B.C.’s long COVID cover-up: what they knew and when they knew it

Correspondence between the Ministry of Health and the Provincial Health Services Authority has unveiled more indisputable long COVID knowledge by B.C.’s senior health officials. This revelation came through a heavily redacted freedom-of-information response (p.1-8) divulging a 2020 PHSA business case and a 2021 legislative session fact sheet. Here are some of the behind-the-curtain disclosures. Along with some rabbit holes.

One of the publicly released documents comes in the form of an August 19, 2020 letter from assistant deputy minister of health, Ian Rongve to Alexandra Flatt, vice-president of pandemic response and chief data governance and analytics officer. Rongve, tasked with overseeing B’C.’s COVID response, thanked Flatt “for submitting the business case on behalf of the PHSA related to the creation of a time limited Post Covid-19 Provincial Clinical Program”.

Rongve also explained that although the health ministry is aware of the evidence of “an emerging need for post-acute COVID care,” it is “unable to provide the requested funding”. Specifically, the government preferred “Option 2”. This indicated support for the program but that the PHSA is directed “to fund it internally or by leveraging other funding sources”.

In fact, on September 11, 2020, Rongve clarified the ministry’s stance in a follow-up letter to Flatt. He wrote that “despite being unable to provide the PHSA with additional funding, the ministry is very supportive of the Post COVID-19 Provincial Clinical program”.  In this same letter, Rongve stated that this initiative will “provide an opportunity for the province to be a leader in centralized clinical care management that is actively learning from the evidence”.

Now for the details revealed and acknowledged in the PHSA business case “Ministry of Health decision briefing note” – drafted on August 12, 2020 – that emphasized the urgent need for the Post COVID program.

Let’s begin with the presentation of the business case itself. It kicks off with this ironic statement summing up the “purpose” of the briefing update, that the information was meant to assist the health ministry “make an informed decision”.

Conversely, please remember how entirely uninformed the B.C. public was back then. In words, actions, and policy, our government and public health officials completely omitted any warnings about the potential long-term risks of COVID-19. This rendered it impossible for people to make properly informed safety decisions. And this is still the case today.

And unlike provincial health officer Dr. Henry’s ambiguous words at the time—especially while justifying B.C. 's back to school plan rife with full classrooms, optional masks, surface cleaning and cohorts—this business case did not mince words. The PHSA laid bare this sobering fact: “increasing evidence shows that people are suffering from lingering symptoms after the acute phase.” Then there was this admission: “ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain.”

Let that sink in. Major organ damage. Oh yes, did they ever know. To add insult to injury, the PHSA also cited a July 9, 2020 research letter from Italy, titled “Persistent Symptoms in Patients After Acute COVID-19.” This demonstrates that close attention was being paid to international research findings back then.

Another reference used to prove the need for a post-COVID program is this 2009 SARS-1 four-year follow-up study from Hong Kong. The conclusion “found that 40 percent of survivors experienced symptoms of chronic fatigue following the illness”. This affirms that public health officials were also paying attention to the long-term effects of what came before, at least behind the scenes.

Also, on the topic of major organ damage, the PHSA quoted a July 27, 2020 editorial, alarmingly titled “COVID-19 and the Heart - Is Heart Failure the Next Chapter? “. It stated that the “evidence is also showing an increase in morbidities and mortality in people with pre-existing cardiovascular conditions”.

And then there’s this final quoted reference from a June 9, 2020 U.K. article titled “How Long Does Covid-19 Last?”: “an online survey of almost 4 million people globally indicates that 10% reported persistent symptoms 25 days after diagnosis, and 5% reported being unwell one month later”. Just FYI, that’s 400,000 and 200,000 people, respectively.

Wow, that’s a strong evidenced based pitch about post COVID complications, isn’t it?

Then there’s the PHSA’s business plan post-COVID program goal “to ensure people recovering from COVID-19 continue to receive evidence-informed care when and if they need it”. Nice, right? At least the unaware public would be properly cared for after the onset of long-term symptoms or at least that was the written intent three years ago.

There was a lot of emphasis on the research too, as per this final statement: “The clinical data collected, including questionnaires and referrals to services, will be complementary to the databases and biobanks already in place”.

Thinking on all that, it’s hard not to ponder about what might have been more enticing to the health ministry and the PHSA back then. The evidenced based long COVID patient care or the research opportunities themselves.

