The incredible stupidity of not putting Dr. Joanne Liu in charge of Quebec’s response to the coronavirus

Quebec has entrusted its response to the inevitable second wave of COVID-19 to a publicist, while the Wayne Gretzky of public health rides the bench
Photo: Mueller / MSC
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This article originally appeared in the French edition of Ricochet and has been translated.

Without fanfare, the Legault government has entrusted a publicist, Daniel Desharnais, with developing Quebec’s strategy to combat the predictable second wave of COVID-19 and with “reorganizing” the province's long-term care homes, which were the hardest hit by the first wave. This double mandate was announced publicly, but curiously the media have not underlined the real meaning of this crucial decision in the middle of a crisis.

First, it means that Dr. Horacio Arruda, the province’s public health director, is no longer the main general in the war against the epidemic under the political command of Premier François Legault and Health Minister Danielle McCann. Desharnais was appointed to the post of deputy minister of health — in charge of “special projects” — in mid-April. That puts him at the same rank in the hierarchy as Dr. Arruda, but with much more strategic responsibility.

Second, it means the government has decided to switch generals in the middle of the war. However, they did not use the opportunity to name the person who has by far the most expertise in the fight against epidemics: Dr. Joanne Liu, former president of Doctors Without Borders, whose competence is universally recognized — the equivalent of a Wayne Gretzky in hockey.

What mediocrity, what macho contempt of these small provincial bureaucrats towards one of the most competent Quebec doctors and managers, trained in the best universities. Why is she not the leader, consulting the ministry’s apparatchiks?

Legault and his chief of staff, Martin Koskinen, instead preferred Desharnais, director of Tact Intelligence Conseil, a public relations firm. Desharnais has a master’s degree in history and previously served as chief of staff to former Liberal health minister Gaétan Barrette. He was a close collaborator when Dr. Barrette carried out devastating reforms in the health ministry marked by extreme centralization and the elimination of numerous managerial positions, the effects of which are being seriously felt in the current epidemic.

This information is available to everyone. The Journal de Montréal reported on April 17 that Legault’s cabinet entrusted Desharnais with “the task of reorganizing” long-term care homes. Journalist Denis Lessard wrote that Koskinen consulted with Dr. Barrette, now the Liberal MNA for La Pinière, before making the appointment.

“The Legault government was slow to give Dr. Joanne Liu the attention she deserves,” wrote François Cardinal, editor with La Presse. “But the noises coming from Quebec City suggest that Deputy Minister Desharnais, who is working on the action plan for the second wave, is considering one of the ideas of the former president of Doctors Without Borders: mobilizing response teams that can act quickly.”

So two questions need to be answered:

  1. What role remains for Dr. Arruda if another deputy minister has been tasked with reorganizing long-term care homes, which are still reeling from the first wave of COVID-19, and developing the strategy for dealing with the second wave?

  2. As for switching generals in the middle of a war, why not choose the best, Dr. Joanne Liu, rather than just taking one of her ideas and, presumably, consulting her on others?

The popular Dr. Arruda

Up to now, it was believed that Dr. Arruda made the decision, on March 13, to rapidly shut down Quebec — a few days before other provinces. Quebecers saw this as the courageous action of a doctor capable of making a difficult decision for the common good, even if it could turn out to be unpopular. This earned him a chorus of praise. Appearing every day alongside Legault and McCann at press conferences, Arruda stole the show.

Fans, glued to their screens each afternoon to watch the “Horacio show,” made a Facebook group with the name “Horacio, our hero.” T-shirts were printed with his likeness. A baker put his face on bread. A microbrewery created a beer in his honour. A petition was launched to encourage him to share his recipe for Portuguese tarts. A rapper made him dance to these lyrics: "Partout sur la Terre y’a un oragio /Mon paratonnerre c’est Horacio / On est chanceux d’avoir François Legault / Suspends tous mes droits, j’te donne le go” (“Everywhere on Earth there is a storm-io / My lightning rod is Horacio / We are lucky to have François Legault / Suspend all my rights, I give you the go”).

When disagreeable sorts (including myself) expressed doubts about the relevance of this little dance, the co-host of Tout le monde en parle, Dany Turcotte, called them “constipated” and said that Dr. Arruda would make a good politician.

Alas, oops! In an analysis published by Radio-Canada on May 25, journalist Martine Biron informed us it was not actually Dr. Arruda who made the decision to shut down Quebec, but rather Martin Koskinen and his special advisor Stéphane Gobeil. Arruda, in fact, was across the Atlantic on vacation when the decision was made. Since the beginning of January, according to Biron, authorities in B.C., Alberta, and Ontario had been alarmed by the spread of COVID-19 outside China and had ordered masks and personal protective equipment. Quebec did not feel the urgency to act and didn’t order masks until about Feb. 19, two to three weeks later than the other provinces.

This is probably the public health director’s main role — to endorse the government’s decisions — and the government takes advantage of his popularity.

The public health emergency was declared March 13. On Tout le monde en parle, Dr. Arruda said we were dealing with “a cursed virus, which, we didn’t know, is transmitted prior to people presenting symptoms.” This crucial information, however, had already been known for many weeks. By the end of April, Quebec’s public health authorities still hadn’t fully appreciated the importance of asymptomatic transmission. A government directive asked health care workers infected with the coronavirus to return to work in long-term care homes before the end of their isolation period if they did not have symptoms, leaving the elderly in these facilities at risk of infection.

Mistakes, blunders, and bad information have come and gone. Also at the end of April, Quebec’s institute of public health warned against adopting a herd immunization strategy, arguing that it would cause thousands of deaths. The next day, Dr. Arruda did not protest when Premier Legault made an appeal for this strategy. The same silence surrounded the decision to hastily reopen schools, as Quebec stood apart from the rest of North America in this regard.

