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Pilot programs reveal benefits and limitations of COVID-19 rapid testing

On a recent weekday afternoon, a fishing vessel called the Arctic Endurance prepared to depart from Mulgrave, N.S., for a month-long clam harvesting trip. Blustery winds blew snow across the ship as it left the dock, but at least on the pandemic front, the coast was clear.

All 35 crew members had undergone testing for COVID-19 within the previous 24 hours, and all their results were negative.

Their employer, Clearwater Seafoods, organized the tests. The company bought its highly accurate polymerase chain reaction (PCR) testing kits from Precision Biomonitoring last fall, putting it among the early corporate adopters of mobile COVID-19 testing technology in Canada. The tests are like those used in health care settings, but results come back in just a couple of hours.

Tony Jabbour, vice-president of Fleet Operations, admits it was a gamble.

“We’re harvesters, we’re not lab technicians or medical professionals. And so getting a fairly complicated system purchase set up was a fairly big undertaking for us,” he said.

Onboard challenges related to physical distancing had compelled the company to put in place added COVID-19 precautions for its crews. Clearwater hasn’t seen any outbreaks to date, but Jabbour said asymptomatic transmission onboard a vessel would be “catastrophic,” both on the business side and for employees.

“Throughout this, I think we’ve been really cognizant of the fact that people are leaving home to go to sea,” he said. “And making sure we take that extra level of precaution was certainly comforting.”

All the crew members aboard Clearwater Seafoods’ fishing vessel Arctic Endurance were screened for COVID-19 using PCR testing before the ship recently put out to sea for a month-long voyage. (Steve Lawrence/CBC)

It’s a notion that has enticed numerous Canadian businesses and institutions to begin pilot programs of their own for onsite COVID-19 testing. As Canadians await full access to vaccines and essential workplaces continue to guard against outbreaks, the appeal of screening asymptomatic front-line staff is growing, driven partly by wider availability of the technology in Canada.

At a busy Shoppers Drug Mart pharmacy in Mississauga, employees without COVID-19 symptoms can get tested twice a week for the virus. Though many pharmacies are already equipped to offer PCR testing to members of the public who meet certain criteria, this new employee-focused pilot uses rapid antigen tests. These are not currently as accurate as PCR, but require a less invasive nasal swab and deliver results much faster.

“Results are being given to me within 15 minutes, so you can’t really beat that,” said Sabina Kapoor, a pharmacist at the store who is participating in the trial program.

With a front-line job and two children at home, Kapoor said she didn’t hesitate when the store offered her regular screening for COVID-19 using rapid tests.

“It brings some sort of security and comfort, I think, when we go home to our families after a shift or working the full week. So, I think everyone was pretty much on board for it,” she said.

Pharmacist Sabina Kapoor is participating in a COVID-19 rapid-testing pilot program at her Shopper’s Drug Mart store in Mississauga. (Jared Thomas/CBC)

Parent company Loblaw is currently offering rapid tests to employees at 20 of its pharmacy and retail locations in Ontario and Alberta. As part of the pilot, staff at the company’s Medisystem service, which provides pharmaceutical services to seniors residences and care homes, can also stop by participating stores to get tested.

If the program is deemed successful, Loblaw said it plans to offer the rapid-testing service to other small and medium-sized businesses and their employees — in a sense, outsourcing workplace COVID-19 testing.

According to Ashesh Desai, the executive vice-president of Pharmacy and Healthcare at Shoppers Drug Mart, employees of participating workplaces could get tested at their local Loblaw pharmacy in the near future.

“So, if I’m grocery shopping [on] Sunday afternoon, maybe there’s an opportunity for me to book a screen at that time,” he said.

Desai added that the test results would go to the employer, and as is currently done for those participating in the pilot, anyone with a positive antigen test result would have to seek out a regular PCR test at a hospital or test centre for confirmation.

Rapid antigen testing cannot be used ‘to rule out infection’

A negative test “does not mean you can let down your guard,” said Desai. He added that Loblaw is working on messaging to convey that masks and social distancing are still “extremely important,” even when a workplace is regularly using rapid tests.

University of Alberta infectious disease specialist Dr. Lynora Saxinger cautions that rapid antigen testing cannot be used “to rule out infection.”

While research on the reliability of rapid tests is growing, the current understanding is that people can rely on a positive test result, but not on a negative one, she added, “which kind of goes against human nature a little bit.”

“It’s just an extra step,” said Antonella Picillo, director of student services at Le Pensionnat du Saint-Nom-de-Marie in Montreal, which is trying out the use of daily rapid testing on the school’s asymptomatic students and teachers.

The private school has a now-familiar myriad of COVID-19 precautions in place, from mandatory masks, to class bubbles, to ventilation upgrades. Rapid test screening is, “just one more way to make sure we have a handle on the situation,” Picillo said.

Le Pensionnat du Saint-Nom-de-Marie in Montreal is pilot-testing daily rapid tests for the school’s students and teachers. (CBC)

The idea was proposed by Dr. Caroline Quach, a pediatric infectious diseases consultant at Montreal’s Sainte-Justine Hospital, as well as a parent at the school.

“I think that in a classroom, when you have a [coronavirus] case and you screen the students around them, you might be able to find secondary transmission right away,” Dr. Quach said.

The goal of the pilot program is to research how well random, daily rapid testing can do that in a school setting. But the limitations of widespread rapid testing are also becoming clearer.

“I’m not convinced that using these rapid tests on a larger scale to screen everybody walking into the school without symptoms is actually a good use of resources,” Dr. Quach said.

One of the main reasons, she explains, is that administering and processing those tests is labour intensive.

It’s one of the reasons there has been less widespread adoption of testing so far across the country. According to the Public Health Agency of Canada, the federal government has delivered nearly 17 million rapid tests to the provinces, but only a fraction of them are in use.

With resources across public health systems already strained, Dr. Saxinger said, “there’s limited bandwidth to expand things” when it comes to rapid testing.

“A lot of places have been doing relatively limited pilot testing of these, but haven’t yet had the capacity to roll them out more broadly,” she said.

It’s an issue the Province of Manitoba has been trying to tackle as it offers rapid testing for educators in the province. Teachers are getting access to rapid testing if they display COVID-19 symptoms, with the idea being they’ll get a potential positive result back faster.

Curtis Aab, acting chair of the life sciences department at Red River College, said proper handling and processing of testing samples is crucial. (Jaison Empson/CBC)

The province has partnered with Red River College to design a micro-credential program to train more people in the skills required to properly process rapid tests, such as transferring liquids using a pipet tube.

“When you’re doing the COVID-19 testing, it’s really important that that pipetting is done accurately and precisely to produce reliable, trusted results,” said Curtis Aab, acting chair of the life sciences department at Red River College.

However, despite the issues around accuracy and administering rapid tests, Dr. Saxinger said targeted use in controlled settings, such as schools and places where people work face-to-face, makes sense.

“I think there’s a possibility that these can add a layer of safety when they’re applied in a structured way to the right places,” she said.

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B.C.’s health authority spent millions on useless face masks, executive meals and renovations, insiders reveal

British Columbia’s health minister has ordered an immediate review of alleged misspending by the Provincial Health Services Authority (PHSA) during the COVID-19 crisis.

The order comes after CBC News brought forward concerns raised by multiple sources with intimate knowledge of operations within the PHSA, which is charged with ensuring access to a provincial network of health-care services.

The whistleblowers accuse B.C.’s central health authority of squandering $ 7 million on the purchase of unusable face masks from China; hundreds of thousands of dollars on unnecessary renovations to its executive offices; and tens of thousands of dollars on high-end catered meals for executives and their staff.

Insiders say the costs were racked up despite Ministry of Health orders to end discretionary spending and direct every dollar to front-line workers fighting the pandemic.

“I was shocked and felt it was simply unconscionable,” said one source.

CBC News has agreed to protect the informants’ identities because they fear professional repercussions.

“As a taxpayer, it makes me sick. It’s wasteful,” said a second insider.

Health Minister Adrian Dix moved quickly after being shown their concerns.

“I appreciate these allegations being raised to me,” Dix said in a statement to CBC News. “I have directed the deputy minister of health to assess PHSA’s decisions and conduct … and provide advice and recommendations to me.” 

