Provincial health officer Bonnie Henry and Health Minister Adrian Dix stage a daily briefing
By treating British Columbians like grownups and delivering a clear public health message, the provincial government won praise for its early management of COVID-19. What lessons does that performance hold for business leaders facing a crisis?
The pandemic which has just swept ’round the earth is without precedent….never before has there been a catastrophe at once so sudden, so devastating and so universal. The most astonishing thing about the pandemic was the complete mystery which surrounded it. Nobody seemed to know what the disease was, where it came from or how to stop it. —George Soper
In his 1919 article “The Lessons of the Pandemic,” originally published in the journal Science, George Soper looked back at the still-fresh Spanish influenza plague that would claim about 50 million lives worldwide. Soper offered advice but was no run-of-the-mill finger wagger. As a sanitation engineer with the New York City Department of Health in the early 1900s, in one of history’s celebrated cases of contact tracing, he deduced that Mary Mallon, a 40-year-old Irish cook whose job had taken her into the kitchens of some of the city’s wealthiest families, was an asymptomatic carrier of the bacterium Salmonella enterica typhi. And responsible for a series of typhus outbreaks in the NYC area.
Before she was stopped, Mallon infected at least 51 people (three of whom died), rendering her a one-woman super-spreader event. The uncooperative cook was eventually incarcerated against her will, and Typhoid Mary, as she would become known, would spend more than 26 years of her life in quarantine, served mostly on an island in the East River.
Hindsight can provide moments of perfect clarity. In Soper’s piece, some of his pandemic proscriptions were remarkably on point. Avoid needless overcrowding. Smother coughs and sneezes. Open the windows. Your fate may rest in your own hands—a colloquial admonishment to wash frequently.
As we look back on the impact of our current generation-defining pandemic—albeit from the eye of an ongoing hurricane—this advice still rings true. But even as these basic measures stand time’s test, much has changed over the past century. Health care has evolved. Vaccines can be developed, often rapidly. Perhaps most telling, however, is that our leadership expectations are dramatically changed: in Soper’s day, the number of times President Woodrow Wilson mentioned the flu publicly was exactly zero.
Today, things are vastly different. In B.C., the advent of COVID-19 was not only a health crisis, it was a test of leadership—for a government, a bureaucracy and a health-care system that was forced to respond to a threat that could have been, and still could be, existential.
So what were the leadership takeaways from this plague? What, so far, have been the lessons of the pandemic?
Minister of Health Adrian Dix and Dr. Bonnie Henry, the province’s public health officer, conducted their first joint press conference in late January. They announced that B.C.’s first case of what was soon dubbed COVID-19, the disease caused by the novel coronavirus, had been discovered in someone recently returned from Wuhan, China. Over the next few weeks, more cases would appear: by March 5, the province had logged 21, including its first known instance of community transmission, a care worker at North Vancouver’s Lynn Valley Care Centre.
Yet for most, the threat was still abstract. On March 6, recommendations from the Office of the Provincial Health Officer and the BC Centre for Disease Control offered between-the-lines reassurance: “It is not necessary to cancel school events, outings or field trips to public locations in B.C. and Canada and to most places in the world.” Parents who had booked spring break travel for the following week breathed a collective sigh of relief. It would be short-lived.
Events unfolded quickly during the second week of March. As daily cases began climbing, it became clear that dramatic steps would be necessary to curtail the virus’s spread. By March 12, one day before the start of spring break, Henry advised British Columbians to avoid international travel altogether. On March 17, she invoked the emergency powers outlined in Part 5 of the Public Health Act. “I reasonably believe that the following criteria…exist,” Henry wrote. “The regional event could have a serious impact on public health; the regional event is unusual or unexpected; there is a significant risk of the spread of an infectious agent; and there is significant risk of travel or trade restrictions as a result.”
Public gatherings were capped at 250 people. Bars and restaurants closed. The practice of having health-care workers work at more than one centre was ended. B.C. moved to freeze rent hikes and enacted a moratorium on most residential tenant evictions. In the event of an out-of-control scenario, the Vancouver Convention Centre was readied as a makeshift treatment centre with a 271-bed capacity.
After repeatedly insisting that closing the borders was unnecessary, the federal government belatedly gave in and shut down most international travel on March 16. The exception? Visitors from the U.S. were exempt.
