Skip to main content

Public Health Agency of Canada has relied heavily on the World Health Organization for information and guidance in its response to the rapid spread of the deadly new virus.Denis Balibouse/Reuters

For seven years, Felix Li served on the distant front lines of Canadian public health, in China. As a doctor posted to Beijing, he fostered ties with health authorities that let him peer beneath the official rhetoric of a country that has been the source of multiple viral epidemics in recent decades.

When Dr. Li returned to Canada in 2015 and retired from the Public Health Agency of Canada (PHAC) after 23 years, he was not replaced.

But he retained his contacts inside the Chinese public health system and was keen to help when another outbreak began to emerge.

So, a few days after the Jan. 23 lockdown of Wuhan, he sent an e-mail to the PHAC, including Chief Public Health Officer Theresa Tam, offering his expertise.

Here’s how to self-isolate

On March 13, Prime Minister Justin Trudeau told any Canadians abroad “it is time for you to come home.”

Who needs to self-isolate:

What is self-isolation:

Self-isolation requires you to stay at home, monitor for symptoms, and avoid contact with other people for 14 days, according to the Government of Canada website.

Expectations for those in self-isolation:

  • Stay home from work and school; avoid public transit;
  • Have supplies such as groceries dropped off at your door;
  • Keep a two-metre distance from other people;
  • Stay clear of elderly people and anyone with compromised immune systems or chronic conditions.

And some tips to maintain your health and wellness:

Additional Globe resources:

Need more answers? Email audience@globeandmail.com

“I offered to go back to Ottawa to work with them on this. I needed to help, to save lives,” Dr. Li said in an interview.

In the e-mail, he described his knowledge of the Chinese system and the contacts he maintains there.

“I got an e-mail back saying, ‘We’ll talk about it and let you know.’ But I never had any response after that.”

Instead, the PHAC has relied heavily on the World Health Organization for information and guidance in its response to the rapid spread of the deadly new virus.

What are the coronavirus rules in my province? A quick guide to what’s allowed and open, or closed and banned

How many coronavirus cases are there in Canada, by province, and worldwide? The latest maps and charts

Coronavirus guide: Updates and essential resources about the COVID-19 pandemic

But critics have questioned the relationship between the WHO and China, whose response the WHO has praised effusively. The health organization has raised few public concerns about the reliability of information provided by Beijing, despite evidence suggesting Chinese authorities have significantly underreported the death toll from the outbreak.

Dr. Li said that, during his time in China, there was a difference in “the quality of the information” he was able to obtain by communicating directly with people at China’s Ministry of Health and the Chinese Centre for Disease Control and Prevention. During the 2013 H7N9 avian influenza outbreak, for example, he received updates directly from Chinese officials.

Were he working now, he’d “probably get a lot more timely and accurate information on things,” he said.

There is good reason to seek more sources of information, public health experts say.

A Chinese woman wears a protective mask as she has her temperature checked by a security guard before entering a shopping area on March 14, 2020 in Beijing, China.Kevin Frayer/Getty Images

“In any acute emergency, there is always benefit of ‘on the ground’ expertise and contacts in getting access to data and understanding the nuances of actual context. There is also always value in having multiple sources of data, information or intelligence, and it would be wise to have as many sources as possible,” said James Orbinski, director of York University’s Dahdaleh Institute for Global Health Research.

“Relying on one source of information for critical decision making leaves you open to all of its biases and limitations, and every source – even ‘official’ ones, like the WHO, the government of China, the CIA, the government of the United States, the government of Canada – has biases and limitations.”

The PHAC says it has full confidence in its methods – and in the WHO. “With the situation related to COVID-19 continuing to evolve rapidly around the world, Canada will continue to work closely with its international partners, including the WHO and China, as well as with provincial and territorial counterparts to reduce risks to Canadians and the global community,” spokesperson Anna Maddison said in an e-mailed statement.

The agency can rely on Canada’s foreign service “to share and gather information related to health and public health matters,” Ms. Maddison said.

Canada’s embassies and consulates in China, however, have been working with low staffing levels after non-essential staff – including provincial representatives – were sent home.

Unlike the U.S., Canada does not have a wide-reaching global public health service, which makes it reliant upon the WHO. That’s not a bad thing, said Srinivas Murthy, an infectious disease specialist at the University of British Columbia who has worked with the WHO.

“The WHO is a very reputable, very strong organization which has that capacity,” Dr. Murthy said. “I don’t think Canada specifically needs a foreign public health agency.”

But there are also risks in relying on an agency that itself relies on information from China, a country where statistics are often bent to political imperatives. The U.S. Centers for Disease Control and Prevention has itself been criticized for cutting its staff in China by two-thirds before the COVID-19 outbreak.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, speaks as charts are displayed during a briefing about the coronavirus in the the White House, Wednesday, April 8, 2020, in Washington, as Vice President Mike PenceAlex Brandon/The Associated Press

In Canada, meanwhile, it appears health leaders are not receiving sufficient advice on the potential weaknesses of Chinese data being transmitted by the WHO, said Charles Burton, a senior fellow at the Macdonald-Laurier Institute who has twice worked out of the Canadian embassy in Beijing.

The result is that China’s “politically motivated misinformation tragically leads to unnecessary Canadian deaths,” he said.

Dr. Li began his public health work in Beijing in 2008 with the belief that “Canada should not be responding to epidemics or pandemics when they reach the shores of Canada. We should be proactively working with China.”

He declined to offer his views on how China and Canada have responded to COVID-19, for fear of damaging his relationships with public health officials he still hopes to work alongside.

“As a medical doctor and a public health doctor, our task is to save lives. If I were called upon, I’d jump on the next plane to Ottawa,” he said.

Now that it is recommended you wear a face covering in dense public settings like grocery stores and pharmacies, watch how to make the three masks recommended by the Centers for Disease Control and Prevention. Written instructions available at tgam.ca/masks

The Globe and Mail

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.