COVID mission far from complete
George W. Bush never did say “Mission Accomplished,” as he declared an end to major combat operations in Iraq. In fact he said: “Our mission continues.” But the giant banner that was used as a backdrop aboard the USS Abraham Lincoln trumpeted that bombastic message, and the incident became a byword for hubris.
Fortunately for Justin Trudeau, there were no banners proclaiming victory when he held his morning press conference Monday to update Canadians on the COVID pandemic.
“After a very challenging spring, things are continuing to move in the right direction,” he said, pointing to the progress in the number of cases, hospitalizations and deaths.
Trudeau was citing a new forecast by the Public Health Agency of Canada that suggests modest increases in cases and deaths in the next two weeks. Neither Trudeau nor Chief Public Health Officer Theresa Tam officially declared an end to the first wave of the pandemic. But it was a feelgood announcement, two days before Canada Day, that signalled an end to the spring lockdown.
The new model suggests that the number of deaths might climb as high as 8,865 by July 12, from the current 8,522, and cases could rise to 108,130 from the present 103,250. But emphasis was placed firmly on the “steady decline” in the number of new cases, deaths, hospitalizations and critical care cases. The effective reproduction number (Rt) has been less than one for eight weeks, an indication the epidemic is under control. Cases among those 80 years old and above and are now on par with other age groups.
The most positive spin possible was put on Canada’s performance, with one graph showing how Canada had “flattened the curve sooner than a number of countries such as the U.K., Italy and the U.S.”
Certainly, if you compare Canada to those three laggards, or Sweden, Brazil and Russia — as the graph does — then this country has fared reasonably well. The grim fandango of death and infection being danced in the U.S. has led to a new prediction of 180,000 fatalities by October (from 125,000 now). Canada’s death rate per 100,000 people is far lower than the U.K., France or United States.
But when compared to countries that have coped well with COVID, the performance looks less impressive. Canada’s death rate per 100,000 people is double that of peer countries such as Germany, Denmark and Norway.
Even when held up against the U.S., Canada is not unimpeachable — 8.3 per cent of all cases resulted in death in Canada, compared to a 4.9-per-cent case-fatality rate in the States. This reflects the appalling carnage in Canadian long-term care homes, where 20,602 cases resulted in 6,920 deaths, fully 81 per cent of all fatalities in this country.
“Canada has flattened the curve but at a high level,” said Amir Attaran, a professor in the Faculty of Law and School of Epidemiology and Public Health at the University of Ottawa. He said he would prefer to see the curve look more like a black diamond ski run. “‘Flattening’ means a simmering, never-disappearing problem … It’s not something to be happy about, or something for which the Liberals should be claiming credit,” said Attaran.
Tam said “the epidemiology indicates transmission is largely under control.” But we are continuing to see outbreaks in unlikely hot spots including Saskatchewan and the Windsor-essex region in Ontario, where many migrant workers are based. There is also evidence of infections spiking from funerals and family gatherings.
The model revealed the hospitalization rate of 15 per cent is roughly what was predicted going into the crisis and the numbers requiring intensive care beds and mechanical ventilation has been far lower than many feared (just 431 people needed ventilators).
But nobody should be under any illusion that the mission has been accomplished. In the Public Health Agency’s early models, it suggested the death toll could be 22,000 people, if the infection rate was five per cent over the course of the pandemic.
Canada’s infection rate is currently around four per cent (103,250 cases from 2.6 million tested). That suggests that we will have a period of respite before second and third waves claim more lives.
Tam said the virus has not been eliminated and, with no effective vaccine, we can expect to see a resurgence as restrictions are lifted. “If we relax too much or too soon, we can expect it to rebound with explosive growth,” she said.
The key to avoiding that kind of transmission is rapid case detection (identifying 50 per cent of cases within five days) and contact tracing (locating 50 per cent of contacts within two days).
Whether provinces can respond to those demands remains to be seen. Logistics have improved. The time from virus onset to lab collection has fallen from eight days to three. But testing levels have never reached the numbers that were promised.
Attaran suggested mandatory mask-wearing would be the quickest and cheapest way of getting to the next level. “It’s stunningly effective,” he said, pointing to the example of Hong Kong, where there have been just seven deaths from COVID and mask-wearing is widespread.
Attaran is highly critical of Trudeau’s emergence “like a cuckoo clock” every morning to offer the same advice: social distancing and hand washing. “They have to change their advice. They have taken it to a plateau, not a point of success,” he said.
Lest there be any confusion, the mission continues.