We Can Eliminate Covid-19 from B.C, Here’s How.
Let’s bale the boat and try to plug the hole.
On March 11 2020 I stood in my backyard and felt a strange mixture of dread, vindication, and adrenaline coarse through my body. The NBA had just announced its plans to suspend the 2019–2020 season due to Covid-19. Within hours, concern seemed to permeate every corner of the public conscience. I had been following the events in China since January through a daily thread on a popular anonymous message board. The threads were filled with raw information on unfolding events: the latest research, institutional opinions, statistics, models, and viral traits. If one was able to dodge the speculative conspiracy theories, the threads were an excellent place to find raw, unbiased information on the so-called Wu Han Flu (this was back before it was political). I would skip class and read about contagions and epidemiology, refreshing threads and reading the latest research. I spent a few nights building naive models in Google sheets or Netlogo until 4 in the morning, emerging red eyed from my room to show roommates the scary curves that said ‘we’re all screwed if this one number is this big’. I would get looks for being the only white guy in the coffee shop with a mask on (it was common to see exchange students with masks that time of year), and marvel in being told by some friend or stranger that ‘masks didn’t work’, or that this (just a) flu was only as bad as the regular flu.
It wasn’t like people were saying these things because they were well researched, it was because every day some global health authority or world leader would downplay the potential impact of the virus. They would say bizarre things like ‘there is no need to secure the boarders at this time’, or that it was more important not to alienate people from the most impacted countries, or that ‘the fear was greater than the flu itself’.
Here are a few quotes from Canada’s Chief Public Health Officer, Dr. Theresa Tam, while China (with 60 million people locked down for some reason) was building hospitals as if the stability of their nation depended on it:
“There is no need to use a mask for well people.”
“Putting a mask on an asymptomatic person is not beneficial.”
“There is no clear evidence that this virus is spread easily from person to person. The risk to Canadians remains low.”
Nice.
There are dozens of accounts of Canadian politicians and policy makers saying damaging things like this that have since been scrubbed to avoid public confusion (or repair legitimacy in the face of a catastrophic screw up).
It is clear that policy leaders underplayed or failed to realize the potential economic and human impact of Covid-19 at a time when preventative action would have made the biggest difference. We should be relentlessly critical of their failures. While I’m glad we eventually attempted a lock down, I am disappointed that we were unable to crush the spread as so many other developed nations have.
Some national governments realized that the conditions surrounding the virus were uncertain. Instead of waiting for more evidence about the potential impact, they were proactive and took steps to prevent the virus from taking hold within their borders. Not because they knew it would ruin them, but because they didn’t know for sure that it wouldn’t. Obviously, B.C. failed to get into that camp - but that doesn’t mean we can’t be a success story. Taiwan, Singapore, New Zealand, and Australia are just a few countries who have been able to reduce the number of new cases per day to less than 10. Let’s get B.C. on that list as well.
We’re currently at an all time high for new cases per day in B.C., and I have a feeling that we’ll be needing to enter another lock down soon. Let’s do it right this time! The ‘flatten the curve’ strategy is akin to bailing water out of a boat without trying to plug the hole. If you get lazy with your bailing you’re going to be back where you started pretty quick. The best approach is to try and do both! In this case, plugging the hole means getting to zero new cases and staying at zero new cases. If we’re serious about beating this thing here’s what we need to do:
- Locate Active Cases: Begin Mass Testing to identify and remove positive cases from circulation, and identify regions with outbreaks.
- Localize Lockdowns: Develop a Provincial Covid Zoning system to contain community spread and localize lock downs.
- Support Those Impacted by These Measures: Offer additional income supports on top of federal programs; create Covid-fighting jobs to support displaced workers; introduce a tutor tax deduction to help students who are struggling with online school as a result of temporary local lockdowns.
Let’s address the vaccine news first.
