bureau, The Star
https://www.thestar.com/politics/federal/2020/04/13/document-reveals-why-canada-sent-protective-equipment-to-china-as-covid-19-threat-was-growing.html

Allison Martell and Moira Warburton   Posted March 9, 2020
Millions of masks stockpiled in Canada's Ontario expired before coronavirus hit.  Reuters.
https://www.reuters.com/article/us-health-coronavirus-canada-supplies-ex/exclusive-millions-of-masks-stockpiled-in-canadas-ontario-expired-before-coronavirus-hit-idUSKBN20W2OG

Ontario, undated, probably 2007
Ontario Health Pandemic Influenza Plan Executive Summary
https://collections.ola.org/mon/18000/275431.pdf
Develop 4- week stockpile of equipment and supplies locally; Develop 4-week provincial stockpile.

Ontario, July, 2009
The Ontario Health Plan for an Influenza Pandemic in Brief
https://collections.ola.org/mon/23008/294271.pdf

Ontario Hospital Association, November 2007
OHA Pandemic Toolkit For Small, Rural, and Northern Hospitals. 186 pages
https://www.oha.com/Documents/Pandemic%20Planning%20Toolkit%20for%20SRN%20Hospitals.pdf

Ontario SARS Commission,   Mr. Justice Archie Campbell, 2006
Spring of fear. Commission to Investigate  the Introduction and Spread of Sars in Ontario. .  Vol. 1. Executive summary.   v. 2. Final report (pgs. 1-873).   v. 3. Final report (pgs. 874-1204).   v. 4. SARS and public health in Ontario: the SARS Commission first interim report.   v. 5. SARS and public health legislation: the SARS Commission second interim report       
https://collections.ola.org/mon/16000/268478.pdf

Ruiz, Karen,   April 1, 2020
The true scale of China's medical stockpile is revealed: More than Two Billion masks were imported into Wuhan in just one month as the coronavirus crisis escalated
https://www.dailymail.co.uk/news/article-8178365/China-imported-2billion-masks-peak-coronavirus-crisis.html

Sutton, Candace.   April 2, 2020
Revealed: China stockpiled 2 billion face masks and 25m medical items.  
https://www.news.com.au/lifestyle/health/revealed-china-stockpiled-2-billion-face-masks-and-25m-medical-items/news-story/5304e5a5080bd4087e4a9be9de210b97

Staples, David, April 5, 2020
From apathy to panic: timeline of Canada'sbattle against COVID-19 . Edmonton Journal
https://edmontonjournal.com/news/politics/from-apathy-to-panic-timeline-of-canadas-home-front-battle-against-covid-19

3MCanada
Why Do Disposable Respirators Have a Defined Shelf Life? | 3M Canada
https://safetytownsquare.3mcanada.ca/articles/why-do-disposable-respirators-have-a-defined-shelf-life

3M Canada
Pandemic Preparedness shelf life for respirators
https://safetytownsquare.3mcanada.ca/articles/pandemic-preparedness-respirator-shelf-life-dating

Toronto, City of,  2009
Staff report for action on Pandemic Planning -  Status of Ongoing Work,
https://www.toronto.ca/legdocs/mmis/2009/ex/bgrd/backgroundfile-19607.pdf

Toronto Public Health, March 2007
Toronto Pandemic Influenza Plan Appendix 1.1  A Planning Guide for Businesses, 39 pages
https://www.longwoods.com/articles/images/Toronto_business.pdf

Trevithick,Matthew,  980 CFPL, Global News,  May 12, 2020
London’s PPE stockpile includes hundreds of thousands of masks, gloves: city official - London
http://globalnews.ca/news/6933778/london-city-ppe-masks/

Walsh,   Marieke  May 1, 2020
Trudeau concedes PPE stockpile fell short, NDP charges a ‘breach of duty’. The Globe and Mail
https://www.theglobeandmail.com/politics/article-trudeau-concedes-ppe-stockpile-fell-short-ndp-charges-a-breach-of/

Marieke Walsh, Grant Robertson and Kathy Tomlinson, Published April 30, 2020
Federal emergency stockpile of PPE was ill-prepared for pandemic - The Globe and Mail
https://www.theglobeandmail.com/politics/article-federal-emergency-stockpile-of-ppe-was-not-properly-maintained/

Monday, 4 May 2020

The Severity of the COVID-19 Pandemic is Not Unprecedented and Was Predicted by Health Canada In Reports Issued in 2006, 2009, 2015 and 2018

It is hard to accept the statements by Health Canada that  the current pandemic is unprecedented and could not have been predicted, when the Spanish Flu resulted in a higher number of deaths in Canada than the current COVID-19 pandemic and when Health Canada’s own publications predicted what would happen.

