In neither the US nor Canada is there any evidence that we are “flattening the curve” in the fight against the coronavirus pandemic. This is a very dangerous situation that risks overhwelming health facilities in the hardest hit regions in both countries.
In the US, there were more than 31,000 new cases reported Friday. In Canada, roughly 1,140 new cases were reported. The US numbers are the highest one-day totals since the pandemic started and the Canadian numbers are roughly equal to the average over the past 4 days.
Late Tuesday, top US government scientists battling the coronavirus estimated that the deadly coronavirus could kill between 100,000 and 240,000 Americans. On Friday, Ontario government health officials estimated that between 3,000 – 15,000 Ontarians coudl die over the next two years.
All levels of Canadian government must act quickly to prevent the rising caseload from overwhelming health facilities in the hardest hit communities. And most importantly, the initiatives must be evidenced-based and highly targeted.
Actions taken have to be developed by public health experts who can interpret the caseload data, and formulate highly targeted initiatives aimed at protecting the most vulnerable in our society.
So here is what the experts are telling us we have to do.
Protect the vulnerable
Canada has not done a good job in protecting the vulnerable.
As of Friday evening, twenty-one residents of a long-term care home in Bobcaygeon, Ontario had died of COVID-19 complications and that number is likely to increase, the facility’s medical director says.
As of Wednesday evening, Toronto Public Health confirmed six new deaths that were reported overnight at the Seven Oaks nursing home in Scarborough, bringing the total there to eight deaths.
Seven Oaks has 23 confirmed cases (14 residents, including 8 deaths; 9 staff with no deaths); 54 probable resident cases. The ages of the residents who died range from their 60s to their 90s; six of these eight were over 85 years old.
The deaths have not only unmasked the impact of Ontario’s chronically understaffed long-term care system, but is demonstrating the frightening potential of COVID-19 to devastate communities of the elderly and the frail.
It has long been known to public health officials that the mortality rate from coronavirus pandemic is much higher amongst the frail and elderly. According to Dr. Theresa Tang, Chief Public Health Officer of Canada, the overall mortality rate from the coronavirus is approximately 1% but is much higher amongst those over 70.
And it goes without saying that while the number of all people with the disease requiring hospitalization remains around six per cent, with two per cent requiring critical care, those numbers are again much higher for the elderly.
In Ontario, it is difficult to say how many nursing homes across the province are fighting outbreaks of COVID-19. Unlike some provinces, the Ontario government does not collect that data and publish it in one place. It leaves local public-health units and long-term-care homes to make that information public.
The Globe contacted all of Ontario’s public health units on Wednesday and learned of at least 40 deaths of residents of long-term-care homes due to the virus. many of these deaths were not reported in the official Ontario government statistics.
Ten of the homes with confirmed cases are in Toronto, including Seven Oaks, a city-owned facility where two residents have died of COVID-19, the disease caused by the virus.
The Ontario government releases total numbers of confirmed cases, but gives few details. Local public-health units communicate other information. This stands in stark contrast to the approaches of British Columbia, Alberta and other provinces, which announce cases in long-term care at daily briefings and update the numbers online.
In Ontario, the government and Chief Medical Officer of Health David Williams are revising widely criticized policies that limited the testing and tracking of COVID-19 cases in long-term care homes.
But is it too late?
We shall see if these new measures work but the truth of the matter is that despite heroic work by frontline long-term care workers, to date the Ontario government has utterly failed to protect its most vulnerable citizens.
Increase testing and shorten result turnaround times
Test, test, test!
And the reason we have to test early and widely is there is a long lag time between when people are infected and before they seek medical help. All the time beforehand, that’s potential transmission time.
Canada simply isn’t testing enough and a lot of that problem, again, is Ontario. According to the Globe and Mail, as of 7 p.m. on March 31, Ontario is testing at a rate of 350 per 100,000 people. In contrast, Quebec is testing at a rate of 791 per 100,000 people, and British Columbia is testing at a rate of 845 per 100,000. Alberta is testing at 1,100 per 100,000.
Moreover, as of March 30, Ontario had 5,600 test results pending – an inexcusable number although an improvement over the 11,000 pending results late last week. At that point, the turnaround time for processing the results of tests was a full week.
The solution: Canada should be testing at least at the rate of B.C. – 845 per 100,000 people. And the turnaround time for getting the results of the tests should be no more than 48 hours.
