WHO publishes guidelines for lifting COVID-19 restrictions. Is Canada ready?

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OTTAWA – Federal and provincial authorities are starting to discuss how and when to start reopening schools and businesses, but Prime Minister Justin Trudeau warned Tuesday that the large-scale blockages that most Canadians currently live in will remain in place for at least several more weeks.

Similar discussions are taking place around the world, as many countries are starting to show positive signs of slowing the spread of COVID-19 – although experts warn that limited testing in most places could mask the true picture of disease.

The World Health Organization is trying to inject some coordination into these decisions, issuing new guidelines on Tuesday on what should be in place before relaxing the restrictions.

“The descent is much slower than the ascent,” said Tedros Adhanom Ghebreyesus, WHO director-general, on Monday. “This means that the control measures must be lifted slowly and with control. It cannot happen all at once. “

The WHO guidelines define six areas that managers should consider if they wish to consider resuming their activities. Here’s where Canada stands on each of them.

1. Is the transmission of the virus under control?

Short answer: we don’t test enough to know.

What the Experts Are Saying: Eleanor Fish, a professor of immunology at the University of Toronto, said tests need to become much more widespread before you really understand the state of community transmission.

Alison Thompson, professor of public health at the Leslie Dan Faculty of Pharmacy at the University of Toronto, said that it takes a long time between a confirmed infection and complete follow-up of a person’s contacts and tests to find out if this confirmed infection had resulted in many other infections.

“We have to make sure that it really stabilizes, or that community transmission has actually stopped, which may take some time,” she said.

If the restrictions are lifted too quickly, thousands of people with COVID-19, who may not know they are infected, could potentially spread it quickly and widely, she said.

Thompson also said it was time to stop thinking about the pandemic in terms of health versus the economy. If there is no healthy workforce, the economy will continue to suffer, she said.

“We could see short-term gains if we relax some of these restrictions,” she said. “But in the long run, if we find ourselves in an uncontrollable situation with COVID, the economy will take much, much longer to recover. “

2. Is the health system equipped to detect, test, isolate and treat each case, and trace each person who came into contact with a positive case?

Short answer: not yet.

What the Experts Are Saying: Timothy Sly, professor emeritus at the Ryerson University School of Professional and Public Health, said that Canada had done “appalling work” in testing and screening.

“We now have a situation where we basically try to grope around who is actually HIV positive and who is negative. We have done a terrible job at that, ”said Sly, who specializes in epidemiology.

Sly pointed to a particularly distressing rate in Ontario, where Premier Doug Ford has promised to perform 8,000 tests a day by Wednesday, compared to about 5,000. Alberta is among the leaders in testing in Canada with around 7,400 tests performed daily, which Sly says isn’t enough yet.

Yet he acknowledged that obstacles beyond Canada’s control have handcuffed efforts, including global shortages of equipment, including swabs and laboratory chemicals needed to process test samples.

Sly said Health Canada’s recent approval of a rapid and mobile testing device by an Ottawa company should help, as does a series of expanded testing criteria that various provinces have adopted in recent days. .

Jianhong Wu, a distinguished research professor at York University who has led several national projects on SARS, pandemic influenza and immunization assessment, said there is a close relationship between contact tracing, testing and social distancing.

“If you are not doing well in one component, you need to dramatically scale up your efforts in other components,” he said.

Sly said provinces are largely trying to contact those exposed to a confirmed case over the phone, which is unsustainable given the growing number of cases.

He highlighted countries like South Korea, which have used cell phone data to track possible contacts. He said it was much more effective, but it would raise privacy concerns.

“People are going to yell and yell about it, but it seems to be working,” he said.

3. Are epidemics minimized in special contexts such as health facilities and nursing homes?

Short answer: No.

What the Experts Are Saying: The risks remain dangerously high in hundreds of nursing homes across the country.

Quebec, where long-term care centers have been particularly affected, announced Tuesday that inspections have identified 41 residences for the elderly who require special monitoring due to the high number of cases of COVID-19. On Tuesday, Prime Minister François Legault called on people with health care experience to help them in understaffed long-term care facilities.

Canada’s Chief Public Health Officer Theresa Tam said Monday that almost half of the deaths in the country from the new coronavirus have occurred in long-term care facilities, and she predicted that the number will increase despite the efforts of the provinces to combat this problem.

Twenty-nine residents of a 65-bed nursing home in Bobcaygeon, Ontario, died during the pandemic. Another Toronto facility recorded 22 deaths on Monday, while the Lynn Valley Care Center in North Vancouver, British Columbia, killed 18. In many establishments workers are also falling in large numbers.

Following the outbreak of the Lynn Valley Care Center, British Columbia decided to prevent staff from working in several establishments to slow the spread of the virus. Ontario did the same on Tuesday.

Isaac Bogoch, a specialist in infectious diseases at the University of Toronto and the University Health Network, believes that the strategy, while limiting visits to the elderly and infection prevention methods, could go a long way in minimizing the risks of possible subsequent waves of COVID. 19 in the elderly.

Canada now has guidelines to help protect residents and workers in long-term care facilities, but Tam said this week that outbreaks are the biggest concern that has arisen in the COVID-19 situation in Canada. in the past two weeks.

