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/
