Saskatchewan government failed to order key equipment and supplies until after COVID-19 arrived

A reviewof Premier Scott Moe and his colleagues'actions and statements over the past two weeksraises questions as to whether the provincial government took the threat of COVID-19 seriously enough, soon enough.

Miles Fahlman, a Saskatchewan-based medical anthropologist who spent five years studying the first SARS virus for his master's thesis, reviewed the Saskatchewan politicians' public actions and words from March 9, 2020, to present.

He said the review caused him to believe the provincial government is "worryingly unprepared" for the epidemic, in part because it seems the politicians allowed political considerations to cloud their vision.

The chronology reveals that the provincial government didn't order key equipment like ventilators, ICU beds and hospital beds until the disease arrived in the province.

"This style of response is dangerous and it can cost lives," he said.

'They're moving way too late'

Ventilators are key to keeping COVID-19 patients with severe infections alive.The machine breathes for the patient when they no longer can.

The province has 91 ventilators as of Monday, March 23.

In an email, the Saskatchewan Health Authority (SHA) confirmed that on March 12, the same day the first COVID-19 cases was confirmed in Saskatchewan, the ministry of health approved an order for 50 more ventilators.

This is the classic unprepared scenario. You gotta move first.- Miles Fahlman, medical anthropologist

Fahlman said it's good the province finally placed that order but he said "they're moving way too late."

He said his training told him to worry when he started seeing the rapidly rising numbers of infections in Wuhan, China, in late January.

"That was my panic date," he said. "That's when I went and got my water, my canned food and all of that kind of stuff."

He said every public health official should have sounded the alarm and ordered critical supplies by late February, when the World Health Organization released a report on the Wuhan crisis.

"If you're not ordering there, you're not watching," said Fahlman.

Asked by CBC about the timeliness of the province's equipment and supplies order, the premier's office responded by email, saying "in all planning and preparations for the COVID-19 response, the Government of Saskatchewan has acted upon the advice of the chief medical health officer and senior officials in the Saskatchewan Health Authority."

The email added that "Saskatchewan's chief medical health officer and senior officials in the Ministry of Health and Saskatchewan Health Authority have the full confidence of the premier, cabinet and the Government of Saskatchewan."

Fahlman said that with most jurisdictions around the globe now hunting for ventilators, an order of 50 on March 12 the day the province announced its first COVID-19 case was too little, too late.

"Everyone is struggling online everywhere, even in New York City, to get the proper stuff and we're behind the eight ball," he said. "This is the classic unprepared scenario. You gotta move first."

Dr. Nazeem Muhajarine, a professor of community health and epidemiology at the University of Saskatchewan agrees that that province didn't act soon enough.

"We are flatlanders. We can see storms brewing miles ahead. And we knew this storm was brewing since early January," Muhajarinesaid. "If you're a good farmer and you can see the storm coming you protect your flock, you take what steps are needed to protect your crop, your flock, everything. And I think we should have at least done that."

Instead of ensuring the equipment and supplies necessary for a pandemic were being ordered, Saskatchewan Party politicians were toying with calling a provincial election.

Moe considered election in midst of pandemic

On March 9, the opposition NDP began asking the Saskatchewan Party government to officially rule out calling a spring election, given the growing pandemic.

Saskatchewan's provincial election date is officially set for October 2020, but rumours had been flying for weeks that the government wanted to go to the polls in the spring.

The NDP expressed surprisethat the rumour persisted, given the number of COVID-19 cases had been growing rapidly across North America, prompting New York State to declare a state of emergency on March 7. Major events, like the South by Southwest music festival, were being cancelled.

"The premier is musing about calling a snap election that would increase social contact. It's backwards," Opposition NDP Leader Ryan Meilisaid during the March 9 question period. "This is a serious matter of public health. It's not a time for political games."

Meili asked why the premier wouldn't shut the door on an election andfocus on the health crisis facing the province.

Moe didn't answer the question directly, but he did acknowledge he was still weighing the possibility of a spring vote.

