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 calling for a lockdown of the country, the other demanding a massive expansion of testing.
But this is not an either/or situation.
We have to do both, and sooner rather than later. We also have to recognize the limitations of each approach.
Currently, cases of COVID-19 are doubling every five days in Canada. That’s the same doubling rate as Italy, where the number of cases and deaths is now mind-numbing.
If we want to avoid being another Italy, extreme social distancing is necessary to slow the rapid spread of the virus. It is the single most important tool we have at this moment.
If people don’t interact, if we all keep a physical distance of one metre to two metres from each other, the coronavirus cannot spread person-to-person. End of problem, theoretically.
But the rules cannot be absolute, so cracks will appear. People have to eat, access medication and, in many cases, do essential work.
Political and public health leaders in our patchwork confederation have also sent all manner of mixed messages and the result is that Canada has slowed down, but not locked down.
Are we supposed to all stay home all the time, or just avoid gatherings of anywhere between five and 50 (depending on where we live)?
Almost every province and territory has declared a state of emergency – but Nova Scotia only did so Sunday, 10 long days after Quebec. Prime Minister Justin Trudeau still insists it’s not yet time to declare a national emergency.
It’s hard to rally Canadians to a common cause when they are getting discordant, even complacent, messaging.
If we’re going to ask everyone to behave as if they are potential coronavirus carriers – and that’s the underlying justification for social distancing – then we have to also figure out who is infected.
We have to test, test, test.
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.”
In Canada, we don’t know.
Research is showing that for every case we know of, there are likely five to 10 others.
Each undetected case is like a smouldering ember left in a dry forest. Each undetected carrier has the potential to spark an outbreak of new coronavirus cases – in nursing homes, at curling clubs, in workplaces.
That doesn’t mean testing willy-nilly, but it does mean broadening the scope.
We need to focus on finding carriers and isolate them and their contacts. We can’t just wait for them to get sick, which is what we’re doing now.
Canada was slow to ramp up testing, and we’ve focused almost exclusively on testing those with obvious COVID-19 symptoms.
That’s not good enough at a time when the coronavirus is spreading unchecked in the community in several provinces.
We’re paying the price for that now with a rapid increase in new infections.
The good news is that testing has really picked up in recent days. Canada has now done 92,000 tests – more than all but five countries in the world – and that’s growing by about 10,000 daily.
Every country is struggling to purchase or secure the extraction kits, reagents and PCR machines needed, but in recent days hospitals and labs across the country have rallied to help.
However, doing the tests is only part of the process. When someone tests positive, public health nurses need to track and (ideally) test all their contacts, and isolate them.
It’s time-consuming and thankless work, but it’s the only way to effectively smother the embers.
Countries that have been the most successful at tamping down the spread of coronavirus – such as South Korea, Taiwan and Singapore – have all used the double-barreled approach of simultaneously imposing extreme social distancing and embracing aggressive testing.
There’s a third element that has played a key role in their success – superb data collection and transparency.
This is the area where Canada fails most miserably. We need to know the demographic details of who is being infected and where.
The tiresome chirping about so-called privacy rules needs to end. There is no reason we cannot produce granular data without violating any individual’s privacy.
To repeat Dr. Tedros’s important admonition: We cannot fight a fire blindfolded. And the last thing we need to do is blindfold ourselves.
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