We’ve blown it again. Seven weeks ago, channelling a number of renowned experts, I warned that many parts of Canada would experience a third wave of the pandemic if provincial leaders didn’t get off their collective asses and change their failing strategy of yo-yo closures and openings with no regard for exponential growth.
Instead I recommended a no-nonsense elimination strategy — the Canadian Shield — with clear targets for reducing transmission devised by a collection of Canadian experts with the goal of banishing this multi-organ disease from our borders.
I warned that the variants of concern from the U.K., Brazil and South Africa represented another pandemic altogether.
I explained that these deadlier and highly contagious variants are harder and costlier to fight, and could undermine the vaccination program and plunge us into a third wave.
The uncertainty they represented added to the urgency of “going for zero” — a slogan that encompasses sharper restrictions on travel, imposing strict lockdowns, marking green zones rendered free of the virus and protecting them, relentlessly testing and tracing — and in the process systematically driving transmission to zero.
I also argued that bare-minimum muddling through by “living with” COVID-19 was a disastrous idea because this pandemic is not just about the dead but about the living.
I wrote that the experience of countries like New Zealand and Australia proved that eliminating the virus in our communities could be achieved in six weeks using going-for-zero tactics, but it would require committed leadership.
If our leaders had acted, Canada could now be COVID-free. Just like the Australians or Taiwanese, we could now be going to concerts and visiting relatives without fear. Our schools and our elders would be safe. Small businesses would be thriving.
Instead we find ourselves in a third wave fretting about the slowness of the vaccine rollout (expect more delays) while the variants are filling hospitals in Ontario, Saskatchewan, B.C. and Alberta.
The wages of dithering
The people now occupying intensive care units are not old. They are largely under 65 years of age with severe COVID-19 disease. And that could have been prevented with some tough decisions. The Ontario internist Irfan Dhalla, who called for an elimination strategy last summer, notes that seven of Canada’s provinces and territories (the North and Atlantic Canada) have ended community spread because they went for zero. “But six have not aimed to stop all community transmission and all are suffering.”
And by the way, every week the data on the long-haul effects of COVID-19 gets worse. It now seems that a third of the infected (that’s tens of thousands of people in Canada alone) suffer from a horror list of after-effects five months after hospitalization including chest pains, inflamed hearts, scarred lungs, shortness of breath, damaged kidneys, debilitating fatigue and brain fog. A majority of these patients are people of colour or women. (SARS and MERS, two other coronaviruses, left a messy trail of woe among their survivors too.)
Here’s what cultivated complacency in much of Canada has achieved in the under two months since I wrote my warning:
Two weeks ago, Regina had 36 cases of COVID-19 due to variants of concern. Now it has more than a thousand. The variants now represent 90 per cent of all infections and that city will be under a lockdown starting Sunday. And savour this fact: Saskatchewan, which boasted the least stringent measures for COVID-19 control, now has the highest rate of infection per 100,000 residents in the country. Congratulations, Mr. Moe.
British Columbia, one of the last provinces to adopt a mask mandate, is not far behind Saskatchewan. In the absence of bold action, its caseload will likely lead the nation next week on a per capita basis. Imagine, it is even reporting more cases than Washington State. “The variants are like a thoroughbred and our vaccines are like a workhorse,” noted UBC evolutionary biologist Sally Otto to CTV News. But spotty data, insufficient testing and an incoherent strategy have underestimated the risks posed by variants as cases explode in the Lower Mainland. Congratulations, Mr. Horgan.
Alberta, which reluctantly imposed restrictions only after lackadaisically letting COVID-19 overrun its hospitals last November — a political act that killed hundreds of Albertans — now boasts the highest number of cumulative variant cases in the nation. Alberta thought it could avoid a third wave with half measures, and has failed again. Congratulations, Mr. Kenney.
In Ontario, the province opened up indoor dining to 50 per cent of capacity “to support the province’s economic recovery” as variants now fill hospitals and increase caseloads. Meanwhile provincial officials set up a vaccine centre that was so crowded it looked “like a mosh pit” reported public health expert Amir Attaran. “The incompetence of public health leaders is on full display.” Congratulations, Mr. Ford.