This had serious implications for B.C. By this point, it was suspected (and later confirmed by genomic analysis) that many of the province’s cases were directly linked to travel to and from Washington state. By not moving to close the border, the Trudeau government was at odds with B.C. Dix was clearly unimpressed and made his displeasure known to his federal counterparts: “I would say that we communicated pretty directly.” At one of the now-ritual weekday briefings, Dix went further. “Don’t come,” he said curtly, aiming his message at Americans who were thinking about a B.C. holiday. (The U.S.-Canada border would finally be shut down to non-essential travel the following week, on March 22.)
The most significant provincial action in the early going, however, was moving to free up 30,000 hospital beds. “We made the decision in the middle of March to cancel all non-urgent scheduled surgeries,” Dix says. It was a dramatic, yet prudent, move. “We had new information at that point about what had happened in other health-care systems, including Italy and Hubei province,” he explains. “We needed to create that ‘space.’”
Reducing hospital capacity to between 50 and 60 percent of normal wasn’t at all easy. “It was profoundly difficult,” says Dix, characterizing the move as “a massive decision.” Ultimately, though, what it accomplished was twofold. First, as intended, it ensured that headroom was built into the system if things went south. Second, it underscored the seriousness of the situation for the public. “So it wasn’t just talk, it was action as well,” Dix says. “And I think that was persuasive.” But there’s more to being persuasive than walking the walk. Talk matters.
To get the message out—to establish credibility and ensure compliance—you need the right messenger. In both Adrian Dix and Bonnie Henry, the government had a convincing tag team. Since 2005, when he was first elected MLA for Vancouver-Kingsway, Dix built a solid reputation for competence and caring. “One thing about Adrian Dix that has been consistent—and I continue to see it today—is that he leads with empathy,” says Vancouver-based crisis manager and media relations expert Renu Bakshi, a former longtime CTV journalist.
Henry’s background was even more of a factor. An on-the-ground physician who had battled the Ugandan Ebola outbreak in 2001, as well as the SARS and H1N1 epidemics, she has a reservoir of gravitas buttressed by a low-key, soft-spoken delivery. As described by the New York Times, Henry’s “preternaturally calm” demeanour has been a significant feature in ensuring that British Columbians get with the pandemic response program. “I think it was very wise,” says BC Green Party Leader (and health critic) Sonia Furstenau of the call to make Henry the face of the province’s pandemic response. “It showed that the decisions were evidence-based and science-based, as opposed to political.”
As a team, Dix and Henry made an excellent information delivery system. Add to this the fact that they showed a willingness to trot out modelling projections as a way of modifying behaviour (and at the same time, creating more social capital by establishing greater trust), and you have a basic recipe for getting people onside—a key factor in any public mobilization. In short, they treated British Columbians as adults.
The fact that the messenger and messaging were transparent, consistent and on point was critical. But what the government didn’t do may have been as important as what it did. Premier John Horgan, for example, wisely stayed out of the spotlight, draining public health directives of at least some partisan blowback potential. But B.C. has always been a politically divided province. After the last bitterly fought election, the NDP had a razor-thin mandate, kept in power only by an alliance with the Greens. It was prime ground for the opposition BC Liberals to pounce on any missteps, sow the seeds of division and make political hay.
But while Henry and Dix remained the public faces of B.C.’s pandemic response, they had allies. One, at least, came from unlikely quarters.
As the Liberal health critic, Norm Letnick, MLA for Kelowna–Lake Country, had been an inspired choice. An entrepreneur and business administration instructor at the now-closed Okanagan University College, he was on track to receive a PhD in health economics from UBC before his new role forced him to postpone his studies. Letnick had an independent streak: in 2009, he voted against his own party, opposing an act that allowed the removal of at-risk persons to a shelter against their will.
It was, he explained at the time, a “matter of conscience.” It was also unconventional, and representative of a mindset that Letnick would bring to the table in his new role. Instead of playing traditional oppositional politics, Letnick, along with Sonia Furstenau, worked hand-in-glove with Adrian Dix—an example of nonpartisan cooperation that reflects well on all three.
The groundwork had been laid immediately after the 2017 election. “Within days after I was asked to be the health critic, I approached the minister,” Letnick remembers, “and I said, ‘I only do things to achieve a positive end. And so we have a choice here. We can either do the traditional opposition/executive council roles, or we can do a holistic government approach.’”
And how was that received? “To [Dix’s] credit, he said, ‘I would love to do it that way.’ And we’ve been doing it that way ever since. So when COVID hit, it was a natural transition.”
Furstenau agrees. “From the very outset,” she says, “Adrian’s been one of the ministers who has gone above and beyond in terms of communicating and asking for input, and being very open and wanting to collaborate.”