It is generally accepted that the 1918  Spanish Flu killed 30,000 to 50,000 Canadians.  Canada’s population in 1918 was about 8 million.  Today Canada’s population is 37 million, about four and a half times higher than in 1918.  The COVID-19 pandemic will have to kill 130,000 to 225,000 Canadians to be proportionally  as deadly as the Spanish Flu pandemic.   If the federal and provincial governments increase their efforts the current pandemic should not kill  more than ten thousand Canadians.   Accordingly, it is hard to accept statements such as those made by Deputy Chief Public Health Officer Howard Njoo on Friday, May 1st that the size of the current pandemic is unprecedented in Canada. 

Not only is the size of the current pandemic not unprecedented, it was actually predicted in a number of federal government publications issued by Health Canada.   Dr. Theresa Tam and Karen Grimsrud were the Co-Chairs of the The Canadian Pandemic Influenza Plan for the Health Sector, 2006 (“Canada’s Pandemic Plan”) , which contains the following statements:

“The next pandemic virus will be present in Canada within 3 months after it emerges in another part of the world, but it could be much sooner because of the volume and speed of global air travel.  ...  Given the increase, different patterns and speed of modern travel, a  new virus once arriving in Canada could spread quickly in multiple directions throughout the country. ... The first peak of illness in Canada could occur within 2 to 4 months after the virus arrives in Canada. The first peak in mortality is expected to be approximately 1 month after the peak in illness.”

That is what happened.

Health Canada also prepared a report following the 2009 H1N1 pandemic entitled ‘Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic’  which mentions that Canada’s Pandemic Plan was based on a ‘moderately severe scenario’  where  “in the absence of a pandemic vaccine and antivirals, it is  estimated that between 15 and 35 percent of Canadians could become ill, 34,000 to 138,000  individuals may need to be hospitalized, and between 11,000 and 58,000 deaths could occur.”   That moderately severe scenario is what is happening now!  It is unfortunate that all actions recommended in Canada’s Pandemic Plan were not followed.

In addition Health Canada distributed a publication in 2015 (updated in 2018)  entitled ‘Canadian Pandemic Influenza Preparedness: Planning Guidance for the  Health Sector” which mentions:

•  The next pandemic could emerge anywhere in the world and at any time of year.
•  There may be no lead time before the novel virus reaches Canada.
•  The first peak of illness in a geographic area within Canada could occur within weeks of first detection  of the novel virus in that area. The first peak in mortality is expected to be several weeks after the peak in illness

How could Health Canada have been taken by surprise by the speed of the COVID-19 pandemic when Health Canada’s own publications predicted what would happen?  Further, how can officials at Health Canada not be aware of the severity of the Spanish Flu and when Health Canada's own publications provide the death toll from the Spanish Flu?  Canada's Pandemic Plan contains the statements that "Historic evidence suggests that pandemics have occurred three to four times per century." and that the worst pandemic was the Spanish Flu that occurred  "during 1918-1919, killed an estimated 30,000 to 50,000 people in Canada and 20 to 50 million people worldwide."  Those statements are repeated in the Health Canada's 2015 and 2018 publications.

Christopher Brett
Ottawa, Ontario

References and Suggested Reading

Anonymous, 2010
Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic.  November, 2010
https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/about_apropos/evaluation/reports-rapports/2010-2011/h1n1/pdf/h1n1-eng.pdf

Anonymous, 2015
Canadian Pandemic  Influenza Preparedness: Planning Guidance for the  Health Sector.  Health Canada, 60 pages
https://www.phac-aspc.gc.ca/cpip-pclcpi/assets/pdf/report-rapport-2015-eng.pdf

Anonymous, 2018
Canadian Pandemic  Influenza Preparedness: Planning Guidance for the  Health Sector.  Health Canada, 64 pages
https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cpip-pclcpi/assets/pdf/report-rapport-02-2018-eng.pdf

