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.
“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.
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.
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.”
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.”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.
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.”