Dr. Fahad Razak on why the province is dissolving the Covid-19 Science Advisory Table

Dr. Fahad Razak on why the province is dissolving the Covid-19 Science Advisory Table

“Sometimes topics of interest related to the pandemic can make the government uncomfortable”

Ontario’s Covid-19 Science Advisory Table is a group of hundreds of volunteer physicians and scientists who have provided critical research and modelling to the government and public over the course of the pandemic. When U of T internist and epidemiologist Dr. Fahad Razak took over for outgoing director Peter Jüni this spring, he assumed he’d be in the position for the foreseeable future. Then, on August 26, Dr. Razak and his team announced that their work would be discontinued as of September 6. While the scientists claim that the independent body is being dissolved, Premier Doug Ford has asserted that it is merely being “absorbed” by Public Health Ontario and will live on in some new form. Leaked correspondence suggests that this new group could be subject to government veto power in terms of the subjects of research and communication. So what is actually going on? We spoke with Dr. Razak to get his take.

You were the head of the Covid-19 Science Advisory Table, and now it seems the table is no more. What happened?
We are still around until September 6, so we will spend the time we have left seeing our existing work to its conclusion. But then, yes, the science table as we have known it for the past two and a half years will come to an end. I learned about this decision on August 18, when we were told by Public Health Ontario executives that the table would be winding down.

You took over just a few months ago. Do you have any idea why the decision was made?
We know that Public Health Ontario has announced its intention to create a new group, but the details of that group have not been announced yet. Certainly, I was surprised by the news. In the long term, it’s unlikely that a table like ours—with 30 to 40 core members and hundreds of associated members—would continue in the same capacity. But, in the short term, we were operating under the assumption that we would.

When questioned last week, Doug Ford said that the table has been “absorbed” by PHO, which is different from what you are saying. 
The table has actually been part of Public Health Ontario since April. Before that, we operated out of U of T. At first, it seemed like a very natural transition for our type of organization to sit within the public health infrastructure of the province, which is PHO, so I wouldn’t say there was any reason to be alarmed at the time.

Why does PHO need a new committee when we already have—or have had—a science table for two and a half years? If it ain’t broke, as they say…
That is an important question. It’s just not one I have an answer to. Based on meetings we had earlier in the month, my understanding is that the new group will have a very different membership and a very different presence in terms of reporting its findings to the public. But I want to emphasize that we still don’t have any of the final details, so I think it’s important to wait and see. It is my sincere hope that whatever comes next is successful. When public health is successful, Ontarians are safer. That’s what I want and what everyone at the table wants.

According to leaked information, the new group will have “limited independence” from the government. Is that something you can talk about?
In our public statement, the table shared our view on why scientific independence has been so critical to the work we have done. We outlined three reasons. The first is the ability to choose topics that are really of interest related to the pandemic. Sometimes those topics are obvious, like: What should you expect in the next fall wave? And sometimes those topics can potentially make the government uncomfortable. For example, maybe we think it’s important to look at why certain groups are getting sicker or dying at higher rates than other groups.

The second thing about independence is that you need to be able to evaluate that information with as little interference as possible in order to come up with scientific findings. In some ways, our job is a lot easier than the government’s job because we are looking at just the science and policy makers have to consider a lot of other factors: cost, individual freedoms and so on.

And then the third piece is the ability to report and communicate our findings: to the government, to the scientific community and to the public.

If a government is in a position to decide what information the public has access to, is it not reasonable to assume that it might want to publicize favourable information and suppress anything that could make it look bad?
I mean, that’s the worry always—not just regarding this pandemic. Historically, that’s the tension with government and information: the control of that information.

Speaking of access to information, for the past two and a half years, the table has provided up-to-date data on Covid-19 via a dashboard. Will that also be over as of September 6?
Yes. The dashboard was conceived by my predecessor, Peter Jüni, as a way to make information on the pandemic as up-to-date and accessible as possible. I think we can say, objectively, that it was a very useful resource, with close to 2.7 million views.

