In the next pandemic, what would Kandola and Cochrane do differently?

The NWT’s chief public health officer says the GNWT needs a different structure for the next pandemic – and must do a better job of helping vulnerable people.

Dr Kami Kandola spoke with Cabin Radio after the publication of a GNWT report on the territory’s response to Covid-19 that made 23 recommendations for the future.

The report draws on a survey filled out by hundreds of residents plus internal GNWT interviews.

It recommends re-examining the legislation used by the NWT in emergencies “to ensure that there is the appropriate level of public accountability for decisions that are made during a pandemic,” and queries whether a state of emergency should be able to last indefinitely.

Using an initialism for the Office of the Chief Public Health Officer, the report states: “Most interview participants expressed concern about the level of OCPHO authority over GNWT operations and the public for prolonged periods of time, and felt that this level of authority should be limited in the future.”

The report says there was agreement that “the CPHO must be involved in pandemic planning, but decisions directly involving GNWT operations and the public needed to involve input from those authorities that may be impacted.”

Responding to that quote, Dr Kandola – who was the NWT government’s de facto spokesperson throughout the pandemic – said she would welcome sharing accountability with more people in future.

“That would have been helpful, and I could have just focused on the pandemic response and not the whole wraparound and services,” she said.

“We need to be working on a different structure – now, because we don’t know what’s around the corner – so that we don’t have a scenario where the perception is that it’s just the Office of the Chief Public Health Officer being fully responsible for pandemic response.”

Equally, she said her figurehead status during the pandemic was “the role I signed up for” as chief public health officer.

“I’m honoured that during a critical time in the NWT’s history, I could take a strong leadership role,” she said. “I showed up when people needed me and I didn’t hightail it out of the NWT.”

Asked what she would do differently in hindsight, Kandola suggested she might have been quicker to ease restrictions on schools now that she knows how readily most young people coped with the Omicron variant of the virus that causes Covid-19.

“When Omicron came, it was like a blessing in disguise because it mainly targeted upper respiratory tract infections, and what we noticed was a dramatic drop in severe outcomes,” she said.

“Once we knew that the rate of severe outcomes was so low in that population, it became a priority to keep the schools open.”

A subject barely referenced in the report, but which Kandola believes is key, is how vulnerable populations – like people who don’t have homes – are protected and given space to isolate in a pandemic.

The chief public health officer said finding wraparound supports and safe isolation for people in that situation was “the biggest difficulty I experienced throughout the pandemic.”

“We as the GNWT, working with communities and Indigenous governments, need to be able to rapidly respond if people have a virus that’s contagious, to be able to safely isolate them and provide those supports, so they’re not interfacing with society and having continuous spread,” Kandola said.

“The hardest part to control was the spread within these hard-to-house and vulnerable populations. We didn’t have the supports there to prevent further introduction to other populations. That’s an issue we need to work on for future pandemics.”

Secretariat shouldn’t be needed again

The NWT government initially declined a succession of requests to interview the chief public health officer regarding the report’s contents.

“The CPHO will not be made available for interview,” a spokesperson wrote at one point.

A week later, once the territory relented, an interview was permitted only with an assistant deputy minister of Executive and Indigenous Affairs, the deputy secretary to cabinet, a cabinet communications officer, a Health and Social Services communications officer, an Executive and Indigenous Affairs communications officer and the chief public health officer’s senior advisor on the line.

“I’m actually really shocked,” said Premier Caroline Cochrane, told that requests to interview the chief public health officer were initially denied. She said she had no knowledge of that sequence of events, adding that “any employee at the GNWT should … within their authority, be able to talk to the media.”

Transcript: Our full interview with Dr Kami Kandola
Transcript: Our full interview with Premier Caroline Cochrane

For her part, Cochrane said that if another pandemic strikes, a special secretariat shouldn’t be needed like the one created to deal with Covid-19, the cost of which was criticized.

The prospect of a Covid-19 Secretariat to unite the GNWT’s pandemic response was first reported by Cabin Radio in July 2020 and became a reality in September that year, drawing staff from various departments into a centralized unit.

In its opening year, the secretariat cost the GNWT $156 million, of which more than $120 million was covered by federal grants. The territory said many of the secretariat’s costs would have been incurred anyway, even if its staff had remained with their original units. The secretariat closed in March 2022.

“We shouldn’t have to do that if it happens again,” said Cochrane of creating a secretariat, but she said a “critical response team” or similar would still be needed to coordinate the territory’s response.

“If we implement the recommendations that we’ve received, then there should be no necessity to set up a secretariat,” she said.

