5 critical measures that will stop the pandemic
Lockdowns not included.
I’ve made my point often – and will again – that lockdowns are not the path out of this pandemic. But, I won’t belabour that again right now. Instead, I’m going to answer a question I get asked often – and rightly so:
“Do you have a better idea?”
Yes, I do.
I’ve answered this many times in conversation, on the radio and on Twitter. This longer format allows me to expand further on my answer and I hope you’ll find it useful.
In addition to constantly reminding everyone to wash their hands, wear masks and keep a 2-meter distance from anyone they don’t live with, there are five things we need to start doing now to beat this virus.
Implementing these measures will allow us to lift the lockdowns sooner rather than later.
1. LEARN to live with COVID
Sickness and death from COVID-19 is exceedingly rare. It’s important to keep this in perspective.
As of this writing, more than 757,000 Canadians have been diagnosed with COVID. That’s just two percent of all Canadians.
Of those infected, 678,000 (90 percent) have recovered, leaving just under 60,000 active cases – about 0.16 percent of Canadians. Some 19,403 people have died of the virus since it was first diagnosed in Canada. That’s a death rate of 2.6 percent of those infected.[i]
In 2019, cancer killed more than 80,000 Canadians. Heart disease killed almost 53,000.[ii]
We know who’s dying from COVID-19.
Seventy percent of deaths attributed to COVID have been in people over the age of 80. Canadians between 60 and 79 represent 26 percent of virus-related deaths. Just 2.4 percent of people who died from COVID were aged 40 to 59. And just 1.1 percent of COVID deaths were of people under 40.
COVID kills old people.
You may find this insensitive, but it’s important to remember no one lives forever. Life expectancy at birth in Canada is 82.1 years.[iii] So, most Canadians who die of COVID have already, in many ways, beaten the odds by living as long as they have.
Many of our 80+ seniors live full and rewarding lives. If they want to be protected from this pandemic by being shuttered inside protective bubbles to avoid infection, then we should do a better job of segregating them in safe spaces. We’ve failed them in that regard.
But, many seniors may instead choose not to hide away from loved ones for their remaining days. They might prefer to enjoy their time with family or in their favourite recreational activities. We should respect their wishes too. Locking them, against their will, into segregated living environments is not a kindness.
More and more scientists believe we will not eradicate the virus that causes COVID.[iv][v][vi] They expect it will become endemic – like the flu, but more virulent and potentially deadly. We may require annual inoculations to protect us from this virus and its mutations going forward. And COVID-19 will not be the last pandemic humans face.
We must learn to live with an appreciation and understanding of new viruses and learn how to mitigate the risks of the next outbreak without forcing millions into poverty and shutting down our economy.
2. MAXIMIZE Rapid Testing
“Rapid tests are a game changer!”
Most of our political and public health leaders announced the game-changing nature of rapid tests last summer when the first tests were approved for use in Canada. Yet, half a year later, these same leaders have still not changed the game.
We should be rapid-testing every person who walks into a hospital, Long Term Care home, school, sensitive workplace, neighbourhood hot zone, airport, or off an airplane. They should be directed to a holding area until their test results are available 15 minutes later.
If someone tests negative, they should be allowed to proceed on their way. If they’re arriving from outside the country, they should be required to have another rapid test three days later.
Every pharmacy should provide rapid tests to anyone who asks at government expense.
If someone tests positive, they should be segregated from the uninfected and rapid-tested again. If they’re still positive, they should be isolated and given a full diagnostic PCR (polymerase chain reaction) test, remaining isolated until they test negative. Those who are infected, should be ordered into government-supervised quarantine where they can be treated and monitored as necessary.
Canada has the rapid tests to do this. We have millions of them. But, most are collecting dust in warehouses across the country, not being used. This must change.
There are many types of rapid tests and they share some things in common. None of them are as accurate as the “gold standard” test currently in use: a PCR test using a nasal pharyngeal (NPT) swab – i.e. the “deep brain biopsy” where a Q-Tip-like swab is inserted into the nose to the back of the sinuses. It’s uncomfortable and normally takes a few days to produce results in a centralized laboratory.
But, rapid tests don’t need to be as accurate as the PCR test. That’s because they serve an entirely different purpose.
The PCR test is a “diagnostic test.” It provides detailed information to assist a medical doctor in making a diagnosis of COVID-19. Waiting 24 to 48 hours for a diagnostic result may be OK.
Rapid tests are not diagnostic tests. They’re “screening tests.” Their value is ease-of-use and near-instant results. A few false positives or false negatives is OK.
Here’s why: other than some pilot programs (no pun intended) we’re currently testing almost none of the people coming off airplanes, or going into schools, factories, hospitals, LTC homes, etc. As a result, we’re identifying roughly zero percent of the people infected with COVID. Any type of rapid test will identify most of those with the virus. Any result greater than zero percent – is a major win.
These tests are cheap. At about $6 per test, they’ll be one of the least expensive elements in our pandemic management plan – and one of the most effective. We should be going through millions of rapid tests every week.
Hand them out at subway stations. Use them to screen people waiting for restaurant reservations, or lining up to get into a Blue Jays game. OK, that’s far-fetched – make it a Raptors game.
Screen everyone every day – or every three days – and we’d have COVID-19 licked in two weeks.
3. SEGREGATE the infected
I’m not going to reiterate my argument against lockdowns – brilliant as it may be. The fact is, we’re in lockdown now and must get out of it as quickly as possible.
But the concept of one, giant “everybody included” lockdown doesn’t make sense.
Why would you ever lock infected people in the same households as healthy people? That’s basically what we’ve done and no matter how you slice it, it’s just dumb.
What we need to do is identify the infected (see rapid testing above) and cut them out of the herd. Infected people should be segregated away from the rest of us until they’re no longer infectious.
