'The story is .. still being written': A pandemic Q&A with Health Minister Patty Hajdu
Hajdu looks back on mistakes made and lessons learned over the course of a year from hell
Health Minister Patty Hajdu was away on holiday with her partner at the start of January 2020 when he brought to her attention a strange report out of China about an unexplained pneumonia.
She had been named health minister in late November 2019 in Prime Minister Justin Trudeau's post-election cabinet shuffle. On her first day back from vacation, she was briefed on the mysterious outbreak of illness in Wuhan, China.
"And everything sort of took off from there," she said in an interview this week with CBC News.
On the first anniversary of the World Health Organization's declaration of a global pandemic, Hajdu spoke about the decisions the government had to make early in the pandemic about travel restrictions and federal-provincial relations, and what she wants to do to address the problems in long term care.
The following transcript has been edited for clarity and length.
Q: Was there a moment when it became clear to you that it was going to be much, much bigger than something that was happening somewhere else?
A: I think my sense of anxiety was growing over the months of January and February. And that was the time that we started repatriating people from Wuhan. And also we ended up extricating a bunch of people from the Diamond Princess [cruise ship] that were stuck off the coast of Japan ... And it was a monumental repatriation. I remember my colleague, [then-foreign affairs minister] Francois-Philippe [Champagne], saying this was one of the largest repatriations we've had since wartime.
When I look back, it just seemed enormous. And then, really, it was just a foreshadowing.
Q: One of the first issues that comes up, obviously, was how to deal with international travel. And there were those calls to restrict travel from China and, I believe, other countries that first experienced the outbreak. You at the time pushed back. It was almost exactly a year ago you were doing a news conference, at the National Press Theatre, and you said viruses don't know borders, a border is not going to stop the virus. You made the argument that travellers could find other ways to get through, that they might be less than honest about where they were coming from.
Obviously, we've now swung in a different direction where the border is a much bigger point of emphasis and most or almost all travel has been shut down. In hindsight, is there anything you wish you had done differently in the first few months of of 2020?
A: You know, I've been asked that question a lot. It's very hard for me to say definitively, yes, that was the right thing to do or not because, of course, I think the story is really still being written on COVID-19, effective border measures and what the short and long-term implications are of different stances at the border.
I'll say this: We were following the advice of the Public Health Agency of Canada, which provided us [with] ... evolving advice as the situation changes. And there was a bit of a game-changer that came along. We were doing screening and isolation of folks that arrived from Wuhan and largely focused on China. But what I think really was alarming to the public health officials, and certainly to the government, was when a doctor out West identified a case from Iran.
The patient came from a country that had no reported cases. Iran was not reporting any cases. And so, what we knew by then was [that] by the time cases are voluminous enough to be exported in that way, it means that there's community spread or growth.
So that was very alarming — not to know which countries to target, to screen. Things had been going very well when the virus was mainly identified in China. And then, of course, there was the United States border to contend with and ... especially on the West Coast, with Seattle so close by. Seattle had that outbreak and in their nursing home. So lots was changing quickly. And the advice changed quickly, and so we pivoted with the advice.
Q: Do you think that Canada could have replicated the success that Australia and New Zealand have had, or seem to have had, in shutting down the virus and stopping it from getting in?
A: I think a country-by-country comparison is very, very difficult. I note that Australia and New Zealand are islands. Now some will say that shouldn't matter, but we do have the longest land border in the world. We have an integrated trade and service industry between Canada and the U.S.
I mean we ... maybe could have restricted all international travel from the air, but the land border was always going to give us challenges. And you know, we've got integrated communities as well. These are communities that, in some cases, they only have one grocery store and everybody goes to the grocery store in the U.S. or in Canada, or there's a school that all the children go to. And so those geographical realities are different, I think.
But again, this is something I'm saying from the top of my head and it is, I think, an area that will be researched for years to come, I would imagine — about what the best stance is in terms of global international travel response and how you possibly get ahead of those kinds of things and future global health threat situations.
