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Head of the Canadian Medical Association Dr. Sandy Buchman, seen in Toronto in 2019, says health officials are doing all they can, but that more should have been done long before the novel coronavirus arrived.Tijana Martin/The Globe and Mail

The head of the organization representing Canada’s doctors says the health care system was “not prepared” for the current pandemic, and doesn’t see why the federal government doesn’t fully acknowledge the weaknesses exposed by the COVID-19 crisis.

“I am trying to understand the government’s response today because I think everyone was caught flat-footed," said Sandy Buchman, president of the Canadian Medical Association. “The front line is telling us over and over that they are not prepared and they are scared. We are hearing it from everywhere.”

Dr. Buchman was responding to a 2006 federal document that warned Canada needed to be better prepared for the outbreak of a pandemic or face serious consequences. Those warnings, which eerily foreshadowed much of what is happening now in the midst of the COVID-19 crisis, were the subject of a Globe and Mail report on Wednesday.

That 2006 plan warned that a new virus could spread very quickly, transmitted by people with no symptoms, and urged governments to be ready with a domestic stockpile of medical supplies to assist and protect health care workers facing surges of infectious patients.

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Instead, provinces are scrambling for resources, partly because the federal emergency stockpile has fallen short. In Alberta, for example, hospitals are urgently waiting on 74 ventilators to treat critically ill patients that the province expected to receive from the national stockpile. However, the Public Health Agency of Canada informed Alberta that the stockpile can only send six.

Doctors have questioned whether federal health authorities acted quickly enough after the virus emerged in late December. Through much of January and February, the government said the risk of an outbreak in Canada was low.

When asked Thursday if she regretted not taking action to prepare for the current situation earlier, Health Minister Patty Hajdu did not answer that directly, but repeatedly praised the work public health officials are doing now. “I just want to reiterate my thanks for the leadership of the phenomenal public health officials who have guided us through this. Certainly, we are grateful for their expertise and their involvement in determining out response,” the minister said.

Dr. Buchman acknowledged that health officials are doing all they can, but said more should have been done long before the virus arrived, to revitalize Canada’s strained health care system. “All we have seen are cutbacks. We haven’t seen adequate resources allocated to health care,” he said. “My fear is, if we experience the surge … because of the lack of access to adequate treatment and supplies, people will die.”

Kulvinder Kaur Gill, who represents 10,000 doctors in the group Concerned Ontario Doctors, said she and her colleagues were devastated Thursday by the news that a custodian who worked in a Brampton hospital has died from COVID-19, believed to be the first death of a health care worker in the province.

“This hits home for me because I practise in Brampton and my fear all along was that there were going to be tragic deaths of front-line workers because of inadequate access to personal protective equipment,” Dr. Gill said. “It is being rationed and often not provided.”

Underfunding of public health has been a limitation. And the alarming case numbers now bring a tremendous amount of work.

Peter Phillips, infectious-disease specialist in Vancouver

Despite numerous warnings about shortages during a pandemic, successive governments have not followed through on plans to bolster the system.

In Thursday’s federal briefing on the pandemic, federal Chief Public Health Officer Theresa Tam said the stockpile is “highly specialized,” but it is not capable of handling the demand it now faces. The system has “smaller surge capacities, but it was never designed to back up the whole health system in Canada," she said.

That is not what many hospitals and provincial governments assumed at the outset of the pandemic, given that the stockpile has for decades been intended as an emergency backstop. Alberta Premier Jason Kenney said his government was told federal stockpiles were not as large as initially thought.

“My understanding is that PHAC simply didn’t stockpile equipment and material in the amounts that would be required to help the country through a pandemic of this nature,” Mr. Kenney said in Edmonton on Thursday.

Dr. Tam defended the plans that were in place when the virus surfaced and stressed it is difficult, if not impossible, to anticipate how pandemics will unfold. "The best thing to do is throw out all the previous assumptions because they are likely to be wrong.” she said.

Many assumptions laid out in the federal government’s 2006 pandemic plan were prescient, however, including instructions to act quickly to stem the spread of the virus and to ensure that the country had, at minimum, “a consistent 16-week supply” of medical equipment stockpiled. “There will be shortages,” it warned.

Peter Phillips, an infectious-disease specialist in Vancouver, said the limitations on the system to respond quickly stems not so much from a lack of planning, but from a chronic lack of money for the public health sector across Canada, an area he believes federal governments have neglected.

“Underfunding of public health has been a limitation. And the alarming case numbers now bring a tremendous amount of work,” Dr. Phillips said.

“Testing needs to be rolled out in a much broader fashion … that should not be left up to the provinces," he said. "Given the absence of treatment and vaccine it is all about stopping the spread, and public health needs all the help they can get.”

National-security expert Wesley Wark said Canada’s slow response to the virus from January to mid-March was puzzling, given the high levels of concern rippling through the medical community when COVID-19 emerged in Wuhan, China, causing the Chinese government to shut down entire cities and restrict travel.

“There was an awareness that some extraordinary things were going on in Wuhan. On the other hand, there was a view [by federal officials] that this would not be a serious outbreak for Canada – that Canada was only a low risk," said Mr. Wark, an adjunct professor at the University of Ottawa. "The Chinese don’t just decide to lockdown a major city and a whole province for no reason.”

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