As coronavirus cases grow again in Canada, policymakers are toying with how to control the spread.
Bars and schools have become flashpoints for outbreaks and, according to the World Health Organization, it may mean countries need to make a choice between the two in order to lower the risks.
“What is more important? Are children back at school? Are the nightclubs and bars open?” Dr. Mike Ryan, executive director of WHO’s health emergencies program, said Tuesday. “I think these are the decisions that we have to make coming into the winter months.”
But experts say it’s not so cut and dried.
“We’d be foolish not to acknowledge that bars are certainly associated with outbreaks when they’re left to function unchecked,” said Dr. Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.
“But it’s naive to think that simply closing the bars is going to resolve all of our issues. It grossly oversimplifies the situation.”
Decisions need ‘nuance’
There is no question bars and restaurants have had a bad rap throughout the pandemic.
Outbreaks have been linked to bars, nightclubs and restaurants in many provinces. While bars opened before schools in most places, the tangling of the two has drawn scrutiny and worry from some.
But the one-over-the-other concept is a “false dichotomy,” said Dr. Sumontra Chakrabarti, an infectious disease physician at Trillium Health Partners in Mississauga, Ont. The discussion has become common throughout the pandemic, he said, but it lacks nuance.
“It’s definitely not cut and dried,” he said. “Moralizing has come with this discussion. We should be able to speak about this dispassionately while making our decisions based on science and not personal preference.”
On one hand, Bogoch said the schools vs. bars argument “ignores many other factors that can be driving transmission in a community.”
The bars might close down, he said, but it might actually be private gatherings bringing up case numbers.
That’s something Ontario has recently clued into. Daily case counts have steadily risen in the province since it entered into its third phase of reopening. Public health officials and mayors have pointed at large gathering limits, which have fostered private indoor parties, as a key contributor to the spread. In response, the government has clamped down on those limits in three regions where the majority of the new cases are occurring.
But in British Columbia, it’s a different story. The province traced its new transmission chains to nightclubs and banquet halls and has since ordered them to close. Restaurants and bars face new restrictions but remain open for now.
These decisions need to be made regionally, Bogoch and Chakrabarti agree.
“We have to look at the unique circumstances in each place,” said Chakrabarti. “Not all bars and restaurants are created equally.”
Experts agree it’s important to consider the wider community at this point in the pandemic, and not think of schools as closed systems, unaffected by what the virus is doing outside their walls.
In some regions, the issue may very well be bars, said Bogoch. In Quebec, for example, a single karaoke bar was linked to dozens of COVID-19 infections, including at three local schools. But for others, that might not be the case.
“It’s foolish to think that closing bars is going to solve all of our individual problems,” he said.
“But like anything else, there’s a tug between those who want to reopen the economy and ignore some of the tougher details associated with the virus, and those who think we should just close everything up, not necessarily acknowledging the world outside of COVID-19.”
Economic balancing act
Schools are crucial to communities in ways that go far beyond basic learning. They’re also a key part of recovering the economy, according to Moshe Lander, an economics professor at Concordia University.
The WHO’s comments are clearly directed at the public health concerns, Moshe said, but that doesn’t negate the fallout that could occur for people financially on either side of the coin.
“When you consider how many young people have jobs in the food and beverage industry — from front-line staff, to backline, to all of the transportation and suppliers — there’s a huge knock-on effect if you shut that down again,” he said.
“It’s a large number of jobs — many that rely on a make-or-break sort of income.”
On the flipside, school closures could have a cascading effect on families who are already trying to reboot after a shaky six months.
In the long term, the impact on students could be far greater, he said.
“It could have long-term ramifications for the capacity of the economy 20 years from now when all of these children who’ve had their education disrupted are not going out into the job force with the same skills and knowledge as the cohort before them,” he said.
While that has “much more dangerous” impacts than another round of restaurant and bar job losses during a second wave, there’s “a lot at stake” either way, he said.
Policymakers and public health need to find a balance between the two.
“We can actually have both,” Lander said.
Is there a tipping point?
There are multiple things to be considered before interventions — big or small — are made to decrease transmission, said Chakrabarti.
Case counts, locations of outbreaks, undetected community spread, health-care capacity and contact tracing are all important factors, he said.
“What best keeps schools running with low risk is to have low community transmission,” he said. Ultimately, “you want to be able to manage all the applicable risks together so that the situation is safest for all of us.”
On the other hand, with new, possibly tighter, restrictions, there’s still room to make bars safer, said Bogoch.
There’s also a chance to be proactive, he added. If policymakers and public health authorities can identify an “interim point,” where cases may be increasing rapidly in certain areas, Bogoch said the right balance can be struck earlier on before things get bad.
“The easy take is — bars are associated it, we close the bars. Sure, but that’s the baseball bat approach,” he said. “There are alternatives to this issue.”
And, at the end of the day, “it’s totally OK to pivot,” Bogoch said.
“It’s OK to learn from the mistake and rapidly change course if the plan doesn’t appear to be working.”
— with files from The Associated Press