“Targeted” coronavirus strategies have prevailed in Canada since stay-home orders expired in the spring.
For months, local and provincial governments have attempted to balance public health and the economy by reopening businesses and schools under new frameworks — and closing them again if needed.
But as virus cases surge across much of Canada yet again, are targeted approaches effective enough?
Experts say they still have value, but that the window for using these strategies is closing — and fast.
“You can target all you want. You can shut down gyms here, limit gatherings there, but if people aren’t actually doing what you tell them, it isn’t going to work,” Raywat Deonandan, an epidemiologist with the University of Ottawa.
“Everything we do is predicated on encouraging a kind of human behaviour. If the policies don’t result in change, then they’ve failed. That’s where we are.”
Unfocused targets
Canada’s daily national tally of coronavirus cases has climbed week-over-week since October. It reached another troubling milestone this week, surpassing 300,000 confirmed cases.
Alarms have been ringing, but each province is responding to the alarm differently.
Rules once binary by province — eg. indoor dining barred in one province, but allowed in another — have been whittled down by region. In Ontario, for example, the latest rules allow indoor dining in Windsor, but not in Toronto. Similar red tape snakes through Quebec, particularly in Montreal.
“Unfortunately, values influence your politics here,” said Deonandan. “The disconnection between federal values and provincial ones may be having an effect, and slowing down cohesive action.”
Sifting through the rules and how they apply has become increasingly tricky, experts agree.
Mix the confusion in public messaging with pandemic fatigue and you’re left with “shortcomings” in some regions, said Sumontra Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.
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“But it’s important to not throw the baby out with the bathwater,” he said, noting it would negate success stories in regions Canadians aren’t “laser-focused” on.
“Look at places like Windsor. It was on fire a couple of months ago, now look at it,” he said. The city — once a hotbed of virus cases among migrant workers on farms — has levelled off considerably, but not entirely.
“In Ontario, the conversation has been very GTA-centric,” said Chakrabarti. “The GTA has special, unique issues — ones that still can be targeted — but let’s not throw out public health principles because of what’s happening in the GTA.”
However, some things are difficult to target, experts say — the main one being indoor private social gatherings.
The focus has been on gyms, bars and restaurants, said Chakarbarti, but neither targeted strategies nor lockdowns effectively address private dwellings.
“It might be the one big thing we weren’t able to target,” he said.
Top doctors both federal and provincially have blamed “more relaxed settings,” like family get-togethers, birthday parties and holiday celebrations, as a key driver to the pandemic’s second wave.
In response, provinces have repeatedly changed their guidance on this — from social circles or bubbles to your “safe six” and, now, household-only.
But the problem itself never actually been “targeted,” said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto. There’s been finger-wagging from all levels of government — often at young people — but few tangible responses.
“We talk about targeted approaches more than we actually do them,” he told Global News. “In terms of problem-solving, we’ve been asleep at the switch on this.”
It’s here that inconsistent messaging — tied to these targeted, now regionally-focused restrictions — continue to show its cracks, he said.
“For months we’ve been saying to people, “Go to bars, take your friends, take off your mask at the table, have some drinks. It’s fine.” But then we say, “Just don’t do that in your living room.” Not everyone has the cash flow to do that in a bar every night,” he said.
“Socioeconomically, where do you think COVID is spreading? It’s spreading where there’s less wealth… Of course people are doing this. They’re appropriating and adapting it in a way that makes sense for them culturally and financially.”
Complementing strategies
There are still options on the table, said Deonandan, they just aren’t always as palatable.
To Deonandan, it falls into two categories: economic closures or refocused “targeted” strategies.
Economic closures “come with their own price,” he said, but can be done temporarily. He pointed to the shorter circuit-breaker-style lockdown, which has picked up steam in Canada. It’s already been imposed in Manitoba and Nunavut and has been considered in Alberta.
Chakrabarti suspects it will be needed in Ontario as well. But widespread closures aren’t the solution, he said, “it’s a means to the end.”
“The end is trying to get the number as low as possible,” he said. “When you have a lot of community burden, sometimes it’s the only thing you can do to bring the numbers down quickly and simultaneously regroup and retarget the strategy.”
That’s the second category — “a targeted approach with a better deployment of messaging to foster public compliance,” said Deonandan.
The approaches need to be better defined, he said.
For provinces like Quebec and Ontario, where hot spots are delegated by colour-coded levels or zones, Deonandan believes monitoring travel between, say, “a red zone to a green zone” would emphasize that so-called “targeted” approach.
Improved focus on marginalized or disadvantaged communities and other “blind spots” in current targeted provincial strategies are also important, said Furness.
Ultimately, a targeted approach won’t prevent additional waves of the virus, but it may succeed in “keeping everything running at an as-needed basis until a vaccine arrives,” said Deonandan.
“It comes down to what you want. What do we want out of this? Do we want to be barely surviving? Or do we want a comfortable buffer, and are we willing to pay to get that buffer?”
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