As public demands escalate for governments to do more to combat the ever-worsening novel coronavirus pandemic, two distinct camps seem to be forming: one essentially calling for a lockdown of the country, the other demanding a massive expansion of testing, isolation and monitoring.
In other words, some are urging a “close everything down – everyone stay at home” approach with all the economic and social fallout that portends, while others are urging an aggressive effort to identify and isolate the carriers of the virus. The United States and much of the world so far have gone the former route.
In contrast, South Korea and some other Asian countries have put more of their resources into mass testing and then aggressively isolating and monitoring those who are positive. The evidence strongly suggests that the “South Korean approach” is getting much better results than the “American approach”.
The truth of the matter, however, is at this stage of the pandemic both approaches are urgently needed in Canada. Ideally, we would have engaged in aggressive testing and isolation in the initial days of the breakout (when most cases were travel related) and put most of our resources there.
Unfortunately, we didn’t. And as local transmission now accounts for about 35% of new cases, it is crucial that the social distancing approach be used in conjunction with the testing and isolation approach.
The problem is that we are implementing both approaches badly – we are using a broad stroke, scattergun approach in both efforts when we should be using a more sophisticated, targeted approach.
In other words, there is a surgical approach to both “social distancing” and “testing and isolating”. The important thing is not to choose between the two but to take a targeted approach to both so as to limit the massive economic collateral damage that the scattergun approach causes.
The “close it all down – everyone stay at home” approach to social distancing will result in severe long-term social, economic and public health consequences related to an enormous disruption of normal life. All “non-essential” businesses are closed in most provinces, all out-of-country travel and most social gatherings are banned — these measures will result in long lasting social and economic damage, possibly graver than the direct toll of the virus itself.
The stock market will bounce back in time, but many small businesses and good paying jobs that average people depend on, will disappear forever. The unemployment, impoverishment and despair likely to result will be the public health scourges of the future.
We are flattening the economy while at the same time doing, at best, a mediocre job of containing the virus.
I need to be perfectly clear here. I agree with the consensus view that we need to increase our social distancing and testing/isolation efforts. But in ramping up our efforts, Canada needs to undertake both social distancing and testing in a much more highly targeted and evidenced-based way than it has to date.
Is it possible to re-open some “non-essential” services while still keeping Canadians safe? Are we doing social distancing right?
Many medical experts question whether Canada is going about social distancing in an effective way. The heart of their concern is that by closing down everything deemed “non-essential” and then making a multitude of arbitrary exemptions, we are not keeping the focus on actual social distancing and the specific hygeinic practices that will keep Canadians safe.
For example, what was the point of Ontario Premier Doug Ford keeping the LCBO (Ontario’s government run liquor stores) open while all other “non-essential” businesses were ordered closed? Aren’t LCBO workers and customers as at risk of contracting the disease as any other retail worker or customer?
And why is the construction sector in Ontario deemed an “essential service” when most manufacturing and services are deemed “non-essential” and forced to close? Are we placing construction workers in danger by arbitrarily labeling construction an “essential service” without working with the industry and unions to develop social distancing and hygeinic protocols that are specific and appropriate to construction?
And finally, why has the government failed to make plexiglass shields in front of retail checkouts mandatory in all workplaces dealing with the general public? Many public health professionals suggest such a government directive would prevent thousands of retail workers from contracting the virus. And if plexiglass sheilds were installed in all workplaces with a customer service orientation, would so many of those “non-essential” services have to close?
A better approach than the long-term closure of all establishments deemed “non-essential” (and then making many arbitrary exemptions like the LCBO and construction), would be for the government to issue a set of strict and mandatory “social distancing” and hygeinic best practices for both essential and non-essential workplaces. Such guidelines would likely include ordering building modifications (e.g. plexiglass sheilds) and enforcing social distancing inside establishments (such as stores) where people gather. If an establishment can pass a government inspection clearly showing that the new distancing standards have been met and the risk of virus transmission has been greatly reduced, the space would be allowed to re-open with ongoing government monitoring.
Such an approach would allow some non-essential establishments to re-open, be less disruptive to everyday life and the economy, and be a more effective way of fighting the virus because there would now be government enforced, social distancing guidelines for both essential and non-essential services that are allowed to operate.
In summary, by allowing governments to take the easy way out by simply shutting down an arbitrarily defined set of “non-essential” services, we are undermining our efforts to fight the coronavirus and killing jobs unnecessarily.
We are also letting our governments off the hook for keeping Canadians safe.
Why aren’t we getting testing right?
The surgical approach to testing, isolating and monitoring – best exemplified by South Korea – requires far more focus on the truly vulnerable than public health bodies in Canada and (especially) the US, are deploying. But it works.
For starters, to implement the surgical approach the scale of testing has to be increased far beyond current US and Canadian efforts.
As Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, has said eloquently: “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”
Until last week, the US was fighting the pandemic almost completely blindfolded and Canada was doing only marginally better.
As a result of the lack of mass testing at the early stages of the outbreak, research is showing that for every case we know of, there are likely five to 10 others undetected.
And each undetected carrier has the potential to spark an outbreak of new coronavirus cases – in nursing homes, at curling clubs, in workplaces.
In order to implement a more surgical approach, we need to focus on finding carriers quickly and isolating them and their recent contacts. We can’t just wait for them to get visibly sick and contact health authorities, which is what we’re doing now. People should be tested that are asymptomatic.
