Canada must invoke the Emergencies Act now

Vincent Lam, The Globe and Mail
November 27, 2020

anada currently faces a situation for which the Emergencies Act of 1988 was intended: an “urgent and critical situation of a temporary nature that seriously endangers the lives, health or safety of Canadians.” The Public Health Agency of Canada projects that, given our current number of contacts, the number of COVID-19 cases will reach 20,000 a day by the end of December. From Nov. 3 to 25, the number of patients hospitalized with COVID-19 increased from 1,114 to 2,219. Doctors nationwide warn that hospitals may soon become overwhelmed, while many provinces vacillate on their public health responses. On Nov. 20, Prime Minister Justin Trudeau urged Canadians, “We need to do everything we can right now.” The federal government should now use the Act. It can respect provincial jurisdiction over health where things are going well, and intervene where provinces need support.

Canadians expect some basic things from government right now: that COVID-19 is managed rather than allowed to run out of control, that people have timely access to health care, and that their province is doing as well as other provinces in mitigating the impact of this pandemic. If an individual province is fulfilling these expectations, there is no reason to involve the federal government. If not, that province faces a situation of “proportions or nature as to exceed the capacity or authority of a province to deal with it,” which is when the Act allows Ottawa to engage in what are normally provincial matters.

The Emergencies Act should be deployed by implementing thresholds of clear indicators, to be reassessed monthly in each province, that address the effectiveness of its pandemic response. Local public health units, hospitals and coroners’ offices should report all relevant data directly to the federal and provincial ministries of health. A province whose response is going well can continue without Ottawa’s help, and may request assistance if desired. A province whose indicators breach pre-set thresholds will be obliged to accept intervention under the Act.

The first indicator would be R0, the reproduction number, a widely used assessment of whether things are getting out of control. R0 is the average number of additional people infected by each infected person. When R0 rises above 1, infections snowball like an unpaid credit card. If R0 were kept below 1, eventually COVID-19 would disappear. A province should have an R0 of below 1, or an R0 that has decreased compared with the previous month, to avoid Ottawa’s knock on the door.

A second indicator should be acute care bed occupancy, a way of gauging whether a sick Canadian who needs to be hospitalized will have a bed. COVID-19 has rapidly overwhelmed hospitals around the world. Physicians across Canada now warn of that scenario here. Hospitals need capacity for a sudden influx, because new beds cannot be created in the time that it takes for a patient to die. Some jurisdictions currently target bed occupancy rates lower than 90 per cent for acute care beds and ICU beds, and 60 per cent for ICU beds with a ventilator. The thresholds should be either that a province meets predetermined bed occupancy numbers, or achieves numbers that have improved from the previous month. If not, Ottawa helps to create more beds.

A third indicator could be per capita excess mortality, a number that estimates how many more people are dying of all causes than would otherwise have been projected to die if COVID-19 had never happened. This captures COVID-19 deaths in people who did not receive a test, and deaths from pandemic response disruptions rather than COVID-19 itself, such as foregone medical treatment, increased drug overdoses or domestic violence. The threshold might be a per capita excess mortality of less than two standard deviations above the mean of all the other provinces. Every province will continue to see excess mortality, but a figure two standard deviations above the mean would suggest that a particular province is somehow faring much worse than others in the overall care of its citizens. This indicator would also counter the possibility of a lower apparent R0 value resulting from insufficient testing, or an 85 per cent bed occupancy achieved by simply neglecting all other health problems.

In a struggling province, the Emergency Act would give the federal government the ability to augment testing and contact tracing. It could have local public health units and hospitals report directly to Ottawa and implement their recommendations directly. It could requisition property, for instance hotels to be used for quarantine, as housing for the homeless and to create additional hospital beds. If needed, it could impose broad lockdown measures, which we should remember were successful in the spring of 2020. The news of effective vaccinations is welcome, and the end-point of nationwide vaccination fulfills the “temporary” mandate of the Act. Canada currently has no clear distribution timeline. The respiratory pandemics of the 20th century all lasted about two years. We hope this one will be cut short by effective vaccination, but until that end-point occurs, Ottawa needs to support the provinces to limit the impact of this pandemic, so that as many Canadians as possible survive to receive the vaccine.

As of Nov. 21, calculations by the Centre for Mathematical Modelling of Infectious Diseases showed an R0 above 1 in every province except Quebec, Manitoba and Prince Edward Island. In other words: Although everyone is tired of COVID-19, Canadian citizens and leaders must understand that the situation is moving in the wrong direction. We are on the cusp of things becoming much worse. We need federal leadership now. The Emergencies Act should be invoked now. Relevant data should be collected immediately and in one month. If any province is not delivering what its citizens can reasonably expect during the COVID-19 crisis, the federal government must help it to do so.