What is a 'circuit breaker' lockdown, and should Canada consider one?
“Circuit breaker,” “wave breaker,” “fire-break” — the terms vary, but the concept is similar: a relatively short COVID-19 lockdown with a set end date as opposed to an extended lockdown until cases drop past a certain point.
It’s a strategy several European countries have implemented or are preparing to, as numerous regions battle a rise in cases.
Wales is in the middle of a two-week fire-break, and has had businesses and schools closed since Oct. 23, with a plan to reopen on Nov. 9. Northern Ireland introduced increased restrictions on Oct. 16, to be in place for four weeks. Germany introduced a partial shutdown Monday, and England is set to enter a four week lockdown on Thursday, which will be followed by a tiered system of restrictions.
But how do these smaller lockdowns differ from the measures seen at the start of the pandemic, and is it something Canada should consider?
WHAT IS IT?
According to Colin Furness, an infection control epidemiologist at the University of Toronto, the idea has been around longer than terms like “circuit breaker,” which have popped up over the last few weeks.
He told CTVNews.ca in a phone interview that the general idea is “breaking the chain of transmission.”
Since the virus is transmitted directly from person to person, and those with the virus are generally thought to remain infectious for 14 days, theoretically, if no one in the country left their home for two weeks, transmission would simply stop, he said.
Of course, this thought experiment doesn’t capture the reality, he added. Even with tightened restrictions, people will still be moving about, and many will still have to work at essential jobs. The goal of a shorter circuit breaker lockdown is not an eradication of transmission, but a pause to hopefully allow cases to drop.
“You would continue to have new cases during that time because of prior exposure,” Furness said, adding that infections would also spread within households during the start of the lockdown, creating, potentially, a small boom of cases before the numbers began to drop off.
“It almost looks like a short-term rise and then a fall.”
HOW LONG IS A CIRCUIT BREAKER LOCKDOWN?
According to Furness, even a short lockdown would have to be longer than two weeks, which is the generally accepted stretch of time needed to self-isolate. Some people will contract COVID-19 from their household members maybe one or two days into a lockdown, he explained, so if the circuit breaker only lasted 14 days, those people could still be infectious at the end.
A lockdown of at least 18 days would be needed to drop cases down effectively, Furness said, adding that he would recommend 20 days for a short lockdown.
“That would bring us down from a 1,000 a day to maybe […] two, 300 a day. That might be achievable,” he said. “But you really need clear messaging for everyone that just said, this is it, we all have to row. We all have to do our bit.”
DOES IT WORK?
It depends on the metric of success — a strict lockdown of 20 days would not wipe out COVID-19.
“It won't actually be an eradication or a real reset the way I think people imagine it,” Furness said.
But even a shorter lockdown would ease the pressure on contact tracers and allow them to catch up.
“It's not just the number of cases that overwhelms contact tracers. It's the fact that cases now have dozens and dozens of contacts instead of one or two or three,” Furness said. “If everyone's in their house for two weeks and then someone gets sick, the contact tracing is very simple.”
It could allow countries to “regain control” of the situation, he said, including Canada, if it implemented such a strategy.
“We do not have control. We're not using testing strategically, our resources are overwhelmed. Our hospitals are going to start to fill up,” he said. “We're not in control.”
In Quebec, which has been the epicentre of the pandemic in Canada, deaths and hospitalizations are not rising at the same rate as cases. According to the most recent data, 13 people were admitted to hospital in the last day, for a total of 539. They added 1,029 new cases on Wednesday.
A short lockdown is easier to sell to the public and wouldn’t hit businesses as hard, Furness added, but it requires discipline and clear communication from public officials, something he pointed out has been lacking in some regions.
“Our ability to convey clearly to people — certainly in Ontario — what’s expected and what's needed, has been really poor,” he said. “So there's a real hypothetical there to have effective communication to get the compliance for this to even work at all.”
Although short lockdowns have allowed some regions to regain their footing in the battle against COVID-19, some have changed their end dates as the time to cease the lockdown approached. Scotland planned a two-week circuit breaker, but extended the restrictions for a further week, then announced they would be transitioning into a five-level system of restrictions depending on different regions of Scotland.
The move led many to suggest circuit breaker lockdowns do not work, or that two weeks is insufficient.
Announcing a temporary lockdown with strict restrictions and a planned end date could backfire if the government extended restrictions after advertising it as temporary, Furness said.
If people are’t compliant with the lockdown — through poor communication from government officials for what is expected of them, or insufficient help from the government to allow people to stay home for 20 days — and cases don’t really drop, “you’ve lost the public,” Furness explained.
“You’re gambling with a snap […] circuit breaker, you’re gambling that you can actually do it effectively, because if you can’t, you’ll really have people’s wrath.”
IS A LOCKDOWN INEVITABLE?
However, Furness said he’d be surprised if Canada’s hot spot regions were not seeing lockdowns again by January — not because lockdowns are the only way to handle rising cases, but because he believes we’ve failed at the other way to control a pandemic: aggressive testing.
“If you look at different countries’ approaches, there's two ways that you can interrupt a pandemic or a big outbreak,” he said. “One is through lockdowns and the other one is through testing.
“In other words, we could test our way out of this.”
But as the second wave has hit Canada, testing rates have not gone up — in fact, the opposite has occurred in Ontario, one of the hardest hit provinces. Only 25,279 tests were performed on Monday, around half of what the province is capable of processing, while 1,050 new cases of COVID-19 were recorded.
Furness said that we have not been using testing proactively in a way that would help to control the virus. If testing had been deployed to test those at risk when lockdown restrictions were easing, we would have a better picture of where transmission is occurring.
Because it’s not just that case numbers are increasing. The percentage of new cases with no known epidemiological source — meaning it’s unknown how and where the person contracted the virus — is growing. According to data tracked by Public Health Ontario, cases with no known source now regularly make up more than a third of new daily cases.
“When we opened schools, it should have come with a plan to test teachers every week,” Furness said. “When we opened bars and restaurants, it should've come with a plan to test waiters and bartenders every single week. In other words, you can do these risky measures if you're actually on top of it and grabbing cases.
“We're not deploying testing at all now in the second wave in any way to try and slow transmission. That is a horrible mistake. And we're going to have to lock down because of it. But we're choosing that, we’re choosing to hurtle toward the need for a lockdown.”
If it does come to more lockdowns in Canada to control the areas where cases are currently rising, Furness believes those lockdowns will need to be severe, no matter how long they are. In March and April, he pointed out, stores that sold “anything remotely edible,” were able to remain open. At the next lockdown, this may not be the case.
“I think pretty much everything locked down except grocery stores, drug stores and arguably liquor stores, and obviously hospitals and public safety services,” he said. “We’re really going to have to clamp down on that. Really, no cake shops, no bakeries, no convenience stores.”