Quebec, which questioned the validity of airborne transmission and other key variables for far too long, continues on its largely reactive course. One group of disgusted physicians pointedly noted this shameful truth: “New Zealand, Australia, Taiwan, Vietnam, South Korea, Iceland, Thailand, Norway, Finland, with a combined population of 283 million, have had 4,116 COVID deaths. If Quebec had had a similar mortality rate, there would have been only 125 deaths in a year.”
Instead Quebec has recorded more than 10,000 deaths. The doctors identified the problem: “So far, the authorities have aimed to slow down the epidemic rather than to prevent it, to reduce the surges instead of suppressing all outbreaks.” Congratulations, Mr. Legault.
The variants and the vaccine
Here’s the message that Canadian leaders have ignored at our collective peril: “Vaccinations shouldn't be expected to be a get-out-of-jail-free card in ending the pandemic.” So explained pandemic and complexity expert Yaneer Bar-Yam. “New variants not only accelerate transmission, they can undermine immunity of prior infection and vaccination. The best strategy is to aim for elimination using vaccination to help.”
Elimination matters for several important reasons. Every day the health and economic costs are increasing due to more infections, ongoing disease, death and disability and social restrictions. The variants keep adding to those costs by increasing transmission, severity and lethality of COVID-19.
More variants equals more mutations, which equals more risk for all of us, and they are outracing vaccines.
“This means that the disease in its increasingly worse state will continue to be around for years to come,” said Bar-Yam. “Those who are at zero can ignore all that and keep going with a different pre-pandemic lifestyle.”
So what’s gone so wrong in Canada? Why has our pandemic response failed so spectacularly in our six most populous provinces? Why have our leaders refused to adopt the lessons of nations that won the fight against COVID-19 months ago?
Why have our public health officials repeated the same mistakes three times in row? And why have Canadians tolerated this incompetence?
Let’s start with arrogance, a dismissive attitude one critic has called “pandemic Orientalism.” When East Asian countries acted quickly at the beginning of the pandemic, Canada’s smaller provinces and territories absorbed the message. But other provinces did not. It’s as if John Horgan refuses to admit that he might have something to learn from Taiwan. Jason Kenney will never bow to Nova Scotia or South Korea. Doug Ford would never admit that East Asian countries outperformed and outclassed Ontario. But that’s exactly what happened.
Larry Brilliant, the man who led the campaign that eradicated smallpox, knows how badly the West including Canada has failed. Whenever he talks to public health people in Taiwan, Vietnam, Singapore, Korea, New Zealand or Iceland, here’s what he hears: “They basically say, what the fuck is wrong with you people? They don't understand. They don't understand how we could have blown it as badly as we have. And we have indeed blown it really badly.”
New Zealand, which smashed the coronavirus with a strict lockdown, sports a healthy economy because its people don’t live in fear.
Yet in Canada there persists a rampant ideological blindness that says the economy must trump public health, or that there is some magical balance between disease and economy. Alberta, for example, still thinks it can separate lives from livelihoods. But you can’t have a livelihood without a life. Economies will not recover until people no longer live in fear of the pandemic. Period.
In an Edge interview, Brilliant said what is still not obvious to leaders like Kenney, Ford and Moe: “You can’t get to economic growth without solving the problem of the pandemic. History shows that in every pandemic in every place.”
Needed: speed and courage
Here’s another way we’ve blown it. The coronavirus that causes COVID-19 is not a flu virus. But Canada’s public health officials remain locked in a pandemic flu playbook especially in B.C. Bad move.
Unlike the flu, which is spread by children, COVID-19 is driven by random superspreader events originating in just 20 per cent of the population. The two viruses represent radically different diseases requiring totally different public health responses.
The flu pandemic playbook, for example, is largely passive: it’s wipe your nose, close some schools and wait for the vaccine, which may or may not be effective.
