A B.C. Ambulance Service employee in protective equipment including an N95 mask, a face shield, goggles and gloves, moves a patient from an ambulance to the emergency department at Royal Columbian Hospital in New Westminster, B.C., on Sunday, April 12, 2020. THE CANADIAN PRESS/Darryl Dyck

A B.C. Ambulance Service employee in protective equipment including an N95 mask, a face shield, goggles and gloves, moves a patient from an ambulance to the emergency department at Royal Columbian Hospital in New Westminster, B.C., on Sunday, April 12, 2020. THE CANADIAN PRESS/Darryl Dyck

WHO issues guidelines for lifting COVID-19 restrictions. Is Canada ready?

The WHO guidelines outline six areas officials must consider

Federal and provincial officials are starting to discuss how and when to start reopening schools and businesses but Prime Minister Justin Trudeau warned Tuesday the full-scale lockdowns most Canadians are living with right now will remain in place for at least several more weeks.

Similar discussions are happening around the world, as many countries are starting to show some positive signs of slowing the spread of COVID-19 — even as experts warn limited testing in most places could be masking the real picture of the disease.

READ MORE: Bank of Canada keeps key interest rate target at 0.25%, early data shows economy plunged

The World Health Organization is trying to inject some co-ordination into these decisions, releasing new guidelines Tuesday for what should be in place before easing restrictions.

“The way down is much slower than the way up,” Tedros Adhanom Ghebreyesus, director-general of the WHO, said in a speech Monday. “That means control measures must be lifted slowly, and with control. It cannot happen all at once.”

The WHO guidelines outline six areas officials must consider if they are to look at resuming activities. Here is where Canada stands on each of them.

1. Is transmission of the virus under control?

Short answer: We’re not testing enough to know.

What the experts say: Eleanor Fish, a professor of immunology at the University of Toronto, said testing must become much more widespread before we really understand the state of community transmission.

Alison Thompson, a public health professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto, said it takes a significant amount of time between a confirmed infection and fully tracing a person’s contacts and testing them, to know whether that confirmed infection has resulted in many more infections.

“We have to make sure it actually is levelling off, or that community transmission has actually ground to a halt, which can take quite awhile,” she said.

If restrictions are removed too quickly, thousands of people with COVID-19, who may not know they are infected, could potentially spread it fast and wide, she said.

READ MORE: ‘We see your grief’: B.C.’s total test positive cases top 1,500 as deaths rise to 72

Thompson also said it’s time to stop thinking of the pandemic in terms of health versus the economy. If there isn’t a healthy workforce the economy will continue to suffer, she said.

“We may see some short-term gains if we did ease up on some of these restrictions,” she said. “But in the long run if we end up with an out-of-control situation with COVID, the economy will take much, much longer to recover.”

2. Is the health-care system equipped to detect, test, isolate and treat every case, and trace every person who came into contact with a positive case?

Short answer: Not yet.

What the experts say: Timothy Sly, professor emeritus at Ryerson University’s school of occupational and public health, said Canada has done “an abysmal job” at testing and tracing.

“We have a situation now essentially where we’re groping along in the dark in terms of finding out who in fact is virus positive and who’s virus negative. We’ve done an abysmal job at that,” said Sly, who specializes in epidemiology.

Sly pointed to an especially woeful rate in Ontario where Premier Doug Ford has vowed to perform 8,000 tests daily by Wednesday, up from about 5,000. Alberta is among Canada’s testing leaders with about 7,400 tests conducted daily, which Sly said is still not enough.

Still, he acknowledged there have been hurdles beyond Canada’s control that have handcuffed efforts — notably, global shortages of equipment including swabs and laboratory chemicals needed to process test samples.

READ MORE: Health Canada approves portable COVID-19 test that can provide results within an hour

Sly said Health Canada’s recent approval of a rapid, mobile hand-held testing device from an Ottawa company should help, as will a series of expanded testing criteria that various provinces have adopted in recent days.

