It’s Time For A Different Approach to COVID: PART TWO

Part One of this Blog argued that our country’s present policies to address COVID have been one-dimensional and ill-chosen. Current federal and provincial policies have not only failed to address many other crucial factors (such as mental health, the economy, social and economic determinants of health, and the backlog of elective surgeries) but also aren’t accomplishing what they are intended to do.

This follow-up blog builds on that analysis. It addresses three questions:

  1. Are we capable of learning from South Korea’s choices, or is the steadiness and discipline that they bring to the table something we Canadians just can’t manage?
  2. To what extent is the current lockdown strategy a blunt and insufficient attempt on the government’s part to deal with years and years of inadequate and mis-allocated spending compounded by poor current strategy that ignores public advice by infectious disease experts?
  3. If we do not change direction, must we swallow the bitter pill and lock the country down for however long it takes to get the job done, all the while accepting a troubling governance model based on quasi-democratic emergency edicts?

South Korean Policies for Canada

Our governments’ current COVID-fighting rules are clear – avoid the 3Cs (close, continuous contact), wear masks inside when you can’t distance, wash hands, and keep 6 feet away from others. This should work – but what if it’s not enough or is mis-messaged by politicians?

We have confused the public in two ways. First, by changing the application of messages by place over time. Second, by saying that this isn’t enough – the only safe thing is to lock everyone and everything up. That’s the policy followed in China and much of Europe.

There is a viable alternative however. Instead of partial and full lockdowns, we should:

  • Invest in widespread quick tests and use the results to track diligently as the focus of an efficacious public-health policy
  • Let healthy citizens responsibly work, play and learn – not blanket all with a stay-in-place order, yet undermine closures/restrictions with a myriad of inconsistent exemptions
  • Target “in need” communities, age cohorts and settings that are already known to be at greater risk of infection
  • Accept that saving everyone and treating all families the same is impossible and inadvisable
  • Reward people who practise this “three C” rule, and reinforce this message at every turn.

Are we capable of learning from South Korea, which focuses on trying to keep a “balance between preventative measures and economic growth”? That country has avoided comprehensive, ever-renewed lockdowns and has a fraction (one-fifteenth) of our COVID death rates. Is the steadiness and discipline they bring to the table something we Canadians just can’t manage?

South Korea, similar to Japan, has not shut down their economy nor do they have many deaths from COVID. It avoids the “yo-yo” of opening and closing. From my readings, both Asian countries tend to be more comfortable with authoritarian dictates and following rules so their compliance with COVID requirements is probably very high and higher than could be expected in Canada. Even before COVID, their citizens culturally were more used to mask-wearing in public (due to fears of air pollution) and not speaking loudly in group settings (not draw attention to self), which might help explain why we have such a surge of infections in our second wave.

Their citizens’ morale and confidence is buoyed as they eat out in restaurants, work out in gyms, and do everyday activities that we avoid even when they are permitted. Contract tracers in Korea and Japan rely on a legal and cultural framework that’s hard to imagine here. Data on patients’ movements, with names left out, are made public on official websites, a legislative requirement born out of criticism that authorities concealed too much information during the MERS outbreak. Koreans are said to be anxious to protect their private information, but they demonstrate willingness to give up some privacy in the attempt to protect the health of their loved ones.

Could we trust Canadians to support similar policy choices? Behavioural psychologists caution that many of us assess our personal lifestyle risk as minimal, although our ability/accuracy in assessing situation risk such as catching the virus may be suspect. That character trait extends to lying, as not a few Canadians who are being traced have lied about their behaviour and contacts, to avoid stigmatization for spreading the virus. According to sociologists, however, Koreans share these two traits.

I feel really strongly that Canadians need to learn to live with this virus and, unless constrained by age or pre-existing health conditions, not shut ourselves away as the only way to prevent spread. There may be more and different infections in the future (likely variant viruses) and we need to have a better response than “yo-yo” lockdowns which should be a blunt instrument choice of last resort.  

