It has been nine days since the World Health Organization declared coronavirus as a world-wide pandemic. Since then, the number of confirmed cases in Canada and across the globe has steadily risen, and with it the public calls from officials to urgently practice social distancing.
Canada has confirmed more than 870 COVID-19 cases across the country as of March 20 in all 10 provinces. Daily life has drastically changed in the face of this pandemic—silence has filled the nation’s busiest streets as people self-isolate, coffee shops and restaurants have closed their doors to the public as provinces from coast to coast declared a state of emergency, and Canada has curbed international travel and shut its borders to even its closest ally, the United States—all in efforts to reign the virus under control.
And as people spend more time at home, scrolling through headlines of rising death tolls in Europe and threats of an overburdened health care system, questions are mounting on how we can better protect ourselves and whether any sense of normalcy is on the horizon.
“Unfortunately, I think in Canada we’re still at the very early phases of this epidemic,” said Dr. Isaac Bogoch, an associate professor at the University of Toronto School of Medicine. He added that extreme public health measures to encourage social distancing have only come into effect about four days ago, and it will be a while before Canadians see the fruits of their labour.
“I think it’s important that Canadians be patient and not get too upset when we continue to see case numbers climb even though we’re all hunkering down,” Bogoch said. “There’s a lag time, and we just have to be patient. If we’re not actually doing it then it’s not going to work.”
So how do we deal with living in the COVID-19 era? How do we ensure our social distancing measures are really working? After helping us iron out some of those practicalities last week, Bogoch has returned to answer more questions from Maclean’s, as Canada falls into a new normal:
Q: What’s the difference between social distancing, self isolation, and household quarantine?
A: There’s a big difference between the three of those things.
Social distancing is really an umbrella term that the theme of which is, people should stay apart from each other. This is the kind of thing that means, work from home, kids are off from school, we’re not having big playdates, we’re not going to restaurants and bars, we’re not going to crowded coffee shops. It’s basically spreading out, and that should be applied to the general public. It’s what health leadership in this country has been stating now for close to two weeks.
Home isolation is different. It’s exactly as it sounds—someone needs to be at home. You can go outside in your front yard, your backyard or your balcony, but you should stick around the house for 14 days. People on home isolation are travellers who have returned to Canada after March 13 with the rising concern of COVID-19 infection globally. The 14-day period of time is chosen because it’s on the long-end of the incubation period for this infection. It’s to ensure those people are at home and not mingling with the general public.
A quarantine is more restrictive. Typically, it involves going to a specific facility, where there is more control over the individual and the environment. The example of quarantine is when we repatriated Canadians from the Diamond Princess Cruise ship, and they went to the Trenton Military Base. The government set up what they felt was an appropriate housing complex for these individuals, and they were tracked. There was no chance that you could escape from this. Your food and basic needs are met, but it’s a more rigid approach to ensuring people are an enclosed area.
Q: Given the rise in cases that we’re seeing, as well as all the significant changes in policy and to our daily lives, has the need to follow public health advice become more pressing?
It only started to hit home in Canada maybe a week ago, when our Prime Minister is speaking to the nation in home isolation because his wife has COVID-19, and the NHL gets cancelled and kids are home from school. All of the sudden it hits that this is real and this is affecting us.
And so it’s extremely important to listen to what public health officials are telling us. We should’ve been doing it from the beginning. Strict social isolation and distancing measures truly work. There’s great evidence demonstrating this. It’s worked elsewhere in the world, and it’s going to work for us. We just have to roll up our collective sleeves and do it.
Q: There’s a lot of talk about #FlattenTheCurve. You mentioned we’re still in the early stages, but are there any signs so far to show whether that curve is flattening
A: It certainly is too early to tell. We won’t know for about probably another seven to 10 days on how we’re faring.
Q: Studies have said that coronavirus can stay in the air for hours. Is that true?
A: This has caused so much confusion. There was a study in the New England Journal of Medicine that looks at how long this virus can last on surfaces and in the air. What they did in the study is use a special machine that aerosolized the virus. We have to remember this was artificially done to measure how long the virus can stay in the air.
This is helpful for creating policy [for medical professionals]. In real-world settings, people don’t aerosolize this virus. It’s transmitted through respiratory droplets and through contact with the virus on surfaces.
It would only be aerosolized in very unique situations where a patient is undergoing a certain procedure, such as if someone has a breathing tube inserted. But outside of that setting, the virus is not transmitted through the airborne route.
Q: So, you can’t just get it from walking outside?
A: Not at all. When [COVID-19] droplets are expatriated, meaning people cough in the air, they don’t last in the air very long. In fact, they only travel in a very small radius around the person and then they drop to the ground or the surfaces around people.
That’s an extremely important point to make, and the [New England Journal of Medicine] study that was done got misinterpreted by so many people.
Q: To set the record straight, how long can COVID-19 stay on surfaces?
A: The obnoxious answer we always give in medicine is: it depends. It depends on the surface, the temperature and ultraviolet rays. But this study answered a lot of those questions.
The virus can live on surfaces for about two hours to two days. It doesn’t live on paper or cardboard surfaces for very long, that’s more around the hour spectrum. And then for plastic and metal surfaces it can be a bit longer, closer to the two-day end of that spectrum. A lot of that does depend on the environment around it as well.
Q: Speaking of the environment, do we know if it prefers hot or cold temperatures?
A: In general, the virus tends to like cooler temperatures. But I don’t think much of that is applicable in these settings.
