All eyes are on bars and restaurants in Canada — particularly in Ontario — as cases of the novel coronavirus rise among young people.
People aged under 39 make up more than half of the 203 cases reported in Ontario on July 21, leading the premier to point squarely at young people violating public health measures by partying and exceeding limit gatherings.
“Guys, you got to rein it in,” Doug Ford told reporters. “Simple as that.”
But according to experts, it’s not all that simple. Since the stay-home order simmered, the rhetoric around what can and can’t be done has changed — sometimes rapidly, sometimes regionally.
Experts say the reopening of bars and restaurants has only exacerbated the problem and that without more consistent messaging and penalities, it will only worsen.
A “tough love” message is long overdue, said Dr. Prabhat Jha, an epidemiologist at the University of Toronto, and director of the Centre for Global Health Research at St. Michael’s Hospital in Toronto.
That message “needs to come from the top” — especially as indoor dining makes a comeback.
While the Ontario government can move parts of the province back to earlier stages if required, that hasn’t been made clear, Jha said. There are also no plans to take further action against young people who break the rules, such as imposing extra fines.
“People need to know it can be shut down again,” he said. “You can’t leave that (messaging) to the public health officers for each and every unit.”
Switzerland, since reopening its bars and restaurants, has shown “lots of tough and not much love,” Jha said.
When a single positive case was tied to a nightclub, the health authority “quarantined the whole lot,” Jha said. Nearly 300 guests and staff were ordered to a 10-day quarantine.
“Canada won’t be that draconian,” Jha said, but what Switzerland had in this case — which Canada lacks — is a contact tracing app.
“The public health objective now is to prevent clusters of cases, so we need to accelerate the contact tracing app,” he said. “Think about it: who’s going to use the app? Mostly young people with cellphones.”
Canada’s contact tracing app, COVID Alert, was due to be tested in Ontario in early July before going nationwide, but it hit a snag. There’s still no word on when it might be rolled out.
“It could be something bar owners insist upon. They could say, ‘No app, no entry,'” he said.
Provinces seeing upticks connected to the bar scene could go as far as sending mobile testing vans to areas where people are congregating, he added.
“Indoor gatherings, like bars, have been identified right around the world as potential hotspots. We need strategies in place very quickly.”
Contextualize the message
But mixed messages are a major factor in compliance, experts say, as they have been since the onset of the pandemic.
Ford on Tuesday urged people not to go to parties. But, as many have pointed out on Twitter, telling people not to party while simultaneously allowing bars to reopen is “not an entirely coherent public health message.”
Bars and restaurants across the country do have to abide by new guidelines.
But, so far, the “one-size-fits-all approach” has been insufficient, said Dr. Raywat Deonandan, an epidemiologist and science communicator based at the University of Ottawa.
Deonandan also fears “misinformation, disinformation, rapid electronic information and political ideologies” are actively working against public health goals, further complicating compliance.
“This pandemic is causing us to throw out the textbook when it comes to how we unroll public health communication,” he told Global News. “Different people respond to different messages differently… Messages should be tailored to different age groups, socioeconomic levels and other demographics.”
Contextualization is missing from the messaging currently, he said.
“The carrot-and-stick model still applies. The stick is scolding — as Doug Ford is doing from his podium — and also the enforcing of bylaws,” he said.
“The carrot is what we don’t focus enough on: that responsible behaviour is heroic and that we all benefit from it.”
Young people not immune
While cases among young people are increasing, experts agree their risk of serious disease is still lower than most. From this, some experts have pointed to a feeling of “invincibility” about the virus and “lockdown fatigue” as reasons for the behaviour change.
Regardless, it doesn’t exclude them from the chain of transmission, Jha said.
“We’re worried about interrupting transmission, not zero transmission because that’s not realistic,” he said. “The role of young people is to understand that they’re in the chain and that we need their cooperation.”
Dr. Jay Kaufman, a professor in the department of epidemiology, biostatistics and occupational health at McGill University, said his Montreal neighbourhood is densely populated with bars and restaurants and that “irresponsible behaviour” is frequent.
He acknowledged that while there’s an economic reason to reopen these sectors and that summertime and nice weather will play a role, the “message of protecting the vulnerable has to be better broadcast.”
Canada’s Deputy Chief Public Health Officer, Dr. Howard Njoo, has advised people to stay away from bars and dance floors to stave off the rise in cases.
But controlling the behaviour will ultimately rest on enforcement from authorities, Kaufman said, adding public shaming might also help. Indonesia at one point cracked down on rulebreakers by uploading them to social media.
“To some extent, it is a natural consequence of reopening economies,” he said. “But young people… their failure to distance and wear masks is classic selfishness.”
To Deonandan, the issues go beyond the marketing of the message and reflect a “fundamental crises in social value.”
He pointed to a quote by author and Holocaust survivor, Viktor Frankl, famously paraphrased by Uncle Ben in Spider-Man.
“With great freedom (to go to parties and bars) comes great power (to infect others), and therefore requires great responsibility and wisdom to use,” he said.
“That kind of contextualization is missing from the messaging.”
— with files from the Canadian PressView link »