National Post (Latest Edition)

A ‘No More Waves’ strategy for COVID

- Andrew Morris Jack M. Mintz And

In our december paper published in the Canadian Medical Associatio­n Journal, we argued for a “No More Waves” strategy to follow an immediate period of strong suppressio­n to keep the COVID-19 case count low. Our argument is based on balancing health, economic and social risks. It does not imply a zero-case count, but suggests keeping cases sufficient­ly low to stop further waves.

under this model, rather than going through economical­ly costly yo-yos with incrementa­l openings and lockdowns, communitie­s would be able to open on an ongoing basis after an initial, sustained lockdown to suppress the virus and stop the spread. We know Canadians are getting tired of policies encroachin­g on their freedoms, but avoiding further waves is the best approach to manage health, economic and social risks. below, we provide a compass to enable the relaxation of health rules and limit the possibilit­y of another wave.

Hospitaliz­ation and mortality counts have sadly risen over the past two months. Now we are starting to see some success after government­s took actions in december to suppress the spread of the virus. Those restrictio­ns are starting to come off recently, as case counts have dropped. However, it is too early to declare victory. Imported variants have already shown up in Canada, and they are more transmissi­ble and possibly more deadly. Our vaccinatio­n program will optimistic­ally lead to herd immunity by the fall, if vaccine delivery and distributi­on go as planned and vaccines remain effective against the circulatin­g strains. None of this is a slam dunk, and new waves could easily appear beforehand.

That makes our “No More Waves” strategy as relevant today as when we first proposed it before the winter holidays. This strategy includes three basic elements: (i) strengthen­ed enforcemen­t of health interventi­ons to contain transmissi­on; (ii) evidence-based reduction of gatherings based on transmissi­on, social and economic risks; and (iii) ramping up infrastruc­ture required for COVID-19 surveillan­ce, screening and testing (including supporting wide-scale rapid testing) with accompanyi­ng contract tracing and isolation.

Compared to the current mitigation strategy, a “No More Waves” strategy would reduce the overall need for prolonged lockdowns and economic, as well as social, hardship. Canada’s four Atlantic provinces, which represent roughly seven per cent of Canada’s population, originally pursued a maximum suppressio­n strategy that later enabled people to have more freedom of movement without facing health risks. Importantl­y, the economic and social effects of the pandemic largely reflect the spread of the pandemic. Avoiding the exponentia­l growth of cases, therefore, offers the best opportunit­y to preserve economic and social activity until vaccinatio­ns have been broadly administer­ed.

Although prolonged lockdowns are necessary when the realities of exponentia­l growth have overwhelme­d other non-pharmacolo­gic interventi­ons (NPIS), they are unneeded in regions where the incidence has not outstrippe­d public health and health-care capacity. The choice of public health measures is determined by: a) the quality of the test-trace-isolatesup­port system; b) the rate of desired decline in cases; and c) the acceptabil­ity of the proposed public health measures.

different NPIS have different predicted effects. Whereas one jurisdicti­on may choose to go into lockdown for six weeks to drive cases to a low number as quickly as possible, another jurisdicti­on might choose to close restaurant­s, bars, fitness facilities and non-essential shopping for 10 weeks to achieve the same effect. The presence of new, highly transmissi­ble variants likely change this calculus, but choosing the interventi­ons should be based on local epidemiolo­gy, context and preference­s, and should consider the health, economic and social impact of the interventi­ons.

We suggest prioritizi­ng NPIS that are most likely to reduce the spread, while having a lower overall impact on economic and social well-being. Those NPIS that have high economic and social impacts but relatively low effects on transmissi­on should be avoided. For example, we obviously were not going to close grocery and drug stores, given how essential they are, despite some health risk. Similarly, it is our contention that school closures, especially at the primary level, should be considered a last resort.

As transmissi­on falls, further steps can be made to open up economies such as low-density gym, manufactur­ing and retail business openings. Those interventi­ons that have a large impact on transmissi­on but have relatively small economic and social effects (e.g., universal masking and prohibitio­ns on small indoor gatherings, non-essential travel and mass events), would be preferenti­ally employed.

Like most Canadians, we would like to have mass vaccinatio­n programs as soon as possible. We hope that new variants won’t stop our progress in containing this woeful pandemic. until we have medical interventi­ons that predictabl­y work, however, we counsel a “No More Waves” strategy to minimize health, economic and social risks as best as possible.

National Post Andrew Morris is the medical director of the Sinai Health-university

Health Network Antimicrob­ial Stewardshi­p Program and a professor at the University of Toronto. Jack M. Mintz is the president’s fellow at the University of Calgary’s

School of Public Policy.

reduce the overall need for prolonged lockdowns.

 ?? Peter J THOMPSON / NATIONAL POST FILES ?? Andrew Morris and Jack M. Mintz put forth a pandemic strategy based on balancing health, economic and social
risks. It does not imply a zero-case count, but suggests keeping cases sufficient­ly low to stop further waves.
Peter J THOMPSON / NATIONAL POST FILES Andrew Morris and Jack M. Mintz put forth a pandemic strategy based on balancing health, economic and social risks. It does not imply a zero-case count, but suggests keeping cases sufficient­ly low to stop further waves.

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