Canada was slow to ramp up testing, and we’ve focused almost exclusively on testing those with obvious COVID-19 symptoms. That has to change fast – especially in Ontario.
For example, Quebec said it had tested more than 36,000 people as of Thursday, with results for 2,622 tests pending. Ontario, in contrast, had administered 38,550 tests since the start of the outbreak – far fewer on a per capita basis than Quebec, B.C. or Alberta – and results were still pending for nearly 10,000 as of Friday. Stories abound of Ontarians waiting the better part of a week for their results.
But doing the tests is only part of the surgical approach. When someone tests positive, public health nurses need to track the case and test all their contacts – and isolate those contacts as well.
This surgical approach to testing and monitoring is time-consuming and very resource intensive work. But it and an equally sophisticated approach to social distancing – are the only way to stop the pandemic without closing the economy down.
Canada’s shame – a culture of secrecy in sharing vital health data
There’s another element that is essential to a more targeted approach to testing, isolating and monitoring – superb data collection and sharing as well as greatly increased transparency by government and public health officials.
We need sophisticated data to guide us to likely “hot spots”. And we need to share that data with the front-line health officials actually doing the testing and isolation work. We also need to share that data with the data analysts whose job it is to predict where the next “hot spot” might erupt.
This is the area where Canada fails most miserably. We need to know the demographic details of who is being infected and where they live. But a culture of secrecy in our health bureaucracies is greatly impeding our ability to target our anti-pandemic efforts.
According to the Toronto Star, Ontario’s Ministry of Health has repeatedly ducked their request for cumulative data over time, insisting on doling out information on daily confirmed cases only.
Each morning, the Ontario government releases the number of new cases online with the information for many cases marked “pending”. At 10:30 a.m. the next morning, the process repeats itself with no sign of yesterday’s confirmed cases and therefore no updating of all that “pending” information in the previous day’s case list that was missing. This missing information includes gender, age, where the case lives, how the case contracted the virus, and whether their current status is hospitalized or in “self-isolation”.
This information gap creates enormous problems for researchers, public health officials and journalists reporting on the story. Why not full transparency from Ontario’s health ministry?
The latest Ontario numbers also show there is now a backlog of more than 10,000 Ontarians waiting for test results. As of March 27, Ontario had 993 confirmed cases. With a test result backlog of more than 10,000, it is extremely difficult for health authorities to target testing and isolation efforts because they have no clear sense of what the real number of actual cases is or where they are.
According to the Toronto Star, there is also a growing outcry amongst Canada’s Artificial Intelligence (AI) researchers — and Canadian scientists of all stripes — that say they are impeded by the lack of provincial data-sharing and a provincial government culture of trapping coronavirus information in “secret jails” and silos, which robs machine-learning algorithms of the fuel they need to function. Many scientists and local health officials single out the Ontario Ministry of Health as the worst offender.
One role for AI could be predicting which patients who test positive for COVID-19 are most likely to suffer severe outcomes and require life-saving medical interventions. That just can’t happen if the AI community doesn’t have the case data from the provincial health authorities.
Under current policies, we are spreading our public health resources far too thin in our fight against the deadly coronavirus. We are also taking an extremely blunt approach to enforcing social distance with our “close everything down – everyone stay at home” approach.
Here is what should be done.
First, we desperately need to have a much more sophisticated approach to closing things down including assessing the pros and cons of shutting down whole sectors of our economy (i.e. those sectors deemed non-essential). Clearly, many closures (e.g. schools, concerts, theatres, bars, etc.) are justified but it is possible that many services could be made safe with items like plexiglass shields and enforced social spacing and hygeniec practices (hand wipes, etc.) inside the establishment.
The essential/non-essential distinction should not be the main criteria for shutting things down. The main criteria should be the ability to ensure that the space in question allows for adequate social distancing to prevent virus transmission. This may involve building modifications, enforced spacing protocols and mandatory hygeinic practices. It may also be the case that many spaces simply cannot ensure adequate social spacing and they should certainly be closed down. That said, government should work with employers, industry associations and unions to make this determination.
Canada also needs to rapidly increase its overall testing and isolating efforts but at the same time, focus its efforts on the more vulnerable segments of society and local “hot spots”. But to do that, we need sophisticated data sets that are only possible if provincial ministries of health overcome their longstanding culture of secrecy and share their data in a timely manner with public health officials, academic specialists and the public at large.
Quick turnaround of testing results is also critical to a more targeted approach. Ontario’s backlog of more than 10,000 tests awaiting processing is an absolute disgrace.
A pivot right now from a scattergun approach to a more focussed, data driven approach, remains entirely plausible in Canada. With each passing day, however, it becomes more difficult. The path we are on may well lead to uncontained viral contagion and monumental collateral damage to our society and economy.
A more targeted approach to social distancing and testing is what we need. And that requires a vast improvement in evidence-based policies and practices from governments.
We need to protect the truly vulnerable in this time of crisis but to do that, our governments must become far more targeted and sophisticated in the way they fight this horrible pandemic.
Recent Canada Fact Check posts on the coronavirus pandemic include the benefits of mass testing at an early stage, the role the World Health Organization should be playing in fighting the pandemic, a look at the impact of travel bans, and the role governments with an anti-science ideology have played in spreading the coronavirus.