"This is not a decision that this government takes lightly. This is a very serious decision, Mr. Speaker, that we continue to have discussions about," said Moe.

In the legislature, the premier pointed out that at that time there were no positive cases of COVID-19 in Saskatchewan but if the virus did arrive, the province was ready.

"The people of this province can be reassured that we are dealing with this from a position of stability with the resources we have in the health sector as well as where we are placed with the economy."

Looking back, Muhajarine said he was surprised Moe was still actively considering an election at that time,given the crisis.

"You live or die by your judgments. And I think it was a poor judgment to even muse or consider a spring early election," he said.

'What's the plan?'

The NDP began pressing the government about its level of preparation.

"Our health system is stretched to its limits and emergency rooms are already bursting at the seams. It's hard to imagine how they could handle the pressures from a COVID-19 outbreak," said the NDP's Vicki Mowat on March 10. "To the minister: what's the plan?"

This premier is bringing politics into a pandemic because he's too busy planning an election to plan for the pandemic that's coming in this province.- Ryan Meili, Opposition NDPLeader

A March 11 Regina Leader-Post story said that when the newspaper asked the government for a copy of its COVID-19 plan, the province provided a copy of a 2009-10 document. It assigned tasks to regional health authorities entities that have been non-existent for more than two years.

Health Minister Jim Reiter told the paper the plan was, "multifaceted There's not one single document."

That day a COVID-19 related document showed up on the government's website. It was a 13-page Powerpoint presentation entitled "Saskatchewan COVID-19 Preparedness Plan."

The NDP was unimpressed.

"This premier is bringing politics into a pandemic because he's too busy planning an election to plan for the pandemic that's coming in this province," Meili said in question period on March 11.

Reiter said Meili was wrong because his officials had developed "a framework for the plan."

"He's been trying to scare and instill fear into the people of Saskatchewan, saying there is no plan. Mr. Speaker, nothing could be further from the truth," Reiter said.

'What not to do in the face of a pandemic'

The NDP also asked if the government had the supplies and equipment needed to handle a major outbreak.

"What's going to happen when there are more ventilators needed but they aren't available because they're all being used? Where are patients going to be treated when hallway medicine is already the new norm?" Mowat asked on March 11. "And how is the Sask Party supposed to come up with a plan when they're out campaigning?"

Reiter said everything waswell in hand.

"I realize that the members opposite are terrified of an election. If I was them, I would be, too, Mr. Speaker," said Reiter. "But the fact of the matter is, on this issue, a very serious issue, the issue of coronavirus, Mr. Speaker, officials do have a plan in place."

Fahlman was shocked and appalled by how the minister was politicizing this public health crisis.

"This is how pandemics are perpetuated this kind of language," said Fahlman.

After reviewing the excerpts of debate in the legislature, he said, "this whole transcript is evidence of what not to do in the face of a pandemic."

Throughout the debate in the legislature from March 9 to 11, the premier spoke of the possibility COVID-19 would arrive.

For example, on March 10 Moe said his officials were working hard "so that we are well prepared to provide the health services should we need to, Mr. Speaker, in the case of an outbreak or multiple cases here, of which we have none today."

"If you're in consultation with public health and epidemiologists they should have warned you that cases are coming, not that they might," said Fahlman. "That's dangerous."

I am hopeful that we will be getting some ventilators in some shape and form. In saying that, the rest of the world is hopeful that they're going to be getting some ventilators as well.- Premier Scott Moe on March 18

At that time, the province was not only leaving the option of a spring election open, it was also still planning to host the Juno Awards, an event that would have seen people pouring into the province from across Canada.

Muhajarinesaid he was surprised the government took so long to pull the plug on this event.

"We knew when all these people are flocking to Saskatoonin this month, the middle of March, that was possibly an invitation for disaster," he said.

Fahlman said from his perspective this means one thing.

"They're not prepared. They don't understand the severity of the situation, even that late in the game," Fahlman said.

In an email from the premier's office, an official said "at no time did considerations regarding a potential spring election impact the decision making process within the Government of Saskatchewan, Ministry of Health or Saskatchewan Health Authority."

