As the COVID-19 crisis evolves, it is becoming apparent that the gradual progression of multi-national containment strategies is failing. In multiple countries, the community-level spread of the novel coronavirus is generating a growing sense of urgency. The time is now for all Canadians to take all necessary actions to stop the community spread of COVID-19.
In late February, there were indications that we were heading into a situation of societal disruptions.
On Feb. 24, Canada’s chief medical officer of health, Theresa Tam, acknowledged that “Canada may no longer be able to contain and limit the virus if it continues to spread around the world.”
On Feb. 25, Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in the United States, issued a dire warning: “Disruptions to everyday life may be severe, but people might want to start thinking about that now.”
Flattening the curve
The critical message right now is that we need to slow the spread of COVID-19, or “flatten the curve.” A reduced number of cases at any given time will allow emergency response to take place without the system becoming overwhelmed. COVID-19 will be a real test of Canada’s disaster management system in ways that it has not been tested in recent years.
We have moved from a preparedness standpoint to response. The tone has shifted from “if” to “when,” and “when” has become “now.”
In Canada, prudent actions have been taken across all sectors to halt activities involving face-to-face interactions. In addition to medical strategies to develop vaccines, implementing community-based non-pharmaceutical interventions are of equal importance. Social countermeasures to fight COVID-19 will result in substantial societal disruptions. These disruptions may be inconvenient or unwelcome, but the alternatives — haphazard responses or doing nothing at all — are worse.
Nonpharmaceutical interventions
In the absence of vaccines, community-level nonpharmaceutical interventions are enacted to slow down and prevent the spread of disease. In Preparedness for High-Impact Respiratory Pathogen Pandemics, a 2019 report commissioned by the Global Preparedness Monitoring Board, the Johns Hopkins Center for Health Security lists nonpharmaceutical interventions as practical opportunities to respond to a high-impact respiratory pathogen. These interventions generally fall within four categories: travel restrictions, movement restrictions, quarantine and social distancing.
Travel restrictions are — as the name suggests — enforceable limitations on travel. An example is the U.S. policy going to effect on March 14: the European travel ban, which is creating chaos and anger across Europe. Effective global pandemic response requires co-operation amongst nations, not unilateral action. Arguments have been made that although travel restrictions are a common response, they are not likely to be effective.
Movement restrictions are implemented to prevent or limit contact between infectious individuals and susceptible populations. Blanket restrictions on freedom of movement have been put in place in multiple countries. For example, Italy has implemented nationwide restrictions on non-essential movement.
Quarantine is defined by the CDC as separating a person or group of people believed to have been exposed to a communicable disease, but who do not yet have symptoms, from unexposed people. Canadian Forces Base Trenton has been the primary quarantine site for Canadians who were airlifted from Wuhan, China, and later, Canadians airlifted from a cruise ship that docked in California carrying passengers with COVID-19. None of the Canadians airlifted from Wuhan to CFB Trenton developed symptoms of COVID-19.
Social distancing measures are aimed at reducing contact between people who may transmit the disease. Examples of social distancing include closing universities and schools, establishing methods to allow employees to work from home, and cancelling present and future events involving mass gatherings. Cancellation of nearly all professional sports events is a prime example of large-scale social distancing measures.
Localized thinking about societal disruptions
While travel restrictions and quarantine have national and regional consequences, movement restrictions and social distancing have direct local-level impact. Despite the global nature of pandemics, it is important to remember that all disasters are local.
Local issues to be thinking about in relation to COVID-19 include:
· Parents of school children making adjustments to their lives so their households can adapt to the implications of closures of public schools for weeks or months.
· Public facilities such as libraries and community centres need to think about how they can find alternative ways to provide services when their physical spaces are closed.
· Public transit operators need to think about how they may be asked to participate in movement restrictions to keep the well from mixing with the sick.
· Businesses need to consider how to shift day-to-day operations to a circumstance of remote work for the foreseeable future.
· Sports, cultural and entertainment venue operators need to consider how forms of entertainment and leisure activities can survive and thrive under the conditions dictated by a global pandemic.
While the actions to mitigate the spread of COVID-19 are creating predictable problems, the cascading effects of the numerous closures will disrupt the community in ways that we are not able to predict.
To support the fight against COVID-19, governments are implementing extraordinary powers under the provisions of “public welfare emergencies.” Such tools are based on a foundation of legislative enabling powers that are rarely enacted.
For Canada, at the federal level, emergency powers fall under provisions of the Emergencies Act, and provincial-level legislation like the Ontario Health Protection and Promotion Act can provide additional extraordinary powers. When broader emergency powers are implemented, the public may become uncomfortable.
All of us will be affected directly or indirectly by this pandemic. Among the many current challenges, two needs stand out. First, we have to adapt to the uncomfortable reality of pandemic-related uncertainties. Second, we need to be flexible in absorbing the impacts of COVID-19 related societal disruptions into our lifestyle.