Tam, Theresa and Grimsrud, Karen,  2006
The Canadian Pandemic Influenza Plan for the Health Sector, 2006 (“Canada’s Pandemic Plan”).
Health Canada.  550 pages

Walsh, Marieke, 2020
Trudeau concedes PPE stockpile fell short, NDP charges a ‘breach of duty’. The Globe and Mail Published May 1, 2020
https://www.theglobeandmail.com/politics/article-trudeau-concedes-ppe-stockpile-fell-short-ndp-charges-a-breach-of/
“One of the country’s top health officials argued that the size of the pandemic was unprecedented and the stress it would put on international supply chains couldn’t be anticipated. ... Deputy Chief Public Health Officer Howard Njoo said Friday the current pandemic is unprecedented in Canada.” [Friday was May 1]

Thursday, 30 April 2020

Asymptomatic Spreaders, Typhoid Mary, SARS, MERS and COVID

“The next pandemic virus will be present in Canada within 3 months after it emerges in another part of the world, but it could be much sooner because of the volume and speed of global air travel.  ...  Given the increase, different patterns and speed of modern travel, a  new virus once arriving in Canada could spread quickly in multiple directions throughout the country. ... The first peak of illness in Canada could occur within 2 to 4 months after the virus arrives in Canada. The first peak in mortality is expected to be approximately 1 month after the peak in illness.”
                       The Canadian Pandemic Influenza Plan for the Health Sector, 2006
                       Dr. Theresa Tam and Karen Grimsrud, Co-Chairs


At the beginning of February I was surprised by Prime Minister Justin Trudeau’s assertions that it was safe to continue to fly to China, that we would only  be testing those who self-reported symptoms, and that his plan for testing was science based.  I was also surprised that Canada's Chief Public Health Officer Dr. Theresa Tam asserted that there was no risk from asymptomatic spreaders.  It has come as no surprise to me that we have now closed our borders to China and most other countries, that we have stepped up our testing and begun contact tracing, and that studies have shown that asymptomatic spreading of COVID-19 is the norm.

I had six  main reasons for objecting to Canada continuing passenger flights to China:
- First, we were the only country continuing to fly to China.
- Second, it was all over the news that by the time Wuhan was placed under quarantine over half the population of Wuhan had fled to other parts of China.
- Third, the virus had spread to many other parts of China, including most major cities, by February 1st
- Fourth, we were not testing people when they got on the planes in China for coronavirus, we were not testing the passengers when they disembarked from the planes, there were no penalties for breaking the quarantine,  there no checks being made of the passengers to ensure that they were adhering to the quarantine, and there were no spot tests of the people coming from China.  A few people arriving from China were advised to self-quarantine, but not everyone.
 - Fifth, in November, 2014 during the Ebola crisis, Prime Minister Stephen Harper banned people  from Ebola-stricken West Africa from traveling to Canada.  As a consequence of his actions no Ebola case arose in Canada. The USA did not ban people from West Africa and confirmed  a case of Ebola diagnosed in the United States in a man who traveled from West Africa to Dallas, Texas. That patient died.  Earlier Saudi Arabia had announced a travel ban aimed at preventing Liberians, Sierra Leoneans and Guineans from visiting Islam's holy sites.   No Ebola case arose in Saudi Arabia.
- Sixth, a ban works. 

My main concern with  Dr. Theresa Tam’s assertion  that there was no risk from asymptomatic spreaders is that I have been aware of Typhoid Mary for over fifty-five years as she was often mentioned in side bars and fillers in newspapers when I was young.   Typhoid Mary is the poster child for  asymptomatic spreaders.   Her real name was Mary Mallon.  She was employed as a cook in various households and kitchens in the New York area over the period from 1907 to 1915.   She was the first person in the United States identified as an asymptomatic carrier of  typhoid fever and is believed to have infected 51 people, at least  three of whom died. (Some estimates put the death total at fifty.)  Eventually she was arrested and put in quarantine to stop her working and spreading the disease.  Interestingly, Marineli et al.  (2013)  mention that “By the time she died New York health officials had identified more than 400 other healthy carriers of Salmonella typhi.”

Intriguingly there is a fair amount of information on diseases having been transmitted by  asymptomatic carriers of diseases.    In addition to typhoid, Wickipedia mentions  C. difficile, influenzas,  tuberculosis, and HIV.  Transmission of diseases by asymptomatic carriers appears to be the norm,  rather than the exception, for infectious diseases.

