Eric M. Meslin is President and CEO of the Council of Canadian Academies, a Fellow of the Canadian Academy of Health Sciences, and a Member of both the Pierre Elliott Trudeau Foundation COVID-19 Impact Committee, and Genome Canada’s CanCOGeN Steering Committee.
In the lifecycle of every disaster or tragedy there is an opportunity to learn: hospitals conduct mortality and morbidity rounds to understand an unexpected death; transportation authorities dispatch teams to determine why a plane or train crashed; environmental protection organizations review spills and outbreaks. Common to each is the need to identify errors, sometimes to find fault, but always to recommend changes in policy or practice that will prevent (or at least reduce the likelihood of) a repeat in the future.
Arguably, we have been at that lesson learning stage for COVID-19 for weeks. Apparentlym there is no shortage of resources. A Google search on July 7 of “pandemic lessons learned” returned 62,100,000 results. Change “pandemic” to “covid-19” and you get 427,000,000. Some of these report on the successful implementation of new approaches based on previous experience, but many are more aspirational than implementable, more descriptive than conclusive. This may be because it is one thing to learn something new; it is another to apply that knowledge.
What do we know about COVID-19?
Less than six months ago, COVID-19 and the novel coronavirus that causes it were mysteries. With unprecedented speed, researchers uncovered the secrets of this coronavirus, from the shape of the protein spikes on its outer shell, to the time that aerosolized droplets containing it remain in a room after a sneeze. Epidemiologists know more about rates of infection, whether asymptomatic carriers can spread it to others, and the hard numbers who is infected, who isn’t, who is recovering, how many have died. We also know more about the impact of COVID-19 on different age groups, racialized groups, institutionalized persons (e.g., prisons and nursing homes), and the most vulnerable in society. Hospitals and health care providers know more about the medicines that may work and the protocols for ICU admission. Most importantly, we know that COVID-19 is an all-purpose, horizontally influential disease, affecting employment and labor practices, housing, commerce, food security, travel, environmental protection, international trade, public safety, foreign affairs, and public transport among others. It is an equal opportunity teacher if we wish to pay attention.
Applying What Has Been Learned
Lesson learning is hard enough even when we know what we should do, harder still when the information is incomplete. It did not take an exponential rise in hospitalizations and deaths, or a shortfall in testing kits, protective masks or ventilators to recognize that preparation and response to the pandemic was uneven at best, and at worst substandard in parts of Canada and around the world. You would have to be asleep for months not to see the havoc wreaked on health, wealth, and wellbeing. Some of the policy post mortems are underway, other studies, assessments, and reviews will be undertaken. Some will point to errors, problems and should-have-knowns; others will focus on strengths and weaknesses of the health care system in particular and civil society more generally. We need not wait for these studies to begin to adopt the following lessons.
The Lessons So Far
· Collecting data is not the same as acquiring knowledge. There’s a difference between accumulating data, organizing it into coherent and understandable information, and having sufficient knowledge to propose policies or other actions. The frustrating thing about data is that while the more you have the better, it can’t answer every important question, especially when data gathering occurs in the middle of a global pandemic and what we know seems to change from day to day. There remains much we don’t know, from whether antibodies confer temporary or permanent immunity, to whether social bubbles will actually reduce spread of the disease, to when a safe and effective vaccine will be available for widespread deployment. But without ongoing collection of data there will be no accumulated information and precious little knowledge to rely on.
· All forms of inquiry can help. Canadian health science has proven its worth in responding to the COVID-19 pandemic, as it did for other outbreaks including SARS, H1N1, and Ebola. However, the entire extended family of experts from the natural sciences, social sciences, humanities and engineering communities have much to offer. Economists, ethicists, legal and policy scholars, historians, sociologists and geographers are all ‘working the problem’. So too are public organizations, advocacy groups, and concerned citizens. Through the epistemic pluralism of our diverse society to the democratizing power of lowered paywalls by journals and other media there is more access to information than ever. Some of it is trash much of it is valuable. By leveraging collective thinking we can shrink the gap between what is known and what isn’t, to our collective benefit. This is not the time to succumb to skepticism about the value of using knowledge to help dig our way out of the toughest social problems.
· Changing policies does not mean decision makers don’t know what they’re doing. It can be frustrating to see policies change: masks no, masks yes; 2 metre distance, but hugging is ok; businesses opening in our province, but not yours. It leaves the impression that it’s all guess-work, a coin toss, a finger in the wind, a political calculation. This seems to be a recurring lesson usually framed in the negative. We should resist this. Policy-making is messy: part art, part science, part timing. Greater transparency about how decisions are made can go a long way to reduce the perception of arbitrariness, but we should begin with the presumption that decisions (especially those made under pandemic conditions) are motivated by the best interests of the country.
· There will always be more lessons. Just when we solve one problem, three more arise. We know more about ventilators and intensive care unit surge capacity than we did before, but how should we apply this experience to the next wave or the next new pandemic? How well did we manage the rest of health care during the pandemic, and should anything change? What lessons do we take from the experiments to craft economic recovery policies for small and medium sized businesses? Did we close (or open) the borders too soon, or too late? What is the takeaway about school openings? What lessons will we learn about Canada’s economic resiliency, or its investments in science, technology and innovation?
It may be too soon to draw lessons from each of these questions, but it is never too early to ask them.
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