A History of Inadequacy and Abandonment
As she withdraws from her role as leader of New Brunswick Public Health with her eye on a national position, CMOH Jennifer Russell leaves a trail of error and omission in her wake.
As one of her last acts as New Brunswick Chief Medical Officer of Health, Jennifer Russell will be questioned by the Standing Committee on Public Accounts November 2 starting at 10:00 am. During the two hour session, the committee will ask her to provide justification for decisions made by her office during the province’s pandemic response.
While the much anticipated Auditor General’s report on COVID-19 Pandemic Response provided little substance, opting instead to focus on documenting the absence of structure, procedure, and documentation, it made one thing clear. The Office of the Chief Medical Officer of Health was at the absolute bottom of the decision making process.
Perhaps it was for this reason the Auditor General neglected to interview the one individual to whom every government office deferred and with whom every government pandemic policy was publicly said to originate.
For over two years PoPNB has done its own work uncovering and analyzing the facts surrounding New Brunswick’s pandemic response, and we have some questions of our own for the CMOH.
The Long Knowledge of Long Covid
First and foremost, it has been established that Jennifer Russell and her Public Health colleagues have known about the ravages of Long Covid since July 2020. In fact, Public Health in every province and territory knew about the prevalence and severity of long term consequences of Covid-19 infection at that early point, and they continued to be supplied with increasing amounts of high-quality evidence throughout the subsequent months and years.
And they did nothing.
In New Brunswick “long covid” was not mentioned in any news conferences nor in any press releases. In fact, it was not mentioned on the government’s Covid-19 webpage until after PoPNB publicly released the evidence that Public Health’s knowledge of the issue was two and a half years old.
This shocking level of omission is tantamount to negligence and exposes the myth that the Office of Public Health exists for any reason other than to provide implied legitimacy to government policy.
Why was the early knowledge of the prevalence and severity of long term consequences of Covid-19 infection withheld from the public? How does withholding this information achieve the objectives of the precautionary principle which forms the very basis of Public Health?
If this question is asked, it is likely that an answer will be given along the lines of "we were waiting for more evidence or consensus."
In response to this, we should ask why that wait occurred considering that would be in contravention of the ethical framework of Public Health, as set out by the Public Health Association of Canada which explicitly states "scientific uncertainty should not prevent decision makers from taking action to reduce risks associated with COVID-19."
In addition to the motivation of common decency or acting in accordance with established principles of ethics, New Brunswick and all provinces and territories have legislation which explicitly requires that employers (the government being the largest in the province) to inform their employees of hazards in the workplace.
Is the omission of information regarding the long term health impacts of Covid-19 infection not in contravention of the requirements of the New Brunswick Occupational Health and Safety Act, if not the Westray Law?
The Imaginary Harms of Helping
In a handful of interviews after Public Health's February 24, 2022 final press conference, Russell began discussing the “harms of masking” and made vague citations of studies which she claimed showed disproportionate mental health impacts on children.
The day mandated protections were removed (March 14, 2022) Russell was interviewed on CBC radio where she stated:
“This conversation has shifted very much to the negative impacts [of protections] and there is recent data that was published…on harms to children.”
When the Child and Youth Advocate investigated the lifting of mandated protections in New Brunswick schools, he wrote the Office of the Chief Medical Officer of Health to request the specific information which led to the removal of mandated protections. On April 8, 2022, she replied to Lamrock and provided the “data” upon which her February 2022 recommendation to government to remove all mandated protections was based.
A PoPNB RTI confirmed the information she provided was cobbled together within the Department of Health four days prior to her response. In addition to a key piece of “evidence” being wholly fabricated, an April 4, 2022 email from Russell to acting Executive Director of Mental Health Services Annie Pellerin, and others, asks for information explicitly on negative impacts of mask wearing... four days before her response to Lamrock.
We would reasonably expect, based on Russell’s previous claims, that her office was in possession of exactly this type of data in February, as she publicly stated that the recommendation to remove mandated masking at that time was a result of evidence regarding the “negative impacts” and “harms to children.” The above email suggests that when obliged by the Child and Youth Advocate to provide such evidence, Russell had to ask her colleagues to produce it.
Why then did Russell not have the evidence on hand? If she did in fact not have any evidence of harms to children, why was the recommendation made to remove protections in schools?
A response to Russell’s email request from Lori (most likely Lori Heron, Senior Program Advisor with the COVID-19 Response Team), offered that available evidence only points to the contrary; namely that negative impacts of masking are not supported by research or evidence.
We also know from the Long Covid documents that while Russell may have been in search of negative impacts of mitigations, she was very well informed of the negative impacts of infection.
Given the established and known negative impacts of infection and the absence of any evidence of negative impacts of masking, why did Public Health nevertheless make the recommendation to remove masks in schools?
The Outdated Abstraction of AGMPs
The Chief Medical Officer of Health was involved in discussions as early as January 2020 regarding the possible airborne transmission of Covid-19, going so far as to advise the Regional Health Authorities to follow both droplet and airborne precautions.
In April 2020 she received a copy of a letter from Dr. Droegemeier of the National Academies of Sciences Engineering and Medicine which stated that "currently available research supports the possibility that SARS-CoV-2 could be spread via bioaerosols generated directly by patients' exhalation."
In October of 2020, British Columbia CDC was presenting internal seminars on communicating airborne transmission, focussing on “the more mechanistic discussion of aerosol generation and dispersal” which “is often divorced from what is observed from epidemiological studies and the experiences of healthcare workers.” The stated intention included how to “contextualize this risk for the public;” an undertaking that was never attempted.