New president, new spending

The whistleblowers claim the misspending started shortly after Feb. 3, when the PHSA board hired a new president and CEO from Montreal, Benoit Morin.

Morin is paid $ 352,000 a year, and his accommodation and a car are provided — part of his relocation package.

Benoit Morin, president and CEO of the PHSA, earns $ 352,000 a year, and his accommodation and a car are provided, part of his relocation package from Montreal. (Sarah Leavitt/CBC)

Both the PHSA and Morin declined to be interviewed, stating the minister has responded on their behalf.

Dix’s written announcement of a review includes the health authority’s submitted response to him — confirming some allegations while denying others.

The health minister indicated the PHSA’s answers will be scrutinized.

$ 7M worth of masks deemed unusable

The most costly mistake by the PHSA was the purchase of unusable face masks in the early days of the COVID-19 pandemic.

The health authority, in its response to Dix, confirms that Morin personally sought a supplier in his home province of Quebec “early in the pandemic.”

Of $ 11.5 million paid to the supplier, almost $ 7 million worth of masks brought in from China were deemed “problematic” and unusable in the health sector.

Sources said many were KN95 masks (Chinese standard) instead of N95 (North American standard) and failed fit tests, while other masks were deemed to be counterfeit.

A photo distributed by the U.S. Centers for Disease Control shows an example of a counterfeit mask that was sold around the world. Similar masks were purchased by the PHSA. (Centers for Disease Control)

The PHSA admits it eventually wrote off $ 6.7 million of the cost at the end of March but said nothing of potential additional losses carried into this fiscal year.

Insiders said the mistake was kept from the public.

By comparison, the federal government admitted it had purchased unusable face masks through a Montreal supplier back in May. It publicly vowed it would not pay for the shipments.

It’s not known if B.C. used the same Montreal-based middleman.

The PHSA said it decided not to pursue court action against the supplier because “the cost … would have outweighed any potential return.”

The health authority said that since the face mask fiasco, the Ministry of Health has toughened ordering procedures, “ensuring due diligence is undertaken before a final purchase is made.”

Redone renos to executive offices

Sources also criticize renovations that were torn up to accommodate more renos.

After more than $ 17 million had already been spent on renovations to the health authority’s new Vancouver headquarters at 1333 West Broadway, the PHSA admits that changes were ordered to the 14th floor.

PHSA insiders allege Morin wanted his office moved to the northwest corner of the building to give him this view from the 14th floor, shown earlier this month. But the PHSA disputes this and says the new office is ‘smaller and incorporates a previously existing meeting room, enabling more privacy.’ (Eric Rankin/CBC)

It says the total cost of the “re-renovations,” which are ongoing, is almost $ 400,000, including nearly $ 60,000 on “technology upgrades.”

Whistleblowers allege that the changes were made to give Morin a better view of downtown Vancouver and the North Shore mountains.

But the PHSA “refutes that the CEO’s office was moved to improve the view. The new CEO office is smaller and incorporates a previously existing meeting room, enabling more privacy.”

It also says the renovations created additional office space, Zoom-enabled facilities and a reception area to “improve security on the floor.”

Critics say that’s spin — and whatever the reasons, the money could have been much better spent.

“At the height of a pandemic, spending $ 400,000 on a re-reno versus putting that money toward … MRI or CT scanners or ventilators, it’s just inexcusable,” one whistleblower said.

The PHSA said the money came out of its internal capital budget.

Construction material sits stacked outside the executive offices of the PHSA. (Eric Rankin/CBC)

Catered avocado toast and steak nicoise salads

Insiders also take issue with catered meals provided at PHSA headquarters, well past the onset of the COVID-19 pandemic.

Staff say they observed breakfast and lunch being brought in for a total of 18 executives and their assistants virtually every workday until about May. This was reduced to just lunches that continued into June, even after local restaurants reopened.

The PHSA confirmed the numbers and dates.

Breakfasts reportedly included avocado toast with lemon ricotta berry crêpes. Lunches featured steak and salmon nicoise salads and sparkling water.

The Provincial Health Services Authority occupies most of the floors at 1333 West Broadway in Vancouver. Staff say they observed breakfast and lunch being brought in for a total of 18 executives and their assistants virtually every workday until about May. (Eric Rankin/CBC)

Sources estimate the total cost to taxpayers was between $ 30,000 and $ 40,000. At the same time, many front-line health-care workers were putting in 12-hour days, often without adequate meal breaks.

“What bothered me the most was seeing the people paid the least suffering the most,” one source said. “And the people paid the most got the most.”

The PHSA insists its executives were working around the clock, holding meetings at all hours, and were trying to keep “their bubbles small.”

Insiders insist that only happened in the early weeks of the pandemic.

Dix, B.C.’s health minister, said one aspect of his review will be to “assess the policies, guidance and spending directives … [for] catered meals.” 

‘Cost-effective’ goals at odds with alleged spending

With a $ 3.7 billion annual budget, the PHSA co-ordinates services with B.C.’s regional health authorities, sets provincewide health standards and runs the B.C. Ambulance Service, among other responsibilities.

Its website states that it’s “driven to … be cost-effective.”

But insiders said key senior executives who once oversaw spending at the health authority no longer have their jobs.

After allegations about misspending at the health authority were brought forward to B.C. Health Minister Adrian Dix, shown in May, he directed his deputy minister ‘to assess PHSA’s decisions and conduct … and provide advice and recommendations to me.’ (Mike McArthur/CBC)

They include the chief internal auditor, the chief financial officer and the executive vice-president of commercial services and procurement.

In addition, the PHSA’s veteran chief operating officer has revealed he’s retiring.

Sources say all four executives had raised concerns about spending prior to their departures being announced.

“No one will speak up internally anymore,” one insider said. “We’ve all seen what’s happened to some of our most respected leaders who’ve already tried.”

The health authority says its board hired a new CEO to lead organizational change — and the resulting changes to the senior leadership team were supported by the PHSA board.

Whistleblowers want more extensive probe

While the whistleblowers who spoke to CBC News welcome the review of spending ordered by B.C’s health minister, they want a deeper investigation.

“The ministry needs to investigate how something like this could have happened and why a number of warning signals were missed or ignored,” one source said.

Yet another insider wants B.C.’s auditor general to look into the spending decisions.

“These are public funds, and our health-care providers and their patients should be a priority — especially during a pandemic,” the insider said. “This is irresponsible … and it needs to stop.”

As for the PHSA’s justifications provided to the health minister, one whistleblower doesn’t mince words: “I think B.C. taxpayers are smart enough to see through all that — they can tell when someone is trying to put lipstick on a pig.”

CBC Vancouver’s Impact Team investigates and reports on stories that impact people in their local community and strives to hold individuals, institutions and organizations to account. If you have a story for us, email impact@cbc.ca.

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Secret recordings reveal political directives, tension over Alberta’s pandemic response

On the morning of June 4, a team of Alberta civil servants gathered — as it had nearly every day since the COVID-19 pandemic began — to co-ordinate the province’s response to the crisis.

A few minutes into the meeting in a boardroom in downtown Edmonton, Chief Medical Officer of Health Dr. Deena Hinshaw weighed in.

The cabinet committee, to which she and the group reported, was pressuring her to broadly expand serology testing, which is used to detect the presence of COVID-19 antibodies in the blood.

The problem was that the tests had limited large-scale clinical value and Hinshaw believed it would overestimate the virus’s presence in the population. 

“Honestly, after the battle that we had about molecular testing, I don’t have a lot of fight left in me,” Hinshaw said during that meeting. The province had introduced rapid molecular testing kits at the start of the pandemic to help testing in rural and remote communities. The recordings reveal some tensions about that decision. 

“I think we need to draw on our experience from the molecular testing battle that we ultimately lost, after a bloody and excruciating campaign, and think about, how do we limit the worst possible implications of this without wearing ourselves down?,” Hinshaw said. 

A few weeks later, Health Minister Tyler Shandro and Hinshaw announced the province would pour $ 10 million into targeted serology testing, the first in Canada to do so.

The level of political direction — and, at times, interference — in Alberta’s pandemic response is revealed in 20 audio recordings of the daily planning meetings of the Emergency Operations Centre (EOC) obtained by CBC News, as well as in meeting minutes and interviews with staff directly involved in pandemic planning.

