Will it really take “weeks” to reduce the physical distance? Maybe not


How much time left?

This is the visceral plea of ​​Canadians who have been trapped at home for over a month, many imprisoned in private purgatory.

Some are failed with violent family members, others see their family businesses deteriorate. There are people struggling with mental illness, chronic disease, addiction and loneliness.

It’s an entire nation with their noses pressed against the window, watching the spring bloom just out of reach.

There could therefore have been a collective discouragement when Prime Minister Justin Trudeau announced tuesday that our isolation must continue for “weeks”.

Weeks? Really?

Will it really take weeks to start easing social restrictions?

Or is there a way to go back that can start earlier – slowly, intelligently and creatively building on the successes Canadians have shown in a collective effort to smooth the curve and protect the system health care?

This is a debate that has only just begun, with some pushing for faster easing and others – especially those on the front lines in hospitals – that are taking longer.

“We would like to relax the measures in a very controlled manner and examine where the greatest benefit would lie,” said Dr. Matthew Muller, medical director of infection prevention and control at St Michael’s Hospital in downtown Toronto.

“So if the hospitals aren’t overwhelmed – and I think it’s a bit too early to tell because we keep going up and I would like things to stabilize a little longer – it might be possible to restore more normal health ‘caring for more people. ”

It works. Canada smoothes the curve

It is now clear that Canadians are to be congratulated for the gift they gave to their public health officials and political leaders.

By putting their lives on hold, Canadians have created precious time to repair broken supply chains and increase the capacity of the already overburdened hospital system.

And after five weeks, there are signs that the sacrifices are paying off.

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Intensive care units in hospitals still see a constant flow of patients with COVID-19, but so far they have not been overwhelmed. As many non-COVID patients were transferred from hospitals several weeks ago, empty beds remain.

Although it is still too early to declare victory, some allow themselves to admit that they see the first rays of light at the end of the tunnel.

“I believe we are at the top but not at the top,” said Dr. MIchael Gardam, infectious disease specialist and veteran of the SARS epidemic and the H1N1 pandemic. He has been preparing for the COVID-19 surge for months as chief of staff at the Humber River Hospital in Toronto.

“I thought it would be much worse. I was thinking about the triage on the battlefield and who would get fans, “he said, adding that he does not expect Canada to face the nightmarish scenarios of New York and the north. Italy “as long as we stay smart. and keep a lid on things. ”

MPs, present in limited numbers and seated apart to practice physical distance, went to the House of Commons on April 11 for an emergency meeting to adopt the federal wage subsidy law . (Justin Tang / Canadian Press)

“Many of the deaths in Wuhan, Italy and New York were due to the fact that people couldn’t even get basic care like oxygen,” said Gardam.

But with cancer screening on hold, routine health care was interrupted and the evidence people hesitate to go to the hospital in the event of a real emergency, non-COVID collateral damage may accumulate.

“We have delayed many fairly urgent surgeries, for example, people who know they have cancer but have not yet had an operation,” said Gardam.

This is why he suggests that it might be reasonable to start relaxing in a specific area – perhaps resuming elective surgeries – and to closely monitor COVID-19 case numbers.

“I think you are starting to open up carefully. You start with your semi-urgent and urgent cases in hospitals. “

Test, PPE still required

The opening of health care depends on a regular supply of protective equipment. So far, Muller, on the front line of the hospital, is not convinced that the support is in place.

“We have already run out of many of our supplies that have not yet been restocked, so there are a number of pieces in the puzzle,” he said.

Another important tool in the return to normal toolkit is a broader diagnostic test – a critical part of the response to the pandemic which has suffered shortages and delays.

This week, Health Canada approved a portable DNA analyzer this will add testing capacity outside the main health care centers. Ontario has erased his laboratory test book and is currently testing more than 8,000 patient samples per day. Ottawa ad a New Brunswick company will supply critical test chemicals.

But testing capacity will need to increase to the point that front-line hospital staff will be able to quickly determine if a patient is infected and use appropriate personal protective equipment.

“If we had better testing infrastructure in place and better testing capacity, it would be more possible to start making the physical distance more flexible,” said Muller.

COVID-19 critical data gap

One of the biggest challenges of COVID-19 has been the lack of evidence for key indicators, including the true infection rate, the actual death rate and the impact of social distancing policies.

Stanford University epidemiologist John Ioannidis is renowned for his factual assessments of drug treatments and other health interventions. It researches the prevalence of COVID-19 and analyzes emerging data. He believes there will be fewer deaths from COVID-19 than expected, partly because the disease has already infected more people than the number of cases suggests.

Applicants take a written exam during a recruitment test for Ansan Urban Corporation at Wa Stadium in Ansan, South Korea, April 4. In addition to sitting apart, all candidates had to wear face masks and have their temperature checked. (Hong Ki-won / Yonhap via AP)

“This means that the death rate from infection is much lower than those that have been incorporated into mathematical models that make astronomical predictions,” he said.

A higher number of infections is important for two reasons. First, it will help establish the true death rate. So far, death rates are based on the number of cases diagnosed. But if there are more cases than we know, the death rate will end up being much lower.

Second, the more people who are infected and cured, the slower the virus will spread in the community, as these people will at least have short-term immunity to the disease.

This includes those who were asymptomatic, which may be a surprising number of cases, with some estimates as up to 80%.

So-called seroprevalence research – using blood tests to check for the presence of antibodies in a random group of people – will help answer this question. These studies are not yet underway in Canada.

“It must be done gradually”

Ioannidis supports a progressive relaxation of social restrictions while protecting the most vulnerable populations.

“I don’t think you can open up immediately.” People are in shock. It has to be done gradually, ”he said. “Start taking these measures and measure what is going on. If you see a resurgence, you can revert to more restrictive measures. “

When can this social easing begin? Not yet, said Muller.

“I think my fellow doctors who work seven days a week, 24 hours a day and deal with COVID patients are strongly in favor of continued physical distancing despite the impact it could have on their personal lives and their families, because we see the harm from COVID, “he said.

“On the other hand, I think they are starting to think and advocate for the provision of care to patients who do not have COVID. So that’s the balance. “

Physical distancing was only intended to slow the spread

The bottom line is that physical distance was never meant to keep people from getting COVID-19. The goal was to keep everyone from getting sick at the same time.

“We want the epidemic not to simmer, not to bubble up. The cases will happen, but if they happen at a simmer, we will be able to handle them, “said Gardam, adding that discussions on how to start relaxing have already started.

“I’m on call today to start talking about the aftermath. So we do it, we get there. And we are going to have to be very selective. “

Do we dare to imagine at least one form of street life this summer?

May be.

“Can you go to a restaurant again in summer? Probably smaller restaurants, maybe by removing a third of the tables and keeping them farther apart, “said Gardam, admitting that he might go out a little on a member.

“Until the cases start to go down, I jump a little forward and say that. But I feel comfortable saying it. ”


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