But as Zeynep Tufekci, the brilliant Turkish sociologist has noted, you can’t do that with a deadly coronavirus because of superspreading events in which one individual can trigger the infection of 5,000 people. (Yes, that happened in a South Korean church.)
SARS, one of COVID’s very deadly cousins, kills one in 10 people who get it. Having dealt with SARS, Taiwan, Japan, Singapore and South Korea kept their flu playbooks on the shelf and pulled out their corona pandemic playbooks.
East Asian nations didn’t dutifully wait for permission from the World Health Organization to act on masks, aerosols and asymptomatic transmission. In particular, Japan recognized very quickly that COVID was all about getting people to avoid close contact, closed quarters and crowded places. Those key principles for preventing superspreaders took months to make into much Canadian public health messaging. Indeed, Canada and most particularly Ontario forgot everything they learned from SARS.
But a key factor for victors has been fearless speed. For a year now, Canada has sat around like some lethargic academic pondering the impact of one, two and now three waves, while successful nations acted. And by eliminating the problem with decisive leadership, they aren’t stuck, like we are, waiting for vaccines to solve their problems. The poverty of that strategy is now obvious as both Europe and India contemplate holding back vaccines to deal with their variant problems.
A year ago Mike Ryan, WHO’s executive director of health emergencies, laid out the ground rules for success in a pandemic driven by a superspreading coronavirus: “Be fast. Have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly,” he said.
“If you need to be right before you move, you will never win. Perfection is the enemy of the good when it comes to emergency management. Speed trumps perfection. And the problem in society we have at the moment is everyone is afraid of making a mistake, everyone is afraid of the consequence of error. But the greatest error is not to move. The greatest error is to be paralyzed by the fear of failure.”
Nova Scotia, New Brunswick, Nunavut, the Northwest Territories and Newfoundland got that message. The rest of Canada put their citizens in a deep freeze, fiddled with the illusion of perfection and said, “Okay let’s now wait for a factory-made cure.”
East Asian success stories add one more factor to speed. They not only acted quickly, they weren’t afraid of overdoing bold new measures. Vietnam got almost obsessively meticulous about contact tracing. Recalling the lessons of SARS, Taiwan pounced immediately as did South Korea. When Singapore realized that guest workers living in cramped quarters represented an ongoing COVID-19 fire, they improved housing and offered free food and care to those with disease. There’s a hundred ways to defeat the virus, but you have to be committed to full measures, closed borders and elimination as the goal. You set targets and then boldly achieve them.
The real problem in Canada, a dysfunctional federal state, is that no one wanted to drive the car during a public health emergency.
Instead our fearless leaders all crammed themselves in the backseat where they still dine on take-out food while hoping that someone, somewhere will eventually find a pharmacy that may or may not offer a foreign-made vaccine.
Michael Mina, a Harvard epidemiologist, diagnosed Canada’s (and the West’s) deficiency for David Wallace-Wells in New York Magazine: “And I do believe that this is a symptom of a bunch of nations and societies that really haven’t had to deal with adversity on our shores in a really long time. We are uncomfortable with making the hard decisions that have to be made.”
Get on with it
Canada needs to put this pandemic behind us.
To do that we need a more aggressive and proactive public health approach, with intensive testing (rapid tests aren’t accurate, but they are good at busting clusters of infection) and better targeted, quicker and stricter lockdowns. We need to do what it takes to get to zero to protect the greater public health. And the sooner we do that, the healthier our nation will be.
The examples to follow lie within our borders. A recent University of Oxford study looked at Canada’s response to the pandemic and marvelled that small and northern provinces had done well while the larger provinces delivered a totally chaotic response. They also marvelled at the lack of co-ordination. Nobody shared what works.
The researchers’ prediction for the future is pretty self-evident:
“Economic support and public health restrictions are likely to be required for some time, but given the highly unco-ordinated provincial pandemic response to date, it would not be surprising if some regions reached a ‘new normal’ well before others.”
There will be no normal in B.C., Alberta, Saskatchewan, Manitoba, Quebec and Ontario — until they change course, get real and go for zero.