National Post (National Edition)
Leadership vacuum fuelling pandemic crisis: experts
An unsmiling Prime Minister Justin Trudeau this week urged provincial premiers to “do the right thing,” to “do more to fight” COVID-19. But some say Canada is in the COVID situation it is in because of a patchwork, “whack-a-mole” response to the pandemic and no clear national strategy to protect the country.
COVID-19's second wave is eclipsing its first. Manitoba, facing bleak trends, enters a month-long shutdown Thursday that will forbid people from socializing with anyone outside their households and shutter non-critical businesses. In Alberta, doctors are pleading for a “circuit breaker,” a short, sharp shutdown to avoid “catastrophic” consequences, while in Toronto, the city's top doctor,
Eileen de Villa, warned the country's biggest metropolis is seeing “spread and risk like we've never seen before.”
Across Canada, there were more than 41,000 known active cases as of Wednesday morning; 1,556 people were in hospital, and 294 in intensive care. Canada reported 68 more COVID-19 related deaths Tuesday, bringing the total recorded fatalities to 10,632. Ontario and Quebec account for most cases (75 per cent) and deaths (92 per cent). Given that hospitalizations and deaths tend to lag infections by three weeks, it's likely we have yet to see the “severe impacts” associated with the virus's resurgence, Dr. Theresa Tam, Canada's chief public heath officer, said this week.
Now, as COVID-19 smoulders in multiple regions, several experts are calling for some long-term vision for sustained resilience against mounting case counts.
“Canada is 11 months into the deadliest peacetime crisis in a century at the highest level of infection ever. How many times has Justin Trudeau used emergency federal powers since COVID began? ZERO,” Amir Attaran, a biologist and professor of law and medicine at the University of Ottawa tweeted this week.
“We're in this mess because our federal government has been AWOL. They have never placed any mandatory federal measures on a province, of any kind,” Attaran said in an interview with the National Post.
The skill of politics is to mediate between competing stakeholders, Attaran said, “to cut deals, to negotiate, to bargain an outcome that's acceptable enough to multiple stakeholders that you get re-elected. But it depends on the stakeholders being thinking beings.”
Viruses don't have brains; they don't think. They have no agency, Attaran said. “If you try to manage them politically you will fail every single time.”
Provinces have responded with a roller-coaster of economic restrictions, a batten-down, lift, batten-down again, shock-therapy approach that's missing any long-term vision, said University of Ottawa epidemiologist Raywat Deonandan. “We've never had the national conversation of a long-term COVID strategy that allows us to wait out the dark winter until the vaccine arrives.”
Increased spread in the autumn was expected, “but it's looking like a very tough winter for millions of Canadians,” said Dr. David Naylor, a professor of medicine at the University of Toronto, and former chair of the federal review of Canada's response to SARS that led to the creation of the Public Health Agency of Canada, as well as the role of Chief Public Health Officer of Canada.
It's easy to criticize from the sidelines, Naylor said. “This is an unprecedented epidemic, the virus has insidious patterns of spread, the world has struggled to find effective treatments and many jurisdictions are faring worse than Canada.”
“But there's time to change course,” he said.
A number of countries have done what Atlantic Canada has done — “reset the count to zero cases, and then re-enter containment mode where the aim is to completely smother any and all flare-ups,” Naylor said.
“Zero COVID” has been achieved in New Zealand, Vietnam, Taiwan and Australia. On Wednesday, Australia's hot spot state of Victoria saw it's 12th straight day with no new cases of COVID. Some five-million residents of the state capital of Melbourne were placed in lockdown, with home confinement orders, travel restrictions, a two-hour time limit for daily exercise and many businesses shuttered, after confirmed cases surged in July. The lockdown lasted 111 days, cost an average of 1,000 jobs daily and was criticized for risking people's mental well being. But Victoria succeeded in wresting a bigger second wave, on a per-capita basis, than Ontario's to the ground, Attaran said.
