Have we shifted aim on COVID?

‘Part of our challenge is that the information around COVID-19 changes all the time, and when (it keeps) changing, people are less likely to trust the information, less likely to make decisions based upon it and less likely to behave.”

So says Ontario Medical Association (OMA) president Samantha Hill. The OMA released its advice on reopening this week, which basically amounts to more of the same: doing as little as possible when it comes to going to work, shopping, visiting, etc.

There is a certain restlessness here in Kingston, Ont., where our medical officer of health, Kieran Moore, acknowledged that “it is very difficult to get COVID-19 in our community at present, we have such a low endemic rate.”

Several weeks ago, Moore wrote to Ontario Premier Doug Ford asking that local restrictions be relaxed in light of prevailing conditions, but the premier rejected the option of regions “going rogue.” Wheeling grandma into the hospital after waiting 18 months for a hip replacement is apparently the kind of rogue behaviour that poses an intolerable risk.

Indeed, so low was our local rate of COVID-19 last week — zero deaths, zero hospitalizations, zero ICU beds, zero active cases — that the diagnosis of case No. 62 (in a population of some 200,000 people) over the long weekend was covered in some detail. There had not been a new case since the end of April, so this was something to talk about. There has also been no community transmission here since early April, nearly eight weeks ago.

All of which goes back to what Hill said about confusing signals being sent by our political and public health authorities. There are hundreds of people in our health area — Kingston, Frontenac, Lennox and Addington — who are languishing in serious pain, anxious about scheduled surgeries that have been cancelled for two months now. Given that it would be “very difficult” for them to be infected in our hospital — which has no COVID-19 patients — why do the authorities insist that they continue to suffer?

That gets to the heart of the issue two months into our coronavirus lockdown. What is the goal? What are we trying to accomplish? It is no longer clear.

At the beginning, we were told that the goal was to “flatten the curve.” At one point, Dr. Theresa Tam, Canada’s chief public health officer, took to calling more intensely for “planking the curve.” The curve now, in many parts of Canada, is subterranean.

“Flattening the curve” was based on the premise that the novel coronavirus, as it spread around the world, would infect populations like the annual flu, but at faster rates of contagion and with many more deaths. This would overwhelm healthcare systems, as happened in northern Italy and New York City.

Flattening the curve meant that infections would be spread out over time, allowing health-care systems to cope. The virus would continue to spread, as viruses do independent of a vaccine. At some point in the (perhaps distant) future, the great desideratum of “herd immunity” would do its trick and the world would be safe for another 17 years until the next novel coronavirus (SARS hit us 17 years ago).

Way back, two months ago, it was not about preventing the coronavirus from spreading altogether, but rendering its spread manageable. One can safely say that, from sea to sea, apart from long-term care homes, Canada’s healthcare systems have been able to manage. Indeed, a great many hospitals across the land have never been emptier in living memory.

If the goal has now changed, it should be made clear. When universities are cancelling classes eight months from now — my alma mater, the University of Cambridge, has moved classes online through to June 2021! — it suggests a different goal.

Minimizing the total spread of the coronavirus until a vaccine is (hopefully) made available may indeed be the correct public health

WHAT IS THE GOAL? WHAT

ARE WE TRYING TO ACCOMPLISH? IT IS NO LONGER CLEAR.

goal. It will be the most expensive goal in the history of human governance in strictly financial terms, but that does not mean that it is the wrong goal. But it is indisputably a different goal than “flattening the curve” in order to manage a slower spread of the virus through the population.

We are now hearing ominous warnings of a “second wave.” But if the “first wave” has been flattened, planked or buried to the extent that in vast areas of the country very few people have been exposed to the virus at all, then the “second wave” is not really a second wave at all, but a delayed first wave. After all the precautions of the past two months, we might be in the same situation indefinitely until a vaccine arrives. There will be no “new normal,” but the abolition of normal.

That might indeed be the best course. But if we are changing our goals at great cost to suffering people, should we not at least have a thorough public discussion about it?