Now, let’s talk about money. Specifically, the original ‘ask’ of “$4,330,226 over three fiscal years”. An amount that the health ministry refused to pay.

It’s also important to note that the PHSA described the “Post-COVID Provincial Clinical Program” as “time limited”. This certainly rings true at least for B.C.’s Post COVID-19 Recovery Centers since they are all set to close on April 1st, 2023.

So, did the PHSA ask again for additional funding from the health ministry so that the PCRCs could be kept open? Or was there no desire to do so by either entity? Is it that with respect to long COVID, senior health officials are now taking a page out of Dr. Henry’s Omicron playbook when she veered from ‘we aren’t seeing a lot of cases’ to ‘it’s everywhere now so you’re on your own’?

What is the goal now? The Post COVID-19 Interdisciplinary Clinical Care Network – BC’s centralized hub for post COVID care, education, and research – has accumulated a lot of patient information via biobanks and databases. Since all in-person team-based care is being eliminated, that leaves just virtual care—and all the research opportunities, of course.

Perhaps, the primary focus now is to further research initiatives by using all the aggregated information similar to the data that has been accumulated in this B.C. wide Covid-19 Cohort platform. Oh yes, this “cloud-based, dynamic platform” called BCC19C includes BC-wide “testing” and “linked health histories.”

The BCC19C is composed of a whole host of actionable uses from informing Covid-19 epidemiology and health outcomes to providing “syndromic surveillance from medical visit data” and the “characterization of long-COVID.” In fact, this wealth of long COVID data has already been capitalized on in BC’s ongoing research. For example, this CIHR funded UBC project leveraged comprehensive population-level data via the BCC19C in order to “map the clusters of syndromes,” analyze and “characterize the burden of long-COVID” including “the risk factors, outcomes and healthcare costs.”

Then there’s this one. An Elastic Net Regression Model for Identifying Long COVID Patients Using Health Administrative Data: A Population-Based Study. Sorry, that’s a mouthful. Essentially, an algorithm was created “to identify long COVID patients at the population level using healthcare administrative datasets,” and its “Methods” section confirms that “known long COVID patients in the BCC19C were either diagnosed in BC’s one of four PCRCs” or identified with a code “for ‘post COVID-19 condition’ during ER visits or hospitalization.”

For the record, all this medical data sharing in BC’s research would not sting so much if all the known risk factors, syndromes and algorithms were used to inform and support our public health safety policies, frontline healthcare, and keep our BC PCRCs open, both prioritizing prevention and putting long COVID patient care first.

Okay, back to the F.O.I.  There’s still another important behind the scenes reveal—the legislative session fact sheet for the Post COVID-Interdisciplinary Clinical Care Network and recovery clinics —approved by Rongve on May 27, 2021.

The fact sheet includes this statement: “in April 2020, the PC-ICCN was conceived”. This confirms that B.C.’s senior health officials were aware of long COVID & post COVID multi-system risks since then. At least, they knew enough to warrant the need for clinical care, didn't they?

Now, for the rest of it. This jam-packed document echoes much of the same PHSA business case talking points. It emphasized that the PC-ICCN is the first of its kind in Canada “to standardize post COVID-19 care across health authorities and integrate real-time research into clinical care”. It also provided a detailed list of all the researchers, institutions and studies that would benefit.

But it’s this statement from the legislative fact sheet that makes the decision to close all B.C. 's PCRCs now, alarming: “COVID-19 survivors with complex presentations who do not receive adequate and evidence-based recovery care are at risk of lifetime disability and chronic diseases”. And similar to the PHSA’s post-COVID business case, this document also specified the known multi-system damage: “such as cardiovascular, respiratory, kidney disease and the known burden of depression and psychological impacts of chronic disease”.  

So, what’s going to happen to all those people with complex presentations now? In this February 10th, 2023 CityNews article, a Long Covid sufferer, expressed this same concern. She explained that the importance of “these specialized clinics where they can do all the tests at once” is that they can find lung issues or heart issues requiring treatment.

From this same article: “According to the province, ‘the number of patients referred to the in-person clinics has plummeted by 80 to 90 percent in recent months — and that factors into the decision.’”

Of course, what government officials fail to mention is that it's next to impossible to access a family doctor, much less get a PCRC referral. Also, there’s the influence of public health downplaying of COVID-19 risks combined with the poor communication about post-COVID complications. Doctors not well-versed on the updated risks are not likely to look for or recognize symptoms. Similarly, those patient sufferers only listening to the public health narrative will not know enough to even advocate for themselves.