The premier also agreed that the chief public health officer’s authority in legislation should be examined.

However, Cochrane made clear that while the duration of that authority could stand more scrutiny, she had “a lot of respect” for Kandola and believed ministers and departments had appropriately shared responsibility for implementing decisions Kandola took.

“I think it does need to be looked at. Should the CPHO have sole authority for something that goes on for two years? Those are questions that I think need to be answered,” Cochrane told Cabin Radio.

“Although she was the person that was on the front page, myself, Minister Green, and other ministers were with her,” she continued, referring to health minister Julie Green.

“There were many things going on in the departments. She would give the direction, for example, saying: ‘We need to set up checkpoints at the border.’ But she didn’t say ‘this is how you’re going to do it.’ It was our responsibility, as ministers and departments, to actually do that.

“So I think it’s important to know that, although Dr Kandola was the public figure, although she was the authority in public health, many, many, many workers throughout the GNWT were working diligently to make sure that we were as prepared as possible for the pandemic.”

Kandola, in turn, said she believed her counterparts in other jurisdictions “envied the Northwest Territories because of the level of support I got from my premier.”

“The reason why we were able to avoid so many casualties, so many hospitalizations and deaths, was that I had the immediate support of the premier to allow something that’s never really been done, I believe – the travel restrictions to prevent the importation of a pandemic virus – which bought us time to vaccinate,” Kandola said.

“Who knows how many people are walking around right now, that would not be walking around, because we missed the first three most deadly waves of the pandemic.”

Rapid decisions and confusion

The GNWT’s report – titled Learning from the Response to Covid-19 – notes that the sheer number of instructions published during the pandemic confused many people.

Residents and front-line workers had trouble following a shifting set of public health orders. While officials say those orders needed to shift to match the evolving virus and changing nature of the pandemic, the report states: “People cannot govern their actions if they are unclear about what they are supposed to do.”

Kandola said her office is working on a new public health information system and recognizes that communication during the pandemic could have been better.

Even so, she said the speed with which some steps had to be taken meant there was no time for the GNWT’s usual communications process to conclude.

“It’s not like I was new at this. I’ve had 20-plus years of experience in public health, I’ve dealt with H1N1 and dealt with flu outbreaks – I know how quickly these outbreaks can occur,” the chief public health officer said.

“I know, once it has settled into a community, how fast it can transmit. Some of the measures were based on where the virus is, the data, the evidence we had at that time. And so those decisions were made, the public health measures were made, and then the communication was provided after.

“In making those rapid public health decisions to protect public safety, if we had to go through reviews – like, if we took one week or two weeks to go through giving feedback on the public health measures – we would have missed some opportunities to contain the outbreak.”

Cochrane said communications from the GNWT could definitely improve if a pandemic returns.

“I hate to say this, because I don’t know where I would find the time, but I think that just having more media availability might have been something that I might change,” said Cochrane.

The report’s other key theme is the need to look again at the legislation underpinning the GNWT’s response.

One recommendation asks the GNWT to examine “whether there should be a maximum number of times that a public health emergency declaration can be renewed consecutively,” and, similarly, if a public health emergency “should undergo an additional level of scrutiny after it has been in force for a certain period of time.”

“We had the Public Health Act and we had the Emergency Management Act. I don’t think, when they were designed or drafted, they really contemplated an event like a prolonged public health emergency,” said Robert Tordiff, an assistant deputy minister at Executive and Indigenous Affairs. “And so we worked with the tools that we had at our disposal.”

Tordiff, who helped to draft the report and conducted some of the interviews on which it relies, said he concurred with the finding that the GNWT’s structure during a public health emergency must change.

“It’s not reasonable to expect one office to be able to work through all the potential complications or challenges that might arise,” he said.

“You’ll see, in the report, recommendations about internally organizing the GNWT to be better prepared to respond, not only to pandemics but to all emergencies, so that there’s more participation in some of the decision-making – or at least some of the design or the implementation.”

The report was based on work carried out in July and August last year. An online survey generated 545 responses, three-quarters of which came from Yellowknife, with 15 other communities represented.

Only one community government took the survey – one community government was also interviewed – and no survey responses were received from Indigenous governments. Thirteen MLAs answered the survey, while 53 interviews were conducted with GNWT staff members “directly involved in the GNWT’s operational management of the Covid-19 pandemic.”

Officials said “pandemic fatigue” had probably played a part in limiting the number of responses.

On the day that the public health emergency ended, the NWT had recorded 10,773 cases of Covid-19. At the time, the deaths of 20 people in the territory had been attributed to the virus.

The recommendations in full

Below are the 23 recommendations contained in the GNWT’s report.