Taken together, they reveal how Premier Jason Kenney, Shandro and other cabinet ministers often micromanaged the actions of already overwhelmed civil servants; sometimes overruled their expert advice; and pushed an early relaunch strategy that seemed more focused on the economy and avoiding the appearance of curtailing Albertans’ freedoms than enforcing compliance to safeguard public health.

“What is there suggests to me that the pandemic response is in tatters,” said Ubaka Ogbogu, an associate law professor at the University of Alberta who specializes in public health law and policy. 

Premier Jason Kenney declared a second state of public health emergency on Tuesday. (Jason Franson/The Canadian Press)

“The story tells me that the chief medical officer of health doesn’t have control of the pandemic response [and] tells me that decisions are being made by persons who shouldn’t be making decisions,” said Ogbogu, who was given access by CBC News to transcripts of specific incidents from the recordings.

“It tells me that the atmosphere in which decisions are being made is combative, it is not collaborative and that they are not working towards a common goal — they are working at cross-purposes.” 

Ogbogu has been a staunch critic of the UCP government. In July, he publicly resigned from the Health Quality Council of Alberta, citing the potential for political interference in its work due to amendments to the Health Statutes Amendment Act.

Shandro did not respond to an interview request.

In a brief emailed statement that did not address specific issues raised by CBC News, a spokesperson for Kenney said it is the job of elected officials to make these sorts of decisions and he said there was no political interference.

Hinshaw also did not respond to an interview request.

But at the daily pandemic briefing Wednesday, as the province announced its 500th death, Hinshaw reiterated her belief that her job is to provide “a range of policy options to government officials outlining what I believe is the recommended approach and the strengths and weaknesses of any alternatives. 

 “The final decisions are made by the cabinet,” she said, adding that she has “always felt respected and listened to and that my recommendations have been respectfully considered by policy makers while making their decisions.”

Secret recordings reveal tension

The recordings provide a rare window into the relationship between the non-partisan civil servants working for the Emergency Operation Centre and political officials.

The EOC team, comprised of civil servants from Alberta Health and some seconded from other ministries, has been responsible for planning logistics and producing guidelines and recommendations for every aspect of Alberta’s pandemic response. 

The recordings also provide context for the recent public debate about the extent of Hinshaw’s authority to act independent of government. 

Even if Hinshaw had the authority to make unilateral decisions, the recordings confirm what she has repeatedly stated publicly: she believes her role is to advise, provide recommendations and implement decisions made by the politicians.

At the group’s meeting on June 8, the day before Kenney publicly announced Alberta’s move to Stage 2 of its economic relaunch plan, Hinshaw relayed the direction she was receiving from the Emergency Management Cabinet Committee (EMCC). That committee included Kenney, Shandro and nine other cabinet ministers.

“What the EMCC has been moving towards, I feel, is to say, ‘We need to be leading Albertans where they want to go, not forcing them where they don’t want to go,'” Hinshaw told the group.

The recordings confirm what Hinshaw has repeatedly stated publicly: she believes her role is to advise, provide recommendations and implement decisions made by the politicians. (Jason Franson/The Canadian Press)

Hinshaw said she didn’t know if the approach would work, but they were being asked to move away from punitive measures to simply telling people how to stay safe.

More of a “permissive model?” someone asked. Hinshaw agreed.

“I feel like we are starting to lose social licence for the restrictive model, and I think we are being asked to then move into the permissive model,” she said. “And worst-case scenario, we will need to come back and [be] restrictive.”

Soaring COVID-19 rates in Alberta

As a second wave of COVID-19 pummels the province, an increasing number of public-health experts say Alberta long ago reached that worst-case scenario.

The province has passed the grim milestone of more than 1,500 new cases reported in a day. To date, 500 people have died. Intensive care units across Alberta are overwhelmed, with COVID-19 patients spilling into other units as beds grow scarce.

On Tuesday, after weeks of pleading from doctors, academics and members of the public for a province-wide lockdown, Kenney declared another state of public health emergency. 

However, he pointedly refused to impose a lockdown, saying his government wouldn’t bow to “ideological pressure” that he said would cripple the economy. Instead, he announced targeted restrictions, including a ban on indoor social gatherings. 

WATCH | Premier Jason Kenney announces new pandemic restrictions:

Alberta Premier Jason Kenney bypassed a renewed lockdown as part of new COVID-19 restrictions, despite having more COVID-19 cases per capita than Ontario. Restaurants and retail can stay open with reduced capacity, though indoor private gatherings are banned and the school year has been altered again. 2:36

Kenney repeated many of the comments he made on Nov. 6.

Even as Alberta’s case count grew so high that the province could not sustain its contact tracing system, Kenney rejected calls for more stringent measures and downplayed the deaths related to COVID-19.

“What you describe as a lockdown, first of all, constitutes a massive invasion of the exercise of people’s fundamental rights and a massive impact on not only their personal liberties but their ability to put food on the table to sustain themselves financially,” Kenney said.

Kenney said it was projected, back in April, that COVID-19 would be the 11th-most common cause of death in the province. 

“And so currently, this represents a tiny proportion of the deaths in our province.”

High evidence threshold for restrictions

A source with direct knowledge of the daily planning meetings said the premier wants evidence-based thresholds for mandatory restrictions that are effectively impossible to meet, especially in an ever-changing pandemic.

As of Wednesday, no thresholds have been designated publicly. 

The source said Kenney’s attitude was that he wasn’t going to close down anything that affected the economy unless he was provided with specific evidence about how it would curtail the spread of COVID-19. 

“This is like nothing we have ever seen before. So [it is] very, very difficult to get specific evidence to implement specific restrictions,” said the source who, like the others interviewed by CBC News, spoke on condition of confidentiality for fear of losing their job.

Another planning meeting source said “there is kind of an understanding that we put our best public health advice forward and that Kenney is really more concerned about the economy and he doesn’t want it shut down again.”

The recordings suggest a desire by Health Minister Tyler Shandro to exert control over enforcement of public health orders. (CBC)

CBC News also interviewed a source close to Hinshaw who said she has indicated that, eight months into the pandemic, politicians are still often demanding a level of evidence that is effectively impossible to provide before they will act on restrictive recommendations.

The source said Hinshaw suggested politicians “have tended to basically go with the minimal acceptable recommendation from public health, because I actually think if they went below — if they pushed too far — that she probably would step down.” 

Ogbogu said it is clear politicians, who are not experts in pandemic response, are not focusing on what matters most to public health.

“The focus needs to be on the disease, on how you stop it,” he said. “Not the economy. Nothing is more important.”

‘I may have gotten in trouble with the minister’s office’: Hinshaw

The government has often used Hinshaw as a shield to deflect criticism of its pandemic strategy, suggesting she is directing the response. The government has at times appeared to recast any criticism of the strategy as a personal attack on her.

At her public COVID-19 updates, Hinshaw has refused to stray from government talking points or offer anything more than a hint of where her opinions may diverge.

Behind the scenes, however, there were clearly times when Hinshaw disagreed with the political direction — although it was also evident the politicians had the final say.

In April, for instance, the government introduced asymptomatic testing in some parts of the province, and later expanded it. 

Hinshaw told a May 22 meeting she had unintentionally started a conversation with Kenney in which she expressed concern about the value of large-scale asymptomatic testing as opposed to strategic testing.  

Kenney in turn asked for a slide presentation that would detail the pros and cons of each approach. 

“I didn’t intend to have that conversation, so I may have gotten in trouble with the [health] minister’s office today about that,” Hinshaw said at that meeting.

The presentation, she said, would include “how expensive it is to test people when we don’t actually get a lot of value, to go forward with a testing strategy that we can stand behind. So we will see if the minister’s office will allow us to put that [presentation] forward,” Hinshaw said. 

The premier, she said, had asked for the presentation for June 2.

But she cautioned the team, “Not to get all of our hopes up or anything.”

A week later, Hinshaw publicly announced the province had opened up asymptomatic testing to any Albertan who wanted it. At a news conference, she said that given the impending Stage 2 relaunch, it was an “opportune time” to expand testing.

‘They don’t want us to enforce anything’

The recordings suggest a desire by Health Minister Shandro to exert control over enforcement of public health orders.

Alberta Health Services (AHS), the province’s health authority, is responsible for enforcing public health orders. It is supposed to operate at arm’s length from government.

