Medical Experts Critiquing Canada's Response to COVID-19

"Canada is 11months 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."

"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."

"[The skill in politics is reflected in the capacity to mediate between competing stakeholders], 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."

Amir Attaran, biologist, professor of law and medicine, University of Ottawa

"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."

"And restrictions don't work unless they're given time to work. Diluted, tepid, weak interventions will cause pain but no gain. They must be strong enough to actually get something out of it."

"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."

Raywat Deonandan, epidemiologist, University of Ottawa

"[Increased spread in the autumn was expected], but it's looking like a very tough winter for millions of Canadians. 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. [A number of countries have undertaken what Atlantic Canada has done to] reset the count to zero cases, and then re-enter containment mode where the aim is to completely smother any and all flare-ups."

Dr.David Naylor, professor of medicine, University of Toronto

 

Parts of Canada are seeing alarming rises in novel coronavirus cases. Ontario notched another new high for daily infections, and right behind is Manitoba recording its deadliest day since the start of the pandemic. Manitoba has reported 431 new infections and nine additional deaths where throughout the summer a mere handful of active cases were identified in the province. Over half of the deaths were concentrated in hospitals and care homes in and around Winnipeg.

Quebec and Ontario have both reported approximately 1,400 new cases daily, with Ontario's last count at 1,426. An average of over 4,000 cases and 50 deaths have been reported over the past week in Canada as a whole. Quebec reported a 39-person rise in hospitalizations as a result of what its health minister characterized as a rise in infections in several provincial regions adding up to 1,378 new cases and 22 additional deaths on the last day of the count, Wednesday. 

In comparison to the United States which has registered a million new cases for November alone, Canada's record may seem moderate, but health experts warn that matters can speedily spiral out of any hope of achieving control should action not be taken as soon as possible. Canada can look at the U.S. where new infection rates exceed 100,000 daily totalling over ten million leading to 61,964 hospitalizations with the virus in the U.S., Canada's is also creeping upward.

"The virus is spreading in a largely uncontrolled fashion across the vast majority of the country", warned Dr.William Schaffner, infectious-disease expert at Vanderbilt University where the U.S. as a whole reported over 1,460 deaths on Tuesday alone, representing the highest single-day count since mid-August. California alone has seen coronavirus hospitalizations spiral by 32 percent in the past two weeks, with intensive-care unit admissions spiking by 30 percent.

 

In comparison, across Canada over 41,000 known active cases as of Wednesday were reported, with 1,556 people hospitalized and of that number 294 in intensive care and 68 additional COVID-19-related deaths, giving Canada total recorded fatalities at 10,632, of which numbers Ontario and Quebec between them are responsible for 75 percent of those cases, leading a number of experts to call for long-term vision for sustained resilience against the mounting case counts. 

The experts point to the hodge-podge of responses from provincial governments, responsible for health care, describing the restrictions imposed as batten-down, lift, batten-down again shock-therapy approach missing a long-term vision, as epidemiologist Raywat Deonandan put it. In New Zealand, Vietnam, Taiwan and Australia, they point out "Zero Covid" has been achieved. Australia's hotspot state of Victoria celebrated its 12th straight day of no new COVID cases.

Case in point; the state capital of Melbourne saw five million residents placed in lockdown under home confinement orders, travel restrictions, a two-hour time limit for daily exercise along with many businesses shuttered once confirmed cases surged in July. After 111 days of lockdown that cost an average of 1,000 jobs daily that brought criticism for risking people's mental health , Victoria realized success in avoiding a large second wave of infection on a per-capita basis as opposed to Ontario's experience.

"It came with an economic price but whatever that price, it's less than not wrestling it to the ground" commented Dr.Attaran, believing inter-provincial travel in Canada should be stopped, including travel within parts of provinces with "cordon sanitaires", drawn around regions such as the greater Toronto area and Ottawa, restricting movement in to and out of regions. "Unless we do an Australia, or an Atlantic Canada, it's obvious where this ends. It ends being the United States."

Dr.Naylor, however, sympathizes with the difficulties involved in handling flareups and where it becomes more difficult to trace cases while the virus gains the upper hand and tracing capacity is overrun "and all those maddening suppressive measures come back into play. Those restrictions hurt the economy, disrupt civil society, bear hugely on the disadvantaged and those with precarious employment, and cause untold psychological distress", he pointed out, even while Canada's process in rapid testing was slow on the ground.

"The thresholds for tolerable case counts were set at levels confusing open flames with embers. There was always a risk those flames would spread easily", he stated. "You need to get a test positivity rate of ten percent before you enter 'red' zone. And they call that 'control'. That's not control. That's the end. That's game over", Dr. Attaran went on. In Atlantic Canada trust is high, alongside confidence in government. Yet instituting measures such as restrictions on travel and mobility would be more difficult persuasively in provinces where risk has a lower perception and even lower acceptance.

Dr.Deonandan points out again the success realized by Asian countries with their protocols of robust case detection and contact tracing, alongside monitoring borders to ensure that cases fail to enter their borders in prevention of outbreaks being re-seeded. "We suck at both those things. A national strategy strengthens those things", pointed out Dr.Deonandan. When people say, "we just need to live with this", it's a good theory, points out Dr.Anthony Morris; "You have to look at the successful countries, the Asian Pacific countries and Atlantic Canada where each has taken an elimination approach. An elimination strategy would have said we can't accept any cases where we don't know what the mode of transmission is."

"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. But we need this kind of discussion -- we need a national discussion around it", emphasized infectious diseases physician Dr.Andrew Morris. "Now there's a bright light at the end of that long tunnel [with the recent revelation of Pfizer's successful vaccine trials]", pointed out Dr.Deonandan "and people think, 'we've just got to wait this out'. Yes, but that tunnel may be a year long."