'we're looking at social distancing for months'

businesses are closing shop, our prime minister and his wife are in self-isolation, and public schools are closed for the next three weeks. to the public eye, it may look like the western world has only just started to panic about covid-19, but infectious diseases doctors and researchers have been preparing for this for at least two months.to some, it may seem like an overreaction. canada’s risk is low at the moment. but if we don’t want to see avoid the turmoil being seen in italy and wuhan — where the number of cases have exceeded the healthcare system’s ability to keep up — we must take immediate action. now.“everything we do before a pandemic will seem alarmist. everything we do after a pandemic will seem inadequate. this is the dilemma we face, but it should not stop us from doing what we can to prepare,” said former u.s. secretary of the department of health and human services, michael leavitt, at the pandemic influenza leadership forum in 2007.“we’ve been preparing for weeks, we have teams that have completely mobilized across all healthcare sectors to prepare for covid-19,” says dr. jerome leis, an infectious diseases physician who has been treating covid-19 patients at sunnybrook hospital in toronto.“the timing for implementing social distancing is now, not after we have seen the first wave of admitted patients,” says leis. “this is a community-based outbreak, limiting community spread is paramount to being able to reduce the overall impact that this will have across our healthcare system.”this doesn’t mean stockpiling on toilet paper or masks that should be rationed for frontline healthcare workers. this means taking social distancing seriously. if you are able, work from home. consider cancelling your travel plans — even if you already have flights booked for march break. in case you missed it, the government has officially urged all canadians to “postpone or cancel all non-essential travel outside of canada.”

social distance yourself so there’s enough resources for everyone

up until recently, canada’s public health approach has been to “try to be a bit of an island” but according to dr. michael gardam, humber river hospital’s chief of staff, this would never have been possible.“[covid-19] was always going to come here, but if it gets here two months later, that’s good,” he says. “you don’t want everyone getting sick at once, which is what happened in italy, iran, and wuhan. they had a huge swell at once. that’s really hard for the system to contain.”instead, we should be following the models of singapore and south korea, where social distancing measures were taken early. south korea has been able to report more recoveries than covid-19 cases for the first time and singapore has prepared with reporting extensive details on where confirmed patients have been. as a result, both countries have lower numbers of infected people and fatalities.“you have to bring in social distancing measures before you think you need to,” says gardam. “right now, the risk to canadians is low because there is no local spread. but we know local spread is coming. we will start to see clear community transmission in canada within the next few days. the way to slow down this virus is by not spreading it to other people.”
and when community transmission starts, the number of cases won’t go up slowly.“[community transmission] doesn’t go up in a linear fashion, like one-two-three-four-five cases each day,” says gardam. “it’s exponential and will go up two-four-eight-16-32-64-128 cases each day. italy is the perfect example of this. they have a well-developed healthcare system, but they’re overwhelmed right now. there are not enough beds and ventilators because everyone [needed them] at once.”unlike sars, covid-19 is much more contagious. gardam, who worked through the 2003 outbreak, says patients with sars did not go to work, take the transit, go to the movies or library because they were too sick. there was less of a chance of encountering sars because patients were too ill to go out. however, the majority of patients with covid-19 have much more mild symptoms, which means patients might unknowingly hop on a plane, go to meetings, conferences, and go to work while coughing, and therefore spread it to many more people.social distancing will slow down and spread out the number of people affected, that way, someone who is acutely ill is more likely to get the care they need. in other words, social distancing will lower the r0 (pronounced “r-naught”), the number of people who get infected.although trivial, covid-19’s mild symptoms can have a devastating consequences. once community transmission starts, it will lead to a steep peak in cases that will profoundly challenge our healthcare system and its ability to care for acutely ill patients. although these patients are the minority those with covid-19, the sheer numbers could overwhelm our current healthcare capacity across the system, from the emergency departments to the critical care wards.“we’ve been focusing an awful lot on hand washing — which, don’t get me wrong, hand-washing is important, but it’s not as relatively important. the fix for all this is social distancing,” says gardam. “this isn’t going to be a thing we do for two weeks and it will be okay. we’re looking at social distancing for months. the entire world has the potential to be infected by this because we don’t have the antibodies. we have roughly a 170,000 cases in the world, but we may be missing a bunch of mild cases. multiply that by 10, now we have 1.7 million cases in the world, that’s when you realize this could go on for a very long time.”diana duong is an editor at healthing.ca. follow her on twitter @dianaduo.dduong@postmedia.com

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