If there's to be another Edmonton lockdown then acknowledge the excesses of the first

COVID-19 has arrived in Edmonton.  No dispute there.  At issue, however, is whether it really arrived prior to October.  

If the City had kept its power dry until recently, one could expect new restrictions to be reasonably well received.  As it stands though, people recall all too well the restrictions that were in place from March to June/July and how, especially but by no means entirely, in hindsight they were overkill with the exception of nursing home restrictions.  Not all people, of course, and perhaps not you, dear reader, but let's review, in rough order from the outrageous to the understandable but nonetheless mistaken, the policies (or, in the case of masks, the way they were communicated) that need to be acknowledged as having been in error or at least of far more doubtful utility than was admitted at the time. 

Outdoor Playgrounds

The City closed playgrounds in March but we knew, or could have known, that for SARS 2003 although the virus was detectable on surfaces no one was ever able to grow the virus from the collected samples.  Samples were taken in Bangkok, Taipei, and Toronto hospitals but all were culture negative.  There wasn't a single case of confirmed "fomite" transmission for SARS-CoV-1 but we're supposed to believe fomite transmission is a serious risk with version #2 when those fomites are exposed to to the elements including solar radiation?  We also had SARS-CoV-2 research on the point by early March.  This was published by Michael Osterholm's University of Minnesota's Centre for Infectious Disease Research and Policy (CIDRAP) on March 9:

Now maybe it's too much to ask city councillors to be aware of this before they decided a serious crackdown on outdoor play was required.  But we had a local medical authority, as strong a local authority as one can find, in fact, specifically address the playgrounds issue:

"Q: What about taking children to outdoor playgrounds? A: Going to playgrounds but maintaining social distance so there isn't a large group of kids congregating, it's perfectly safe."

This from Mark Joffe, VP and Medical Director for Northern Alberta at AHS, who is also a Department of Medicine professor at the U of A and an adjunct professor in medical microbiology and immunology at the School of Public Health.  If you work for AHS odds are you know who Joffe is.  

Now you may have followed the weblink above to the CBC article and noted that what I quoted above does not appear in the article.  That's because after the cities closed playgrounds the CBC deleted Joffe's statement about playgrounds being safe.  Don't believe me?  Check the comments.  Do you see Matt Beaubien quoting the now deleted statement?

Note the sequence here: an expert weighs in, politicians defy the expert (and cite zero experts or evidence to support their own take), the mainstream media then scrubs the record to accord with The Truth handed down by City Council.  

The appropriate remedy to this outrage by both City Council and the CBC is apology.  Not an update or correction, an apology.  Freedoms were taken away without evidence, even contrary to evidence, and the MSM colluded with this.

Hinshaw's reaction, in case you were wondering, was to shrug "most playgrounds are now closed across the province."  No profile in courage, that, but at least her statement was based on observed facts. 

Cancelled surgeries

Here's Edmonton Zone hospitalizations to date, courtesy of @ByMatthewBlack:

Hospitalizations at any given point in time never exceeded 10 until late June (while Zone population is more than 1.3 million), by which time more than three months had passed and #Lockdown1 was ending.  10 when AHS had postponed enough surgeries and repurposed enough ORs/surgical recovery rooms to free up 1500 beds provincially for COVID by April 8 and 2250 by April 15.  Just for COVID.  And ICU admissions in the Zone apparently never exceeded 4 during this period.

I'll grant that the fact that we ended up with all the idle space and idle clinical staff that we did was not very foreseeable in March.  There were hints, though, in the fact that for all the horror stories coming out of Lombardy and NYC, stories of swamped healthcare facilities weren't there to the extent one would expect when journos were surely looking for such stories.  And for all the exponential growth models going around, it was still notable how it was believed at the time that it would take quite a while yet for interior and less connected regions like Montana to be hit.  Edmonton is not New York City and as such a wait and see approach would have been better advised given the consequences of cancelling surgeries.  It's particularly tragic in the Canadian healthcare system given our wait lists.

While this may have been one of the most understandable mistakes it's also the most consequential.  Even for people who didn't have their surgery postponed, how many didn't seek early intervention for emerging heart problems for fear of the hospital already being full of COVID patients?  How many childhood vaccinations were missed?

I'm not saying all the physicians currently warning of filling hospitals are false prophets.  I'm saying it should be acknowledged that in April there were large numbers of AHS staff who didn't have patients to care for and unused capacity but this time it's different.  Admit that demand was overestimated last time and people will take the new estimates more seriously.

Closed Libraries

This one's something of a pet peeve.  I have a four year old and if I can't read to her what am I supposed to do?  It's not like she can go to either indoor or outdoor playgrounds!  Never mind preschool, dance class, etc etc.  Sure, I can buy books, and did, but her mother is Chinese and needs Chinese books to read to her.  I simply couldn't acquire those like Edmonton Public Libraries could.  Not a big deal, some might say.  Sure, but the remedy here also would have been an exceedingly easy deal: allow people to put books on hold through the online catalogue that they then pick up from a branch by appointment.  It shouldn't have taken months to figure out a solution there.  And the situation was not so urgent in mid-March that the public couldn't have gotten 24 hours notice of the closures so that they could pick up their holds.  If we are talking a two week pandemic then, sure, maybe every day counts, but it was apparent enough to those of us who were paying attention that this pandemic would be with us for many months to come.