A vaccine means that the end could be in sight, but there is no telling how long it will take to get vaccinations to British Columbians. The gap between H1N1 vaccination human trials and deployment to British Columbians was about 2 months. Initial supplies of the Pfizer vaccine will be limited and it could be a long time before a vaccine is generally available. In the meantime, we need to stop the spread. Stopping the spread with a locate and localize strategy will also make vaccinations more effective: we’ll be able to more easily prioritize vaccinations for those in impacted communities who are most at risk. Additionally, the logistical lessons learned through the programs proposed below will prepare the province for a national vaccination campaign (for which there is currently no plan).
1. Begin Mass testing to identify and remove positive cases from circulation, and identify communities with outbreaks.
In the fight against Covid-19, the Eastern European country of Slovakia was doing really well. The best in Europe actually. In their first wave, the country saw very few cases of Covid-19 thanks to an early lock down, border closure, and a solid healthcare apparatus. Over the summer, Slovakia let off the gas, eased lockdown restrictions, and reopened schools. In September, Slovakia reached a 7 day median of 2,500 active cases with 458 cases per 1 million people. Sounds familiar right?
B.C. currently has at least 5133 active cases (and growing) with 1026 cases per 1 million people.
Faced with the possibility of needing to enter yet another costly full lockdown, the government of Slovakia looked for other options and landed on Operation Common Responsibility. OCR had 2 objectives:
- Get positive cases out of circulation to avoid further spread.
- Avoid additional strict lockdowns to save the economy, and allow life for most Slovakians to carry on as usual with sanitary and social distance measures in place.
Slovakia tested 3.6 million people in just 2 days using Korean-made lateral flow tests and identified 38,000 new positive cases. Over a weekend, Slovakia doubled its number of recorded active cases (previously, they estimated 39,000 active cases). This information on positive cases allowed epidemiologists to more accurately identify and lock down at-risk communities. Regions with identified or potential outbreaks (red zones) were locked down; those who tested positive were quarantined; those who opted to not get tested were required to re-enter lockdown; and those who tested negative were allowed to roam freely with social distancing in effect. All new entrants into Slovakia are tested free of charge.
We should adopt a similar strategy.
In B.C., we need to get an idea of how many cases we actually have, and where these cases are. The actual number is likely higher, and possibly much higher, than what we’re catching with our current test and trace system. In the Slovakian mass testing operation, the country identified 15x the daily average found under their test and trace system.
Once we have identified where these cases are, we can lock down specific affected areas and allow communities with few or no cases to continue about their day-to-day. Mass testing is only one part of the solution though, once we have determined where these cases are, we need a system for ensuring cases are not transmitted between communities.
2. Develop a provincial Covid zoning system to contain community spread and localize lock downs.
Suppose your community is doing a superb job of reducing the number of active cases. Yay! You’re on track to eradicate it locally by the end of the month. AND THEN some out of town ne’er do well starts coughing at your re-opening party. No one kept him out, there was no system in place to make sure he didn’t come from his community to yours, he just did. Limiting travel between zones is crucially important. Without any system in place to do so, we will remain in a state of lockdown limbo with communities perpetually infecting each other.
Extraordinary circumstances require extraordinary measures.
Mass testing will give us a more accurate picture of the infection landscape: which communities have lots of cases, which do not. Once we have information about the degree of spread in our communities, we should shut down all non-essential travel to and from zones with active community spread. Right now, thats the Vancouver Coastal and Fraser regions; although, we will be able to determine more precisely what sub-districts need to be locked down once we have more data. We’re not talking polite requests for people to stay at home during Dr. Bonnie Henry’s daily press conference, we’re talking fines, and traffic management.
I propose that any zoning strategy be based on the system devised by the New England Complex Systems Institute, summarized (ripped) below:
The system requires separating geographic districts into zones. A zone should be a district that is naturally or artificially separated from its neighbouring districts. A zone should only have controllable traffic transitions with neighbouring zones. If two geographical regions have a shared border that cannot be effectively controlled, they should be considered as one zone
Travel restrictions should apply to travellers from a high risk area to any other area, including other high risk areas. The status of a designated area (zone) should be identified as being in one of three colours: Green, Yellow and Red
- Green zone — no new local (within community) transmission for 14 consecutive days. All new cases, if any, occur in individuals who were effectively isolated from the moment they entered the zone (imported travellers);
- Yellow zone — no new local transmission for 14 consecutive days, but there are new cases identified using contact tracing, or the zone is adjacent to red zones;
- Red zone — community transmission identified within the last 14 days.
