Lessons Canada Can Learn from the US Mismanagement of COVID-19

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Almost two months ago, a health care advisor to two US presidents burst with frustration when asked if Americans would see a rapid increase in new COVID-19 cases when states reopen.Zeke Emanuel, who served in Obama’s White House and unofficially advised President Donald Trump, expressed exasperation that people continue to seek immediate effect.

Speaking in a sermon on the mathematical realities of exponential growth rates, Emanuel said that the disastrous consequences of reopening too early would not appear until early summer.

“Two months, not two weeks,” said Emanuel in early May. “It’s probably when you see the effects of what we’re doing today. … Then people will recognize: “Wow, now we have 1,000 cases today, 3,000 cases tomorrow, 6,000 the next day. “”

He predicted the country would wake up to disaster around mid-July.

It is happening earlier than expected.

Few people wear masks as they walk the beach wharf in Oceanside, Calif., On Monday, despite the increasing number of COVID-19 cases in the state. (Mike Blake / Reuters)

The United States has exceeded 127,000 deaths and the number of cases is increasing rapidly in many states, mainly in the south. An alarming surge has forced Texas to suspend plans to reopen. Hospitalizations have reached records in Arizona and California.

Florida has backtracked on its bullish reopening. Governor who recently accused media of raising fear about COVID-19 – wiggling his finger to reporters on what he called “black helicopter” conspiracy theories – was forced to announce on Friday that bars are closing again after Florida has seen an astronomical peak in positive tests.

“This is what happens when you reduce the social distancing measures and community transmission continues and these two things collide and it spreads,” said Jason Kindrachuk, assistant professor of viral pathogenesis at University of Manitoba in Winnipeg and holder of the Canada Research Chair in Emerging Viruses.

Kindrachuk said Canadians would be well advised to learn from the US response to the pandemic.

“We can take this information and state here in Canada that, as we reduce social distance, especially in areas that are more densely populated, we are likely to see a resurgence of cases, because in the end, the virus is still in our communities and is still able to spread. ”

South American hard hit

On Friday, the disturbing trend in the United States prompted the White House to resume its previously suspended coronavirus press conferences. Vice President Mike Pence maintained that the country is doing much better than a few weeks ago, but said that 16 states have a total of increasing cases and, more worryingly, an increasing percentage of positive test rates.

Although this virus is an evolving phenomenon, making any general conclusion risky, here is what we know of places in the United States that are experiencing epidemics: they are mainly in the south; mainly in states that reopened early and aggressively and resisted the widespread use of masks; and mainly led by Republicans, unlike a previous wave that mainly hit the northern states led by Democrats.

The rapid increase in cases and hospitalizations is due to the desire to reopen states without first establishing appropriate case tracking and treatment systems, said Dr. Amesh Adalja, infectious disease physician and principal investigator at Johns Hopkins Center for Health Security.

“There was never any question of whether or not we would have more cases when people started to interact socially,” he said. “The question has always been: could we keep these cases at a manageable pace? ”

Adalja said: “It is clear that in these states that are currently under stress, there has not been enough preparation for these cases.”

He said states faced with pressure on their healthcare systems have squandered opportunities during closings to increase capacity and prepare for an outbreak.

People line up to get tested for COVID-19 at a test site in Phoenix, Arizona on June 20. (Matt York / Associated Press)

“From the start, this epidemic was really mismanaged in terms of what the government’s response should have been,” he said. “People thought they could get back to the norm – without realizing that the virus was still there. ”

Adalja said parts of the United States that had been spared from large COVID-19 outbreaks at the start of the pandemic erroneously believed that they would not be hard hit after the lifting of the lockdowns – or that they could adequately manage the number of new cases.

He said that was the main point to remember for Canada as provinces hard hit by COVID-19, such as Ontario and Quebec, decided to lift the foreclosure measures.

“What you can learn is that the virus has not disappeared, that social interaction will generate new cases,” said Adalja. “The bottom line is: can you handle these new cases? “

US tests more, finds more cases

The initial debacle over the lack of testing in the United States is well documented, as is Trump’s bragging about the amount of testing and his subsequent suggestions that the government should cut testing because it only reveals more positive cases.

Another story about testing in the United States is less well known. Is that the United States jumped in front of Canada in per capita tests, thanks to public-private partnerships.

In Canada, all COVID-19 tests are done through the healthcare system of hospitals or designated test sites. But in the United States, different people have different access to tests.

For example, Washington, D.C., resident Carlos Sabatino said he had been tested in 20 minutes. Sensing certain symptoms, he went to a service behind the wheel of a CVS pharmacy, received a kit, explained how to take a nasal swab, cleaned the kit with sanitary wipes and returned it.

Three days later, he went online and got the results, which declared him COVID-free. His health insurance covered the cost. “The whole experience, door to door, lasted 45 minutes,” he said. “I was surprised at how effective it was. … Frankly, I was impressed. ”

Sabatino learned of the tests from the pharmacy after he gave up testing by the city government. He was deterred by the long brutal lines and the news that he would only get the results by mail in a week.

But Sabatino is one of the lucky ones. Disparities in healthcare in the United States are a constant problem.