Dr. Theresa Tam stated that she followed and implemented The Canadian Pandemic Influenza Plan for the Health Sector , 2006 (“Canada’s Pandemic Plan”), of which she was the co-author.  If she had followed the plan she should have noticed that “Transmission by asymptomatic persons is possible but it is more efficient when symptoms,  such as coughing, are present and viral shedding is high (i.e. early in symptomatic period).” and that the  “potential for asymptomatic infection and spread from asymptomatic individuals greatly limits the effectiveness and feasibility of most traditional public health control measures.” 


In addition Health Canada distributed a publication in 2015 (updated in 2018)  entitled ‘Canadian Pandemic  Influenza Preparedness: Planning Guidance for the  Health Sector” which mentions that “The pandemic virus will behave like seasonal influenza viruses in significant ways:  ...  Transmission is possible from asymptomatic persons but is greater when symptoms, such as coughing, are present and viral shedding is high (i.e., early in the symptomatic period).


If she had done a bit of research Dr. Tam might also have located an article by Fraser  et al. (2004) discussing factors that make an infectious disease outbreak controllable, in which they argue that “Direct estimation of the proportion of asymptomatic and presymptomatic infections is achievable by contact tracing and should be a priority during an outbreak of a novel infectious agent.” noting that “no confirmed cases of transmission from asymptomatic patients have been reported to date in detailed epidemiological analyses of clusters of SARS cases, which suggests that, for SARS, there is a period after symptoms develop during which people can be isolated before their infectiousness increases. Actions taken during this period to isolate or quarantine ill patients can effectively interrupt transmission.”   This is a warning that tests should be conducted for
asymptomatic and presymptomatic infections.Dr. Tam might also have noted a paper by Myoung-don Oh et al.  (2018) analyzing the 2015 MERS coronavirus outbreak in Korea in which they mention that  “the potential for transmission from asymptomatic rRT-PCR positive individuals is still unknown. Therefore, asymptomatic [persons who test] positive for MERS-CoV should be isolated and should not return to work until two consecutive respiratory-tract samples test negative.”

Another paper that Dr. Tam might have located without much trouble is a 2018 report by the World Health Organization providing guidance for asymptomatic persons who test positive for Middle East respiratory syndrome coronavirus (MERS-CoV). She should have noted the paper in part because Katherine Defalco, Public Health Agency of Canada, Ottawa, Canada contributed to the WHO’s report.  In this report WHO state that the potential for transmission from asymptomatic  positive MERS-CoV  persons is currently unknown  but still recommended that “asymptomatic RT-PCR positive persons should be isolated , followed up daily for development of any  symptoms and tested at least weekly – or earlier, if symptoms develop – for MERS-CoV.  The place of isolation (hospital or home) shall depend on the  health - care system’s isolation  bed capacity, its capacity to  monitor asymptomatic RT- PCR positive persons daily outside a health-care setting, and  the  conditions of the household and its occupants.”    WHO also recommended that “When providing home isolation of asymptomatic RT-PCR  positive persons, the person and family  should be provided with clear instructions on:
•  adequate physical separation from potential householdor social contacts, especially those with risk conditions for severe MERS-CoV illness (e.g. separate room and toilet); 
•  having  food in the room and avoid sharing food or  being in the same room with others as much as possible; 
•  avoidance of visitors and travel; ...

WHO also cautioned that “sometimes it is difficult to classify a case as ‘asymptomatic’ because although the person may not have any symptoms at the time of testing, he or she may develop illness during the course of infection.”

In contrast to WHO’s recommendations for asymptomatic MERS-CoV coronavirus persons, Canada did no testing to find asymptomatic COVID-19 coronavirus carriers. Instead we were told that they posed no threat, and that it was only those that developed symptoms who required testing.   As noted above, recent studies have shown that asymptomatic spreading of COVID-19 is the norm.   More importantly, Lai et al. (2020) report that “the transmission of COVID-19 through asymptomatic carriers via person-to-person contact was observed in many reports” citing reports published on the web by Rothe on January 30, 2020; by Liu on February 12, 2020; by Yu on February 18; and by Bai on February 21, 2020.    Surprisingly, despite these warnings no effort was made in Canada in February or March to test for asymptomatic carriers.  In fact, we still don’t test for asymptomatic carriers. 