“It came with an economic price, but whatever that price, it's less than not wrestling it to the ground,” said
Attaran, who believes interprovincial travel in Canada should be halted, even travel within parts of provinces, with “cordon sanitaires” drawn around regions like the GTA and Ottawa to restrict the movement into and out of regions. Treat regions like islands, even if they aren't ones, he and others said.
“Unless we do an Australia, or an Atlantic Canada, it's obvious where this ends. It ends being the United States,” Attaran said.
But it's hard to smother flare-ups when a city or region accepts a high amount of community spread, Naylor said. It becomes harder to trace cases, the virus gains the upper hand, tracing capacity is overrun, “and all those maddening suppressive measures come back into play,” he said.
“Those restrictions hurt the economy, disrupt civil society, bear hugely on the disadvantaged and those with precarious employment and cause untold psychological distress,” Naylor said.
But Canada has been slow getting on with rapid testing, jurisdictions didn't build up enough testing and tracing capacity, and in some cases “the thresholds for tolerable case counts were set at levels that confused open flames with embers,” Naylor said. “There was always a risk those flames would spread easily.”
Trudeau, speaking to reporters yesterday, said Ottawa
“doesn't decide who closes down where and how fast.”
But Attaran said national guidelines are needed for reopenings that provinces could not deviate from without federal permission, instead of a confusing hodgepodge of rules that seem to be changing week by week.
Ontario's five-tier, colour-coded system, for example, includes thresholds for action many experts worry are too high.
“You need to get a test positivity rate of 10 per cent before you enter `red.' And they call that `control.' That's not control. That's the end. That's game over,” Attaran said.
Others say an approach in one jurisdiction might not be successful or even appropriate in another, or that elimination, in the absence of a vaccine, is an unrealistic pipe dream given the pandemic is going to be around through 2021, or longer. There are parts of Canada where public trust and confidence is high, like Atlantic Canada, but pulling off measures like restrictions on travel and mobility would be harder sells in provinces where there is a lower perception of risk and lower buy-in. And restrictions don't work unless they're given time to work, Deonandan said. “Diluted, tepid, weak interventions will cause pain but no gain,” he said. “They must be strong enough to actually get something out of it” and there has to be the political will to do the necessary, he said.
“Circuit breakers are great, but you're just giving the system a breath, and then, after it catches its breath, the virus is back, slogging through again, because the second you lift the circuit breaker, cases go up again, unless you are investing in additional tools
and strategies,” Deonandan said, including what Asian countries do well — robust case detection and contact tracing, and monitoring borders to extinguish cases as they enter to prevent reseeding outbreaks.
“We suck at both those things,” Deonandan said. “A national strategy strengthens those things.”
Yes, the virus shouldn't paralyze us, said infectious diseases physician Dr. Andrew Morris. When people say “we just need to live with this,” it's a good theory, but “the practicalities don't pan out. They fail, and they have failed,” Morris said. “You have to look at the successful countries, the Asian Pacific countries and Atlantic Canada who have all taken an elimination approach.”
Over the summer, cases were low, and regions kept opening up. “An elimination strategy would have said we can't accept any cases where we don't know what the mode of transmission is.” Morris said.
Today, nationally, 32 per cent of COVID-19 infections are of unknown source. We've fallen back, and it was totally predictable, Morris said.
“There is an important but significant number of experts who believe we should stay on the mitigation approach, because the collateral damage of an elimination approach is too great,” Morris said. “But we need this kind of discussion — we need a national discussion around it.”
Deonandan doesn't believe Canadians have the stomach for a hard lockdown. With Pfizer's news this week that an early look at its experimental vaccine suggests its 90 per cent effective in preventing infection, a possible vaccine has shown its face.
“Now there's a bright light at the end of that long tunnel, and people think, `we've just got to wait this out.' Yes, but that tunnel may be a year long.”
TREAT REGIONS LIKE ISLANDS, EVEN IF THEY AREN'T ONES.