Irfan Dhalla is a physician and vice-president at Unity Health Toronto. In 2003, he served as an editorial and research associate for the National Advisory Committee on SARS and Public Health.
A new report from Australia’s leading universities defines two distinct goals that every country must choose between in deciding how to tackle COVID-19. It’s a choice that we are making in Canada right now, even without a public debate.
The first option is to aim for elimination. The target here is no local transmission of COVID-19, with the only new cases being those imported from other countries.
The second option is to aim for what the report’s authors call “controlled adaptation.” Government would aim to limit the spread of the virus by repeatedly relaxing and tightening restrictions, in a way that would keep the health care system from being overwhelmed. This approach would allow more people to get back to work sooner than if we were to aim for elimination.
For Australia, the authors conclude that while both options are feasible, elimination is the preferred option.
The choice between elimination and controlled adaptation is a much more difficult one in Canada than it is in Australia. Australia is an island. Canada shares a 9,000-kilometre border with the United States. Australia is currently reporting between one and two dozen new cases each day. In Canada, we have around or above a thousand new cases reported daily. Australia currently has only about 27 people with COVID-19 in intensive care units. Ontario alone has more than 200.
Seeing these numbers, it has to be tempting for public health officials to throw up their hands and conclude that we must simply figure out how to co-exist with the new virus. But that would be a mistake. The courageous choice for Canada’s premiers and our prime minister is to aim for elimination.
Controlled adaptation means accepting that dozens or even hundreds of older Canadians will continue to die of COVID-19 every month. Controlled adaptation means accepting that health care workers may continue to lose their lives to an infection that we could be doing much more to prevent. Controlled adaptation means that anyone needing dialysis or chemotherapy will continue to worry about becoming infected with COVID-19 inside a hospital. The ongoing outbreaks in several Canadian hospitals make plain that this is not just an abstract concern.
Elimination is obviously the more desirable goal, but is it a feasible one? In some countries the answer increasingly seems to be yes. Australia is not the only open, democratic country that has nearly achieved elimination. South Korea and New Zealand are also well on their way. Whether elimination is feasible in Canada or not remains less clear. Australia, South Korea and New Zealand have geographical advantages that Canada does not. More than one epidemiologist has pointed out that the biggest risk for Canada is the feeble response in the United States and travel between our two countries. But perhaps an even bigger risk for us is complacency. Heartening stories from New Brunswick and Kingston show that elimination is not only a desirable target in Canada but also one that may be within reach, if we and our governments are willing to put in the work.
Choosing to eliminate COVID-19 does not mean we have to continue a full lockdown for months to come. We just need to relax restrictions judiciously, and double down on a focused strategy.
That strategy can be summarized, as it was by Scotland’s government in four words: test, trace, isolate and support.
The lack of testing in Canada’s largest provinces has received widespread attention in the media. The lack of contact tracing has not. Ontario has set an ambitious goal of tracing 90% of contacts within one day. Our governments need to do more to achieve this goal, and they also need to start publishing data on how well we are tracing contacts now.
Isolation is another area that has received insufficient attention. Large-scale forced isolation would be inconsistent with our values, but we must at minimum offer comfortable isolation to those who are unable to isolate themselves. We should also support individuals infected with COVID-19 to isolate away from their families if public health officials feel that isolation at home is not likely to succeed. All of the hotel rooms that are currently vacant could be used for this purpose.
The 9,000-kilometre border we share with the United States is a uniquely Canadian problem. It may be that we have no choice but to settle for a small number of infections coming over the border each day, causing some continuing chains of transmission within Canada. But even if we have to settle for this outcome, aiming for elimination with a well-resourced “test, trace, isolate and support” strategy will help us achieve an equilibrium that is far better than the one we have now.
When looking to ease restrictions, our first priority should be to ensure that routine health care services can once again be made available for everyone who needs care. Otherwise, we run the risk of losing more lives to routine killers such as heart failure and chronic obstructive lung disease than we do to COVID-19. At the same time, as we learn more about the virus, we can selectively relax restrictions that are unsupported by evidence. If columnists who have paid attention to the evidence can change their views on topics like exercising outside, governments can, too.
No one knows when an affordable and effective vaccine against COVID-19 will be available. Until that happy day arrives, we will need to employ a range of tactics to minimize direct and indirect harm from the new disease. But we also need a clear objective. That goal should be to eliminate COVID-19.
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.