There have been further reports of asymptomatic spreading.  On March 23 Qian et al. reported a COVID-19 family cluster in China caused by a presymptomatic case.  On April 1st  Wei et al, reported on an investigation of all 243 cases of COVID-19 reported in Singapore during January 23–March 16 and identified seven clusters of cases in which presymptomatic transmission is the most likely explanation for the occurrence of secondary cases.  Ten of the cases within these clusters were attributed to presymptomatic transmission and accounted for 6.4% of the 157 locally acquired cases reported as of March 16.

Dr. Tam was on the CBC News the other night reporting that only ten cases in Canada could be traced to origins in China.  However, we only tested those who self-reported symptoms.   As we never  tested for  asymptomatic spreaders , we will never  know how many asymptomatic spreaders from China (or other countries) were in Canada.   Further, we have only traced a fraction of those who have developed the disease, and will only know that many people contracted the disease while in Canada, without knowing the source for their disease.  By April 29th  Health Canada, for confirmed cases of COVID-19, was able to trace the travel history (location travelled to) of only 1,201 cases in Ontario out of 16,000 confirmed cases; and 1,032 cases in Quebec out of 28,000 confirmed cases.   The vast majority of cases are allocated simply to community spread without knowing the source and with no way of knowing whether the source was an
asymptomatic spreader.

Christopher Brett
Ottawa
 

Added May 15 -17, 2020:  There are other earlier papers that warn against asymptomatic spreading of coronavirus.  For example, Dave Cavanagh (2003) reviewed attenuated vaccines and inactivated vaccines developed for a coronavirus that affects chickens to forecast the development of vaccines for use against the SARS coronavirus, and commented with respect to possible SARS vaccines that “Application of a SARS vaccine is perhaps best limited to a minimal number of targeted individuals who can be monitored, as some vaccinated persons might, if infected by SARS coronavirus, become asymptomatic excretors of virus, thereby posing a risk to non-vaccinated people.” and that   “Coronaviruses can establish persistent infections, in at least a proportion of their hosts, resulting in chronic asymptomatic shedders, with subsequent problems for containment of the disease.” 

Another early paper was by Che et al. (2006) who reported “An asymptomatic case of severe acute respiratory syndrome (SARS) occurred early in 2004, during a community outbreak of SARS in Guangzhou, China.”

Dr. Paul Auwaerter, M.D. of John Hopkins University has commented (last updated May 13) for COVID-19  that ‘Viral shedding by asymptomatic people may represent 25–50% of total infections.’ noting that “Why widespread and rapid transmission occurs is not completely certain, and is provoking changes in public health recommendations as well as anxieties.  Asymptomatically infected people who shed and spread is a likely explanation.”  


Timeline for Mentions of Aymptomatic and Presymptomatic Spreading


January 26, 2020
China's health minister Ma Xiaowei states that people can spread the Wuhan coronavirus before they become symptomatic. [Elizabeth Cohen, CNN,  Sunday, January 26, 2020]

January 29, 2020
Theresa Tam appears before Canada’s Standing Committee on Health and states:
-“For other completely asymptomatic people, currently there's no evidence that we should be quarantining them.”
-“We do know that asymptomatic people are not the key driver of epidemics. That is very important to understand.”
- “I know that the World Health Organization is actively in China looking at the evidence. That is a very key piece of evidence that we are trying to ascertain. We do know something about coronaviruses, given that we've had other coronaviruses that cause anything from a mild illness through the common cold all the way to a more severe end of the spectrum such as SARS, the coronavirus and MERS, or Middle East respiratory syndrome coronavirus. Based on what we know about those coronaviruses, is it possible that an asymptomatic person could transmit the virus? Even if it's possible, it is, we believe, a rare event. It is not that type of transmission that drives the force of an epidemic.”

January 30, 2020
The Honorable  Patty Hajdu (Liberal Member of Parliament ) tells Parliament:  “Mr. Speaker, it is really important that we remember there is a difference between quarantine and isolation. If people are sick, they need to be in isolation to prevent the spread of illness, because the spread of illness is transmitted through droplets. Quarantine is used when there are people that are asymptomatic. Right now, what we know about the virus is that it cannot be transmitted while people are asymptomatic.”