Paying for Past and Present Bad Governance

To what extent is our lockdown-centred, public-health policy a blunt attempt on the government’s part to deal with years and years of poor management policy? Sources who have worked for many years in health management have told me that:

  • We’ve suffered from too few ICUs for the longest time (as we have MRIs and doctors) because it was just “too expensive” to invest in such infrastructure (and the government, of course, has sole control of medical funding in Canada).
  • Seniors homes have chronically been badly neglected for the past few decades. As reported in Blog Nursing Homes: Ethics and Solutions (May 5), code requirements were violated time and again, but most provincial governments neither publicize nor punish the offending parties.
  • Even before COVID, some elective surgeries took forever to schedule, and our PPE preparation was quite pathetic.
  • Our national lack of vaccine manufacturing occurred, in part, because our politicians were guilty of short-term thinking in selling off our world class crown corporation Connaught-Sanofi laboratories.
  • Citizens are dis-empowered by governments’  failure to release hundreds of thousands of dollars’ worth of taxpayer-funded data on alternative COVID management choice policies.

Looking at this list leads one to appreciate just how neglectful our leaders of various political parties have been, for decades now. Before and during the pandemic, we haven’t had:

  • Adequate funding of widespread and aggressive infection-testing, high-tech contact tracing, tracking and mandatory isolation.
  • Acknowledgement that not all lives can be protected or patients saved – we know that the older our more vulnerable population gets, the more it is at risk of adverse outcomes from any infectious disease.
  • More international comparisons of health policy choice alternatives.
  • Recognition that pre-teen, school-age children need interpersonal, in-class social learning.
  • Transparent release of data on those specific businesses, workplaces or buildings that are sites of non-compliance, virus transmission, or both.
  • Acknowledgement that a majority of cases are asymptomatic with low threat to health.
  • Mandatory, paid sick leave and danger pay for all workers, at least during the pandemic.

After analyzing over 750 international articles and reports in preparing eight dozen blogs, the prescription I think we need is RESPONSIBLE TESTING, TRACKING AND TRACING rather than DISTANCING AND SHUT-DOWN. Applying a testing regimen for infectious diseases inspired by South Korean experience here would include:

  • (a) use fast diagnostic tests for much more of the population;
  • (b) make such tests more widely available;
  • (c) recommend a tester wear only a mask (not full PPE) in a sort of modified phone booth where he or she would stand, using a pair of gloves embedded in one of its glass walls, to test patients;
  • (d) implement drive-through testing sites across communities;
  • (e) amend the law to allow contact tracers for cause to scrape relevant data from cell phones, credit card, public transit records, and other sources; and
  • (f) apply temperature and saliva testing before school, at school and after school, with isolation where necessary.

Where tracing is inadequate for a pathogen as infectious as COVID, as has often been the case in Canada, the U.S., and Europe, small outbreaks become big ones, and big ones become national crises that require lockdowns to stop. A suggested alternative regimen centred on comprehensive testing and robust contact tracing would look like this:

Public  Policy Personal  Empowerment Business New Normal
Require a non-binding on-line  referendum the week before any new emergency edict Allow families or households to self-define essential services Require all patrons and workers to scan a QR Code linked to a national contact tracing system before entering  the premises
Apply stiff quarantining only of the sick or those being tracked as infected and/or suspicious Allow all businesses to stay open normally but with responsible self-regulation Put nursing homes and congregate settings in real-time touch with hospitals and regulators
Reallocate resources to support widespread  testing, tracking and tracing Insist that all those who test positive must quarantine and have their contacts screened Make mask-wearing mandatory in virtually every public place
Put priority attention on monitoring hazardous sites and congregate settings Adjust social distancing and stay-in-place measures to local realities Invest in neighbourhood-based BIAs that offer local home-delivery services
Give citizens information on which specific settings or institutions are spreading COVID End discretionary international travel as long as needed Encourage shopping locally as well as community collaboration and enterprise
Require businesses to protect every employee who chooses to work when sick in order to pay their bills   End discretionary inter-regional travel if and where needed Shut down or control circulation within all face-to-face-contact indoor businesses and for back-office (kitchen, warehouse) functions
Emphasize building immunity among the low risk majority Require confirmed carriers to  show medical status or exemption cards in order to enter public buildings and use transit Require all factories and warehouses to offer worker paid sick leave for suspect infections
Focus enforcement on eliminating risk from known or suspect spreaders Leave home and go to work only when it’s safe to do so Mandate businesses practice symptom screening, entry/exit tracking, and instruction on what to do if a worker becomes sick with COVID-19 symptoms
Recognize, reward and support front line workers Volunteer online to support the more vulnerable around you in your community Require pandemic danger wage supplements to front line workers
Advise those of any age who are at high risk to quarantine as much as possible (1) Reinforce responsible personal behaviour in congregate settings Favour “re-shoring” rather than outsourcing procurement in strategic health industries   (2)

Source: the author’s opinions only
(1) for example, immunocompromised, lung disease, obesity, etc
(2) PPE, vaccines

Leadership to Reset and Change Policy

Canada’s barrier to improvement may be more political than cultural. This barrier involves  our constitutional split of responsibilities.  While we had some degree of coordination across the federal, provincial and territorial governments in the first wave, but even then less than ideal, we are now quite literally into warring approaches.  Second-wave responses are driven primarily by the media story of the day in most parts of the country. This makes communications, consultation, and agreeing on approaches even harder. 

