WHO issues guidelines for lifting COVID-19 restrictions: Is Canada ready?

OTTAWA — Federal and provincial officials are starting to discuss how and when to start reopening schools and businesses but Prime Minister Justin Trudeau warned April 14 the full-scale lockdowns most Canadians are living with right now will remain in place for at least several more weeks.

The World Health Organization is trying to inject some co-ordination into these decisions, releasing new guidelines for what should be in place before easing restrictions. They outline six areas officials must consider if they are to look at resuming activities. Here is where Canada stands on each of them.

1. Is transmission of the virus under control? Short answer: We’re not testing enough to know.

Eleanor Fish, a professor of immunology at the University of Toronto, said testing must become much more widespread before we really understand the state of community transmission.

Alison Thompson, a public health professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto, said it takes a significant amount of time between a confirmed infection and fully tracing a person’s contacts and testing them, to know whether that confirmed infection has resulted in many more infections.

“We have to make sure it actually is levelling off, or that community transmission has actually ground to a halt, which can take quite awhile,” she said.

If restrictions are removed too quickly, thousands of people with COVID-19, who may not know they are infected, could potentially spread it fast and wide, she said.

Thompson also said it’s time to stop thinking of the pandemic in terms of health versus the economy. If there isn’t a healthy workforce the economy will continue to suffer, she said.

2. Is the health-care system equipped to detect, test, isolate and treat every case, and trace every person who came into contact with a positive case? Short answer: Not yet.

“We have a situation now essentially where we’re groping along in the dark in terms of finding out who in fact is virus positive and who’s virus negative. We’ve done an abysmal job at that,” said Timothy Sly, professor emeritus at Ryerson University’s school of occupational and public healthly, who specializes in epidemiology.

Sly pointed to an especially woeful rate in Ontario where Premier Doug Ford has vowed to perform 8,000 tests daily by April 15, up from about 5,000. Alberta is among Canada’s testing leaders with about 7,400 tests conducted daily, which Sly said is still not enough.

Still, he acknowledged there have been hurdles beyond Canada’s control that have handcuffed efforts – notably, global shortages of equipment including swabs and laboratory chemicals needed to process test samples.

Sly said Health Canada’s recent approval of a rapid, mobile hand-held testing device from an Ottawa company should help, as will a series of expanded testing criteria that various provinces have adopted in recent days.

Jianhong Wu, a distinguished research professor at York University who has led multiple national projects on SARS, pandemic influenza and immunization evaluation, said there is a close relationship between contact tracing, testing and social distancing.

“If you don’t do well in one component, you need to significantly magnify your effort in other components,” he said.

Sly said provinces are largely trying to contact people exposed to a confirmed case by telephone, which is not sustainable given the soaring number of cases.

He pointed to countries such as South Korea, which have employed cellphone data to track possible contacts. He said that is much more effective, but it would raise privacy issues.

3. Are outbreaks minimized in special settings like health facilities and nursing homes? Short answer: Risks remain dangerously high in hundreds of nursing homes across the country.

Canada’s chief public health officer, Theresa Tam, said nearly half of the country’s deaths from the novel coronavirus have come from long-term care facilities, and she predicted the number will increase despite provinces’ efforts to fight the problem.

The Lynn Valley Care Centre in North Vancouver, BC, has had 18 residents die. In many facilities workers are also getting sick in high numbers.

After the Lynn Valley Care Centre outbreak, British Columbia moved to stop staff from working in multiple facilities as a way to slow the spread of the virus. Ontario made the same move Tuesday.

Isaac Bogoch, an infectious-disease specialist at the University of Toronto and the University Health Network, feels that strategy, along with limiting visits with seniors and infection-prevention methods, could go a long way in minimizing risks for possible subsequent waves of COVID-19 among the elderly.

Canada now has guidelines for helping to protect long-term care residents and workers, but Tam indicated this week the outbreaks are the biggest concern that has arisen in Canada’s COVID-19 situation over the last two weeks.