This means Ontario has to massively increase the number of Ontarians tested by increasing its testing rate. Yes, it is a huge challenge to hit the B.C. rate, but if Ontario doesn’t increase its testing dramatically, many Ontarians will die unnecessarily.
The truth of the matter is that while Ontario appears to (and may very well) have fewer cases per capita than Quebec at this point of time, Quebec has tested far more people and has far more up to date caseload information. Quebec therefore, likely has a more accurate picture of the current spread of the virus than Ontario.
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 two weeks ago, the US was fighting the pandemic almost completely blindfolded and the results have been catastrophic. Canada was doing only marginally better at that point.
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.
Both the US and Canada have picked up the pace on testing somewhat in the last few weeks but both are far behind most Asian countries some of which are now reporting almost no new cases. We are also far behind some European countries.
Governments need to practice “smart” social distancing
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 hygienic practices that will keep Canadians safe. In other words, we are taking too broad stroke an approach to social distancing.
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 first working with the industry and unions to develop social distancing and hygienic protocols that are specific and appropriate to construction?
Condos and houses are hardly urgently essential enterprises in the short term, as health and safety officials have repeatedly stated.
Unlike Ontario, Quebec, most hard-hit by the coronavirus pandemic among Canada’s provinces, has suspended all construction activity except for emergency, security and dispatching service.
The Star reports mass confusion on Ontario construction sites as workers are unsure of the new rules – mostly becasue their aren’t any.
The advice Premier Doug Ford has given to construction workers? If you feel unsafe, leave.
And that is a sure recipe for ongoing chaos on Ontario’s construction sites. If Ontario’s construction sites are to stay open durign the pandemic, there needs to be clear and detailed rules that will keep construction workers safe.
Canada is doing a middling job at best in dealing with the coronavirus pandemic and Ontario is pulling the overall national effort down. Ontario has to get its testing rate up fast and has to be more transparent with its caseload data. It also has to vastly improve its initiatives to protect the frail and elderly in Ontario’s long-term care facilities.
But while we may be behind most Asian countries and some European countries in our response, we are doing better than the United States.
The US is on the worst trajectory of any advanced country — yes, worse than Italy at the same stage of the pandemic — with confirmed cases increasing at an alarming rate.
The absence of a universal medicare program is certainly one reason for the abysmal US response and there are clearly many other factors.
One major underlying factor is that the US has a serious, longstanding problem with science denial. In fact, most US public health experts now suggest that it is decades of science denial on multiple fronts (including a particularly virulent strain of science denial in Donald Trump’s Republican Party) that set the stage for the virus denial that paralyzed U.S. policy (e.g. lack of testing) during the crucial early weeks of the current pandemic.
The US is a wealthy country and many aspects of its health care system are world class. But the strengths of the US system are of little use in fighting a pandemic. Even in normal times, the US health care system fails its overall population. The fact is that even before the coronavirus pandemic, the US had the lowest life expectancy among all advanced countries, and the gap has been steadily widening for decades.
Pandemics can’t be fought by one country alone and Canada, with much of its population within a three-hour drive of the US border, is threatened by what is happening in the US.
This post has primarily concerned itself with what Canadian authorities must do immediately to prevent an economic and health disaster from overtaking the country. But we also have to think long-term and begin to discuss how an interconnected world deals with the anti-fact, anti-science populist (US) and authoritarian (e.g. China) governments that are in power in many countries. The regimes in power in these countries initially denied the seriousness of the outbreaks in their countries for purely political reasons and in doing so, put the rest of the world in danger.
The answer clearly has to be that, in times of crisis, countries that won’t respect scientific fact need to lose their sovereignty over certain public health matters.
In other words, in times of crisis, internationally recognized public health best practices need to be forced upon governments that don’t respect science. And the only way to do that is to strengthen the World Health Organization (WHO) and other international organizations related to health so that they can’t be bullied as was the case with China or ignored, as is the case with the US.
The question then becomes: How do we reform our global order to make the WHO and other international health related organizations stronger? Such a reform would strike a new balance between international well-being and national sovereignty.
And maybe the time to act is while we are in crisis and there is public support for international co-operation. It was possible to build a new global order in the 1940s (the creation of the U.N., etc.) because a war ravaged world saw the damage done by global conflict; in the 1940’s no one needed to be convinced that our fate is collective.
We should bear this in mind if we want a post-pandemic world where disease is less likely to unleash disaster.