Did Canada wait too long to stem spread of virus within community?
Distancing guidelines put in place in mid-March, but signs indicated earlier transmission
Did Canadian health officials act fast enough to curb community transmission of COVID-19? This week’s growth in positive tests, from people infected earlier in March, suggests they did not.
While infectious disease experts say it is believed Canada had community transmission as early as March 1, governments did not bring in physical (or social) distancing guidelines until the middle of the month, and emergency orders to close businesses came only in recent days. On March 12, Premier Doug Ford even encouraged people to enjoy themselves on March break holidays, which shocked experts in the infectious disease field. In Quebec, health officials in Montreal have recently begun contact tracing of people suspected of spreading the infection on public transit as early as March 6.
Across the country, there has been growing concern about spread of the disease at conferences, including a mining conference and a dental conference early in the month.
A Toronto synagogue was closed for cleaning over fears of COVID-19 transmission from a visitor on March 9.
“Certainly for the entire month of March we have had local transmission
“By the time you have seen evidence of community spread, presumably that is just the tip of the iceberg.”
DR. MICHAEL GARDAM INFECTIOUS DISEASE EXPERT
going on,” said Dr. Michael Gardam, an infectious disease expert and chief of staff at Humber River Hospital in Toronto. Gardam is a veteran of other outbreaks, including SARS (2002 to 2004).
“I think all of us who have been involved in this have felt that we likely had local transmission going on very early at a low level, but obviously as you import more travel-related cases and as they spread to others and those spread to others, then local transmission becomes a much bigger thing,” Gardam told the Star.
The question of whether Canadian officials acted in time reveals a tension between concrete evidence of local transmission and educated deductions based on how outbreaks typically spread and how COVID -19 was known to be spreading internationally.
Public health officials say they need firm evidence — confirmation of close contact between a known positive case and another person who has tested positive — before they can announce that local transmission is occurring. Compounding the problem is that in the case of this disease, experts say, patients can “shed” the virus before symptoms appear, as well as while they are sick and for roughly a week after. A person with COVID-19 could transmit the disease for roughly a month. Here’s the timeline in Canada. According to the World Health Organization’s own records, a Canadian federal official contacted the WHO on March 1 to inform the agency that Canada, like China, Italy and other countries, had confirmed local transmission (as distinct from an infected traveller returning home and testing positive).
Neither the WHO nor Canadian officials will say which part of Canada made that report on March 1, but experts say it likely came from a cluster of cases in a nursing home in B.C.
To put that March 1 date in perspective, the Toronto Maple Leafs had the night before defeated the Vancouver Canucks 4-2 and were looking forward to a winning record in the last weeks of the season. The phrases “social distancing” and the now preferred “physical distancing” were not part of everyday jargon and at all levels of school in the country it was business as usual.
Ontario reported 16 cases by March 1, of which 14 were listed by the province as travel-related — people who had arrived in Canada from Iran, Egypt and China. For the other two cases, the province did not list the nature of the transmission.
Over the next 10 days, leading up to March break across Canada, media reports show a rising level of concern, but the focus was still on travel. Would you get COVID-19 by travelling, and was it still safe to take a trip with your family?
At this point, no public health agency in Canada had stated publicly that it had confirmation of local transmission of the virus, beyond the original B.C. report. But there were signs that the virus was out there.
In Toronto, the Beth Sholom Synagogue closed for cleaning March 9 after a lay leader who had been to a Washington, D.C., conference became sick and tested positive for COVID-19. Other members of the synagogue went into self-isolation, as did a Toronto city councillor, who had a conversation with the lay leader previously, on March 5.
Around this time, a Sudbury man tested positive and it was believed he may have contracted the virus at a March 2-3 mining conference in Toronto.
According to B.C. health officials, it is now known that about 20 people tested positive after attending a March 5-7 dental conference in Vancouver. One dentist who attended the conference has since died. B.C. health officials have not said if the man died of COVID-19 but the man’s friends have told the media that he was very healthy prior to the onset of symptoms.
With politicians across Canada struggling to come up with a clear plan on what to tell the public, Ontario’s premier on Thursday, March 12, urged parents and their children to go away on March break and have a “good time,” though Ford also said the province was monitoring the situation daily.
By the time Ford made those comments, public health officials were sounding alarms and suggesting travel might not be wise. But still, the public was being told by health officials that community transmission was a low risk.
By the night of Thursday, March 12, it began to change. First Western University in London, the University of Toronto, Dalhousie University in Halifax and others across the country closed and made plans to move classes online. Elementary and secondary schools, at the direction of provinces, followed suit, telling people students would not be coming back after March break.
Still, stores and malls were open. People sat at tables in restaurants as they always had.
On Saturday, March14, Alberta health officials confirmed their first case of community transmission. On Monday, March 16, Toronto’s medical officer of health confirmed community transmission, and other agencies across the country began to issue similar confirmations.
“Physical distancing” was by then in the jargon, with people told to stay two metres from each other — the distance the virus could travel following a sneeze or a cough. Work from home began for many. More recently, an increasing number of rules have been put in place, closing all but the most essential services and stores. You can go to the drugstore and buy food, beer and liquor, but you cannot sit in a restaurant or coffee shop, or buy clothes in a store. Dog walkers, barbers and a myriad of other workers were told to stay home in Toronto and other cities.
On Wednesday in Toronto, sports fields were closed, even to the most casual athlete wanting to dribble a ball.
Why did it take so long?
Gardam said at the start of the outbreak public health officials and doctors were focusing on travel cases and “not doing surveillance early on for local transmission.”
Even though, as Gardam says, “there is no way we were not going to have local transmission. There’s no way Canada would be different than any other place in the world.”
Public health officials have said that in doing contact tracing, it is sometimes easier to confirm a travel-related case than a community transmission case.
As to why governments across Canada waited several weeks to bring in tough rules, Gardam said that is typical of an outbreak. “It is very difficult thing for governments to (bring in tough rules like shutting down businesses or even strict social distancing guidelines) because they have to bring it in almost before you think you need to,” Gardam said.
“By the time you have seen evidence of community spread, presumably that is just the tip of the iceberg …
“You need to bring it in as soon as you possibly can but what countries tend to do is bring it in later and in a stepwise fashion.”
Some provinces have also struggled with their testing capacity, including Ontario, which only this week is beginning to clear its backlog.
As of Wednesday, Ontario still had more than 10,000 tests for which there were no results. And testing parameters have changed in Canada in the past week, with a focus now on health-care and other frontline workers, and the very sick. Experts say there is a chance more community transmission cases will be missed as a result.