In recent weeks attention has shifted from the primary goal of containing the spread of the coronavirus outbreak to asking whether it’s time to start reopening the economy and relaxing restrictions.
The rate of new Covid-19 cases has been leveling off in B.C., fewer people are being hospitalized and even fewer are in intensive care.
People who have been staying at home and physically distancing in public are getting antsy – especially those with young children underfoot.
And while some businesses are doing well in these unusual times, overall the economy has slowed to levels not seen since the Great Depression. Workers are laid off, and many businesses that were already struggling may not recover, even when the virus is gone.
But reopening too quickly or too drastically poses the risk that the virus will flare up again and all the gains achieved by social distancing may be lost. For many businesses, it might be more costly to open up too soon and then have to close again when the virus again spreads out of control.
The peaking of new cases earlier in April, followed by decline is testimony to the success of social distancing. There is no evidence to support the claim that some are making, that enough people have recovered from Covid-19 that the decline is due to “herd immunity.”
While it’s likely that many more people have had the disease and recovered than official numbers suggest, it is estimated that between 60 and 80 per cent of a population would need to have immunity before this would protect the “herd.” Even that’s far from clear because the degree of immunity to Covid-19 among people who have recovered from the disease is still not well understood.
“Herd immunity” is achieved when a sufficient number of people in the population have immunity that the virus can’t sustain itself by infecting new hosts.
There is, however, plenty of evidence that spread of the disease slowed significantly when social distancing measures were introduced, whether by law or by people acting voluntarily.
The big question is which social distancing measures are most effective and which are an unnecessary imposition on society. It may, for example, be found that improving screening of people coming into long-term care homes and reducing contact between patients is effective. On the other hand, measures such as closing Haynes Point (swiws) Provincial Park to walkers may be an unnecessary imposition that achieved no significant benefit.
Is it safe to open restaurants to sit-down diners if tables are well spaced? Should personal services like barbers or tattoo parlours remain closed, or can the danger be mitigated through wearing of masks and other measures? We don’t know.
- The question of whether some measures are more effective than others is discussed in this article on Stat.
Canadian public health officials are generally agreed on what must happen before there can be a major reopening:
- There must be a sustained drop in new cases for a period of two to four weeks;
- The health system must have the capacity to handle a new surge in cases, in terms of hospital space, hospital personnel and personal protective equipment (PPE);
- There must be the ability to rapidly test both any new cases and those who were likely exposed;
- And there must be a robust system of contact tracing to determine who an infected person might have had contact with in the previous couple of weeks.
It’s clear though that these conditions have not yet been fully met. Nonetheless, some provinces, notably Quebec, New Brunswick and Saskatchewan, are already preparing to open up in stages. While New Brunswick and Saskatchewan have had fewer cases than most other provinces, Quebec now (April 28) has close to 25,000 cases, about half the Canadian total.
In B.C., Dr. Bonnie Henry, provincial health officer, has said the province is looking at reopening some services in the near future.
Currently the main challenge in this province is long-term care facilities and other facilities such as prisons and meat packing plants where people live or work in very close quarters. Spread in the wider community has diminished.
In the U.S., where the number of confirmed cases has now surpassed 1 million and the number of deaths has overtaken the total number of Americans lost in 20 years of the Vietnam War, the push to reopen is more aggressive.
Georgia, under hard-line Republican Governor Brian Kemp, has moved quickly to reopen his state, even allowing barbershops and tattoo parlours to open right away. The move at first won praise from U.S. President Donald Trump, but even he reconsidered the following day and said Kemp was going too far too quickly.
On Friday, Trump tried to distance himself further from Kemp’s move with a tweet:
“I (or @VP) never gave Governor Brian Kemp an OK on those few businesses outside of the Guidelines. FAKE NEWS! Spas, beauty salons, tattoo parlors, & barber shops should take a little slower path, but I told the Governor to do what is right for the great people of Georgia (& USA)!” – U.S. President Donald Trump
Whether or not Georgia’s gamble turns out to be a blunder, it will provide an important case study on what happens when controls are lifted.
Meanwhile, there are case studies in other countries that have tried different approaches to controlling the virus. One often cited example is South Korea, which has been very aggressive with testing and contact tracing, but has not imposed some of the social distancing measures used in Canada, the U.S. and European countries. Restaurants and bars, for example, remained open in South Korea.
South Korea has a population of just over 50 million, but its total number of Covid-19 cases as of April 28 was just 10,752 and total deaths were just 244. By comparison, Ontario with a population of just under 15 million, has more than 15,000 cases and 951 deaths.
After a sharp rise in cases in late February, South Korea was able to flatten the curve in early March.
Much of Korea’s initial spread was the result of one “super-spreader,” a woman in a Christian sect who didn’t self isolate after showing symptoms, but instead attended several large religious events, resulting in the infection of an estimated 5,000 people.
But South Korea’s success with testing and contact tracing to control the virus might not be easily replicated here.
The country learned about the importance of testing when it was hit with MERS (Middle East Respiratory Syndrome) in 2015, and so it was able to launch testing quickly for Covid-19. Canada and the U.S. have been much less successful in conducting testing and there are still shortages of some of the reagents (testing ingredients).
Korean contact tracing is in part the result of tracking of people’s movements through cellphone data and their credit card information. People are notified if they might have been near someone infected and they are encouraged to get tested. But there is greater reluctance to sharing such personal data in North America, where the culture puts a greater premium on individual privacy.
Regardless of whether the South Korean model would work here, it does provide one important lesson – with the right use of technology and a better understanding of how the disease is spread, we might be able to relax social distancing as we wait for the development of a successful vaccine.