Dr. Shahab says pleas from health officers in line with his own recommendations to government

Saskatchewan's top doctor says a public request from medical health officers for more restrictions to combat COVID-19 are in line with his own recommendations to the provincial government. 

In a recent letter to Health Minister Paul Merriman obtained by CBC News, medical health officers urged the province to implement more stringent restrictions, including gathering limits, a proof of vaccination requirement with no option for a negative COVID-19 test, expanded testing and contact tracing, and clearer government messaging on reducing contacts and working from home. 

"Certainly those are all important steps that we should consider, and they're closely aligned with many recommendations that I made to government," Dr. Saqib Shahab said at a news conference on Tuesday. 

Although Shahab did not offer specific examples, it is the first time the province's chief medical health officer has confirmed the nature of the recommendations he has put forward to the government. 

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Shahab has previously resisted directly answering questions about what recommendations he has put forward.

Saskatchewan's Health Ministry and the province's executive council have also declined to provide specifics on Shahab's recommendations.

Earlier this month, Merriman would only say there have been "lots of recommendations over the last little while." 

'Calls for provincewide action have not been answered'

The letter sent to Merriman, dated Oct. 21, was signed by 21 of the province's medical health officers.

It said the delay in implementing some of the recommendations they called for in August has "resulted in a much larger fourth wave" of COVID-19 cases, and stronger restrictions are now needed needed to bring it under control.

"Our calls for provincewide action have not been answered," it read. 

"In our current context, reported positive cases do not tell the full story. Without further action, it is highly likely that we will face even higher rates of hospitalization in coming weeks and risk health system collapse, as well as many more preventable deaths."

At the same Tuesday news Shahab spoke at, Dr. Tania Diener, one of the health officers who signed the letter, said she felt it was important to speak out. 

"Our case numbers, our deaths, our ICU numbers compared to the rest of Canada is significantly high, and we felt the correct thing is to again write a set of recommendations that we believe is important to implement as soon as possible if we want to get this fourth wave under control and minimize disease and death in this province," she said. 

Diener added that the health officers were still awaiting Merriman's response. 

On Tuesday, the provincial government confirmed it had received the letter and that a response was "forthcoming."

The letter

While much of Saskatchewan's population is now fully immunized and coverage rates have improved following proof of vaccination requirements, physicians said the province is not yet expected to meet the level of immunity needed to stop the growth of the pandemic for several months.

Dr. Cory Neudorf — a senior medical health officer with the Saskatchewan Health Authority who helped pen the letter — said the biggest issue continues to be widespread community transmission, particularly among the unvaccinated population.

"It's no longer an issue where we can afford to wait for increasing immunization rates for a number of weeks to take effect," he said in an interview Monday. "We need something that's very quick and decisive — and quite blunt."

Neudorf said "stop-gap measures" — via a provincial order — are needed. Those include:

• Gathering restrictions:
  • Unvaccinated people should not gather outside their households.
  • Vaccinated people can gather with up to one other household.
  • Venues (used for weddings and funerals) should be reduced to 25 per cent capacity, with no indoor dining unless proof of vaccination is required at entry. 
  • Places of worship that don't require proof of vaccination should mandate mask wearing and reduce in-person attendance to 25 per cent capacity.
• Proof of vaccination required with no negative test option for:
  • School staff, students 12 and older, and households of students under 12 that aren't vaccinated.
  • All daycare staff.
  • All facilities hosting youth sports or extracurricular activities, including participants, staff, coaches, volunteers and spectators.
• Clearer government messaging around:
  • Reducing contacts and outings by 50 per cent for the next 28 days.
  • Working from home again, if possible.
  • The importance of being fully vaccinated and for people to seek out reliable information sources.
• Adopt the remainder of the Aug. 26 recommendations, including:
  • Expanding testing and contact tracing capacity.
  • Publicly reporting more detailed COVID-19 information, such as modelling data and case and immunization numbers in narrower age groups.
  • Increasing access to linked data so epidemiologists can give better advice to public health teams.

The doctors said these restrictions, on top of the already-in-place masking mandate, is needed until at least the new year. Their removal should be tied, the letter added, to when 85 per cent of Saskatchewan's population is fully immunized and the health-care system is stabilized.

"We understand that returning to these restrictions is not what our population wants, or what our leaders want to contemplate, but with the health system in crisis, the alternatives are much worse," the letter said.

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If the government chooses not to implement any new restrictions, doctors say a lockdown similar to spring 2020 could be needed. That would include moving all students back to online learning.

Medical association stands behind MHOs

In a letter to physicians on Monday, Saskatchewan Medical Association president Dr. Eben Strydom said he's feeling "such a mix of frustration, anger, sadness, fear and despair" over the government's inaction.

"Even though it seems like most everything we have advocated so far — as individuals, as groups of physicians, collectively as the SMA — appears to have fallen on deaf ears, we must not stop," he said in Monday's letter.

"So you ask: 'What more can we do if government continues to dismiss our advice?' We need to reinforce our advocacy efforts by asking each one of you to be directly involved."

Strydom called on the roughly 3,000 doctors in Saskatchewan to use their voices to educate their patients, along with everyone they interact with in the community.

"In a province our size it wouldn't take long to reach hundreds of thousands of people. We can make a difference," he wrote.

Strydom noted he met with Health Minister Paul Merriman last week, and although he "did not leave this meeting encouraged," he said the medical association will continue to advocate for increased public health measures alongside health officers.

"Our future depends on what we do today. It really, truly does. We must continue doing everything we possibly can to slow community transmission," he wrote. "Our patients, our neighbours, our communities, the province need us to stay strong on their behalf, for the safety of themselves and their loved ones."