Coronavirus cases in Canada had surpassed 20,000 on Thursday, as much of the nation continues to be on lockdown in an attempt to help slow the spread of infection. Positive signs that the curve might start to flatten have been observed in British Columbia, but experts stay we’re still in the beginning of a months-long battle.
In his daily statement on Thursday morning, Prime Minister Justin Trudeau stressed life will not return to normal until a vaccine is developed and widely available.
As the days lost to novel coronavirus pile up, so do our questions. Scientists have been working furiously worldwide to understand the nature of what we’re dealing with, and certain answers are revealing themselves in real time. For example, last week a tiger was discovered to be infected with COVID-19 at New York’s Bronx Zoo, raising concern about whether we should be more careful with our pets. And with the weather getting warmer, the itch to go outside is more painful than ever.
While we continue to navigate our new normals, Dr. Isaac Bogoch, an infectious disease specialist and associate professor at the University of Toronto School of Medicine, has returned to answer more of our pressing questions:
Q: The growth rates of confirmed cases has slowed in several countries. The number of people in Canadian ICUs seems to be lower than was expected for this time. So does this mean our efforts are working?
A: Those numbers are helpful, but don’t tell the whole story. We have to remember there’s going to be a delay from the time we see new cases to the time where people may be admitted to hospital, and to the time people may enter an ICU.
While we might be seeing early signs of the epidemiological curve flattening out at the country level and even some provinces, we can still expect to see hospitalizations and the percentage of beds occupied by people infected with COVID-19 to grow over time.
We have to remember that people who get sick with this don’t just come in for a day or two. There are some people who might require more prolonged hospital and ICU stays. So while the numbers look good right now, in one snapshot in time, when we step back and look at the pace of this epidemic, we’re still rather early.
Q: You’ve expressed concern about the rate of positive results from tests in Ontario. Why?
A: Ontario is the last in the country for diagnostic tests per capita. It’s unfortunate because we know we need to expand testing to really help from a public health standpoint, and I would even argue it would help from a one-on-one clinical standpoint, as well.
There were several issues in Ontario that prevented the scale of diagnostic testing. But much of those have been resolved as recently as yesterday (April 8), when the Premier Doug Ford stated that this is unacceptable and we have to do better. Many of us who are following this closely agree completely, and I think we’re going to see a very rapid turn-around and expansion of testing in Ontario, hopefully, in the days to come.
Q: When you say “expansion of diagnostic testing,” who should we be testing?
A: People who are coming to hospital by and large, if they have signs or symptoms compatible with COVID-19, are getting tested.
The expansion, however, should really be in out-patient settings. They’re doing anywhere from 2,500 to 3,000 tests per day, but the goal at this point was to do well over 5,000 tests per day, and Premier Ford yesterday said the goal is to get to 13,000 tests per day. I think that’s a very reasonable goal that is reflective of the needs of the province.
Q: As we see the curve flatten like you said earlier, do you see a danger in a “mission accomplished” syndrome, where we think we’re closer to stopping it than we are?
A: One hundred per cent. The messaging should be very clear: even though there are early signs of success in certain provinces, namely B.C. and Alberta, the job is by no means over. And in fact, sadly this is where the hard part begins.
For one thing, there’s still room for improvement even in those provinces. We certainly should celebrate our success where we have them, but on the other hand, it would be helpful if those provinces expanded diagnostic testing as well in community settings.
The room for improvement in Ontario is obviously larger compared to those Western provinces, and by no means should we be complacent. We all need to continue to adhere to the public health measures that are in place so that not only does the curve flatten, but it starts to decrease. And we really want to see a sustained reduction in the number of new cases per day across the country.
Q: You mentioned this is the hard part. “Cabin fever” is certainly hitting people more at home as it’s getting warm. They want to exercise in the fresh air. But in some places they’re not even allowed to walk in the park. What advice do you have for them?
A: The first point is, whatever the local public health guidelines are, those should be strictly adhered to.
I get it. There are some differences across the country, and different municipalities have the same theme but perhaps it’s phrased differently. But in many places it is okay to go outside and go for a run. It is okay to walk your dog. It is okay to go for a bike ride for some exercise, as long as you’re still adhering to physical distancing measures.
