Physical Distance Dilemmas

April 12, 2020

Written by Jenna McHugh

The initial onset of panic during the worldwide pandemic has tapered off for me and turned into a dull, mystifying pulse of nervousness that creeps up on me when I make my weekly trip into an almost empty office and the grocery store. The ominous feeling is arguably more concerning than the initial onset of anxiety and panic grocery shopping 4 weeks ago. Now we are waiting. We are all idling in our homes refreshing our Twitter feeds and watching Justin Trudeau say things like, “speaking moistly” during national Coronavirus updates on the CBC. It’s hard to carry on through this new lifestyle without wondering when things will get back to some level of normalcy. 

We’re in a tough situation for multiple, obvious reasons that hardly need restating. We are concerned about ourselves and family members. We are also facing a meaningful economic problem that will set the world back financially for years to come. Analyzing these competing obstacles will surely lead to differing opinions amongst experts. I’m becoming increasingly interested in considering the conundrum the political system is facing and how these decisions are working together with healthcare and the economy. Physical distancing measures are moving towards extremes that are inhibiting the livelihood of our citizens, instilling a deep sense of fear and forgoing what it means to be a law-abiding citizen in Canada. Parks and other amenities such as: community gardens, dog parks, trails and basketball courts are closed across Canada, meaning you could be fined and potentially jailed for visiting one of these locations, even if you’re alone. From where I stand, the decision making is based on evidence that does not paint a complete picture of the problem. Because Canada and many other countries are unable to implement mass testing, the projections are not reflective of the current situation. Theresa Tam states simply, ‘Models are not a crystal ball.’ and are ‘imperfect’. Projecting the number of cases to the number of deaths without mass testing is akin to shooting a moving target that’s toying with you at every shot. 

The Government of Canada is using two modelling approaches: Forecasting Models and Dynamic Models to determine its course of action. The Forecasting models estimates for the coming week, whereas the Dynamic models show the epidemic over the course of the coming months. The Dynamic models consider the average number of people one will infect each day, the % of cases that will be identified and isolated, and the % of people who have been in contact with a COVID case and who will be traced and isolated.  Immediately, we see apparent limitations. Due to the developing physical distancing guidelines in place, to determine these variables accurately is a long-shot. Furthermore, the lack of testing amongst Canadians ensures that we do not have accurate pictures of the number of infected. Even still, many who are demonstrating symptoms are not being tested due to the limited capacity. On April 9, the federal government released its projections stating that there could be anywhere from 11,000 to 22,000 deaths over the course of the pandemic, which may last up to two years and suggested that physical distancing and quarantines could be in place for months. 

We also know that when these isolation restrictions are lifted we will see a resurgence of cases, known as ‘waves’. These waves will likely go on for the rest of 2020 and into 2021. In order to avoid a second peak, the ideal situation is to have single digit numbers of deaths before removing physical distancing measures. The two scenarios in play to end these increasingly restrictive measures are: a vaccine and herd immunity. With the way things are going, we won’t be seeing either of those solutions anytime soon. Developing a vaccine is extremely complicated, costly, and time consuming. I’m optimistic about the prospects, but we are over 18 months away from its development and rollout. Moreover, in order to develop herd immunity, 40-70% of the population will need to become infected. The epidemic will die out at the point when the reproductive mode of the virus dies out. At this rate, that many Canadians becoming infected would take many months, particularly with the onset of the extreme physical distancing measures. This means, on the low-end, 15 million Canadians would need to be infected with the virus and as it stands Canada has 22, 559 confirmed cases. Perhaps the herd immunity model deserves more consideration, with a vaccine over a year away. Ripping off the band-aid could lead to harsh consequences, but leaving it on too long may let it fester and worsen the “economic” scar. 

These unsteady projections pose a problem because this level of physical distancing is based on numbers that may be grossly inaccurate. The data that’s being collected is unreliable given the limited testing, leaving uncertainty about the risks of dying. These realities could be seen as negative or positive. On one hand, the lack of knowledge could mean that the situation is worse, or it could mean that we need not worry about those who aren’t vulnerable. The measures enacted have led to major consequences for the economy, society and mental health. Many people in the world are losing their livelihoods sitting at home and worrying. On April 9th, Statistics Canada reported that one million jobs were lost. With that, 5.47 million Canadians have applied for emergency assistance since March 15, with anticipated increases through April. Canadians should not forget that the funds provided by the government will put Canada into a deficit of $184 billion and the $2000/month emergency benefit costing $22.3 billion. We will be paying for these necessary responses well into the future. 

All this is not to say that the lives of our most vulnerable citizens matter less than our economic standing. I will be the first to point out that an overwhelmed health care system is not something that I want to see. The doctors, nurses and essential services that are treating the people who are sick are truly outstanding individuals. The Canadian healthcare system already runs at capacity and increasing the number of ICU patients with COVID-19 is trying, but also inhibits the outcomes of regularly occurring illnesses and diseases that exist in the hospital. Furthermore, I am thankful that individuals who have lost their jobs are receiving benefits from the Canadian government, and this is an important step to ensure that citizens are able to cope with the troubled times we are in. The swift movement is both recognized and admirable. 

