Here we go. Where we end up, nobody knows
Of course we want to spring free. No, Canada and Ontario and Toronto were never asked to lock down the way they did it in China, or Italy. As epidemiologist and lawyer Dr. Amir Attaran of the University of Ottawa puts it, we tried “a half-ass lockdown.”
And still, so many are tired of COVID-19, and Ontario says it is ready to move on. And the worry is that the province is moving too fast.
“If you’re asking purely from an epidemiological, infectious disease, containment standpoint, I don’t think we feel comfortable with this right now,” says Dr. Nitin Mohan, a physician epidemiologist who teaches public and global health at Western University, and who co-founded a public health consulting firm called ETIO.
“If you’re asking from an economic standpoint, I can’t speak to that. But I don’t think we’re at the point we need to be where we can comfortably go into Phase 1, and talk about Phase 2 at this point.”
When Ontario Premier Doug Ford outlined the province’s next step Thursday — including the well-off buffet bundle of golf, boating, horse riding, house cleaners and personal chefs — it sounded like some people’s kind of freedom. Add non-mall retail shops, private campgrounds, animal grooming, and the most important thing — an expansion of shuttered medical procedures — and it was a nice idea. The virus, after all, spreads best indoors.
But there were holes, and questions. Family visits are still barred, but cleaners or private chefs, who can be in a house for hours and who can work in multiple homes, are back on. The province made a website connecting businesses to manufacturers of personal protective equipment, or PPE; meanwhile, Toronto-area hospital workers report there are numerous cheap surgical masks that slip off your face, and garbage bag-like gowns, in circulation. Adequate PPE for employees will be hard to find.
The recommendations for businesses are admirably clear, but won’t work without real regulation. And Toronto Mayor John Tory pointed out there were no actual public data thresholds for moving to Stage 1, or to the eventual Stage 2, and chief medical officer Dr. Eileen de Villa agreed they were necessary.
Ontario chief medical officer Dr. David Williams had said 200 or fewer communityspread cases for 14 straight days was the goal, but as Ontario plateaus we still don’t actually know how many people are being infected outside longterm-care homes, where Ontario has concentrated testing.
“The testing is delayed and the testing capacity is not where we need it to be, so we should assume the case count is higher,” said Mohan.
So that is a point of discomfort in the epidemiological and public health communities. And given Ontario’s data problems, when will we know if we make a mistake?
“It depends how far we go,” said Attaran. “If it sets off an utter explosion we’ll know faster than if it’s a simmering fire.
“I’m speaking in metaphors of explosions and fires because that’s all I can do. I’d love to be able to tell you, we’re going to find tripwires using data, as other countries have done, and if any one of these tripwires is exceeded, then of course we’ve made that mistake, and we close down immediately.”
Germany’s thresholds on transmission levels, positive test levels and ICU capacity, for example, sound “perfectly rational,” Attaran said. “We can’t have those. It’s an impossibility.”
Data isn’t sexy, even in this stay-home era. But this paper has written so many stories about how sclerotic Ontario’s data is that “Ontario can’t even count the bodies correctly” is not a controversial statement.
Epidemiologists tell you we need tons of testing, because you can’t always tell who has the virus, but Ontario has struggled mightily to approach a provincially average level of per capita testing. University of Toronto epidemiologist and leading modeller David Fisman recommends symptomatic testing, drive-thru outreach testing, expanded testing parameters, and random pooled testing in supermarkets on parking lots, to start. We have the first part.
Then you need contact tracing, so after a positive test you can figure out who else might have got the virus. And then you need to be able to move fast, isolating the virus before it escapes.
“Best case, there’s an overthe-counter test, and a surveillance system attached to your iPhone, and it sends the information to the city or the province,” said Mohan. “South Korea has gotten close to that.”
He told a story about an Ontario worker who had tested positive for the coronavirus on May 4, and whose employer informed the other employees on May 13. That’s before a testing lag that has ranged between seven days and 24 hours, and is said to be improving. There were 17,578 tests under investigation in Ontario as of Thursday afternoon.
“You can see the delays in data capture there,” says Mohan, whose models set a threshold of 150 new cases per day for 14 straight days, and indicated physical distancing would need to be in place until at least late June to do so. “There’s already a built-in delay in how the virus works, right? In every sense the virus has a head start; even in terms of us catching basic data from it, it has a head start.
“I strongly think there’s a negotiation period, where on the economic side they said, let’s try this and see how it goes, and we on the public health side are waiting with bated breath.”
We seem to lack the societal and governmental patience to truly wait this out, which is understandable, because this is difficult on so many, hard on parents, hardest on the poor. But jumping forward too fast could send us backwards, too.
“I think it’s the ultimate bet we’re placing,” says Mohan. “We’re betting on ourselves, and I know (Raptors guard) Fred VanVleet showed us the way, but we’re really betting on ourselves. And you need to look at your neighbour and really look at your colleagues and say, are we really in this together?”
Are we? Let’s hope.