Closed Elementary Schools

This didn't impact me personally but this was clearly a major mistake in Edmonton.  It was apparent very early on that young children were not being threatened by COVID any more than flu (in fact less so) with the few studies suggesting otherwise having obvious flaws.  It's one thing to have high schoolers go online and quite another to expect a Grade 1 student to rack up hours of screen time to edifying effect unless constantly supervised.  That the education of children of lower income families would be disproportionately impacted was also totally predictable.

The saving grace has been that Edmonton students were able to go back in September because teacher unions aren't quite as powerful as they are south of the border.  I'm routinely amazed at how many opinion leaders in the US can demand "close the schools!" while having no interest at all in closing daycares never mind that daycares are notorious cold and flu spreaders.

Masks

This one's different in that I wouldn't call Edmonton's mask mandate a mistake.  I wear a mask almost continually when I'm outside the home unless I'm in the car or outdoors.  And have been since April (mostly due to in-laws in China sending me masks that weren't then generally available here).  

But can we please stop moralizing the issue of members of the general public without symptoms wearing masks as the Enlightened versus the dark forces of obscurantism?  Let's review what the Enlightened were saying up until the end of March:

• European Centre for Disease Prevention and Control (ECDC) said evidence that mask wearing slows virus spread exists only for symptomatic people wearing masks
• The ECDC was in turn cited by the Canadian government when discussing the mask issue
• WHO stands by recommendation to not wear masks if you are not sick or not caring for someone who is sick
• "Seriously people- STOP BUYING MASKS!  They are NOT effective in preventing general public from catching #Coronavirus" - US Surgeon General
• "There is no role for these masks in the community" - CDC Director Robert Redfield House Foreign Affairs Committee testimony
• "there is no evidence to suggest that face masks worn by healthy individuals are effective" - Journal of the American Medical Association
• "if you are healthy there is not thought to be any additional benefit to wearing a mask" - Mayo Clinic
• there is very little evidence widespread benefit for members of the public wearing masks - UK NHS
• There is not enough evidence to prove that wearing a surgical mask significantly reduces a healthy person’s risk of becoming infected while wearing it - Federal Ministry of Health, Germany (Bundesministerium für Gesundheit)

There's two possibilities before us now regarding the Received Wisdom about masks: 1) the above takes aren't as wrong as commonly supposed 2) the current Received Wisdom is not as right as commonly supposed.

The true answer is probably somewhere in the middle.  It does make sense to say that there was probably overconcern about the general public contaminating themselves when donning or doffing given the gradual (too gradual) realization that surface contamination is not a significant danger with COVID.  But level with the public please.  I strongly suspect that what really works is a fitted N95 but our experts are not telling us that because there isn't enough N95 supply and certainly not enough capacity to get everyone fitted.  But just state that if that's the case.

The reaction to the recent Danish study finding no significant benefit is telling.  "Just because it didn't find a highly significant benefit doesn't mean there isn't s small significant benefit!"  Well of course.  But just admit that you still have no hard evidence and the mask thing remains an educated guess!  There need not be any shame in that.  An educated guess is good enough for me.  But please stop trying to memory hole what the experts were telling his up until April.

The endgame

When I see people complain about Premier Kenney waiting for Trudeau to introduce a national mask mandate so that the federal level can take the political heat I have to ask, do you not recall how Mayor Iveson complained about having to take the hit for introducing an Edmonton mask mandate because the province didn't act?  Of course the politicians are all trying to pass the buck.  The biggest problem I have with #WhereIsKenney is that there isn't nearly enough recognition of the fact that public policy doesn't seem to make that much difference relative to the things that can't be changed by a politician overnight like a community's demographic/cultural profile.

Where, may I ask, were the demands that Mayor Nenshi take personal responsibility for the fact active cases in the city of Calgary were nearly twenty (20!) times active cases in Edmonton at one point?   Sure, public policy makes a difference but there isn't nearly enough evidence to justify all the morality tales people are telling about why such and such a city or province/state or country is doing better or worse.

How far away a vaccine (or some sort of endgame) happens to be is extremely relevant to the debate here yet is rarely referenced.  A key reason why I feel the March to June lockdown was a mistake is that it wasn't sustainable for a full year and a full year (at least) is what informed people knew it would take before we could talk about getting on the other side of this pandemic.  

The UK was roundly criticized in March for not moving more rapidly lock down.  Here's what I wrote at the time (March 16):

Say what you will about what I called the "British strategy" but at least they put their minds to it.   There was no evidence at all of such foresight on Edmonton city council or in the mayor's office in March.  Adopting this strategy would have made a lot of sense for Edmonton but more importantly articulating such a strategy would have prepared the public for what we are facing now.  At a minimum, ease up at the end of April when it was apparent the hospitals were empty and seasonality could work in our favour (instead of dragging out the restrictions into June/July as they were) and explain to people that they need to get out of the house when it comes to socializing and make the most of their summer because we will need to be prepared to lock down when the snow comes and we are forced indoors.

What's done, or wasn't done, is done.  But it isn't too late to admit that too much was asked of too many for too long before now asking them for more.