However, I am starting to appreciate the stirrings of a more controlled approach to physical distancing, with isolation for some and well-mannered, diligent hygiene habits for others. This would mean that businesses could reopen with cautious measures in place and citizens would continue to be mandated to practice measures of physical distancing with masks. The government could keep a watchful eye on its outcomes and those who are vulnerable could continue to remain in isolation, with support from families, friends and designated agencies. In Ontario, hospitals have been bracing for the worst only to be left twiddling their thumbs awaiting a projected flood of Coronavirus cases requiring hospitalization. Even projections below indicate that in a best case scenario the healthcare system, with proactive measures, will be able to handle the onset of a surge. Furthermore, the green bars indicating the number of confirmed cases in Ontario have remained lower than projected numbers at almost every instance. 

Source: Government of Ontario 

This is not the only narrative highlighting what seems to be a lack of ICU level cases of Coronavirus. Anyone who has been graced with Alex Bereson’s Twitter account has seen his obnoxious level of commitment to narrate the low levels of hospitalizations and a lack of crisis-level situations in many cities across America. He’s taken on the task of challenging the projection models that are formulating government decisions. Bereson is arguing that projection models have grossly overestimated the outcomes leading to extreme economic loss in the U.S. He is arguing for a more targeting approach, but believes that the political pressures are now too strong to reverse measures in place.  Moreover, we’ve seen Michael Burry, famous in investment circles and from his character in the movie, The Big Short join Twitter in order to respond to the lockdown measures in place that are “devastating” the livelihoods of Americans. He’s insisting that these stay-at-home policies should not be universal. As a private person, he felt compelled to respond to the lockdown.  

Canada’s latest blunder was its misinformation and misdirection regarding the usefulness of masks. Masks help! Theresa Tam finally made the recommendations for Canadians to wear masks as of last week. Previously, citizens were told to preserve masks for healthcare personnel. In fact, we were told it might increase the likelihood of contracting the virus as people would be prone to touch the mask, dissuading many. Masks, even homemade ones, have been proven to significantly reduce the number of microorganisms expelled. More resources are required to manufacture masks and distribute them to the masses in Canada. Healthcare workers in Canada are experiencing a shortage. Last week there was increasing concern surrounding shipments of masks from the U.S., leading hospitals to ration equipment and frontline workers have been told to use one mask per shift. 

We can see from examples like South Korea where they have been successful at flattening the curve aided by the increased usage of masks. South Korea is seeing fewer cases a day than Ontario with a population of 51 million. The country has been able to pivot away from lockdowns towards ongoing management. As noted previously on Vigor, South Korea has completed much higher levels of testing for their population, which helped their projections and prevention strategies. The government quickly recommended that people wear masks and acquired them in mass quantities promptly; businesses haven’t been forced to close, but they continue to practice physical distancing measures.   

Trudeau suggests the pivot towards reducing physical distancing measures and embarking on back-to-work strategies will be conducted, rightly so, in graduated stages in order to prepare for the increased onset of cases once physical distancing is rescinded in a few months. Austria and Denmark are looking to pivot towards a new normal earlier than other countries, with a detailed plan in place to reopen schools and small businesses by May 1 if all goes well. Precautions are being mandated through the use of masks and capacity restrictions. The lockdown will end in stages based on the assessments of risks. 

As we move into more serious levels of lockdown for longer periods of time, there is an increased desire for social connection amongst populations. Technology is working well, but it’s not a long-term solution. Social cohesion should be more important to governments than ever before, as citizens’ confidence in its leaders will have a direct effect on the uptake of more extreme physical distancing measures. I worry as movement for Canadians becomes more constrained, we will see more mistrust of leadership. Physical distancing and isolation is a hard pill to swallow because throughout history, during times of hardship, communities have banded together to support one another. This time we are forced to remain at distance. 

In a world where it’s hard to know what’s what with a pandemic, careful consideration is necessary when enacting different measures. Every word spoken by the government is under a magnifying glass because lives are on the line. There is a balancing act between saving lives and saving the economy. A misstep is costly in either direction and some countries are achieving better results than others. I think it’s fair to say I’m torn and it’s okay if you are too. Perhaps I am on the fence about what to do next because I am searching for action out of frustration for the current circumstances. Everywhere we look, we are seeing harrowing stories from individuals who have experienced the virus firsthand, and the strain on healthcare workers in the eye of the storm. Physical distancing is working exactly how it should be, but I fear we are starting to slide down a slope of government lockdown that may prove to be detrimental to social cohesion and long-term sustainability of the economy. Looking towards the future, this pandemic may be an opportunity to argue for surge capacity and capabilities in healthcare settings. Hospitals run on a funding model that does not allow for a surplus of hospital beds, ICU beds and Personal Protective Equipment, but maybe it should for times like these. In a perfect world, we wouldn’t be dealing with a pandemic, but in a perfectly prepared pandemic world, we wouldn’t need to stop living so the healthcare system could keep up. 

Jenna McHugh is the Founding Editor of Vigor. Follow her at @jennoratorr

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