Canadians have a clear and urgent choice to make this month as two highly transmissible variants of COVID-19 now sweep across the globe.
They can accept the approach provincial governments are taking across the country now. In which case Canadians will be hit continually by the wrecking ball of a mutating virus for the next eight to 12 months.
Or they can choose to go to zero over the next four to six weeks. Going to zero is shorthand for a range of approaches that include sharper restrictions on travel, imposing strict lockdowns, marking green zones rendered free of the virus and protecting them, relentlessly testing and tracing — and in the process systematically driving transmission to zero.
If going for zero succeeds as it has in Australia, Vietnam, Taiwan and New Zealand, then Canadians will live their lives normally with vaccine programs as part of the solution — as opposed to the only solution.
As it stands, provincial governments are using techniques that fall under the headings of mitigation and suppression as they slowly roll out a variety of vaccines that may or may not stop viral transmission. Those techniques include soft or partial lockdowns, limited testing, inadequate contact tracing and often ineffective controls on travel as recent political scandals highlight.
But we now see that half-hearted or “balanced” measures don’t really achieve a significant, longstanding victory against the virus. They have only prolonged the misery. High rates of infection have Quebec facing a provincewide curfew and Ontario is keeping children at home from school after their holiday break. Hospitals and ICU units in many parts of the country are full.
Bar-Yam argued that passively living with a constantly evolving virus is just as much a political choice as actively deciding to eliminate the virus from a community’s midst.
However, very few countries have welcomed an honest debate about our pandemic future choices for a variety of complicated reasons, he explained. These included basic political inertia, fatalism, misinformation and the narrow clique of experts that governments draw upon.
“The challenge is to get past the barrier of communication,” said Bar-Yam.
Bar-Yam is hardly alone in claiming that current approaches have been ineffective and it’s time to go for zero.
The COVID Strategic Choices Group, a group of doctors and economists across the country, is now arguing for a dramatic shift from Canada’s failing mitigation approach.
They propose building “a Canadian shield” against COVID-19 that consists of three concrete actions:
- An effective lockdown;
- a relaxing of restrictions that keeps caseloads dropping by approximately 20 per cent a week until near zero;
- assistance to communities and businesses to help meet these goals to avoid a third wave of the pandemic.
“It is important that people clearly understand that there is a choice and that they can clearly act on that option,” said Bar-Yam who supports the Canadian Shield initiative. (It is largely based on ideas that the physicist has been advocating for nearly a year.)
There is also growing support for a zero or near zero approach from both frontline medical workers and the business community.
A recent report from the Boston Consulting Group, for example, found that eliminating the virus — an approach adopted by New Zealand, Taiwan and parts of Atlantic Canada — reduced deaths and minimized economic costs in those places. It also cost 30 to 40 per cent less than other approaches that let the virus pulsate through society in ongoing waves. “In order to win the fight, you have to fight to win,” noted the report.
Bar-Yam says public opinion polls clearly show that most people — eight out of ten — would gladly sacrifice their mobility for six weeks if it resulted in a return to normalcy and other healthy outcomes such as visiting elders without fear.
Bar-Yam, who founded the New England Complex Systems Institute, speaks from a well of experience.
Since 2004 he has been writing about the risks that novel pathogens pose in a highly connected world where unprecedented volumes of long-range air transport now actually represent an existential threat to civilization.
In an extremely mobile world, he has postulated, a killer virus capable of wiping out a community in one geographic region can now go global and be responsible for a “global extinction event.”
In 2014, Bar-Yam provided recommendations on how to control the spread of Ebola in West Africa. His advice was pointed: “Instead of treating individuals as being sick, you have to treat the community as being sick.”
Rather than waiting for Ebola, a much deadlier virus than COVID-19, to march into the local hospital, he recommended that the community engage the disease in the streets by identifying anyone with symptoms, isolating them and employing contact tracing to find anyone they’d recently been around.
Only when the governments of Sierra Leone, Guinea and Liberia changed their strategies and engaged their communities in this way were they able to stop the outbreak.
As soon as COVID-19 officially appeared in China in January of 2020, Bar-Yam, along with his colleague Nicholas Nassim Taleb, penned a dramatic note urging governments to act quickly.
They warned governments that normal risk strategies would not work and they must act decisively and respect the precautionary principle. Governments uniformly ignored the paper.
The paper noted, for instance, that “common public health response is fatalistic, accepting what will happen because of a belief that nothing can be done. This response is incorrect as the leverage of correctly selected extraordinary interventions can be very high.”
Bar-Yam explains, “We basically said that we can stop the pandemic by over-reacting. We have to do everything we can to get ahead of the virus.”
Why? “Because exponential growth is unforgiving. It looks like it’s nothing until it slams you in the face.”
He cites as an example California where so many people are now sick that there are not enough doctors, beds or oxygen to save lives.
Most people now know the essential approaches that many Canadian politicians have failed to adequately utilize.