Some Americans have access problems, while others describe appalling insurance bills. Video from some locations in the southern United States shows huge queues.

WATCH | Large queues at test sites in the United States:

Traffic is stopped as drivers wait at the COVID-19 test sites while driving in the United States. 1:11

This pandemic has revealed profound inequalities in health care in the United States, as Black Americans are less likely to Health care access and much more likely to become very sick.

This week, a former US health insurance executive said the system had failed and he apologized for previously derogatory Canadian public health care.

Testing capacity took a long time to increase in the United States at the start of the pandemic, giving the virus enough time to spread across the country before it could be exposed. Even now, test shortages are reported last hot spots.

This is why experts say that the percentage of positive tests in the United States is considerably higher per capita than in Canada. If you test early and often, you quickly identify cases. If you test late, the first cases will be missed and the positivity rate will be higher.

For each positive case in Canada, an average of 110 people are tested. In the U.S., that number is currently around one for 17 tests.

“When I look at the American scenario, it’s … almost like watching a train wreck in slow motion, because a lot is fairly predictable, mainly because they were really, really late to start testing,” said Dr. Lynora. Saxinger, a doctor specializing in infectious diseases at the University of Alberta.

“They are expanding their tests now, but the percentage of positivity in their test continues to increase, which is horribly scary. “

Saxinger said this leaves only one tool to deal with the increasing number of cases in the United States – reinstate the lockdowns, which Texas and Florida have done.

“The problem I see coming is that if you open when you don’t have the ability to control things, it’s really hard to put the genie back in the bottle, because the public doesn’t agree with that Said Saxinger.

“I don’t know how well the reinstitution of public health measures will go if a place has had the strictest measures, releases them and then returns. “

In the United States, masks become political

One difference between the Canadian and American experience is that partisan politics has infected the American response.

Apparently, all aspects of this pandemic have taken on a partisan tinge, from social distancing to medicine – for example, being for or against hydroxychloroquine, once considered an effective treatment for COVID-19, has become an indirect indicator for find out if the Americans were pro or anti-Trump.

Masks have also become a symbol of political status.

Even the masks have become political. Joe Biden, left, always wears one in public. Trump, right, made fun of Biden and a reporter for wearing them. (Jim Bourg / Reuters, Drew Angerer / Getty Images)

“There is a feeling of:” This is the United States of A and I can do whatever I want, please, “said Dr. Linsey Marr, an expert in virus transmission through aerosol at Virginia Tech. There are “certain segments [of the population] who are very anti-government, who don’t want to know what to do. ”

This has been recognized by the country’s biggest cinema chain: AMC Theaters said the masks have become politicized and not be mandated for moviegoers. In the public uproar that followed, reverse course.

A Pew poll this month found a 23 percentage point gap between Democratic and Republican voters as to whether they claimed to wear masks in stores all or most of the time.

WATCH: Trump hosts controversial rally in Tulsa, Okla .:

President Donald Trump’s first campaign rally in months did not have the participation he boasted about, but the Tulsa, Okla. Event was a glimpse of what drives fans and the game book from Trump for his re-election. 2:27

The President’s own statements helped shape this conversation. They understand the first predictions that COVID-19 will disappear soon, mockery politicians and journalists to wear masks and his repeated requests that states reopen faster than recommended by the White House’s own guidelines.

In the fight against the spread of COVID-19, masks can be a game-changer. A Philadelphia Inquirer survey found a strong correlation between a state’s mask rules and its recent case rate.

“The irony here is that if everyone was ready to put on a mask, I think we could get back closer to normal without having that huge spike in the cases,” said Marr. “Otherwise, we will all be limited in our movements and in the economy. “

Trump rally reveals gap

As for the masks, loyal Trump supporters expressed their feelings clearly at a recent indoor rally in Tulsa, Okla.

A tiny percentage of the crowd wore masks – despite an increase in the number of cases this state and news that a handful of Trump campaign workers tested positive.

Event organizers even distributed masks. Most participants took one. Few wear them.

President Donald Trump staged an election demonstration at the BOK Center in Tulsa, Okla., On June 20, as infection rates in the state continue to rise. (Win McNamee / Getty Images)

“Science [has come] to show that this coronavirus is much less deadly than people thought, “said rallygoer Jason Yeadon. I think the numbers are exaggerated and the data will show it at the end. ”

He blamed “supposed professionals” for pressuring elected officials to stop the economy and insisted that governments overreact in the first place.

“I am not a prophet”

The current increase in the number of cases in the United States is not a surprise to Zeke Emanuel, Obama’s former health care consultant.

“Anyone who has studied two weeks of epidemiology could have predicted this,” he said in a follow-up interview this week. “I am not a prophet – it was completely predictable. ”

According to Saxinger, given the high percentage of the population in the United States and Canada still susceptible to COVID-19 infection, neither country is outside the “line of sight” in terms of major epidemics of the disease.

“Although we feel like we dodged this ball, it is still possible in many places in Canada,” she said.

“People are so hungry that everything is normal and they do it – but this is clearly not the case. The virus is not gone and as soon as you start to mix, it starts to go up. “



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