Q: At various points, there were questions from reporters about whether the federal government should invoke the Emergencies Act and questions were raised about different approaches across provinces and whether every jurisdiction was doing enough. Then there were questions about whether there were sort of conflicting messages coming across from different jurisdictions.
I guess the counter-argument would be that health care services and decisions are best made at a local level. But from where you sat, does it feel like federalism, and having these different jurisdictional responsibilities, was a big problem or even ... a positive in some way?
A: That's a really hard question. I feel like I'm being asked to be sort of almost a constitutional expert. What I will say is that, that is the system we exist in. We have 13 distinct health care jurisdictions.
The question of the Emergencies Act did come up and we explored that and we explored it with provinces and territories, who essentially did not feel that they needed the additional, I suppose, oversight that the Emergencies Act might provide. We certainly stepped actively into the space of supporting provinces and territories with money, with expertise, with equipment, with drugs, with now vaccines. And money for things that traditionally we haven't ever invested in.
For example, the $2 billion safe school restart money, so that provinces could spend money on whatever they needed within their own education system to make schools safer. These are things that I don't think we've ever seen a federal government do quite so rapidly.
I think the other thing that we did early on that I actually think saved lives — and I feel confident in saying this — was the financial measures for Canadians. I'll always remember this conversation I had with [then-finance minister] Bill Morneau early on when it was clear that we were going to have to ask people to stay home. [Chief Public Health Officer] Dr. [Theresa] Tam was saying the only way is to reduce mobility — we have to get people to stay home. And I said, 'People can't stay home if they can't afford to eat, so we are going to have to pay people to stay home.'
And, you know, to his credit, [Morneau] didn't — I mean, I think every finance minister gulps a bit when you propose as the health minister that you're going to have to spend billions of dollars to keep people at home. But to his credit, he got it right away.
Q: Did it feel like there was enough communication and cohesion across jurisdictions, or do you think that's something that needs to be looked at in the future?
A: I think, overall, there was a good collaboration among the health ministers. We [meet] every couple of weeks and we were meeting every week during that first surge in the crisis. There's always differences, especially political differences, when you have so many different leaders from different stripes. But everybody has the same focus, which was to try and save lives.
Obviously, in these kinds of places, there's tension and there's some differences of opinion. But by and large, I would say my relationship with my colleagues has been incredibly collegial. All of them have my cell phone number. Many times I would get texted or called for an immediate need, for some particular piece of equipment that was needed for testing or reagents in the early days. So we've had a very collegial relationship. There's a lot of tension, of course, just because it's a lot of pressure on any health minister all around the world.
Q: The prime minister has said, when he's been asked to look back, that he wishes there had been a bit more stockpiling of (personal protective equipment) to begin with, that the government [had] realized how much PPE was needed. Do you agree with him?
A: I think the review of the emergency stockpile is a really appropriate thing to do. Obviously, each pandemic will require different equipment. But there are some across-the-board things that you'll always need: gloves and gowns and various kinds of masks. So I think his reflection was just the sense of anxiety that the health care workers and other front line workers were feeling in those early days. Were we going to have enough PPE? Were we going to run out of PPE?
So yes, I think the task ahead is [figuring out] what tangibly needs to be stockpiled and for how long, and how do you use that material as it becomes stale-dated. Because you have to keep replacing it and circulating it. In the past, the federal government kept a certain amount of supply, but PPE was actually stockpiled by provinces and territories. That was really in addition to the federal emergency stockpile, which typically held more along the lines of things like retro antiviral medications — things that you might need in the case of an influenza pandemic. But provinces and territories also had their own PPE stockpiles.
So I think figuring out who stockpiles what and how you do that most efficiently, so that you are not wasting any of this — those are the kinds of things that I think need to be studied as we do that review of the response, but also the review of the Public Health Agency of Canada and its role.