On June 9, the same day Kenney announced the Stage 2 economic relaunch, Hinshaw told the EOC meeting Shandro’s office wanted to be informed how AHS would consult with “us” before taking any action on COVID-19 public orders.

Alberta Health lawyers, working with the EOC, were responsible for writing the Stage 2 relaunch order that would outline restrictions on businesses and the public.

Hinshaw said she needed to verify with Shandro’s office, but she thought “they don’t want us to enforce anything. [They] just want us to educate, and no enforcement.”

But the group’s chief legal advisor was adamant.

“Under no circumstance will AHS check with the political minister’s office before undertaking an enforcement action under the Public Health Act,” he said

Hinshaw said Shandro’s office wanted AHS to check with her first, so she could report back to his office. 

The legal advisor challenged that, saying AHS was supposed to check with Hinshaw and a colleague “with respect to prosecutions, not enforcement generally.

“So what is going on?” he asked.

Shandro’s office was “mad that AHS has enforced things like no shaving in barber shops,” Hinshaw responded. 

Hinshaw said all local medical officers of health and environmental health officers were already expected to tell her and the team about any impending orders or prosecutions. 

But a week later, a senior health official told the meeting AHS was “struggling about what they should be doing” regarding enforcement. 

The official said AHS had been told: “Don’t turn a blind eye but don’t issue any orders.

“And then come to us, and if push comes to shove, I think it will be up to the ministry to figure out if we are going to do something.”

Ubaka Ogbogu, an associate law professor at the University of Alberta who specializes in public health law and policy, said ‘the atmosphere in which [COVID-19] decisions are being made is combative, it is not collaborative and [politicians and health officials] are not working towards a common goal.’  (CBC)

In mid-September, CBC News reported that AHS had received more than 29,000 complaints about COVID-19 public health order violations since the beginning of April.

A total of 62 enforcement orders, including closure orders, were issued in that period. As recently as last week, AHS has said that “every effort” is made to work with the public before issuing an enforcement order. 

‘Uphill battle’

In private conversations as recently as this month, Hinshaw has characterized her interactions with Kenney and cabinet as difficult, said a source close to her.

“I would say that she has used the phrase ‘uphill battle,'” they said.

The source said Hinshaw has been understanding of the reasons for the difficulty, “which I think we both see as being rooted in a completely different weighting of the risks of the disease and the risks of, for example, public-health restrictions.”

Hinshaw, however, “did allude to some of the meetings as being very distressing.”

But the source said Hinshaw worries about what could happen if she leaves her role.

“She sees her position, optimally, as trying to do the best she can from inside. And that if she wasn’t there, there would be a risk that things would be worse in terms of who else might end up taking that position and what their viewpoint was on the best direction.”

Ogbogu, the health law expert, said that while Hinshaw may be well-meaning, her willingness to allow politicians to subvert her authority is ultimately undermining the fight against COVID-19.

If the government is not following scientific advice, if it is not interested in measures that will effectively control a pandemic that is killing Albertans, then Hinshaw “owes us the responsibility of coming out and saying, ‘They are not letting me do my job,'” Ogbogu said.

“And if that comes at a risk of her job, that is the nature of public service.”

At the planning meeting on June 4, a civil servant told the team there was concern the province wasn’t giving businesses much time to adjust to shifting COVID-19 guidance. 

“I’ve been advocating everywhere I can to move it up, and they moved it back,” Hinshaw replied.

“So you can see I have a lot of influence,” she said sarcastically. “But I will keep trying.”

If you have information about this story, or for another story, please contact us in confidence at cbcinvestigates@cbc.ca.

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PS5 Temperature Measurements Reveal Potential Trouble Spot

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There’s some evidence that the PlayStation 5 may get very hot in one specific place while gaming, and while this seems to be causing no problems at the moment, gamers who live in hot climates and/or lack air conditioning should pay attention.

According to the PS5 device teardown at Gamers Nexus, most of the device temperatures are excellent in all cases, though temperatures drop moderately if you remove both plates from the device. This is scarcely surprising, as even well-ventilated PCs will typically also show slightly improved temperatures if you run them case-open. None of the temperatures GamersNexus recorded at any point on the PS5 raised any eyebrows, with one noteworthy exception:

The RAM temperature at the bottom of the machine is positively scorching, and this only improves modestly with the panels removed. The problem here is that the bottom module isn’t in contact with the PS5 heatsink. This explains the thermal differential between the bottom VRAM and the rest of the system.

Is This a Problem?

Unknown. Maximum operating temperature of the relevant GDDR6 module, according to Micron, is 105C. At the very least, we’d say that the PlayStation 5 is walking perilously close to the maximum safe operating temperature. Companies also do not necessarily guarantee that a product run at or near maximum safe operating temperature year after year will have exactly the same lifespan as products that are not run at these temperatures. High, sustained operating temperatures are harder on all electronic devices, not just the PlayStation 5. This is one of the reasons that PC gamers tend to pay a lot of attention to temperatures — dust build-up is a not-uncommon cause of gaming PC instability, especially if there are no signs of hardware failure or driver conflict.

The ambient temperature of GamerNexus’ test room was 21.9 – 23.2 Celsius. At 30C (about 86F) you’d be as close to the operational limit of Micron’s GDDR6 as you ever really want to get without specific assurances that a given chip is intended to operate for long periods of time at the temperature in question.

It’s worth being aware of this if you are forced to set your PlayStation 5 in an area with poor ventilation or higher-than-ambient temperatures, possibly due to sharing the space with other electronics. Any device will destabilize if it exceeds its safe operating temperature, and the bottom RAM chip on the PS5 is close enough to its safe operating range that it’s conceivable for room configuration to create a problem, particularly once we start considering the long-term impact of dust.

I don’t want to make it sound like PlayStation 5’s are going to start dying. But I have no idea if Sony was aware of this and found no problems with the configuration, or if the company made a mistake. It’s the kind of problem that might be correctable (or at least ameliorated) with a very small heatsink mounted to the VRAM chip itself, but I do not know if that kind of aftermarket modification will even be possible given the construction of the system chassis and its internal clearances. It seems odd for Sony to bother cooling one RAM module and not the other, but the company may have found that both ICs were actually running at safe tolerances and only cooled one of them because there was no practical way not to, given where it was placed relative to the other PS5 components.

I can tell you that I would not be happy to discover that my PC’s RAM or components ran this close to their manufacturer-defined safe temperatures, but not whether this represents a material flaw that will impact the longevity of the console.

Hat tip to NoteBookCheck for surfacing this.

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Ripples Reveal Ancient Global Megafloods on Mars

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Mars is a mostly dry, dusty planet these days, but the more we study it, the more we learn about its watery past. Very watery, it would seem. New findings from the Curiosity rover point to megafloods in the planet’s past. NASA couldn’t see the evidence of this event from space, but Curiosity was able to make the determination by scanning Martian geology from the surface. 

Curiosity has been on Mars since 2012, using an array of instruments to photograph, sample, and analyze little bits of Mars. The team from Jackson State University, Cornell, NASA’s Jet Propulsion Laboratory (JPL), and the University of Hawaii used data from the Mars Hand Lens Image (MALI) and Mastcam cameras to detect features in Gale Crater called megaripples. These features are identical to features formed by melting ice on Earth about 2 million years ago. 

According to the new study, megaripples are large geological formations consisting of sediment deposited in wave-like ripples. A catastrophic flash flood is the only event scientists know of which can produce such features. The team believes that at some point after Gale Crater formed, an even larger object impacted Mars. This hypothetical impact released enough heat to melt ice deposits on the planet, along with releasing huge volumes of carbon monoxide and methane. 

For a time following this impact 4 billion years ago, Mars would have been a warm, watery world again. Rain would have fallen across the globe, causing floodwaters to wash over places like Gale Crater. The torrential downpour washed sentiment off of Mount Sharp and into the floor of Gale Crater, and that’s how we end up with the 30-foot megaripples spotted by the Curiosity team. 

A false-color image of Mount Sharp inside Gale crater on Mars shows geologists a changing planetary environment.

Scientists believe that liquid water is essential for life as we understand it. Understanding when and where water existed on Mars could help guide the hunt for evidence of alien life. Curiosity can help point us in that direction, but it’s ill-equipped to search for the evidence itself. 