It’s been a strategic win for B.C., which has been able to focus on trying to get things right instead of protecting exposed political flanks, a refreshing shift from what has taken place elsewhere. Federally, the all-party team spirit witnessed in the early days of the pandemic has dissolved into more familiar patterns of partisan bickering. And in the U.S., where wearing a mask has become an ideological litmus test, Dr. Anthony Fauci, that nation’s leading infectious disease expert, was sidelined because his expert opinions didn’t align with what the Trump administration wanted its “base” to hear.
In B.C., there’s been very little, if any, politically based confusion. (During the recent provincial election campaign, Letnick avoided disparaging Dix, even as Liberal Leader Andrew Wilkinson hammered Horgan on the NDP’s COVID economic recovery plan.) And that, notes crisis manager Bakshi, is as it should be. “There’s no room for politics in a public health emergency, because politics hinders response and distorts public perception of a situation,” she says. “While other governments were playing politics, B.C. took decisive action, including letting a scientist with war room experience lead the pandemic [response] while elected officials played supportive roles.”
In the pre-COVID 2019 Global Health Security Index from the Economist Intelligence Unit (EIU), Canada ranked fifth overall for pandemic preparedness—not bad, but behind the U.S. and the U.K. (ranked No. 1 and No. 2, respectively). Although there are several metrics trotted out to measure the devastation wrought by COVID, from overall infection rates to the total number of deaths, perhaps the most relevant number is the cumulative per capita death rate.
With a COVID mortality rate of 27.69 per 100,000 people as of November 1, Canada’s death toll, while unacceptably high, is dwarfed by those of some other industrialized countries. By the same point, with 70.77 deaths per 100,000, the U.S. had fared worst of all the Group of Seven nations, followed by the U.K. (70.60), Italy (64.63) and France (55.69). (Germany had experienced 12.87 deaths per 100,000 through early November, while Japan had only 1.41—a suspiciously low figure that some have said may be due to misreporting.)
The EIU’s assessment notwithstanding, Canada’s showing indicates that we were fairly well positioned to engage the kind of system-wide response necessary to curtail the spread of COVID-19. “Canada overall—and British Columbia even more so—is benefiting a great deal from having an integrated system where public health is part of the overall health system,” says health economist Peter Berman, director of UBC’s School of Population and Public Health.
Berman, who recently came to UBC after 25 years at Harvard, cites several factors that allowed for this. Perhaps foremost is the ability to effectively take control of the health-care system and make decisions that are in the public interest. This is antithetical to the U.S. profit-based private hospital system, where there’s a financial disincentive to postpone or cancel elective surgeries. “The ability of a single entity—i.e., the Ministry of Health—to adjust resources to address a crisis like this, in contrast to the United States, is incredible,” Berman says.
Of the deaths from COVID that have occurred in Canada, the vast majority were in Ontario and Quebec. As of November 1, the cumulative mortality rate in B.C. was significantly less than the national rate: around 5.3 per 100,000 people. Considering that this province was arguably ground zero for the virus’s entry into Canada, was there anything specific to B.C.’s response that mitigated its impact?
Trust had a lot to do with it, Berman says. And much of that trust was built through frank and transparent public conversations—the sharing of modelling data scenarios, for example, or by freeing up beds, demonstrating to British Columbians that the province was ready. “Did that set of actions prevent something worse from happening? Probably not,” Berman says. “But what prevented it from being worse was…the cooperation of the citizens, and the trust that was instilled. That was part of the whole process. And I think they deserve some credit for that.”
Berman notes that, unlike many jurisdictions in Canada and beyond, B.C. never actually introduced a full lockdown. From the beginning, Dix and Henry avoided a heavy-handed approach, a decision Dix defends. “In our society, a strictly coercive approach would have been counterproductive,” he says. “For something to be effective, people have to buy in.”
There’s plenty of evidence to back this up, says UVic associate professor of psychology Frederick Grouzet, who heads the university’s Centre for Youth and Society. In most cases, he says, the best approach is a soft approach. “The theory of motivations, and empirical research, tends to demonstrate that it is the best way for long-term impact,” Grouzet notes. “For short-term impact, the ‘hard way’ is more efficient,” he adds. “The problem with the ‘hard way’ is that it could work for a very short period of time. In the long term, that won’t work. So it depends on what effect we would like to have.”
