Zain Chagla is an infectious diseases physician and associate professor at McMaster University. Sumon Chakrabarti is an infectious diseases physician and lecturer at University of Toronto. Kwadwo Kyeremanteng is an intensive care physician and assistant professor at the University of Ottawa.
The arrival of SARS-CoV-2 variants in Canada carries the potential for more efficient transmission, potential escape from natural immunity, and decreased susceptibility to our current vaccine arsenal – not to mention concern, especially for health care systems already struggling to deal with the demands of the pandemic.
The fervour over how to address these mutations has led to a flurry of recommendations from experts, including double-masking, outdoor masks, travel restrictions, airport testing, hotel quarantines and expanding genomic surveillance.
But while these approaches all have some role to play, they do not address the elephant in the room: We’re ignoring the best possible way to stop this spread.
Any discussion around the most effective methods for controlling more transmissible SARS-CoV-2 variants requires looking closely at recent data to identify where the highest rates of COVID-19 circulation and transmission are being seen. After all, these are the settings where the heightened transmission of a variant would be most amplified. Concentrating resources there would have the highest yield in reducing not only hospitalizations and death, but also community spread in the long term. With limited resources and time, slowing transmission among the communities COVID-19 is hitting the hardest would provide the best bang for our buck.
And with much of Canadian society under some form of restriction and many working remotely, the answer has been fairly apparent: Those working essential jobs – and thus unable to stay home – carry the highest burden of COVID-19 acquisition.
We have to look no further than the outbreaks that occurred on farms during the first wave to get a jarring example. A different but comparable situation is seen in long-term care, where workers, often poorly remunerated and carrying multiple jobs to make ends meet, are one of the most at-risk populations for acquisition and spread of COVID. And in recent weeks, a large outbreak at a postal facility in the Peel region led to the death of an employee, and likely spread the virus into the households of affected workers.
Modelling in Ontario has showed that even during the recent restrictions, communities with the most essential workers had three times more daily confirmed cases than communities with the least – reflecting trends that have been seen in other jurisdictions such as California. This raises the obvious question: What happens when these communities come into contact with novel variants? Reports of outbreaks of the B.1.1.7 variant in two long-term care facilities and a meat-packing plant in Ontario appear to be the grim answer.
While many are afforded the privilege of working from home, the reality is that this is only possible with the help of essential workers in the background. The ability to get groceries, turn on the lights, access the internet, get Amazon deliveries and have access to health care exists thanks to workers putting themselves at a higher exposure risk.
So controlling the spread of COVID-19 variants will be less about trying to prevent them from getting in, and more about using tried and true public health principles to prevent and mitigate risk of transmission among and from our most at-risk populations. That means increasing access to infection control and occupational health supports for essential non-health care sectors to navigate workplace outbreaks, and providing safe places for people to isolate away from home if needed.
While the federal government’s Canada Recovery Sickness Benefit offers some financial protections to essential workers needing to isolate and quarantine, it is a slow and cumbersome process that only results in less than minimum wage in most jurisdictions. Without easily accessible and rapid paid sick leave support, workers are disincentivized from reporting symptoms for fear of economic instability. Equitable access to rapid testing with prioritized turnarounds can also help identify individuals at risk of viral transmission. Perhaps most crucially, making these industries a priority population for vaccination – while creating local champions to address vaccine hesitancy – will be key to protecting this population in the long term.
While investments can be made into masking, travel restrictions and genomic surveillance, the most efficient use of our resources would be to protect those who continue to be infected at the highest rates across the country, and who will only become more vulnerable with time. It has long been clear that these essential workers were at the highest risk of acquiring COVID-19 even with restrictive public health measures in place. The arrival of variants hasn’t mutated that fact.
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