After the first wave there was an attempt to build testing and tracing capacity (The Safe Restart Agreement) but, despite billions of dollars thrown at the provinces, they failed to build up the capacity. According to highly-placed sources, the appropriate advice from many health scientists has been there all along – we just have not had a rational decision-making process or the political will. We have let privacy concerns hinder the development of appropriate contact tracing tools. COVID Alert is been exposed as a very weak tool. Privacy issues continue to hinder sharing of case data and limit our response capacity. 

Throughout both pandemic waves, there have been no white or green policy discussion papers, no ongoing on-line stakeholder dialogue, and closed door decisions. Who can be called upon to speak truth to power—that current policies have caused undue harm, as well as preventable deaths, some of which could have been avoided by a more focused infection-control response?

When will more provinces and territories accept infectious disease experts’ advice and use available Safe Restart Agreement federal monies to replace default option “yo-yo” (on again-off again) lock-downs with a saner and safer COVID-fighting program based on components like the ones suggested in the above table?

Do we citizens have the leverage and constitutional means to compel politicians to abandon the same message and decisions that have punished or adversely affected the sick and the well together?

As someone who consults on scenario development and testing, I am motivated to ask what if COVID persists even with a vaccine in circulation and (fuelled by variant coronavirus strains) claims thousands of lives each year like the flu only we can’t counteract it because we’ve mis-allocated resources, run up the deficit, and run out of money? We may be breeding inter-generational and inter-regional demonstrations and unrest.

To be clear, the current health policy is a threat to freedoms, such as right to congregate, to see government rule by informed consent, and to privacy of the person. Its damage is to morale, open consultation, and social cohesion– not just economic insecurity. We are right to be concerned about how much the government has increased its future powers, given it has operated so unilaterally with recurring, ever changing, renewable emergency edicts in the recent months.

It is neither reasonable nor realistic in a democracy to either lockdown everything or reduce harm for everyone. We don’t have the resources, nor the quality of political leadership, and not everyone is at equal risk. We need policies that empower us. We need to focus on identifying, alerting through warning, and quarantining those of greatest risk of being a spreader or infecting others, as well as those with co-morbidities in specific locations that have been or are putting them at great health risk. What may be a more valuable, prudent and effective public policy than keeping everyone distanced and staying at home is saving lives among those most at risk. To do so requires no longer ignoring advice to invest in as rigorous a testing, tracking and tracing program as possible.

Conclusion

There are lots of reasons to press the restart button on public health policy.

Lack of communication and facts led consumers to hoard toilet paper and other items.
It’s time to be more effective.

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Further Reading – EthicScan Blog Articles:

The Future: Tracing, Tracking and Ethics:
https://ethicscan.ca/blog/2020/05/21/the-future-the-ethics-of-tracking/

Recovery Choice Planning Part 1: Testing and Tracing:
https://ethicscan.ca/blog/2020/07/08/recovery-choice-planning-part-one-testing-and-tracing/

The Debate Over Governments’ COVID Decisions Goes Public:
https://ethicscan.ca/blog/2020/10/05/the-debate-over-governments-covid-decisions-goes-public/

Recovery Choice Planning Part 2: Opening the Economy:
https://ethicscan.ca/blog/2020/07/10/recovery-choice-planning-part-two-economic-renewal/

Recover Choice Planning Part 3: Social Distancing:
https://ethicscan.ca/blog/2020/07/12/recovery-choice-planning-part-three-social-distancing/

Planning for Recovery Part 4: Re-Opening Public Schools:
https://ethicscan.ca/blog/2020/07/14/planning-for-recovery-part-four-re-opening-public-schools/

Planning for Recovery Part 5: Addressing the Needs of the Poor:
https://ethicscan.ca/blog/2020/07/17/planning-for-recovery-part-five-addressing-the-needs-of-the-poor/

Cure vs. Care: Flattening the Curve:
https://ethicscan.ca/blog/2020/03/24/cure-vs-care/

David Nitkin
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