Curfews, stay-at-home orders, travel restrictions and closures.
It may seem like Canada’s hardest-hit provinces have gone to the nth degree on COVID-19 interventions for a second time around, but experts say they can still go further.
The question is, how?
There are two ways to look at it, according to Isaac Bogoch, an infectious disease expert based out of Toronto General Hospital. One, provinces impose rules that could, theoretically, curb transmission in the short-term, like a stay-at-home order or curfew.
But those types of interventions have consequences, he said, and can’t last forever.
The second option focuses on getting to the root of infections.
“It’s sort of stating the obvious — we need to deal with the source instead of band-aid solutions,” Bogoch said.
“It’s about turning off the tap. I can’t believe we’re still talking about this in January of 2021, but it’s never too late to do it.”
As the Swiss cheese model has taught us, no one measure is entirely effective on its own. Each of these rules — known as non-pharmaceutical interventions — has flaws and need to be stacked together to ensure there are fewer holes for the virus to get through.
This week, Ontario tacked on a stay-at-home order and reduced retail hours to its pre-existing lockdown, which has kept non-essential businesses closed and social gatherings limited or barred for many weeks now.
Last week, Quebec imposed Canada’s first provincial nightly curfew. That, too, was stacked onto a pile of other previously implemented restrictions.
Despite this, Canada’s top doctor, Dr. Theresa Tam, insists more needs to be added to the pile to curb transmission nationally.
“Unless public health measures are further intensified, we will not be able to sufficiently suppress the current rate of epidemic growth,” she said Friday.
At this point, things like curfews and reduced business hours won’t make a very big dent in transmission, said Dr. Sumon Chakrabarti, a Toronto-based infectious diseases specialist.
He described it as “squeezing that last drop of juice out of an already squeezed lemon.”
“I think there are other issues we need to focus on,” he said.
With so many outbreaks in occupational settings — like food processing plants and warehouses, where people can’t work from home — many of these new interventions miss the target, experts say.
Ontario intends to ramp up workplace inspections this month, including at crowded big box stores. The blitz will monitor the implementation of health and safety measures, adherence to physical distance and masking rules, and, for retail stores, capacity limits.
In December 2020, Quebec Premier François Legault warned that workplace health and safety inspectors would be cracking down on those who flout the COVID-19 rules, though no reinforcement of that warning was mentioned in the province’s latest lockdown announcement.
“We have to be really aggressive with workplace inspections. We have to come down like a bag of hammers on employers who don’t get it, who don’t think this is important,” said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto.
“Stopping people in the street and making sure they’re out for an essential purpose, that’s not helpful. Deploying that enforcement to inspecting workplaces, that is.”
Whether it’s factories, food processing plants or construction sites, the latest numbers show heavily populated, essential workplaces are hotspots for COVID-19 in Ontario. Toronto recently joined Peel, Ottawa, Kingston, Windsor-Essex, Waterloo and Brant in publicizing workplace outbreaks. A recent report includes a skincare product factory and food processing plant among active outbreaks.
Quebec’s workplace safety board (CNESST) said Friday that it has handed out fines to nine Dollarama stores for alleged non-compliance with novel coronavirus health guidelines since mid-March.
“We have to answer a couple questions here. How do you create a safer workplace? How do you ensure that there are safer workplaces operating? And how do you focus resources on screening these workplaces that are at risk of infection?” Bogoch said.
“We have to find a way to turn off this tap.”
Bogoch and Furness agree that this type of strategy is long overdue. It falls in line with looking more closely at the inequities that have been exacerbated by the pandemic, outlined in Tam’s report in October, titled “From Risk to Resilience: An Equity Approach to COVID-19.” In it, Tam described the broader consequences of the pandemic and how a “health equity approach” is crucial for recovery and response to future health crises.
“These are tougher to face because they deal with uncomfortable truths, which are some of the inequities we have in Canada,” Bogoch said, noting that accessible and adequate paid sick leave would play a pivotal role in addressing this.
“If I were to pick between a paid sick leave or a curfew, I’d take a paid sick leave any day. You’re dealing with an infection driver rather than a band-aid solution.”
Furness said putting more focus on the source of large outbreaks could result in infection reduction “pretty immediately.”
“These two populations — what people do at home vs. what people do at work — they are related. People get infected in one setting and bring it to work, and vice versa,” he said.
However, he’s not convinced Ontario’s plan to scale up inspections is enough — or should be totally trusted.
“They’ve said it, but are they going to do it? This isn’t the first time they’ve said this.”
Rapid diagnostic testing “at a mass level” — especially in environments susceptible to outbreaks — as well as screening in high-risk areas and policies like sick leave are all just as important at this stage, the experts agree.
While federal officials appear keen on provinces and territories imposing further controls, they’re leaving it up to them. Neither Tam nor her colleague, Dr. Howard Njoo, vouched for or against a suggestion of travel restrictions between provinces.
Prime Minister Justin Trudeau echoed that Friday, saying each province and territory will “make decisions that are right for them,” which the federal government will be there to support.
Make no mistake, there are other things provinces can do, Furness and Bogoch agree.
“At this point, when our health-care system is stretched — not stretching — beyond capacity… Any incremental benefit will always be welcome,” Bogoch said.
“But if we want the most bang for our buck, we have to go to high-yield drivers in the first place.”
— with files from the Canadian Press