That’s where the new Perseverance rover comes in. The rover, which is based on the wildly successful Curiosity, is already en route to Mars following its summer 2020 launch. When it reaches Mars in February, the rover will use instruments like the Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC) and ChemCam to hunt for evidence of past or present life on Mars.

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Health officials reveal new projections as Ontario sees 934 more COVID-19 cases

New provincial projections for COVID-19 spread released Thursday show that virus growth in Ontario is slowing and the province is seeing a “more gentle curve” than it was initially preparing for, public health officials say. 

Dr. Adalsteinn Brown, who is advising the province on its pandemic response, presented the projections at a news conference Thursday.

Brown said the province is now estimating a steady level of cases between 800 to 1,200 per day.

“Most indicators are showing a slowing growth … but cases are continuing to climb,” he said.

“We are seeing continued growth in cases. We are not going on a decline right now, but we’re not going on as steep of a curve,” echoed Dr. Dirk Huyer, Ontario’s chief coroner.

That in no way means Ontario is out of the woods, Brown added.

“This disease … can dramatically turn, and you can have rapid, rapid growth, quite quickly,” he said.

The projections come as Ontario reported another 934 cases of COVID-19 on Thursday, pushing the seven-day average of new daily cases to nearly 900.

The new cases include 420 found in Toronto, the most on a single day in the city. However, Medical Officer of Health Dr. David Williams said Thursday there was an “extra entry of data” that had been missed included in that number, and the real number was actually somewhere in the mid-300s.

The previous record in Toronto was 330 infections recorded on Sept. 29.

Additionally, 169 were confirmed in Peel Region, 95 in York Region and 58 in Ottawa.

Several other areas also saw double-digit increase:

  • Halton Region: 35
  • Hamilton: 28
  • Durham Region: 19
  • Niagara: 16
  • Simcoe Muskoka: 15
  • Waterloo Region: 13
  • Eastern Ontario: 13

The seven-day average of new daily cases, a measure that helps limit noise in the data to provide a clearer picture of long-term trends, is now about 899, also a new record high since the first case was reported in Ontario in January. 

The province’s new projections show significant differences in percent positivity in different regions of the province. Peel, for example, stands at 6.5 per cent, with Toronto at 4.8 per cent, York at 4.5 per cent and Ottawa at 3.1 per cent. The provincial benchmark for concern is 2.5 per cent.

The data also shows there is a substantial variation depending on location in the percentage of cases where no epidemiological link could be found — which essentially means cases where public health units cannot trace back where the infection came from.

In Toronto, that number stands at 65 per cent. The next highest is Ottawa, at 48.8 per cent.

WATCH | Health officials explain Ontario’s latest projections:

After Premier Doug Ford promised a “positive” projection report on COVID-19 numbers in Ontario, public health officials say the province is seeing a “more gentle curve” than it was initially preparing for. Dr. Dirk Huyer, coordinator of Ontario’s Provincial Outbreak Response, said the slowing of growth in case numbers “speaks to the efforts that everybody is making.” 1:15

Province seeing ‘slower growth’ in hospitalizations than projected

The new infections come with 35,621 completed tests, more than typically done throughout this week but still below capacity, which is about 45,000 daily, according to provincial public health officials.

Further, the number of people in Ontario hospitals with confirmed cases of COVID-19 jumped 10 up to 322 after two straight days of staying steady. Those being treated in intensive care increased by six, up to 77, while the number of patients on ventilators is 52.

Brown said Thursday that the province is also seeing “slower growth” in hospitalizations and ICU usage than it originally expected, but noted growth still exists, which is “still a cause for concern.”

Brown also said the average age for cases is moving up, and now stands at 40. That, he said, “creates a warning signal,” as cases in older people are where the province will see the biggest health system issues.

The province is seeing “sharper growth” in cases in long term care homes, and that is where the greatest consequences for virus spread can be found, Brown said.

Ontario saw more deaths in long-term care in the last week than it did in the entire period from Aug. 15 to Oct. 8, Brown added.

10 new deaths recorded

The province also added 10 more COVID-19-linked deaths, bringing the total to 3,118. Some 2,001 of those deaths were residents of long-term care facilities.

There are currently about 7,578 confirmed, active cases of the illness provincewide, the most ever. 

(Note: All of the figures used in this story are found in the Ministry of Health’s daily update, which includes data from up until 4 p.m. the previous day. The number of cases for any particular region on a given day may differ from what is reported by the local public health unit, which often avoid lag times found in the provincial system.)

Premier Doug Ford said Thursday that the province is seeing “a little bit of a decline” in numbers. Health officials, however, did not say that the numbers are declining, but rather that growth is slowing.

Amidst this backdrop, Ford and his ministers spent the first 25 minutes of Thursday’s press conference talking about “Ontario made” labels and branding. At one point, Ford told viewers to “buy a BBQ” from the manufacturer hosting the news conference.

“We need to support the local home team as I always say,” Ford said.

Ford was again asked Thursday if he’s anticipating that Ontario regions that are currently in a “modified Stage 2” will be able to go back to Stage 3 of reopening measures once a 28-day period is finished early next month.

The premier said the province is looking at taking a “surgical approach,” in these regions.

“We’re working with our health team, and I can’t give you 100 per cent,” Ford said.

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NFL nears COVID-19 crisis as Titans, Patriots reveal more positive tests

Tennessee will not be returning to the team’s facility Wednesday after two more players tested positive amid the NFL’s first COVID-19 outbreak, and the New England Patriots have cancelled practice amid reports that a third player has tested positive for the coronavirus.

The New England Patriots cancelled a practice scheduled for Wednesday after reigning Defensive Player of the Year Stephon Gilmore tested positive for COVID-19, according to the National Football League’s website.

Quarterback Cam Newton tested positive Saturday and is on the reserve/COVID-19 list, and the Patriots placed a defensive tackle from the practice squad on that list Tuesday. The Patriots are scheduled to host Denver on Sunday.

“WEAR YOUR MASK. KEEP YOUR DISTANCE,” Newton posted on Twitter Wednesday along with a photo of himself wearing a mask.

The Titans had no positive tests Monday or Tuesday for the first time after six consecutive days of positive results. A third straight day was necessary for the team to be allowed back in its headquarters, stopping its planned return, according to a person familiar with the situation.

Buffalo coach Sean McDermott said no one’s perfect when asked about the NFL’s stricter protocols as his Bills (4-0) prepare for a game at Tennessee that may now be in jeopardy. McDermott said no one’s perfect.

“We’re fighting an uphill battle,” McDermott said. “I think we know that there’s a challenge because of how easily this thing spreads.”

McDermott said the Bills have had no positives after beating the Raiders 30-23 in Las Vegas last week. The Raiders placed defensive tackle Maurice Hurst on the reserve/COVID-19 list Tuesday.

Instead, the Titans’ outbreak now is up to 22 cases with 20 now returned since Sept. 29, according to the person who spoke to the AP on condition of anonymity because neither the NFL nor the Titans announced the latest results.

The Titans announced they will not have any media availability Wednesday.

The new positive tests put into question Tennessee’s scheduled game Sunday against Buffalo (4-0), a matchup between two of the NFL’s six remaining undefeated teams. The NFL has rescheduled the Titans’ game with Pittsburgh from Oct. 4 to Oct. 25.

The NFL gave New England and Kansas City an extra day after Newton tested positive Saturday, and Kansas City beat the Patriots 26-10 on Monday night. But pushing the Bills’ game with the Titans back by a day will be challenging because Buffalo is scheduled to host Kansas City on Thursday night, Oct. 15.

The league is attempting to play a full schedule amid the pandemic without teams isolated in a bubble as other sports have done to protect players and staff from the virus. No games were affected through the first three weeks of the season.

Pittsburgh defensive tackle Cam Heyward said Wednesday it was “ludicrous” to think the NFL wouldn’t have positive tests and warned there would be more. He said players and teams were under pressure to minimize outbreaks.

“Things are going to change every minute now,” said Heyward, the Steelers’ player representative. “And we’ve just got to be willing to adjust. I know the NFL and the NFLPA is trying to do right by the players and the coaches, but there’s only so much they can do.”

Breaking rules could mean forfeits, fines

NFL commissioner Roger Goodell warned all 32 teams Monday that any violations of COVID-19 protocols that force schedule changes could result in punishment including forfeiting games, fines or loss of draft picks.

