Irfan Dhalla is a physician and vice-president at Unity Health Toronto, and an associate professor at the University of Toronto. He serves in a volunteer capacity on the federal government’s COVID-19 Expert Group on Health Systems.
Canadian winters are long, long seasons, primarily lived indoors. With COVID-19 cases at low levels, patios open, and friends and family gathering in parks and backyards, this looming reality is easy to forget.
Yet, with schools re-opening and the virus resurgent in provinces such as Manitoba and British Columbia, now is not the time to be complacent. Most provinces seem to be content with a COVID-19 strategy that tolerates “untraced” community spread so long as the health care system is not unduly strained. According to data from the Ontario government agency tasked with supporting our pandemic response, about half the new infections in Ontario have an unknown source and should therefore be considered untraced.
Untraced spread makes some Canadians – particularly those who are older or who have chronic health conditions – less willing to engage in permitted activities, as they lack the confidence that these activities are truly low risk. Indeed, about a quarter of Ontario families do not want to send their children back to school this fall. As fall turns to winter, if case counts continue to rise, private social gatherings may also become increasingly risky. And children and parents will suffer immensely if outbreaks cause schools to close again.
Winter is coming. Canada needs a plan.
That plan should be to stop untraced community spread of COVID-19. Knowing exactly how community spread is happening allows public-health officials to control outbreaks as they arise, gives governments the confidence to further relax restrictions, lets parents feel confident about sending children to school, and helps families and friends feel comfortable about gathering indoors.
Public-health authorities should also improve their efforts to find every case of COVID-19 and break every existing chain of transmission. We must reduce lag times in this process, monitoring each of the following: time from symptom onset to test; test transport time; lab turnaround time; time to transmit result from the lab to public health; time to reach the case; and time to reach, test and quarantine all close contacts.
To support this process, individuals should be encouraged to keep personal logs and contact lists in addition to downloading Ottawa’s exposure notification app. Restaurants, bars and gyms should be using government-issued QR codes to help facilitate contact tracing.
Each province must also stop new chains of transmission. Provinces should follow the lead of Atlantic Canada and require quarantine after interprovincial travel, with exceptions for people who live in one province but work in another.
If carefully implemented, this strategy will reduce the likelihood that we need to close schools and workplaces again. The tactics associated with this strategy will require investment. For example, employees will need sick days, people experiencing homelessness will need individual rooms, and people returning home may need testing at the border or the airport, and perhaps even a hotel room for quarantine.
But the successful implementation of this strategy will bring a faster social and economic recovery, and so the return on investment will be high.
We can look to New Zealand and Taiwan as models.
Faced with a new outbreak after 102 days of near normalcy, New Zealand’s government and media are both laser focused on defeating untraced community spread. Citizens can turn to media reports to see important data including the number of new cases, the source of identified cases, and the number of identified contacts who have not yet been tested. Cases of unknown origin are linked to known cases with genomic testing, and gaps in chains are aggressively filled. Known virus clusters and locations of interest are published on a government website.
Taiwan, another success story we should be learning from, also strives to completely identify each chain of transmission and provides clear guidance for isolating people with infections, possible cases, and travellers. Taiwan has been so successful with its approach that it may be one of the only countries on the planet whose economy actually grows in 2020.
Of course, New Zealand and Taiwan are islands. But other success stories such as Vietnam and China, and, closer to home, New Brunswick and Nova Scotia, show that control over political borders is as critical as physical obstacles when it comes to stopping incoming cases.
Ending untraced community transmission is a bold but realistic target that should inspire Canadians. Pursuing this goal would require both courage and competence from governments, but these efforts would likely be rewarded by voters.
With summer nearing an end, now is the time for Canadian governments to adopt a new strategy, stop a second wave, and save our winter.
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