From a crisis management perspective, persuasion over punishment is also prudent. “COVID introduced a novel element to crisis communication, and that is managing the psychology of a pandemic—namely, the fear of the unknown,” Renu Bakshi says. “What we learned is that information brings relief. B.C., by sharing data on a daily basis, helped maintain vigilance without hysteria and took people from the unknown to the known, which is a more comfortable place to be.” And stern crackdowns? In Bakshi’s opinion, they’re not going to help. “Gaining public confidence and compliance is the key to stopping a virus in its tracks. If it feels like a scolding or punishment, you create rebellion.”
And when you have a relatively united population that’s open to cooperating, that helps, Berman says. “It wasn’t necessary to introduce more formal legal measures, like a full lockdown, although the government is certainly empowered to do that. So when my friends in the States ask me, ‘Well, aren’t you under lockdown in British Columbia?’, I say, ‘Actually, no. But people are pretty locked down.’”
…but carry a big stick
Not everything has worked. The initial advice surrounding face masks was confusing and widely viewed as inconsistent —or, more to the point, wrong-headed. (Henry’s reluctance to make masks mandatory in public indoor spaces is controversial, considering it’s a relatively painless intervention that most British Columbians abide by already.) Testing rates have remained low compared to some other provinces, painting an incomplete picture of how many British Columbians have actually been infected.
And, of course, daily new infection totals are rising precipitously; it’s a worrisome trend, especially among the 20-29 age demographic, a group whose increasingly cavalier approach to social distancing protocols has set the stage for conflict with those who are playing by the rules.
What once worked may not be working as well. That’s understandable. In the beginning, says Shachi Kurl, president of the Vancouver-based Angus Reid Institute, the messages we received were uncomplicated and direct: stay home, don’t socialize. “These are simple messages to absorb. As we moved into Phase 2 and Phase 3, there’s much more nebulosity,” Kurl says, adding that when people see, say, bars, hotels and banquet halls opening, they assume that things are safe. And the message? “It just gets fuzzier.”
In this case, “fuzzy” is dangerous. To counteract scofflaws, on August 21, provincial Minister of Public Safety Mike Farnworth brought the hammer down, announcing fines of up to $2,000 for the organizers or hosts of events that violated social distancing rules. Forced compliance, which both Dix and Henry had avoided implementing, was now officially part of the toolkit. And on September 8, Dr. Henry, fed up with the accelerating number of infections, ordered all nightclubs and banquet halls closed and strictly limited the hours during which bars and restaurants could serve alcohol.
It was a bold move, and a devastating blow to the food and beverage sector. But Henry’s recalibrated message was also a leadership lesson: in a pandemic, the ability to pivot and adjust to circumstances as they evolve is critical. As is the ability to make tough calls.
Other challenges loom. John Horgan’s politically savvy yet highly questionable decision to call an election in the middle of a pandemic put at least a temporary kibosh on all that tripartite sweetness and light, a shift that was clearly evident during the televised leaders’ debate. The onslaught of seasonal influenza, with its similar set of symptoms to COVID, will have to be managed. The situation in recently reopened schools is fluid, and on this file, the government remains vulnerable. Then there are the sheer numbers: in mid-November, the province was reporting 600-plus new cases per day, a tally that dwarfed our first-wave experience.
But accepting that mistakes will occur is also part of the leadership equation. “It’s not a question of always being right, because you can’t aways be right,” Dix says. “COVID is an unfeeling, brutal adversary….You know it’s going to keep us humble.”
Perhaps the greatest challenge in the months ahead will be pandemic fatigue. The longer the crisis drags on, the more difficult it will be to get people to keep doing what’s needed. At some point—and it may not be too far away—Dr. Bonnie Henry’s preternaturally calm voice might begin to sound like fingernails being raked on concrete.
In “The Lessons of the Pandemic,” George Soper offered another key takeaway: that isolating oneself to protect others is not a normal human inclination. Unfortunately, that’s what it will take until this, too, passes. Like it did a century earlier, our fate rests in our hands.
Act decisively—and be prepared to make the tough calls.
Put the right people in the right place. Getting your team onside largely depends on the credibility of your top management.
Get everyone on the same page. In critical situations, especially, there’s no room for internal politicking or self-interested manoeuvring.
The structure of your organization is critical to its success. Make sure you have contingency plans and adequate systems in place to cover potential disruptions.
Be prepared to pivot quickly. Shifting gears when necessary is an essential leadership quality.
Internal and external communication should should be clear, consistent and, as much as possible, transparent.
Even the best-laid plans can go awry. Accept that mistakes will happen—and that they can
Attack potential conflicts without resorting to a heavy-handed approach. People—and businesses—respond better to rationale and reasoning than to threats and bullying.