4. Are there measures in the workplace and in schools to prevent the spread of the virus?

Short answer: not yet.

What workplace experts say: In most provinces, only essential businesses like grocery stores and pharmacies can stay open. All others must work with employees working from home. If they can’t do that, they have to close. Restaurants generally only allow takeout or deliveries.

Many companies say they are too focused on setting up their employees to work from home, and have not yet started to think about what to do to reopen.

Provinces and business groups say it is too early to speculate on what measures can be lifted. Any change in approach would be on the advice of the Chief Medical Officer of Health “and with extreme caution to avoid a resurgence of the virus as seen in other jurisdictions,” said spokesperson Hayley Chazan. from Ontario Minister of Health Christine Elliott. .

The Canadian Chamber of Commerce says it wants clear advice from public health officials before the restrictions loosen.

“We expect there will unfortunately be a case where an employee will be positive. What does this mean for the workplace? Should there be a total stop? Deep cleaning? Asked Mark Agnew, senior director of international chamber policy.

Industry rules will remain crucial as the lockdown begins to lift, he said, noting that retailers, meat processors and refrigerator technicians may all need different physical distance and distance protocols. individual protection equipment.

What experts say from schools: Children, although less susceptible to the new coronavirus, are well equipped to transmit it.

“Children are generally less compliant with effective hand hygiene, and they do not necessarily control their secretions,” said Dr. Nisha Thampi, head of infection prevention and control at the Children’s Hospital in the East. from Ontario to Ottawa. “It poses a risk of exposure for staff as well as other children.”

The Public Health Agency of Canada stopped recommending specific changes schools could make to their operations, but offered more general advice to schools in February, before Canada started to really feel the impact of COVID-19. This included regular hand washing and supervised use of hand sanitizer, education on an appropriate “breathing tag”, such as covering coughs and sneezing, speeding up cleaning and disinfection procedures in school buildings and strengthen “non-sharing” policies.

Thampi said medical experts will also need to develop advice that will balance student safety with development needs.

“Children have always viewed school as a social environment,” she said, adding that many no longer benefit from this type of stimulation in the era of physical remoteness. “How can we be sensitive to this while teaching them infection prevention strategies?” “

5. Are the risks of importing more cases from outside the country managed?

Short answer: Especially yes.

What Experts Are Saying: The federal government has taken unthinkable measures in the past month to prevent more cases of COVID-19 from arriving in Canada. These include a ban on most non-Canadians from entering the country and a mandatory 14-day quarantine for anyone who does.

On Tuesday, Ottawa further improved the game, now requiring everyone arriving to explain their quarantine plan and if that is not enough, they will be forced to stay on federal sites.

The problem is that Canada is heavily dependent, both economically and socially, on foreign trade and immigration. This means that he cannot keep the border closed forever.

“We have done a lot, but economically it is not sustainable,” said Daniel Beland, director of the McGill Institute for the Study of Canadian Studies.

Experts say there are a variety of potential ways to reopen the border and manage risk.

The ability to screen potential visitors, preferably with on-site testing at airports and other ports of entry, would greatly facilitate the identification of carriers and would prevent them from entering Canada or quarantine them.

York University Professor Steven J. Hoffman and Scientific Director of the Canadian Institutes of Health Research Institute of Population and Population, said that the 14-day quarantine “could be the catalyst for government to reopen our borders, especially if this system is really operational and fully implemented. And applied so you can trust it. “

There may also be more targeted travel restrictions for visitors from different countries, depending on how those countries handle the virus, although experts recognize that partial bans and quarantine requirements could create challenges and anger. .

Beland nevertheless believes that Canadians will have to accept that there will be changes in the way they travel, such as the way the September 11 terrorist attacks resulted in increased security measures.

6. Are local communities educated, committed and empowered to adapt to the “new standard”?

Short answer: maybe

What Experts Are Saying: Canadians have been inundated with warnings from political leaders and public health experts for weeks to prepare for bad news. Trudeau has not hesitated to make sure people know that until there is a vaccine, we will all have to get used to having at least some restrictions on our movement and behavior.

In Canada, most experts believe the number of cases will peak this month. Data based on Canada’s limited epidemiology show that the number of cases doubled every three to four days in the last two weeks of March, but had slowed to double every five to eight days in the first two weeks of ‘April.

But officials are also warning of more than one wave, with outbreaks and new infections continuing for months. A vaccine is at least 12 to 18 months away, and the “new standard” really means longer-term adjustments to limit the impact of these new outbreaks.

Some experts around the world have warned that things like live concerts and massive public gatherings for sporting events will not be safe for months.

Hoffman said he thinks Canadians need to prepare for a top-down scenario, “where the government will first reduce these restrictions, then two weeks later will have to tighten them in light of new data and news information on where it spreads or how it happens. “

This report from The Canadian Press was first published on April 14, 2020.

– With files from Mia Rabson and Lee Berthiaume in Ottawa, Kelly Geraldine Malone in Winnipeg, Cassandra Szklarski and Michelle McQuigge in Toronto, and Christopher Reynolds and Julian McKenzie in Montreal.

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