an insider's history of saskatchewan's fight against covid-19
8 minute read
john ash, sha executive director of acute care, served as the first head of the emergency operations centre that managed the response to covid-19, and later as its operations section chief.
brandon harder
/
regina leader-post
by: arthur white-crummey, regina leader-post
from the beginning, the people who managed the saskatchewan health authority’s (sha) emergency response to covid-19 knew they’d be in for criticism — no matter what they did.
“if we’re successful in managing this, people will criticize that we overreacted,†john ash remembers telling his colleagues.Â
“but i would rather be criticized for overreacting than not doing anything.â€
ash was the first official to head the sha’s emergency operations centre (eoc), before becoming chief of its operations section.
now, as he looks back at those early efforts, he defends the “aggressive posture†the sha took to preparing for the covid-19 pandemic.
“we made the best decisions based on the information that was available at the time,†ash said in an interview on wednesday.
those decisions are chronicled in 34 eoc situation reports released to the leader-post through a freedom of information request. they tell the behind-the-scenes story of the first six weeks of the sha’s fight against the virus, marked by pressure and uncertainty as officials juggled dozens of files at once.
they battled 10-hour wait times on the 8-1-1 healthline tele-service, grappled with donald trump’s blockade of vital ppe exports and drew up a plan to combat the virus in a matter of days.
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the push for a plan
the eoc met for the first time on march 6, 2020, in a royal university hospital boardroom. its creation followed a session the day before, when sha and ministry of health officials met to
“kick off planning†for covid-19.
derek miller, who took over leadership from ash on march 11, told the leader-post the team wasn’t starting from scratch.
the sha had begun updating a years-old pandemic plan that fall, and there was already a “centralized committee†adapting it to covid-19 over the winter.
the eoc simply accelerated that work as the threat became more pressing, according to miller.
“it wasn’t like there was nothing happening, by any stretch. in fact there was a lot of activity,†he said. “it was just, at that moment, we recognized that this has the potential to become a very significant event and that we needed to accelerate our planning and our ability to respond.â€
by march 10, planning was underway to open three assessment centres within two days of the province’s first presumptive case. teams were given deadlines as early as march 13 to submit planning work on specific topics like surge capacity or supply chain management. that became the basis for updates to existing pandemic plans in specific regions, which were bracing for outbreaks in the range of one to 100 cases.
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the eoc was ready to take a look at a province-wide planning document on march 19. it was presented alongside modelling information that was later leaked to the media. the modelling painted a dire picture, warning that
covid-19 could kill 15,000 saskatchewan people if left unchecked.
ash said the presentation showed the “stark reality†of what could happen if the team didn’t take action.
miller, who had watched the virus overwhelm health systems in other parts of the world, said the numbers brought those nightmare possibilities closer to home.
“i think everybody had a similar reaction,†miller added. “the numbers were significant in the worst-case scenarios, but that’s what we needed in order to really inform all of our planning activities that followed from that.â€
planning work was never really over. as march came to a close, the eoc reviewed updated modelling, selected field hospital sites and responded to a new deadline of april 2 for a provincial surge plan.
by then, the province’s numbers were on the downturn after a late-march spike, but the eoc remained wary.
“it is too early to conclude that an overall flattening of the curve is happening,†the april 2 situation report said.
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the ‘turnaround story’ of 8-1-1
as it planned for the future, the eoc was also putting out fires from day to day.
one of the earliest flared up around march 13, the day after saskatchewan announced its first confirmed case of covid-19.
the situation report that day warned of “increases to call volumes†on the 8-1-1 line. the eoc responded by doubling staffing and phone capacity.
it soon moved to a new phone system with a call-back option. but call volumes kept increasing. on march 19, the situation report warned about long waits. staffing up was “a significant challenge,†but a “top priority.â€
the next day was even worse. there were more than 1,000 people waiting for a call back, on average, at any given time. the waits could be up to 10 hours.
the eoc warned staff to “stop calling 811.†the sha brought on 150 new staff to take calls that weekend.
those efforts paid off within days. by march 22, the queue was down to zero.
