When the “bubbling” method was first floated by public health officials as a relatively safe approach to socializing, the pandemic curve was flattening in Canada.
Then came the reopening of economies. Canadians returned to work, children to school, and dining on a patio and working out at a gym were once again allowed.
The “stay at home” mentality diminished, and for a variety of reasons, spikes in cases across the country have followed.
The “bubbling” or “social circles” method may have been feasible in June and July, but experts say it’s become increasingly complicated as we approach a possible second wave.
“The concept of bubbling was that you keep yourself as low risk and protect your bubble as an entirety so you can be close to people,” said Dr. Zain Chagla, an infectious disease expert with McMaster University in Hamilton.
“But the reality is there’s been an expansion of society. One person’s contacts in an individual day — even if they’re masking and doing hand hygiene — are just going up and up and up. That’s now at an intersection with rising cases and the risk of coming into contact with the virus. Those lines are getting closer together.”
Burst bubbles
Toronto poked a hole in the bubbling method on Monday.
The city’s top doctor, Dr. Eileen de Villa, recognized that it was a “sensible approach to exiting the strict isolation and restrictions of last spring,” but it no longer applies.
“In Toronto, we have to acknowledge that the extent of the infection spread and the nature of city life means that the concept of the bubble or the social circle no longer reflects the circumstances in which we live,” she said.
“With reopening and the return to school, times have changed. And that is what you need to think about before you make a decision to go anywhere.”
It’s a different tone from exactly one month ago, when de Villa told Torontonians that it is “critical to remember you can only belong to one bubble.”
The changing directive is reflective of the changing risks, said Chagla. Low community transmission in the summertime provided a “secondary blanket” on top of protections like bubbling, he said, but now that rates are going up, that “failsafe is broken down.”
“Every day as cases go up, the chance of someone coming into your bubble, even if they’re not entirely stuck within your household, is also going up.”
Ontario’s chief medical officer of health, Dr. David Williams, said Tuesday that the province still values the concept of social circles, but “the question is, have people maintained consistency?”
Differences by province
The method has operated under different titles and rules across Canada.
Atlantic Canada was the first to roll out the relaxed restriction, allowing two households to link under a “family bubble” or “double bubble.”
In Ontario, “social circles” allow up to 10 people to gather without the usual precautions in place. Those who make up your circle — whether that be family, friends or neighbours — must agree to only socialize with each other.
Quebec never outrightly used the bubble method, but focused on social gathering limits. However, since the dramatic rise in cases in recent weeks, the province is now asking people in three hard-hit regions to not socialize with anyone outside their household.
Social circles have fluctuated in British Columbia, where the “bubble” guidelines now encourage people to try and limit their group to six people.
When schools reopened, the concept effectively burst, said Dr. Sumontra Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.
Not only are children “cohorting” or “bubbling” within their own large groups at school, but they may also take the bus or require after-school care, said Chakrabarti, widening the scope of contacts they make each day before returning to the home bubble.
“It’s much harder now,” he said. “De Villa is saying is that, rather than concentrating on the definition of the bubble, we should just be mindful of the contacts we make and reduce them across the board.”
It doesn’t mean the bubbling method has or should evaporate, he added. It may very well still be effective in certain regions depending on community cases, demographics and other factors.
Chakrabarti pointed to his hometown of Sarnia, Ont., where there have been “minimal” cases in the last few months.
“There, a bubble system might work a lot better. There are more families, more individual homes, as opposed to downtown Toronto, where you have a lot more single people living in condos,” he said.
“In a place like Toronto, the bubble has burst… but the idea shouldn’t be completely thrown out.”
Focus on what you can control
Regardless of where you are in Canada, the economic restart will make the “bubbling” concept difficult, the experts agree.
It’s better to focus on what you can control, said Chakrabarti.
“Going by the hard definition of a 10- or 15-person bubble, it’s impossible. But if you have a child, it’s what you can do once they’re home that you can control,” he said.
For example, families could stick to socializing exclusively with one other family after school hours, he said.
“That way you’re still limiting the number of contacts. In essence, it’s still a type of bubble.”
The focus now should be on teaching people how to mitigate risks, said Chagla, rather than creating “artificial constructs” based solely on numbers.
“We need to say, ‘Hey, listen, at this point in time, if you’re not residing under the same roof and you need to interact, do it outside, wear a mask, add distance,” he said.
“It’s important to remember that while some of us live in nuclear households of four, there are still people who live in households of one. You have to make the teaching equitable to that, too.”
What about Thanksgiving?
It will be a really tricky event, said Chagla.
“People visit their relatives for Thanksgiving. You’re sticking them in a room together and sending them back into their communities,” he said. “It has the potential to be a very serious event for community transmission not only locally, but wherever those visitors go back to.”
B.C.’s top doctor, Dr. Bonnie Henry, warned residents against large gatherings, particularly where seniors from other places get together with people outside of individual bubbles.
Only days earlier she urged the province that people must “slow down on social interactions” in general.
Chagla said that theoretically, you could isolate everyone in your bubble for 14 days “like you would come off a plane” and go directly to your relatives for Thanksgiving to isolate, but it harks back to the complexities of where Canada is in the pandemic.
“People have to go back to their jobs again, their workplaces. Kids have to go to school,” he said.
“I think people need to make serious plans about how to do this, whether by minimizing people gathering, doing it outdoors, or minimizing their external contacts for as long as possible prior to Thanksgiving dinner.”