Wow. Those are funny cat video numbers.
Exactly. For a dashboard that presents scientific information, that’s a very large audience, and I think that’s because the dashboard was used by a large and varied group: the media, the scientific community and members of the public. If you look at a lot of the reporting—let’s say a newspaper article that’s describing the wastewater signal in Ontario or protection levels of the vaccine—there’s a pretty good chance that the graph in the piece is a direct screenshot from the dashboard. And, for the public, I think the dashboard became an important source where people could get a snapshot of what was happening in their communities so that they could make better decisions. That kind of information is really, really important as we move into a phase of the pandemic where more of the risk assessment on what to do falls on individuals.

When you first started your role in the spring, you said you were very concerned about a potential new wave in the fall or winter. Is that still how you’re feeling?
Yes. I am very concerned that we are heading into a dangerous period, and that is for a few reasons. If you look at certain risk indicators in the province—positive tests, people in hospitals—we are seeing numbers that are five to ten times higher than this time last year. That is because we had a wave, the BA.5 wave, in the middle of summer, which did not happen in 2021. Our hospitals aren’t getting the same downtime that we generally get at this time of year. Normally, August is a period of recovery for hospitals, when they catch up and get ready for fall and winter, which tend to be a lot busier. Instead, we are dealing with capacity issues and staffing shortages that are worse than anything I have seen in my career. This isn’t just a Covid issue—it’s about caring for the patient who’s in a car accident or who has a heart attack; it’s about delivering cancer screening and surgery. And keep in mind that the past few years have seen very little influenza because the same steps we’ve taken to control Covid have reduced influenza. So, as many stop taking those steps, what happens when that additional burden returns?

You recently wrote an op-ed saying that our leadership needs to “stop minimizing.” Given everything you’re saying about the next few months, would it be prudent for our elected officials to consider maximizing, or at least being honest about what’s coming?
I think the challenges around risk communication have been glaring in the past two and half years. How do you keep telling people that they need to be worried and having them respond? We’re talking about the psychology of a pandemic, which has resulted in severe fatigue. Certainly, there is an opportunity for the government to step forward and say that we are facing a serious problem and that controlling viral spread is part of the solution.

I want to ask about masking in schools. The table recently released its back-to-school recommendations. Those recommendations did not include mask mandates because of a “lack of consensus.” What does that mean, exactly?
There have been a lot of questions about that report and a lot of controversy, so let me do my best to explain, starting with what we know. Does a mask protect you from getting infected? And does it protect others from being exposed if you are infected? The answer to both of those things is absolutely yes. There is clear scientific agreement on those two things. The next question is whether a mask mandate works in a school setting. Public Health Ontario looked at every available study about mask mandates in schools and found that, yes, mask mandates do work to prevent infection from being spread in schools. Furthermore, they found no scientific evidence that mask mandates in schools cause any clear harm in terms of speech or intellectual development or mental health, which some people have been worried about. The next question is, if we know there is a benefit to masking, at what level of spread do we activate a mandate? That is not a scientific question; it is a question of a risk threshold, and that is where we had the lack of consensus.

That all makes sense. Still, do you worry that a lot of people skip the fine print and just get the idea that doctors aren’t sure if masks work?
I absolutely have that worry. And I have definitely seen some reporting that seems to be conflating a mask mandate with whether masks themselves work. Let me say it again for anyone who will listen: the evidence as to whether masks work is 100 per cent clear among scientists. There is no debate.

You are the father of two young kids. Any advice to parents who do want their little ones to mask up at school?
My kids are four and three years old, so the only advice I have is to ask them nicely and then accept that they are kids. As a parent, you do what you can.

Do your kids know that Dad has had a pretty big job for the past few months?
Ha! They know that I have a lot of meetings. One of them will sometimes sit with me and read a book while I’m doing interviews. They are a lot more interested in PAW Patrol than in anything I’m doing. I’m looking forward to having a little more time to spend with them in the fall.

Any other plans? Maybe take up fishing?
Well, I’ll be going back to my work as a physician and a researcher, so it’s going to be a very busy time for the reasons we have talked about. I guess I am hoping to be a little less tired. That would be nice.

This interview has been edited and condensed for clarity.