January 30, 2020
German researchers (Rothe et al.) pre-release a report of a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period, entitled ‘Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany.’
(Later published March 5, 2020 New England Journal of Medicine 2020; 382:970-971] 

January 31, 2020
Dr. Anthony Fauci says a new study published Thursday night shows people can spread the Wuhan coronavirus before symptoms set in.  In this report German researchers found that the virus was transmitted by people without symptoms in five instances in one cluster of people: from a parent to a daughter; from that daughter to two colleagues; and from one of those colleagues to two other coworkers.   "There's no doubt after reading this paper that asymptomatic transmission is occurring," said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases. "This study lays the question to rest."[see Elizabeth Cohen and John Bonifield, CNN, Friday, January 31, 2020]

February 1, 2020
WHO issues Novel Coronavirus (2019 - nCoV) Situation Report 12 which states “The main driver of transmission, based on currently available data, is symptomatic cases . WHO is aware of possible transmission of 2019- nCoV from infected people before they developed symptoms. Detailed exposure histories are being taken to better understand the pre-clinical phase of infection and how transmission may have occurred in these few instances. Asymptomatic infection may be rare, and transmission from an asymptomatic person is very rare with other coronaviruses, as we have seen with Middle East Respiratory Syndrome coronavirus . Thus, transmission from asymptomatic cases is likely not a major driver of transmission. Persons who are symptomatic will spread the virus more readily through coughing and sneezing.

February 5, 2020
Canada’s Standing Committee on Health –  Mr. Don Davies (MP, NDP),  states “The World Health Organization's February 1 situation report on the novel coronavirus stated, “WHO is aware of possible transmission of 2019-nCoV from infected people before they developed symptoms.” An early study on asymptomatic transmission of the virus published last week in the New England Journal of Medicine also appeared to confirm that asymptomatic transmission is possible.” and asks Dr. Tam “How does the existence of asymptomatic transmission change your approach to containing this virus, if at all?”
Theresa Tam replied (2020-02-05 16:18): “ We are aware of a very small number of case reports in which it's suspected that asymptomatic transmission may have occurred, but these have not been verified. In fact, with regard to the New England Journal study, there's now been a publication to say that it was incorrect and that this person was, in fact, symptomatic and had been taking some medication that suppressed his fever, for example. That's a very important fact to verify and correct. I'm very happy that German scientists and WHO have verified that.
We have heard other potential reports, which have not been substantiated. What we know is that it could possibly happen, but we think it would be rare and very unlikely that asymptomatic persons would be the key driver of an actual outbreak or epidemic.”

February 5, 2020
Canada’s Standing Committee on Health  –
Ms. Jenny Kwan (MP, Vancouver East, NDP): “The Minister of Health said in the House last week that those who are asymptomatic cannot spread the virus. I'm glad to hear the additional information from WHO. It seems to verify that, at least to that extent.... However, the Minister of Health in China has been reported as saying that it can spread asymptomatically.    My question, then, is this. Have we contacted China directly to ask this question for clarification? As was acknowledged last week by the panel, China has the foremost knowledge about the virus. Can we not contact China directly to verify that information? It seems to me that it is a critical question that we should have a definitive answer on.”

March 30, 2020
Dr. Theresa Tam: "Putting a mask on an asymptomatic person is not beneficial, obviously, if you're not infected,"  


March 31, 2020
Evan Dyer  CBC News  Posted: Mar 31, 2020:   “Dr. K.K. Cheng, director of the Institute of Applied Health Research at the University of Birmingham in the U.K., said that Tam's advice makes a dangerous assumption — that an asymptomatic person is not a spreader.  "The important thing about this coronavirus is that some patients start to shed virus, and become infectious, even before they have symptoms," he said. "In public health, a principle is we try to limit the source of harmful exposures rather than do mitigation, if we can.”“

April 2, 2020
The World Health Organization releases Coronavirus disease 2019 (COVID-19) Situation  Report  – 73, which comments on Pre-symptomatic and Asymptomatic transmission.

Pre-symptomatic transmission:  The  incubation period for COVID -19, which is the time between exposure to the  virus (becoming infected) and  symptom onset, is on average 5 - 6 days, however can be up to 14 days. During this period, also known as the “pre- symptomatic” period, some infected persons can be contagious. Therefore, transmission from a pre-symptomatic case  can occur before symptom onset.  In a small number of case reports and studies, pre-symptomatic transmission has been documented through contact  tracing efforts and enhanced investigation of clusters of confirmed cases. [12 - 17]  This is supported by data suggesting that  some people can test positive for COVID-19  from  1 - 3 days before they develop symptoms. [6,16] Thus, it is possible that  people infected with COVID-19 could transmit the virus before significant symptoms develop. It is important to  recognize that pre-symptomatic transmission still requires the virus to be spread via infectious droplets or through  touching contaminated surfaces. 