1. The GNWT: (i) mandate the implementation of a coordinated Incident Command System (ICS) across all departments and agencies; (ii) establish and document roles and responsibilities with appropriate authority, expertise and resources within the GNWT, including specific and generic job descriptions that may support the timely redeployment of staff to support the expertise required to respond to such events; and (iii) formally establish a process to identify and resolve issues that may arise with use of the ICS structure.
2. The GNWT identify specific competencies and skill sets to respond to urgent situations, support the ICS and ensure the most effective teams can be obtained in a short timeframe.
3. The GNWT continue to support transfer assignments and other mechanisms of hiring to help stabilize workload, and contribute corporate knowledge and expertise, while remaining agile to respond to emergency circumstances.
4. The GNWT continue to develop appropriate tools and resources to support managers and employees who work from home or manage staff working from home.
5. The GNWT develop phased approaches to stand down emergency organizations, and the transition of staff back to their home positions and duties while accommodating the need for recuperation and reorientation.
6. Public health officials, ICS officials, along with representatives from GNWT departments and agencies, be closely involved in the development of local health-related emergency plans with community governments through the Local EMO.
7. Where community government facilities are identified for use during a health-related emergency response, consideration be given to collaboration with the Office of the Fire Marshal and other regulators, to ensure plans comply with fire codes and other regulatory requirements, and public health officials work with community governments to ensure alignment with community emergency plans.
8. GNWT communications products, protocols and processes should be reviewed to consider the development of crisis communication responses in an emergency. The GNWT should consider adopting an ICS approach to crisis communication, which would enable a streamlined approval and implementation process.
9. Staff workload and capacity should be evaluated continually to ensure adequate resources are available, recognizing the demand for increased communications during a crisis.
10. Information about new and changing Public Health Orders should be provided in advance to groups responsible for preparing frontline staff for changes, and to groups responsible for modifying public facing communications (i.e. – websites), to ensure that these channels accurately reflect the most up-to-date information as soon as new or amended orders are released.
11. Internal communications material should be developed in a manner that provides clearer guidance and support to frontline workers as they inform and communicate with the public.
12. The GNWT evaluate the effectiveness of communications in Indigenous languages at the GNWT level with respect to capacity for translation and ensure resources are available for timely and reliable translation in crisis situations.
13. Internal timelines for changes to public health orders should build in adequate time: to share the information internally as between GNWT departments and agencies; to provide feedback; prepare internal communications and implementation plans; and to notify the public in advance of changes to the orders as efficiently as possible.
14. Order-making authority under the Public Health Act should be examined to ensure that there is the appropriate level of public accountability for decisions that are made during a pandemic.
15. The 14-day time period for which a public health emergency can be in force under the Public Health Act should be examined to determine whether that time period could be lengthened in the legislation, and whether there should be a maximum number of times that a public health emergency declaration can be renewed consecutively. The authority responsible for first issuing a public health emergency, as well as the question of whether a public health emergency should undergo an additional level of scrutiny after it has been in force for a certain period of time (i.e. – 30 or 60 days) should also be examined.
16. Legislative processes and timelines within the Access to Information and Protection of Privacy Act, Financial Administration Act, Official Languages Act, and Employment Standards Act should be re-examined to determine whether they are effective and achievable in an emergency response situation.
17. The interplay between the provisions in the Public Health Act and the Emergency Management Act should be examined, to avoid duplication of powers and authorities in the EMA and the PHA related to public health emergencies.
18. Policies and procedures that were adapted to meet emergent needs during the pandemic should be examined by the GNWT Red Tape Reduction Working Group as there may be lessons learned that could improve ongoing GNWT programs and services.
19. Individuals designated as Public Health Officers or transferred into specialized roles such as those individuals who staffed isolation centres, be given appropriate training, supervision and that there be a shared understanding of their roles and responsibilities.
20. Core skills and competencies required for emergency response be identified as part of emergency planning and taken into consideration for redeployments, including experience in procurement, policy, financial administration, crisis management and mental health first aid.
21. Should a future public health emergency result in border control measures, border checkpoints should be located as close as practical to the geographical border. Reliable means of communication should be made available in a timely manner for Compliance and Enforcement Officers and the public.
22. The GNWT should support community governments in their desire to protect residents and inform travellers in the case of future public health emergencies insofar as it is within a community government’s authority.
23. The GNWT should encourage Local Authorities to engage with Indigenous Governments to determine whether the Indigenous Governments would like to participate in emergency response activities through the Local EMO and, if so, to reflect those commitments in the relevant Local Authority’s Emergency Plan.