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Inquiry must assess how Canada’s fragmented COVID-19 response lost the public’s trust

Now is the time to learn from the COVID-19 response through an action-oriented independent inquiry focused on accountability. Reforms to data generation,…

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It is clear that some public trust in public health, science and government has been lost in Canada and around the world. (Shutterstock)

Over the course of the pandemic, more than 53,000 Canadians died and nearly five million contracted COVID-19.

While Canada had lower numbers of cases and deaths and higher vaccination rates than most other G10 countries, these successes mask inequities across communities, socio-economic conditions and demography. They also hide challenges in data sharing and loss of public trust over time, evidenced by the “freedom convoy” movement that occupied Canada’s capital, Ottawa, in early 2022.

These and other challenges are laid out in a series of articles published in the British Medical Journal (BMJ) on July 24, that we co-authored with other clinical, research and public health experts across Canada. Now is the time to learn from the COVID-19 response through an action-oriented, independent inquiry focused on implementation and accountability.

Loss of public trust

Canada’s public health response was hampered by fragmentation in decision-making, shared between federal and provincial/territorial and sometimes municipal governments. The Public Health Agency of Canada, which was created in the wake of the first SARS outbreak in 2003, develops national clinical and public health guidelines while provincial and territorial health agencies make decisions for their individual jurisdictions.

In the absence of a co-ordinated planning and delivery authority, different public health measures were implemented in different locales. For example, measures like vaccine eligibility and mandates, masking and school closures varied among provinces.

The rationale and supporting evidence for these different approaches were unclear. Some variations addressed local risk factors as evidence evolved, but insufficient availability and sharing of data and analyses — combined with a lack of transparency — made it hard to explain the variation to the public. Over time, this led to a loss of confidence in public health guidance.

Fragmented data

Part of the problem is outdated data infrastructure that isn’t able to support public health decision-making in real time. Health information systems lack integration and interoperability between data sources, even after $130 million of investment over the past eight years.

However, other problems are legal and cultural. Canada’s health data privacy and protection laws, developed before the era of big data applications, create legal impediments to using and analyzing data across jurisdictions.

These impediments were exacerbated by a culture of risk aversion among the custodians of data in different jurisdictions and organizations. This culture requires a shift from a safeguarding mindset to one of stewardship for public good.

Technological advances mean data no longer need to be pooled across jurisdictions. Data need never leave their secure data environments; instead, de-identified data may be accessed and analyzed across independent systems using federated data structures. Unfortunately, these structures were not in place at the start of the pandemic and have not been implemented over the past three years.

Improved data access also presumes that data are fit for purpose, and that was not the case. Comparisons between jurisdictions were difficult for several reasons, including policy differences in testing eligibility, types of tests, how test results were reported and how hospitalizations or deaths were attributed to COVID-19.

Over the course of the pandemic, most jurisdictions reported COVID-19 case numbers, but data about demographics or location were withheld due to privacy concerns. This lack of nuanced data left people with a lack of understanding of their personal or community-level risk factors. The lack of ability to make informed decisions contributed to loss of public trust over time.

Even worse, the initial pandemic response was ill-designed to address the socio-economic and structural inequities that led to disproportionate burdens of the pandemic.

Health inequities

Highest rates of COVID-19 cases and deaths were among racialized people, recent immigrants, lower-wage essential workers and those living in higher density and multigenerational households.

Case rates were highest where high-density living intersected with high-density working conditions, and were amplified by barriers to testing, vaccination and ability to isolate. This trend did not resolve over the successive waves of the pandemic.

Health data that include not only locale, but also racial identity, occupations, household size and income can help unpack social determinants of infection and health outcomes, and can be used to tailor public health programs. However, the collection of such data give rise to responsibilities to reduce inequalities, not just describe them.

Sadly, decisions to collect such data can be politicized. Ontario only collected relevant data after pressure from community activists and Québec resisted similar community pressure to collect race-based data.

Canada’s diversity was also not adequately represented at decision-making or advisory tables, nor was it represented in research that generated evidence for the public health response.