Asymptomatic transmission:   An asymptomatic laboratory - confirmed case is a person infected with COVID - 19 who does not develop symptoms.  Asymptomatic transmission refers to transmission of the virus from a person, who does not develop symptoms . There are few reports of laboratory - confirmed cases who are truly asymptomatic, and to date, there has been no  documented asymptomatic trans mission. This does not exclude the possibility that it may occur. Asymptomatic cases  have been reported as part of contact tracing efforts in some countries.  WHO regularly monitors all emerging evidence about this critical topic and will provide an upda te as more information  becomes available

April 3, 2020
Karina Roman  CBC News:  Mounting evidence of COVID-19 'silent spreaders' contradicts government's earlier messages: “[A] growing body of research indicates [Dr. Theresa Tam and  Health Minister Patty Hajdu] were wrong. In fact, people don't have to appear ill at all to infect others.  Jeffrey Shaman, a professor of environmental health sciences at Columbia University in New York, says he is frustrated when people deny that asymptomatic spread can happen. "We have so much evidence that that is going on," he said. "It's ridiculous." It remains unclear if understanding the threat earlier might have affected policy. Had the threat been fully realized, different decisions might have been made regarding travel restrictions, quarantines and physical distancing.  Shaman and other researchers argue that even two months ago, officials like Tam and Hajdu should have been more open to the possibility of asymptomatic transmission, considering by that point there was a flurry of research being undertaken by scientists racing to understand how the virus was spreading so fast and far. Many of those researchers suspected asymptomatic transmission.”

Thursday, April 23, 2020
 Standing Committee on Procedure and House Affairs
Hon. Kirsty Duncan: Is asymptomatic spread of COVID-19 possible, yes or no?
Dr. Barbara Raymond:      Yes, it is possible. We do not know the degree to which it is driving the epidemic, but we do believe it to be possible. In addition to that, pre-symptomatic spread, through people who are infectious before they are aware that they are ill, is also a significant concern


++++++++++++++++++
Cavanagh, Dave,  2003
Severe Acute Respiratory Syndrome Vaccine Development: Experiences of Vaccination Against Avian Infectious Bronchitis Coronavirus.    Avian Pathol . 2003 Dec;32(6):567-82.
doi: 10.1080/03079450310001621198.  https://pubmed.ncbi.nlm.nih.gov/14676007/
https://www.tandfonline.com/doi/full/10.1080/03079450310001621198


Paul G. Auwaerter, M.D., Updated: May 13, 2020
Coronavirus COVID-19 (SARS-CoV-2).  Johns Hopkins ABX Guide,
https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_

Xiao-yan Che, Biao Di, Guo-ping Zhao, Ya-di Wang, Li-wen Qiu, Wei Hao, Ming Wang, Peng-zhe Qin, Yu-fei Liu, Kwok-hong Chan et al., 2006
 A Patient with Asymptomatic Severe Acute Respiratory Syndrome (SARS) and Antigenemia from the 2003–2004 Community Outbreak of SARS in Guangzhou, China.  Clinical Infectious Diseases, Volume 43, Issue 1, 1 July 2006, Pages e1–e5,     https://doi.org/10.1086/504943
https://academic.oup.com/cid/article/43/1/e1/310697


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References and Suggested Reading

Anonymous, 2003
Learning from SARS - Renewal of Public Health  in Canada. A report of the National Advisory Committee on SARS and Public Health October 2003. 234 pages https://www.phac-aspc.gc.ca/publicat/sars-sras/pdf/sars-e.pdf


Anonymous, 2015
Canadian Pandemic  Influenza Preparedness: Planning Guidance for the  Health Sector.  Health Canada, 60 pages
https://www.phac-aspc.gc.ca/cpip-pclcpi/assets/pdf/report-rapport-2015-eng.pdf

