'Show your work': Calls grow for greater COVID-19 transparency in B.C.

Experts from various fields are adding their voices to the growing chorus of demands for more information on B.C.’s pandemic policy-making process.

Even the most ardent of rule-followers is growing weary after more than a year of sacrifices and restrictions, so experts say explanations and transparency with information could bolster morale and improve trust in health officials.

University of Toronto epidemiology professor David Fisman said he’s troubled by what he called “asymmetrical information” from the provincial government.

“You can’t, in British Columbia, have five million decision makers,” Fisman said. “Public health, at the end of the day, have to make some hard calls. But you also, I think, need to be transparent with people and treat them like grown-ups and show them what your decisions are based on and be open to the possibility you may not be right about everything.”

One of the province’s advisors on COVID-19 strategy and response echoed that sentiment, saying greater transparency is especially important as coronavirus variants spread in B.C.

“Let’s call, as a community, for more transparency,” said UBC biomathematics professor, Sally Otto. “We can only fight this new variant if the community ramps up their restrictions and they have to be informed about why.” 

One of Metro Vancouver’s most high-profile data analysts and modellers points out some public health and frontline medical workers have little sense of what’s going on because they have access to the same information as the public.

“Half of your organization is going to be in the dark if you don’t put this out publicly, and that’s a problem,” said Jens von Bergmann. “There is outside expertise that’s useful and the BCCDC has been drawing on this.”

The province has been facing increasing criticism for sticking to existing policies rather than ratcheting up restrictions or introducing other measures to combat the variants now driving infections ever higher. B.C.’s top doctor insists the guidelines are sufficient, but acknowledges people aren’t following them as closely as they should be.

“Unfortunately what we're seeing is that the numbers of contacts that people are having in those social networks have been expanding in the last little while,” said provincial health officer Dr. Bonnie Henry on Tuesday. “We need to work together on this.”

Ken Coach, a veteran public relations strategist and crisis management consultant, said he believes it’s time for the government to change its approach to get more buy-in from a pandemic-fatigued populace.

"I think that a lot of the things that were done in the beginning of this pandemic worked for a while, but people just feel they’ve been hearing the same thing without any new results, so how we can deal with that? I think put everything on the table is one way,” said Coach.

He also pointed out that while pandemics were new and strange terrain for many a year ago, the intellectual landscape has changed as the public learns more and inevitably compares B.C.’s approach with others.

“People want to know more about how those decisions are being made, what data is being used, and maybe even a little explanation about why something might be working somewhere else but is not applicable to B.C.” said Coach. “Information is always useful.”

Claims of openness don’t line up with reality

When Metro Vancouver mayors penned a letter to the province in November saying they were getting far less information than their counterparts across the country, B.C.’s premier disputed their premise.

“We have been as transparent as any jurisdiction in North America on a daily basis for months, giving appropriate information to the public,” said Premier John Horgan at the time. “I’ll defer to Dr. Henry for her rationale about how we distribute this information, but first and foremost we do not want to stigmatize individuals, we do not want to stigmatize communities or neighbourhoods.”

In the early days of the pandemic, Henry refused to give detailed demographic or geographic information, citing worries about communities being stigmatized. That also meant that leaders in minority and First Nations communities, as well as in some high-risk occupations, had little sense of the virus’ impact and didn’t respond until infections were widespread and difficult do address.

On Tuesday, Henry was asked to provide detailed information about hospitalizations, but fumbled through her notes as she said she didn’t have it available and advised the questioner to check the broad information available on the BCCDC’s dashboard.

“I'm not sure what you want, to be honest,” she said.

That off-the-cuff statement and the overall default to a “need to know” attitude toward information and details is at odds with other jurisdictions across the country. Even though the doctors in charge of those provinces and health authorities have access to the same information; they have chosen to provide more to the public, rather than less.

Quebec officials, for example, provide more information about occupation-based COVID infections, while disclosing how many cases are in each hospital, the number in ICU and a range of duration for the patients’ stays. They provide statistics on infections in public versus private schools, as well.

In Alberta, not only does a single website show how many active cases and deaths have taken place in each neighbourhood, an interactive map includes information on school infections.

Ontario has the kind of information many British Columbians can only dream of: not only is county-level data available, but users are able to see overall infections, active cases, variant cases and vaccination rates in their area. 

A difficult but necessary conversation

Opening up the books, as it were, doesn’t necessarily have to be a difficult or uncomfortable move for the government.

“I’m a huge believer in ‘transparency builds trust,’” said palliative care physician and UBC associate professor Dr. Amy Tan.

She says the vast majority of patients and their families would rather have more information than less when making difficult decisions at the end of a loved one’s life. She believes the parallel during a pandemic is an important one to draw.

“I get that it’s more difficult from a population health perspective, but I think having a paternalistic approach of ‘we know best’ is not working, because look at where we’re at right now,” said Tan. “There’s a desire for more information, there’s a desire for more transparency in data, there is a desire in explaining the rationale behind the way things have been decided.”

Fisman praised Henry’s ability to communicate empathy and pointed to her early success in connecting with British Columbians as an opportunity to re-connect with people.

“This is where I see B.C. has an advantage over a lot of other provinces, I think Dr. Henry is a particularly gifted communicator,” he said. “I know it’s easier to win the argument if you say, ‘Oh, I have this data and I’m not going to show it to you, but I know what I’m doing.’ It’s much easier to win that argument, but I think in the long-term it undermines trust and undermines credibility.”

Coach points out that when private companies go to him with a crisis, he suggests a three-step plan: accept responsibility, fix the problem, and take measures to ensure it doesn’t happen again.

“If you pull back the curtain and say, ‘Here’s what we know and here’s everything we’re making our decisions about, here it is laid out,’ that’s helpful,” he said. "The downside to that is you’re going to have people question those decisions based on the data we give them. But, if we are comfortable in the decisions we’re making, there should be no reason why we wouldn’t show our work and show how we reached that decision.”