Jianhong Wu, a distinguished research professor at York University who has led multiple national projects on SARS, pandemic influenza and immunization evaluation, said there is a close relationship between contact tracing, testing and social distancing.

“If you don’t do well in one component, you need to significantly magnify your effort in other components,” he said.

Sly said provinces are largely trying to contact people exposed to a confirmed case by telephone, which is not sustainable given the soaring number of cases.

He pointed to countries such as South Korea, which have employed cellphone data to track possible contacts. He said that is much more effective, but it would raise privacy issues.

“People are going to be hollering and screaming about that but it does seem to work,” he said.

3. Are outbreaks minimized in special settings like health facilities and nursing homes?

Short answer: No.

What the experts say: Risks remain dangerously high in hundreds of nursing homes across the country.

Quebec, where long-term care centres have been particularly hard hit, announced Tuesday that inspections have identified 41 seniors residences that require special monitoring because of a high number of COVID-19 cases. Premier Francois Legault on Tuesday appealed for people with experience in health care to help out in understaffed long-term care facilities.

Canada’s chief public health officer, Theresa Tam, said Monday nearly half of the country’s deaths from the novel coronavirus have come from long-term care facilities, and she predicted the number will increase despite provinces’ efforts to fight the problem.

READ MORE: B.C. MP deletes tweet about Canadians returning to work if most COVID-19 deaths are in care homes

Twenty-nine residents in a 65-bed nursing home in Bobcaygeon, Ont., have died amid the pandemic. Another facility in Toronto recorded 22 deaths by Monday, while the Lynn Valley Care Centre in North Vancouver, B.C., has had 18 residents die. In many facilities workers are also getting sick in high numbers.

After the Lynn Valley Care Centre outbreak, British Columbia moved to stop staff from working in multiple facilities as a way to slow the spread of the virus. Ontario made the same move Tuesday.

Isaac Bogoch, an infectious-disease specialist at the University of Toronto and the University Health Network, feels that strategy, along with limiting visits with seniors and infection-prevention methods, could go a long way in minimizing risks for possible subsequent waves of COVID-19 among the elderly.

Canada now has guidelines for helping to protect long-term care residents and workers, but Tam indicated this week the outbreaks are the biggest concern that has arisen in Canada’s COVID-19 situation over the last two weeks.

4. Are there measures in workplaces and schools to prevent the spread of the virus?

Short answer: Not yet.

What the experts say about workplaces: In most provinces, only essential businesses like grocery stores and pharmacies can remain open. All others must operate with employees working from home. If they can’t do that, they must close. Restaurants can generally only allow takeout or delivery.

Many businesses report being too focused on setting their employees up to work from home, and haven’t yet begun to think about what to do to reopen.

Provinces and business groups say it’s too early to speculate on which measures can be lifted. Any shift in approach would come at the advice of the chief medical health officer “and with extreme caution so as to avoid a resurgence of the virus as has been seen in other jurisdictions,” said Hayley Chazan, a spokeswoman for Ontario Health Minister Christine Elliott.

The Canadian Chamber of Commerce says it wants clear advice from public health authorities before restrictions loosen.

“We fully expect that there will unfortunately be an instance where an employee does test positive. What does that mean for the workplace? Does there have to be a total shutdown? A deep clean?” asked Mark Agnew, the chamber’s senior director of international policy.

Sector-specific rules will remain critical as the lockdown starts to lift, he said, noting that retailers, meat processors and refrigerator technicians might all require different protocols around physical distancing and personal protective equipment.

What the experts say about schools: Kids, while less susceptible to the novel coronavirus, are well equipped to transmit it.

“Children are generally less compliant with effective hand hygiene, and they don’t necessarily control their secretions,” said Dr. Nisha Thampi, infection prevention and control lead at Children’s Hospital of Eastern Ontario in Ottawa. “That presents an exposure risk to the staff as well as to other children.”