Anonymous, 2018
Canadian Pandemic  Influenza Preparedness: Planning Guidance for the  Health Sector.  Health Canada, 64 pages
https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cpip-pclcpi/assets/pdf/report-rapport-02-2018-eng.pdf


Anonymous, 2020a
Asymptomatic carrier
https://en.wikipedia.org/wiki/Asymptomatic_carrier

Anonymous, 2020b
Mary Mallon
https://en.wikipedia.org/wiki/Mary_Mallon

Anonymous, 2020c
Subclinical infection
https://en.wikipedia.org/wiki/Subclinical_infection#List_of_subclinical_infections

Y. Bai, L. Yao, T. Wei, F. Tian, D.Y. Jih, L. Chen, et al., 2020 Feb 21
Presumed asymptomatic carrier transmission of COVID-19
J Am Med Assoc (2020 Feb 21), 10.1001/jama.2020.2565



Filio Marineli, Gregory Tsoucalas, Marianna Karamanou, and George Androutsos, 2013
Mary Mallon (1869-1938) and the history of typhoid fever.  Ann Gastroenterol. 2013; 26(2): 132–134.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959940/

Fraser C, Riley S, Anderson R et al. 2004
 Factors that make an infectious disease outbreak controllable. Proc Natl Acad  Sci USA 2004;101(16):6146–51.
https://www.pnas.org/content/101/16/6146

Lai, Chih-Cheng; Liu, Yen Hung; Wang, Cheng-Yi; Wang, Ya-Hui; Hsueh, Shun-Chung; Yen, Muh-Yen; Ko, Wen-Chien; Hsueh, Po-Ren (2020-03-04).
Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths". Journal of Microbiology, Immunology and Infection. doi:10.1016/j.jmii.2020.02.012. ISSN 1684-1182.

Y.C. Liu, C.H. Liao, C.F. Chang, C.C. Chou, Y.R. Lin , 2020 Feb 12
A locally transmitted case of SARS-CoV-2 infection in Taiwan.
 New England J Med (2020 Feb 12), 10.1056/NEJMc2001573

Myoung-don Oh, Wan Beom Park, Sang-Won Park, Pyoeng Gyun Choe, Ji Hwan Bang, Kyoung-Ho Song, Eu Suk Kim, Hong Bin Kim, and Nam Joong Kim, 2018
Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea.  Korean J Intern Med. 2018 Mar; 33(2): 233–246.
Published online 2018 Feb 27. doi: 10.3904/kjim.2018.031

Qian G, Yang N, Ma AHY, et al. Epub March 23, 2020
 A COVID-19 Transmission within a family cluster by presymptomatic infectors in China. Clin Infect Dis 2020. https://www.ncbi.nlm.nih.gov/pubmed/32201889

C. Rothe, M. Schunk, P. Sothmann, G. Bretzel, G. Froeschl, C. Wallrauch, et al. (2020 Jan 30)
Transmission of 2019-nCoV infection from an asymptomatic contact in Germany
N Engl J Med, 10.1056/NEJMc2001468

Theresa Tam and Karen Grimsrud, Co-Chairs, 2006
The Canadian Pandemic Influenza Plan for the Health Sector.  Public Health Agency of Canada.
550 pages.  https://www.longwoods.com/articles/images/Canada_Pandemic_Influenza.pdf

W. E. Wei; , Z. Li; C. J. Chiew, S. E. Yong, M. P. Toh, V. J. Lee,  2020, April 10& April 1
Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020
Morbidity and Mortality Weekly Report (MMWR), 69(14);411–415.  On April 1, 2020, this report was posted online as an MMWR Early Release.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm

World Health Organization,   2018
Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): Interim guidance . 3 January  2018
WHO/MERS/IPC/15.2 Rev.1 Geneva:
http://apps.who.int/iris/bitstream/10665/180973/1/WHO_MERS_IPC_15.2_eng.pdf?ua=1&ua=1

P. Yu, J. Zhu, Z. Zhang, Y. Han, L. Huang, 2020 Feb 18
A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period
J Infect Dis (2020 Feb 18), 10.1093/infdis/jiaa077

Peter Zimonjic, Rosemary Barton, Philip Ling, 2020
'Was it perfect? No': Theresa Tam discusses Canada's early pandemic response.   'Could we have done more at the time? You can retrospectively say yes,' Canada's top doctor says   CBC News  Posted: Apr 27, 2020 5:29 PM ET | Last Updated: April 28
 
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