Quebec has already introduced an alert system similar to this to help citizens understand what zones are safe, and which are not.
The most basic zone border protocol includes:
- No unnecessary travel into any zone from a yellow or red zone.
- 14 day quarantine for any individual arriving with permission into any zone from a yellow or red zone.
I encourage everyone, especially policy makers to read the full paper which covers zone entry, transit, deliveries, and essential worker travel in more detail.
B.C. is currently ordering lock downs based on regional health authorities. This means that when there are lots of cases concentrated in Metro Vancouver, the lockdown order impacts communities as far away as Pemberton. This strategy makes sense when you take into account that health authorities have incomplete information how many cases there are. It is obviously safest to put everything on lockdown to avoid additional spread. If we were able to gather more information on where cases exist through mass testing, we’d be able lock down much smaller geographical regions. This is why gathering that missing information through mass testing is incredibly important.
A good zoning strategy allows some communities to reopen while others are locked down, meaning that not everyone needs to suffer in isolation and uncertainty. We could also expect less lockdown fatigue, better social/psychological outcomes for British Columbians due to reduced isolation, and a speedier economic recovery enabled by the opening of green zones. A travel management system like this will require a significant labour force to manage travel between zones: more Covid-fighting jobs!
3. Support those most impacted by these measures
Dr. Bonnie Henry claims that schools are not transmission centres, and merely reflect the conditions of the communities they are part of. Proving causality here is difficult if not impossible given the asymptomatic delay of many active cases. Even if it were casual, open schools would accelerate spread — which makes assigning causality not only difficult, but useless. Despite Dr. Henry’s claims, there are many examples of schools being hotbeds for transmission in Montreal, Toronto, and Israel.
If we are serious about beating Covid, it would be advisable to only open schools in Zones which are not experiencing community spread (i.e. Green Zones). Obviously, children and parents in communities with school shutdowns will be impacted. Parents may lose wages while they care for out of school children, and learning outcomes for children may be impacted by the transition to temporary online learning. To help improve learning outcomes, a tax deduction to help with the costs of employing tutor services for students should be introduced. For parents who may lose wages while taking care of their at-home school children, there is the Canada Recovery Caregiving Benefit.
I’ve been mentioning Covid-fighting jobs throughout this article. Covid-fighting jobs are jobs created by the Provincial government that are intended to reduce the spread of Covid-19. Either of the two programs discussed above would require a significant labour force. It is estimated that it would require at least 40,000 staff to roll out a mass testing program similar to Slovakia’s in British Columbia (8,000 staff per 1 million). The province has the opportunity to create new jobs for those who have been displaced or lost income due to lockdown and social distancing measures. It’s a double whammy!
In addition to Covid-fighting jobs, stimulus spending should be directed to topping up federal income support programs like the CRB. If the province provided even an additional $200 per transfer, it could make a big difference for those who are struggling the most.
Plotting a new course
If we take this new approach, I’m confident we can eradicate Covid from our province before the New Year. British Columbians should not, and do not, have to endure the long bleed strategy proposed by the Ministry of Health. There is a smarter, more measured way to deal with this crisis; we just need the courage to try something new.
Sign the petition for B.C. to purse a more aggressive Covid strategy!
Please send this article to your local MLA and show our leaders that we support extraordinary measures to deal with extraordinary circumstances.
We need to demand that our provincial health authorities pursue a more aggressive strategy.
#PlugTheHole #CrushTheCurve #LocateAndLocalize
Twitter: @rhizospastic
Works Referenced:
Report: Slovakia COVID-19 Population Testing