Pittsburgh quarterback Ben Roethlisberger said he’s allowing his wife and three children to attend the Steelers’ game Sunday against Philadelphia. The Steelers had an unexpected bye last weekend with the Titans’ outbreak affecting their schedule.

“I don’t think they’ll consider forfeiting our game, and of course we got the short end of the stick,” Roethlisberger said.

Titans last together on Sept. 27

Titans coach Mike Vrabel told reporters Tuesday he was hoping to hear more good news Wednesday morning when the latest batch of daily testing results came back. Instead, he’ll have to try to prepare a game plan with his team possibly not back into its facility until Saturday because it needs back-to-back days of negative tests.

Tennessee hasn’t been together as a team since Sept. 27, when the Titans beat the Vikings 31-30 in Minnesota. The Titans played that game after leaving outside linebackers coach Shane Bowen in Nashville following his positive test result Sept. 26, and the NFL shut down the team facility on Sept. 29.

The franchise has continued daily testing since then, and the league sent all 32 teams a memo Oct. 1 with list of new protocols for clubs to follow when dealing with a coronavirus outbreak or having been exposed to an outbreak.

The Las Vegas Raiders put their first player on the reserve/COVID-19 list Tuesday — defensive tackle Maurice Hurst. He didn’t attend the charity function last week that led the NFL to fine 10 Raiders players for conduct violating COVID-19 protocols. The list is for players who either test positive for the coronavirus or have had close contact with an infected person.

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The Chicks, Formerly the Dixie Chicks, Reveal What They Almost Changed Their Name To

The Chicks, Formerly the Dixie Chicks, Reveal What They Almost Changed Their Name To | Entertainment Tonight

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China delayed releasing coronavirus info, frustrating WHO, documents and recordings reveal

Throughout January, the World Health Organization publicly praised China for what it called a speedy response to the new coronavirus. It repeatedly thanked the Chinese government for sharing the genetic map of the virus “immediately” and said its work and commitment to transparency were “very impressive, and beyond words.”

But behind the scenes, it was a much different story, one of significant delays by China and considerable frustration among WHO officials over not getting the information they needed to fight the spread of the deadly virus, The Associated Press has found.

Despite WHO’s praise, China in fact sat on releasing the genetic map, or genome, of the virus for more than a week after three different government labs had fully decoded the information. Tight controls on information and competition within the Chinese public health system were to blame, according to dozens of interviews and internal documents.

Chinese government labs only released the genome after another lab published it ahead of authorities on a virologist website on Jan. 11. Even then, China stalled for at least two more weeks on providing WHO with detailed data on patients and cases, according to recordings of internal meetings held by the UN health agency through January — all at a time when the outbreak arguably might have been dramatically slowed.

Recordings obtained by the AP suggest WHO officials were lauding China in public because they wanted to coax more information out of the government. Privately, they complained in meetings the week of Jan. 6 that China was not sharing enough data to assess how effectively the virus spread between people or what risk it posed to the rest of the world, costing valuable time.

“We’re going on very minimal information,” said U.S. epidemiologist Maria Van Kerkhove, now WHO’s technical lead for COVID-19, in one internal meeting. “It’s clearly not enough for you to do proper planning.”

“We’re currently at the stage where yes, they’re giving it to us 15 minutes before it appears on CCTV,” said WHO’s top official in China, Dr. Gauden Galea, referring to the state-owned China Central Television, in another meeting.

WHO facing questions about handling of pandemic

The virus has now infected over six million people worldwide and killed more than 376,000, according to a database from Johns Hopkins University that tracks recorded cases. 

WATCH | What we know about the novel coronavirus:

Information about the coronavirus outbreak is spreading fast, but what do we actually know about the illness? CBC News medical contributor and family physician Dr. Peter Lin breaks down the facts about what it is, where it came from, how it spreads and what you can do to protect yourself. 5:10

The story behind the early response to the virus comes at a time when the UN health agency is under scrutiny and has agreed to an independent probe of how the pandemic was handled globally.

After repeatedly praising the Chinese response early on, U.S. President Donald Trump has blasted WHO in recent weeks for allegedly colluding with China to hide the extent of the crisis. He cut ties with the organization on Friday, jeopardizing the approximately $ 450 million the U.S. gives every year as WHO’s biggest single donor.

In the meantime, Chinese President Xi Jinping has vowed to pitch in $ 2 billion over the next two years to fight the coronavirus, saying China has always provided information to WHO and the world “in a most timely fashion.”

The new information does not support the narrative of either the U.S. or China but instead portrays an agency now stuck in the middle that was urgently trying to solicit more data despite limits to its own authority.

Although international law obliges countries to report information to WHO that could have an impact on public health, the UN agency has no enforcement powers and cannot independently investigate epidemics within countries. Instead, it must rely on the co-operation of member states.

The recordings suggest that rather than colluding with China, as Trump declared, WHO was kept in the dark as China gave it the minimal information required by law. However, the agency did try to portray China in the best light, likely as a means to secure more information. And it appears WHO experts genuinely thought Chinese scientists had done “a very good job” in detecting and decoding the virus, despite the lack of transparency from Chinese officials.

WHO staffers debated how to press China for gene sequences and detailed patient data without angering authorities, and worried about losing access and getting Chinese scientists into trouble. Under international law, WHO is required to quickly share information and alerts with member countries about an evolving crisis.

In the second week of January, Dr. Michael Ryan told colleagues it was time to ‘shift gears’ and apply more pressure on China to share information, fearing a repeat of the outbreak of SARS that started in China in 2002 and killed nearly 800 people worldwide. (Salvatore Di Nolfi/The Associated Press)

Galea noted WHO could not indulge China’s wish to sign off on information before telling other countries because “that is not respectful of our responsibilities.”

‘Shift gears’

In the second week of January, WHO’s chief of emergencies, Dr. Michael Ryan, told colleagues it was time to “shift gears” and apply more pressure on China, fearing a repeat of the outbreak of Severe Acute Respiratory Syndrome (SARS), which started in China in 2002 and killed nearly 800 people worldwide.

“This is exactly the same scenario, endlessly trying to get updates from China about what was going on,” he said. “WHO barely got out of that one with its neck intact given the issues that arose around transparency in southern China.”

Ryan said the best way to “protect China” was for WHO to do its own independent analysis with data from the Chinese government, because otherwise the spread of the virus between people would be in question and “other countries will take action accordingly.” Ryan also noted that China was not co-operating in the same way some other countries had in the past.

“This would not happen in Congo and did not happen in Congo and other places,” he said, probably referring to the Ebola outbreak that began there in 2018. “We need to see the data … It’s absolutely important at this point.”

The delay in the release of the genome stalled the recognition of its spread to other countries, along with the global development of tests, drugs and vaccines. The lack of detailed patient data also made it harder to determine how quickly the virus was spreading — a critical question in stopping it.

Between the day the full genome was first decoded by a government lab on Jan. 2 and the day WHO declared a global emergency on Jan. 30, the outbreak spread by a factor of 100 to 200 times, according to retrospective infection data from the Chinese Center for Disease Control and Prevention. 

WATCH | What it’s like to get tested for COVID-19:

A look at what patients could expect if they end up in an emergency room with COVID-19 symptoms. 1:59

“It’s obvious that we could have saved more lives and avoided many, many deaths if China and the WHO had acted faster,” said Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington.

However, Mokdad and other experts also noted that if WHO had been more confrontational with China, it could have triggered a far worse situation of not getting any information at all.

If WHO had pushed too hard, it could even have been kicked out of China, said Adam Kamradt-Scott, a global health professor at the University of Sydney. But he added that a delay of just a few days in releasing genetic sequences can be critical in an outbreak. And he noted that as Beijing’s lack of transparency becomes even clearer, WHO Director-General Tedros Adhanom Ghebreyesus’s continued defense of China is problematic.

“It’s definitely damaged WHO’s credibility,” said Kamradt-Scott. “Did he go too far? I think the evidence on that is clear… it has led to so many questions about the relationship between China and WHO. It is perhaps a cautionary tale.”

WHO and its officials named in this story declined to answer questions asked by The Associated Press without audio or written transcripts of the recorded meetings, which the AP was unable to supply to protect its sources.