The Public Health Agency of Canada has stopped short of recommending specific changes schools could make to their operations, but did offer more general guidance for schools in February, before Canada began to really experience the impact of COVID-19. That included regular hand-washing and supervised use of hand sanitizer, education on proper “respiratory etiquette” such as covering coughs and sneezes, ramped-up cleaning and disinfection routines within school buildings, and reinforcement of “no sharing” policies.

Thampi said medical experts will also have to craft advice that strikes a balance between student safety and developmental needs.

“Children have always seen school as being a social environment,” she said, adding many are no longer getting that kind of stimulation in the era of physical distancing. “How can we be sensitive to that while also teaching them about infection-prevention strategies?”

5. Are the risks of importing more cases from outside the country being managed?

Short answer: Mostly yes.

What the experts say: The federal government has adopted once-unthinkable measures over the past month to keep more cases of COVID-19 from arriving in Canada. Those include banning most non-Canadians from entering the country and a 14-day mandatory quarantine for anyone who does.

On Tuesday, Ottawa upped that game again, now requiring anyone arriving to explain their quarantine plan and if it’s not good enough, they will be forced to stay in federal sites.

The trouble is that Canada is heavily reliant from both an economic and social perspective on foreign trade and immigration. That means it can’t keep the border closed forever.

“We have done a lot, but economically it’s not sustainable,” said Daniel Beland, director of the McGill Institute for the Study of Canada.

Experts say there is a variety of potential avenues to reopen the border and manage the risk.

Being able to screen potential visitors, preferably with on-the-spot testing at airports and other ports of entry, would make it much easier to identify carriers and either bar them from coming into Canada or put them into quarantine.

Steven J. Hoffman, a York University professor and the scientific director of the Canadian Institutes of Health Research’s Institute of Population and Public Health, said the 14-day quarantine ”could be the enabler that allows government to reopen our borders, particularly if that system is really up and running and fully implemented. And enforced in a way that we can have confidence in it.”

There could also be more targeted travel restrictions for visitors from different countries, depending on how those countries are managing the virus, though experts acknowledge partial bans and quarantine requirements could create challenges and anger.

Beland nonetheless believes Canadians will need to accept that there will be changes in the way they travel, similar to how the 9/11 terrorist attacks led to increased security measures.

6. Are local communities are educated, engaged and empowered to adjust to the “new norm”?

Short answer: Maybe

What the experts say: Canadians have been inundated with warnings from political leaders and public health experts for weeks now to be prepared for bad news. Trudeau has not been shy about making sure people know that until there is a vaccine, we are all going to have to get used to having at least some restrictions on our movements and behaviours.

In Canada, most experts think the number of cases is going to peak this month. The data based on the limited epidemiology Canada has shows the number of cases was doubling every three to four days in the last two weeks of March, but had slowed to doubling every five to eight days in the first two weeks of April.

But officials also warn of more than one wave, with flare-ups and new infections continuing for months. A vaccine is at least 12 to 18 months away, and the “new norm” really means longer-term adjustments to limit the impact of those new outbreaks.

There have been warnings from some experts around the world that things like live concerts and massive public gatherings for sporting events won’t be safe for months to come.

Hoffman said he thinks Canadians must get ready for an up-and-down scenario, “where first the government lessens these restrictions and then a couple weeks later has to tighten them again in light of new data and new information about where spread is happening or how it’s happening.”

— With files from Mia Rabson and Lee Berthiaume in Ottawa, Kelly Geraldine Malone in Winnipeg, Cassandra Szklarski and Michelle McQuigge in Toronto, and Christopher Reynolds and Julian McKenzie in Montreal.

The Canadian Press


Like us on Facebook and follow us on Twitter.