Public health decisions involve health, social and economic tradeoffs that need to be informed not only by standard epidemiological data, but also by social science data. These data can illuminate the social determinants of health, the spread of misinformation and disinformation and political factors, such as the rise in social unrest due to public health measures. Evidence generation needs to be inclusive of diverse voices, specifically from those communities that bore the greatest burden of the pandemic.

Public inquiry and reforms

It is clear that some public trust in public health, science and government has been lost in Canada and around the world. This does not bode well for future threats, such as emerging pandemics, and current threats from the opioid crisis and climate change.


Read more: Let evidence, not opinion, guide harm reduction policy and practice in Canada's drug poisoning crisis


For these reasons, we call for a different kind of inquiry, agreeing that another expert report packed with recommendations will gather dust and not serve to rebuild public trust.

We need political will to call an independent inquiry that is inclusive of a diversity of voices, accountable to communities and with a mandate to implement change. Reforms to data generation, access and use are essential in preparing for the next public health emergency.

Tania Bubela receives funding from the Canadian tri-councils, Genome Canada, Genome British Columbia, Brain Canada, ALS Canada, and other philanthropic and government funders. She sits on the boards of Canadian Science Publishing and The Institute for Health System Transformation and Sustainability. With respect to COVID-19 work: she received funding from Genome Canada to conduct COVID-19 research on return to campus/work practices and served on the BC COVID-19 strategic research advisory committee, the executive governance group for the COVID-19 Clinical Research Coordination Initiative, and the Royal Society of Canada COVID-19 Task Force.

Kimberlyn McGrail receives funding from the Canadian Institutes of Health Research.

Sharmistha Mishra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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There will soon be one million seats on this popular Amtrak route

“More people are taking the train than ever before,” says Amtrak’s Executive Vice President.

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While the size of the United States makes it hard for it to compete with the inter-city train access available in places like Japan and many European countries, Amtrak trains are a very popular transportation option in certain pockets of the country — so much so that the country’s national railway company is expanding its Northeast Corridor by more than one million seats.

Related: This is what it's like to take a 19-hour train from New York to Chicago

Running from Boston all the way south to Washington, D.C., the route is one of the most popular as it passes through the most densely populated part of the country and serves as a commuter train for those who need to go between East Coast cities such as New York and Philadelphia for business.

Veronika Bondarenko captured this photo of New York’s Moynihan Train Hall. 

Veronika Bondarenko

Amtrak launches new routes, promises travelers ‘additional travel options’

Earlier this month, Amtrak announced that it was adding four additional Northeastern routes to its schedule — two more routes between New York’s Penn Station and Union Station in Washington, D.C. on the weekend, a new early-morning weekday route between New York and Philadelphia’s William H. Gray III 30th Street Station and a weekend route between Philadelphia and Boston’s South Station.

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According to Amtrak, these additions will increase Northeast Corridor’s service by 20% on the weekdays and 10% on the weekends for a total of one million additional seats when counted by how many will ride the corridor over the year.

“More people are taking the train than ever before and we’re proud to offer our customers additional travel options when they ride with us on the Northeast Regional,” Amtrak Executive Vice President and Chief Commercial Officer Eliot Hamlisch said in a statement on the new routes. “The Northeast Regional gets you where you want to go comfortably, conveniently and sustainably as you breeze past traffic on I-95 for a more enjoyable travel experience.”

Here are some of the other Amtrak changes you can expect to see

Amtrak also said that, in the 2023 financial year, the Northeast Corridor had nearly 9.2 million riders — 8% more than it had pre-pandemic and a 29% increase from 2022. The higher demand, particularly during both off-peak hours and the time when many business travelers use to get to work, is pushing Amtrak to invest into this corridor in particular.

To reach more customers, Amtrak has also made several changes to both its routes and pricing system. In the fall of 2023, it introduced a type of new “Night Owl Fare” — if traveling during very late or very early hours, one can go between cities like New York and Philadelphia or Philadelphia and Washington. D.C. for $5 to $15.