They include mandatory masks and social distancing combined with a no-nonsense lockdown of four to six weeks. This includes the closure of schools, given evidence showing children and young people are more likely to bring the virus home than those in their 20s.
A strict lockdown robs the virus of oxygen by reducing interpersonal contact by 80 per cent, which therefore results in an exponential decline in transmission.
At the same time governments must carefully manage their borders with closely supervised quarantines. Next comes comprehensive testing, contact tracing and isolation as COVID-19 cases begin to exponentially drop.
The physicist’s “green zone strategy” allows for an exit from the lockdown. It essentially breaks up a large political geography into manageable units as small as city blocks.
As soon as one unit reports zero cases for 14 days, it can open up and connect to other green zones allowing people to move normally again.
There are such green zones in rural Canada and Indigenous communities. Emulate and build upon their examples, said Bar-Yam.
A green zone strategy requires active community engagement or what Bar-Yam calls a “shared response.”
That requires that the government ask different communities what they need to get the job done such as monetary support, quarantine hotels or local contact tracers familiar with the community customs and languages.
“It is like a ratchet. You keep on tightening in the right direction until you get to zero transmission,” said Bar-Yam.
The physicist has no patience with politicians who argue that the economy must come first — a key dogma in many Canadian provinces.
That’s simply not what the evidence supports, says Bar-Yam. Nations that have purposed their four-to-six week lockdowns to get to zero (New Zealand, Australia and Atlantic Canada) now have healthy economies with higher GDP than those struggling with other approaches.
The science repeatedly shows that strong health action demonstrably curbs the economic cost of the pandemic, adds Bar-Yam.
Having a specific goal such as getting to zero matters, explained Bar-Yam.
It gives people a definable and measurable goal. It also promises and then delivers a tangible reward for their sacrifice: freedom from COVID-19.
“If you don’t do something to stop the virus, it won’t stop by itself,” adds Bar-Yam. “And if you enact strong measures, you will get exponential decline of the virus.”
The advantages of eliminating the coronavirus, as the British Medical Journal recently noted, are self-evident.
Hospitals are not overwhelmed or on life support. The elderly and the vulnerable are no longer prisoners in their homes. The economy opens but with strict travel restrictions. Vaccines can be delivered to the community with far greater ease. Last but not least, any COVID-19 flare-up can be readily traced and extinguished because the government is no longer blindsided by the exponential growth of the virus.
In Canada, many First Nations, the northern territories and Atlantic Canada all chose to not live with the virus.
They took government recommendations and bettered them. All started by engaging their communities.
As a consequence, these regions such as Nunavut and Atlantic Canada have been able to stamp out any outbreaks quickly and rather painlessly.
“The contrast between Atlantic Canada and the rest of Canada is very stark,” noted Bar-Yam.
Meanwhile the citizens of Ontario, Quebec, Manitoba and Alberta are all living in burning houses because specific political decisions were made with no clear goals.
British Columbia, the only government that has asked Bar-Yam for information on how to get to zero, has faired better, but it still doesn’t have a defined goal.
Going for zero is doable but it is tough, concluded Bar-Yam. It also requires competent leaders who are prepared to “stand up and say that going to zero is a shared purpose and that we are doing this together. The outcome we want comes from shared action.”
THE DANGER POSED BY MUTATED COVID-19 VARIANT
While current mitigation strategies to combat COVID-19 have failed in Europe and North America, the virus has mutated. New variants have emerged in both the United Kingdom and South Africa that appear to be at least 50 per cent more transmissible. That means they are much more infectious than varieties of COVID-19 that created the first global wave.
And that’s a big problem because the ability to spread faster gives the virus even greater exponential power.
Although the variants do not appear to make people sicker, their rapid spread means more deaths, more illness and overwhelmed hospitals. It also means controlling the virus will be much more difficult.
One of the new variants, dubbed B.1.1.7, also seems harder to detect because it responds to traditional PCR testing differently. U.K. researchers even noted a significant increase in the number of false negatives in southern England where the variant now dominates all infections. Adam Kucharski, a prominent U.K. mathematician, recently explained the core problem in Science: “If you have something that kills one per cent of people but a huge number of people get it, that’s going to result in more deaths than something that a small number of people get but it kills two per cent of them.”
As he later explained in the Atlantic, the math is terrifying. To illustrate the scale of the threat, Kucharski compared a virus mutation with 50 per cent increase in lethality to mutation with a 50 per cent increase in infectiousness.
With a reproduction rate of about 1.1 and a death rate of 0.8 per cent, current strains of COVID-19 now deliver 129 deaths per 10,000 infections. A virus that is 50 percent more lethal will kill 193 people in a month.
But an increase in the transmissibility of the virus changes the entire picture because it infects more people. It leads to 978 deaths in just one month.
That exponential threat could change course of the pandemic says Bar-Yam.
“We are on the edge already. Hospitals in the United States and parts of Canada are full. Add a variant that doubles the caseload every 10 to 15 days. Well, that’s insane.” — Andrew Nikiforuk
Teaser photo credit: By Julie Anne Workman – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=35398098