People should be encouraged to get their exercise, but by the same token they should also be doing this in a manner that is compatible with public health measures in place. I am sure we’re able to figure out a way to do this that will enable people to have a life and be outside, but also not cluster together and facilitate transmission of COVID-19.
Q: Anecdotally, we’re seeing a lot of litter, including latex gloves and masks outside grocery stores. We’ve also seen coffee cups around Tim Hortons outlets. Is there any COVID-related risk to throwing stuff down you’ve just touched?
A: First of all, littering anything is just bad. It’s totally irresponsible. Still, the risk of getting this infection from litter is going to be extraordinarily low. But we do know the virus can live on surfaces anywhere from two hours to a couple of days, and there should be a responsible disposal of masks and gloves if people are using those.
It should be in the garbage, and a garbage where people aren’t going to be able to go through it and accidentally touch those items. Let’s all be responsible.
Q: You’ve been a voice in favour of common sense when it comes to social distancing and isolation. But the federal health minister just told everyone not to invite anyone—including family—to their homes over the holiday weekend, full stop. Is that absolute level of distancing warranted, do you think?
A: Yes. I think that’s extremely reasonable, and I would factor that into common sense because that is completely aligned with what the message has been so far, which is essentially: if you don’t live under that roof, you should not go into that home.
Of course there are going to be extenuating circumstances. Of course there are going to be issues where people, for example, need urgent child care or support for elderly parents. And you can’t have negative value judgement towards that. But in general, if you don’t live in the house, you shouldn’t go into it.
Q: We’ve also talked about pets and COVID-19. The virus has been found in a tiger at the Bronx Zoo and it’s now believed some animals can carry that. Does that change your advice when it comes to how we should handle animals and pets?
A: This is fascinating. Early on in the epidemic, it seemed, amongst virologists, that COVID-19 likely emerged in bats, perhaps jumped to another non-human animal, and then jumped to humans. That’s one of the theories. Presumably, this virus can affect other animals.
More recently, some studies emerged that demonstrates COVID-19 can replicate in cats, especially older cats, and also in ferrets. But it didn’t replicate well in dogs, pigs, chickens, and ducks. So what does this mean for pet owners?
It’s still early and kind of hard to draw meaningful conclusions from this. But if people do have pet cats, I think we should be careful if there’s someone with COVID-19 in the house. It’s not clear to what extent a cat would be able to transmit COVID-19 to another cat or a human, but I think it should at least enter our radar that cats can be come infected.
We’d be foolish to think we have all the answers, and there’s still a possibility there may be a role of transmission back to humans, it’s just not clear to what extent that is. I think it’s worthwhile to at least be mindful that a cat can get this infection, and there might be a role that the cat can be involved in transmission. Perhaps the house can be set up in a way where the uninfected individual would care for the cat, and the person with the infection would not.
Q: Some paramedical health-care providers, like physiotherapists and chiropractors, are still allowed to work on what is vaguely described as an “urgent care” basis. Appointments are still being scheduled. Should we still go see our physiotherapist?
A: We have to think about this. There’s not going to be a one-size-fits-all answer here. Certain things are more urgent or medically-pressing than others.
Most doctors are seeing patients virtually, and if at all possible, we have to wonder if other health-care providers can do the same, providing expert advice over the phone or video-conferencing as opposed to face-to-face. Of course, it’s not ideal, it’s always best to see people and there’s no substitute for that. But during these times, we have to get creative, and if at all possible reduce the number of people we see day-to-day, and that includes doctors and physiotherapists.
Sometimes face-to-face assessment is unavoidable, but hopefully the frequency of those can be significantly reduced and much can be accomplished over the phone.
Q: Earlier today, Prime Minster Trudeau said life really won’t go back to normal until there is a vaccine for coronavirus. What do you make of that?
A: I totally agree. It’s sad.
We might start to see some return to normal in a few months if we can flatten our curve and reduce the number of new cases and sustain that. But I really don’t think that until we have wide-spread vaccination and demonstrate immunity in the population that we can go back to the way we remember life before.
We just know how devastating this infection can be in certain populations, especially those over the age of 60, and really those over the age of 80. Until a sustainable long-term solution is in place, like a vaccination, we’re all going to be living with this hanging over our heads.
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