A recent coronavirus outbreak linked to a family gathering in British Columbia set off a new alarm about the importance of physical distancing, even as provincial rules loosen up.
While the province’s top doctor deemed it a “warning sign to us all,” some Canadian experts put it more simply — it’s inevitable.
“It’s not nice to say, ‘Get used to it,’ but we are going to see this. There’s much more of this to come,” said Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital.
“You don’t need a crystal ball to know that this is also going to happen when we start to open up daycares, schools, or when people go back to the office.”
At least 15 recent cases were tied to a family event in B.C.’s Fraser Health region. Roughly 30 people attended the gathering, which took place both indoors and outdoors, according to health officials.
The province is currently in the second phase of its recovery plan. Restaurants, gyms and hair salons were given the green light to reopen at half-capacity about three weeks ago. Despite this, transmission rates have stayed relatively low.
The cluster of new cases — called a super-spreader event — is under a microscope now that infection rates are gradually subsiding, both in B.C. and across Canada, Bogoch said. But, he said, outbreaks like this have been happening all along the way.
“When you’re having hundreds and hundreds of cases per day in a province, you don’t see that granularity. But when you have so few cases, you can really appreciate how this infection is transmitted,” he said. “There’s just certain individuals and certain settings where this will happen, and it’s not unique to this virus, either.”
Bogoch pointed to recent global incidents as examples.
South Korea, often seen as a success story in containing the virus, saw cases spike when restrictions were loosened. Around 200 cases were linked to nightclubs and more than 90 infections have been traced to church gatherings near Seoul.
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In Iran, a wedding contributed to a new surge of coronavirus infections. The father of the bride, who was symptomatic, infected 76 of the 360 attendees at an indoor ceremony and party. Nine additional household contacts were infected after that. A study on the super-spreading event highlights hugging, cheek-kissing, hand-shaking, crowded dancing and traditional congratulatory wedding practices as contributing factors.
“Were they obeying the rules? Were these rules being followed? I have no idea, it’s always going to be hard to say,” Bogoch said of the family gathering in B.C.
“Even with the best-laid plans, this is still going to happen.”
But policies and ever-changing guidelines play their own unique role as well, according to Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto.
Overall, Furness believes B.C. has done a good job with communication and compliance, but “vigilance is dropping to an alarming degree” across the board.
“People seem to be kind of done.”
“Fear has a short half-life. People were really afraid in March and April, they’re less afraid in May, and now it seems they’re not at all afraid in June. It’s an irony — the safer we get, the better position we’re in, the more dangerous the behaviour gets.”
In B.C., residents got the go-ahead in May to expand their social “bubbles” as businesses and services reopened their doors. Gatherings of more than 50 people are still not permitted but smaller ones are, so long as people can maintain proper distancing from one another.
Opening up social contacts to friends and family makes sense, said Furness, nodding to a social network-based distancing theory currently being studied. It’s some of the other reopenings, done in tandem with expanded limit gatherings, that are cause for concern.
“The elevated risk is not in hanging out with people you like and trust or are related to, that would be in your natural bubble,” he said. “The problem is that there are high-risk activities that are also being allowed at the same time.”
A family gathering of 30 people is relatively low risk, he said, “but one or more of them brought contagion into the group because of a different risky activity.”
Recreational shopping could very well be the culprit, he said.
“It’s maximally connective. You’re more likely to bump into the virus that way,” he said. “You can have the same number of interactions with the people who are closer to you and it’s way less risky. It would be a matter of policy to tell people to bubble, but not go shopping. In Ontario, we’ve done the opposite.”
Furness believes the messaging in Ontario needs to be tightened.
The vast majority of the province has been given the green light to move into the next stage on June 12, but the Greater Toronto and Hamilton Area (GTHA) and other regions will need to wait. Things like hair and beauty salons, campgrounds and shopping malls can all reopen under existing health protocols and restrictions.
At the same time, Ontarians in all regions will be allowed to increase social gathering limits from five to 10.
“The simple message in the early days was: stay home. People can understand that. But now, you can get a massage in Ontario but not a haircut. There’s a valid answer to that, but that doesn’t mean it’s not confusing,” Furness said.
“It doesn’t take that much inconsistency or contradiction to really confuse people. You’re going to see people just throwing their hands up and letting it go.”
Along with simpler messaging, both Bogoch and Furness agree that ramping up testing capacity and contact tracing is the only way forward as people get together again, and the so-called super-spread events become part of a new reality.
“The key thing will be to rapidly identify them, rapidly respond to it to quell these outbreaks before they spread into larger outbreaks,” Bogoch said.
“We’re going to see this until we have a vaccine.”
— with files from the Canadian Press
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