There’s also this soundbite from Minister Dix: “The move to Post Covid virtual care was a decision made as a result of a recommendation [from clinicians].” Maybe this has more to do with the fact that the healthcare crisis and overload of patients is severely compromising the PCRC clinician teams’ ability to divide their time in multiple roles.

And this final excerpt from this same article takes us back to the subject of funding. Here, Dix explained that B.C. is “the only province that has a Post COVID-19 Interdisciplinary Clinical Care Network, and we are making that a permanent investment”. Unbelievably, he also stated that the health ministry is “expecting the budget to increase by about $2.5 million [for post COVID services] which is a significant increase”.

So, the health ministry is in full support of the PC-ICCN for the long-term now, and is finally investing more in post COVID services, all the while replacing PCRCs with virtual care. But why a sole emphasis on virtual care and research?  

Perhaps it has something to do with the federal government’s recent announcement of its 29-million-dollar investment for the creation of a long COVID “online network”. Since B.C. is an established leader in this regard, it’s not surprising that PC-ICCN’s health officials and researchers would want to keep their virtual network and research hub on the national stage. As a matter of fact, the PC-ICCN is already included as an “in-kind” supporter on the newly created national long COVID web.  

In this March 18, 2023 Vancouver Sun article – highlighting Canada’s chief science advisor, Dr. Mona Nemer’s sobering report specifying that Canada is likely facing “a mass disabling event” – Dr. Adeera Levin, PC-ICCN executive director, “‘said the move to a virtual care model shouldn’t change the quality of care’”. Levin also parroted B.C. health minister Dix’s talking points by explaining “’that most of the visits had turned into virtual’” and the number of referrals had dropped off’”. It sounds like they are both talking from the same fact sheet, doesn’t it?

Speaking of fact sheets, let’s circle back to the F.O.I May 2021 legislative one. We know that all the serious multi-system COVID-19 risks outlined in it were not being shared publicly by our health officials.  But were these truths being discussed in the B.C. Legislature? A simple Google search of the words “Hansard” and “long COVID,” brings up four instances.

The first is from a March 3, 2021 Question Period and features Green Party leader, Sonia Furstenau, citing international long haul research findings showing that mostly women are affected and that children are suffering too. She then asked Dix, if “his ministry is collecting data about long-term COVID illness experienced by British Columbians, and if so, where is the information being posted for the public”?  

Dix’s answer, if you can believe it, was “that COVID-19 as a long-term impact, is at the center of our responses”. He also stated that these “issues” have been reported on and answered by Dr. Henry in public briefings. He then suggested a separate briefing “so that [Furstenau] can get a sense of the actions” being taken to support people “who are dealing with the long-term effects”.

Next, Furstenau asked how the government is preparing to support patients “in the event that they are unable to work or go to school, while navigating a long and uncertain recovery”. Dix’s answer to this was to explain that there are specialty clinics “to address the needs of people who are dealing with the ongoing effects of a COVID-19 infection.” He also said: “Everything we do is based on the evidence.”

On the contrary, according to this Vancouver CityNews article, here’s what Henry was saying the very next day in a March 4, 2021 public health briefing: “’Maybe I’m too optimistic, but we’re going to be in our post-pandemic world by the summer, if things continue to go the way that we want them to’”. Does this sound like a public health response centered on protecting people from the long-term impacts of COVID-19?

Long COVID was also mentioned in the Legislature on June 17, 2021. This official transcript recorded Furstenau again, pressing for answers. After pointing out that “people are struggling with increased fatigue, brain fog, nerve and muscle pain, high blood pressure and psychiatric issues,” she asked how the health ministry plans to provide long-term support.

Dix’s answer? “It’s also true that COVID-19—this is, of course, a new virus in the world—is having long-lasting effects. That’s why we are leading in terms of research in British Columbia, under the direction of Dr. Henry and teams throughout health authorities, in addressing these questions. We’ve added specialty clinics to support long-haulers, and we will continue to do so.”

These statements from B.C.’s health minister are on the heels of Henry’s June 3, 2021 Vancouver Sun OpEd in which she emoted: “We will finally be able to do more of the things we love, like gathering with friends, celebrating an important life occasion with family, and even hugging a loved one.”

So, through her words and actions, heading into the summer of 2021, Henry did not appear to be cautioning people about post COVID health complications. She also did not seem too concerned about increased COVID-19 transmissions that would put more people at risk. According to Dix though, it sounded like Henry, and her teams, were very busy conducting studies.

