Eric Hoskins is a medical doctor, public health specialist and the former health minister for Ontario.
Here’s the COVID-19-related question I am asked most: “When will life get back to normal?” There is no definitive answer, unfortunately. But there are important, objective signs that things are improving.
The epidemiological evidence shows that by the end of April, Canada should be through the worst of the pandemic. The most reliable modelling I have reviewed suggests that, at that point, Canada will have in the order of 50,000 to 75,000 confirmed cases, depending on testing rates; sadly, approximately 3,000 people will have lost their lives.
After this, and depending on our actions, some degree of spread will continue until herd immunity is reached or a vaccine is proven effective. But overall, Canada will be in a much better place by May – which means that our actions are having a decisive impact.
That is not to say we should relax. Nearly half of all COVID-19 deaths in Canada have occurred in long-term care homes – a crisis within a crisis. At-risk communities and individuals who have difficulty accessing health care will remain especially vulnerable.
But British Columbia is now past the peak of daily new infections; at time of writing, there were just 115 COVID-19 patients in hospital and 54 in intensive care in the entire province. Alberta, with far fewer infections than first predicted, is also approaching its peak, and is sending personal protective equipment and ventilators to neighbouring provinces. Ontario and Quebec, the worst-hit provinces, should reach their peaks within days. And this follows recent trends in countries such as Italy, Spain, Germany, Switzerland and Austria, where cases and deaths from COVID-19 have reached their peaks and are slowing.
Most health systems, notwithstanding shortages of PPE in many jurisdictions, remain entirely capable of supporting hospitalized COVID-19 patients. Ontario currently has 197 COVID-19 patients on ventilators; roughly 80 per cent of the province’s 2,811 ventilator-equipped critical-care beds are unoccupied and ready for use by new patients.
The expected surge, thankfully, has not materialized. Still, it has been gruelling for front-line health care workers in hospitals, long-term care, primary care, home care and hospices, as well as for first responders. They have been true heroes in this crisis, regularly putting themselves in harm’s way to save lives.
The herculean efforts of health care workers, public health, government and Canadians who are isolating mean that we are finally seeing some light at the end of the tunnel. I am now cautiously optimistic, and for good reason: The numbers indicate that deaths from COVID-19 in Canada will be at the low end or even significantly lower than even the best projections at the start of this crisis.
What lies ahead? Recent University of Toronto and Harvard University studies suggest that a dynamic (open-close-open) approach to isolation and physical distancing will likely be highly effective in reducing and containing a second viral spread. If cases surge, restrictions and controls would be tightened until levels drop again. And this must be done in conjunction with widespread, easy-to-access testing, isolation measures and rigorous contact tracing. With such measures in place, the threat of future waves of the virus can be blunted.
Luckily, Canada can also look to others ahead of us in this struggle. Italy, Germany and Switzerland are about to reopen certain small businesses. Spain’s manufacturing and construction industries are starting to come back online. The United States is adopting a three-phased approach to reopening, focused on maintaining physical distancing and protecting the vulnerable. We need to closely monitor these experiments and take lessons that can guide our decision-making.
A good place to start for Canada would be to thoughtfully reopen parts of the health system, including elective surgery and cancer care. The list of “essential services” can be carefully expanded to include more businesses and allow for a gradual reopening of the economy.
But absent any fundamental change in this epidemic, those first steps at cautiously loosening social and economic life – done with a nationally co-ordinated strategy that creates specific gating criteria for reopening and allows for regional response – can and should be taken by early May. The epidemiological evidence is already telling us that by then, it will be reasonable to do so.
Some will disagree with my assessment. But the data is telling us that what we have done so far – while imperfect and challenging – has worked.
Tragically, many lives have already been lost, and we will still see more deaths. But we have already made a difference, and by doing so, we’ve saved thousands, perhaps tens of thousands, of lives. This success can continue, even as we begin to test the waters and restart our communities.
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