Q: Of the 22,000 Canadians who died in the past 12 months, more than 14,000 of them — 65 per cent — were long term care residents. You and the government have said that part of the answer to that is national standards on long term care. Is it possible to give an update on where things stand on that?
A: We've been working on what long term care standards would look like and we actually discussed it briefly at the health ministers meeting [last week], and it's something that's on the agenda to discuss, especially as the budget arrives and as we start to have deeper conversations about health care renewal across the country.
It's not just a question, for me, of having standards. It's about also a commitment and a path forward to enforcing those standards, or to upholding those standards. Because, of course, some provinces and territories did have standards and it didn't necessarily lessen the tragedy in those provinces and territories. So it's about figuring out what the standards need to be. And then the separate process is how you ensure that those standards are applied consistently so folks that are dependent on care are indeed safe in those places.
Q: And do you have any idea of what kind of things you would be looking for in standards?
A: Well, there are different kinds of categories. For example, standards around infection prevention and control, training and capacity. There's standards around hours of care or hands-on care. There's a variety of components that go into care, including, for example, training of staff and adequate staffing levels. Those are the kinds of things that I think [are] going to be very important to have provinces and territories weigh in on as well. But at the end of the day, I don't think that there's anybody across the country disputing that we have to do a better job of long term care.
Q: The NDP has pushed for essentially getting for-profit centres out of the long term care system. Is that something you would push for?
A: You know, I don't know enough about the issue yet to definitively answer that question, I think. I think that it's important that we understand what role profit care provides and whether or not a public system can augment the beds that might be lost if we were to, for example, eliminate private care.
I think that whatever we do in terms of standards, that has to apply across the board. And obviously, I think you've heard the prime minister say that there has to be accountability by owners as well in terms of how they've met their obligations and their duties to the seniors that they obviously are compensated for taking care of.
Q: This is maybe a question for the finance minister, but would new standards come with more federal funding?
A: I think there'd be an expectation by provinces and territories that we would help them with this work. But again, the mix of how we'll augment supporting better health care across the country and what goes into that next — you're right, that is probably a better question for the finance minister.
I do know, though, that quality care will come with an increased cost. We've talked a lot about the care economy and how underpaid, for example, front line workers are. We tried to address that in a temporary way by providing wage top-ups for front line care workers. It was an acknowledgement that the pay in some of these long term care home settings was just inadequate for people to make a living. And most often those are women and often they're racialized women.
And that instability in the labour force caused people to have to have multiple jobs. One of the most heartbreaking stories I heard during the first wave — when I spoke to the Ottawa Public Health Unit and I met with [Medical Officer of Health for the City of Ottawa] Dr. [Vera] Etches and her team — was the story of the outbreak that they were trying to contain in one of the shelters. And it had been imported to that homeless shelter by two long term care workers that were not making enough in their roles to pay for rent. Clearly, something's broken.
Q: Do you have a timeline in mind for standards?
A: Well, my timeline is as soon as possible for everything, because I obviously think that people are depending on us to work together with provinces and territories, but a lot of that will depend on the work of the provinces and territories, too. So I'm not solely in charge of the timeline and it will need to be done in complete partnership with the provinces and territories, and so it's hard for me to predict, but obviously it is a priority, meaning that we're working on it right now.
Q: Most of us would probably rather forget the last 12 months, but is there anything that's going to stick with you in particular about the last year that you want to sort of carry with you going forward?
A: I am consistently moved by the compassion of Canadians that have stepped up in the most heroic ways to help each other, sometimes putting themselves at harm.
In my own community, for example, the amount of volunteers that stepped into the space of emergency food and just came together as community partners, packing food, delivering food, reaching out to people that typically had had other supports in the community. And that's just one small example. People have provided support to strangers, emotional support, lifelines, checked on neighbours ... just the most heartwarming stories across the country of Canadians stepping up for each other, in ways that we can know and in ways that we'll never know.