An upcoming nightly curfew in Quebec is hogging the headlines, but some public health experts say it's another plank of Premier Francois Legault's new plan that other provinces should pay the most attention to.
The measures include a curfew that will affect the vast majority of Quebecers. As of Saturday, anyone caught outside their home between 8 p.m. and 5 a.m. for any reason other than work, walking a pet within one kilometre of their home or visiting a pharmacy will be subject to a fine of up to $6,000.
CTV News' Infectious Disease Specialist Dr. Abdu Sharkway told CTV's Your Morning on Thursday that while the curfew may seem heavy-handed, it is necessary to find a way to reverse COVID-19's upward trend in Quebec.
"If incentive to do the right thing isn't working, at some point, when do you have to invoke disincentive to make sure that more people don't die and that our health-care system doesn't collapse?" he said.
"We're really playing with fire at this point in time."
Places of worship will also be closed around the clock in Quebec, except for funerals with up to 10 people in attendance. Legault additionally said that "non-essential" manufacturing operations will be halted, although discussions are still ongoing to determine what exactly that entails.
Even that first hint of a willingness to close non-retail and non-service workplaces is a positive sign that may do more to slow the pandemic than the curfew, Dr. Zain Chagla, an infectious disease specialist affiliated with McMaster University in Hamilton, told CTVNews.ca.
"I think everyone is focusing on the curfew part. The one thing that I think may actually have a big potent effect … is the fact that they're looking at really ramping down manufacturing," he said Thursday via telephone.
"It's showing up more and more that workplaces are becoming a major, major issue."
As of Dec. 23, 2020 – the last report available – there were 699 active workplace outbreaks in Quebec. In total, they had been directly linked to 3,367 cases of COVID-19. Manufacturing facilities accounted for 27 per cent of those outbreaks and 40 per cent of those cases.
Data released this week by the City of Toronto shows that manufacturing facilities, construction sites, offices and warehouses account for more than 40 per cent of workplace outbreaks in Canada's largest city during the pandemic – more than three times as many as bars and restaurants.
Despite that, lockdown-like measures to date have largely focused on bars, restaurants and other public-facing businesses, while requiring non-public-facing workplaces only to ensure mask-wearing and physical distancing.
"Many of our lockdowns really haven't been able to [tackle workplace transmission]," Chagla said.
"If hospitals and long-term care facilities struggle to prevent transmission to their staff for COVID coming in, then a workplace is going to be even harder to try to prevent that type of transmission."
Dr. Isaac Bogoch, an infectious diseases physician affiliated with the University of Toronto, said Thursday that "upstream drivers" of COVID-19 cases, such as workplace transmission, need to be addressed by any new public health restrictions.
"Otherwise, this is a Band-Aid solution," he told CTV News Channel.
As for the curfew, Chagla said he is "not 100 per cent certain" about its effectiveness.
Curfews have been used in Australia, France and other jurisdictions as part of successful efforts to flatten COVID-19 curves, but Chagla said there is little proof that the curfews themselves made as much of a difference as other measures introduced around the same time.
"There's not great evidence to suggest it actually works, other than that when these things get rolled out, they get rolled out as a bundle – so when it works, you don't know which part of the bundle was actually the component that worked," he said.
THE 'CANADIAN SHIELD' APPROACH
Meanwhile, a group of 17 public health experts and business leaders is calling for other provinces to enact measures far stronger than Quebec's.
They released a strategy last week that they call "the Canadian Shield," arguing that Canada should be placed into a "short, sharp" and more severe lockdown until the national COVID-19 active case tally is approximately one-quarter its current size.
Once that has been achieved, they argue, the caseload will be low enough for the World Health Organization-endorsed strategy of testing, contact tracing and isolation to be effective. Restrictions could then start to be relaxed, as long as the number of active cases continues to fall by between 17 and 25 per cent per week.
While the restrictions are in place, the group argues, governments would need to do more than they have done thus far to support the people and businesses most affected by the lockdown.
One of the 17 people behind this strategy is André Beaulieu, the senior vice-president of corporate services for Bell Canada, which owns CTV News.
In a report released last week, the group argued that if their recommendations were followed immediately, the active case total in Canada could fall by 75 per cent by the end of January, the country could see fewer than 40 new cases a day by May 1, and 5,000 lives could be saved. Following the current path could lead to 9,000 new infections per day in the spring, even as vaccines are rolled out, they said.
"Building the Canadian Shield is a challenging strategy requiring quick, decisive actions by government and a whole of society engagement. However, it is achievable, and massively better than the status quo," they wrote.
Asked for his opinion, Chagla said he can see the Canadian Shield strategy being realistic as far as reducing COVID-19 cases and deaths, but worries it does not account for "collateral damage" such as increases in depression, financial instability, household violence and worsened non-COVID-19 medical outcomes as a result of a more severe lockdown.
"More restrictive measures and that are needed. Supports for essential populations and essential staff are needed. Ramping down manufacturing as much as possible is needed. But to do this bundled approach, to significantly lock down as part of the approach … I have some hesitation saying that's an ideal plan to roll out," he said.
"People are so frustrated, so upset, they see a lot of inconsistencies with public health messaging – I'm able to do X but not Y – I don't think, without huge militaristic support, you're able to even invoke a plan like this."
'THIS SITUATION IS UNTENABLE'
There are also questions around how Quebec plans to enforce its curfew. Existing COVID-19 restrictions have been haphazardly enforced in many Canadian jurisdictions. More than 40,000 people entering or returning to Canada during have been contacted by police about concerns they are not following quarantine restrictions, but only 138 of those interactions had resulted in tickets or charges as of last week.
"A lot of questions arise in my mind around 'How is this going to be enforced? How do you determine if somebody's out for an essential reason or not?'" Dr. Sumon Chakrabarti, an infectious diseases specialist at Trillium Health Partners in Mississauga, Ont., said Wednesday on CTV News Channel.
Whatever the strategy, the experts say it's important that something be done to stop Canada's ever-escalating COVID-19 case counts from continuing on their current path.
"This situation is untenable. We simply cannot accept the loss of life that is going on in much of Canada at this time," Sharkaway said.
Bogoch cautioned that there was ample warning of the current COVID-19 spike "for probably over a month," and that numbers will likely continue to increase in the near future.
"You've got your health-care system in many parts of the country stretched beyond capacity, you've got ICUs that are full, you've got rising case numbers, rising hospitalizations, rising deaths," he said.
"This is clearly, clearly an emergency. It is not going to get better. It is probably going to get worse over the next couple of weeks."