As travel on the same routes during peak hours can reach as much as $300, this was a deliberate move to reach those who have the flexibility of time and might have otherwise preferred more affordable methods of transportation such as the bus. After seeing strong uptake, Amtrak added this type of fare to more Boston routes.

The largest distances, such as the ones between Boston and New York or New York and Washington, are available at the lowest rate for $20.

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The next pandemic? It’s already here for Earth’s wildlife

Bird flu is decimating species already threatened by climate change and habitat loss.

I am a conservation biologist who studies emerging infectious diseases. When people ask me what I think the next pandemic will be I often say that we are in the midst of one – it’s just afflicting a great many species more than ours.

I am referring to the highly pathogenic strain of avian influenza H5N1 (HPAI H5N1), otherwise known as bird flu, which has killed millions of birds and unknown numbers of mammals, particularly during the past three years.

This is the strain that emerged in domestic geese in China in 1997 and quickly jumped to humans in south-east Asia with a mortality rate of around 40-50%. My research group encountered the virus when it killed a mammal, an endangered Owston’s palm civet, in a captive breeding programme in Cuc Phuong National Park Vietnam in 2005.

How these animals caught bird flu was never confirmed. Their diet is mainly earthworms, so they had not been infected by eating diseased poultry like many captive tigers in the region.

This discovery prompted us to collate all confirmed reports of fatal infection with bird flu to assess just how broad a threat to wildlife this virus might pose.

This is how a newly discovered virus in Chinese poultry came to threaten so much of the world’s biodiversity.

H5N1 originated on a Chinese poultry farm in 1997. ChameleonsEye/Shutterstock

The first signs

Until December 2005, most confirmed infections had been found in a few zoos and rescue centres in Thailand and Cambodia. Our analysis in 2006 showed that nearly half (48%) of all the different groups of birds (known to taxonomists as “orders”) contained a species in which a fatal infection of bird flu had been reported. These 13 orders comprised 84% of all bird species.

We reasoned 20 years ago that the strains of H5N1 circulating were probably highly pathogenic to all bird orders. We also showed that the list of confirmed infected species included those that were globally threatened and that important habitats, such as Vietnam’s Mekong delta, lay close to reported poultry outbreaks.

Mammals known to be susceptible to bird flu during the early 2000s included primates, rodents, pigs and rabbits. Large carnivores such as Bengal tigers and clouded leopards were reported to have been killed, as well as domestic cats.

Our 2006 paper showed the ease with which this virus crossed species barriers and suggested it might one day produce a pandemic-scale threat to global biodiversity.

Unfortunately, our warnings were correct.

A roving sickness

Two decades on, bird flu is killing species from the high Arctic to mainland Antarctica.

In the past couple of years, bird flu has spread rapidly across Europe and infiltrated North and South America, killing millions of poultry and a variety of bird and mammal species. A recent paper found that 26 countries have reported at least 48 mammal species that have died from the virus since 2020, when the latest increase in reported infections started.

Not even the ocean is safe. Since 2020, 13 species of aquatic mammal have succumbed, including American sea lions, porpoises and dolphins, often dying in their thousands in South America. A wide range of scavenging and predatory mammals that live on land are now also confirmed to be susceptible, including mountain lions, lynx, brown, black and polar bears.

The UK alone has lost over 75% of its great skuas and seen a 25% decline in northern gannets. Recent declines in sandwich terns (35%) and common terns (42%) were also largely driven by the virus.

Scientists haven’t managed to completely sequence the virus in all affected species. Research and continuous surveillance could tell us how adaptable it ultimately becomes, and whether it can jump to even more species. We know it can already infect humans – one or more genetic mutations may make it more infectious.

At the crossroads

Between January 1 2003 and December 21 2023, 882 cases of human infection with the H5N1 virus were reported from 23 countries, of which 461 (52%) were fatal.

Of these fatal cases, more than half were in Vietnam, China, Cambodia and Laos. Poultry-to-human infections were first recorded in Cambodia in December 2003. Intermittent cases were reported until 2014, followed by a gap until 2023, yielding 41 deaths from 64 cases. The subtype of H5N1 virus responsible has been detected in poultry in Cambodia since 2014. In the early 2000s, the H5N1 virus circulating had a high human mortality rate, so it is worrying that we are now starting to see people dying after contact with poultry again.

