OTTAWA—As new cases of COVID-19 surge across Canada, the federal government and the provinces have been imposing stricter measures to try to limit the illness’s spread.
John Brownstein, Montreal-born Harvard University epidemiologist and chief innovation officer at Boston Children’s Hospital:
Having a national testing strategy in Canada that uses rapid tests people could do at home would limit the spread of the virus, Brownstein says.“That would enable us to get insight on infection and actually have people isolate,'' he says.
No such tests have been approved in Canada yet.
“We’ve been saying this all along, so it’s not just a purely Canadian issue, but having a strategy that implements that kind of information would go a long way to drive infections down in communities while we wait for the vaccine.'’
Brownstein says curfews have unintended consequences because they force people to get together over a shorter period of time during the day.
“We haven’t seen a lot of evidence that curfews have driven down infection.'’
He says a mix of testing and quarantine is the best way to make sure international travellers don’t cause outbreaks when they return from the pandemic hot spots.
Testing alone is not enough, he says, because tests can come back negative during the novel coronavirus’s incubation period; people should be careful about relying on test results that could give a false sense of security.
Brownstein says pandemic fatigue is real and the governments’ support for people suffering in the crisis should continue.
He says promoting low-risk activities, including walking and exercising outdoors, is also important.
David Juncker, professor of medicine and chair of the department of biomedical engineering at McGill University:
Canada needs a national strategy for how to use rapid tests for the virus that causes COVID-19, says Juncker.Juncker is an adviser for Rapid Test and Trace, an organization advocating for a mass rapid-testing system across Canada.
“Initially the Canadian government (spoke) against (rapid tests) and then they pivoted sometime in October or September,'' he says. The federal government then bought thousands of rapid tests and sent them to the provinces, where they’ve mostly sat unused.
“Every province is trying to come up with their own way of trying them—running their own individual pilots. There’s a lack of exchange of information and lack of guidelines in terms of how to best deploy them,'' he says.
Juncker says the testing regime based on swabs collected in central testing sites was working in the summer but it collapsed in the fall.
He says medical professionals prefer those tests because they are more accurate and can detect low levels of the virus, which is important for diagnoses, but rapid tests can be useful for public health through sheer volume, if they’re used properly.
A federal advisory panel’s report released Friday, laying out the best uses for different kinds of tests, is a step in the right direction, he says.
“I’m happy to see we’re slowly shifting from the point of view of ‘Should we use rapid tests?’ to a point of view (of) ‘How can we best use them?’'’
More recent research suggests that rapid tests are more accurate than was previously thought, he says.
“We still don’t have enough capacity to test everyone so we‘d have to use them in a strategic way.’’
Juncker says the lockdowns in Ontario and Quebec should have happened earlier in the fall, when cases started to rise.
He says the late lockdowns in Canada won’t be as effective as those in countries such as Australia, New Zealand and South Korea, where early lockdowns effectively stopped the disease from spreading.
“Countries that were most aggressive early on, are the ones that have, I think, the best outcome.'’
He says countries where health decisions are fragmented across the country, including Canada, have added challenges.
Donald Sheppard, chair of the department of microbiology and immunology in the faculty of medicine at McGill University and member of Canada’s COVID-19 therapeutics task force:
Canada’s federal-provincial sharing of power over health care is highly inefficient and has led to major problems, says Sheppard.“There’s a lot breakdown in communication, a lot of territorialism. It’s greatly impacted the efficiency of the response,'' he says.
The problems in long-term care homes are examples.
“Quebec is screaming they want money but they’re refusing to sign on to the minimum standards of long term care,'‘ he says. ”I think it’s heinous.’’
He says highly centralized authority and decision-making has had a stifling effect on innovation.
“It puts up roadblocks, and has led to the Canadian health-care system having lost any attempt to be innovative and nimble,'' he says.
Sheppard says he doesn’t think there will be mass vaccinations for Canadians this summer and the September timetable that the federal government is talking about for vaccinating everybody is optimistic.
“Remember that we don’t have vaccines that are approved in under-11-year-olds,'‘ he says. ”There will still be opportunities for the virus to circulate in children, particularly children are in school settings.’’
He suggested that the current immunization campaign’s goal is not herd immunity, eliminating transmission of the virus and rendering is extinct.
“The goal here is to create an iron wall of immunity around the ’susceptibles’ in our population, such that this becomes a virus of the same public health importance as influenza.'’