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Skeena Bulkley-Valley MP Taylor Bachrach has been working across party lines to have rail safety issues addressed. An April 27, 2020 train derailment blocked five intersecting tracks on the CN rail line in Prince Rupert close to the waterfront on Bill Murray Drive. (Photo: K-J Millar/The Northern View)
Bachrach pushes for rail safety and wants NW voices to be heard

Residents and community leaders are concerned about safety and preparedness in the NW

Over 8000 BC Hydro customers have been affected by the power outage. (BC Hydro outage map)
Power outage affects 8000 BC Hydro customers in Prince Rupert area

BC Hydro has assigned crews to restore power

Josie Pottle rocks out to placing painted rocks by more than 14 different Prince Rupert childcare organization staff and tots for rock gardens around the city to mark May as Childcare Awareness month. (Photo: K-J Millar/The Northern View)
Childcare month is rocking it in Prince Rupert

More than 14 local childcare organizations participated in making rock gardens

Volunteers at the AFFNO drive-in movie theatre night at the Jim Ciccone Centre on May 8, directed traffic and braved the rain before the movies started. (Photo: K-J Millar/The Northern View)
It was lights, camera, action for AFFNO’s drive-in movie night

Volunteers and moviegoers watched a double feature in both official languages

Pembina Prince Rupert Terminal has entered into a one-year agreement with Mitsui & Co. for the majority of its production for supply to the Asian markets, Pembina announced on May 6th. (Photo: Supplied
Prince Rupert Terminal highlighted in Pembina first quarter

Pembina announced one-year agreement with Mitsui & Co. to supply Asian market

A bullet hole is seen in the windshield of an RCMP vehicle approximately 4 km from Vancouver International Airport after a one person was killed during a shooting outside the international departures terminal at the airport, in Richmond, B.C., Sunday, May 9, 2021. THE CANADIAN PRESS/Darryl Dyck
Homicide team IDs man in fatal YVR shooting as police grapple with spate of gang violence

Man, 20, charged in separate fatal shooting Burnaby over the weekend

The site of Sunfest, Laketown Ranch, will be open for camping this summer. (Citizen file)
Sunfest country music bash won’t be shining on B.C. in 2021

Annual Vancouver Island Festival cancelled due to COVID-19, along with Laketown Shakedown

Tla-o-qui-aht First Nation elected chief councillor Moses Martin, who was also Chantel Moore’s grandfather, speaks to media in Port Alberni on Aug. 16, 2020, during a visit from NDP leader Jagmeet Singh following the police shooting of Chantel Moore. (Elena Rardon photo)
Mother of 2 shot by police in critical condition, says B.C. First Nation chief

Community ‘devastated’ by third member of 1,150-person Vancouver Island nation shot in less than a year

B.C. Agriculture Minister Lana Popham promotes the government’s BuyBC food program in 2019. (B.C. government)
Money running out for fresh fruit, vegetables, milk in B.C. schools

‘Looking at ways to support this type of program,’ minister says

(Paul Henderson/ Chilliwack Progress file)
Experts now predict 33.6% rise in B.C. home sales for 2021

BCREA economists also predict home prices to increase by 14.3%

B.C. Auditor General Michael Pickup in 2017. THE CANADIAN PRESS
B.C. didn’t effectively manage conservation lands program: auditor general

Michael Pickup says staff had limited approaches to resolving the unauthorized use of the most at-risk conservation lands

The majority of city council votes in favour of this design for a new Salmon Arm flag on Monday, May 10, 2021. (City of Salmon Arm image)
Majority of council salutes new flag for Salmon Arm

Two councillors raise concerns about logo being too corporate for a flag

(Pixabay)
B.C. doctors could face consequences for spreading COVID misinformation: college

College says doctors have a higher level of responsibility to not spread incorrect information

Prime Minister Justin Trudeau receives his COVID-19 AstraZeneca vaccination in Ottawa, Friday, April 23, 2021. THE CANADIAN PRESS/Adrian Wyld
75% of Canadians need 1st vaccine dose to have more normal summer: Trudeau

The country is on track to hit a major milestone on the road to COVID-19 herd immunity Tuesday, with 40% vaccinated with a 1st dose

Most Read