It’s not just H5 subtypes of bird flu that concern humans. The H10N1 virus was originally isolated from wild birds in South Korea, but has also been reported in samples from China and Mongolia.

Recent research found that these particular virus subtypes may be able to jump to humans after they were found to be pathogenic in laboratory mice and ferrets. The first person who was confirmed to be infected with H10N5 died in China on January 27 2024, but this patient was also suffering from seasonal flu (H3N2). They had been exposed to live poultry which also tested positive for H10N5.

Species already threatened with extinction are among those which have died due to bird flu in the past three years. The first deaths from the virus in mainland Antarctica have just been confirmed in skuas, highlighting a looming threat to penguin colonies whose eggs and chicks skuas prey on. Humboldt penguins have already been killed by the virus in Chile.

A colony of king penguins.
Remote penguin colonies are already threatened by climate change. AndreAnita/Shutterstock

How can we stem this tsunami of H5N1 and other avian influenzas? Completely overhaul poultry production on a global scale. Make farms self-sufficient in rearing eggs and chicks instead of exporting them internationally. The trend towards megafarms containing over a million birds must be stopped in its tracks.

To prevent the worst outcomes for this virus, we must revisit its primary source: the incubator of intensive poultry farms.

Diana Bell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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This is the biggest money mistake you’re making during travel

A retail expert talks of some common money mistakes travelers make on their trips.

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Travel is expensive. Despite the explosion of travel demand in the two years since the world opened up from the pandemic, survey after survey shows that financial reasons are the biggest factor keeping some from taking their desired trips.

Airfare, accommodation as well as food and entertainment during the trip have all outpaced inflation over the last four years.

Related: This is why we're still spending an insane amount of money on travel

But while there are multiple tricks and “travel hacks” for finding cheaper plane tickets and accommodation, the biggest financial mistake that leads to blown travel budgets is much smaller and more insidious.

A traveler watches a plane takeoff at an airport gate.

Jeshoots on Unsplash

This is what you should (and shouldn’t) spend your money on while abroad

“When it comes to traveling, it's hard to resist buying items so you can have a piece of that memory at home,” Kristen Gall, a retail expert who heads the financial planning section at points-back platform Rakuten, told Travel + Leisure in an interview. “However, it's important to remember that you don't need every souvenir that catches your eye.”

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According to Gall, souvenirs not only have a tendency to add up in price but also weight which can in turn require one to pay for extra weight or even another suitcase at the airport — over the last two months, airlines like Delta  (DAL) , American Airlines  (AAL)  and JetBlue Airways  (JBLU)  have all followed each other in increasing baggage prices to in some cases as much as $60 for a first bag and $100 for a second one.

While such extras may not seem like a lot compared to the thousands one might have spent on the hotel and ticket, they all have what is sometimes known as a “coffee” or “takeout effect” in which small expenses can lead one to overspend by a large amount.

‘Save up for one special thing rather than a bunch of trinkets…’

“When traveling abroad, I recommend only purchasing items that you can't get back at home, or that are small enough to not impact your luggage weight,” Gall said. “If you’re set on bringing home a souvenir, save up for one special thing, rather than wasting your money on a bunch of trinkets you may not think twice about once you return home.”

Along with the immediate costs, there is also the risk of purchasing things that go to waste when returning home from an international vacation. Alcohol is subject to airlines’ liquid rules while certain types of foods, particularly meat and other animal products, can be confiscated by customs. 

While one incident of losing an expensive bottle of liquor or cheese brought back from a country like France will often make travelers forever careful, those who travel internationally less frequently will often be unaware of specific rules and be forced to part with something they spent money on at the airport.

“It's important to keep in mind that you're going to have to travel back with everything you purchased,” Gall continued. “[…] Be careful when buying food or wine, as it may not make it through customs. Foods like chocolate are typically fine, but items like meat and produce are likely prohibited to come back into the country.

Related: Veteran fund manager picks favorite stocks for 2024

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