You hear of people saying, I’m going to put my newspaper in the freezer so I don’t get the COVID-19 infection. I think we really have to bring this information back down to planet earth, and just appreciate that we should be mindful of hand hygiene, and we know the virus can stick to some surfaces and if we’re in contact with high-contact surfaces we should wash our hands with soap and water or use an alcohol-based hand sanitizer, and we’re going to be just fine.
Q: Let’s say your child has a best friend across the street, and no one in either household has symptoms or reason to think they’re exposed to virus. Can the kids still play together?
A: The short answer and the party line is, no.
The nuanced answer is, we might be doing this for a long time, and we can also temper our social distancing with common sense and humanity. And it’s hard to micromanage every situation. But truly, if we’re getting together with very few people under one roof, meaning there’s two children, and truly those two children have not had any interaction with any other people, it’s probably okay.
Q: Rush hour traffic seems to still be a thing. Is that a sign that social isolation in the city isn’t working?
A: I’ve felt the opposite. I feel the roads are way clearer than before. We do know that across the board, many people are working from home and businesses are doing what they can. But we know some jobs just can’t be done from home. If you work in the nuclear power plant, for example, you can’t phone that in.
It’s important that employers are mindful of employees that have to come into work, and should be setting them up for success in the sense that they should be spread out, there should be access to hand sanitizer, and high-contact surfaces should be cleaned and wiped down on a regular basis. Appropriate safety measures should be put in place so that they’re at a lower risk of getting this infection.
Q: Why do public health officials advise not to wear a mask if you don’t have symptoms. Won’t a mask stop people from breathing in the virus or touching their face?
A: Masks are helpful if someone has an infection, because they help stop them from spreading it. But the counter-fact is, if you don’t have an infection, a lot of the time these masks don’t reduce your risk of getting an infection.
Here’s why: these masks are not reusable and most people are reusing their masks. People are wearing masks that are not fitted properly, and some people aren’t actually wearing the mask properly overall. It has to be on the right part of your face at the right time for the right duration. Also, watch anyone wearing a mask walking around. People touch their mask, they touch their face, they adjust their mask all the time, and that is completely counterintuitive.
Q: With social distancing measures in effect, should we be cancelling our dog-walkers or house cleaners, for example?
A: We really need to think about this. Even though that might be one individual, we have to ask ourselves, what’s the network of that individual, and how many people does that individual come into contact with on a day to day basis?
Again, the party line is yes, you probably should cancel. The fewer the people that you come into contact with, the better. But on the other hand, we also have to temper these pretty rigid policies with a touch of humanity and common sense. Maybe you do need that dog walker because you’re being pulled into 10-different directions and you can’t add that into your daily schedule.
We’re doing the best we can. We’re trying our hardest to abide by these principles. They’re pretty rigid, and we should do our best to adhere to them, but there may be areas where we can slightly, slightly bend the rules.
Q: You hear a lot about people washing or disinfecting their groceries when they get home. Is that sensible or overkill?
A: I think it’s overkill. Just put your fruits and vegetables in the fridge where they belong, and then when it’s time to eat them, wash them. You’re going to be fine.
Q: What about food delivery?
A: I think food delivery is excellent. Many people shouldn’t be going to restaurants, and many restaurants have shuttered their doors. With grocery stores, we have to be careful about social distancing there as well, but it’s still okay to go if there’s a few people around. And so, I think it’s totally acceptable to order food in.
We just have to be mindful that, when someone’s delivering this to your door, they’re going to be touching the bag that this is coming in, and you’re going to be touching that same bag. We have to treat that as a contact situation, so wash your hands afterwards.
Q: Some random items seem to be flying off the shelves, like toilet paper. But I’m curious about medicine. If we’re in self isolation for 14-days, what essentials, if any, should we have in our medicine cabinet just in case we have symptoms?
A: Nothing. There’s no just in case. The same rules apply. I think it’s important for people to have a 14-day supply of items that they may need. Whatever food, whatever medicine you need, have a 14-day supply of that. That’s the longest people would be on a home-isolation program for. For a medicine cabinet, it’s different for each individual. Probably things like acetaminophen (Tylenol), or regular emergency kit-type things.
If you or your family need a four-month supply of toilet paper in a two-week time, so be it. But most people don’t.
Q: If you have pets, should you be worried about them getting sick?
A: No. But I think we should be mindful of having other people pet our dogs. We’re not shaking people’s hands, for example, we’re not touching other individuals, so why would we have other individuals put their hands all over your dog? It doesn’t really jive.
Dogs need love and need to be pet, but that just means we have to give our pets more love because they’re not going to be getting it from other people in the park.
Q: On social media, people seem to be talking a bit about rushing to the liquor store and drinking their way through the outbreak. Is this cause for concern?
A: I think we’re all coping with this in our different ways. As long as it’s not problematic drinking or substance abuse, I think we’re okay. And it’s certainly okay to make the best of a rough situation, as long as we’re being mindful of our health and wellness and we’re not taking it too far.
Sadly, there are going to be some significant psychological impacts of this social isolation. It’s sad and it’s predictable. And we’re going to see a rise and exasperation in mental illness as a result of this, and we’re going to see substance abuse, be it alcohol or other drugs.
I think we have to be mindful of this for ourselves and our family and friends. We should be encouraging healthy behaviour as much as possible, but it is okay to have a bit of fun and to make the most out of a pretty tough situation, as long as we’re mindful about overall general health and we’re not taking it too far.