At the beginning of May, Dr. Mona Nemer, a former researcher and now chief science adviser to Prime Minister Justin Trudeau, questioned Quebec’s testing strategy. “I would have expected to see a plan, but I haven't seen one. And yet, I have asked for it several times,” she said. Dr. Arruda took off his director of public health hat and put on his politician one to retort that Quebec is not accountable to Ottawa.

According to my sources, Dr. Arruda’s offices are in the same building as those of Premier Legault’s political staff. We never hear him calling into question the premier’s decisions, unlike his counterpart in Ontario, Dr. David Williams, who has publicly opposed Premier Doug Ford’s plans to reopen.

In Quebec, nearly every day Legault or one of his ministers announce decisions by claiming they have the approval of “public health,” meaning Horacio Arruda. This is probably the public health director’s main role — to endorse the government’s decisions — and the government takes advantage of his popularity. But in fact, it's the assistant deputy minister, Daniel Desharnais, who will do the real work.

The austere Dr. Joanne Liu

Dr. Liu is in some senses the opposite of Dr. Arruda. The serious look behind her glasses, a face framed by long black hair, an almost awkward smile in photos — she doesn’t go out of her way to seek attention.

The whole world, however, was able to see her expressing her anger after the bombing of a Doctors Without Borders hospital by U.S. forces in Kunduz, Afghanistan, on Oct. 3, 2015. Four days later, then president Barack Obama phoned her to offer an apology. Coming from the leader of the greatest world power, it was a rare gesture, and nearly anyone on the planet would have accepted the apology. Not Dr. Liu. She curtly refused and continued to demand an independent inquiry, including when addressing the UN Security Council one year later.

After specializing in pediatric emergency medicine at the famous Bellevue Hospital in New York, she earned a management degree: an International Master’s in Health Leadership. She deployed with Doctors Without Borders medical teams to countries on the Indian Ocean to help victims of the 2004 tsunami, then moved to conflict zones in Kenya, Palestine, Central African Republic, Darfur and the Congo. In 2013, she took over the management of Doctors Without Borders, a large organization with hundreds of members located in 24 countries.

Quebec has deprived us of this extraordinary woman, who could be leading the fight against COVID-19, even as the province is one of the five regions in the world with the highest mortality rate due to the disease.

She has been at the forefront of combating cholera epidemics in Haiti and Yemen. She led a veritable marathon against the largest Ebola epidemic in history in West Africa. It is partly thanks to her that the devastation caused by this epidemic was relatively limited, not exceeding 12,000 dead. In 2015, Time magazine included her in its list of the 100 most influential people in the world.

Quebec has deprived us of this extraordinary woman, who could be leading the fight against COVID-19, even as the province is one of the five regions in the world with the highest mortality rate due to the disease. When I read a report by journalist Sophie Langlois on this subject, I could not hold back tears of rage. Writing this down, I’m still crying.

As a journalist, I should remain neutral. I am not. I’ve never been so angry. I learned that, just last week, a member of the premier’s office continued to repeat the government’s mantra: Dr. Liu has only run an NGO and has no knowledge of how the health ministry works. What mediocrity, what macho contempt of these small provincial bureaucrats towards one of the most competent Quebec doctors and managers, trained in the best universities. She is “consulted” by the department, and probably consulted by the new deputy minister, Daniel Desharnais, who wants to implement one of her “ideas.” Why on earth is it not the opposite? Why is she not the leader, consulting the ministry’s apparatchiks?

“The decision to dismiss Dr. Joanne Liu, an international authority on epidemic control, [made by] the government’s experts, was motivated by a fear that she could not be controlled,” wrote Sophie Langlois.

“She was asked to go to the far north. For them, her experience in Africa coincided more with Indigenous realities,” one of her friends, who advocated for her to the Legault government, was quoted as saying. “They were afraid that Dr. Liu, who is not accountable, could not be controlled, that she would be too difficult to manage in a boat already led by three captains [the “shock trio” formed by Legault, McCann and Arruda].”

On Sunday, March 29, Dr. Liu had a piece online for the Globe and Mail, where she proposed three lines of action against COVID-19. Even before it was printed in the Monday newspaper, I hastened to translate it and share it. You must read this text again. Based on her experience, she proposed three courses of action:

  1. Dedicate entire hospitals or sections to COVID-19. In each establishment, “there needs to be a dedicated COVID-19 area and a non-COVID-19 area with no interchange of staff or patients between the two.” Numerous testimonies from health care personnel show that quite the opposite has been done, under the leadership of the “shock trio.”

  2. Protect the physical and mental wellbeing of health workers. “We need to make sure that our medical staff will always have the right PPE available at all times.” In fact, care attendants, nurses and other workers were sent into long-term care homes without the necessary equipment. They were infected with COVID-19 and also spread it. Four of them died.

  3. Continue intensive care for patients without COVID-19. “We should not create a second-rate status for non-COVID-19 patients with acute needs.” But this is exactly what has happened. Thousands of surgeries have been postponed, increasing the anxiety of so many and possibly worsening their condition.

Some people have started to say aloud the taboo word: “failure.” It is indeed time to admit that management of the epidemic has been a gigantic failure. Of course, there was also an external situation for which the Quebec government is not responsible. The Canadian government, which did not take the 2003 SARS outbreak seriously like countries such as South Korea or Taiwan did, also has to take its share of responsibility.

But now is not the time to speak of a public inquiry or an investigation. It’s time to shake up the leadership, and to put in charge not the doctor who would have liked to be an actor, nor a publicist who helped a minister turn the health ministry upside down, but a real expert who has proven herself time and again and shown her skills.

Because the war against COVID-19 is far from being won.

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