Long COVID was still not being disclosed by public health officials almost a full year later either. A good example of this is Henry’s March 31, 2022 response  to human rights commissioner, Kasari Govender, to justify lifting the mask mandate. In it she stated: “Thankfully the data tell us the risk is no longer elevated in most people, even in people with underlying medical conditions, who are fully vaccinated.”

Now, let’s compare these words above from Henry with those spoken by Furstenau and Dix in these next two legislature transcripts from 2022.

On April 6, 2022 , Furstenau explained that there are “potentially 83,000 B.C. residents experiencing symptoms of long COVID”. She specified that according to the research, the spectrum of symptoms include “systemic neuropsychiatric, respiratory, cardiac, gastrointestinal and endocrine complications”. Adding that symptoms are affecting those vaccinated and “after both mild and severe cases of COVID”, Furstenau asked about the government’s responsibility “to inform, educate and support the public”.

Dix’s response was to insist that long COVID is an “absolute priority” and that: “We know that many people recover differently, do not recover well and have long-term consequences.” He also explained that the PCRCs support patients “in the thousands, with positive results”. And he even proclaimed: “B.C. is leading Canada in that regard and working with everyone in the world to support people who are struggling with COVID-19.”

Yet, outside the legislature walls, just nine days prior, Dix was not only not informing the public about long COVID, he was doubling down on defending Henry’s mask repeal. As he said in this March 29, 2023 Tyee article, “the decision to end the mask mandate was made after careful consideration of the evidence”.  

In this last May 12, 2022 transcript, in his response to Furstenau on the topic of PCRCs and the  PC-ICCN, Dix championed the PCRC “knowledge sharing” that has involved “1,109 physicians across B.C.''. He then explained that the reason his ministry supports the PC-ICCN is “to successfully deal with a phenomenon such as long COVID, which we’re uncertain about—uncertain about its impact over time, about how people who had different variants will react over periods of time”.

Let all these words within the walls of the legislature sink in. Especially Dix's acknowledgements about the risks of long COVID, and his statements that it has always been ‘a priority.’ Yet, the revealed post COVID knowledge in the F.O.I documents—that he, his government, and Henry have all been privy to for three years now—was never prioritized in B.C.’s public health messaging nor has it ever played a central role in Covid-19 safety policies.

These F.O.I documents and Dix’s affirmations in the legislature, thanks to Furstenau, are just the tip of the iceberg about all that has been known and not shared. But even so, let’s travel back to August 2020 when the PHSA’s post-COVID-19 business case was officially being presented to the health ministry. Let’s imagine, back then, that this document was also being publicized without censorship through our government, media, and public health officials. All our family and friends united in the knowledge of the long-term risks. All of these truths fully informing our public health policies with proactive protections in place to keep our children, grandparents, school staff, and health care workers safe.

Now, in this alternate reality, fast forward to today. How many more British Columbians would still be living their full lives? How many more people would still be alive today?

Addendum

After writing this, there was yet another instance of truth-telling in the B.C legislature. On April 27, 2023, during this Committee of Supply Debate (3:40-3:54), Sonia Furstenau challenged Minister Dix on the facts about what was known, as revealed in my piece above, as well as emphasizing that, to date, BC public health briefings were devoid of any long COVID education or information about the risks of multi-system organ damage, especially heart complications.  

In his response, while reading from what sounds like the same legislature fact sheet revealed in the F.O.I above, Minister Dix proudly stated on the record that “with respect to long COVID, we started to put together — conceived in April 2020, right at the beginning of the COVID-19 pandemic, within a month of it — the post COVID-19 interdisciplinary clinical care network.”

Confirming that post COVID harms and long COVID were not only known about by B.C’s top government and public health officials back then but that they were serious enough to warrant a PC-ICCN. As per: April 27, 2023 Official Report of Debates (Hansard) - p.28

More about what was known by B.C’s PHSA & what was being communicated behind the scenes via the PC-ICCN. My first piece: https://docs.google.com/document/d/1HX0vxzOh5HOnaDAr8wa8oFTrMi5ODgHItGLqnb9yEZA/edit 

My third piece. A complete timeline inclusive of my first two pieces and PopNB’s RTI work: https://docs.google.com/document/d/1MRKVMX0nbAwpvQHqfSmg2k0n-b9O9LkaBcF_10KeoQY/edit