The goal of reopening countries without sparking new coronavirus outbreaks has proven to be a challenge around the world.
Even as some countries begin to see normal signs of life again, the virus has kicked back, prompting governments to review or reverse reopening plans.
“One thing is clear — when countries have reopened, they haven’t gone back to normal or to the way things were,” said Steven Hoffman, director of the Global Strategy Lab and a global health professor at York University.
Germany is one example. Just days after the country rolled out its first tentative steps to reopen the economy, it saw a surge in new coronavirus infections.
The German government recently allowed shops, playgrounds, museums and memorial sites to reopen so long as they abide by enhanced hygiene measures. Households can meet with members of one other household and hairdressers can return to work, but limits on social contact are still in place until early June.
But, by Monday, public health authorities reported that the virus reproduction rate had risen above one, indicating that COVID-19, the disease caused by the virus, was spreading exponentially.
The new outbreak, coupled with one in South Korea, sounded a global alarm as many other countries begin to wind down economic lockdowns.
It shows just how quickly progress can be reversed, even in a country with one of the best records for containing the pandemic in Europe so far, according to Hoffman.
“There’s no clear recipe on the best way of reopening society because so many of the decisions should be based not only on science but on citizens’ values and preferences,” he said.
South Korea has already seen its own hiccups as rules are relaxed. Officials in Seoul are scrambling to contain a new outbreak linked to nightclubs and bars that reopened as part of eased restrictions.
The news influenced some parts of the country to backtrack on their plans. The country’s education ministry put off restarting high schools in light of the new cases, and nightclubs have been temporarily closed down again.
Revising or reversing plans is not out of the cards for any country, Canada included, said Hoffman. In fact, he said it could very well be part of the “new normal.”
“All the talk about reopening society makes it sound like these restrictions were a one-time measure,” he said. “No matter our strategy for reopening society, if we start to go back to a situation where new cases are increasing, we will have to very quickly reimpose layers of protection in order to reverse that.”
South Korea once had the largest outbreak outside of China, but stringent public health measures, a rapid move to widespread testing and contact tracing helped contain the virus without a heavy or widespread lockdown. As of May 12, the national death toll stood at 258, according to data from John Hopkins University.
Germany is similar. The country’s death toll has remained relatively low compared to other European countries — 7,676 as of May 12 — and it was able to conduct mass testing from the onset of its outbreak. The strength of Germany’s universal health system also played a role.
It’s what these countries did early on that will guide what they can do now, according to Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto.
“The countries that have had the most success are the ones that took really restrictive steps really early — a matter of days or weeks are huge,” he said.
“While it’s tempting and important to look at the experiences of countries that have been opening to try and learn from that, we have to have a nuanced eye. We can’t be naive. We can’t say ‘They did A and B’ or ‘C and D didn’t happen.’ We can’t assume that the virus will behave or the policy will work out the same way here.”
In Canada, reopening plans are coming province by province. British Columbia is allowing a partial reopening of its economy starting May 19, Quebec has moved to reopen schools in parts of the province and Manitoba has given the green light to restaurant patios, museums and other non-essential businesses. Though Ontario has allowed some businesses and services to partly reopen, the province is expected to extend its state of emergency to June.
Both the federal government and provincial authorities have emphasized “cautiousness” as plans roll out, but cautiousness means little without more robust testing, said Furness.
He believes Canada can only be confident about reopening once it ramps up testing. Furness said “sentinel testing,” which targets asymptomatic virus carriers, could help paint a better picture of the rate of community spread in Canada. It could also help narrow in on groups with “major occupational exposure,” he said, like grocery store workers and taxi drivers, as citizens begin to venture out of their homes more.
“This is an asymptomatic pandemic. You can’t just look around and say, ‘Hey, everyone looks fine. No one’s walking into hospitals. It must be gone.’ That’s not how the virus works,” he said.
“It’s not about loosening. It’s about loosening without doing the measurements to know what the risk actually is.”
Canada’s chief public health officer, Dr. Theresa Tam, said Tuesday that the next phase of Canada’s response to the virus will involve testing people with a wider range of potential symptoms. She said Canada needs to cast a wider net when deciding who to test. However, no clear timeline on when that might come into play was provided.
As for how the country may look in the future, Tam said large gatherings and non-essential travel won’t be happening any time soon. Even for small gatherings, approaches will have to change, she said, and “core public health practices” will need to be maintained.
Like in other countries, she said Plexiglass and physical-distancing measures will likely become a mainstay in stores and shops once they reopen.
Lifting layers of protection in Canada will happen in lockstep with “good news” like declining cases and hospitalizations, said Hoffman.
But even then, there’s no roadmap for what should be relaxed first and how.
“We need to be really strategic about those layers of protection. We don’t exactly know which provide the most protection versus which ones we can replace with alternative measures,” he said.
“Some alternative measures can be less intrusive and almost as effective. Those are the sweet spots we need to find out in our society before we reopen.”
— With files from Reuters and the Canadian PressView link »