“Our leadership and staff have worked night and day in compliance with the organization’s rules and regulations to support and share information with all Member States equally, and engage in frank and forthright conversations with governments at all levels,” a WHO statement said.

China’s National Health Commission and the Ministry of Foreign Affairs had no comment. But in the past few months, China has repeatedly defended its actions, and many other countries — including the U.S. — have responded to the virus with even longer delays of weeks and even months.

Tedros Adhanom Ghebreyesus, director-general of the WHO, has said he welcomes a review of how the organization responded to the pandemic. (Salvatore Di Nolfi/Keystone/The Associated Press)

“Since the beginning of the outbreak, we have been continuously sharing information on the epidemic with the WHO and the international community in an open, transparent and responsible manner,” said Liu Mingzhu, an official with the National Health Commission’s International Department, at a press conference on May 15.

How did events unfold? 

The race to find the genetic map of the virus started in late December, according to the AP’s reporting. That’s when doctors in Wuhan noticed mysterious clusters of patients with fevers and breathing problems who weren’t improving with standard flu treatment. Seeking answers, they sent test samples from patients to commercial labs.

By Dec. 27, one lab, Vision Medicals, had pieced together most of the genome of a new coronavirus with striking similarities to SARS. Vision Medicals shared its data with Wuhan officials and the Chinese Academy of Medical Sciences, as first reported by Chinese finance publication Caixin and independently confirmed by the AP.

On Dec. 30, Wuhan health officials issued internal notices warning of the unusual pneumonia, which leaked on social media. That evening, Shi Zhengli, a coronavirus expert at the Wuhan Institute of Virology who is famous for having traced the SARS virus to a bat cave, was alerted to the new disease, according to an interview with Scientific American. Shi took the first train from a conference in Shanghai back to Wuhan.

The next day, Chinese CDC director Gao Fu dispatched a team of experts to Wuhan. Also on Dec. 31, WHO first learned about the cases from an open-source platform that scouts for intelligence on outbreaks, emergencies chief Ryan has said.

WHO officially requested more information on Jan. 1. Under international law, members have 24 to 48 hours to respond, and China reported two days later that there were 44 cases and no deaths.

By Jan. 2, Shi had decoded the entire genome of the virus, according to a notice later posted on her institute’s website.

In this 2017 photo, Shi Zhengli, left, works with other researchers in a lab at the Wuhan Institute of Virology. (The Associated Press)

Scientists agree that Chinese scientists detected and sequenced the then-unknown pathogen with astonishing speed, in a testimony to China’s vastly improved technical capabilities since SARS, during which a WHO-led group of scientists took months to identify the virus. This time, Chinese virologists proved within days that it was a never-before-seen coronavirus. Tedros would later say Beijing set “a new standard for outbreak response.”

But when it came to sharing the information with the world, things began to go awry.

On Jan. 3, the National Health Commission issued a confidential notice ordering labs with the virus to either destroy their samples or send them to designated institutes for safekeeping. The notice, first reported by Caixin and seen by the AP, forbade labs from publishing information about the virus without government authorization. The order barred Shi’s lab from publishing the genetic sequence or warning of the potential danger.

Chinese law states that research institutes cannot conduct experiments on potentially dangerous new viruses without approval from top health authorities. Although the law is intended to keep experiments safe, it gives top health officials wide-ranging powers over what lower-level labs can or cannot do.

“If the virologist community had operated with more autonomy … the public would have been informed of the lethal risk of the new virus much earlier,” said Edward Gu, a professor at Zhejiang University, and Li Lantian, a PhD student at Northwestern University, in a paper published in March analyzing the outbreak.

Commission officials later repeated that they were trying to ensure lab safety, and had tasked four separate government labs with identifying the genome at the same time to get accurate, consistent results.

Virus independently sequenced by Chinese CDC

By Jan. 3, the Chinese CDC had independently sequenced the virus, according to internal data seen by the Associated Press. By just after midnight on Jan. 5, a third designated government lab, the Chinese Academy of Medical Sciences, had decoded the sequence and submitted a report.

Yet even with full sequences decoded by three state labs independently, Chinese health officials remained silent. The WHO reported on Twitter that investigations were underway into an unusual cluster of pneumonia cases with no deaths in Wuhan, and said it would share “more details as we have them.”

WATCH | Experts say when it comes to COVID-19, we’re in it for the long haul

What mathematical simulations tell us about how the COVID-19 pandemic will play in the real world. 5:04

Meanwhile, at the Chinese CDC, gaps in coronavirus expertise proved a problem.

For nearly two weeks, Wuhan reported no new infections, as officials censored doctors who warned of suspicious cases. Meanwhile, researchers found the new coronavirus used a distinct spike in protein to bind itself to human cells. The unusual protein and the lack of new cases lulled some Chinese CDC researchers into thinking the virus didn’t easily spread between humans — like the coronavirus that causes Middle East respiratory syndrome, or MERS, according to an employee who declined to be identified out of fear of retribution.

Li, the coronavirus expert, said he immediately suspected the pathogen was infectious when he spotted a leaked copy of a sequencing report in a group chat on a SARS-like coronavirus. But the Chinese CDC team that sequenced the virus lacked specialists in the molecular structure of coronaviruses and failed to consult with outside scientists, Li said.

Media outlets like the New York Times have reported that Chinese health authorities rebuffed offers of assistance from foreign experts, including the U.S. Centers for Disease Control and Prevention.

On Jan. 5, the Shanghai Public Clinical Health Center, led by famed virologist Zhang Yongzhen, was the latest to sequence the virus. He submitted it to the GenBank database, where it sat awaiting review, and notified the National Health Commission. He warned them that the new virus was similar to SARS and likely infectious.

“It should be contagious through respiratory passages,” the centre said in an internal notice seen by the AP. “We recommend taking preventative measures in public areas.”

On the same day, WHO said that based on preliminary information from China, there was no evidence of significant transmission between humans, and did not recommend any specific measures for travellers.

Emergency level raised

The next day, the Chinese CDC raised its emergency level to the second highest. Staffers proceeded to isolate the virus, draft lab testing guidelines and design test kits. But the agency did not have the authority to issue public warnings, and the heightened emergency level was kept secret even from many of its own staff.

By Jan. 7, another team at Wuhan University had sequenced the pathogen and found it matched Shi’s, making Shi certain they had identified a novel coronavirus. But Chinese CDC experts said they didn’t trust Shi’s findings and needed to verify her data before she could publish, according to three people familiar with the matter. Both the National Health Commission and the Ministry of Science and Technology, which oversees Shi’s lab, declined to make Shi available for an interview.

A major factor behind the gag order, some say, was that Chinese CDC researchers wanted to publish their papers first. “They wanted to take all the credit,” said Li Yize, a coronavirus researcher at the University of Pennsylvania.

Internally, the leadership of the Chinese CDC is plagued with fierce competition, six people familiar with the system explained. They said the agency has long promoted staff based on how many papers they can publish in prestigious journals, making scientists reluctant to share data.

As the days went by, even some of the Chinese CDC’s own staff began to wonder why it was taking so long for authorities to identify the pathogen.

In mid-January, Dr. Maria van Kerkhove, WHO’s current technical lead for COVID-19, said in a briefing ‘it is certainly possible there is limited human-to-human transmission.’ But a tweet from the WHO hours later confused the issue. (Martial Trezzini/Keystone/The Associated Press)

“We were getting suspicious, since within one or two days you would get a sequencing result,” a lab technician said, declining to be identified for fear of retribution.

WSJ reports scientists have identified new virus 

On Jan. 8, the Wall Street Journal reported that scientists had identified a new coronavirus in samples from pneumonia patients in Wuhan, pre-empting and embarrassing Chinese officials. The lab technician told the AP they first learned about the discovery of the virus from the Journal.

The article also embarrassed WHO officials. Dr. Tom Grein, chief of WHO’s acute events management team, said the agency looked “doubly, incredibly stupid.” Van Kerkhove, the American expert, acknowledged WHO was “already late” in announcing the new virus and told colleagues that it was critical to push China.

Ryan, WHO’s chief of emergencies, was also upset at the dearth of information.

“The fact is, we’re two to three weeks into an event, we don’t have a laboratory diagnosis, we don’t have an age, sex or geographic distribution, we don’t have an epi curve,” he complained, referring to the standard graphic of outbreaks scientists use to show how an epidemic is progressing.