Making this easy would be well worth the investment. That may mean government-supervised – and possibly government funded – quarantine hotels. If you test positive, you check in and remain under medical care and supervision in a private room, until you test negative. There are thousands of empty hotels across Canada that could desperately use the business and would be happy to negotiate steeply discounted bulk rates. Make the accommodation bare bones and allow people to upgrade to nicer digs at their own expense.
In our hospitals, keep the sick as far away as possible from the healthy. This may mean moving COVID patients to central quarantine hospitals (see increasing healthcare capacity below) as has already been envisaged in the Greater Toronto Area. Move infected seniors out of their LTC homes and into designated quarantine homes with private rooms.
Some uninfected LTC residents and other very vulnerable people may choose to segregate away from the general public as a preventive measure. We should designate some LTCs specifically for this purpose and staff them with volunteer healthcare providers who will quarantine with them. Inside a bubble. One LTC in Quebec has already done this. Pay those volunteers a significant bonus from public funds. We all benefit from their dedication and sacrifice. If “bubbling” worked for the NHL and NBA, it will work for others too.
4. ACCELERATE Vaccinations
Clearly, the federal government needs to pull out all the stops in its negotiations with vaccine manufacturers to increase the speed and reliability of deliveries. The sooner vaccines can be injected into Canadians, the sooner we can turn the corner on the pandemic and return to a normalized state. We should push for licensing and invest in the start up of vaccine manufacturing capacity in Canada. We will need these vaccines – and others – forever.
Public Health leaders, military generals, logistics experts and ethical advisors have drafted comprehensive guidelines outlining the priority with which vaccines should be dispensed in every instance. I’m sure every one of Canada’s 37.5 million names is on a list, in exactly the right order, somewhere. Or, soon will be. It’s a bureaucrat’s wet dream.
Read the ethical guideline, then put the priority list in a drawer and just start jabbing people. We’re over-thinking this by a long, deadly stretch. Like rapid-testing, we don’t need perfection. We need speed and boldness.
Start at one end of an LTC home or hospital and vaccinate everyone inside. Knock on every door in a hot zone and jab everyone you see. Put bottles of vaccine in every firehall, ambulance station and health care office. Let them vaccinate each other. Get the vaccine out of the warehouses and into the arms of Canadians.
Speed is the goal. Not ethical excellence.
As for that priority list, if we were truly taking this pandemic seriously and triaging properly – the first group to be vaccinated might not be the over-80 set. They’re most likely to die from COVID, for sure. But, they also have the least to lose. They will die soon whether they’re vaccinated or not. On the other hand, people under 60 are unlikely to die of this virus. The group with the most to lose and the greater likelihood of dying includes Canadians between 60 and 79 – and those under 60 with complicating medical histories. If we’re truly prioritizing – they should be at the head of the line.
5. INCREASE healthcare capacity
The initial goal of Canada’s pandemic management strategy was – and remains – to protect the capacity of our healthcare system. This is crucial.
Case numbers are not particularly telling. They depend on a number of discretionary factors, including the number of people tested, the type of test used, policy and calibration decisions related to the sensitivity of testing equipment, and whether the “case” numbers report positive tests or actual diagnoses. All this to say, they’re a common metric reported by public health agencies and most news media – but they don’t tell us much useful information.
Much more important, is to know how well we are actually protecting our healthcare capacity. That’s measured by reporting the number of people with COVID who are hospitalized, and whether they’re occupying a critical care (ICU) bed and/or utilizing a ventilator. Ventilators were in very short supply early on in the pandemic, but government procured thousands more and they’re no longer scarce. The critical path is ICU beds.
Hospitals need ICU beds to be available for car crashes, post-surgical care and other medical emergencies. The number of these beds is constrained by the equipment required – and by the availability of skilled critical care personnel to staff them.
As COVID patients occupy more ICU beds, this leaves fewer available for other uses and may push hospitals to delay scheduled surgeries if there will not be space available to care for post-operative patients.
As of January 18 (the last date for which national data has been reported,) there were 868 ICU beds occupied by COVID patients in Canada. 483 of those patients required ventilators.[vii] A number of hospitals have begun postponing scheduled surgeries.
Obviously, most pandemic mitigation measures are aimed at reducing the demand on critical healthcare infrastructure. However, government should also be actively working – as it was early in the pandemic – to increase the supply of such infrastructure.
Increasing capacity includes streamlining pandemic patients into specialist wards or hospitals, where it makes sense, to make more efficient use of scarce resources – especially skilled personnel. We should also increase the number of beds and other critical care equipment available – which is beginning to happen with the move of two federal mobile field hospitals into the Greater Toronto Area to provide more ICU beds.
Finally, critical care healthcare personnel are not born – they’re trained. Government should accelerate the training of these personnel to assist in expanded ICU facilities during the pandemic. There are many family doctors, specialist MDs, nurse practitioners and others who may be available for such training and re-allocation to ICUs. Medical, nursing and other allied health profession students in their final year of training could learn on the job in a hospital setting, where this is not already being done.
SOURCES:
[i] https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html
[ii] https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401
[iii] https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/011/life-expectancy-at-birth/;mapC1;mapLevel2;/
[iv] https://www.ctvnews.ca/health/coronavirus/who-predicts-covid-19-will-become-endemic-but-some-experts-are-less-certain-1.5248847
[v] https://www.cnbc.com/2020/11/12/coronavirus-dr-fauci-says-he-doubts-whether-covid-can-be-eradicated.html
[vi] https://www.gavi.org/vaccineswork/could-covid-19-ever-be-eradicated
[vii] https://health-infobase.canada.ca/src/data/covidLive/Epidemiological-summary-of-COVID-19-cases-in-Canada-Canada.ca.pdf