the 8-1-1 issues were mentioned for the last time in the april 2 situation report. as of that day, the system had taken almost 50,000 calls. about 70 per cent were related to covid-19. by that time, 250 staff had been trained to take them, and the situation was considered “stabilized.â€
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the eoc called it a “turnaround story.â€
the phone line wasn’t the only technical challenge facing the eoc in those early days.
on march 19, the eoc noted “challenges for data entry for contact tracing.â€
ash told the leader-post that the issue only affected reporting to the province and federal government, not the ability of local officials to identify and support people at risk of infection.
why were surgeries suspended?
the first time the eoc considered the prospect of slowing down elective surgeries in its situation reports was on march 16.
it said doing so would support social distancing, reduce traffic inside facilities and free up staff to deal with outbreaks.
the next day, the slowdown was “being planned.†another potential benefit popped up in the situation report that day, when the eoc was also worrying about “major reductions in inventory†for certain supplies.
“there will be a positive impact on the utilization of personal protective equipment and supplies,†the report noted as it examined the impact of pausing elective surgeries.
miller said that was never the main reason for the slowdown
“there were a multitude of different factors that kind of contributed to that,†he said. “ppe was identified as a secondary potential impact, but it certainly wasn’t a driver in making the decision.â€
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supply shortages a persistent worry
supply worries never let up. fears of ppe or testing swab shortages pop up again and again during the entire six-week period detailed in the situation reports.
the march 17 report deemed the risk of shortages “high†and noted that swabs were already in short supply. the sha placed an order with 3m for one million n95 masks on march 20, but warned that there was “
no guarantee of the order being filled fully or partially†as health systems around the world fought for supply.
the eoc would soon start working on plans to triage ppe whenever demands made that necessary. as of march 26, ppe remained
“the priority concern with physicians and front line health care workers.†the next day, “ongoing supply challenges†were still limiting the sha’s ability to supply private clinics.
that led the eoc to bring on a ppe task force and a ppe expert panel to face up to the challenge. days later, the eoc found itself grappling with what premier scott moe would call a “betrayal†from the united states. president donald trump had invoked the defense production act to cut off mask exports from 3m.
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that threatened 1.2 million masks due to saskatchewan. though miller didn’t want to comment on the dispute after the fact, the eoc was clearly worried.
“this would translate into us not receiving any of those masks,†said the situation report that day.
“this undoubtedly puts added pressure on our already strained supply chain.â€
it was only on april 8 that 3m confirmed to the eoc that some n95 masks would be allowed to leave the united states, though officials still didn’t have a timeline. they discussed the idea of reprocessing used ppe supplies, and were working on “a two masks per person per day protocol.â€
testing supplies remained a “major challenge.†yet, on april 8, moe set a targetâ of testing 1,500 people each day by the end of april as he prepared to unveil his reopening plan.
the eoc was soon working on “sourcing lab supplies†to meet that target.
as of april 16, they noted that “availability of swabs is one of the limiting factors of our testing.â€
miller cautioned against reading too much into that. he said there were never any actual shortages, though there were certainly concerns as the eoc looked to meet the target.
“there were concerns about the potential supply and how increased testing, as you go forward and with a specific target of 1500 tests, how that might be impacted by potential shortages,†he said.Â
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“we didn’t actually experience those shortages, but it was certainly raised as a risk as we were planning on implementing the strategy to achieve that target.â€
saskatchewan never met moe’s target, with the sha chalking it up to people showing less interest in testing as flu season subsided and fewer people faced symptoms.
***
miller said he never felt panic as he lived through those first six weeks. “it was more pressure,†he explained. the focus was always on saving lives, as his team navigated long work hours and hundreds of emails per day rushing into their inboxes.Â
“in those early days, there were many demands and pressures and a very rapidly changing environment as we tried to stay up to speed on what was happening elsewhere,†said miller.
“in any emergency, you’re always operating in a pretty high level of uncertainty, especially in the early hours of an event, and there was no exception in this case.â€
ash said the covid-19 response “trumped†every other emergency he’s faced over his career. he said the sha was well placed to handle it.
“i think our response was made infinitely better because we were the sha,†he said. “we weren’t 12 different health authorities trying to manage this individually.
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