After the article, state media officially announced the discovery of the new coronavirus. But even then, Chinese health authorities did not release the genome, diagnostic tests or detailed patient data that could hint at how infectious the disease was.

By that time, suspicious cases were already appearing across the region.

On Jan. 8, Thai airport officers pulled aside a woman from Wuhan with a runny nose, sore throat and high temperature. Chulalongkorn University professor Supaporn Wacharapluesadee’s team found the woman was infected with a new coronavirus, much like what Chinese officials had described. Supaporn partially figured out the genetic sequence by Jan. 9, reported it to the Thai government and spent the next day searching for matching sequences.

A health worker monitors arriving passengers at Suvarnabhumi International airport in Bangkok in January to help detect passengers who may be infected with new coronavirus. (Thai Government/The Associated Press)

But because Chinese authorities hadn’t published any sequences, she found nothing. She could not prove the Thai virus was the same pathogen sickening people in Wuhan.

“It was kind of wait and see, when China will release the data, then we can compare,” said Supaporn.

On Jan. 9, a 61-year-old man with the virus passed away in Wuhan — the first known death. The death wasn’t made public until Jan. 11.

WHO officials complained in internal meetings that they were making repeated requests for more data, especially to find out if the virus could spread efficiently between humans, but to no avail.

“We have informally and formally been requesting more epidemiological information,” WHO’s China representative Galea said. “But when asked for specifics, we could get nothing.”

Emergencies chief Ryan grumbled that since China was providing the minimal information required by international law, there was little WHO could do. But he also noted that last September, WHO had issued an unusual public rebuke of Tanzania for not providing enough details about a worrisome Ebola outbreak.

“We have to be consistent,” Ryan said. “The danger now is that despite our good intent … especially if something does happen, there will be a lot of finger-pointing at WHO.”

Ryan noted that China could make a “huge contribution” to the world by sharing the genetic material immediately, because otherwise “other countries will have to reinvent the wheel over the coming days.”

On Jan. 11, a team led by Zhang, from the Shanghai Public Health Clinical Center, finally published a sequence on Virological.org, used by researchers to swap tips on pathogens. The move angered Chinese CDC officials, three people familiar with the matter said, and the next day, his laboratory was temporarily shuttered by health authorities.

Zhang referred a request for comment to the Chinese CDC. The National Health Commission, which oversees the Chinese CDC, declined multiple times to make its officials available for interviews and did not answer questions about Zhang.

A portrait of Dr. Li Wenliang is left at Li’s hospital in Wuhan on Feb. 7. Li died of COVID-19 after raising the alarm about the novel coronavirus. (Getty Images)

Supaporn compared her sequence with Zhang’s and found it was a 100 per cent match, confirming that the Thai patient was ill with the same virus detected in Wuhan. Another Thai lab got the same results. That day, Thailand informed the WHO, said Tanarak Plipat, deputy director-general of the Department of Disease Control at Thailand’s Ministry of Public Health.

Sequences published

After Zhang released the genome, the Chinese CDC, the Wuhan Institute of Virology and the Chinese Academy of Medical Sciences raced to publish their sequences, working overnight to review them, gather patient data and send them to the National Health Commission for approval, according to documentation obtained by the AP.

On Jan. 12, the three labs together finally published the sequences on GISAID, a platform for scientists to share genomic data.

By then, more than two weeks had passed since Vision Medicals decoded a partial sequence, and more than a week since the three government labs had all obtained full sequences. Around 600 people were infected in that week, a roughly three-fold increase.

Some scientists say the wait was not unreasonable considering the difficulties in sequencing unknown pathogens, given accuracy is as important as speed. They point to the SARS outbreak in 2003, when some Chinese scientists initially — and wrongly — believed the source of the epidemic was chlamydia.

“The pressure is intense in an outbreak to make sure you’re right,” said Peter Daszak, president of the EcoHealthAlliance in New York. “It’s actually worse to go out to go to the public with a story that’s wrong, because the public completely lose confidence in the public health response.”

Still, others quietly question what happened behind the scenes.

A worker is seen helping build a hospital in Wuhan earlier this year as coronavirus case numbers rose in Wuhan and surrounding Hubei province, China. (Getty Images)

Infectious diseases expert John Mackenzie, who served on a WHO emergency committee during the outbreak, praised the speed of Chinese researchers in sequencing the virus. But he said once central authorities got involved, detailed data trickled to a crawl.

“There certainly was a kind of blank period,” Mackenzie said. “There had to be human-to-human transmission. You know, it’s staring at you in the face. I would have thought they would have been much more open at that stage.”

On Jan. 13, WHO announced that Thailand had a confirmed case of the virus, jolting Chinese officials.

The next day, in a confidential teleconference, China’s top health official ordered the country to prepare for a pandemic, calling the outbreak the “most severe challenge since SARS in 2003,” as the AP previously reported. Chinese CDC staff across the country began screening, isolating and testing for cases, turning up hundreds across the country.

Yet even as the Chinese CDC internally declared a level one emergency, the highest level possible, Chinese officials still said the chance of sustained transmission between humans was low.

Questions around human-to-human transmission

WHO went back and forth. Van Kerkhove said in a press briefing that “it is certainly possible there is limited human-to-human transmission.” But hours later, WHO seemed to backtrack, tweeting that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission” — a statement that later became fodder for critics.

A high-ranking official in WHO’s Asia office, Dr. Liu Yunguo, who attended medical school in Wuhan, flew to Beijing to make direct, informal contacts with Chinese officials, recordings show. Liu’s former classmate, a Wuhan doctor, had alerted him that pneumonia patients were flooding the city’s hospitals, and Liu pushed for more experts to visit Wuhan, according to a public health expert familiar with the matter.

On Jan. 20, the leader of an expert team returning from Wuhan, renowned government infectious diseases doctor Zhong Nanshan, declared publicly for the first time that the new virus was spreading between people. Chinese President Xi Jinping called for the “timely publication of epidemic information and deepening of international co-operation.”

Despite that directive, WHO staff still struggled to obtain enough detailed patient data from China about the rapidly evolving outbreak. That same day, the UN health agency dispatched a small team to Wuhan for two days, including Galea, the WHO representative in China.

Cluster of cases in doctors, nurses

They were told about a worrying cluster of cases among more than a dozen doctors and nurses. But they did not have “transmission trees” detailing how the cases were connected or a full understanding of how widely the virus was spreading and who was at risk.

In an internal meeting, Galea said their Chinese counterparts were “talking openly and consistently” about human-to-human transmission. Galea reported to colleagues in Geneva and Manila that China’s key request to WHO was for help “in communicating this to the public, without causing panic.”

On Jan. 22, WHO convened an independent committee to determine whether to declare a global health emergency. After two inconclusive meetings where experts were split, they decided against it — even as Chinese officials ordered Wuhan sealed in the biggest quarantine in history. The next day, WHO chief Tedros publicly described the spread of the new coronavirus in China as “limited.”

For days, China didn’t release much detailed data, even as its case count exploded. Beijing city officials were alarmed enough to consider locking down the capital, according to a medical expert with direct knowledge of the matter.

WHO Director-General Tedros Adhanom Ghebreyesus shakes hands with Chinese President Xi Jinping before a meeting in Beijing in late January. (Naohiko Hatta/The Associated Press)

On Jan. 28, Tedros and top experts, including Ryan, made an extraordinary trip to Beijing to meet President Xi and other senior Chinese officials. It is highly unusual for WHO’s director-general to directly intervene in the practicalities of outbreak investigations. Tedros’s staffers had prepared a list of requests for information.

“It could all happen and the floodgates open, or there’s no communication,” Grein said in an internal meeting while his boss was in Beijing. “We’ll see.”

At the end of Tedros’s trip, WHO announced China had agreed to accept an international team of experts. In a press briefing on Jan. 29, Tedros heaped praise on China, calling its level of commitment “incredible.”

The next day, WHO finally declared an international health emergency. Once again, Tedros thanked China, saying nothing about the earlier lack of co-operation.

“We should have actually expressed our respect and gratitude to China for what it’s doing,” Tedros said. “It has already done incredible things to limit the transmission of the virus to other countries.”

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