COVID-19 arrives in Sask.

On March 11, the World Health Organization declared the COVID-19 outbreak a pandemic.

The next day, March 12, Saskatchewan announced its first case of COVID-19.The Junos were cancelled.

Moeannounced that day there would be no spring election.

However, the government was still planning to go ahead with a full provincial budget release the following week. This would have involved hundreds of people descending on the legislature to take in the pomp and ceremony of the event.

In the Saskatchewan legislature that day,Meili urged the government to postpone that event given the unprecedented collapse of the global markets.

"Let's not table a budget that is divorced from the realities that we're facing in the province today," Meilisaid. "Let's have a responsible, collective response to this challenge today."

Reiter said the government was prepared and that the NDP was "lighting their hair on fire, running around, trying to instill fear in the citizens of Saskatchewan."

Meili again pressed Reiter about the province's preparation for the crisis that had now arrived.

"There are serious concerns on the front line. There are serious gaps in the plan," he said.

The world is hunting for ventilators

The province has 91 ventilators as of Monday, March 23.

The government approved an order for 50 additional ventilators on March 12, the day the first case in Saskatchewan was confirmed.

Fahlman saidthe province ordered too late and ordered too few.

Five days later, on March 17, the ministry approved the order of another 200 ventilators.

Fahlman said given the global demand, they may never arrive.

At a news conference on March 18, the premier acknowledged this is a concern.

"I am hopeful that we will be getting some ventilators in some shape and form. In saying that, the rest of the world is hopeful that they're going to be getting some ventilators as well," said Moe. "We're working feverishly like other provinces and like other areas around the world to source products that we need including ventilators."

ICU and hospital beds ordered

As budget day approached, Meili asked the province during question period on March 17 about its supply of hospital beds.

"Ontario and British Columbia have ordered hundreds of beds for acute care, ICU [intensive care unit] beds, even stretchers," Meili said. "Have these beds been ordered and, if not, when will that happen?"

"It's my understanding that has happened," Moe replied.

In an email late last week,Saskatchewan Health Authority officialsconfirmed the province currently has a combined total of 109 ICU beds and 3,000 acute care beds in 65 hospitals across Saskatchewan.

The SHA said that it ordered 74 additional ICU beds and 176 hospital beds on March 17 and March 18.

Tracy Zambory, the president of the Saskatchewan Union of Nurses, saidher members are "feeling lots of concern particularly around the lack of supplies around personal protective equipment and swabs to do the testing out in the rural areas."

The province said it has about 16,000 test collection kits available for gathering and shipping samples, with another 37,500expected to arrive in increments over the next sixweeks. It also said it has also ordered 190,000 individual swabs for collecting samples.

In addition, the province said it has 2.5 million masks and it has placed orders for $3.8M worth of personal protective equipment on February 14, March 12 and March 13.That equipment includes gowns, gloves, masks and hand sanitizer.

The premier saidthat in addition to the orders placed, the SHA "is actively starting to reduce some of the elective surgeries and some of the elective procedures that are occurring in our communities in Saskatchewan to start to create that space in our facilities should we need it."

Flatten the curve

Fahlman said the province's actions since March 18, the day it declared a provincialstate of emergency, have shown it is now treating this crisis with the appropriate level of urgency.

On thatday, Saskatchewan's chief medical health officer Dr. Saqib Shahab saidit is up to every Saskatchewan resident to ensure that this province can make it through this crisis.

"Over the course of 12 to 18 months, 30 to 70 per cent of us will get COVID-19," he said.

Shahab said most of those infections will be mild and the patients will recover, but that 20 per cent of the cases will require some form of hospitalization and "a further two per cent will require ICU care."

He said if the province spreads those serious infections out over that entire 12- to 18-month period, that will reduce the pressure on the health care system.

Shahab said that is why the government is so insistent that people follow self-distancing rules.

He said if too many people get sick at the same time it will overwhelm our system.

"There is no health system in the world that can manage this virus if we are not able to practice personal distancing social distancing, if we're not able to flatten the curve in some way," said Shahab.