4. Are there measures in workplaces and schools to prevent the spread of the virus? Short answer: Not yet.

In most provinces, only essential businesses like grocery stores and pharmacies can remain open. All others must operate with employees working from home. If they can’t do that, they must close. Restaurants can generally only allow takeout or delivery.

Many businesses report being too focused on setting their employees up to work from home, and haven’t yet begun to think about what to do to reopen.

Provinces and business groups say it’s too early to speculate on which measures can be lifted. Any shift in approach would come at the advice of the chief medical health officer “and with extreme caution so as to avoid a resurgence of the virus as has been seen in other jurisdictions,” said Hayley Chazan, a spokeswoman for Ontario Health Minister Christine Elliott.

The Canadian Chamber of Commerce says it wants clear advice from public health authorities before restrictions loosen.

“We fully expect that there will unfortunately be an instance where an employee does test positive. What does that mean for the workplace? Does there have to be a total shutdown? A deep clean?” asked Mark Agnew, the chamber’s senior director of international policy.

Sector-specific rules will remain critical as the lockdown starts to lift, he said, noting that retailers, meat processors and refrigerator technicians might all require different protocols around physical distancing and personal protective equipment.

Kids, while less susceptible to the novel coronavirus, are well equipped to transmit it.

The Public Health Agency of Canada has stopped short of recommending specific changes schools could make to their operations, but did offer more general guidance for schools. That included regular hand-washing and supervised use of hand sanitizer, education on proper “respiratory etiquette” such as covering coughs and sneezes, ramped-up cleaning and disinfection routines within school buildings, and reinforcement of “no sharing” policies.

Thampi said medical experts will also have to craft advice that strikes a balance between student safety and developmental needs.

5. Are the risks of importing more cases from outside the country being managed? Short answer: Mostly yes.

The federal government has adopted once-unthinkable measures that include banning most non-Canadians from entering the country and a 14-day mandatory quarantine for anyone who does. Ottawa is now requiring anyone arriving to explain their quarantine plan and if it’s not good enough, they will be forced to stay in federal sites.

The trouble is that Canada is heavily reliant from both an economic and social perspective on foreign trade and immigration. That means it can’t keep the border closed forever.

Experts say there is a variety of potential avenues to reopen the border and manage the risk.

Being able to screen potential visitors, preferably with on-the-spot testing at airports and other ports of entry, would make it much easier to identify carriers and either bar them from coming into Canada or put them into quarantine.

There could also be more targeted travel restrictions for visitors from different countries, depending on how those countries are managing the virus, though experts acknowledge partial bans and quarantine requirements could create challenges and anger.

Canadians will need to accept that there will be changes in the way they travel, similar to how the 9/11 terrorist attacks led to increased security measures.

6. Are local communities are educated, engaged and empowered to adjust to the “new norm”? Short answer: Maybe

In Canada, most experts think the number of cases is going to peak this month. The data based on the limited epidemiology Canada has shows the number of cases was doubling every three to four days in the last two weeks of March, but had slowed to doubling every five to eight days in the first two weeks of April.

But officials also warn of more than one wave, with flare-ups and new infections continuing for months. A vaccine is at least 12 to 18 months away, and the “new norm” really means longer-term adjustments to limit the impact of those new outbreaks.

There have been warnings from some experts around the world that things like live concerts and massive public gatherings for sporting events won’t be safe for months to come.

Steven J. Hoffman, a York University professor and the scientific director of the Canadian Institutes of Health Research’s Institute of Population and Public Health, thinks Canadians must get ready for an up-and-down scenario, “where first the government lessens these restrictions and then a couple weeks later has to tighten them again in light of new data and new information about where spread is happening or how it’s happening.”

— With files from Mia Rabson and Lee Berthiaume in Ottawa, Kelly Geraldine Malone in Winnipeg, Cassandra Szklarski and Michelle McQuigge in Toronto, and Christopher Reynolds and Julian McKenzie in Montreal.