On November 12, 2021, the Public Health Agency of Canada confirmed aerosol transmission and expressed the importance of ventilation:
"We have learned how the virus can linger in fine aerosols and remain suspended in the air we breathe, much as expelled smoke lingers in poorly ventilated spaces. Similar to second hand smoke, those in close proximity to the infected person inhale more aerosols. This is why opening a window helps reduce the risk and why wearing a well-fitting and well-constructed mask is so important when you are spending time in indoor public spaces, particularly if ventilation is not optimal."
To this day, New Brunswick Public Health has not admitted or even suggested or that Covid-19 is transmitted primarily via the airborne route, nor have they advised the public on ways to mitigate airborne transmission.
First and foremost, will Dr. Russell admit/state for the record that Covid-19 is primarily transmitted via airborne aerosols?
Given the early and ever increasing body of evidence that Covid-19 is transmitted through airborne aerosols, why did Public Health not revise their recommendations or make any effort to inform the public of this risk and how to effectively protect themselves? Why does Public Health continue to this very day to omit this now widely agreed upon information in its limited public communications?
Because Public Health never communicated the importance of ventilation to reduce airborne transmission, continually scarce resources were spent on ineffective mitigation measures such as hand sanitizer and plexiglass shields. Though the Public Health Agency of Canada confirmed aerosol transmission nearly two years ago, the New Brunswick Teachers Association is just this month having its first meetings on Indoor Air Quality. Had Public Health been forthcoming regarding aerosols, this work could have started prior to the Omicron wave which killed hundreds of New Brunswickers. Instead, resources, including people’s attention and time and energy, have been depleted pursuing wholly ineffective solutions.
Given the established science and corresponding requirement to shift focus for prevention of transmission, why did and does Public Health continue to promote ineffective mitigation measures such as hand washing?
If asked this question, we anticipate there is a good chance Dr. Russell will respond with claims that they were “following protocols for aerosol generating medical procedures (AGMPs).” She mentioned these particular discreet situations multiple times during the pandemic in the context of recommendations for people working on the front lines of healthcare. Russell would be far from alone amongst Public Health officials who leaned into the fallacy of AGMPs being the sole source of transmission via aerosols.
It should be noted and reinforced that AGMPs are
not the sole source of aerosols, and
explicitly discussed very early on as being only one source of potential infection.
Any suggestion that AGMPs were, or should have been treated differently than other forms of contact will be a misdirection and/or based on obsolete science.
The AGMP paradigm is based on the outdated assumption that patients do not produce airborne aerosols unless an AGMP is being performed, typically within the confines of a healthcare facility. This is categorically false. The broad medical consensus in literature from the past fifteen years shows a single cough produces hundreds to thousands of aerosols. Sneezing produces a few hundred thousand to a few million aerosols and basic respiration, simply breathing, produces aerosols, the numbers of which increase with heavier breathing, talking, singing, or shouting.
Had the public been informed of Covid-19’s primary route of transmission and the proper, effective methods to mitigate that transmission, we would be dealing with far less anti-mask science denialism from well meaning people who wore inadequate fabric and surgical masks only to become infected anyway.
Hauntingly, we would also have lost far fewer of our fellow New Brunswickers to Covid-19.
The Death of Due Diligence
At numerous points during the pandemic when Dr. Russell was asked to provide data or evidence upon which changes in mandated protections were predicated, particularly when those changes involved removing protections, she stated that New Brunswick Public Health was "following other jurisdictions."
What if any due diligence was performed by New Brunswick Public Health to verify that other jurisdictions' decisions were based on sound science and epidemiological rigour and that those decisions were applicable to the unique distribution of New Brunswick citizens?
In times of crisis, we can be sympathetic to the interest in not “reinventing the wheel,” but to adopt policy from elsewhere uncritically is reckless to the point of negligence.
In any situation where the adoption of strategic direction involves risk, one would expect metrics to be put into place to evaluate, in an ongoing manner, whether these actions were advancing the organization’s efforts toward their goal or away from it.
What monitoring was put in place to ensure that decisions largely based on the actions of other unrelated jurisdictions were having the desired effects and were not contributing to worsening the Covid-19 situation in New Brunswick?
The Organized Abandonment
Lastly, as this is being written we are twenty-one months past the final New Brunswick Public Health press conference on the state of the pandemic. New and better data continues to be produced regarding the virus and its impacts, however Public Health has continually reduced the amount of information available to the public, going so far as to outright deny media requests for relevant information.
Why did Public Health stop providing information updates to the public once mandates were ended? Why has Public Health moved to actively reduce information being provided to the public?
If asked, it is likely Dr. Russell will reply with the canned response parroted endlessly by her colleagues in Public Health. Whenever asked, Public Health spokespeople answer nearly all questions posed to the perpetually unavailable Chief Medical Officer of Health by stating “New Brunswickers are advised to assess and manage their personal risk and to continue using public health precautions that can decrease their risk of contracting or spreading COVID-19." An objective that cannot reasonably be met considering the uninhibited obfuscation of information from all levels of the government office whose entire reason to exist is to facilitate this objective.
Adding insult to injury, Public Health never passes up a chance to uphold its own manufactured legitimacy by means of the circular logic in their reassurances of "if there is reason to alert the public it will be communicated.”
The objective history of New Brunswick Public Health includes a deadly list of critical information that was never, and in many case still has not been, communicated. You’ll pardon us for being skeptical regarding the competence and good intentions of the Office which seems to undermine its own validity in the exceptionally rare occasion it opens its mouth.
The Standing Committee on Public Accounts is scheduled to hear form Chief Medical Officer of Health, Dr. Russell, on November 2, at 10:00. You can watch the live webcast here.